Looking at the methods of drug administration, and based on your understanding, list and discuss each method in order, from most immediate and intense to the method which takes the longest to act and
DAAC 1319: Intro to AOD
Module Two Notes
Drugs of Abuse and How They Work
Module Two
Drugs of Abuse and How They Work
Drug Classes
The Controlled Substances Act (CSA) regulates five classes of drugs: narcotics, depressants, stimulants, hallucinogens, and anabolic steroids. Each class has distinguishing properties, and drugs within each class often produce similar effects. However, all controlled substances, regardless of class, share a number of common features. When we look at drug classes we will add cannabinols, inhalants and over-the-counter drugs as each of these groups also contain psychoactive ingredients.
With the exception of anabolic steroids, drugs in the other classes are utilized to alter mood, thought, and feeling through their actions on the central nervous system (brain and spinal cord). For example, some of these drugs alleviate pain, anxiety, or depression. Some induce sleep and others energize. Though therapeutically useful, the "feel good" effects of these drugs contribute to their abuse. The extent to which a substance is reliably capable of producing intensely pleasurable feelings (euphoria) increases the likelihood of that substance being abused.
When drugs are used in a manner or amount inconsistent with the medical or social patterns of a culture, it is called drug abuse. In legal terms, the non‑sanctioned use of substances controlled in Schedules I through V of the CSA is considered drug abuse. While legal pharmaceuticals placed under control in the CSA are prescribed and used by patients for medical treatment, the use of these same pharmaceuticals outside the scope of sound medical practice is drug abuse.
In addition to having abuse potential, most controlled substances are capable of producing dependence, either physical, psychological or both. Physical dependence refers to the changes that have occurred in the body after repeated use of a drug that necessitates the continued administration of the drug to prevent a withdrawal syndrome. This withdrawal syndrome can range from mildly unpleasant to life‑threatening and is dependent on a number of factors. The type of withdrawal experienced is related to the drug being used; the dose and route of administration; concurrent use of other drugs; frequency and duration of drug use; and the age, sex, health, and genetic makeup of the user. Psychological dependence refers to the perceived "need" or "craving" for a drug. Individuals who are psychologically dependent on a particular substance often feel that they cannot function without continued use of that substance. While physical dependence disappears within days or weeks after drug use stops, psychological dependence can last much longer and is one of the primary reasons for relapse/initiation of drug use after a period of abstinence.
Individuals that abuse drugs often have a preferred drug that they use, but may substitute other drugs that produce similar effects (often found in the same drug class) when they have difficulty obtaining their drug of choice. Drugs within a class are often compared with each other with terms like potency and efficacy. Potency refers to the amount of a drug that must be taken to produce a certain effect, while efficacy refers to whether or not a drug is capable of producing a given effect regardless of dose. Both the strength and the ability of a substance to produce certain effects play a role in whether that drug is selected by the drug abuser.
Controlled Substances Act of 1970
The Controlled Substances Act (CSA) Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 is the legal foundation of the government’s fight against abuse of drugs and other substances. This law is a consolidation of numerous laws regulating manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, anabolic steroids and chemicals used in the illicit production of controlled substances.
The CSA placed all substances which were in some manner regulated under existing Federal law into one of five schedules. This placement is based upon the substance’s medical use, potential for abuse and safety or dependence liability. The Act also provides a mechanism for substances to be controlled, or added to a schedule; de-controlled, or removed from control; and rescheduled or transferred from one schedule to another (Hanson, 2011).
Schedule of Drugs
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 the United States.
There is a lack of accepted safety for use of the drug or other substance under medical supervision.
Some Schedule I substances include: heroin, LSD, peyote, Quaalude, ecstasy, PCP analogs, and marijuana.
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 the United States or a currently accepted medical use with severe restrictions.
Abuse of the drug or other substance may lead to severe psychological or physical dependence.
Schedule II substances include morphine, opium, Seconal, Ritalin, amphetamine, Demerol, PCP, cocaine, methadone, and methamphetamine.
Schedule III
The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
Anabolic steroids, codeine, low dose morphine, codeine containing meds, paregoric, and hydrocodone with aspirin or Tylenol and some barbiturates are Schedule III substances.
Schedule IV
The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule III.
Included in Schedule IV are Darvon, Talwin, Equanil, Valium and Xanax.
Schedule V
The drug or substance has a low potential for abuse relative to the drugs or other substance in Schedule IV.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substances may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule IV.
Over-the-counter cough medicines with codeine are classified in Schedule V.
How Drugs of Abuse Work
Psychoactive drugs have an effect on the central nervous system by altering consciousness and/or perceptions. Psychoactive drugs are classified as licit (legal) or illicit (illegal). Drugs of abuse are psychoactive in nature; that is why it is important to understanding both the physiological and psychological impact of these drugs (Hanson/Venturelli, 1998). It is important to keep in mind that the effects produced by any drug can vary significantly and is largely dependent on the drug dose and route of administration and the client’s expectation of how the drug will work, set and setting also play a role. Concurrent use of other drugs can enhance or block an effect and substance abusers often take more than one drug to boost the desired effects or counter unwanted side effects. This means that the risks associated with drug abuse cannot be accurately predicted because each user has their own unique sensitivity to a drug. There are a number of theories that attempt to explain these differences, and it is clear that a genetic component may predispose an individual to certain toxicities or even addictive behavior; these theories will be further discussed in module two.
Methods of Drug Administration
There are four primary means of introducing drugs into the body: oral ingestion, inhalation, injection and topical application. How the drug is administered greatly impacts how quickly it will be absorbed into the bloodstream and ultimately begin to affect the brain.
Oral ingestion: this is the most common route of drug administration. Food impacts the absorption of orally administered drugs. The liver is the major detoxifying organ in the body, removing toxins from the blood. This process of metabolizing the drug, effects how rapidly the drug will produce its effects on the central nervous system. The liver has a dramatic effect on orally administered drugs because these drugs may be metabolized before producing their psychoactive effects.
Inhalation: drugs that are administered by inhalation into the lungs through the mouth or nose have a very rapid effect, traveling from the lungs to the brain in only five to eight seconds. This route of administration takes advantage of the fact that the lungs offer a blood-rich environment with an extremely large surface area that allows for rapid absorption. Drugs may be administered by inhalation through smoking (burning the substance and breathing in the smoke), or through inhaling the vapors of the chemical. Among the risks in inhaling drugs are: emphysema, asthma, lung and throat irritations due to chronic use, and the possibility of lung cancer from inhaling tars and hydrocarbons in the smoke (Levinthal, 1996).
Injection: there are three distinct methods of injecting a drug. Intravenous injections involve delivering the drug directly into a vein. This is one of the fastest methods of drug administration. Mainlining (intravenous injection) a drug not only speeds up the drugs effects but also intensifies them. Intramuscular injections, delivering the drug into a large muscle results in slower absorption. Subcutaneous delivery of the drug is done by inserting the needle into the tissue just under the skin the results in a steady absorption into the bloodstream. This method of administration avoids the dangers presented when the drug is taken orally. Only small amounts of a drug may be administered this way (Levinthal, 1996).
Topical application: involves absorption of the drug through surface tissue such as skin or the lining of the nose and mouth. Intra nasal administration involves sniffing or snorting a drug in dust or powder form into the nose. Sublingually administering a drug involves placing the drug in the cheek so that it is absorbed through the lining of the mouth. Transdermal patches provide for a drug to be administered by placing a small patch directly on the skin, the drug is then slowly absorbed through the skin (Levinthal, 1996).
Introduction to the Nervous System
Brain Anatomy: The brain is divided into several large regions, each responsible for activities vital for living. The five major regions include the brainstem, cerebellum, limbic system, diencephalon, and cerebral cortex.
The brainstem is the part of the brain that connects the brain and the spinal cord. The brain and the spinal cord together form the central nervous system. The brainstem controls many basic functions, such as heart rate, breathing, eating and sleeping. It accomplishers this by directing the spinal cord, other parts of the brain and the body to do what is necessary to maintain these basic functions.
The cerebellum represents only one-eighth of the total weight of the brain but is responsible for coordinating the brain’s instructions for skilled repetitive movements and for maintaining balance and posture. It is a prominent structure located above the brainstem.
The limbic system structures are buried under the cortex on top of the brainstem. They are involved in emotions and motivations, particularly those that are related to survival, such as fear, anger and sexual behavior. The limbic system is sometimes referred to as the pleasure center of the brain because it is also involved in feelings of pleasure. The amygdala and hippocampus, parts of the limbic system are involved in memory. Drugs of abuse act directly on this more primitive brain structure, which has the ability to override the cortex in controlling behavior. This in part accounts for the powerful effect that drugs can have.
The diencephalon located beneath the cerebral hemispheres, contains the thalamus and hypothalamus. The thalamus is involved in sensory perceptions and regulation of motor functions. It connects areas of the cerebral cortex that are involved in sensory perception and movement with other parts of the brain and spinal cord that also have a role in sensations and movement. The hypothalamus is a very small but important component, it plays a major role in regulating hormones, the pituitary gland, body temperature, the adrenal glands just to name a few.
The cerebral cortex is divided into right and left hemispheres and accounts for two-thirds of the brain’s mass. It physically covers many of the brain’s remaining structures. It is the most highly developed part of the brain and is responsible for thinking, perceiving, and producing and understanding language. It is divided into areas, each with a very specific function.
Nerve Cells and Neurotransmission: Understanding the functioning of neurons and their interaction through synaptic communication is important in understanding how psychoactive drugs work. In general, drugs work at the neuron level by altering the way in which neurotransmitters are released and bind to receptor sites. While the mechanisms behind the effects might vary, psychoactive drugs cause neurotransmitter to be either more or less active at the synapse (Levinthal, 1996).
The brain is made up of billions of nerve cells. A neuron contains three important parts: a cell body that directs all activities of the neuron; dendrites, short fibers that receive messages from other neurons and relay them to the cell body; and an axon, a long single fiber that transmits messages from the cell body to the dendrite of other neurons or to body tissues. There is a wide range of diversity in the shapes and sizes of neurons as well as their axons and dendrites.
The transfer of a message from the axon of one nerve cell to the dendrites of another is known as neurotransmission. Although axons and dendrites are located extremely close to each other, the transmission of a message from an axon to a dendrite does not occur through direct contact; instead communication is accomplished through the release of a chemical substance into the space between the axon and dendrites. This space is known as the synapse. When neurons communicate, a message traveling as an electrical impulse moves down an axon and toward the synapse; there it triggers the release of molecules called neurotransmitters from the axon into the synapse. The neurotransmitters then diffuse across the synapse and bind to special molecules, called receptors that are located within the cell membranes of the dendrites of the adjacent nerve cell. Neurotransmitters act as chemical messengers, carrying information from one neuron to another.
Each neurotransmitter can only bind to a very specific matching receptor, like fitting a key into a lock. This matching starts a whole cascade of events at both the surface of the dendrite of the receiving nerve cell and inside the cell. The message carried by the neurotransmitter is received and processed by the receiving nerve cell. Once this has occurred, the neurotransmitter is inactivated in one of two ways. It is either broken down by an enzyme or reabsorbed (re-uptake) back into the nerve cell that released it.
Effects of Drugs of Abuse on the Brain
The body is constantly adjusting and responding to its environment in order to maintain internal stability and balance (homeostasis) (Hanson/Venturelli, 1998). In studying the effects of drugs on the brain it is important to study the brain’s pleasure circuit. This circuit is made up of the brainstem, limbic system and the frontal cerebral cortex. All drugs that are addicting can activate the brain’s pleasure circuit. Drug addiction is a biological, pathological process that alters the way in which the pleasure center, as well as other parts of the brain functions. To understand this process it is necessary to examine the effects of drugs on neurotransmission. Some drugs, like heroin and LSD, mimic the effects of a natural neurotransmitter. Others like PCP block receptors and as a result block neuronal messages from getting through. Still others like cocaine interfere with the molecules that are responsible for transporting neurotransmitters back into the neurons that released them causing the neurotransmitter to continuously stimulate the receptors. Drugs such as methamphetamine act by causing neurotransmitters to be released in greater amounts than normal. Prolonged drug use changes the brain in fundamental and long-lasting ways. These long-lasting changes are a major component of addiction.
Factors Affecting the Physiological and Psychological Impact of Drugs
A number of factors affect both the physiological and psychological impact that a drug may have on a particular individual. The physiological effects of a drug can vary as a factor of the time elapsed since the drug was taken, the possible combination of drugs used, and personal characteristics of the individual using the drug. In addition it is important to consider things such as the main effect (intended drug response); tolerance (changes in the body that decrease response to a drug even though the dose remains the same) that the individual may have to the drug, the half-life (the time required for the body to eliminate and/or metabolize half of a drug dose) of the drug, and the drugs impact on neurotransmission. Individual factors such as gender, age, body size, general health and ethnic background can have an impact on the drugs affect. How the individual expects the drug to affect them has a tremendous impact on their perceptions. This placebo effect (effects caused by suggestion and psychological factors, not the pharmacological activity of a drug) is an important part of research into drug abuse (Levinthal, 1996).
Four principle factors that affect drug use include:
Biological, Genetic, and Pharmacological Factors: What biological and genetic factors exist in the user, and how do the ingredients of the drug interact with the body and the nervous system?
Cultural Factors: How do societal views, determined by custom and tradition, affect our initial approach to and use of the drug?
Social Factors: What are the specific reasons why a drug is taken (e.g., curing an illness, self-medicating, escape from reality, peer pressure, family upbringing, membership in drug-abusing subcultures)?
Contextual Factors: How do physical surroundings (rock concerts, bars, nightclubs, or fraternity and sorority parties) affect the amount of drug use? (Hanson, 2011)
What is an Addiction?
There is considerable controversy over what constitutes an addiction or an addictive behavior. Central to any definition of addiction is the notion of compulsive, repetitive behaviors. For the purposes of this module we will approach the definition of addiction from a Biopsychosocial perspective. The Diagnostic and Statistical Manual of Mental Disorder IV, published by the American Psychiatric Association in 1994, is designed to offer guidelines for making diagnoses. The purpose of the DSM is to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study and treat people with various mental disorders.
The DSM IV defines: Substance Abuse: as a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences repeated to the repeated use of substance. Substance Dependence: as a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of a substance despite significant substance-related problems.
Let’s expand the definitions in this way:
Substance Abuse/Drug Abuse: the maladaptive and consistent use of a drug despite (1) social, occupational, psychological or physical problems exacerbated by the drug, (2) recurrent use in situations that are physically hazardous, such as driving while intoxicated.
Substance Dependence/Drug Dependence: impaired control of drug use (1) despite adverse consequences, the (2) development of a tolerance to the drug, the (3) occurrence of withdrawal symptoms when drug intake is reduced or stopped, and (4) repeated unsuccessful attempts to quit using the drug.
The DSM-IV breaks down substance abuse and dependence according to the drug of choice. You will learn more about this as you progress through the program. One of the methods used to classify drugs of abuse is according to the effect the drug has on the Central Nervous System (CNS). These classes include: CNS Depressants (sedative-hypnotics), CNS Stimulants, Opioids (narcotics), Hallucinogens, Cannabinols, Inhalants & Volatile Hydrocarbons, Anabolic Steroids, and Over the Counter & Prescription Drugs.
Central Nervous System Depressants (Sedative-Hypnotics)
Depressants
Historically, people of almost every culture have used chemical agents to induce sleep, relieve stress, and allay anxiety. While alcohol is one of the oldest and most universal agents used for these purposes, hundreds of substances have been developed that produce central nervous system depression. These drugs have been referred to as downers, sedatives, hypnotics, minor tranquilizers, anxiolytics, and anti‑anxiety medications. Unlike most other classes of drugs of abuse, depressants are rarely produced in clandestine laboratories. Generally, legitimate pharmaceutical products are diverted to the illicit market. A notable exception to this is a relatively recent drug of abuse, gamma hydroxybutyric acid (GHB).
Alcohol
No drug is used more extensively or serves as many functions as alcohol. It played an integral role in the early history of the United States, when it was viewed positively because it contained nutrients and other beverages were unsanitary. The rum trade was instrumental to the economic prosperity of the United States. Concern over immoderate drinking and alcohol’s role in the breakdown of the family eventually led to the temperance movement and to politically active groups such as the Women’s Christian Temperance Union, the Anti-Saloon League, and the National Prohibition Party.
National prohibition of alcohol, the Eighteenth Amendment, went into effect in 1920. At first it reduced alcohol-related illnesses and deaths. But the law was difficult to enforce, illegal alcohol posed hazards, and there was widespread contempt for the law. In 1933, Prohibition was repealed by the Twenty-first Amendment.
Most people who drink alcohol are social drinkers. Drinking behavior varies according to geography, sex, race, and age. Generally, men drink more alcohol than women, some ethnic groups, such as Asian-Americans drink less than other groups, and older people consume less alcohol than younger people.
Ethyl alcohol is a central nervous system depressant consisting of carbon, hydrogen, and oxygen. Beer is about 5% alcohol, and table wine is around 10% to 12%. Distilled spirits contain approximately 40% to 50% alcohol. A 12 oz can of beer, a 5 oz glass of wine and a 1 ½ oz shot of 80 proof liquor contain the same amount of alcohol. Alcohol is absorbed primarily in the small intestine. Food in the stomach, carbon dioxide in the beverage, emotional state, and body size affect the rate of absorption. The liver is responsible for metabolizing alcohol out of the body. The body can metabolize approximately one drink per hour.
Alcohol affects every organ in the body. It affects the brain by altering inhibitions, judgments, coordination and memory. More than 2 million Americans suffer from alcohol‑related liver disease. Some drinkers develop alcoholic hepatitis, or inflammation of the liver, as a result of long‑term heavy drinking. Its symptoms include fever, jaundice (abnormal yellowing of the skin, eyeballs, and urine), and abdominal pain. Alcoholic hepatitis can cause death if drinking continues. If drinking stops, this condition often is reversible. About 10 to 20 percent of heavy drinkers develop alcoholic cirrhosis, or scarring of the liver. Alcoholic cirrhosis can cause death if drinking continues. Although cirrhosis is not reversible, if drinking stops, one's chances of survival improve considerably. Those with cirrhosis often feel better, and the functioning of their liver may improve, if they stop drinking. Although liver transplantation may be needed as a last resort, many people with cirrhosis who abstain from alcohol may never need liver transplantation.
The esophagus and existing peptic ulcers become inflamed from alcohol consumption which untreated can cause life threatening hemorrhaging. Moderate drinking can have beneficial effects on the heart, especially among those at greatest risk for heart attacks, such as men over the age of 45 and women after menopause. But long‑term heavy drinking increases the risk for high blood pressure, heart disease, and some kinds of stroke. Long‑term heavy drinking increases the risk of developing certain forms of cancer, especially cancer of the esophagus, mouth, throat, and voice box. Women are at slightly increased risk of developing breast cancer if they drink two or more drinks per day. Drinking may also increase the risk for developing cancer of the colon and rectum.
The pancreas helps to regulate the body's blood sugar levels by producing insulin. The pancreas also has a role in digesting the food we eat. Long‑term heavy drinking can lead to pancreatitis, or inflammation of the pancreas. This condition is associated with severe abdominal pain and weight loss and can be fatal. Women who drink while pregnant can deliver children with fetal alcohol syndrome (FAS), a condition characterized by mental retardation and other physical anomalies (Goldberg, 2000).
Chloral Hydrate
The oldest of the hypnotic (sleep inducing} depressants, chloral hydrate was first synthesized in 1832. Marketed as syrups or soft gelatin capsules, chloral hydrate takes effect in a relatively short time (30 minutes) and will induce sleep in about an hour. A solution of chloral hydrate and alcohol constituted the infamous "knockout drops" or "Mickey Finn." At therapeutic doses, chloral hydrate has little effect on respiration and blood pressure; however; a toxic dose produces severe respiratory depression and very low blood pressure. Chronic use is associated with liver damage and a severe withdrawal syndrome. Although some physicians consider chloral hydrate to be the drug of choice for sedation of children before diagnostic, dental, or medical procedures, its general use as a hypnotic has declined. Chloral hydrate (Noctec®) and compounds, preparations, or mixtures containing choral hydrate are on Schedule IV of the CSA.
Barbiturates
Barbiturates were very popular in the first half of the 20th century. In moderate amounts, these drugs produce a state of intoxication that is remarkably similar to alcohol intoxication. Symptoms include slurred speech, loss of motor coordination, and impaired judgment. Depending on the dose, frequency, and duration of use, one can rapidly develop tolerance, physical dependence, and psychological dependence to barbiturates. With the development of tolerance, the margin of safety between the effective dose and the lethal dose becomes very narrow. That is, in order to obtain the same level of intoxication, the tolerant abuser may raise his or her dose to a level that may result in coma or death. Although many individuals have taken barbiturates therapeutically without harm, concern about the addiction potential of barbiturates and the ever‑increasing number of fatalities associated with them led to the development of alternative medications. Today, less than 10 percent of all depressant prescriptions in the United States are for barbiturates.
The primary differences among barbiturates are how fast they produce an effect and how long those effects last. Barbiturates are classified as ultrashort, short, intermediate, and long‑acting.
The ultrashort‑acting barbiturates produce anesthesia within about one minute after intravenous administration. Those in current medical use are the Schedule IV drug methohexital (Brevital®), and the Schedule III drugs thiamyl (Surital®) and thiopental (Pentothal®). Barbiturate abusers prefer the Schedule II short‑acting and intermediate‑acting barbiturates that include amobarbital (Amyta®), pentobarbital (Nembutal®), secobarbital (Seconal®), and Tuinal (an amobarbital/secobarbital combination product). Other short and intermediate‑acting barbiturates are in Schedule III and include butalbital (Fiorina®), butabarbital (Butisol®), talbutal (Lotusate®), and aprobarbital (Alurate®). After oral administration, the onset of action is from 15 to 40 minutes, and the effects last up to six hours. These drugs are primarily used for insomnia and preoperative sedation. Veterinarians use pentobarbital for anesthesia and euthanasia.
Long‑acting barbiturates include phenobarbital (Luminal®) and mephobarbital (Mebaral®), both of which are in Schedule IV. Effects of these drugs are realized in about one hour and last for about 12 hours, and are used primarily for daytime sedation and the treatment of seizure disorders.
Benzodiazepines
Benzodiazepines were first marketed in the 1960s. Touted as much safer depressants with far less addiction potential than barbiturates, today these drugs account for about one out of every five prescriptions for controlled substances. Although benzodiazepines produce significantly less respiratory depression than barbiturates, it is now recognized that benzodiazepines share many of the undesirable side effects of the barbiturates. A number of toxic central nervous system effects are seen with chronic high‑dose benzodiazepine therapy, including headaches, irritability, confusion, memory impairment and depression. The risk of developing over‑sedation, dizziness, and confusion increases substantially with higher doses of benzodiazepines. Prolonged use can lead to physical dependence even at doses recommended for medical treatment. Unlike barbiturates, large doses of benzodiazepines are rarely fatal unless combined with other drugs or alcohol. Although primary abuse of benzodiazepines is well documented, abuse of these drugs usually occurs as part of a pattern of multiple drug abuse. For example, heroin or cocaine abusers will use benzodiazepines and other depressants to augment their "high" or alter the side effects associated with over‑stimulation or narcotic withdrawal. Fifteen members of this group are presently marketed in the United States, and about 20 additional benzodiazepines are marketed in other countries. Benzodiazepines are controlled in Schedule IV of the CSA.
Short‑acting benzodiazepines are generally used for patients with sleep‑onset insomnia (difficulty falling asleep) without daytime anxiety. Shorter‑acting benzodiazepines used to manage insomnia include estazolam (ProSom®), flurazepam (Dalmane®), temazepam (Restoril®), and triazolam (Halcion®). Midazolam (Versed®), a short‑acting benzodiazepine, is utilized for sedation, anxiety, and amnesia in critical care settings and prior to anesthesia. It is available in the United States as an injectable preparation and as a syrup (primarily for pediatric patients).
Benzodiazepines with a longer duration of action are utilized to treat insomnia in patients with daytime anxiety. These benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (librium®), clorazepate (Tranxene®), diazepam (Valium®), halazepam (Paxipam®), lorzepam (Ativan®), oxazepam (Serax®), prazepam (Centrax®), and quazepam (Doral®). Clonazepam (Klonopin®), diazepam, and clorazepate are also used as anticonvulsants.
Benzodiazepines are classified in the CSA as depressants. Repeated use of large doses or; in some cases, daily use of therapeutic doses of benzodiazepines is associated with amnesia, hostility, irritability, and vivid or disturbing dreams, as well as tolerance and physical dependence. The withdrawal syndrome is similar to that of alcohol and may require hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering‑down the dose eliminates many of the unpleasant symptoms.
Given the millions of prescriptions written for benzodiazepines (about 100 million in 1999), relatively few individuals increase their dose on their own initiative or engage in drug‑seeking behavior. Those individuals who do abuse benzodiazepines often maintain their drug supply by getting prescriptions from several doctors, forging prescriptions, or buying diverted pharmaceutical products on the illicit market. Abuse is frequently associated with adolescents and young adults who take benzodiazepines to obtain a "high." This intoxicated state results in reduced inhibition and impaired judgment. Concurrent use of alcohol or other depressant; with benzodiazepines can be life threatening. Abuse of benzodiazepines is particularly high among heroin and cocaine abusers. A large percentage of people entering treatment for narcotic or cocaine addiction also report abusing benzodiazepines. Alprazolam and diazepam are the two most frequently encountered benzodiazepines on the illicit market.
Gamma Hydroxybutyric Acid (GHB)
In recent years, GHB has emerged as a significant drug of abuse throughout the United States. Abusers of this drug fall into three major groups: (1) users who take GHB for its MDMA‑like hallucinogenic effects or as an intoxicant or euphoriant; (2) bodybuilders who abuse GHB for its alleged utility as an anabolic agent or as a sleep aid; and (3) individuals who use GHB as a weapon for sexual assault. These categories are not mutually exclusive and an abuser may use the drug illicitly to produce several effects. GHB is frequently taken with alcohol or other drugs that heightens its effects and is often found at bars, nightclubs, rave parties, and gyms. Teenagers and young adults who frequent these establishments are the primary users. Like flunitrazepam, benzodiazepine is often referred to as a "date‑rape" drug, and GHB involvement in rape cases is likely to be unreported or unsubstantiated. GHB is quickly eliminated from the body making detection in body fluids unlikely; and its fast onset of depressant effects may render the victim with little memory of the details of the attack.
There are marked similarities among the withdrawal symptoms seen with most drugs classified as depressants. In the mildest form, the withdrawal syndrome may produce insomnia and anxiety, usually the same symptoms that initiated the drug use. With a greater level of dependence, tremors and weakness are also present, and in its most severe form, the withdrawal syndrome can cause seizures and delirium. Unlike the withdrawal syndrome seen with most other drugs of abuse, withdrawal from depressants can be life threatening.
Rohypnol
Flunitrazepam (Rohypnol®) is a benzodiazepine that is not manufactured or legally marketed in the United States, but is smuggled in by traffickers. In the mid‑1990s, flunitrazepam was extensively trafficked in Florida and Texas. Known as "rophies," "roofies," and "roach," flunitrazepam gained popularity among younger individuals as a "party" drug. It has also been utilized as a "date rape" drug. In this context, flunitrazepam is placed in the alcoholic drink of an unsuspecting victim to incapacitate them and prevent resistance from sexual assault. The victim is frequently unaware of what has happened to them and often does not report the incident to authorities. A number of actions by the manufacturer of this drug and by government agencies have resulted in reducing the availability and abuse of flunitrazepam in the United States.
Newly Marked Drugs: Zolpidem (Ambien®) and zaleplon (Sonata®) are two relatively new, benzodiazepine‑like CNS depressants that have been approved for the short‑term treatment of insomnia. Both of these drugs share many of the same properties as the benzodiazepines and are in Schedule IV of the CSA.
Central Nervous System Stimulants
Stimulants are sometimes referred to as uppers and reverse the effects of fatigue on both mental and physical tasks. Two commonly used stimulants are nicotine, found in tobacco products, and caffeine, an active ingredient in coffee, tea, some soft drinks, and many non‑prescription medicines. Used in moderation, these substances tend to relieve malaise and increase alertness. Although the use of these products has been an accepted part of U.S. culture, the recognition of their adverse effects has resulted in a proliferation of caffeine‑free products and efforts to discourage cigarette smoking.
A number of stimulants, however, are under the regulatory control of the CSA. Some of these controlled substances are available by prescription for legitimate medical use in the treatment of obesity, narcolepsy, and attention deficit disorders. As drugs of abuse, stimulants are frequently taken to produce a sense of exhilaration, enhance self-esteem, improve mental and physical performance, increase activity, reduce appetite, produce prolonged wakefulness, and to "get high." They are recognized as among the most potent agents of reward and reinforcement that underlie the problem of dependence.
Stimulants are diverted from legitimate channels and clandestinely manufactured exclusively for the illicit market. They are taken orally; sniffed, smoked, and injected. Smoking, snorting, or injecting stimulants produces a sudden sensation known as a "rush" or a "flash." Abuse is often associated with a pattern of binge use‑sporadically consuming large doses of stimulants over a short period of time. Heavy users may inject themselves every few hours, continuing until they have depleted their drug supply or reached a point of delirium, psychosis, and physical exhaustion. During this period of heavy use, all other interests become secondary to recreating the initial euphoric rush. Tolerance can develop rapidly; and both physical 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 known as a "crash."
Therapeutic levels of stimulants can produce exhilaration, extended wakefulness, and loss of appetite. These effects are greatly intensified when large doses of stimulants are taken. Physical side effects, including dizziness, tremor; headache, flushed skin, chest pain with palpitations, excessive sweating, vomiting, and abdominal cramps, may occur as a result of taking too large a dose at one time or taking large doses over an extended period of time. Psychological effects include agitation, hostility, panic, aggression, and suicidal or homicidal tendencies. Paranoia, sometimes accompanied by both auditory and visual hallucinations, may also occur. In overdose, unless there is medical intervention, high fever, convulsions, and cardiovascular collapse may precede death. Because accidental death is partially due to the effects of stimulants on the body's cardiovascular and temperature‑regulating systems, physical exertion increases the hazards of stimulant use.
Cocaine
Cocaine, the most potent stimulant of natural origin, is extracted from the leaves of the coca plant (Erythroxylon coca), which is indigenous to the Andean highlands of South America. Natives in this region chew or brew coca leaves into a tea for refreshment and to relieve fatigue, similar to the customs of chewing tobacco and drinking tea or coffee.
Pure cocaine was first isolated in the 1880s and used as a local anesthetic in eye surgery. It was particularly useful in surgery of the nose and throat because of its ability to provide anesthesia, as well as to constrict blood vessels and limit bleeding. Many of its therapeutic applications are now obsolete due to the development of safer drugs.
Illicit cocaine is usually distributed as a white crystalline powder or as an off‑white chunky material. The powder, usually cocaine hydrochloride, is often diluted with a variety of substances, the most common being sugars such as lactose, inositol, and mannitol, and local anesthetics such as lidocaine. The adulteration increases the volume and thus multiplies profits. Cocaine hydrochloride is generally snorted or dissolved in water and injected. It is rarely smoked because it is heat labile (destroyed by high temperatures).
"Crack," the chunk or "rock" form of cocaine, is a ready‑to‑use freebase. On the illicit market, it is sold in small, inexpensive dosage units that are smoked. Smoking delivers large quantities of cocaine to the lungs, producing effects comparable to intravenous injection; these effects are felt almost immediately, are very intense, and are quickly over. Once introduced in the mid‑1980s, crack abuse spread rapidly and made the cocaine experience available to anyone with $10 and access to a dealer. In addition to other toxicities associated with cocaine abuse, cocaine smokers suffer from acute respiratory problems including cough, shortness of breath, and severe chest pains with lung trauma and bleeding. It is noteworthy that the emergence of crack was accompanied by a dramatic increase in drug abuse problems and drug‑ related violence.
The intensity of the psychological effects of cocaine, as with most psychoactive drugs, depends on the dose and rate of entry to the brain. Cocaine reaches the brain through the snorting method in three to five minutes. Intravenous injection of cocaine produces a rush in 15 to 30 seconds, and smoking produces an almost immediate intense experience. The euphoric effects of cocaine are almost indistinguishable from those of amphetamine, although they do not last as long. These intense effects can be followed by a dysphoric crash. To avoid the fatigue and the depression of coming down, frequent repeated doses are taken. Excessive doses of cocaine may lead to seizures and death from respiratory failure, stroke, or heart failure. There is no specific antidote for cocaine overdose.
Cocaine is the second most commonly used illicit drug (following marijuana) in the United States. Approximately 10 percent of the population over the age of 12 has tried cocaine at least once in their lifetime, about 2 percent has tried crack, and nearly one percent is currently using cocaine. There are no drugs approved for replacement‑pharmacotherapy (drugs taken on a chronic basis as a substitute for the abused drug, like methadone for heroin addiction). Cocaine addiction treatment relies heavily on psychotherapy and drugs like antidepressants to relieve some of the effects resulting from cocaine abuse.
Amphetamines/Methamphetamine
Amphetamine, dextroamphetamine, methamphetamine, and their various salts, are collectively referred to as amphetamines. In fact, their chemical properties and actions are so similar that even experienced users have difficulty knowing which drug they have taken.
Amphetamine was first marketed in the 1930s as Benzedrine® in an over‑the‑counter inhaler to treat nasal congestion. By 1937, amphetamine was available by prescription in tablet form and was used in the treatment of the sleeping disorder narcolepsy and the behavioral syndrome called minimal brain dysfunction, which today is called attention deficit hyperactivity disorder (ADHD). During World War II, amphetamine was widely used to keep the fighting men going; both dextroamphetamine (Dexedrine®) and methamphetamine (Methedrine®) became readily available.
As use of amphetamines spread, so did their abuse. In the 1960s, amphetamines became a cure‑all for helping truckers to complete their long routes without falling asleep, for weight control, for helping athletes to perform better and train longer; and for treating mild depression. Intravenous amphetamines, primarily methamphetamine, were abused by a subculture known as "speed freaks." With experience, it became evident that the dangers of abuse of these drugs outweighed most of their therapeutic uses.
Increased control measures were initiated in 1965 with amendments to the federal food and drug laws to curb the black market in amphetamines. Many pharmaceutical amphetamine products were removed from the market including all injectable formulations, and doctors prescribed those that remained less freely. Recent increases in medical use of these drugs can be attributed to their use in the treatment of ADHD. Amphetamine products presently marketed include generic and brand name amphetamine (Adderall®, Dexedrine®, Dextrostat®) and brand name methamphetamine (Desoxyn®). Amphetamines are all controlled in Schedule II of the CSA.
To meet the ever‑increasing black market demand for amphetamines, clandestine laboratory production has mushroomed. Today, most amphetamines distributed to the black market are produced in clandestine laboratories. Methamphetamine laboratories are, by far; the most frequently encountered clandestine laboratories in the United States. Law enforcement personnel routinely raid both large and small ("mom and pop") laboratories. The ease of clandestine synthesis, combined with tremendous profits, has resulted in significant availability of illicit methamphetamine, especially on the West Coast where abuse of this drug has increased dramatically in recent years. Large amounts of methamphetamine are also illicitly smuggled into the United States from Mexico.
Amphetamines are generally taken orally or injected. However, the addition of "ice," the slang name for crystallized methamphetamine hydrochloride, has promoted smoking as another mode of administration. Just as "crack" is smokable cocaine, "ice" is smokable methamphetamine. Methamphetamine, in all its forms, is highly addictive and toxic.
The effects of amphetamines, especially methamphetamine, are similar to cocaine, but their onset is slower and their duration is longer. In contrast to cocaine, which is quickly removed from the brain and is almost completely metabolized, methamphetamine remains in the central nervous system longer, and a larger percentage of the drug remains unchanged in the body, producing prolonged stimulant effects. Chronic abuse produces a psychosis that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with one's own thoughts, and auditory and visual hallucinations. These psychotic symptoms can persist for months and even years after use of these drugs has ceased and may be related to the neurotoxic effects of these drugs. Violent and erratic behavior is frequently seen among chronic abusers of amphetamines, especially methamphetamine.
Methylphenidate
Methylphenidate, a Schedule II substance, has a high potential for abuse and produces many of the same effects as cocaine or the amphetamines. The abuse of this substance has been documented among narcotic addicts who dissolve the tablets in water and inject the mixture. Complications arising from this practice are common due to the insoluble fillers used in the tablets. When injected, these materials block small blood vessels, causing serious damage to the lungs and retina of the eye. Binge use, psychotic episodes, cardiovascular complications, and severe psychological addiction have all been associated with methylphenidate abuse.
Methylphenidate is used legitimately in the treatment of excessive daytime sleepiness associated with narcolepsy, as is the newly marketed Schedule IV stimulant, modafinil (Provigil®). However; the primary legitimate medical use of methylphenidate (Ritalin®, Methylin®, and Concerta®) is to treat attention deficit hyperactivity disorder (ADHD) in children. The increased use of this substance for the treatment of ADHD has paralleled an increase in its abuse among adolescents and young adults who crush these tablets and snort the powder to get high. Youngsters have little difficulty obtaining methylphenidate from classmates or friends who have been prescribed it. Greater efforts to safeguard this medication at home and school are needed.
Opioids (Narcotics)
Narcotics
The term "narcotic," derived from the Greek word for stupor, originally referred to a variety of substances that dulled the senses and relieved pain. Today, the term is used in a number of ways. Some individuals define narcotics as those substances that bind at opiate receptors (cellular membrane proteins activated by substances like heroin or morphine) while others refer to any illicit substance as a narcotic. In a legal context, narcotic refers to opium, opium derivatives, and their semi‑synthetic substitutes. Cocaine and coca leaves, which are also classified as "narcotics" in the Controlled Substances Act (CSA), neither bind opiate receptors nor produce morphine‑like effects, and are discussed in the section on stimulants. For the purposes of this discussion, the term narcotic refers to drugs that produce morphine‑like effects.
Narcotics are used therapeutically to treat pain, suppress cough, alleviate diarrhea, and induce anesthesia. Narcotics are administered in a variety of ways. Some are taken orally, transdermally (skin patches), or injected. They are also available in suppositories. As drugs of abuse, they are often smoked, sniffed, or injected. Drug effects depend heavily on the dose, route of administration, and previous exposure to the drug. Aside from their medical use, narcotics produce a general sense of well‑being by reducing tension, anxiety, and aggression. These effects are helpful in a therapeutic setting but con tribute to their abuse.
Narcotic use is associated with a variety of unwanted effects including drowsiness, inability to concentrate, apathy, lessened physical activity, constriction of the pupils, dilation of the subcutaneous blood vessels causing flushing of the face and neck, constipation, nausea and vomiting, and most significantly, respiratory depression. As the dose is increased, the subjective, analgesic (pain relief), and toxic effect become more pronounced. Except in cases of acute intoxication, there is no loss of motor coordination or slurred speech as occurs with many depressants.
Among the hazards of illicit drug use is the ever‑increasing risk of infection, disease, and overdose. While pharmaceutical products have a known concentration and purity, clandestinely produced street drugs have unknown compositions. Medical complications common among narcotic abusers arise primarily from adulterants found in street drugs and in the non‑sterile practices of injecting. Skin, lung, and brain abscesses, endocarditis (inflammation (the fining of the heart), hepatitis, and AIDS are commonly found among narcotic abusers. Since there is no simple way to determine the purity of a drug that is sold on the street, the effects of illicit narcotic use are unpredictable and can be fatal. Physical signs of narcotic overdose include constricted (pinpoint) pupils, cold clammy skin, confusion, convulsions, severe drowsiness, and respiratory depression (slow or troubled breathing).
With repeated use of narcotics, tolerance and dependence develop. The development of tolerance is characterized by a shortened duration and a decreased intensity of analgesia, euphoria, and sedation, which creates the need to consume progressively larger doses to attain the desired effect. Tolerance does not develop uniformly for all actions of these drugs, giving rise to a number of toxic effects. Although tolerant users can consume doses far in excess of the dose they took, physical dependence refers to an alteration of normal body functions that necessitates the continued presence of a drug in order to prevent a withdrawal or abstinence syndrome. The intensity and character of the physical symptoms experienced during withdrawal are directly related to the particular drug of abuse, the total daily dose, the interval between doses, the duration of use, and the health and personality tend to produce shorter; more intense withdrawal symptoms, while longer acting narcotics produce a withdrawal syndrome that is protracted but tends to be less severe. Although unpleasant, withdrawal from narcotics is rarely life threatening.
The withdrawal symptoms associated with heroin/morphine addiction are usually experienced shortly before the time of the next scheduled dose. Early symptoms include watery eyes, runny nose, yawning, and sweating. Restlessness, irritability, loss of appetite, nausea, tremors, and drug craving appear as the syndrome progresses. Severe depression and vomiting are common. The heart rate and blood pressure are elevated. Chills alternating with flushing and excessive sweating are also characteristic symptoms. Pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms. Without intervention, the syndrome will run its course, and most of the overt physical symptoms will disappear within 7 to 10 days.
The psychological dependence associated with narcotic addiction is complex and protracted. Long after the physical need for the drug has passed, the addict may continue to think and talk about the use of drugs and feel strange or overwhelmed coping with daily activities without being under the influence of drugs. There is a high probability that relapse will occur after narcotic withdrawal when neither the physical environment nor the behavioral motivators that contributed to the abuse have been altered.
There are two major patterns of narcotic abuse or dependence seen in the United States. One involves individuals whose drug use was initiated within the context of medical treatment who escalate their dose by obtaining the drug through fraudulent prescriptions and "doctor shopping" or branching out to illicit drugs. The other; more common, pattern of abuse is initiated outside the therapeutic setting with experimental or recreational use of narcotics. The majority of individuals in this category may abuse narcotics sporadically for months or even years. Although they may not become addicts, the social, medical, and legal consequences of their behavior are very serious. Some experimental users will escalate their narcotic use and will eventually become dependent, both physically and psychologically. The younger an individual is when drug use is initiated, the more likely the drug use will progress to dependence and addiction.
Narcotics of Natural Origin
The poppy Papaver somniferum is the source for non‑synthetic narcotics. It was grown in the Mediterranean region as early as 5000 B.C., and has since been cultivated in a number of countries throughout the world. The milky fluid that seeps from incisions in the unripe seedpod of this poppy has, since ancient times, been scraped by hand and air‑dried to produce what is known as opium. A more modern method of harvesting is by the industrial poppy straw process of extracting alkaloids from the mature dried plant. The extract may be in liquid, solid, or powder form, although most poppy straw concentrate available commercially is a fine brownish powder. More than 500 tons of opium or its equivalent in poppy straw concentrate are legally imported into the United States annually for legitimate medical use.
Synthetic Narcotics
In contrast to the pharmaceutical products derived from opium, synthetic narcotics are produced entirely within the laboratory. The continuing search for products that retain the analgesic properties of morphine without the consequent dangers of tolerance and dependence has yet to yield a product that is not susceptible to abuse. A number of clandestinely produced drugs, as well as drugs that have accepted medical uses, fall within this category.
Opium
There were no legal restrictions on the importation or use of opium until the early 1900s. In the United States, the unrestricted availability of opium, the influx of opium‑smoking immigrants from East Asia, and the invention of the hypodermic needle contributed to the more severe variety of compulsive drug abuse seen at the turn of the 20th century. In those days, medicines often contained opium without any warning label. Today, there are state, federal, and international laws governing the production and distribution of narcotic substances.
Although opium is used in the form of paregoric to treat diarrhea, most opium imported into the United States is broken down into its alkaloid constituents. These alkaloids are divided into two distinct chemical classes, phenanthrenes and isoquinolines. The principal phenanthrenes are morphine, codeine, and thebaine, while the isoquinolines have no significant central nervous system effects and are not regulated under the CSA.
Morphine
Morphine is the principal constituent of opium and can range in concentration from 4 to 21 percent. Commercial opium is standardized to contain 10‑percent morphine. In the United States, a small percentage of the morphine obtained from opium is used directly (about 15 tons): the remaining is converted to codeine and other derivatives (about 120 tons). Morphine is one of the most effective drugs known for the relief of severe pain and remains the standard against which new analgesics are measured. Like most narcotics, the use of morphine has increased significantly in recent years. Since 1990, there has been about a 3‑fold increase in morphine products in the United States.
Morphine is marketed under generic and brand name products including MS‑Contin®, Oramorph SR®, MSIR®, Roxanol®, Kadian®, and RMS®." Morphine is used parenterally (by injection) for preoperative sedation, as a supplement to anesthesia, and for analgesia. It is the drug of choice for relieving pain of myocardial infarction and for its cardiovascular effects in the treatment of acute pulmonary edema. Traditionally; morphine was almost exclusively used by injection. Today, morphine is marketed in a variety of forms, including oral solutions, immediate and sustained‑release tablets and capsules, suppositories, and injectable preparations. In addition, the availability of high‑concentration morphine preparations (i.e., 20‑mg/ml oral solutions, 25‑mg/ml injectable solutions, and 200‑mg sustained‑release tablets) partially reflects the use of this substance for chronic pain management in opiate‑tolerant patients.
Heroin
First synthesized from morphine in 1874, heroin was not extensively used in medicine until the early 1900s. Commercial production of the new pain remedy was first started in 1898. While it received widespread acceptance from the medical profession, physicians remained unaware of its potential for addiction for years. The first comprehensive control of heroin occurred with the Harrison Narcotic Act of 1914. Today, heroin is an illicit substance having no medical utility in the United States. It is in Schedule I of the CSA.
Four foreign source areas produce the heroin available in the United States: South America (Colombia). Mexico, Southeast Asia (principally Burma), and Southwest Asia/Middle East (Turkey, Pakistan, Lebanon). However, South America and Mexico supply most of the illicit heroin marketed in the United States. South American heroin is a high purity powder primarily distributed to metropolitan areas on the East Coast. Heroin powder may vary in color from white to dark brown because of impurities left from the manufacturing process or the presence of additives. Mexican heroin, known as "black tar," is primarily available in the western United States. The color and consistency of black tar heroin result from the crude processing methods used to illicitly manufacture heroin in Mexico. Black tar heroin may be sticky like roofing tar or hard like coal, and its color may vary from dark brown to black.
Pure heroin is rarely sold on the street, and the average purity of heroin for major metropolitan areas nationally averaged about 37.2 percent in 2000. A "bag" slang for a small unit of heroin sold on the street‑currently contains about 30 to 50 milligrams of powder; only a portion of which is heroin; the remainder could be sugar, starch, acetaminophen, procaine, benzocaine, or quinine, to name a few of the cutting agents for heroin. Traditionally, the purity of heroin in a bag ranged from 1 to 10 percent. More recently, heroin purity has ranged from about 10 to 70 percent. Black tar heroin is often sold in chunks weighing about an ounce. Its purity is generally far less than South American heroin and it is most frequently dissolved, diluted, and injected.
Until recently, heroin in the United States was almost always injected, because this is the most practical and efficient way to administer low‑purity heroin. However; the recent availability of higher purity heroin at relatively low cost has meant that a larger percentage of today's users are either snorting or smoking heroin, instead of injecting it. This trend was captured in the 1999 National Household Survey on Drug Abuse, which revealed that 60 to 70 percent of people who used heroin for the first time from 1996 to 1998 never injected it. According to that survey, an estimated 73 percent of the 471,000 first‑time heroin users (from 1996 to 1999) were under 25 years old. Snorting or smoking heroin is more appealing to these new users because it eliminates both the fear of acquiring syringe‑borne diseases, such as HIV and hepatitis, as well as the social stigma attached to intravenous heroin use. Many new users of heroin mistakenly believe that smoking or snorting heroin is a safe technique for avoiding addiction. However, both the smoking and the snorting of heroin are directly linked to high incidences of dependence and addiction.
Methadone
German scientists synthesized methadone during World War II because of a shortage of morphine. Although chemically unlike morphine or heroin, methadone produces many of the same effects. Introduced into the United States in 1947 as an analgesic (Dolophinel), it is primarily used today for the treatment of narcotic addiction. It is available in oral solutions, tablets, and injectable Schedule II formulations, and is almost as effective when administered orally as it is by injection. Methadone's effects can last up to 24 hours, thereby permitting once‑a‑day oral administration in heroin detoxification and maintenance programs. High‑dose methadone can block the effects of heroin, thereby discouraging the continued use of heroin by addicts under treatment with methadone. Chronic administration of methadone results in the development of tolerance and dependence. The withdrawal syndrome develops more slowly and is less severe but more prolonged than that associated with heroin withdrawal. Ironically, methadone used to control narcotic addiction is frequently encountered on the illicit market and has been associated with a number of overdose deaths.
LAAM
Closely related to methadone, the synthetic compound levo alphacetylmethadol, or LAAM (ORLMM®), has an even longer duration of action (from 48 to 72 hours) than methadone, permitting a reduction in frequency of use. In 1994, it was approved as a Schedule II treatment drug for narcotic addiction. Both methadone and LAAM have high abuse potential. Their acceptability as narcotic treatment drugs is predicated upon their ability to substitute for heroin, the long duration of action, and their mode of oral administration.
Buprenorphine
This drug is a semi‑synthetic narcotic derived from thebaine and is currently being investigated for the treatment of narcotic addiction. Like methadone and LAAM, buprenorphine is potent (30 to 50 times the analgesic potency of morphine), has a long duration of action, and does not need to be injected. The buprenorphine products under development are sublingual tablets. Unlike the other treatment drugs, buprenorphine produces far less respiratory depression and is thought to be safer in overdose. Buprenorphine is currently available in the United States as an injectable Schedule V narcotic analgesic (Buprenex®) for human and veterinary use.
Hydromorphone
Hydromorphone (Dilaudid®) is marketed in tablets (2, 4, and 8 mg), rectal Suppositories, oral solutions, and injectable formulations. All products are in Schedule II of the CSA. Its analgesic potency is from two to eight times that of morphine, but it is shorter acting and produces more sedation than morphine. Much sought after by narcotic addicts, hydromorphone is usually obtained by the abuser through fraudulent prescriptions or theft. The tablets are often dissolved and injected as a substitute for heroin.
Codeine
Codeine is the most widely used, naturally occurring narcotic in medical treatment in the world. This alkaloid is found in opium in concentrations ranging from 0.7 to 2.5 percent. However, most codeine used in the United States is produced from morphine. Codeine is also the starting material for the production of two other narcotics, dihydrocodeine and hydrocodone.
Codeine is medically prescribed for the relief of moderate pain and cough suppression. Compared to morphine, codeine produces less analgesia, sedation, and respiratory depression, and is usually taken orally. It is made into tablets either alone (Schedule II) or in combination with aspirin or acetaminophen (i.e., Tylenol with Codeine, Schedule III). As a cough suppressant, codeine is found in a number of liquid preparations (these products are in Schedule V). Codeine is also used to a lesser extent as an injectable solution for the treatment of pain. Codeine products are diverted from legitimate sources and are encountered on the illicit market.
Oxycodone
Oxycodone is synthesized from thebaine. Like morphine and hydromorphone, Oxycodone is used as an analgesic. It is effective orally and is marketed alone in 10, 20, 40, 80, and 160 mg controlled‑release tablets (OxyContin), or 5 mg immediate‑release capsules (OxyIR®), or in combination products with aspirin (Percodan®) or acetaminophen (Percocet®) for the relief of pain. All oxycodone products are in Schedule II. Oxycodone is abused orally or the tablets are crushed and sniffed or dissolved in water and injected. The use of oxycodone has increased significantly. In 1990, nearly three tons of Oxycodone was manufactured in the United States. In 2000, about 47 tons were manufactured.
Historically, oxycodone products have been popular drugs of abuse among the narcotic abusing population. In recent months, concern has grown among federal, state, and local officials about the dramatic increase in the illicit availability and abuse of OxyContin products. These products contain large amounts of oxycodone (10 to 160 mg) in a formulation intended for slow release over about a 12‑hour period. Abusers have learned that this slow‑release mechanism can be easily circumvented by crushing the tablet and swallowing, snorting, or injecting the drug product for a more rapid and intense high. The criminal activity associated with illicitly obtaining and distributing this drug, as well as serious consequences of illicit use, including addiction and fatal overdose deaths, are of epidemic proportions in some areas of the United States.
Hallucinogens
Hallucinogens are among the oldest known group of drugs used for their ability to alter human perception and mood. For centuries, many of the naturally occurring hallucinogens found in plants and fungi have been used for a variety of shamanistic practices. In more recent years, a number of synthetic hallucinogens have been produced, some of which are much more potent than their naturally occurring counterparts.
The biochemical, pharmacological, and physiological basis for hallucinogenic activity is not well understood. Even the name for this class of drugs is not ideal, since hallucinogens do not always produce hallucinations. However, taken in non‑toxic dosages, these substances produce changes in perception, thought, and mood. Physiological effects include elevated heart rate, increased blood pressure, and dilated pupils. Sensory effects include perceptual distortions that vary with dose, setting, and mood. Psychic effects include disorders of thought associated with time and space. Time may appear to stand still and forms and colors seem to change and take on new significance. This experience may be either pleasurable or extremely frightening. It needs to be stressed that the effects of hallucinogens are unpredictable each time they are used.
Weeks or even months after some hallucinogens have been taken; the user may experience flashbacks‑‑fragmentary recurrences of certain aspects of the drug experience in the absence of actually taking the drug. The occurrence of a flashback is unpredictable, but is more likely to occur during times of stress and seem to occur more frequently in younger individuals. With time, these episodes diminish and become less intense.
The abuse of hallucinogens in the United States received much public attention in the 1960s and 1970s. A subsequent decline in their use in the 1980s may be attributed to real or perceived hazards associated with taking these drugs. However, a resurgence of the use of hallucinogens in the 1990s is cause for concern. By 1999, one out of every six college students (14.8 percent) reported some use of hallucinogens in their lifetime, and an estimated 900,000 Americans 12 years of age or older, were current users of hallucinogens. Hallucinogenic mushrooms, LSD, and MDMA are popular among junior and senior high school students who use hallucinogens.
There is a considerable body of literature that links the use of some of the hallucinogenic substances to neuronal damage in animals, and recent data support that some hallucinogens are neurotoxic to humans. However, the most common danger of hallucinogen use is impaired judgment that often leads to rash decisions and accidents.
MDMA & Other Phenethylamines
3, 4‑Methylenedioxymethamphetamine (MDMA, Ecstasy) was first synthesized in 1912 but remained in relative obscurity for many years. In the 1980s, MDMA gained popularity as a drug of abuse resulting in its final placement in Schedule I of the CSA. Today, MDMA is extremely popular among "rave" participants, and in 2000, it was estimated that two million tablets were smuggled into the United States every week.
MDMA produces both amphetamine‑like stimulation and mild mescaline‑like hallucinations. It is touted as a "feel good" drug with an undeserved reputation of safety. MDMA produces euphoria, increased energy, increased sensual arousal, and enhanced tactile sensations. However, it also produces nerve cell damage that can result in psychiatric disturbances and long‑term cognitive impairments. The user will often experience increased muscle tension, tremors, blurred vision, and hyperthermia. The increased body temperature can result in organ failure and death.
MDMA is usually (distributed in tablet form and taken orally at doses ranging from 2 to 10 mg per kilogram, depending on the users body weight. Individual tablets are often imprinted with graphic designs or commercial logos, and typically contain 100 mg of MDMA. After oral administration, effects are felt within 30 to 45 minutes, peak at 60 to 90 minutes, and last for 4 to 6 hours. Analysis of seized MDMA tablets indicates that about 80 percent of all samples actually contain MDMA. About 10 percent of the MDMA‑positive samples also contain MDA (3.4‑methyl‑ enedioxyamphetamine), and MDEA (3.4‑methyl‑enedioxyethyl amphetamine), while another 10 percent contain amphetamine, methamphetamine, or both. Fraudulent MDMA tablets frequently contain combinations of ephedrine, dextromethorphan, and caffeine.
Many chemical variations of mescaline and amphetamine have been synthesized for their "feel good" effects. 4‑Methyl‑2,5‑dimethoxyamphetamine (DOM) was introduced into the San Francisco drug scene in the late 1960s and was nicknamed STP; an acronym for "Serenity, Tranquility, and Peace." Other illicitly produced analogues include 4‑bromo‑2,5‑dimethoxyamphetamine (DOB) and 4‑bromo‑2.5‑dimethoxyPhenethylamine (2C‑B or Nexus). In 2000, para methoxyamphetamine (PMA,) and para methoxymethamphetamine (PMMA) were identified in tablets sold as Ecstasy. PMA, which first appeared on the illicit market briefly in the early 1970s, is associated with a number of deaths in both the United States and Europe. In 2001, significant seizures of 2c‑t‑7 (dimethoxy‑4‑(n)‑propylthiophenethylamide) and BZP (benzerpiperazine/and TFMPP Trifluoromethylphenolpiperazine) were made. BZP and TFMPP were sold in combination and promoted as MDMA‑like or even as MDMA. Tablets are often very similar to MDMA tablets.
Hundreds of compounds can be produced by making slight modifications to the phenethylamine molecule. Some of these analogues are pharmacologically active and differ from one another in potency, speed of onset, duration of action, and capacity to modify mood with or without producing overt hallucinations. The drugs are usually taken orally, sometimes snorted, and rarely injected. Because they are produced in clandestine laboratories, they are seldom pure and the amount in a capsule or tablet is likely to vary considerably.
Lysergic Acid Diethylamide (LSD)
Lysergic acid diethylamide (LSD) is the most potent hallucinogen known to science, as well as the most highly studied. LSD was originally synthesized in 1938 by Dr. Albert Hoffman. However, its hallucinogenic effects were unknown until 1943 when Hoffman accidentally consumed some LSD. It was later found that an oral dose of as little as 0.000025 grams (or 25 micrograms, equal in weight to a few grains of salt) is capable of producing rich and vivid hallucinations. LSD was popularized in the 1960s by individuals like Timothy Leary who encouraged American students to "turn on, tune in, and drop out." LSD use has varied over the years but it still remains a significant drug of abuse. In 1999, over 12 percent of high school seniors and college students reported that they had used LSD at least once in their lifetime.
Because of its structural similarity to a chemical present in the brain and its similarity in effects to certain aspects of psychosis, LSD was used as a research tool to study mental illness. The average effective oral dose is from 20 to 80 micrograms with the effects of higher doses lasting for 10 to 12 hours. LSD is usually sold in the form of impregnated paper (blotter acid), typically imprinted with colorful graphic designs. It has also been encountered in tablets (microdots), thin squares of gelatin (window panes), in sugar cubes and, rarely, in liquid form.
Physical reactions may include dilated pupils, lowered body temperature, nausea, "goose bumps," profuse perspiration, increased blood sugar, and rapid heart rate. During the first hour after ingestion, the user may experience visual changes with extreme changes in mood. In the hallucinatory state, the user may suffer impaired depth and time perception, accompanied by distorted perception of the size and shape of objects, movements, color; sound, touch, and the users own body image. During this period, the users' ability to perceive objects through the senses is distorted: they may describe "hearing colors" and "seeing sounds." The ability to make sensible judgments and see common dangers is impaired, making the user susceptible to personal injury. After an LSD "trip," the user may suffer acute anxiety or depression for a variable period of time. Flashbacks have been reported days or even months after taking the last dose.
Peyote & Mescaline
Peyote is a small, spineless cactus, Lophophora williamsii, whose principal active ingredient is the hallucinogen mescaline (3, 4, 5‑trimethoxyphenethylamine). From earliest recorded time, peyote has been used by natives in northern Mexico and the southwestern United States as a part of their religious rites.
The top of the cactus above ground‑‑also referred to as the crown consists of disc‑shaped buttons that are cut from the roots and dried. These buttons are generally chewed or soaked in water to produce an intoxicating liquid. The hallucinogenic dose of mescaline is about 0.3 to 0.5 grams and lasts about 12 hours. While peyote produced rich visual hallucinations that were important to the native peyote cults, the full spectrum of effects served as a chemically induced model of mental illness. Mescaline can be extracted from peyote or produced synthetically. Both peyote and mescaline are listed in the CSA as Schedule I hallucinogens.
Phencyclidine (PCP) & Related Drugs
In the 1950s, phencyclidine was investigated as an anesthetic but, due to the side effects of confusion and delirium, its development for human use was discontinued. It became commercially available for use as a veterinary anesthetic in the 1960s under the trade name of Sernylan® and was placed in Schedule III of the CSA. In 1978, due to considerable abuse, phencyclidine was transferred to Schedule II of the CSA and manufacturing of Sernylan® was discontinued. Today, virtually all of the phencyclidine encountered on the illicit market in the United States is produced in clandestine laboratories.
Phencyclidine, more commonly known as PCP, is illicitly marketed under a number of other names, including Angel Dust, Supergrass, Killer Weed, Embalming Fluid, and Rocket Fuel, reflecting the range of its bizarre and volatile effects. In its pure form, it is a white crystalline powder that readily dissolves in water. However, most PCP on the illicit market contains a number of contaminants as a result of makeshift manufacturing, causing the color to range from tan to brown, and the consistency from powder to a gummy mass. Although sold in tablets and capsules as well as in powder and liquid form, it is commonly applied to a leafy material, such as parsley, mint, oregano, or marijuana, and smoked.
The drug's effects are as varied as its appearance. A moderate amount of PCP often causes the user to feel detached, distant, and estranged from his surroundings. Numbness, slurred speech, and loss of coordination may be accompanied by a sense of strength and invulnerability. A blank stare, rapid and involuntary eye movements, and an exaggerated gait are among the more observable effects. Auditory hallucinations, image distortion, severe mood disorders, and amnesia may also occur. In some users, PCP may cause acute anxiety and a feeling of impending doom; in others, paranoia and violent hostility; and in some, it may produce a psychosis indistinguishable from schizophrenia. PCP use is associated with a number of risks, and many believe it to be one of the most dangerous drugs of abuse.
Modification of the manufacturing process may yield chemically related analogues capable of producing psychic effects similar to PCP. Four of these substances (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 been encountered on the illicit market and have been placed in Schedule I of the CSA. Telazol®, a Schedule III veterinary anesthetic containing tiletamine (a PCP analogue), in combination with zolazepam, (a benzodiazepine), is sporadically encountered as a drug of abuse.
Psilocybin & Psilocyn and other Tryptamines
A number of Schedule I hallucinogenic substances are classified chemically as tryptamines. Most of these are found in nature but many, if not all, can be produced synthetically. Psilocybin (O‑phosphoryl‑4‑hydroxy‑N, N‑ethyltryptamine) and psilocyn (4‑hydroxy‑N, N‑dimethyltryptamine) are obtained from certain mushrooms indigenous to tropical and subtropical regions of South America, Mexico, and the United States. As pure chemicals at doses of 10 to 20 mg, these hallucinogens produce muscle relaxation, dilation of pupils, vivid visual and auditory distortions, and emotional disturbances. However, the effects produced by consuming preparations of dried or brewed mushrooms are far less predictable and largely depend on the particular mushrooms used and the age and preservation of the extract. There are many species of "magic" mushrooms that contain varying amounts of these tryptamines, as well as uncertain amounts of other chemicals. As a consequence, the hallucinogenic activities, as well as the extent of toxicity produced by various plant samples, are often unknown.
Dimethyltryptamin (DMT) has a long history of use and is found in a variety of plants and seeds. It can also be produced synthetically. It is ineffective when taken orally, unless combined with another drug that inhibits its metabolism. Generally it is sniffed, smoked, or injected. The effective hallucinogenic dose in humans is about 50 to 100 mg and lasts for about 45 to 60 minutes. Because the effects last only about an hour; the experience has been referred to as a "businessman’s trip."
A number of other hallucinogens have very similar structures and properties to those of DMT. Diethyltryptamine (DET), for example, is an analogue of DMT and produces the same pharmacological effects but is somewhat less potent than DMT. Alpha‑ethyltryptamine (AET) is another tryptamine hallucinogen added to the list of Schedule I hallucinogens in 1994. Bufotenine (5‑hydroxy‑N‑N‑dimethyltryptamine) is a Schedule I substance found in certain mushrooms, seeds, and skin glands of Bufo toads. In general, most bufotenine preparations from natural sources are extremely toxic. N,N‑Diisopropyl‑5‑methoxytryptamine (referred to as Foxy‑Methoxy) is an orally active tryptamine recently encountered in the United States.
Cannabinols (Marijuana)
Cannabis
Cannabis sativa L., the hemp plant, grows wild throughout most of the tropic and temperate regions of the world. Prior to the advent of synthetic fibers, the cannabis plant was cultivated for the tough fiber of its stem. In the United States, cannabis is legitimately grown only for scientific research. Cannabis contains chemicals called cannabinoids that are unique to the cannabis plant. Among the cannabinoids synthesized by the plant are cannabinol, cannabidiol, cannabinolidic acids, cannabigerol, cannabichromene, and several isomers of tetrahydrocannabinol. One of these, delta‑9‑tetrahydrocannabinol (THC), is believed to be responsible for most of the characteristic psychoactive effects of cannabis. Research has resulted in development and marketing of the dronabinol (synthetic THC) product, Marinol®, for the control of nausea and vomiting caused by chemotherapeutic agents used in the treatment of cancer and to stimulate appetite in AIDS patients. Marinol® was rescheduled in 1999 and placed in Schedule III of the CSA.
Cannabis products are usually smoked. Their effects are felt within minutes, reach their peak in 10 to 30 minutes, and may linger for two or three hours. The effects experienced often depend upon the experience and expectations of the individual user, as well as the activity of the drug itself. Low doses tend to induce a sense of well‑being and a dreamy state of relaxation, which may be accompanied by a more vivid sense of sight, smell, taste, and hearing, as well as by subtle alterations in thought formation and expression. This state of intoxication may not be noticeable to an observer. However; driving, occupational, or household accidents may result from a distortion of time and space relationships and impaired coordination. Stronger doses intensify reactions. The individual may experience shifting sensory imagery, rapidly fluctuating emotions, fragmentary thoughts with disturbing associations, an altered sense of self‑identity, impaired memory, and a dulling of attention despite an illusion of heightened insight. High doses may result in image distortion, a loss of personal identity, fantasies, and hallucinations.
Three drugs that come from cannabis marijuana, hashish, and hashish oil‑‑are distributed on the U.S. illicit market. Having no currently accepted medical use in treatment in the United States, they remain under Schedule I of the CSA. Today, cannabis is illicitly cultivated, both indoors and out, to maximize its THC content, thereby producing the greatest possible psychoactive effect.
Marijuana
Marijuana is the most frequently encountered illicit drug worldwide. The term "marijuana," as commonly used, refers to the leaves and flowering tops of the cannabis plant that are dried to produce a tobacco‑like substance. Marijuana varies significantly in its potency, depending on the source and selection of plant materials used. The form of marijuana known as sinsemilla (Spanish, sin semilla: without seed), derived from the unpollinated female cannabis plant, is preferred for its high THC content. Marijuana is usually smoked in the form of loosely rolled cigarettes called joints, or hollowed out commercial cigars called blunts. Joints and blunts may be laced with a number of adulterants including phencyclidine (PCP), substantially altering the effects and toxicity of these products. Street names for marijuana include pot grass, weed, Mary Jane, and reefer. Although marijuana grown in the United States was once considered inferior because of a low concentration of THC, advancements in plant selection and cultivation have resulted in highly potent domestic marijuana. In 1974, the average THC content of illicit marijuana was less than one percent; in 1999, potency averaged 7.03 percent. The THC of today's sinsemilla averages 13.65 and ranges as high as 30 percent.
Marijuana contains known toxins and cancer‑causing chemicals. Marijuana users experience the same health problems as tobacco smokers, such as bronchitis, emphysema, and bronchial asthma. Some of the effects of marijuana use also include increased heart rate, dryness of the mouth, reddening of the eyes, impaired motor skills and concentration, and frequently hunger and an increased desire for sweets. Extended use increases risk to the lungs and reproductive system, as well as suppression of the immune system. Occasionally, hallucinations, fantasies, and paranoia are reported. Long‑term chronic marijuana use is associated with an Amotivational Syndrome characterized by apathy; impairment of judgment memory and concentration; and loss of interest in personal appearance and the pursuit of conventional goals.
Hashish
Hashish consists of the THC‑rich resinous material of the cannabis plant, which is collected, dried, and then compressed into a variety of forms, such as balls, cakes, or cookie‑like sheets. Pieces are then broken off, placed in pipes, and smoked. The Middle East, North Africa, and Pakistan/Afghanistan are the main sources of hashish. The THC content of hashish that reached the United States, where demand is limited, averaged about 5 percent in the 1990s.
Hashish Oil
The term hash oil is used by illicit drug users and dealers, but is a misnomer in suggesting any resemblance to hashish. Hash oil is produced by extracting the cannabinoids from plant material with a solvent. The color and odor of the resulting extract will vary, depending on the type of solvent used. Current samples of hash oil, a viscous liquid ranging from amber to dark brown in color, average about 15 percent THC. In terms of its psychoactive effect, a drop or two of this liquid on a cigarette is equal to a single "joint" of marijuana.
Inhalants
Inhalants are a diverse group of substances that include volatile solvents, gases, and nitrites that are sniffed, snorted, huffed, or bagged to produce intoxicating effects similar to alcohol. These substances are found in common household products like glues, lighter fluid, cleaning fluids, and paint products. Inhalant abuse is the deliberate inhaling or sniffing of these substances to get high, and it is estimated that about 1,000 substances are misused in this manner. The easy accessibility, low cost, legal status, and ease of transport and concealment make inhalants one of the first substances abused by children. Survey data indicates that about 15 to 20 percent of junior and senior high school students have tried inhalants with about 2 to 6 percent reporting current use. The highest incidence of use is among 10 to 12 year old children with rates of use declining with age. Parents worry about alcohol, tobacco, and drug use but may be unaware of the hazards associated with products found throughout their homes. Knowing what these products are, how they might be harmful, and recognizing the signs and symptoms of their use as inhalants, can help a parent prevent inhalant abuse.
Volatile solvents are found in a number of everyday products. Some of these products include nail polish remover, lighter fluid, gasoline, paint and paint thinner, rubber glue, waxes, and varnishes. Chemicals found in these products include toluene, benzene, methanol, methylene chloride, acetone, methyl ethyl ketone, methyl butyl ketone, trichloroethylene, and trichlorethane. The gas used as a propellant in canned whipped cream and in small lavender metallic containers called "whippets" (used to make whipped cream) is nitrous oxide or "laughing gas"‑‑the same gas used by dentists for anesthesia. Tiny cloth‑covered ampules called poppers or snappers by abusers contain amyl nitrite, a medication used to dilate blood vessels. Butyl nitrite, sold as tape head cleaner and referred to as "rush," "locker room," or "climax," is often sniffed or huffed to get high.
Inhalants may be sniffed directly from an open container or huffed from a rag soaked in the substance and held to the face. Alternatively, the open container or soaked rag can be placed in a bag where the vapors can concentrate before being inhaled. Some chemicals are painted on the hands or fingernails or placed on shirt sleeves or wrist bands to enable an abuser to continually inhale the fumes without being detected by a teacher or other adult. Although inhalant abusers may prefer one particular substance because of taste or odor, a variety of substances may be used because of similar effects, availability, and cost. Once inhaled, the extensive capillary surface of the lungs allows rapid absorption of the substance and blood levels peak rapidly. Entry into the brain is fast and the intoxicating effects are intense but short lived.
Inhalants depress the central nervous system, producing decreased respiration and blood pressure. Users report distortion in perceptions of time and space. Many users experience headaches, nausea, slurred speech, and loss of motor coordination. Mental effects may include fear, anxiety, or depression. A rash around the nose and mouth may be seen, and the abuser may start wheezing. An odor of paint or organic solvents on clothes, skin, and breath is sometimes a sign of inhalant abuse. Other indicators of inhalant abuse include slurred speech or staggering gait, red, glassy, watery eyes, and excitability or unpredictable behavior.
The chronic use of inhalants has been associated with a number of serious health problems. Glue and paint thinner sniffing produce kidney abnormalities while the solvents toluene and trichloroethylene cause liver damage. Memory impairment, attention deficits, and diminished non‑verbal intelligence have been related to the abuse of inhalants. Deaths resulting from heart failure, asphyxiation, or aspiration have occurred.
Anabolic Steroids
As athletes gathered at the 2000 Olympic Games in Sydney, Australia, the issue of performance enhancing drugs, especially anabolic steroids, once again gained international attention. These drugs are used by high school, college, professional, and elite 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 anabolic steroids to improve their physical appearance, and individuals in occupations requiring enhanced physical strength (e.g. body guards, night club bouncers, construction workers) are also known to use these drugs.
Concerns over a growing illicit market, abuse by teenagers, and the uncertainty of possible harmful long‑term effects of steroid use, led Congress in 1991 to place anabolic steroids as a class of drugs into Schedule III of the Controlled Substances Act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth.
Once viewed as a problem associated only with professional and elite amateur athletes, various reports indicate that anabolic steroid abuse has increased significantly among adolescents. For example, the National Institute on Drug Abuse 1999 Monitoring the Future survey reveals that more than a half million 8th and 10th grade students were using anabolic steroids. Abuse is higher among males than females, but is growing most rapidly among young women.
Most illicit anabolic steroids are sold at gyms, competitions, and through mail operations. For the most part, these substances are smuggled into the United States from many countries. The illicit market includes various preparations intended for human and veterinary use as well as bogus and counterfeit products. The most commonly encountered anabolic steroids on the illicit market include testosterone, nandrolone, methenolone, stanozolol, and methandrostenolone. Other steroids seen in the illicit market include boldenone, fluxoymesterone, methandriol, methyltestosterone, oxandrolone, oxymetholone, and trenbolone.
A limited number of anabolic steroids have been approved for medical and veterinary use. The primary legitimate use of these drugs in humans is for the replacement of inadequate levels of testosterone resulting from a reduction or absence of functioning testes. Other indications include anemia and breast cancer. Experimentally, anabolic steroids have been used to treat a number of disorders including AIDS wasting, erectile dysfunction, and osteoporosis. In veterinary practice, anabolic steroids are used to promote feed efficiency and to improve weight gain, vigor, and hair coat. They are also used in veterinary practice to treat anemia and counteract tissue breakdown during illness and trauma.
When used in combination with exercise training and high protein diet, anabolic steroids can promote increased size and strength of muscles, improve endurance, and decrease recovery time between workouts. They are taken orally or by intramuscular injection. Users concerned about drug tolerance often take steroids on a schedule called a cycle. A cycle is a period of between 6 and 14 weeks of steroid use, followed by a period of abstinence or reduction in use. Additionally, users tend to "stack" the drugs, using multiple drugs concurrently. Although the benefits of these practices are unsubstantiated, most users feel that cycling and stacking enhance the efficiency of the drugs 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 time and/or the dose and frequency of one or more steroids), reach a peak amount at mid‑cycle and gradually taper the dose toward the end of the cycle. The escalation of steroid use can vary with different types of training. Body builders and weight lifters tend to escalate their dose to a much higher level than do long distance runners or swimmers.
The long‑term adverse health effects of anabolic steroid use are not definitely known. There is, however, increasing concern of possible serious health problems associated with the abuse of these agents, including cardiovascular damage, cerebrovascular toxicity, and liver damage. Physical side effects include elevated blood pressure and cholesterol levels, severe acne, premature balding, reduced sexual function, and testicular atrophy. In males, abnormal breast development (gynecomastia) can occur. In females, anabolic steroids have a masculinizing effect, resulting in more body hair, a deeper voice, smaller breasts, and fewer menstrual cycles. Several of these effects are irreversible. In adolescents, abuse of these agents may prematurely stop the lengthening of bones, resulting in stunted growth.
With some individuals the use of anabolic steroids may be associated with psychotic reactions, manic episodes, feelings of anger or hostility, aggression, and violent behavior. A variety of non‑steroid drugs are commonly found within the illicit anabolic steroid market. These substances are primarily used for one or more of the following reasons: 1) to serve as an alternative to anabolic steroids; 2) to alleviate short‑term adverse effects associated with anabolic steroid use; or 3) to mask anabolic steroid use. Examples of drugs serving as alternatives to anabolic steroids include clenbuterol, human growth hormone, insulin, insulin‑like growth factor, and GHB. Drugs used to prevent or treat adverse effects of anabolic steroid use include tamoxifen, diuretics, and human chorionic gonadotropin. Diuretics, probenecid, and epitestosterone may be used to mask anabolic steroid use.
Over the last few years, a number of precursors to either testosterone or nandrolone have been marketed as dietary supplements in the United States. Some of these substances include androstenedione, androstenediol, norandrostenedione, norandrostenediol, and dehydroepiandrosterone (DHEA).
Medicinal Drugs (Over the Counter & Prescription Drugs)
Two categories of medicinal drugs are available to us: prescription drugs, which require medical approval, and over-the-counter (OTC) drugs, which can be purchased without any restriction. In either case, the U.S. Food and Drug Administration (FDA) is responsible for setting the standards of safety, effectiveness, and honesty in labeling. Recent trends in the use of herbal extracts have contributed to the controversy since they are protected under the 1994 Dietary Supplement Health and Education Act. This law requires governmental proof that a supplement contains some harmful ingredient before it can be removed from the market place (Leventhal, 1996).
Trends in prescription drug abuse
Several indicators suggest that prescription drug abuse is on the rise in the United States. According to the 1999 National Household Survey on Drug Abuse, in 1998, an estimated 1.6 million Americans used prescription pain relievers non-medically for the first time. This represents a significant increase since the 1980s, when there were generally fewer than 500,000 first‑time users per year. From 1990 to 1998, the number of new users of pain relievers increased by 181 percent; the number of individuals who initiated tranquilizer use increased by 132 percent; the number of new sedative
users increased by 90 percent; and the number of people initiating stimulant use increased by 165 percent. In 1999, an estimated 4 million people ‑ almost 2 percent of the population aged 12 and older ‑ were currently (use in past month) using certain prescription drugs non-medically: pain relievers (2.6 million users), sedatives and tranquilizers (1.3 million users), and stimulants (0.9 million users).
Although prescription drug abuse affects many Americans, some trends of concern can be seen among older adults, adolescents, and women. In addition, health care professionals ‑ including physicians, nurses, pharmacists, dentists, anesthesiologists, and veterinarians ‑ may be at increased risk of prescription drug abuse because of ease of access, as well as their ability to self‑prescribe drugs. In spite of this increased risk, recent surveys and research in the early 1990s indicate that health care providers probably suffer from substance abuse, including alcohol and drugs, at a rate
similar to rates in society as a whole, in the range of 8 to 12 percent.
Older adults
The misuse of prescription drugs may be the most common form of drug abuse among the elderly. Elderly persons use prescription medications approximately three times as frequently as the general population and have been found to have the poorest rates of compliance with directions for taking a medication. In addition, data from the Veterans Affairs Hospital System suggest that elderly patients may be prescribed inappropriately high doses of medications such as benzodiazepines and may be prescribed these medications for longer periods than are younger adults. In general, older
people should be prescribed lower doses of medications, because the body's ability to metabolize many medications decreases with age.
An association between age‑related morbidity and abuse of prescription medications likely exists. For example, elderly persons who take benzodiazepines are at increased risk for falls that cause hip and thigh fractures, as well as for vehicle accidents. Cognitive impairment also is associated with benzodiazepine use, although memory impairment may be reversible when the drug is discontinued. Finally, use of benzodiazepines for longer than 4 months is not recommended for elderly patients because of the possibility of physical dependence.
Adolescents and young adults
Data from the National Household Survey on Drug Abuse indicate that the most dramatic increase in new users of prescription drugs for non-medical purposes occurs in 12‑ to 17‑year‑olds and 18‑ to 25‑year‑olds. In addition, 12‑ to 14‑year‑olds reported psychotherapeutics (for example, painkillers or stimulants) as one of two primary drugs used. The 1999 Monitoring the Future survey showed that for barbiturates, tranquilizers, and narcotics other than heroin, the general, long‑term
declines in use among young adults in the 1980s leveled off in the early 1990s, with modest increases again in the mid‑ to late 1990s. For example, the use of methylphenidate (Ritalin) among high school seniors increased from an annual prevalence (use of the drug within the preceding year) of 0.1 percent in 1992 to an annual prevalence of 2.8 percent in 1997 before reaching a plateau.
It also appears that college students' nonmedical use of pain relievers such as oxycodone with aspirin (Percodan) and hydrocodone (Vicodin) is on the rise. The 1999 Drug Abuse Warning Network, which collects data on drug‑related episodes in hospital emergency departments, reported that mentions of hydrocodone as a cause for visiting an emergency room increased by 37 percent among all age groups from 1997 to 1999. Mentions of the benzodiazepine clonazepam (Klonopin) increased by 102 percent since 1992.
Gender differences
Studies suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and anti‑anxiety drugs ‑ in some cases 48 percent more likely. Overall, men and women have roughly similar rates of non-medical use of prescription drugs. An exception is found among 12‑ to 17‑year‑olds: In this age group, young women are more likely than young men to use psychotherapeutic drugs non-medically. In addition, research has shown that women and men who use prescription opioids are equally likely to become addicted. However, among women and men who use either a sedative, anti‑anxiety drug, or hypnotic, women are almost two times more likely to become addicted.
Drug Trafficking in the United States (information from www.dea.gov 2004)
The illegal drug market in the United States is one of the most profitable in the world. As such, it attracts the most ruthless, sophisticated, and aggressive drug traffickers. Drug law enforcement agencies face an enormous challenge in protecting the country's borders. Each year, according to the U.S. Customs Service, 60 million people enter the United States on more than 675,000 commercial and private flights. Another 6 million come by sea and 370 million by land. In addition, 116 million vehicles cross the land borders with Canada and Mexico. More than 90,000 merchant and passenger ships dock at U.S. ports. These ships carry more than 9 million shipping containers and 400 million tons of cargo. Another 157,000 smaller vessels visit our many coastal towns. Amid this voluminous trade, drug traffickers conceal cocaine, heroin, marijuana, MDMA, and methamphetamine shipments for distribution in U.S. neighborhoods.
Diverse groups traffic and distribute illegal drugs. Criminal groups operating from South America smuggle cocaine and heroin into the United States via a variety of routes, including land routes through Mexico, maritime routes along Mexico's east and west coasts, sea routes through the Caribbean, and international air corridors. Furthermore, criminal groups operating from neighboring Mexico smuggle cocaine, heroin, methamphetamine, amphetamine, and marijuana into the United States. These criminal groups have smuggled heroin and marijuana across the Southwest Border and distributed them throughout the United States since the 1970s. In addition to distributing cocaine and methamphetamine in the West and Midwest, these Mexico-based groups now are attempting to expand the distribution of those drugs into eastern U.S. markets.
Likewise, the use of the drug 3, 4-methylenedioxymethamphetamine (MDMA), also known on the street as "Ecstasy," has increased at an alarming rate in the United States over the last several years. Israeli and Russian drug trafficking syndicates and Western Europe-based drug traffickers are the principal traffickers of MDMA worldwide. MDMA, primarily manufactured clandestinely in Western Europe, is smuggled into the United States by couriers via commercial airlines, as well as through the use of express package carriers. Finally, criminal groups based in Southeast and Southwest Asia smuggle heroin into the United States. Using New York City as a major distribution hub, these criminal groups move heroin up and down the eastern seaboard and into the Midwest.
Besides these criminal groups based abroad, domestic organizations cultivate, produce, manufacture, or distribute illegal drugs such as marijuana, methamphetamine, phencyclidine (PCP), and lysergic acid diethylamide (LSD). By growing high-potency sinsemilla, domestic cannabis growers provide marijuana that easily competes with other illegal drugs. With demand for methamphetamine remaining high, especially in the West and Midwest, so, too, does the number of illicit laboratories that supply methamphetamine to a growing number of addicts. Additionally, a small number of chemists manufacture LSD that is subsequently distributed primarily to high school and college students throughout the United States.
Cocaine
Cocaine trafficking and abuse continue to threaten the health and safety of American citizens. According to drug abuse indicators, the use of both powder and crack cocaine has stabilized, albeit at high levels. The trafficking, distribution, and abuse of cocaine and crack cocaine have spread from urban environments to smaller cities and suburban areas of the country, bringing a commensurate increase in violence and criminal activity. The level of violence associated with cocaine trafficking today, however, does not compare to the rampant violence of the 1980s when the crack epidemic was at its worst.
Trafficking by Colombian and Mexican Organizations
The U.S./Mexico border is the primary point of entry for cocaine shipments being smuggled into the United States. According to a recent interagency intelligence assessment, approximately 65 percent of the cocaine smuggled into the United States crosses the Southwest border. Cocaine is readily available in nearly all major cities in the United States. Organized crime groups operating in Colombia control the worldwide supply of cocaine. These organizations use a sophisticated infrastructure to move cocaine by land, sea, and air into the United States. In the United States, these Colombia-based groups operate cocaine distribution and drug money laundering networks comprising a vast infrastructure of multiple cells functioning in many major metropolitan areas. Each cell performs a specific function within the organization, e.g., transportation, local distribution, or money movement. Key managers in Colombia continue to oversee the overall operation.
Over the past decade, the Colombia-based drug groups have allowed Mexico-based trafficking organizations to play an increasing role in the U.S. cocaine trade. Throughout most of the 1980s, the criminals in Colombia used the drug smugglers in Mexico to transport cocaine shipments across the Southwest border into the United States. After successfully smuggling the drugs across the border, the Mexican transporters transferred the drugs back to the Colombian groups operating in the United States. However, the seizure of nearly 21 metric tons of cocaine in 1989 led to a new arrangement between transportation organizations operating from Mexico and the organized crime groups operating from Colombia. This new arrangement radically changed the role and sphere of influence of the Mexico-based trafficking organizations in the U.S. cocaine trade. By the mid-1990s, Mexico-based transportation groups were receiving up to half the cocaine shipment they smuggled for the Colombia-based groups in exchange for their services. Both sides realized that this strategy eliminated the vulnerabilities and complex logistics associated with large cash transactions. The Colombia-based groups also realized that relinquishing part of each cocaine shipment to their associates operating from Mexico ceded a share of the wholesale cocaine market in the United States.
Today, traffickers operating from Colombia continue to control wholesale-level cocaine distribution throughout the heavily populated northeastern United States and along the eastern seaboard in cities such as Boston, Miami, Newark, New York, and Philadelphia. There are indications, however, that other drug trafficking organizations are playing a larger role in the distribution of cocaine in conjunction with the Colombian organizations. Dominican drug trafficking organizations have traditionally been responsible for the street-level distribution of cocaine. The DEA Philadelphia Field Division reports that the primary sources of supply for cocaine in the city are Colombian and Dominican organizations, which are capable of moving multi-kilogram quantities. The DEA Boston Field Division reports that Dominican traffickers are expanding their roles in cocaine distribution, and have been instrumental in obtaining multi-kilogram quantities of cocaine for distribution in New England. In New York City, Colombian, Dominican, and Mexican drug trafficking organizations distribute multi-kilogram quantities of cocaine. Furthermore, Mexican drug trafficking organizations are increasingly responsible for the transportation of cocaine from the Southwest border to the New York market.
Traffickers operating from Mexico now control wholesale cocaine distribution throughout the western and Midwestern United States. Mexico-based trafficking groups in cities such as Chicago, Dallas, Denver, Houston, Los Angeles, Phoenix, San Diego, San Francisco, and Seattle control the distribution of multi-ton quantities of cocaine, once dominated by the Colombia-based drug groups. In the early 1990s, when the organized crime groups from Mexico were expanding their roles as cocaine transporters and wholesale-level distributors, most of their U.S.-based command and control operations were in southern California. Today, Chicago is also a key command and control center for their cocaine operations, and Atlanta is increasingly important as a trafficking hub for cocaine movement. Currently, these traffickers control cocaine shipments from the time they are smuggled across the border until they are distributed to markets across the country.
The role of Mexico-based trafficking organizations is continuing to evolve. Recent reports suggest that some major international criminals in Colombia are further distancing themselves from day-to-day wholesale-level cocaine distribution in the United States by turning this task over, at least occasionally, to the organizations operating from Mexico. A likely motivation for this change is the non-retroactive extradition law enacted by the Colombian National Assembly in December 1997. Accordingly, Colombian traffickers now face the prospect of extradition for overt acts committed on or after the date (December 17, 1997) that the extradition amendment went into effect. By distancing themselves from overt acts in the United States, Colombian drug lords hope to minimize the threat that the United States will gather sufficient evidence to support an extradition request. This shift does not mean to suggest that traffickers operating from Colombia will abandon the U.S. cocaine market in masses. Emerging drug lords-who do not face the difficulties in micro-managing operations as do the jailed Cali criminal leaders-have little reason to forego the profits generated by the wholesale U.S. cocaine market.
Colombian drug trafficking organizations increasingly rely upon the eastern Pacific Ocean as a trafficking route to move cocaine to the United States. Law enforcement and intelligence community sources estimate 65 percent of the cocaine shipped to the United States moves through the Central America-Mexico corridor, primarily by vessels operating in the eastern Pacific. Colombian traffickers utilize fishing vessels to transport bulk shipments of cocaine from Colombia to the west coast of Mexico and, to a lesser extent, the Yucatan Peninsula. The cocaine is off-loaded to go-fast vessels for the final shipment to the Mexican coast. The loads are subsequently broken down into smaller quantities to be moved across the Southwest border.
However, cocaine continues to be transported through the Caribbean; Puerto Rico, the Dominican Republic, and Haiti are the predominant transshipment points for Colombian cocaine transiting the Caribbean. Because of lawlessness and deteriorating economic conditions, Haiti is a growing transshipment point for Colombian cocaine destined for eastern U.S. markets. Haitian drug traffickers, utilizing maritime shipments to transport cocaine to South Florida, are becoming a major threat. Law enforcement reporting indicates that Jamaica is an increasingly significant transshipment point for cocaine destined for the United States since it is located midway between South America and the United States. Cocaine is primarily smuggled into Jamaica by maritime methods, and the cocaine transshipped through Jamaica often is destined for the Canadian, European, and U.S. markets. Cocaine destined for the United States is usually smuggled from Jamaica to the Bahamas aboard go-fast boats. The cocaine is subsequently smuggled to the Florida coast using go-fast boats, pleasure craft, and fishing vessels.
Crack Cocaine Trafficking
Crack, the inexpensive, smokable form of cocaine, continues to be distributed and used in most major cities. While cocaine use in the United States has declined over the past decade, the rate of use in recent years has stabilized at high levels. Crack cocaine usage, which initially drove these rates, has similarly stabilized, and shows some indications of declining although it also remains at a high level. Street gangs, such as the Crips and the Bloods, and criminal groups of ethnic Dominicans, Puerto Ricans, and Jamaicans dominate the retail market for crack cocaine nationwide. The directed expansion of these gangs to smaller U.S. cities and rural areas, as well as a growth in street gangs that imitate their urban counterparts, results in an increase in homicides, armed robberies, and assaults as gang members use physical violence to maintain their drug distribution monopolies.
Prices and Purity
Cocaine prices in 2001 remained low and stable, suggesting a steady supply to the United States. Nationwide, wholesale cocaine prices ranged from $12,000 to $35,000 per kilogram. In most major metropolitan areas, however, the price of a kilogram of cocaine ranged from $13,000 to $25,000. Average purity for cocaine at the gram, ounce, and kilogram levels remained stable at high levels. In 2001, the average purity of a kilogram of cocaine was 73 percent. Typically, cocaine HCl is converted into crack cocaine, or "rock," within the United States by the secondary wholesaler or retailer. Crack cocaine is often packaged in vials, glassine bags, and film canisters. The size of a crack rock can vary, but generally ranges from 1/10 to 1/2 gram. Rocks can sell for as low as $3 to as high as $50, but prices generally range from $10 to $20.
Seizures
According to the Federal-wide Drug Seizure System (FDSS), U.S. federal authorities seized over 111 metric tons of cocaine in Calendar Year 2001. This moderate increase over the nearly 107 metric tons seized in 2000 is due in part to an increase in maritime seizures in the Southwest Pacific. Maritime seizures in this region increased by 9 metric tons between CY 2000 and CY 2001. Two of the more notable seizures in the Eastern Pacific corridor in CY 2001 reflect the importance of the region in cocaine movement to the United States. In February 2001, the fishing vessel Forever My Friend was intercepted with over 17 metric tons of cocaine. In May 2001, the fishing vessel Svesda Maru was seized with another 17 metric tons of cocaine on board.
Heroin
Heroin is readily available in many U.S. cities as evidenced by the unprecedented high level of average retail, or street-level, purity. Criminals in four foreign source areas produce the heroin available in the United States: South America (Colombia), Southeast Asia (principally Burma), Mexico, and Southwest Asia/Middle East (principally Afghanistan). While virtually all heroin produced in Mexico and South America is destined for the U.S. market, each of the four source areas has dominated the U.S. market at some point over the past 30 years. Over the past decade, the United States has experienced a dramatic shift in the heroin market from the domination of Southeast Asian heroin to a dominance of the wholesale and retail markets by South American heroin, especially in the East. In the West, by contrast, "black tar" and, to a lesser extent, brown powdered heroin from Mexico have been, and continue to be, the predominant available form.
The increased availability of high-purity heroin, which can effectively be snorted, has given rise to a new, younger user population. While avoiding the stigma of needle use, this user group is ingesting larger quantities of the drug and, according to drug treatment specialists, progressing more quickly toward addiction.
South American Heroin
The availability of South American (SA) heroin, produced in Colombia, has increased dramatically in the United States since 1993. SA heroin is available in the metropolitan areas of the Northeast and along the East Coast. Independent traffickers typically smuggle SA heroin into the United States via couriers traveling aboard commercial airlines, with each courier usually carrying from 500 grams to 1 kilogram of heroin per trip. These traffickers increased their influence in the lucrative northeastern heroin market, which has the largest demand in the United States, by pursuing an aggressive marketing strategy. They distributed high-quality heroin (of purity frequently above 90 percent), undercut the price of their competition, and used their long-standing, effective drug distribution networks. Investigations also indicate the spread of SA heroin to smaller U.S. cities.
Since the mid-1990s, Colombian heroin traffickers have diversified their methods of operation. Couriers still come into Miami, New York City, San Juan, and other U.S. cities on direct commercial flights from Colombia. Increasingly, however, Colombian traffickers are smuggling heroin from Colombia into the United States through such countries as Costa Rica, the Dominican Republic, Ecuador, Panama, Mexico, Argentina, and Venezuela.
In response to increased drug law enforcement presence at eastern ports of entry, some SA heroin traffickers have sought alternative routes. They transship heroin through the Dallas/Fort Worth International Airport before it reaches its final destination of New York City's LaGuardia Airport. Their couriers often transport heroin impregnated within clothing. Couriers with other destinations also smuggle the drug using this same method of concealment. In January 2002, USCS agents at the Miami International Airport arrested a courier who had arrived from Venezuela with 14 kilograms of heroin-saturated clothing. The following month, 18 kilograms of clothing saturated with heroin were seized in New York. Another increasingly used method is to smuggle heroin by sewing it into clothing. In New York in March 2002, two couriers were arrested at a hotel with approximately 8 to 10 kilograms of heroin sewn into 24 pieces of clothing. Also in New York that month, a married couple, Venezuelan nationals, who had arrived at JFK International Airport on a flight from Caracas, had in their luggage jackets that had a combined total of 6 kilograms of heroin sewn into them.
Colombian heroin traffickers have also used commercial maritime methods to move larger amounts of their drug into the United States. Some of the past maritime heroin shipments have been intermixed with larger shipments of cocaine, and some have been transported via cruise ships. Larger shipments of heroin have also been smuggled via containerized cargo, as evidenced by the May 16, 2001, seizure of 54 kilograms of SA heroin in New York. The heroin, packaged in 1.5 pound bricks, was secreted in false bottoms of 1,400 25-pound boxes of frozen plantains. This seizure represents the largest seizure of SA heroin to date in the United States.
Within the United States, ethnic Dominican criminal groups have played a significant role in retail-level heroin distribution in northeastern markets for at least the past two decades. During the 1990s, Dominican groups secured their role in the heroin trade by selling high-purity SA heroin. Currently, Dominican groups dominate retail heroin markets in northeastern cities such as New York City, Boston, and Philadelphia. New York City is the primary base of operation for ethnic Dominican groups. Colombian distribution networks at the wholesale level deal directly with Dominican trafficking groups responsible for retail sales.
Mexican Heroin
Mexican heroin has been a threat to the United States for decades. It is produced, smuggled, and distributed by polydrug trafficking groups, many of which have been in operation for more than 20 years. Nearly all of the heroin produced in Mexico is destined for distribution in the United States. Organized crime groups operating from Mexico produce, smuggle, and distribute the black tar heroin sold in the western United States. Traditionally, trafficking groups operating from Mexico evaded interdiction efforts by smuggling heroin to the U.S. market as they received orders from customers. By keeping quantities small, traffickers hoped to minimize the risk of losing a significant quantity of heroin in a single seizure. Even large polydrug Mexican organizations, which smuggle multi-ton quantities of cocaine and marijuana, generally limited smuggling of Mexican heroin into the United States to kilogram and smaller amounts. Nevertheless, trafficking organizations were capable of regularly smuggling significant quantities of heroin into the United States.
Although illegal immigrants and migrant workers frequently smuggle heroin across the U.S./Mexico border in 1- to 3- kilogram amounts for the major trafficking groups, seizures indicate that larger loads are being moved across the border, primarily in privately owned vehicles. Once the heroin reaches the United States, traffickers rely upon well-entrenched polydrug smuggling and distribution networks to deliver their product to the market, principally in the metropolitan areas of the Midwestern, southwestern, and western United States with sizable Mexican immigrant populations.
Indicative of larger shipments of Mexican heroin being smuggled into the United States are several seizures that occurred in the Southwest in recent years. Following a traffic stop in April 2002 near Pleasanton, Texas - about 25 miles south of San Antonio - Department of Public Safety troopers seized 34 kilograms of brown powder heroin. The heroin bundles, placed inside metal boxes, were found in all four tires of a pickup truck which was headed for San Antonio. In January 2001, the USCS in Del Rio, Texas, seized 42 kilograms of black tar heroin and in December 2000, they seized 27 kilograms of black tar heroin at the Laredo port of entry. Texas has not been the only border state where large amounts of black tar heroin have been seized. In October 2000, 46 kilograms of black tar heroin were seized in Arizona at the San Luis port of entry. This seizure ranks as one of the largest ever made along the Southwest border.
Although recent DEA cases have involved Mexican black tar heroin trafficking groups east of the Mississippi River, there has been no successful, long-term penetration of the East Coast markets by organizations selling Mexico-produced heroin.
Southeast Asian Heroin
High-purity Southeast Asian (SEA) heroin dominated the market in the United States during the late 1980s and early 1990s. Over the past few years, however, all indicators point to a decrease in SEA heroin available domestically. Significant investigations led to the incarceration in Thailand and extradition to the United States of more than a dozen high-level violators who played key roles in moving SEA heroin shipments to the United States. SEA heroin trafficking links run from independent brokers and shippers in Asia through overseas Chinese criminal populations to ethnic Chinese criminal wholesale distributors in the United States. In the United States, ethnic Chinese criminals rely upon local criminal organizations for the distribution of SEA heroin. Despite the recent decline in the trafficking of SEA heroin in the United States, Chinese criminal groups remain the most sophisticated heroin trafficking organizations in the world.
SEA heroin shipments destined for U.S. markets may transit through China, Japan, Malaysia, the Philippines, Singapore, Taiwan, or South Korea. Largely independent U.S.-based ethnic Chinese traffickers control distribution within the United States, principally in the Northeast and along the East Coast. During the late 1990s, Vancouver, British Columbia, emerged as a key operational headquarters for ethnic Chinese criminal elements. These criminal groups were enmeshed with North American gangs of Asian descent in transporting SEA heroin to the United States, mainly to the East Coast. A DEA New York Field Division investigation led to the seizure, in January 2001, of 57 kilograms of SEA heroin from a container ship docked at the port in Elizabeth, New Jersey in the largest seizure of SEA heroin in recent years.
Trafficking groups composed of West African criminals also smuggle SEA heroin to the United States. Nigerian criminals have been most active in U.S. cities and areas with well-established Nigerian populations, such as Atlanta, Baltimore, Houston, Dallas, New York City, Newark, Chicago, and Washington, D.C. Over the past several years, Chicago has become a hub for heroin trafficking controlled by Nigerian criminals who primarily deal in SEA heroin.
Southwest Asian Heroin
While a large portion of Southwest Asian (SWA) heroin is consumed in Western Europe, Pakistan, and Iran, traffickers operating from Middle Eastern locations smuggle SWA heroin to ethnic enclaves in the United States. Criminal groups composed of ethnic Lebanese, Pakistanis, Turks, and Afghans are all involved in supplying the drug to U.S.-based groups for retail distribution. SWA heroin traffickers and wholesale distributors generally have been consistently cautious, rarely conducting heroin business with persons not of Southwest Asian or Middle Eastern ethnicity. Therefore, the ethnic aspect of SWA heroin importation and distribution has made SWA heroin more prevalent in areas with large Southwest Asian populations.
West African traffickers, who primarily smuggled SEA heroin to the United States in the 1990s, now also deal in SWA heroin. In a particularly noteworthy seizure of approximately 24 kilograms of heroin in New York in May 2000, 90 percent of the seized heroin consisted of SWA heroin, and the remaining 10 percent was SEA. While unusual, a shipment containing the two types of heroin is not unexpected. For the last several years, West African traffickers, based in Bangkok who normally deal in SEA heroin, have been sending couriers to Pakistan to buy the cheaper Afghanistan-produced SWA heroin. Heroin in Pakistan is about half the price of SEA heroin in Bangkok where the West Africans pay between $13,000 and $16,000 for a kilogram.
The most recent sizeable seizure of SWA heroin occurred in New York City in September 200l when officers of the city police department confiscated approximately 50 kilograms of the substance. According to the Federal-wide Drug Seizure System, this was one of the largest seizures of powdered heroin in the past five years.
Purity
On the street, heroin purity and price often reflect the drug's availability. High purities and low prices, for example, indicate that heroin supplies are readily available. DEA's Domestic Monitor Program (DMP), a retail heroin purchase program, tracks urban street-level heroin purity and price. The most recent data available show that, in 2000, the nationwide average purity for retail heroin from all sources was 36.8 percent. This number is significantly higher than the average of 7 percent reported two decades ago and higher than the 26 percent recorded in 1991. The significant rise in average purity corresponds to the increased availability of high-purity SA heroin, particularly in the northeastern United States.
Moreover, the DMP indicated that the retail purity of SA heroin was the highest for any source, averaging 48.1 percent in 2000. SWA heroin followed with a 34.6 percent average and Mexican heroin averaged 20.8 percent. Heroin purity at the street level generally remained highest in the northeastern United States, where most of the nation's user population lives. In 2000, Philadelphia recorded the DMP's highest heroin purity average of 74.0 percent. Over the last several years, Philadelphia has ranked consistently at or near the top in DMP retail heroin purity levels. In addition, New York City continues to be one of the major importation and distribution centers for SA and SEA heroin.
Prices
Nationwide, in 2000, SA heroin ranged from $50,000 to $200,000 per kilogram. SEA and SWA heroin ranged in price from $40,000 to $190,000 per kilogram. Wholesale-level prices for Mexican heroin were the lowest of any type, ranging from $13,200 to $175,000 per kilogram. The wide range in kilogram prices reflects variables such as buyer/seller relationships, quantities purchased, purchase frequencies, purity, and transportation costs.
Seizures
FDSS statistics indicate that U.S. federal law enforcement authorities seized 2,506 kilograms of heroin in 2001, compared to 1,673 kilograms in 2000.
Methamphetamine
Domestic methamphetamine production, trafficking, and abuse are concentrated in the western, southwestern, and Midwestern United States. Methamphetamine is also increasingly available in portions of the South and eastern United States, especially Georgia and Florida. Clandestine laboratories in California and Mexico are the primary sources of supply for methamphetamine available in the United States.
Over the last decade, the methamphetamine trafficking and abuse situation in the United States changed dramatically. In 1994, ethnic Mexican drug trafficking organizations operating "super labs" (laboratories capable of producing in excess of 10 pounds of methamphetamine in one 24-hour production cycle) based in Mexico and in California began to take control of the production and distribution of methamphetamine domestically. Independent laboratory operators, including outlaw motorcycle gangs, previously maintained control of methamphetamine production and distribution within the United States, and continue to operate today on a lesser scale. The entry of ethnic Mexican traffickers into the methamphetamine trade in the mid-1990s resulted in a significant increase in the supply of the drug. Mexican criminal organizations, based in Mexico and California, provided high-purity, low-cost methamphetamine originally to cities in the Midwest and West with Mexican populations.
In 2001, approximately 8,000 clandestine methamphetamine laboratories were seized and reported to the National Clandestine Laboratory Database at the El Paso Intelligence Center (EPIC). In 2001, 298 seized super labs were reported to EPIC. This represents a rise in the number of super labs from 2000, in which the total number of super labs totaled 168. Further, for all of calendar year 2000, the Tijuana Residence Office (TJRO) reported only two seized methamphetamine laboratories. During calendar year 2001, the number of clandestine laboratories seized in Baja California Norte increased substantially, with 24 clandestine laboratories seized as of December 2001. The majority of these laboratories have been seized in the cities of Tijuana and Mexicali. Due to the proximity of these laboratories to the United States, it is believed that the majority of the methamphetamine was bound for the United States.
According to EPIC, the methamphetamine seized annually in transit from Mexico to the United States has increased dramatically since 1992. Authorities seized 1,370 kilograms of methamphetamine along the border in 2001, compared with only 6.5 kilograms in 1992. The primary points of entry into the United States for methamphetamine produced in Mexico have traditionally been California ports of entry, particularly San Ysidro. Although a great amount of methamphetamine still transits this area, ports of entry in South Texas have experienced increases in smuggling activity, although this activity appears to be stabilizing. The most common method of transporting methamphetamine is within concealed compartments in passenger vehicles.
The supply of methamphetamine in the United States also stems from multiple small-scale laboratories, often operated by independent cooks who obtain the ingredients necessary for manufacture from retail and convenience stores. Methamphetamine produced in these "mom-and-pop" laboratories is generally for personal use or limited distribution. A clandestine laboratory operator can use relatively common items, such as mason jars, coffee filters, hot plates, pressure cookers, pillowcases, plastic tubing, and gas cans to substitute for sophisticated laboratory equipment. The growing use of the Internet, which provides access to methamphetamine "recipes," coupled with increased demand for high-purity product, has resulted in a dramatic increase in the number of mom-and-pop laboratories throughout the United States. In 2001, the number of labs with capacities under ten pounds totaled over 7,700.
Methamphetamine precursor chemicals diverted to large clandestine laboratories in the United States are usually dosage-form pseudoephedrine or ephedrine drug products. Because of law enforcement attention and strong state precursor control laws in California, traffickers have now diversified to pseudoephedrine suppliers nationwide, buying at relatively lower prices in other parts of the country and trafficking the product to California, where the black market price can bring up to $5,000 per pound of product.
Nationwide networks of suppliers, working together, now provide ton quantities of pseudoephedrine tablet products to the market in California and to distributors in other states. The latter divert the product to local methamphetamine laboratories. Small-scale lab operators commonly buy over-the-counter pseudoephedrine products in small amounts from legitimate retailers. Recent reporting indicates that Canadian companies are a major source of supply for pseudoephedrine destined for U.S. laboratories because of minimal chemical controls in Canada. On March 7, 2002, search warrants were served on two residences, one in Paramount and the other in Lynwood, California. Four hundred containers of 25,000 count pseudoephedrine jars, or "pickle jars," (approximately 10,000,000 tablets) and $1,502,000 USC were seized. The pseudoephedrine is believed to have originated in Canada.
Pseudoephedrine and ephedrine are also purchased from unscrupulous U.S. distributors who sell case quantities of the tablets. Ultimately, the tablets are destined for California where they are manufactured into multiple pounds of methamphetamine. The finished methamphetamine is then distributed throughout the United States through preexisting smuggling methods to the traffickers.
In addition, the use of methylsulfonylmethane (MSM) has been encountered as a "cut" in methamphetamine produced primarily by Mexican organizations. Legitimately used as a dietary supplement for horses and humans, MSM is readily available at feed and livestock stores, as well as health and nutrition stores. The addition of MSM can be used to add volume to the finished methamphetamine, thus increasing the profit. Increases in the use of MSM may be a signal of difficulty in obtaining precursors, or a simple marketing method to meet demand while increasing profit.
The crystalline form of methamphetamine, known as "ice," "glass," or "crystal," is gaining popularity. Converted from powder by criminal elements in Southeast Asia, Mexico, and the United States, ice traditionally was used in Hawaii and southern California. More recently, its use has spread along the West Coast and Southwest border areas.
The importation of methamphetamine tablets from Southeast Asia, primarily via the mail system, remains a potential threat. Produced mainly by the United States Army, the largest heroin and methamphetamine trafficking group in Burma, the tablets, which weigh approximately 90 milligrams (mg), typically contain 25 to 30 mg of methamphetamine, and 45 to 65 mg of caffeine. Although it is believed that the tablets are trafficked primarily by ethnic Thais or Laotians for use in the Asian community, it is possible that larger amounts will be smuggled into the United States if demand increases outside that community.
Purity
Until 1999, the methamphetamine problem was increasing at an alarming rate. International chemical control efforts reduced the supply of those chemicals needed to produce high-quality methamphetamine. As a result, the national purity level for methamphetamine has decreased dramatically. The average purity of methamphetamine exhibits seized by DEA dropped from 71.9 percent in 1994 to 30.7 percent in 1999. The average purity of methamphetamine exhibits seized by DEA in 2000 rose slightly to 35.3 percent and 40.1 in 2001.
Prices
Methamphetamine prices vary throughout different regions of the United States. At the distribution level, prices range from $3,500 per pound in parts of California and Texas to $21,000 per pound in southeastern and northeastern regions of the country. Retail prices range from $400 to $3,000 per ounce.
Seizures
According to the FDSS, U.S. federal authorities seized a total of 2,807 kilograms of methamphetamine in 2001 compared to 3,373 kilograms in 2000.
In 2000, authorities seized 301,697 SEA methamphetamine tablets in U.S. Postal Service facilities in Oakland, Los Angeles, and Honolulu. This represents a 656-percent increase from the 1999 seizure total of 39,917.
Marijuana
Marijuana is the most widely abused and readily available illicit drug in the United States, with an estimated 11.5 million current users. At least one-third of the U.S. population has used marijuana sometime in their lives. The drug is considered a "gateway" to the world of illicit drug abuse. Relaxed public perception of harm, popularization by the media and by groups advocating legalization, along with the trend of smoking marijuana-filled cigars known as "blunts," contribute to the nationwide resurgence in marijuana's popularity.
The Internet also contributes to marijuana's popularity. Websites exist that provide information and links extolling the virtues of marijuana. These sites provide forums for user group discussions, post documents and messages for public discussions, and advocate the "legal" sale of marijuana. Several web sites advertising the sale of marijuana and providing instructions on home grows have also been identified.
Marijuana smuggled into the United States, whether grown in Mexico or transshipped from other Latin American source areas, accounts for most of the marijuana available in the United States. Marijuana produced in Mexico remains the most widely available. Moreover, high-potency marijuana enters the U.S. drug market from Canada. The availability of marijuana from Southeast Asia generally is limited to the West Coast. U.S. drug law enforcement reporting also suggests increased availability of domestically grown marijuana.
Domestic Marijuana
According to 2000 Domestic Cannabis Eradication/Suppression Program (DCE/SP) statistics, the five leading states for indoor growing activity were California, Florida, Oregon, Washington, and Wisconsin. DCE/SP statistics indicate that the major outdoor growing states in 2000 were California, Hawaii, Kentucky, and Tennessee; these states accounted for approximately three-quarters of the total of eradicated outdoor cultivated plants.
Mexican Marijuana
Organized crime groups operating from Mexico have smuggled marijuana into the United States since the early 1970s. These groups maintain extensive networks of associates, often related through familial or regional ties to associates living in the United States, where they control polydrug smuggling and wholesale distribution from hub cities to retail markets throughout the United States.
Groups operating from Mexico employ a variety of transportation and concealment methods to smuggle marijuana into the United States. Most of the marijuana smuggled into the United States is concealed in vehicles - often in false compartments - or hidden in shipments of legitimate agricultural or industrial products. Marijuana also is smuggled across the border by rail, horse, raft, and backpack. Shipments of 20 kilograms or less are smuggled by pedestrians who enter the United States at border checkpoints and by backpackers who, alone or in groups ("mule trains"), cross the border at more remote locations. Jamaican organizations also appear to be involved in dispatching Mexican marijuana via parcel carriers.
Organized crime groups operating from Mexico conceal marijuana in an array of vehicles, including commercial vehicles, private automobiles, pickup trucks, vans, mobile homes, and horse trailers, driven through border ports of entry. Larger shipments ranging up to multi-thousand kilograms are usually smuggled in tractor-trailers, such as the 6.9 metric tons of marijuana seized on April 3, 2001, by USCS officials from a tractor-trailer at the Otay Mesa, California, port of entry. The marijuana packages had been wrapped in cellophane, coated with mustard, grease, and motor oil, and commingled in a load of television sets.
Besides overland smuggling, drug traffickers use ocean vessels to move Mexican marijuana up the coast of Mexico to U.S. ports, drop-off sites along the U.S. coast, or to rendezvous points with other boats bound for the United States. Law enforcement authorities in southern California indicate that marijuana is transferred from mother ships in international waters to Mexican fishing vessels. The smaller vessels then deliver the marijuana to overland smugglers on the Mexican Baja California Peninsula. From there, the marijuana is generally moved to border transit points and then carried to the Los Angeles metropolitan area for distribution to eastern markets.
Canadian Marijuana
Canada is becoming a source country for indoor-grown, high-potency (15 to 25 percent THC) marijuana destined for the United States. Canadian law enforcement intelligence indicates that marijuana traffickers there are increasingly cultivating cannabis indoors. Such indoor-grow operations have become an enormous and lucrative illicit industry, producing a potent form of marijuana that has come to be known as "BC Bud." Canadian officials estimate that cannabis cultivation in British Columbia is a billion-dollar industry, and that traffickers smuggle a significant portion of the Canadian harvest into the United States.
Prices and Potency (THC Content)
Prices for commercial-grade marijuana have remained relatively stable over the past decade, ranging from approximately $400 to $1,000 per pound in U.S. Southwest border areas to between $700 to $2000 per pound in the Midwest and northeastern United States. The national price range for sinsemilla, higher quality marijuana usually grown domestically, is between $900 and $6,000 per pound. BC Bud sells for between $1,500 and $2,000 per pound in Vancouver; but when smuggled into the United States, it sells for between $5,000 and $8,000 per pound in major metropolitan areas.
During the past two decades, marijuana potency has increased. According to the University of Mississippi's 2000 Marijuana Potency Monitoring Project (MPMP), commercial-grade marijuana THC levels rose from under 2 percent in the late 1970s and early 1980s to 6.07 percent in 2000. The MPMP reports that sinsemilla potency also increased, rising from 6 percent in the late 1970s and 1980s to 13.20 percent in 2000.
Seizures
According to the FDSS, U.S. federal authorities seized 1,211 metric tons of marijuana in 2001 compared to 1,236 metric tons in 2000.
MDMA
Commonly referred to as Ecstasy, XTC, Clarity, or Essence, 3, 4-methylenedioxymethamphetamine (MDMA) is a synthetic psychoactive drug possessing stimulant and mild hallucinogenic properties. In the early 1990s, MDMA became increasingly popular among European youth. However, it is within the last five years that MDMA use in the United States has increased at an alarming rate.
MDMA is popular among middle-class adolescents and young adults. MDMA is increasingly becoming an abuse problem because many users view it as non-addictive and benign. MDMA is sold primarily at legitimate nightclubs and bars, at underground nightclubs sometimes called "acid houses," or at all-night parties known as "raves."
MDMA tablets range in weight from 150 to 350 mg and contain between 70 to 120 mg of MDMA. The profit margin associated with MDMA trafficking is significant. It costs as little as 25 to 50 cents to manufacture an MDMA tablet in Europe, but the street value of that same MDMA tablet can be as high as $40, with a tablet typically selling for between $20 and $30.
Although the vast majority of MDMA consumed domestically is produced in Europe, a limited number of MDMA laboratories operate in the United States. Law enforcement seized 17 clandestine MDMA laboratories in the United States in 2001 compared to 7 seized in 2000. It should be noted that these laboratories were primarily capable of limited drug production. While recipes for the clandestine production of MDMA can be found on the Internet, acquiring the necessary precursor chemicals in the United States is difficult.
MDMA is manufactured clandestinely in Western Europe, particularly in the Netherlands and to a lesser extent in Belgium. Much of the MDMA is manufactured in the southeast section of the Netherlands near Maastricht. Despite the Dutch Government's efforts to curtail MDMA trafficking, the Netherlands remains a primary source country for the drug. International MDMA traffickers based in the Netherlands and Belgium, and a significant number of U.S.-based traffickers who coordinate MDMA shipments to major metropolitan areas of the United States sometimes use Montreal and Toronto as transit points. In December 2000, the Royal Canadian Mounted Police (RCMP) seized approximately 150,000 MDMA tablets in Toronto that had been shipped via DHL from Brussels, Belgium, by an Israeli MDMA trafficking organization. The shipment was destined for distributors in the United States.
Due to the availability of precursor chemicals in Canada, a number of MDMA laboratories have been discovered operating near metropolitan areas such as Vancouver, Toronto, and Montreal. Such laboratories continue to supply U.S. and Canadian-based MDMA trafficking organizations. According to the RCMP, the total potential yield of MDMA from laboratories uncovered in Canada since 1999 is in excess of 10 million tablets.
Another emerging trend is the use of Mexico as a transit zone for MDMA entering the United States. During 2000, several seizures were reported in or destined for Mexico. In September 2000, Dutch authorities seized a 1.25 million-tablet shipment of MDMA destined for Mexico. Previously, in April 2000, a shipment of 200,000 MDMA tablets was seized at the airport in Mexico City. The MDMA was discovered in an air cargo shipment manifested as aircraft parts sent from the Netherlands and destined for the United States.
In recent years, traffickers have begun to tap the potential of the Caribbean and South America as alternative routes for moving synthetic drugs, predominantly MDMA, from Europe to the United States. The region's numerous and established drug transportation groups, extensive network of commercial flights, abundance of couriers, and historic connections to Europe provide traffickers with the means to route synthetic drugs through South America and the Caribbean to the United States. Available seizure and investigative information indicates that practically all of the MDMA transiting South America and the Caribbean is transported from Europe on commercial flights. Thus far the Caribbean has overshadowed South America as a transit zone for European MDMA destined to the United States.
USCS statistics show a dramatic increase in seizures of MDMA tablets. In FY 1997, approximately 400,000 MDMA tablets were seized compared to approximately 7.2 million tablets seized in FY 2001. On July 22, 2000, approximately 2.1 million tablets were seized in Los Angeles. To date, this is the largest seizure of MDMA tablets in the United States.
LSD
Lysergic acid diethylamide (LSD) remains available in retail quantities in virtually every state. LSD production reportedly is centered on the West Coast, particularly in San Francisco, northern California, the Pacific Northwest, and recently the Midwest. Since the 1960s, LSD has been manufactured illegally within the United States. LSD production is a time-consuming and complex procedure. Several chemical recipes for synthesizing LSD are on the Internet, but clandestine production requires a high degree of chemical expertise. Chemists maintain tight control at the production level, but do not necessarily participate in the distribution of the drug. These chemists usually sell the crystal LSD product to one or two trusted associates, insulating themselves from the wholesale distributors.
Few LSD laboratories have ever been seized in the United States because of infrequent and irregular production cycles. In 2000, DEA seized one LSD laboratory that was located in a converted missile silo in Kansas. LSD is produced in crystal form that is converted to liquid and distributed primarily in the form of squares of blotter paper saturated with the liquid. To a lesser extent, LSD is sold as a liquid, contained in breath mint bottles and vials; in gelatin tab form ("window panes") of varying colors; and in pill form known as "microdots."
Distribution of LSD is unique within the drug culture. A proliferation of mail order sales has created a marketplace where the sellers are virtually unknown to the buyers, giving the highest level traffickers considerable insulation from drug law enforcement operations. The vast majority of users are middle-class adolescents and young adults attracted by its low prices. Rock concerts continue to be favorite distribution sites for LSD traffickers; however, distribution at raves throughout the United States is becoming more popular. Contacts made at raves and concerts are used to establish future transactions and shipments of larger quantities of LSD.
PCP
Phencyclidine (PCP), a clandestinely manufactured hallucinogen commonly used in conjunction with marijuana, causes users to feel detached from their surroundings and, in some cases, paranoid and violent. PCP production is centered in the greater Los Angeles metropolitan area. During the late 1980s and early 1990s, the widespread availability and use of crack cocaine displaced demand for PCP. More recently, however, reporting suggests that PCP abuse is increasing slightly in many cities, as some crack addicts return to the use of this drug. DEA reporting indicates that many large seizures of PCP have occurred in Texas. Every seizure of PCP had originated in the Los Angeles metropolitan area and was primarily destined for Houston.
Since 2000, four major seizures of PCP have occurred in Sierra Blanca, Texas, alone: approximately 6 kilograms of PCP were seized on April 21, 2000; 2 kilograms seized on December 12, 2000; 1,773 dosage units of liquid PCP seized on June 11, 2001; and 33 kilograms of liquid PCP on July 31, 2001. DEA, state, and local authorities also seized four PCP laboratories in 2000 and five in 2001.
Flunitazepam
Flunitrazepam is sold under the trade name Rohypnol, from which the street name "Rophy" is derived. Other street names include "circles," "Mexican valium," "roofies," and "R-2." Flunitrazepam is a depressant used in the treatment of short-term insomnia and as a hypnotic sedative and pre-anesthetic medication.
Flunitrazepam is manufactured worldwide, particularly in Europe and Latin America, where it is sold legally by prescription. This drug is neither manufactured nor approved for medical use in the United States. Distributors in Texas allegedly travel to Mexico to obtain the drug. In addition, Colombian sources of supply smuggle flunitrazepam into South Florida via international mail services and/or couriers using commercial airlines.
According to law enforcement officials in south Florida, flunitrazepam is routinely referred to as a "club drug," since it is popular in local nightclubs. It is also referred to as the "date rape drug," characteristically causing the victim to experience short-term memory loss after ingestion. It is ingested orally, frequently in conjunction with alcohol or other drugs. High school and college students are the most frequent users of flunitrazepam, commonly using it as an "alcohol extender." Young people also have the misconception that flunitrazepam is unadulterated, and, therefore, "safe" because of pre-sealed bubble packaging.
GHB/GBL
GHB (gamma hydroxybutyrate), a central nervous system depressant, was banned by the FDA in 1990. On February 18, 2000, President William J. Clinton signed the Hillory J. Farias and Samantha Reid Date-Rape Prohibition Act of 2000. This legislation makes GHB a Schedule I drug under the Controlled Substance Act (CSA).
GHB generates feelings of euphoria and intoxication. It is often combined in a carbonated, alcohol, or health food drink, and is reportedly popular among adolescents and young adults attending raves and nightclubs. At lower doses, GHB causes drowsiness, nausea, and visual disturbances. At higher dosages, unconsciousness, seizures, severe respiratory depression, and coma can occur.
GHB has been used in the commission of sexual assaults because it renders the victim incapable of resisting, and may cause memory problems that could complicate case prosecution. GHB recipes are accessible over the Internet; the drug is simple to manufacture, and can be made in a bathtub or even a Pyrex baking dish. DEA, along with state and local law enforcement agencies, seized 13 GHB laboratories in 2001, 5 of which were located in California, compared to 20 GHB laboratories in 2000 with 12 of these seized in California.
GBL (gamma butyrolactone), an analog of GHB, is also abused. GBL is a chemical used in many industrial cleaners and it also has been marketed as a health supplement. GBL is synthesized by the body to produce GHB. One 55-gallon drum yields 240,000 capfuls of GBL. One capful sells for $8.00, potentially yielding 1.9 million dollars per 55-gallon drum.
Steroids
The Anabolic Steroid Control Act was passed by Congress in the fall of 1990 and became effective on February 21, 1991. The Steroid Act classified 27 steroids as Schedule III substances under the CSA. Street prices of anabolic steroids have increased substantially as a result.
Fitness clubs have been, and continue to be, the primary distribution centers of steroids, since bodybuilders and weightlifters comprise a predominant portion of the user population. Once viewed as a problem strictly associated with professional athletes, a recent survey of students indicates increased steroid use among boys in the 8th and 10th grades. The percentage of 8th grade boys reporting past-year use of steroids increased from 1.6 percent in 1998 to 2.5 percent in 1999 and from 1.9 percent to 2.8 percent among 10th grade boys.
Anabolic steroids are illicitly smuggled from Mexico and European countries to the United States. Recent DEA reporting indicates that Russian, Romanian, and Greek nationals are significant traffickers of steroids and are responsible for substantial shipments of steroids entering the United States. The lack of international control over foreign sources of supply, however, makes it impossible to attack the trafficking at its source.
Federal Trafficking Penalties
| DRUG/SCHEDULE | QUANTITY | PENALTIES | QUANTITY | PENALTIES |
| Cocaine (Schedule II) | 500 - 4999 gms mixture | First Offense: 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 not an individual Second Offense: Not less than 10 yrs, and not more than life. If death or serious injury, life imprisonment. Fine of not more than $4 million if an individual, $10 million if not an individual
| 5 kgs or more mixture | First Offense: 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 not an individual. Second Offense: Not less than 20 yrs, and not more than life. If death or serious injury, life imprisonment. Fine of not more than $8 million if an individual, $20 million if not an individual. 2 or More Prior Offenses: Life imprisonment |
| Cocaine Base (Schedule II) | 5-49 gms mixture | 50 gms or more mixture | ||
| Fentanyl (Schedule II) | 40 - 399 gms mixture | 400 gms or more mixture | ||
| Fentanyl Analogue (Schedule I) | 10 - 99 gms mixture | 100 gms or more mixture | ||
| Heroin (Schedule I) | 100 - 999 gms mixture | 1 kg or more mixture | ||
| LSD (Schedule I) | 1 - 9 gms mixture | 10 gms or more mixture | ||
| Methamphetamine (Schedule II) | 5 - 49 gms pure or 50 - 499 gms mixture | 50 gms or more pure or 500 gms or more mixture | ||
| PCP (Schedule II) | 10 - 99 gms pure or 100 - 999 gms mixture | 100 gm or more pure or 1 kg or more mixture | ||
| PENALTIES | ||||
| Other Schedule I & II drugs (and any drug product containing Gamma Hydroxybutyric Acid) | Any amount
| First Offense: Not more than 20 yrs. If death or serious injury, not less than 20 yrs, or more than Life. Fine $1 million if an individual, $5 million if not an individual. Second Offense: Not more than 30 yrs. If death or serious injury, not less than life. Fine $2 million if an individual, $10 million if not an individual | ||
| Flunitrazepam | 1 gm or more | |||
| Other Schedule III drugs | Any amount
| First Offense: Not more than 5 years. Fine not more than $250,000 if an individual, $1 million if not an individual. Second Offense: Not more 10 yrs. Fine not more than $500,000 if an individual, $2 million if not an individual | ||
| Flunitrazepam (Schedule IV) | 30 to 999 mgs | |||
| All other Schedule IV drugs | Any amount | First Offense: Not more than 3 years. Fine not more than $250,000 if an individual, $1 million if not an individual. Second Offense: Not more than 6 yrs. Fine not more than $500,000 if an individual, $2 million if not an individual. | ||
| Flunitrazepam (Schedule IV) | Less than 30 mgs | |||
| All Schedule V drugs | Any amount | First Offense: Not more than 1 yr. Fine not more than $100,000 if an individual, $250,000 if not an individual. Second Offense: Not more than 2 yrs. Fine not more than $200,000 if an individual, $500,000 if not an individual. | ||
Federal Trafficking Penalties - Marijuana
| DRUG | QUANTITY | 1st OFFENSE | 2nd OFFENSE |
| Marijuana | 1,000 kg or more mixture; or 1,000 or more plants |
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| Marijuana | 100 kg to 999 kg mixture; or 100 to 999 plants |
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| Marijuana | more than 10 kgs hashish; 50 to 99 kg mixture more than 1 kg of hashish oil; 50 to 99 plants |
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| Marijuana | 1 to 49 plants; less than 50 kg mixture |
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| Hashish | 10 kg or less | ||
| Hashish Oil | 1 kg or less |
Reference materials used in this module have been taken from the following sources:
Goldberg, Raymond. 2002. Drugs Across the Spectrum 3rd Ed. Wadsworth, New York, NY.
Hanson, Glen & Venturelli, Peter, 2011, Drugs and Society, 11th Edition, Sudbury, Jones & Bartlett, Sudbury,
MA.
Leventhal, Charles F., 1996, Drugs, Behavior and Modern Society, Allyn & Bacon, Needham Heights, MA.
National Clearinghouse for Alcohol and Drug Information: www.health.org/
National Institute on Alcohol Abuse & Alcoholism: www.niaaa.nih.gov/
National Institute on Drug Abuse: www.nida.nih.gov/
U.S. Drug Enforcement Administration: www.dea.gov/
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