Drugs Encyclopedia

Tamadol

2009-04-23T07:09:00.000-07:00

What is tamadol?
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Tramadol is a centrally acting synthetic analgesic of the aminocyclohexanol group with opioid-like effects. Its mode of action is not completely understood but it appears to act by modifying transmission of pain impulses via inhibition of noradrenaline and serotonin re-uptake and also by weakly binding to mu-opioid receptors.

How its work
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Tramadol may work as a pain blocker and may have a very mild antidepressant benefit. Alternatives include non-medication modalities, pain interventions and other medications that may work in a similar manner.

Tramadol has become a standard analgesic for the treatment of moderate to moderately-severe or severe pain; it is a stronger alternative to NSAIDS and an alternative to lower-dose morphine. Scheduling of tramadol would restrict its legitimate therapeutic use and worsen the existing under treatment of pain.

Thus given the already minimal levels of abuse, scheduling tramadol will have little or no impact on abuse and will only increase the potential for harming patients. The nature of the increased potential harm comes from
1) continued under treatment of pain;
2) increased use of NSAIDS;
3) increased use of potent opioids.
This would invert the concept of balancing benefit and risk and undermine the precautionary principle.

Tramadol has demonstrated therapeutic usefulness in the treatment of moderate to moderately-severe or severe pain, e.g. in postoperative and post-traumatic pain, cancer pain, and pain associated with chronic benign diseases. Tramadol’s efficacy overlaps with low doses of morphine.

Classical side effects of morphine-like drugs such as constipation, respiratory depression and sedation are reduced with tramadol.

Studies
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Studies of tramadol extended-release tablets suggest that in addition to relief from pain and improved function, additional benefits of fewer interruptions in sleep and improved compliance may occur. Thus, tramadol is an effective and safe drug for the treatment of pain. As such, tramadol is a unique tool for filling the analgesic gap that exists between NSAIDs and potent prototypic opioids.

Opium Addiction Treatment

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Opium has been used as a medicine for hundreds of years, inevitably creating countless addicts. Scientists have conducted a never-ending search for effective cures for opium addiction, morphine addiction (morphinism), and heroin addiction. For most of its history, opium addiction was treated as a disease with no cure, and doctors concerned themselves with treating the symptoms of addiction rather than the root cause. As a result, other opiates were used to lessen the effects of withdrawal. The addict is placed on a regimen of opiates that slowly decrease over time, weaning the addict from his or her addiction. This process of treatment is still used today.

Over the years, scores of seemingly counterintuitive methods have been tried to cure the addict. When morphine was first isolated and synthesized, it was considered to be, and utilized as, a cure for opium addiction. Later, heroin was created, and used as a treatment for morphinism. In the mid-twentieth century, lysergic acid diethylamide (LSD) likewise was tried as a therapy. The sad truth is that even today there is no real cure for any of the various forms of opiate addiction.

Modern therapy uses a drug called methadone.
Methadone, discovered in the 1940s, is similar to morphine and heroin as a powerful analgesic. When injected, methadone prevents heroin and morphine from working and lessens the withdrawal effects of both. While also an addictive drug, methadone is used to treat heroin and morphine addiction because it is supposedly easier to quit using. Essentially, an addict on the therapy is given a dose of methadone equivalent to that of their heroin or morphine use. The patient receives lower and lower dosages, until they eventually need no drug at all.

Many addicts, however, report that weaning themselves off of methadone is just as bad as coming off of heroin or morphine addiction. Ultimately, primary treatments for opiate addiction rely on replacing one drug for another and are essentially palliative treatments. The user is never “cured” and will always be tormented by the specter of addiction.

ACTIVE INGREDIENTS IN OPIUM

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Seventy-five percent of raw opium consists of ingredients that have no significant biological effects, such as water, sugars, and fatty acids. The remaining 25 percent contains numerous biologically active ingredients that interact with opioid receptors. These agents are termed the opiod alkaloids.

Alkaloids are complex organic molecules, many of which have been used in traditional medicine or as poisons.

Atropine from the deadly nightshade plant dilates the pupil of the eye, and curare is a skeletal muscle relaxant employed in anesthesia, but both agents have also been used as poisons.

Opium contains at least 20 alkaloids and by some claims as many as 50. However, five principal alkaloids are of major interest: these are morphine, codeine, noscapine, papaverine, and thebaine.

Morphine is the most abundant of the opium alkaloids. It constitutes as much as 15 percent of the plant extract.

Morphine has been used as a medicine and narcotic for thousands of years. Therapeutically, morphine has three principal uses: as an analgesic for the relief of acute and chronic pain, as a respiratory depressant, and as an antidiarrheal agent. The analgesic properties are morphine’s most important clinical use.

Codeine is a close chemical relative of morphine, differing in only one chemical group. Once administered, codeine is actually metabolized by enzymatic action, and its actions mimic those of morphine. Codeine is used primarily as a cough suppressant, although it certainly also possesses significant analgesic properties (approximately one tenth those of morphine) as in the relief of pain from toothache.

Noscapaine has only minimal therapeutic and narcotic properties. It can be used as a cough suppressant, but has no apparent advantage over other agents.

Papaverine also has minimal narcotic properties.However, it does have vasodilator (blood vessel relaxant) properties, and because of this property it has been employed for both cognition enhancement and erectile dysfunction.

Thebaine has, despite its chemical similarity to morphine, no narcotic or therapeutic uses. It does, however, cause convulsions at high doses. It is also a useful chemical intermediate in the laboratory for production of other opioid compounds.

PHARMACOLOGICAL AND OPIOID RECEPTORS

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It has been recognized for more than a century that the neurotransmitters of the nervous system produce their biological effects through interaction at specific drug binding sites or receptors. These receptors, many of which have been isolated and characterized in the past two decades, are typically specialized proteins on the cell surface. The function of these proteins is to recognize the neurotransmitter and to enable the molecule to bind to the receptor to trigger a biological response— muscle contraction, hormone or neurotransmitter secretion, or increased cardiac rate, for example. These interactions are typically quite specific and are often viewed in terms of a “lock and key”model. Despite this specificity it is usually found that a number of chemical variations around a particular structure can also be accommodated at the receptor site.

When these chemical variants can also trigger the biological response they
are termed “agonists.” However, some molecules can bind to the receptor and not trigger the response, but rather block the response: these drugs are termed “antagonists.”Thus, for example, the naturally occurring atropine from the Belladonna plant can block the actions of the neurotransmitter acetylcholine in the parasympathetic system by interacting with the same receptors that acetylcholine uses.

The alkaloids in opium, including morphine, also interact with specific receptors (opiate receptors) within the central and peripheral nervous systems. At these receptors, the alkaloids in opium mimic the effects of the body’s natural opiates.

There are actually three major structural classes of opiates that occur in the body: enkephalins, endorphins, and dynorphins. The existence of these endogenous molecules was initially theorized because morphine and related drugs had been shown to exert their pharmacological and therapeutic effects through interaction at specific receptors.Due to the specific locations of these interactions, scientists postulated that there must exist corresponding endogenous physiologically employed molecules. A similar argument was employed in the search for the endogenous equivalent of the cannabinoids found in marijuana and led to the recognition of the so-called “endocannabinoid” system.

There are three principal classes of opiate receptors, designated m, k, and d, and there exist a number of drugs that are specific for each of these receptor types. However, most of the clinically used opiates are quite selective for the mÙreceptor: the endogenous opiates enkephalin, endorphin and dynorphin are selective for the mÙand d, d and k receptors respectively.When activated by opioids these receptors produce biochemical signals that block neurotransmitter release from nerve terminals, a process that underlies their blockade of pain signaling pathways as well as other effects, such as constipation, diuresis, euphoria, and feeding.

Brief administration of opioids leads to the development of acute tolerance, whereby increased quantities of the opioid are required to produce the same end result, but this process is rapidly reversed once the administration is ceased.

However, more prolonged administration leads to classical or chronic tolerance from which state recovery to full sensitivity make take several days. These phenomena are not unique to opioid drugs, but rather are common to virtually all drug-receptor interactions and appear to be a common property of pharmacological receptors. Tolerance may also be associated with the state of physical dependence. The chronic administration of a drug, in this context an opioid, may result in a resetting of homeostatic mechanisms, and maintenance of this new state requires continued drug administration. Cessation of drug administration can then result in the phenomenon of withdrawal, during which the nervous system is excessively perturbed as it readapts to its original drug-free state. It should be emphasized that tolerance and physical dependence are physiological responses to continued administration of opioids and are not, contrary to some popular opinion, predictors of addiction. For example, patients with severe pain from bone cancer require very large amounts of opioids, yet these patients do not become addicted and will not even show withdrawal if the drug doses are reduced slowly over a period of days. Unfortunately, misinformation about opioids has led to patients with severe pain being undertreated.

The Principal Alkaloids in Opium

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Alkaloid---Chemical Class---Amount in Opium

Morphine---Phenanthrene---10%–15%
Noscapine---Benzylisoquinoline---4%–8%
Codeine---Phenanthrene---1%–3%
Papaverine---Benzylisoquinoline---1%–3%
Thebaine---Phenanthrene---1%–2%

Adapted from Moraes, Francis, and Debra Moraes. Opium. Oakland, Calif.: Ronin Publishing, 2003, p. 58

OPIUM AND THE NERVOUS SYSTEM

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Although the nervous system is often discussed in terms of peripheral and central components, it should be regarded as a highly integrated whole in which the central nervous system (brain and spinal cord) plays a critical information gathering and processing role. The peripheral nervous system is often divided into the autonomic and somatic components. The somatic system controls the voluntary functions of the body, like those of the skeletal muscles. The autonomic system, in contrast, is often referred to as the “involuntary” system. It regulates parts of the body where we execute little or no conscious control, such as the heart, intestines, vasculature, and other internal organs.

The autonomic nervous system is divided into the sympathetic and parasympathetic components, which typically exert opposing effects. The sympathetic system is involved in the “fight or flight” reaction (increased blood pressure and heart rate, and accommodation for increased vision, for example) that prepares the organism for stressful situations. The parasympathetic system conversely establishes a more relaxed situation, for instance, the rest period after a meal. The autonomic nervous system that is responsible for the independent control of the mechanical and secretory functions of the gastrointestinal tract is sometimes called the enteric system.

Drugs that affect the central nervous system may also have a major action in the gut. Thus, the constipating effects of opium alkaloids are exerted through this system and a number of the important withdrawal symptoms reflect the actions of the enteric nervous system. The nervous system is often regarded as a command (efferent) system that sends instructions to be executed. However, there is also a sensory (afferent) component, that receives information from innervated systems and that is vital to the overall integrated nervous response.

Despite the anatomical and functional differences between the various components of the nervous system, they share a fundamental similarity in their use of chemicals (neurotransmitters) to convey information.

The individual unit of the nervous system is the neuron, a specialized cell that both receives and transmits information.

The nervous system contains more than 100 billion neurons and is a major user of metabolic energy in the human body. It is also a region particularly susceptible to injury from toxic chemicals, lack of oxygen, and other assaults. Depending on the nervous region in which they reside, neurons may have different anatomical features and may use different chemical transmitters. Neurons communicate with each other and with their end organs by these chemical signals, which are released from the nerve terminal and interact with specific receptors on adjacent neurons or cells.

The chemical transmitters may be small molecules—notably acetylcholine, norepinephrine, epinephrine, serotonin, dopamine, or histamine. Acetylcholine and norpeinephrine are the dominant neurotransmitters in the parasympathetic and sympathetic nervous systems, respectively.

Dopamine and serotonin are employed primarily in the central nervous system. Neurotransmitters may also be more complex peptides (small proteins) such as substance P, vasopressin, endorphins, and enkephalins. The latter agents are of particular importance to our considerations of opium since they represent the “endogenous” opiates—agents that exist within the body whose actions are mimicked by exogenous, or outside, agents such as morphine, heroin, codeine, and so on. These neurotransmitters serve to convey information between neurons across the synaptic cleft (the junction where two neurons meet) or at the neuroeffector junction (the site between neuron and an innervated organ such as muscle or secretory gland).

Each neuron has specific synthetic machinery that enables it to both synthesize and eliminate a specific neurotransmitter.

For example, neurons of the sympathetic nervous system employ norepinephrine and epinephrine as their transmitters. Other neurons, particularly in the central nervous system, employ dopamine as their transmitter. Dopamine is a particularly important transmitter for a variety of neuronal functions. Its loss is associated with Parkinson disease, and it is a critical agent in the mediation of pleasure and reward processes. Dopamine, due to its association
with pleasurable sensations, is widely implicated in the actions of a number of drugs of abuse, including cocaine, opiates, and methamphetamines.

The International Language of Poppy (Opium)

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Contrary to what its name suggests, opium is not a single chemical compound. Its chemical make-up is more like a salad, consisting of various substances including sugars, proteins, acids, water, and many alkaloids, among others. The people who grow opium for its narcotic value are primarily interested in the alkaloids.

An alkaloid is a complex organic chemical substance found in plants, which characteristically combines nitrogen with other elements, has a bitter taste, and typically has some toxic, stimulant, analgesic effects. There are many different alkaloids, 30 of which are found in the opium plant. While morphine is the most important alkaloid in opium—for its natural narcotic qualities as well as providing the chemical structure for heroin—another alkaloid, codeine, is also sought after for its medicinal attributes. Other alkaloids include papaverine, narcotine, nicotine, atropine, cocaine, and mescaline. While the concentration of morphine in opium varies depending on where and how the plant is cultivated, it typically ranges from 3 percent to 20 percent.

The International Language of Poppy
Bengali Afing-gach, Posto
Burmese Bhainzi
Dutch Papaver
English Poppy
French Pavot somnifere
German Mohnblume
Hindi Post, Khas-khas, Post dana
Hungarian Mak, Kerti mak
Italian Papavero
Japanese Hinageshi
Polish Mak lekarski
Portuguese Popoula
Romanian Mac
Sanskrit Ahiphena
Spanish Adormidera, Amapola
Swedish Vallmo
Thai Ton fin
Turkish Hashhash tohuma

Phenmetrazine (Filon, Preludin)

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Pronunciation: fen-MET-rah-zeen
Chemical Abstracts Service Registry Number: 134-49-6
Formal Names: Filon, Preludin
Informal Names: Sweeties
Type: Stimulant (anorectic class).
Federal Schedule Listing: Schedule II (DEA no. 1631)
USA Availability: Prescription

Uses.
Immediately upon announcement of the drug’s discovery in 1954 it was utilized in Germany as an appetite suppressant. A couple years later the same medical use began in the United States with expansive claims about patients obtaining substantial weight loss without having to follow a regimen of dieting, claims that became more modest as experience with the drug spread. One experiment testing the drug’s influence on appetite yielded a result relevant to drug experiments in general: The substance worked better when people knew its intended effect. If people knew they were supposed to feel less hungry, they noticed less desire for food and then ate less. Early reports praised phenmetrazine for producing more appetite loss than amphetamine and with fewer unwanted effects. Since then phenmetrazine has fallen into disfavor due to concern about addictive potential even though the drug is described as resembling caffeine more than amphetamine.

In dogs phenmetrazine has only one sixth to one tenth the strength of amphetamine. One type of canine experiment showed dextroamphetamine to be 250 times stronger than phenmetrazine. In dogs a much higher dose of phenmetrazine is needed for the same weight loss produced by benzphetamine, and an experiment with 75 humans had results consistent with that tendency,
finding phenmetrazine to be less effective than benzphetamine in promoting weight loss. In contrast, another human weight reduction experiment with 81 persons was unable to demonstrate such a difference. That study did show, however, that users obtain fewer amphetamine effects from phenmetrazine than from dextroamphetamine.

Phenmetrazine has worked as an antidepressant, and for some overweight persons that effect may enhance the drug’s appeal (overeating can be a response to depression). The substance shows effectiveness against motion sickness and against symptoms of diabetes insipidus. As a possible cure for bedwetting, the drug produced mixed results. The compound has also been
used to treat asthma and Parkinson’s disease.

Drawbacks.
Intravenous abuse can harm muscles and kidneys. Phenmetrazine can produce standard amphetamine effects such as euphoria, restlessness, jumpiness, insomnia, tics, fatigue reduction, faster breathing, and higher blood pressure. Studies have found phenmetrazine’s actions on patients with heart trouble or hypertension (high blood pressure) to be measurable but negligible.

Taking the high blood pressure medicine propranolol along with phenmetrazine can relieve cardiac effects without diminishing anorectic effects. Studies with diabetic users find phenmetrazine having little influence on blood sugar levels or on insulin needs.

Fluctuating emotions and even psychosis have been attributed to phenmetrazine abuse. Psychosis can include hallucinations and paranoia. That affliction can stop when drug taking stops, or instead the drug may break down barriers releasing full-fledged and long-lasting schizophrenia. Phenmetrazine interferes with dreaming during sleep, which in itself may cause psychological trouble.

Abuse factors.
Tests of drug preference, in which users could choose among several substances, found benzphetamine and phenmetrazine to have about the same amount of appeal even though benzphetamine is a Schedule III substance (a status implying a lower addictive potential than phenmetrazine). In one such test, volunteers found phenmetrazine to be a satisfying substitute
for dextroamphetamine but preferred the latter. Abusers of amphetamine and methamphetamine have routinely switched to phenmetrazine when their favored drug was unavailable.

Drug interactions.
An experiment found that chlorpromazine (Thorazine) interacts with phenmetrazine, hindering phenmetrazine’s normal anorectic benefit.

Cancer.
In pregnant women phenmetrazine may undergo transformations suspected of promoting childhood tumors.

Pregnancy.
Phenmetrazine was formerly prescribed to pregnant women seeking to lose weight. A study of over 10,000 birth and childhood records found the drug having no “severe” impact on fetal development. Other studies have found no birth defects at all, although medical literature from the early 1960s does contain a handful of reports in which the drug is suspected of harming fetuses. Those suspicions were never verified but were strong enough to suspend medical use of the drug in some countries for a while.

Combination products.
Filon combines phenmetrazine theoclate (CAS RN 13931-75-4) and phenbutrazate hydrochloride and is promoted as having phenmetrazine’s weight loss characteristics while lacking hazard of addiction. Initial clinical trials showed Filon to be an effective anorectic with fewer of phenmetrazine’s unwanted qualities, but a later study found the two drugs
to have the same unwanted effects. A case of Filon addiction also surfaced, but that single instance hardly proves Filon to have more addictive potential than any other drug considered to have low or zero potential.

Additional scientific information may be found in:
Gilstrap, L.C. III, and B.B. Little, eds. Drugs and Pregnancy. New York: Elsevier, 1992.

Martin, W.R., et al. “Physiologic, Subjective, and Behavioral Effects of Amphetamine, Methamphetamine, Ephedrine, Phenmetrazine, and Methylphenidate in Man.”
Clinical Pharmacology and Therapeutics 12 (1971): 245–58.

Mellar, J., and L.E. Hollister. “Phenmetrazine: An Obsolete Problem Drug.” Clinical
Pharmacology and Therapeutics 32 (1982): 671–75.

Negulici, E., and D. Christodorescu. “Phenmetrazine Psychosis.” British Medical Journal
3 (1968): 316.

Penick, S.B, and J.R. Hinklele. “The Effect of Expectation on Response to Phenmetrazine.”
Psychosomatic Medicine 26 (1964): 369–73.

Rosen, A., and I.J. Oberman. “Addiction to Phenmetrazine Hydrochloride and Its Psychiatric
Implications.” Journal of the American Osteopathic Association 59 (1960): 722–26.

Spillane, J.P. “The Use of Phenmetrazine.” The Practitioner 185 (1960): 102–6.

Phendimetrazine (Bontril, Plegine, Prelu-2)

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Pronunciation: fen-di-MEH-tra-zeen (also pronounced fen-dye-MEH-trah-zeen)
Chemical Abstracts Service Registry Number: 21784-30-5 (Bontril format); 569-59-5 (Plegine format); 50-58-8 (Prelu-2 format).
Formal Names: Bontril, Plegine, Prelu-2
Informal Names: Pink Hearts
Type: Stimulant (anorectic class).
Federal Schedule Listing: Schedule III (DEA no. 1615)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Phendimetrazine is related to phenmetrazine. Indeed, the body converts part of a phendimetrazine dose into phenmetrazine, a fact to be remembered if employment drug screening unjustly accuses someone of using phenmetrazine. Short-term weight control is the main medical use of phendimetrazine; one experiment found it 20 more times effective than placebo— an astonishing result for any diet pill. Effectiveness declines as administration
continues, and standard practice is then to stop the drug gradually rather than increase the dosage. A derivative of the drug has been found useful for treating pyoderma gangrenosum, a skin affliction involving large sores.

Drawbacks.
If dosage suddenly stops, weariness and depression can occur. A small reduction in blood pressure is observed among some users, but generally the drug raises blood pressure and is considered inappropriate for persons with hypertension (high blood pressure). The compound has been linked with hypertension in blood circulation to lungs, a potentially fatal condition
causing trouble in breathing. Users have experienced edginess, disturbed sleep, headache, dizziness, lightheadedness, accelerated pulse rate, and feelings of heart tremors. Other muscle tremors can occur. Phendimetrazine can interfere with functioning needed to handle a car or dangerous tools. The compound can dry and even inflame the mouth, upset the stomach, loosen or tighten the bowels, and make urination frequent and painful. Persons should avoid the drug if they suffer from restlessness, glaucoma, excessive thyroid activity, heart disease, hardening of the arteries, or drug abuse. The substance may affect diabetics’ insulin needs. Overdose symptoms are similar to those of amphetamine: hyperactivity, fear, aggression, hallucination.

Abuse factors.
Phendimetrazine is a chemical relative of amphetamine and is therefore considered addictive. In an experiment using rhesus monkeys to measure phendimetrazine’s addictive potential, however, the test animals indicated no interest in it. This same study showed the drug having about 10% to 20% of dextroamphetamine’s potency.

Drug interactions.
Drinking milk can counteract phendimetrazine’s anorectic quality. The drug can dangerously increase blood pressure by interacting with monoamine oxidase inhibitors (MAOIs, found in some antidepressants and other medicine). After highly publicized incidents of adverse effects associated with combination therapy of phentermine and fenfluramine, medical practitioners became especially alert to any problems associated with diet drugs. Someone taking phendimetrazine two times a day developed heart and lung difficulty that substantially improved when dosage was halted, and a case of temporary skin rash and kidney inflammation is reported from someone who was taking phendimetrazine and phentermine. The latter drug combination is also suspected of responsibility for temporary trouble with blood circulation in the brain (leading to a stroke in at least one instance). Whether these isolated cases can be extrapolated into general principle is questionable, but such reports raise questions worthy of further scientific investigation.

Cancer.
Not enough scientific information to report.

Pregnancy.
Impact on fetal development is unknown. The drug is not recommended for pregnant women.

Additional scientific information may be found in:
Hadler, A.J. “Sustained-Action Phendimetrazine in Obesity.” Journal of Clinical Pharmacology
8 (1968): 113–17.

Mazansky, H. “A Review of Obesity and Its Management in 263 Cases.” South African
Medical Journal 49 (1975): 1955–62.

Ressler, C., and S.H. Schneider. “Clinical Evaluation of Phendimetrazine Bitartrate.”
Clinical Pharmacology and Therapeutics 2 (1961): 727–32.

Rostagno, C., et al. “Dilated Cardiomyopathy Associated with Chronic Consumption
of Phendimetrazine.” American Heart Journal 131 (1996): 407–409.

Runyan, J.W. “Observations on the Use of Phendimetrazine, a New Anorexigenic
Agent, in Obese Diabetics.” Current Therapeutic Research: Clinical and Experimental
4 (1962): 270–75.

Sash, S.E. “Anorectic Effects of OBEX LA (D-Phendimetrazine Bitartrate) in the Treatment
of Obesity.” Current Therapeutic Research: Clinical and Experimental 31 (1982):
181–84.

Peyote (Lophophora williamsii)

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Pronunciation: pay-OH-tih (also pronounced peh-YOH-teh)
Chemical Abstracts Service Registry Number: 11006-96-5
Formal Names: Lophophora williamsii
Informal Names: Bad Seed, Big Chief, Black Button, Britton, Buttons, Cactus, Cactus
Head, Challote, Devil’s Root, Dry Whiskey, Dumpling Cactus, Half Moon, Hikori, Hikuli, Hyatari, Mescal, Mescal Beans, Mescal Buttons, Mescalito, Mescy, Nubs, P, Pellote, Peyotl, Seni, Shaman, Tops
Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7415)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
Peyote is part of a cactus plant. Native American folk medicine has used peyote cactus root for doctoring scalp afflictions. In folk medicine peyote has also been used against snake bite, influenza, and arthritis. Scientists have determined that peyote contains substances that might fight infections. Some Native Americans are reported to use light doses of peyote as a stimulant to maintain endurance when engaged in relentless activity permitting little nourishment
or water, a practice sounding much like traditional use of coca. Spaniards observed such peyote usage in the Aztec empire.

Peyote’s main active component is the hallucinogen mescaline. Some other varieties of cactus also contain mescaline, although generally in much smaller amounts. Researchers suspect the peyote cactus may additionally contain chemicals similar to those appearing in the brain upon use of alcohol. In addition to causing hallucinations, peyote can change perception of time.

Psychic effects can include feeling more peaceful and connected with life; craziness of the everyday world can recede. People can use the experience to work through their concerns and may be more open to suggestions. Physical senses may seem enhanced, and barriers between them may melt, such as allowing sounds to be seen.

Normally a Schedule I substance is illegal to possess except under special permission to do research with it, but for many years members of the Native American Church were allowed to possess and use peyote (but not the pure drug mescaline) for religious purposes. During the 1990s their legal situation became confused, and the issue was a matter of controversy when this book was written.

The religion of Peyotism (of which the Native American Church is but one variety) is a topic beyond the scope of this book, but drug-induced visions are only one part of the practitioners’ way of life. Observers have noted that Peyotism can be an effective way of dealing with addiction to alcohol and opiates. Traditional peyote use occurs in a group context, a social gathering
of persons sharing and furthering the same beliefs and goals. A solitary user estranged from such a setting is likely to have a far different peyote experience.

For instance, one element of a peyote session can be nervousness and fear, emotions that may have different impacts depending on whether a user is alone or is with a group of reassuring and supportive persons. A researcher with the Indian Health Service of the U.S. Public Health Service estimated that traditional peyote usage produced bad psychological experiences once in
70,000 doses, a safety record that the researcher attributed to the social context of traditional use. Physical damage has not been noted from traditional use.

Drawbacks.
Chills, muscle tension, nausea, and vomiting are typical unwanted peyote effects.

Abuse factors.
A study published in the 1950s concluded that peyote tolerance, dependence, and craving did not occur from traditional usage—a finding supported by other authorities as well. A canine experiment showed that tolerance to the vomiting effect occurred if dogs received daily peyote for a year.

Drug interactions.
Not enough scientific information to report.

Cancer.
Not enough scientific information to report.

Pregnancy.
Peyote has caused birth defects in hamsters. A study comparing peyote users to nonusers from the same Indian group found no increase in chromosome damage among the users.

Additional information.
Peyote is sometimes called “mescal,” which is also the name of an alcoholic beverage. The two substances are different, and the beverage has no connection with peyote. Likewise “mescal beans” are an alternative peyote name and also the name of a nonhallucinogenic food.

Additional scientific information may be found in:
Bergman, R.L. “Navajo Peyote Use: Its Apparent Safety.” American Journal of Psychiatry
128 (1971): 695–99.

Boyer, L.B., R.M. Boyer, and H.W. Basehart. “Shamanism and Peyote Use among the
Apaches of the Mescalero Indian Reservation.” In Hallucinogens and Shamanism,
ed. M.J. Harner, 53–66. New York: Oxford University Press, 1973.
Bruhn, J.G. “Mescaline Use for 5700 Years.” Lancet 359 (2002): 1866.
Ellis, H. “Mescal: A New Artificial Paradise.” The Contemporary Review 71 (1897). Reprinted
in Smithsonian Institution’s Annual Report 1897. Washington, DC: Author,
1898. 537–48.

Huttlinger, K.W., and D. Tanner. “The Peyote Way: Implications for Culture Care Theory.”
Journal of Transcultural Nursing 5, no. 2 (1994): 5–11.

Kapadia, G.J., and M.B.E. Fayez. “Peyote Constituents: Chemistry, Biogenesis, and Biological
Effects.” Journal of Pharmaceutical Sciences 59 (1970): 1699–1727.

La Barre, W. “Peyotl and Mescaline.” Journal of Psychedelic Drugs 11 (1979): 33–39.

Pentobarbital (Cafergot, Nembutal, Pentobarbitone, Phenobarbitone )

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Pronunciation: pen-toh-BAR-bi-tal
Chemical Abstracts Service Registry Number: 76-74-4
Formal Names: Cafergot, Nembutal, Pentobarbitone, Phenobarbitone
Informal Names: Nebbies, Nembies, Nemmies, Nimbies, Yellow Bullets, Yellow Dolls, Yellow Jackets, Yellows
Type: Depressant (barbiturate class).
Federal Schedule Listing: Schedule II (oral and parentral, DEA no. 2270), Schedule
III for suppositories (DEA no. 2271)
USA Availability: Prescription
Pregnancy Category: D

Uses.
This short-acting substance has sedative qualities but is considered ineffective in treating nervous apprehension. Because of the drug’s sleepinducing characteristics, it is used as a preliminary to administering anesthesia and as a short-term treatment for insomnia. Pentobarbital has been observed to lower blood pressure, body temperature, and muscle tone. The compound can be used as an emergency anticonvulsant when a person has seizures, and
has been used to treat alcohol addicts undergoing withdrawal. Pentobarbital has been found effective in reducing pressure that fluid creates in the brain after severe head injury. Pentobarbital reduces a type of nerve cell death called neuronal apoptosis, and this reduction may help prevent stroke. Animal studies indicate that pentobarbital can help protect brain tissue against radiation, which might have practical application during treatment of brain tumors. Veterinarians use the substance for euthanasia: An unusual demonstration of the drug’s strength occurred when a lion was poisoned by eating meat from a horse that had been killed with pentobarbital.

Drawbacks.
Although the drug is a sedative, it can cause hyperactivity in children. Sudden stoppage of combined pentobarbital and benzodiazepine therapy in an infant caused temporary chorea (involuntary jerking). A feline experiment showed that tremors reminiscent of Parkinson’s disease can occur when pentobarbital is administered with chlorpromazine (also called Thorazine, often used to treat psychotic behavior). Persons with porphyria, a body chemistry affliction that can provoke violence, are supposed to avoid pentobarbital. Examination of epileptic children receiving pentobarbital shows elevated readings for total cholesterol, though levels of high-density lipoprotein (so-called good cholesterol) and triglycerides (associated with heart attack and stroke) seem unaffected.

In a monkey experiment pentobarbital interfered with time perception, ability to learn, short-term memory, attention span, and interest in tasks. The substance impeded task performances in a human experiment, with performance getting worse as the amount of thinking necessary for a chore increased.

Such a drug is unlikely to be welcome in the workplace. Although children using the substance apparently have trouble with language skills, a study found language development to be normal two years after the medication ceased.

Abuse factors.
In a test, alcohol drinkers who were not alcoholics found pentobarbital less appealing than a placebo and experienced no euphoria from pentobarbital, a finding consistent with other studies of persons who do not abuse drugs. When given choices of assorted substances, monkeys chose pentobarbital less often than water, which indicates the compound has low addictive potential. In contrast, drug abusers participating in an experiment found effects of pentobarbital and diazepam to be similar. Those two drugs thus had comparable appeal even though scientists running the experiment found pentobarbital possessing only 10% of diazepam’s strength. A study testing various effects on former drug addicts found pentobarbital to be 15 times
stronger than meprobamate, but morphine acted 6 times stronger than pentobarbital.

Cross-tolerance among chlordiazepoxide, pentobarbital, and alcohol has been observed in rats. A study of sedative drug abusers found alcohol and pentobarbital to deliver similar effects, with pentobarbital possibly having more appeal. A monkey experiment indicates that alcohol increases the attractiveness of pentobarbital. Dependence can develop, and in humans the
pentobarbital withdrawal syndrome can duplicate the delirium tremens of alcohol withdrawal. A mice study found that tolerance to pentobarbital developed more rapidly if assorted drugs of abuse were also being administered (morphine, amphetamine, alcohol, or cocaine).

Drug interactions.
A case report notes that pentobarbital can almost double the speed with which theophylline (commonly used to treat asthma and other breathing difficulties) disappears from the bloodstream, requiring changes in normal theophylline dosage. In a mice experiment alcohol boosted pentobarbital’s potency. A human study found that chronic alcohol ingestion reduces
the effective length of a pentobarbital dose. Grapefruit juice extends the amount of sleep produced by pentobarbital in rats, and in mice the drug inhibits caffeine effects. At one time researchers suspected that taking pentobarbital along with MDMA would reduce organic brain damage caused by MDMA, but rat experiments indicate that any apparent benefit comes simply
from the lower body temperature produced by pentobarbital. Although cocaine is a stimulant, in a rat experiment it increased the sleep-inducing quality of pentobarbital.

Cancer.
In animal experimentation pentobarbital has caused cancer. In humans long-term usage is associated with cancer of the ovaries and bronchi, but that finding is weakened by the patients also smoking cigarettes. Pregnancy. A large survey of pregnancy outcomes found that pentobarbital does not appear to cause birth defects. Nonetheless pregnant women are supposed
to avoid the drug.

Additional information.
Some capsule formats of Nembutal (pentobarbital sodium CAS RN 57-33-0) contain FD&C Yellow No. 5 (tartrazine), which can cause asthma attacks or other allergic responses in sensitive persons, particularly if someone has adverse reactions to aspirin. Cafergot PB is a combination
of bellafoline, caffeine, and ergotamine tartrate. The combination was tested with and without pentobarbital sodium to determine effect on migraine headache. Presence of pentobarbital not only enhanced reduction of pain but also helped treat anxiety, nausea, vomiting, poor appetite, and low tolerance of light.

Additional scientific information may be found in:
Cole-Harding, S., and H. de Wit. “Self-Administration of Pentobarbital in Light and
Moderate Alcohol Drinkers.” Pharmacology, Biochemistry, and Behavior 43 (1992):
563–69.

Hambly, G., C. Frewin, and B. Dodd. “Effect of Anticonvulsant Medication in the Preschool
Years on Later Language Development.” Medical Journal of Australia 148
(1988): 658, 661–62.

Mintzer, M.Z., et al. “Ethanol and Pentobarbital: Comparison of Behavioral and Subjective
Effects in Sedative Drug Abusers.” Experimental and Clinical Psychopharmacology
5 (1997): 203–15.

Pickworth, W.B., M.S. Rohrer, and R.V. Fant. “Effects of Abused Drugs on Psychomotor
Performance.” Experimental and Clinical Psychopharmacology 5 (1997): 235–41.
Pierce, James I. “Drug-Withdrawal Psychoses.” American Journal of Psychiatry 119
(1963): 880–81.

Pentazocine (Fortral, Fortralgesic, Fortralin, Fortwin, Liticon, Pentgin, Sosegon, Sosenyl, Talacen, Talwin, Talwin Nx)

2009-03-08T22:33:00.000-07:00

Pronunciation: pen-TAZ-oh-seen
Chemical Abstracts Service Registry Number: 359-83-1. (Hydrochloride form 64024-15-3)
Formal Names: Fortral, Fortralgesic, Fortralin, Fortwin, Liticon, Pentgin, Sosegon, Sosenyl, Talacen, Talwin, Talwin Nx
Informal Names: 4 4s, Teacher, Ts, Yellow Footballs. Combination with methylphenidate:
Crackers, 1s & 1s, Poor Man’s Heroin, Ritz & Ts, Ts & Rits, Ts & Rs, Sets. Combination with tripelennamine: Ts & Blues, Ts & Bs
Type: Depressant.
Federal Schedule Listing: Schedule IV (DEA no. 9709)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Pentazocine became available in the 1960s. Some authorities classify the drug as an opioid; some do not. Rather than having cross-tolerance with opiates and opioids, pentazocine can provoke a withdrawal syndrome from them. Volunteers who receive pentazocine have been uncertain about what sort of drug it is; some say it is a hallucinogen; some think they are receiving
alcohol.

Pentazocine has about the same pain relief strength as codeine. An experiment using oral surgery patients found pentazocine’s pain relief to be the same as aspirin’s. After drug abusers began grinding down Talwin tablets and injecting the powder to get morphine and heroin sensations, the manufacturer introduced Talwin Nx tablets, which include a chemical designed to block those sensations if the substance is injected. Dispute exists about whether the Nx version of Talwin actually prevents effects sought by illicit users.

Research indicates that women surgical patients tend to get better pain relief from pentazocine than male patients. Research also indicates that the drug’s surgical pain control is more effective for older patients and less effective for neurotics and for individuals with outgoing personalities.

The drug has been routinely used to ease cancer pain and has had success in reducing joint pain
caused by various afflictions, including arthritis. After noting that pentazocine does not prolong bleeding times, researchers called it suitable to fight pain from hemophilia, a blood disease that promotes bleeding. The substance has also been given as a treatment for stubborn cases of hiccups.

Investigators have documented that people can briefly experience euphoria after taking the drug. Some users feel more amiable and serene after a dose. Drawbacks. Unwanted pentazocine actions include rapid heartbeat, blood pressure changes (up or down), fainting, sweating, confusion, sleepiness, blurred vision, nausea, vomiting, and constipation. Studies have found that
1% to 10% of persons receiving the drug (especially an injectable pharmaceutical version) have odd psychological reactions such as hallucinations, delusions, or a sense of unreality about the world. The substance can interfere with decision making and physical movement. Research has shown that driving skills decline when a person uses the drug, and users should avoid operating
motor vehicles or other dangerous machinery. Because pentazocine has occasionally been associated with seizures, it should be used cautiously by persons prone to that affliction. The substance should also be used cautiously by people suffering from pancreas malfunction or breathing difficulty. The drug may be particularly hazardous for asthma sufferers who are overly sensitive to aspirin. Pentazocine is associated with skin hardening, which can result in
extensive surgical removal of affected areas, to be replaced with skin grafts.

Case reports tell of the drug provoking not only skin lesions but internal lesions in the digestive tract. Prolonged use of the substance can also cause muscle destruction that cripples a person’s ability to move arms and legs. The compound can dangerously reduce white blood cell levels. Rat experiments indicate the drug may provoke attacks of porphyria, a body chemistry disease
that can make people violent and sensitive to light.

One group of researchers documented that pentazocine increased the heart’s workload by 22% in cardiac disease patients. Another group found that after a heart attack the drug increases blood pressure and the heart’s need for oxygen and concluded that pentazocine is dangerous for heart attack patients.

Not all authorities agree with that conclusion, however; some say that such adverse cardiac effects can be avoided through careful dosage, and other opinion says the drug is preferable to morphine for heart attack patients.

Abuse factors.
Some abusers inject powder from oral pentazocine tablets.
Oral pentazocine tablets contain ingredients not intended for introduction into the bloodstream, and injection can be fatal even though the digestive system can handle the same ingredients without difficulty.

Pentazocine and the antihistamine-anesthetic tripelennamine are a common illicit drug combination called Ts & Blues, sometimes used as a substitute for heroin (“T” standing for Talwin and “Blues” for the antihistamine tablets’ color). The combination can create more euphoria than pentazocine alone produces and reduce the discontent caused by some doses of pentazocine. Users report development of memory trouble. Lung damage is a classic consequence of the combination, promoted by injecting oral formats of the drugs. Users
have been hospitalized with chest pain, anxiety, spasms, sweating, nausea, and lightheadedness. Fainting and seizures are less common problems. Kidney damage has been noted. Other antihistamines can also be dangerous to use with pentazocine.

Pentazocine tolerance and dependence can occur. After daily doses were given to monkeys for six weeks, mild withdrawal symptoms appeared when the animals received nalorphine, a substance that provokes withdrawal signs if someone has been using opioids. That result supports classifying pentazocine as an opioid, but in humans nalorphine does not cause pentazocine withdrawal— a result consistent with pentazocine not being an opioid. Pentazocine
withdrawal is normally likened to a light version of the opiate withdrawal syndrome, although case reports tell of some persons suffering intense physical discomfort for up to two weeks (cramping muscles, painful abdomen and back, nausea, itching, sweating, and general discomposure). Debate exists about whether pentazocine addiction should be treated by substituting other drugs such as methadone or whether treatment should avoid substitution
altogether. Some authorities have wondered if pentazocine addiction occurs in persons who are not polydrug abusers. Some authorities even question whether pentazocine addiction exists, noting cases in which body fluid testing contradicted drug users’ claims to be using the drug (while indicating they were using other substances). German researchers found that addiction reports are at least exaggerated; upon investigation, only 8 of 60 reports turned out to be authentic.

Drug interactions.
Persons who smoke or who live in a polluted air environment may need higher doses of pentazocine than persons who breathe clean air. Morphine and pentazocine boost each other’s pain-relieving action. Alcohol and possibly monoamine oxidase inhibitors (found in some antidepressants) may react badly with pentazocine.

Cancer.
Animal research has not shown pentazocine to cause cancer.

Pregnancy.
Normal production of litters has occurred when pentazocine was given to pregnant rats and rabbits, and no birth defects were apparent.

The drug is absorbed by the fetus if a pregnant woman takes a dose. Examination of one hospital’s records of all pregnant patients who used pentazocine illicitly in a two-year period showed that their infants tended to be premature and undersized, but no malformation was attributed to the drug. Newborns were occasionally dependent. Despite those disadvantages the children seemed to develop normally in their first year of life. When pentazocine was given simply as a pain reliever in childbirth, examination of the infants revealed no difference from children born to women who did not receive a medical dose of the drug during childbirth.
A study found Ts & Blues mothers to have an increased rate of assorted diseases that would not promote healthy fetal development: hepatitis, anemia, gonorrhea, syphilis. Such afflictions indicate a risk-taking lifestyle in which prenatal care is a small concern. A survey of maternity records at one hospital showed that pregnant women who used Ts & Blues tended to produce smaller infants, but no major birth defects were associated with the drug combination.

Another study found behavioral abnormalities in newborns that had fetal exposure to Ts & Blues, although the conduct may simply have been a temporary sign of drug withdrawal. Investigators running a rat experiment, however, noted long-term behavioral differences between a group of rats having fetal exposure to the drug combination and another group that was unexposed.

Additional scientific information may be found in:

Brogden, R.N., T.M. Speight, and G.S. Avery. “Pentazocine: A Review of Its Pharmacological
Properties, Therapeutic Efficacy and Dependence Liability.” Drugs 5
(1973): 6–91.

Debooy, V.D., et al. “Intravenous Pentazocine and Methylphenidate Abuse during
Pregnancy. Maternal Lifestyle and Infant Outcome.” American Journal of Diseases
of Children 147 (1993): 1062–65.

“Pentazocine.” British Medical Journal 2 (1970):409–10.

Saarialho-Kere, U., M.J. Mattila, and T. Seppala. “Parenteral Pentazocine: Effects on
Psychomotor Skills and Respiration, and Interactions with Amitriptyline.” European
Journal of Clinical Pharmacology 35 (1988): 483–89.

Showalter, C.V. “T’s and Blues: Abuse of Pentazocine and Tripelennamine.” Journal of
the American Medical Association 244 (1980): 1224–25.

Zacny, J.P., et al. “Comparing the Subjective, Psychomotor and Physiological Effects of
Intravenous Pentazocine and Morphine in Normal Volunteers.” Journal of Pharmacology
and Experimental Therapeutics 286 (1998): 1197–207.

Pemoline (Cylert)

2009-03-08T22:26:00.000-07:00

Pronunciation: PEM-oh-leen
Chemical Abstracts Service Registry Number: 2152-34-3
Formal Names: Cylert
Informal Names: Popcorn Coke
Type: Stimulant.
Federal Schedule Listing: Schedule IV (DEA no. 1530)
USA Availability: Prescription
Pregnancy Category: B

Uses.
In the United States pemoline became available for medical purposes during the 1970s. It is used to treat depression, weariness, and attention deficit hyperactivity disorder (ADHD). The drug’s stimulant effects are described as greater than caffeine but less than amphetamine. Unlike many scheduled stimulants, pemoline is unrelated to amphetamine.

Studies find pemoline useful in reducing symptoms of depression, and experimental usage of pemoline with monoamine oxidase inhibitor (MAOI) antidepressants has helped depressed persons who obtain insufficient relief with other drugs.

Pemoline has eliminated drowsiness felt by persons taking antihistamines. The drug has been proposed for workplace usage to reduce fatigue but has not been tested extensively for that purpose. Tests have found that the drug improves ability to perform arithmetic when users are tired. In a different but more robust experiment, members of the U.S. Navy Special Warfare group stayed awake 64 hours around the clock while using pemoline. Though their performance appeared to decline as the experiment continued, they not only did better than participants who used placebos, but they also did better than persons using methylphenidate. In England, Royal Air Force experimenters concluded that pemoline can help keenness and capabilities during long shifts of duty. A Russian report endorses the drug’s usefulness for “urgent increase” of functioning but notes that persons using pemoline cannot maintain initial ability if body temperature rises and oxygen supply declines, nor does the drug help persons push past emotional strain or fulfill complicated task requirements.

During the 1980s and 1990s sports officials in Belgium found the drug was frequently used by cyclists seeking a competitive edge. Multiple sclerosis patients using pemoline sometimes report less exhaustion than those using a placebo, but investigators who rigorously reviewed studies about multiple sclerosis fatigue found no evidence of pemoline improving weariness.

An instance is known of an elderly man taking pemoline to help him stay awake during lectures, but the regimen seemed to promote prostate trouble. Pemoline has been successfully used against narcolepsy.

Studies find pemoline about as effective as either dextroamphetamine or methylphenidate in helping children with ADHD. Pemoline has been used successfully against ADHD in teenagers and adults as well. Growth rates are below normal in some youngsters with ADHD, and pemoline itself can temporarily hold back such development but without long-term harm—youngsters
develop normal adult weight and height. Those deficient growth rates may be treated with growth hormone. One study found, however, that pemoline seems to make the hormone treatment less effective in some patients. As the age of ADHD patients grows, so can unwanted effects that they experience from pemoline.

Animal experiments in the 1960s indicated that pemoline boosts learning ability. The lure of a “smart pill” had understandable appeal to suffering students and teachers, but when the drug was tested on college students, no improvement in learning ability occurred. The same dismal outcome occurred when elderly persons received the drug; indeed, some performed worse than
elderly persons receiving a placebo. Group results in still another experiment showed either no improvement or worsening of learning scores when people used the drug. In contrast, long-term daily administration of the drug seemed to improve memory in some persons entering senility.
A review covering 10 years of pemoline reports found none attributing euphoria to the drug, a lack that sets it apart from other scheduled stimulants.

Unlike some other stimulants, pemoline also seems to have little effect on pulse rate or blood pressure.

Drawbacks.
The drug can bring on tics and partial muscle movements, in a particularly severe way if an overdose occurs. An instance is known of muscle damage in an adult misusing pemoline. Pemoline is also known to reduce appetite and salivation, increase crankiness, bring on headaches and stomachaches, cause skin rash, and interfere with sleep. Hallucinations from
pemoline have been reported.

In rats and mice pemoline can cause self-harm behavior, and the amount needed to induce such behavior declines when a certain kind of brain damage is present, damage that is often seen in mentally retarded humans. Those findings suggest that such persons receiving pemoline may need monitoring to guard against self-injury. Long-term excessive usage may generate temporary psychotic behavior, but such an outcome appears untypical.

Probably the most serious unwanted results of taking pemoline can be hepatitis and other liver injury, injury so severe as to require a transplant. Damage can continue to worsen after the drug is stopped, and people have died from liver failure induced by pemoline. Victims tend to be children. Such an adverse effect is particularly disquieting because it occurs at therapeutic dosage, rather then being created by reckless abuse. A child can take pemoline for months before harm is apparent, or alarming symptoms can arise after just a week of use.

Methylphenidate is suspected of contributing to liver trouble in persons who are also taking pemoline. Debate exists about how dangerous pemoline is to liver function when no other drugs are being taken, but the debate has limited practical significance because many patients taking pemoline receive other drugs as well. Because of concern about liver damage, parents are supposed to sign a written consent form before their children begin pemoline therapy.

Abuse factors.
Although pemoline is a scheduled substance, a review of reports covering the first 10 years of its medical availability in the United States found little evidence of addiction or abuse. A Norwegian review of pemoline use boldly described it as “a stimulant which cannot be abused.”

1 When given a choice of drugs, animals show no particular interest in pemoline, a sign of low abuse potential. Nonetheless, a case report does exist of a pemoline addict who developed a paranoid psychosis that went away after stopping the drug. A British medical practitioner reported that drug misusers were supplementing their amphetamine habit with pemoline.

An experiment tested pemoline’s ability to help reduce cocaine usage among persons receiving methadone treatment (meaning the persons were addicted to cocaine and heroin both). Results were unencouraging. In contrast, favorable response in an ADHD alcoholic caused researchers to predict that pemoline may be useful for treating alcohol addiction. Mice experimentation
shows that pemoline reduces effects produced by THC, considered the primary drug in marijuana.

Drug interactions.
Pemoline is suspected of interfering with epilepsy medicines.
It can boost mono amine oxidase inhibitor (MAOI) antidepressants and
urinary acidifers (the latter action interfering with pemoline’s psychostimulant
effects).

Cancer.
Rat experiments do not indicate any cancer risk from pemoline.

Pregnancy.
Experiments with rabbits and rats reveal no harm to fetal development, but influence on human fetal development is unknown.

Additional information.
When tested on mentally handicapped workers, magnesium pemoline (CAS RN 18968-99-5) brought on the kinds of temperament modification associated with caffeine but failed to increase either productivity or time worked. Two cocaine addicts who appeared to have mild ADHD were able to reduce their intake of cocaine while receiving magnesium pemoline, a result leading the scientific investigators to wonder if magnesium pemoline might have potential for helping to break cocaine addiction. Animal experiments have shown that both pemoline and magnesium pemoline can provide protection against atomic radiation.

Additional scientific information may be found in:
Bostic, J.Q., et al. “Pemoline Treatment of Adolescents with Attention Deficit Hyperactivity
Disorder: A Short-Term Controlled Trial.” Journal of Child and Adolescent Psychopharmacology 10 (2000): 205–16.

Elizur, A., I. Wintner, and S. Davidson. “The Clinical and Psychological Effects of
Pemoline in Depressed Patients—A Controlled Study.” International Pharmacopsychiatry
14 (1979): 127–34.

Honda, Y., and Y. Hishikawa. “Long Term Treatment of Narcolepsy and Excessive Daytime Sleepiness with Pemoline (Betanamin).” Current Therapeutic Research:
Clinical and Experimental 27 (1980): 429–41.

Langer, D.H., et al. “Evidence of Lack of Abuse or Dependence Following Pemoline
Treatment: Results of a Retrospective Survey.” Drug and Alcohol Dependence 17
(1986): 213–27.

Newlands, W.J. “The Effect of Pemoline on Antihistamine-Induced Drowsiness.” The
Practitioner 224 (1980): 1199–1201.

Shevell, M., and R. Schreiber. “Pemoline-Associated Hepatic Failure: A Critical Analysis
of the Literature.” Pediatric Neurology 16 (1997): 14–16.

Sternbach, H. “Pemoline-Induced Mania.” Biological Psychiatry 16 (1981): 987–89.
Valle-Jones, J.C. “Pemoline in the Treatment of Psychogenic Fatigue in General Practice.”
The Practitioner 221 (1978): 425–27.

Note
1. N. Lie, “Sentralstimuleren Midler ved AD/HD Hos Voksne. Kan De Misbrukes?
[Central Stimulants in Adults with AD/HD. Can They Be Abused?],” Tidsskrift for den
Norske Laegeforening 119 (1999): 82–83. Abstract in English.

PCP (Phencyclidine)

2009-03-08T22:21:00.000-07:00

Pronunciation: pee-see-pee
Chemical Abstracts Service Registry Number: 77-10-1. (Hydrochloride form 956-90-1)
Formal Names: Phencyclidine
Informal Names: Ace, Ad, Alien Sex Fiend (with heroin), Amoeba, Angel, Angel Dust, Angel Hair, Angel Mist, Angel Poke, Animal Trank, Animal Tranq, Animal Tranquilizer, Aurora Borealis, Belladonna, Black Dust, Black Whack, Blotter Acid, Blue Madman, Boat, Bohd, Bush, Busy Bee, Butt Naked, Cadillac, Cannabinol, Cigarrode Cristal, CJ, Clicker, Clickum, Cliffhanger, Columbo,
Cozmo’s, Crazy Coke, Crazy Eddie, Crystal, Crystal Joint, Crystal T, Cycline, Cyclone, D, Detroit Pink, Devil’s Dust, Dipper, DMT, DOA, Do It Jack, Domex, Drink, Dummy Dust, Dust, Dusted Parsley, Elephant, Elephant Trank, Elephant Tranquilizer, Elysion, Embalming Fluid, Energizer, Erth, Fake STP, Flake, Flying Saucer, Fresh, Fuel, Good, Goon, Goon Dust, Gorilla Biscuit, Gorilla Tab, Green, Green Leaves, Green Tea, Happy Sticks, HCP, Heaven & Hell, He-Man,
Herms, Hinkley, Hog, Hog Dust, Horse Tracks, Horse Tranquilizer, Ice, Ill, Illy Momo, Jet Fuel, Juice, K, Kap, Kay Jay, K-Blast, Killer, KJ, Kool, Koolly High, Krystal, KW, LBJ, Leaky Bolla, Leaky Leak, Lemon Drop, Lemon 714, Lenos, Lethal Weapon, Little One, Live One, Log, Loveboat, Lovely, Mad Dog, Madman, Magic, Magic Dust, Magic Mist, Mean Green, Mint Dew, Mint Leaf, Mint Weed, Missile, Mist, Monkey Dust, Monkey Tranquilizer, More, New Acid,
New Magic, Niebla, Octane (mixed with gasoline), Oil, Omen, OPP, Orange Crystal, Ozone, P, Parsley, Paz, PCPA, Peace, PeaCe Pill, Peace Weed, Peep, Peter Pan, Pig Killer, Pikachu (mixed with MDMA), Pit, Polvo, Polvo de Angel, Polvo de Estrellas, Puffy, Purple Rain, Red Devil, Rocket Fuel, Scaffle, Scuffle, Selma, Sernyl, Sernylan, Sheets, Sherm, Sherman, Sherm Stick, Skuffle, Smoking, Snort, Soma, Space Base (mixed with crack cocaine), Space Cadet (with
crack), Space Dust (with crack), Speedboat (with crack and marijuana), Spore, Squirrel (with crack and marijuana), Stardust, Stick, STP, Super, Super Grass (with marijuana), Super Joint, Super Kool, Super Weed, Surfer, Synthetic Cocaine, Synthetic THT, TAC, T-Buzz, Tea, Tic, Tic Tac, Tish, Titch, Trank, Wac, Wack, Water, Weed, Wet (alone or with marijuana), Wet Daddy, Whack (with crack or heroin), Whacky Weed, White Devil, White Horizon, White Powder,
Wicky Stick (with crack and marijuana), Wobble Weed, Wolf, Wooly (with marijuana), Worm, Yellow Fever, Zimbie, Zombie Dust, Zombie Weed, Zoom

Type: Depressant.
Federal Schedule Listing: Schedule II (DEA no. 7471)
USA Availability: Prescription

Uses.
This substance was invented in the 1920s, but not until the 1950s was it introduced as a drug, intended as a human and veterinary anesthetic. Human medical use soon ended because of psychological effects discovered during tests on patients. PCP is related to ketamine and, like that substance, has hallucinogenic qualities. Depending on how PCP is used, it can have stimulant, depressant, or hallucinogenic actions. In monkeys PCP is about 10 times stronger than ketamine.

Drawbacks.
PCP can make people feel aloof from the world around them, cause numbness, interfere with movement, and distort perception of time. Hallucinations, floating sensations, euphoria, and mania can occur. People may forget what they did while under the drug’s influence; such amnesia can last for 24 hours after a dose. Although euphoric effects are well documented,
one group of researchers noted bouts of depression brought on by chronic use of the substance, though not by intermittent use. Yet the same researchers also found people successfully using the drug as an antidepressant, and animal studies suggest PCP may have antianxiety properties. The substance reduces appetite in dogs. Rats lost weight when they chronically received PCP.

Law enforcement authorities say the drug can make people hostile and give them extra physical strength, and the same has been experienced by medical personnel dealing with overdose emergencies. Researchers, however, have generally not observed such results from PCP (although one of the very first studies in the 1950s noted violent reactions from about 5% of surgery patients who received the drug as an anesthetic). A study examining PCP cases at a
Los Angeles psychiatric hospital emergency room explicitly noted that wild conduct among PCP patients was uncommon. Perhaps police simply have more dealings with hostile individuals; for example, alcohol can embolden belligerent persons, but violence is not considered an inherent effect of alcohol.

Persons who become violent after taking PCP already have such a history without the substance, and during a police encounter they may well be under the influence of alcohol or other drugs as well. Military research found that PCP hostility did not occur unless persons were under stress, and not all stressed individuals reacted that way. The military study also found that psychotic
episodes did not occur with normal persons; someone had to be prone to psychosis in order for such behavior to occur while using the drug (a finding supported by other studies as well). In mice research PCP reduces violent behavior. Most species, including monkeys, act more docile after taking the drug. Some violent human episodes are described as coming not from aggression
but from a PCP user’s panic when police or medical personnel try to restrain the person. One group of addicts spoke of the substance lowering inhibitions, which is not the same as causing violence, although an already enraged person who loses inhibitions may engage in stormy behavior. In addition, users who attract attention from police or emergency medical personnel
are not necessarily representative of recreational users in general, either in personality or size of dose or reaction to the dose.

PCP’s physical effects include increased salivation, body temperature, pulse rate, and blood pressure. Case reports about humans indicate that PCP can raise blood pressure so high that a medical emergency occurs. The drug can bring on dizziness and double vision, create seizures, and cause muscle discoordination and damage. Numbness caused by PCP can promote injury due to lack of pain signals that ordinarily warn a person to stop doing something.

Cases of kidney failure and liver destruction have been associated with the
substance.

The higher one rises in the traditional evolutionary scale (for example, from mice to rats to humans), the lower the dose necessary for PCP to create anesthesia. Two observers who noted that trend concluded that human brains are exquisitely sensitive to PCP. Animal experiments reveal brain damage when the substance is used chronically for as little as five days. PCP addicts
have complained of memory trouble. A small human study found impaired ability for abstract thinking and for physical movement in response to signals, impairment measured years after the persons said they had stopped using PCP. Moreover, users of the drug may have normal scores on intelligence tests but have emotional disabilities and be crippled in their ability to cope with
problems. Those latter defects may be caused by the drug or may instead be reasons why people resort to the drug.

Abuse factors.
Initially PCP was a Schedule III drug, but in 1978 government authorities shifted it to Schedule II because of recreational use. At about that time a Los Angeles psychiatric hospital emergency room tested 145 consecutive patients for PCP; 63 were positive (over 40%).

A study of 200 recreational users found differences in effects reported by persons who took a little of the drug once a month and by persons who took a lot every day for years. Heavy users felt more pepped-up, violent, and suicidal. Regular users of PCP are known for self-destruction; one study found that 24% of regular users had tried to commit suicide, and 36% had overdosed
on other drugs. A study of PCP users who were treated at a charity hospital found no behavioral difference between black or white males, but black females acted much stranger and more aggressively than white females. The meaning of that finding is unclear—it could be racial, could be cultural, could be a statistical oddity that would disappear after more research.

When monkeys were given a choice between water or PCP, the animals showed no preference; such indifference is a sign of low addictive potential.

An experiment measuring rats with prenatal exposure to PCP found the animals were more sensitive to the drug than were rats lacking prenatal exposure— the opposite of tolerance. Dependence has been reported in monkeys that receive PCP. Pigeons that received the drug every day for 215 days did not develop dependence. Human research has found tolerance but not dependence among users, although dependence is suspected.

Various cold remedies contain doxylamine succinate, which can cause a false-positive drug test for PCP.

Drug interactions.
In a rat experiment neither alcohol nor PCP affected blood pressure, but blood pressure rose when they were used simultaneously. They also speeded up the heart. One human study found that PCP may be more likely to induce excitability in alcoholics than in nonalcoholics, possibly meaning that alcohol increases the likelihood of a manic reaction. In mice marijuana has reduced hyperactivity caused by PCP.

Cancer.
Not enough scientific information to report.

Pregnancy.
Two studies published only a few months apart in the 1980s gave different impressions about the prevalence of PCP use among pregnant women. In one study a group of 2,327 pregnant women were tested for PCP use; 19 were taking the drug. Those 19 were typically polydrug abusers. A different study of 200 pregnant women found 24 using PCP, a rate 15 times
higher than in the other group.

If a pregnant woman uses PCP, it passes into the fetus. Reports exist of PCP being detected in newborns three months after the mothers claimed to have stopped using the drug during pregnancy, which would mean that the drug remains in a fetus months after a pregnant woman stops taking PCP. Whether the women’s claims of abstinence were confirmed by laboratory testing during those months of pregnancy is unclear, however. In mice and pigs PCP builds
up in the fetus, reaching levels 7 to 10 times higher than in the female’s bloodstream.

The drug is suspected of causing birth defects. At dosage levels high enough to poison the pregnant female, birth defects have been produced in rats and mice. Rats with prenatal exposure to PCP show defective memory and learning ability. The substance is suspected of harming fetal brain development in humans. Pregnant women who use the drug tend to produce infants who are smaller than normal. In a group of 83 infants with prenatal PCP exposure,
almost half had a head circumference below the 25th percentile (meaning that 75% of infants in the general population have bigger heads and, by implication, larger brains). Some were below the 10th percentile. Smaller-than-normal infant skulls may interfere with physical growth of the brain. People who abuse one drug tend to abuse others as well; one study of 41 women who
used PCP during pregnancy found that most had also been using cocaine.

Two studies of women who used PCP during pregnancy found that all were poor; most were unmarried, were in an ethnic minority, and had received inadequate prenatal care. Such factors confound efforts to confirm what effect PCP alone has on pregnancy.

Offspring of mothers who have been using PCP can exhibit symptoms similar to those seen in infants undergoing opiate withdrawal—even though the drug is not an opiate, and research has yet to demonstrate that PCP dependence occurs. Infant distress may be real, but the newborn may be responding to the unpleasant effects of the drug itself rather than responding to sudden
absence of the drug.

A year after birth, a group of 57 babies with prenatal PCP exposure showed normal development in mental ability and physical coordination, although almost half were ill-tempered. About 15% had trouble sleeping, and the same percentage lacked normal emotional attachment. Those findings are consistent with other studies. Home environment, of course, may influence behavior as much or more than prenatal drug exposure. Factors noted above (lack of money, absent father, being in a disadvantaged ethnic minority) can weaken home life. Still, the kinds of brain function damage seen in animal studies are the kinds of damage that should interfere with children’s abilities to socialize normally—exactly the kind of deficit seen in children who have prenatal exposure to PCP.

In mice PCP not only passes into maternal milk, but milk levels are 10 times higher than maternal blood levels.

Additional information.
PCP is related to the Schedule I hallucinogens PCE (CAS RN 2201-15-2), PCPy (2201-39-0), TCP (21500-98-1), and TCPy (22912- 13-6).

Rat experimentation measured PCPy as about the same strength as PCP.
Other laboratory measurement shows TCP as stronger than PCP, and PCE as stronger than TCP. French military experiments found that TCP could protect rats and guinea pigs from the chemical warfare agent soman.

“Cannabinol” is a nickname for PCP and refers to THC, which is the active chemical in marijuana and dronabinol, but PCP is not THC. Likewise “DMT” and “STP” (DOM) are nicknames for PCP, but they are all different drugs.

Additional scientific information may be found in:
Baldridge, E.B., and H.A. Bessen. “Phencyclidine.” Emergency Medicine Clinics of North
America 8 (1990): 541–50.

Brecher, M., et al. “Phencyclidine and Violence: Clinical and Legal Issues.” Journal of
Clinical Psychopharmacology 8 (1988): 397–401.

Giannini, A.J., R.K. Bowman, and J.D. Giannini. “Perception of Nonverbal Facial Cues
in Chronic Phencyclidine Abusers.” Perceptual and Motor Skills 89 (1999): 72–78.

Graeven, D.B., J.G. Sharp, and S. Glatt. “Acute Effects of Phencyclidine (PCP) on
Chronic and Recreational Users.” American Journal of Drug and Alcohol Abuse 8
(1981): 39–50.

Harry, G.J., and J. Howard. “Phencyclidine: Experimental Studies in Animals and
Long-term Developmental Effects on Humans.” In Perinatal Substance Abuse: Research
Findings and Clinical Implications, ed. T.B. Sonderegger. Baltimore, MD:
Johns Hopkins University Press, 1992. 254–78.

Khajawall, A.M., T.B. Erickson, and G.M. Simpson. “Chronic Phencyclidine Abuse and
Physical Assault.” American Journal of Psychiatry 139 (1982): 1604–6.

Pradhan, S.N. “Phencyclidine (PCP): Some Human Studies.” Neuroscience and Biobehavioral
Reviews 8 (1984): 493–501.

Schuckit, M.A., and E.R. Morrissey. “Propoxyphene and Phencyclidine (PCP) Use in
Adolescents.” Journal of Clinical Psychiatry 39 (1978): 7–13.

Sioris, L.J., and E.P. Krenzelok. “Phencyclidine Intoxication: Literature Review.” American
Journal of Hospital Pharmacy 35 (1978): 1362–67.

Oxymorphone (Numorphan)

2009-03-08T22:19:00.000-07:00

Pronunciation: ox-i-MOR-fohn
Chemical Abstracts Service Registry Number: 76-41-5. (Hydrochloride form 357-07-3)
Formal Names: Numorphan
Type: Depressant (opioid class).
Federal Schedule Listing: Schedule II (DEA no. 9652)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Medically this drug is used to ease pain and assist in anesthesia. It is about 9 to 13 times stronger than morphine, with similar actions. Oxymorphone has been likened to heroin. Because body chemistry transforms part of an oxycodone dose into oxymorphone, scientists wondered if oxycodone’s therapeutic actions actually came from oxymorphone; upon investigation, experimenters concluded that oxycodone does produce effects apart from those of oxymorphone. Allowing hospitalized patients to control their own oxymorphone dosage for pain relief has caused no problems. Hydromorphone can sometimes be used as a substitute. A case report indicates oxymorphone can have antidepressant actions.

Drawbacks.
Unwanted effects of oxymorphone can include nausea, vomiting, and breathing difficulty. Euphoria has been noted in horses that receive the drug.

Abuse factors.
Not enough scientific information to report, but the drug is legally classified as highly addictive.
Drug interactions. Other depressants should generally be avoided, and monoamine oxidase inhibitors (MAOIs, found in some antidepressants and other medicine) should also be avoided.

Cancer.
Not enough scientific information to report.

Pregnancy. Birth defects appeared after experimenters gave pregnant hamsters 1,500 times the recommended human dose. Effects on human pregnancy are unknown. The drug can influence fetal heartbeat if used in childbirth.

Oxymorphone has been found effective for easing pain after caesarean section.

Additional scientific information may be found in:
Heiskanen, T.E., et al. “Morphine or Oxycodone in Cancer Pain?” Acta Oncologica
(Stockholm, Sweden) 39 (2000): 941–47.

Johnstone, R.E., et al. “Combination of Delta-9-Tetrahydrocannabinol with Oxymorphone
or Pentobarbital: Effects on Ventilatory Control and Cardiovascular Dynamics.”
Anesthesiology 42 (1975): 674–84.

Sinatra, R.S., and D.M. Harrison. “Oxymorphone in Patient-Controlled Analgesia.”
Clinical Pharmacy 8 (1989): 541, 544.

Sinatra, R.S., et al. “A Comparison of Morphine, Meperidine, and Oxymorphone as
Utilized in Patient-Controlled Analgesia Following Cesarean Delivery.” Anesthesiology
70 (1989): 585–90.

Stoll, A.L., and S. Rueter. “Treatment Augmentation with Opiates in Severe and Refractory
Major Depression.” American Journal of Psychiatry 156 (1999): 2017.

Oxymetholone (Adroyd, Anadrol, Anapolon, Anasteron, Oxymethalone)

2009-03-08T22:16:00.000-07:00

Pronunciation: ok-see-METH-ah-lohn
Chemical Abstracts Service Registry Number: 434-07-1
Formal Names: Adroyd, Anadrol, Anapolon, Anasteron, Oxymethalone
Type: Anabolic steroid.
Federal Schedule Listing: Schedule III (DEA no. 4000)
USA Availability: Prescription
Pregnancy Category: X

Uses.
This drug’s main medical usage is for treatment of anemia and other blood disorders. The compound has also seen success against hereditary angioedema, a condition involving painful swelling of body tissues. Discouragement of blood clots and encouragement of weight gain are other medical applications. Particular success has been noted in weight gain with HIV/AIDS
(human immunodeficiency virus/acquired immunodeficiency syndrome) patients, accompanied by general improvement in quality of life. Cancer patients have also benefitted from the drug’s weight-gain property. An experiment indicated that short-term dosage can help persons suffering from heart failure.

In another experiment the drug improved bone density in bedridden people. Still another experiment showed that oxymetholone can boost height and weight in boys and girls who are small for their age; such usage requires careful monitoring, as the substance has potential for stopping bone growth and thereby preventing attainment of normal adult height.

Drawbacks.
Oxymetholone can produce masculine physical characteristics in women (facial hair, deeper voice) and disrupt the menstrual cycle; some authorities indicate that such masculinization is uncommon. Experimentation with male rats lowered their blood levels of testosterone and halted sexual activity. In human males oxymetholone may promote enlargement of the prostate
gland. Men with prostate or breast cancer should avoid the drug, as should women who have both breast cancer and signs of a bone-weakening disease called osteoporosis. Oxymetholone can damage the liver and, in unusual circumstances, is associated with fatal harm to the spleen.

Cholesterol levels can rise, increasing the risk of conditions leading to heart attack and
stroke; kidney dialysis patients are considered to be at special risk for such outcomes. Case reports attribute stroke to oxymetholone. The drug may cause fluid retention, a possible hazard for persons with heart, liver, or kidney disease. Other unwanted effects have included nausea, vomiting, chills, acne, and painful testicles. Case reports have noted severe changes in several persons’ ability to handle blood sugar levels. Another case report noted mental confusion
that developed in a patient receiving oxymetholone and that continued for weeks after the therapy stopped.

Abuse factors.
Some athletes use the compound with the hope it will improve their sports performance. A case report attributed rupture of the triceps tendon to a regimen of oxymetholone, nandrolone, and testosterone, although analysts have noted that a nonanabolic steroid called cortisone may have promoted the injury. Another case report told of a 20-year-old athlete developing persistent balance problems after taking oxymetholone and two other steroids; investigators of that case felt that steroids were a likely cause, given their ability to promote brain damage (stroke) and mental difficulties (mood and thinking). A case report notes manic activity in a person using oxymetholone.

Another case report notes an even-tempered person who became rageful and violent after beginning a regimen of oxymetholone. Researchers tested one group of athletes who were using that compound and other steroids, a second group composed of former users, and a third group that had never used these drugs. Compared to the other groups, current users perceived themselves as more antagonistic, but investigators found only slight psychological differences
among the groups. Chickenpox is a childhood disease that adults can suffer, and a bodybuilder who used oxymetholone and other anabolic steroids came down with a severe case requiring extended hospitalization; the case report did not blame the steroids but considered his drug use important enough to emphasize.

A case report speaks of oxymetholone “dependency” but in the context of persons needing the drug to maintain good health, not dependency in the traditional terminology of drug abuse. Another case report, however, does describe dependence in a bodybuilder who was taking oxymetholone and other anabolic steroids. A noteworthy aspect of this case was the person’s
sudden development of opiate withdrawal symptoms when he received a drug that provokes opiate withdrawal.

Drug interactions.
Not enough scientific information to report, although anabolic steroids as a drug class tend to boost effects from medicines intended to reduce blood clotting.

Cancer.
Oxymetholone gives negative results in assorted laboratory tests designed to detect cell mutations that may lead to cancer and gives mixed results in tests involving animals dosed on the substance. Oxymetholone is suspected of causing human cancer, with liver cancer a particular risk. Scientists have been unsure about any connection between the substance and
human cancer, but the high level of suspicion is illustrated by numerous published case reports noting development of cancer by patients using oxymetholone.

Pregnancy.
The drug may reduce fertility. In rat experiments the substance masculinized female fetuses even more than methyltestosterone. Whether oxymetholone passes into human milk is uncertain, but nursing mothers are advised to avoid the substance.

Additional scientific information may be found in:
Alexanian, R., and J. Nadell. “Oxymetholone Treatment for Sickle Cell Anemia.” Blood
45 (1975): 769–77.

Barker, S. “Oxymethalone and Aggression.” British Journal of Psychiatry 151 (1987): 564.
Bond, A.J., P.Y. Choi, and H.G. Pope, Jr. “Assessment of Attentional Bias and Mood

in Users and Non-Users of Anabolic-Androgenic Steroids.” Drug and Alcohol
Dependence 37 (1995): 241–45.

Hengge, U.R., et al. “Oxymetholone Promotes Weight Gain in Patients with Advanced Human Immunodeficiency Virus (HIV-1) Infection.” British Journal of Nutrition 75 (1996): 129–38.

Keele, D.K., and J.W. Worley. “Study of an Anabolic Steroid: Certain Effects of Oxymetholone
on Small Children.” American Journal of Diseases of Children 113 (1967): 422–30.

Murchison, L. “Uses and Abuses of Anabolic Steroids.” Prescribers’ Journal 26 (1986):
129–35.

“Oxymetholone.” IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals
to Man: Some Miscellaneous Pharmaceutical Substances 13 (1977): 131–39.

Oxycodone (Endocet, Endocodone, Endodan, M-Oxy, Oxycet, Oxycocet, OxyContin, OxyFast, OxyIR, Percocet, Percodan, Percodan-Demi, Percolone, Roxicet, )

2009-03-08T22:13:00.000-07:00

Pronunciation: ox-i-KOH-dun
Chemical Abstracts Service Registry Number: 76-42-6 (Hydrochloride form 124-
90-3)
Formal Names: Endocet, Endocodone, Endodan, M-Oxy, Oxycet, Oxycocet, OxyContin, OxyFast, OxyIR, Percocet, Percodan, Percodan-Demi, Percolone, Roxicet, Roxicodone, Roxilox, Roxiprin, Supeudol, Tylox
Informal Names: Oxicotten, Oxy, Oxycotton, Oxy 80s, Percs
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9143)
USA Availability: Prescription
Pregnancy Category: B

Uses.
This drug is considered more addictive than codeine, from which oxycodone is derived. Some authorities say oxycodone comes from thebaine, which is correct also, because thebaine is the parent chemical that yields codeine.

Oxycodone is anywhere from 7 to 12 times stronger than codeine and about 0.3 to 2.2 times the strength of morphine, depending on the way the drugs are used. Body chemistry transforms part of an oxycodone dose into oxymorphone. Patients have found pain relief from oxycodone to be as satisfactory as relief from ketamine and morphine. Oxycodone has been used successfully to reduce pain from dentistry, surgery, cancer, and osteoarthritis (a painful disease of a person’s joints). The drug is also used as a sedative and as a cough suppressant. It is sometimes prescribed for “restless leg syndrome,” an affliction in which persons keep moving their arms and legs around. The drug has also reduced tics associated with Tourette’s syndrome.

Oxycodone can relax people and at times even create euphoria. Some researchers speculate that oxycodone’s euphoric effects may improve patients’ sensation of pain relief, making the substance more effective for that purpose than a drug that lacks euphoric effects. The drug works an antidepressant for some persons.

Blood levels from a given dose of oxycodone tend to be about 25% higher in females than in males. The cause is unknown, but the difference apparently has no impact on medical usage.

Drawbacks.
Unwanted effects include nausea, vomiting, constipation, itching, sweating, sleepiness, reduced sex drive, general weakness, impairment of breathing, and momentary low blood pressure when a person stands up. One study found the drug to impair breathing more than various other opiates do, and in another study, doses of oxycodone had to be stopped lest the volunteers
be harmed by further breathing difficulty. Normally the drug should be avoided if a person suffers from pancreatitis, enlarged prostate, difficulty with urination, or poorly functioning thyroid or adrenal glands. Experimenters have demonstrated that the drug reduces physical and mental abilities needed for driving automobiles.

Abuse factors.
The drug’s potential for abuse is considered the same as morphine’s, and oxycodone is a sought-after product among opiate abusers. A study that reviewed medical records found no evidence of tolerance developing in a medical context. Regardless of whether people use the drug
medically or recreationally, dependence can develop, followed by withdrawal symptoms if dosage stops suddenly. Withdrawal symptoms are described as minor and can be avoided by gradually discontinuing the drug instead of suddenly stopping it or by administering clonidine, a substance normally used to control high blood pressure.

Drug interactions.
People should use oxycodone cautiously if they are also taking antihistamines, various antidepressants, or a monoamine oxidase inhibitor (MAOI, found in some antidepressants and other medicine). Combining those sorts of drugs with oxycodone can produce excessive effects. The same is true of alcohol. Oxycodone also seems to interact with cyclosporine, a substance used to suppress an individual’s immune system (an effect useful in preventing rejection of organs in transplant patients).

Cancer.
Oxycodone’s potential for causing cancer is unknown.

Pregnancy.
Oxycodone is believed to pose a small risk of causing birth defects, but safety for administration during pregnancy has not been determined. An examination of medical records found a slightly higher likelihood of birth defects if pregnant women use oxycodone, but, unlike most drugs associated with malformations, no particular type of birth defect appeared after using oxycodone. That suggests the drug might not be responsible for the observed abnormalities.

Newborns may have dependence on the drug if their mothers have been taking it during pregnancy. Enough of the drug can pass into a woman’s milk to cause dependence in a breast-feeding infant.

Combination products.
Tylox contains sodium metabisulfite, to which asthmatics and other persons may have a serious allergic reaction, and should be used cautiously if the user is sensitive to sulfites.

Additional scientific information may be found in:
Kalso, E., and A. Vainio. “Morphine and Oxycodone Hydrochloride in the Management
of Cancer Pain.” Clinical Pharmacology and Therapeutics 47 (1990): 639–46.

Saarialho-Kere, U., M.J. Mattila, and T. Seppala. “Psychomotor, Respiratory and Neuroendocrinological Effects of a Mu-Opioid Receptor Agonist (Oxycodone) in Healthy Volunteers.” Pharmacology and Toxicology 65 (1989): 252–57.

Schick, B., et al. “Preliminary Analysis of First Trimester Exposure to Oxycodone and
Hydrocodone.” Reproductive Toxicology 10 (1996): 162.Stoll, A.L., and S. Rueter. “Treatment Augmentation with Opiates in Severe and Refractory Major Depression.” American Journal of Psychiatry 156 (1999): 2017.

Walters, A.S., et al. “Successful Treatment of the Idiopathic Restless Legs Syndrome in
a Randomized Double-Blind Trial of Oxycodone versus Placebo.” Sleep 16 (1993): 327–32.

Ytterberg, S.R., M.L. Mahowald, and S.R. Woods. “Codeine and Oxycodone Use in patients with Chronic Rheumatic Disease Pain.” Arthritis and Rheumatism 41 (1998): 1603–12.

Oxazepam (Anxiolit, Serax, Serenid D)

2009-03-08T22:10:00.000-07:00

Pronunciation: ox-A-zeh-pam (also pronounced ox-AZ-eh-pam)
Chemical Abstracts Service Registry Number: 604-75-1
Formal Names: Anxiolit, Serax, Serenid D
Type: Depressant (benzodiazepine class).
Federal Schedule Listing: Schedule IV (DEA no. 2835)
USA Availability: Prescription
Pregnancy Category: C

Uses.
This substance is a metabolite of diazepam, temazepam, chlordiazepoxide, and clorazepate dipotassium. Oxazepam’s primary medical usage is to fight insomnia, hostility, and anxiety. Some researchers have found the drug also works against depression. Studies show oxazepam, diazepam, and flunitrazepam to have about the same therapeutic effects, though not the same
strengths (oxazepam being the weakest). In the 1990s a survey of pharmacies in Cracow, Poland, illustrated oxazepam’s worldwide popularity; around 14% of benzodiazepine prescriptions were for oxazepam, predominantly to women. One advantage of the drug is its safe “therapeutic ratio,” meaning that the amount needed to produce a desired medical effect is far below the amount needed to produce a poisonous effect. Thus medical practitioners have
considerable flexibility in adjusting dosage to an exact amount needed by a patient.

Experimental use against tinnitus (ringing in the ears) has been promising. Sometimes oxazepam is the preferred antianxiety medicine for alcoholics suffering from cirrhosis, because a fully functioning liver is unnecessary to flush the substance from the body. Oxazepam is used to alleviate alcohol withdrawal syndrome and has been used to treat neuroses and schizophrenia.

Oxazepam is considered appropriate for short-term treatment of agitation in elderly persons suffering from dementia. Tests indicate the drug can reduce hostility as well as anxiety, an ability that would set oxazepam apart from other benzodiazepines. In a cat experiment, however, the drug increased predator behavior. The drug makes mice more combative. Rats kill more mice when dosed with oxazepam, but researchers interpret that result as illustrating
potency of the drug rather than indicating it would promote aggression in humans. Human oxazepam reactions that increase hostility and combativeness are unusual and unexplained, although factors may include size and frequency of dose along with inherent personalities of users. Hostile human reactions are “paradoxical” effects, meaning they are the opposite of what
normally happens after taking an oxazepam dose.

Drawbacks.
While under the drug’s influence people exhibit memory trouble. Oxazepam lowers body temperature in mice and rats. Case reports tell of oxazepam causing blisters or other skin eruptions on people. In mice the substance boosts the poisonous action of the cancer medicine ifosfamide. Some experiments using oxazepam to induce sleep find no hangover effect on persons’ performance the next day, but that result is not invariable; size of dose appears relevant. An experiment testing the drug’s effect on vigilance (an important ability when driving a car) found normal ability while persons were under the influence of a low dose. Another experiment using a dose four times greater did find vigilance impairment. Still another experiment showed slower movements.

Abuse factors.
One reviewer of the drug’s characteristics reported that it may have less addictiveness than diazepam. In one study opiate addicts found oxazepam no more attractive than a placebo. In another study sedative abusers judged the drug less attractive than diazepam and indeed mistakenly identified oxazepam as a placebo one third of the time (a mistake they almost
never made with diazepam) and even considered a placebo more appealing than oxazepam about one fifth of the time (a preference never occurring with diazepam). A similar experiment in which drug abusers compared oxazepam, diazepam, and placebo produced comparable results.

An animal research study found no tolerance produced by the drug. Monkeys, however, exhibit signs of tolerance, dependence, and withdrawal after taking the drug for a week or two. One human study found tolerance but no withdrawal symptoms. Nonetheless, melancholy, mood swings, confusion, anxiousness, panic, and seizures have been observed when doses of the drug
stopped abruptly. Some of those “withdrawal symptoms,” however, are also conditions for which the drug is prescribed; so emergence of those conditions upon stopping the drug may simply mean the underlying conditions were not cured. A case report recounts a rare instance of someone having visual hallucinations while undergoing oxazepam withdrawal. Tapering oxazepam does not necessarily prevent abstinence symptoms, but symptoms have been controlled by substituting another drug. One authority warns that stopping oxazepam can be as touchy as stopping barbiturates. In the 1980s a health official in Australia portrayed oxazepam dependence as a growing problem. In contrast, another authority reviewing oxazepam’s history for a medical journal found only four accounts of human dependence on the drug and declared
withdrawal symptoms to be unusual upon sudden stoppage. This reviewer speculated that oxazepam’s slow delivery of drug effects and its tendency to make people dizzy if a lot is consumed help discourage abuse.

Drug interactions.
A driving skills test showed that oxazepam worsens impairment induced by alcohol. Cigarette smoking shortens the time span that an oxazepam dose stays in the body. A mouse study found that animals could withstand higher doses of morphine and methadone if oxazepam was also
used.

Cancer.
Findings about oxazepam’s potential for causing human cancer have been inconclusive. Gene mutations would be a possible sign that cancer might eventually emerge; some laboratory tests show that the drug does not cause gene mutations, but genetic mutations were apparent after a six-month administration of the drug to mice. Oxazepam is described as causing liver cancer in mice. Researchers testing the drug on rats concluded that an unclear potential for causing cancer exists, but their uncertain conclusion was partly based on some dosages so high that apparently they were fatal to various individual animals.

Pregnancy.
Experiments have exposed mice to oxazepam during fetal development, and assorted differences in their behavior (compared to mice with no exposure) have been documented, including decreased sociability and decreased interaction with surroundings. What those differences might mean in a human context is unclear. Experimental evidence indicates that prenatal exposure to oxazepam may harm a mouse’s learning ability and temporarily slow growth. In humans the drug passes from a pregnant woman into the fetus. A survey of 4,014 instances of birth defects in the Netherlands from 1981 to 1994 found an association between oxazepam and cleft lip. The same association was found in Finland a few years earlier. Mice experiments have also produced head and mouth malformations, but the doses involved were
far higher than humans would be expected to take.

Oxazepam is considered to have less impact than other benzodiazepines on a nursing mother’s milk supply. Two nursing mothers who had measurable levels of oxazepam in their blood had no evidence of the substance in their milk. A case report tells of a nursing mother whose milk contained about 4.7% of her oxazepam dosage, with no apparent effect on the infant. In other cases, not even 0.001% of the oxazepam dose taken by a mother passed into her milk.

Additional scientific information may be found in:
Ayd, F.J., Jr. “Oxazepam: Update 1989.” International Clinical Psychopharmacology 5
(1990): 1–15.

Bliding, A. “The Abuse Potential of Benzodiazepines with Special Reference to Oxazepam.”
Acta Psychiatrica Scandinavica. Supplementum, no. 274 (1978): 111–16.

Bucher, J.R., et al. “Toxicity and Carcinogenicity Studies of Oxazepam in the Fischer
344 Rat.” Toxicological Sciences 42 (1998): 1–12.

Fouks, L., et al. “The Clinical Activity of Oxazepam.” Acta Psychiatrica Scandinavica.
Supplementum, no. 274 (1978): 99–103.

Griffiths, R.R., et al. “Comparison of Diazepam and Oxazepam: Preference, Liking and
Extent of Abuse.” Journal of Pharmacology and Experimental Therapeutics 229
(1984): 501–8.

Mewaldt, S.P., M.M. Ghoneim, and J.V. Hinrichs. “The Behavioral Actions of Diazepam
and Oxazepam Are Similar.” Psychopharmacology 88 (1986): 165–71.

Vaisanen, E., and E. Jalkanen. “A Double-Blind Study of Alprazolam and Oxazepam
in the Treatment of Anxiety.” Acta Psychiatrica Scandinavica 75 (1987): 536–41.

Oxandrolone

2009-03-08T22:08:00.000-07:00

Pronunciation: ok-SAN-droh-lohn
Chemical Abstracts Service Registry Number: 53-39-4
Formal Names: Anatrophill, Anavar, Lipidex, Lonavar, Oxandrin, Provitar, Vasorome
Type: Anabolic steroid.
Federal Schedule Listing: Schedule III (DEA no. 4000)
USA Availability: Prescription
Pregnancy Category: X

Uses.
This drug is used to encourage return of adequate heaviness in persons who have lost too much weight from illness, injury, or medical therapy. Experiments with AIDS (acquired immunodeficiency syndrome) patients measured substantial improvement in weight and strength. Oxandrolone may diminish pain from a bone disease called osteoporosis, although the drug has potential for worsening the underlying bone affliction. In rats and in humans the drug has hastened healing of wounds. Experimental therapy using oxandrolone against Duchenne muscular dystrophy has been successful.

Drawbacks.
Nausea and diarrhea are among the less serious reports of unwanted effects. The substance can masculinize female users and interfere with menstrual periods. In immature rats oxandrolone has drastically interfered with the male reproductive system, a finding that may be relevant to young athletes using the compound without medical supervision. In humans the substance
can promote prostate disease and should be avoided by men with breast cancer and generally by anyone with kidney disease (although doctors sometimes give oxandrolone to dialysis patients). The drug has been used to treat hepatitis in alcoholics despite its ability to interfere with bile flow and to cause jaundice or liver malfunction. Fluid retention can occur and be a serious problem for heart patients. Other unwanted effects may include overall higher cholesterol levels (accompanied by reduction of the HDL “good cholesterol”), although unlike some other drugs of this type, oxandrolone has been seen to reduce levels of triglycerides (which are associated with increased risk of heart attack and stroke), and in some cases oxandrolone reduced overall
cholesterol as well. Such effects may, however, depend upon what causes the original levels.

Oxandrolone can bring about premature bone maturation in children, preventing attainment of normal adult height. Nonetheless, the compound is used to treat delayed puberty in boys, increasing their height and weight. Turner’s syndrome interferes with height and sexual maturation in girls, deficits that have improved with oxandrolone therapy.

Abuse factors.
Sports competitors are forbidden to use the substance. Violation of the ban may risk punishment for nothing: Even though oxandrolone can promote muscle mass, a study examining users and nonusers of oxandrolone found no difference between the two groups in muscle mass, strength,
and general fitness. Athletes who abuse oxandrolone may suffer bad psychological effects. In one case a person became hyperactive and had racing thoughts. In another case someone abusing this and other steroids became suspicious of other people, rageful, and occasionally suicidal.

An addiction case report mentioned not only psychological craving for oxandrolone and other anabolic steroids but physical dependence as well. When the bodybuilder in question received a dose of a substance that provokes withdrawal symptoms in opiate addiction, he responded with classic opiate withdrawal signs.

Drug interactions.
Oxandrolone can alter insulin needs of diabetics and boost actions of anti–blood clot medicines. The steroid can help rats survive an overdose of meprobamate or nicotine.

Cancer.
Potential for causing cancer is unknown. A case report associates oxandrolone with development of colon cancer in a 27-year-old bodybuilder.

Pregnancy.
Potential for causing birth defects is unknown. In animal studies testing oxandrolone at nine times the normal human dose, fetal injury has occurred, including introduction of male characteristics into a female fetus.

Pregnant women are advised to avoid the drug. Oxandrolone’s ability to pass into milk of nursing mothers is unknown.

Additional scientific information may be found in:
Frasier, S.D. “Androgens and Athletes.” American Journal of Diseases of Children 125
(1973): 479–80.

Freinhar, J.P., and W. Alvarez. “Androgen-Induced Hypomania.” Journal of Clinical
Psychiatry 46 (1985): 354–55.

Levien, T.L., and D.E. Baker. “Reviews of Trimetrexate and Oxandrolone.” Hospital
Pharmacy 29 (1994): 696–702.

Mendenhall, C.L., et al. “Short-Term and Long-Term Survival in Patients with Alcoholic
Hepatitis Treated with Oxandrolone and Prednisolone.” New England Journal
of Medicine 311 (1984): 1464–70.

Rosenfeld, R.G., et al. “Six-Year Results of a Randomized, Prospective Trial of Human
Growth Hormone and Oxandrolone in Turner Syndrome.” Journal of Pediatrics
121 (1992): 49–55.

Taiwo, B.O. “HIV-Associated Wasting: Brief Review and Discussion of the Impact of
Oxandrolone.” AIDS Patient Care and STDs 14 (2000): 421–25.

Wilson, D.M., et al. “Oxandrolone Therapy in Constitutionally Delayed Growth and
Puberty.” Pediatrics 96 (1995): 1095–1100.

Opium (Papaver album, Papaver somniferum, Poppy)

2009-03-08T22:01:00.000-07:00

Pronunciation: OH-pi-uhm
Chemical Abstracts Service Registry Number: 8008-60-4
Formal Names: Papaver album, Papaver somniferum, Poppy
Informal Names: Ah-pen-yen, Aunti, Aunti Emma, Big O, Black, Blackjack, Black Pill, Black Stuff, Chandoo, Chandu, Chinese, Chinese Molasses, Chinese Tobacco, Chocolate, Cruz, Dopium, Dover, Dover’s Deck, Dover’s Powder, Dreamer, Dream Gun, Dreams, Dream Stick, Easing Powder, Emma, Fi-Do-Nie, Garden-Poppy, Gee, God’s Medicine, Goma, Gondola, Gong, Goric, Great Tobacco, Gum, Guma, Hard Stuff, Hocus, Hop, Indonesian Bud, Joy, Joy Plant, Mawseed, Midnight Oil, Mira, Mud, O, Oil, OJ, OP, Ope, Pen Yan, Pen Yen, PG, Pin Gon, Pin Yen, Plant, PO, Pox, Skee, Tar, Tongs, Tox, Toxy, Toys, When- Shee, Winshee, Yen Shee Suey, Ze, Zero
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9600)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Many opium products are discussed elsewhere in this book, but here we are dealing with the substance from which all those products originate. Opium has long been used to relieve pain, fight coughs, cure diarrhea, and control spasms. Traditionally, opium is dried sap harvested from the seedproducing portion of opium poppy plants. At harvest time fields of poppies can have a strong smell, and children in the fields can be overcome by those airborne chemicals. A modern opium variety is “poppy straw,” composed of dry or liquid extracts from the plant. The natural product can be used by itself or can be refined to produce various drugs known as “opiates,” valued for their medicinal effects.

Archaeologists have found evidence of opium poppy cultivation dating from 15,000 years ago, but examination of historical records has not proven that ancient peoples understood opium’s medicinal benefits; the product may have been used traditionally but without understanding how or even whether it worked. Opium may have been used in Roman Empire religious ceremonies, perhaps exploiting the drug’s effects to symbolize a process of death and reincarnation, and even older records imply that ancients may have believed that opium could produce happiness, although evidence of ancient recreational use is nonexistent.

The Opium War from 1840 to 1842 was the first drug war, followed by the second Opium War of 1856 to 1860. These military conflicts were fought against China by England and other European powers in order to force the Chinese government to legalize the opium trade (certainly a goal different from that of the “drug war” familiar to Americans as the twenty-first century
began).

Opium and its morphine component were widely used to treat wounded soldiers in the American Civil War, and later historians have routinely said that addiction became so common that it was called “the soldier’s disease.” Such illness may have existed, but an investigator who diligently examined medical writings from that time found none that attributed postwar addictions to war-related medical use. In that era the opium trade was legal, and someone who analyzed opium import statistics found no evidence that consumption rose due to Civil War addictions; a distinguished authority has noted that people of that era called dysentery “the soldier’s disease.”

Just before World War I an article in the Journal of the American Medical Association declared, “If the entire materia medica at our disposal were limited to the choice and use of only one drug, I am sure that a great many, if not the majority, of us would choose opium; and I am convinced that if we were to select, say half a dozen of the most important drugs in the Pharmacopeia,
we should all place opium in the first rank.”1 Although many useful drugs have been discovered since then, opium is still the basis for many standard medications. Because opium is a natural product, its morphine content can vary greatly from batch to batch. Opium commercially processed for medical use is adjusted so that 10% of any given amount of medical opium is composed of morphine.

Although medical opinion about opium has changed little, public opinion has changed a lot. Reasons for that shift go beyond the scope of this book, but in the nineteenth century, use of opium and its derivatives had wide social approval in America. Alcohol was considered more hazardous to health and home. One of the most telling measures of approval came from the life insurance industry in India, which freely granted policies to known opium users, as mortality statistics showed opium having no effect on life span. A life insurance official reported similar experience in China, although older users in China had higher mortality than older nonusers (probably many users took the drug for diseases that nonusers did not have, with the death rate
related more to those diseases than to opium). Some of those statistics would change as the twentieth century progressed because drug laws would change the kinds of people who used opium, thereby associating opium with populations having higher mortality for reasons unrelated to opium’s drug properties.

Although identified with China, opium has been grown in the United States. In the late eighteenth century Benjamin Franklin used laudanum (typically wine laced with opium) to treat himself for kidney stones. During the nineteenth century Americans used opium mainly as an ingredient in laudanum and paregoric. Paregoric is a liquid including anise, camphor, and opium. Paregoric was first produced in the eighteenth century as an asthma medicine.

The compound is no longer used for that purpose but can reduce lung congestion by helping people to cough up mucus. Paregoric is a standard diarrhea remedy and is used to help infants suffering from drug withdrawal syndromes. In the 1960s the compound had a flurry of popularity among opiate addicts who would process the product in hopes of isolating the opium, then inject the substance they produced. The outcomes were typical of what happens when oral medications are injected, resulting in lung damage and disfiguring injuries to injection sites.

Less familiar modern opium preparations include home remedy mixtures of the substance with caffeine, aspirin, and acetaminophen (Tylenol or other brands). In America opium preparations were once a standard method of quieting noisy infants and children, and that practice is still followed in some parts of the world. One hazard in that custom is the possibility of fatal overdose,
as people administering such concoctions do not always understand pediatric dosage.

Drawbacks.
Although some opium users have generally unhealthy lifestyles, few ailments have been attributed solely to the drug. Those ailments tend to be in the gastrointestinal tract, such as problems with the small intestine’s bile duct. “Cauliflower ear,” in which an ear thickens and becomes misshapen, was once associated with opium smoking. The affliction, however,
apparently came not from the drug but rather from the habit of lying down for hours in a comatose condition with an ear pressing against a hard surface.

Abuse factors.
Recreational use of opium is harder to define than we might think, because even if persons take the drug in a social setting, they can be seeking to reduce mental anxiety or physical pain, which is not the same as using a drug for fun. Some people swallow dry opium or drink tea made with
seed or with dried heads of poppy flowers. In the nineteenth century poppy tea was a common medicinal drink, but in the early twenty-first century the habit tends to be limited to opiate addicts. The traditional recreational way to use opium is to inhale its smoke. Heating opium enough to make it smoke can reduce the drug content, and opium is already far weaker than substances refined from it (such as morphine and heroin). One authority estimates that
the amount of active drug inhaled by someone who smokes a given weight of opium will typically be 300 to 400 times less than the drug content in the same weight of injected heroin. Moreover, while an entire dose of heroin might be ingested in a few seconds, a pipeful of opium is smoked over a much longer period to slowly savor its effects, further reducing the opium’s impact. The English poet Samuel Taylor Coleridge started out using opium for medical purposes, as did Thomas De Quincey, and both men produced classic accounts of hallucinations and creative inspiration occurring under opium’s influence. Those accounts and later ones may well be true, but for such results people need to be particularly sensitive to the drug and also be prone to such experiences regardless of pharmaceutical encouragement. Arsenic is sometimes added to opium to increase smokers’ interest in sexual activity, a practice generating reports of arsenic poisoning among users. Drug interactions. Not enough scientific information to report about the natural product, although many studies have examined drug interactions with opiates and opioids.

Cancer.
Laboratory tests find that opium smoke may cause cancer, as may opium dross (waste products, such as scrapings from the inside of an opium pipe, which some persons chew or suck). Opium is suspected of causing esophageal and bladder cancer.

Pregnancy.
A pregnant woman using paregoric can give birth to an infant having dependence with opium.

Additional information.
Seed from opium poppies is a food product commonly used in breads, cakes, and candies. Consumption of amounts found in a normal meal can cause a false opiate positive in drug screens; controversy exists about whether further analysis of results from such testing can show
that poppy seed was the cause. Poppy seed oil is a comparatively unfamiliar product, but animal tests indicate it has good potential for human nutrition. In some parts of the world iodized poppy seed oil has been used instead of iodized salt to treat goiter and has been suggested as a means of preventing nervous endemic cretinism caused by iodine deficiency in the diet of pregnant
women. Iodized poppy seed oil is taken up by cancerous portions of a liver, giving the substance clinical usefulness if anticancer drugs are blended into it, as the drugs then concentrate exactly where they are needed in the liver. Results from animal research have led investigators to speculate that consuming normal poppy seed oil may help prevent cancer.

Opium lettuce is not related to opium but can produce mild sensations similar to opium. Sedative and pain relief qualities of opium lettuce have been used for centuries. Lung and urinary tract afflictions have been treated with it. Opium lettuce is smoked for recreational purposes, but results have not caused the practice to gain popularity. A case report tells of individuals who
received medical care after injecting a preparation made from the plant. It has other names including Acrid Lettuce, Bitter Lettuce, Compass Plant, Great Lettuce, Green Endive, Lactucarium, Lactuca virosa, Poison Lettuce, Prickly Lettuce, Strong-Scented Lettuce, and Wild Lettuce.

Additional scientific information may be found in:
Aurin, M. “Chasing the Dragon: The Cultural Metamorphosis of Opium in the United
States, 1825–1935.” Medical Anthropology Quarterly 14 (2000): 414–41.

Gharagozlou, H., and M.T. Behin. “Frequency of Psychiatric Symptoms among 150
Opium Addicts in Shiraz, Iran.” International Journal of the Addictions 14 (1979):
1145–49.

Goodhand, J. “From Holy War to Opium War? A Case Study of the Opium Economy
in North-Eastern Afghanistan.” Disasters 24 (2000): 87–102.

Haller, J.S. “Opium Usage in Nineteenth Century Therapeutics.” Bulletin of the New
York Academy of Medicine 65 (1989): 591–607.

Kalant, H. “Opium Revisited: A Brief Review of Its Nature, Composition, Non-Medical
Use and Relative Risks.” Addiction 92 (1997): 267–77.

Lerner, A.M., and F.J. Oerther. “Characteristics and Sequelae of Paregoric Abuse.” Annals
of Internal Medicine 65 (1966): 1019–30.

Quinones, M.A. “Drug Abuse during the Civil War (1861–1865).” International Journal
of the Addictions 10 (1975): 1007–20.

Strang, J. “Lessons from an English Opium Eater: Thomas De Quincey Reconsidered.”
International Journal of the Addictions 25 (1990): 1455–65.
Note
1. 64 (February 6, 1915): 477.

Nutmeg (Mace, Myristica fragrans)

2009-03-08T21:59:00.000-07:00

Pronunciation: NUT-mehg
Chemical Abstracts Service Registry Number: 84082-68-8
Formal Names: Mace, Myristica fragrans
Type: Hallucinogen.
Federal Schedule Listing: Unlisted
USA Availability: Nonprescription (food)
Pregnancy Category: None

Uses.
Nutmeg is a familiar spice, but when used in larger amounts, it can act as a drug. Nutmeg originated in the Spice Islands of Indonesia. It is a seed coming from an evergreen tree that can reach 45 feet in height. Folk medicine uses nutmeg for treating insomnia, mouth sores, stomach inflammation, gas, diarrhea, and vomiting. Animal research verifies the antiinsomnia and antidiarrhea properties; they have been observed among humans undergoing formal
medical care, and recreational users mention sleep-inducing action. The substance is also used as an aphrodisiac, and laboratory tests show that it kills headlice. Nutmeg may be able to help improve dysentery, infections, and rheumatism. In rabbit experiments, nutmeg lowered cholesterol levels and aided in coughing up mucus. Nutmeg, like many other spices, has antimicrobial actions that appear to retard spoilage of unrefrigerated food.

Nutmeg can produce false positives for marijuana in a field test that law enforcement officers have used to identify an unknown substance, but of course more sophisticated laboratory examination can correct such an error.

Drawbacks.
A nutmeg dose sufficient to produce hallucinations is also sufficient to produce headache, thirst, nausea, constipation, rapid heartbeat, dizziness, and a miserable hangover. Muscular discoordination can be severe enough to mimic multiple sclerosis. Research on cats produced liver destruction. All these results are from dosage quantities much higher than the small
amounts used for spicing foods.

Abuse factors.
Nutmeg is not considered addictive, although a case report notes a patient hospitalized for nutmeg poisoning, who craved the substance so much that he had a supply smuggled to him during his hospital stay. The report said he was never able to go beyond two weeks without nutmeg.

Some researchers are skeptical that nutmeg possesses hallucinogenic qualities, but for centuries numerous users have said otherwise. Betel chewers sometimes add nutmeg to a quid for extra sensations, and mixing tobacco with nutmeg is a practice reported in Asia. Research indicates that human body chemistry converts part of a nutmeg dose into substances related to amphetamine, affecting mood and sometimes causing hallucinations. The effects from a dose can last three days. Overdose requiring medical intervention is possible, although only one fatality is recorded. Nutmeg has received mixed reviews as a recreational drug. Some people call it incomparable; others resort to it only as an act of desperation when nothing else is available. A favorable description says nutmeg is “capable of removing one completely from the
world of reality in a hypnotic trance accompanied by golden dreams and euphoric bliss.”1 In contrast, someone who used nutmeg together with marijuana received emergency hospital treatment for gagging, hot and cold flashes, numbness, blurred vision, double vision, triple vision, and difficulty in controlling movements—among other complaints. Persons who use nutmeg by
itself have also reported bad experiences.

Drug interactions.
In a mice experiment nutmeg boosted actions of alcohol and reduced those of dextroamphetamine. One authority describes nutmeg as a weak monoamine oxidase inhibitor (MAOI), and MAOIs interact badly with many drugs described in this blog.

Cancer.
A laboratory test using a nutmeg extract found evidence that it might cause cancer, and a nutmeg experiment with mice produced DNA changes that might be related to eventual cancer.

Pregnancy.
Male mice that received nutmeg in an experiment did not show chromosome damage. A case report notes a normal full-term infant born to a woman who had experienced nutmeg poisoning during pregnancy, but pregnant women are advised to avoid using nutmeg as a drug.

Additional information.
As with many other natural products, nutmeg’s effects may be produced by the combination of hundreds of chemicals found in the substance. Researchers have identified several chemicals as likely causes of nutmeg’s effects: elemicin, eugenol, myristicin, and safrole. Under laboratory
conditions myristicin can be chemically converted to MDMA and safrole to MDA, but this conversion has never been detected in animals or humans.

Body chemistry does convert myristicin into substances resembling amphetamine.
Myristicin is found not only in nutmeg but in plants related to carrots. An experiment testing myristicin on rats found no poisonous result. Researchers found no evidence of cancer after dosing mice with the substance, but the study did not last long enough to reveal whether cancer would eventually develop. Myristicin’s potential for causing birth defects is unknown. Safrole
has a faint ability to promote cancer; pregnant women are advised to avoid using it as a drug.

Mace comes from the same seed as nutmeg does, but is a different spice. Folk medicine uses mace to reduce inflammation and pain; research indicates it can protect against some chemically caused cancers. Mace is routinely added to areca nut quids.

Additional scientific information may be found in:
Fras, I., and J.J. Friedman. “Hallucinogenic Effects of Nutmeg in Adolescent.” New York
State Journal of Medicine 69 (1969): 463–65.

Lewis, P.W., and D.W. Patterson. “Acute and Chronic Effects of the Voluntary Inhalation
of Certain Commercial Volatile Solvents by Juveniles.” Journal of Drug
Issues 4 (1974): 172.

Lewis, W.H., and M.P.F. Elvin-Lewis. Medical Botany: Plants Affecting Man’s Health. New
York: John Wiley & Sons, 1977. 408–10.

Panayotopoulos, D.J., and D.D. Chisholm. “Hallucinogenic Effect of Nutmeg.” British
Medical Journal 1 (1970): 754.

Sjoholm, A., A. Lindberg, and M. Personne. “Acute Nutmeg Intoxication.” Journal of
Internal Medicine 243 (1998): 329–31.

Van Gils, C., and P.A. Cox. “Ethnobotany of Nutmeg in the Spice Islands.” Journal of
Ethnopharmacology 42 (1994): 117–24.

Weiss, G. “Hallucinogenic and Narcotic-Like Effects of Nutmeg.” Psychiatric Quarterly
34 (1960): 346–56.

Note
1. W.H. Lewis and M.P.F. Elvin-Lewis, Medical Botany: Plants Affecting Man’s Health
(New York: John Wiley & Sons, 1977), 408.

Nitrite (Amyl Nitrite, Butyl Nitrite, Cyclohexyl Nitrite, Isoamyl...

2009-03-08T18:39:00.001-07:00

Pronunciation: NIGH-tright
Chemical Abstracts Service Registry Number: 8017-89-8 (amyl nitrite); 542-56-3
(isobutyl nitrite)
Formal Names: Amyl Nitrite, Butyl Nitrite, Cyclohexyl Nitrite, Isoamyl Nitrite,
Isobutyl Nitrite, Nitrous Acid
Informal Names: Aimes, Aimies, Ames, Amys, Army, Aroma of Men, Blackjack, Blue Heaven, Bolt, Boppers, Buds, Bullet, Buzz Bomb, Climax, Dixcorama, Hardware, Heart-On, High Ball, Liquid Gold, Liquid Incense, Locker Room, Man Aroma, Oz, Ozone, Pearls, Poppers, Quicksilver, Ram, Rush, Snappers, Thrust, Whiteout
Type: Inhalant.
Federal Schedule Listing: Unlisted, but may be in state schedules
USA Availability: Prescription for some formats; nonprescription for others
Pregnancy Category: X (amyl nitrite, also called isoamyl nitrite)

Uses.
Various chemical subvarieties of nitrite inhalants exist. Isobutyl nitrite is popular in some teenager circles and has been called "the cocaine of poor people." Although anyone is physically free to use any drug, authorities find that nitrite sniffing has particular appeal to male homosexuals, especially during sexual activity. Aphrodisiac qualities are claimed for the substance. Amyl nitrite sniffers report euphoria and muscle relaxation. Isobutyl nitrite users
report losing their sense of who they are and also becoming calm or, in contrast, becoming prone to wild conduct—differences that may illustrate the impact that someone's personality and surroundings have on drug experiences.

Regardless of exact content of a nitrite experience, sensations are brief. Some persons have confused nitrites with nitrates; they have a similar spelling but are different substances.

Drawbacks.
Nitrite inhalants have brief action but may incapacitate a person during that time and thus should not be used while engaged in dangerous activity such as driving a car. Unwanted actions of nitrites include feelings of falling and spinning, headache, facial flushing, rapid heartbeat, generalized throbbing feelings, and low blood pressure (low enough to make a person
faint). Less common are nausea, vomiting, agitation, sweating, loss of energy and strength, and loss of bladder and rectal control. In mice experiments involving single and multiple exposures, inhaling isobutyl nitrite can cause anemia, harm the immune system, create nose and lung abnormalities, and disturb the spleen. Similar results are seen with rats. Blood and spleen abnormalities developed in a mice experiment using cyclohexyl nitrite. In a human patient, sniffing isobutyl nitrite caused bronchitis severe enough to affect the trachea. Amyl nitrite (which has a long medical history as a heart medicine) and isobutyl nitrite may each cause methemoglobinemia, a sometimes fatal blood disease interfering with the body's use of oxygen; this affliction is particularly likely if a person drinks isobutyl nitrite instead of inhaling the
vapor. Isobutyl nitrite interference with the body's ability to use oxygen may be perilous for persons with inadequate oxygen supply to the heart.

In the early days of AIDS (acquired immunodeficiency syndrome) research, scientists noticed that many victims were nitrite sniffers. Because of this association, at one time nitrite sniffing was suspected to be the cause of AIDS, an excellent example of why association of a chemical with a disease cannot be assumed to demonstrate a cause-effect relationship. The substance is still, however, suspected of worsening the progression of AIDS once the disease strikes. In addition, damage to the immune system caused by nitrite inhalation is suspected of making a user more susceptible to AIDS and to a type of cancer called Kaposi's sarcoma.

Abuse factors.
Tolerance to amyl nitrite can develop.

Drug interactions.
Although amyl nitrite is used as an antidote for cyanide poisoning, isobutyl nitrite can interact with coffee in a way that produces enough cyanide to poison someone who drinks the combination beverage. Using amyl nitrite with alcohol can cause heart failure. Nitrites are flammable, making them hazardous around flames or lit cigarettes. Persons with glaucoma
are supposed to avoid amyl nitrite. People report burns caused by isobutyl nitrite splashing on skin.

Cancer.
Laboratory tests and animal experiments (the latter involving longterm exposure) indicate that isobutyl nitrite liquid and vapor each cause cancer.

Pregnancy.
In the body nitrite breaks down into chemicals that may promote birth defects. The lower blood pressure produced by amyl nitrite is believed harmful to a fetus. Whether amyl nitrite passes into the milk of nursing mothers is unknown.

Additional scientific information may be found in:
Bradberry, S.M., et al. "Fatal Methemoglobinemia Due to Inhalation of Isobutyl Nitrite."
Journal of Toxicology: Clinical Toxicology 32 (1994): 179–84.

Covalla, J.R., C.V. Strimlan, and J.G. Lech. "Severe Tracheobronchitis from Inhalation
of an Isobutyl Nitrite Preparation." Drug Intelligence and Clinical Pharmacy 15
(1981): 51–52.

Haverkos, H.W., and J. Dougherty. "Health Hazards of Nitrite Inhalants." American
Journal of Medicine 84 (1988): 479–82.

Haverkos, H.W., et al. "Nitrite Inhalants: History, Epidemiology, and Possible Links
to AIDS." Environmental Health Perspectives 102 (1994): 858–61.

Israelstam, S., S. Lambert, and G. Oki. "Use of Isobutyl Nitrite as a Recreational Drug."
British Journal of Addiction to Alcohol and Other Drugs 73 (1978): 319–20.

Lange, W.R., and J. Fralich. "Nitrite Inhalants: Promising and Discouraging News."
British Journal of Addiction 84 (1989): 121–23.

Soderberg, L.S. "Immunomodulation by Nitrite Inhalants May Predispose Abusers to
AIDS and Kaposi's Sarcoma." Journal of Neuroimmunology 83 (1998): 157–61.

Nitrous Oxide (Dinitrogen Monoxide, Dinitrogen Oxide, Entonox)

2009-03-08T18:33:00.000-07:00

Pronunciation: NIGH-truhs OX-eyed
Chemical Abstracts Service Registry Number: 10024-97-2
Formal Names: Dinitrogen Monoxide, Dinitrogen Oxide, Entonox
Informal Names: Fall Down, Gas, Hippie Crack, Hysteria, Laughing Gas, Nitro, Nitrous, Nitrous Acid, Noss, Pan, Shoot the Breeze, Tanks, Thrust, Whippets
Type: Inhalant.
Federal Schedule Listing: Unlisted
USA Availability: Nonprescription, but sales and usage are controlled in some
jurisdictions

Uses.
This drug has been known since the 1720s. Some authorities describe nitrous oxide as an opioid; some persons even use the gas to counteract effects from stimulants. Nitrous oxide actions and its recreational use are similar to those of other inhalants. Recreational use is illegal in some jurisdictions but has a venerable history. The writer Samuel Taylor Coleridge, thesaurus compiler Peter Mark Roget, and potter Josiah Wedgwood were all eighteenthcentury notables who relaxed with nitrous oxide.

Although this substance is a pharmaceutical product, it also occurs naturally. For instance, eating lettuce generates enough nitrous oxide that scientists can measure it in a person’s breath. Large quantities are produced by wild prairie grass. Humans do not receive enough nitrous oxide from such natural sources to be affected, however. The substance is also produced by the human
body. One study found the amount to increase as oral hygiene declined. As with the amounts produced by grass and lettuce, the level created by the body is too small to have any known effect on a person. From a global environmental perspective, however, nitrous oxide is a gas that promotes the greenhouse effect and ozone layer destruction, and concern exists about medical
usage affecting the world’s climate. Medical sources are estimated to create 2% of the atmosphere’s supply. Such usage may seem insignificant in that regard, but the gas is so durable in the atmosphere that any artificial source has been described as an environmental hazard.

Medically this drug is used as an anesthetic and to relieve pain ranging from dental work to migraine headache and cancer. In a medical context nitrous oxide is considered a reliable sedative. Experimental usage to treat anxiety has been successful, and one authority has noted a therapeutic antidepressant action. The substance has been used to help persons break entazocine addiction. Researchers report success in using the gas to ease alcohol,
nicotine, and opioid withdrawal and to reduce craving for alcohol, tobacco, and marijuana among addicts. The latter three substances are so different from one another that nitrous oxide’s ability to reduce craving for all of them is remarkable. Some medical practitioners claim that a single dose of the gas actually eliminates craving for those substances, but that claim sounds much
like those made for other “miracle cure” addiction treatments over the years but that turned out to be overly optimistic.

In former times, nitrous oxide was used to fight ear afflictions. For many years the substance was believed to make hearing more acute, but tests of hearing ability while using the compound show no improvement—and volunteers in those tests even felt they had lesser ability to detect soft sounds.

Nitrous oxide can increase pressure in the middle ear, and a case report tells of treatable hearing loss caused by the drug. Hearing defect has been reported from recreational use as well.

Typical nitrous oxide actions are tingling, numbness, dreaminess, euphoria, dysphoria (the opposite of euphoria), altered sensory perceptions, changed awareness of the body, and different experience of time flow. Although nitrous oxide is not classified as a hallucinogen, some descriptions of experiences are indistinguishable from hallucinations, particularly if a user is talented at creating internal imagery. Some persons claim to achieve mystical insight
while under the drug’s influence. Intoxication from a dose lasts only a few minutes.

Drawbacks.
The substance disrupts learning ability. That action has been exploited medically to promote amnesia of unpleasant procedures. In a typical experiment volunteers who inhaled a low dose of the drug showed worsened reaction time, worsened ability to do arithmetic, and general sedation accompanied by nervous system depression (as opposed to stimulation). Interference with driving ability has been noted one-half hour after a dose. In another experiment volunteers felt stimulated; in still another experiment some individuals were sedated, and others became stimulated. One group became weary, uneasy, and confused. Short-term exposure can cause dizziness, nausea, vomiting, and breathing difficulty. Some recreational users quickly inhale
as much nitrous oxide as possible and hold their breath. This technique causes a sudden change of pressure inside the lungs and can rupture small interior structures needed for breathing. Blood pressure can go up or down, depending on dosage. Users can lose consciousness, which may be hazardous in a recreational context due to falls or inability to shut off the gas source. The
substance deactivates vitamin B12, an effect that can cause numbness and difficulty in moving arms and legs. Other results can be impotence and involuntary discharge of urine and feces. Nitrous oxide interferes with blood clotting, and long-term exposure has caused blood abnormalities. Persons with chronic industrial exposure have more kidney and liver disease than usual.

Nitrous oxide can become very cold when released as a gas from a pressurized container, cold enough to cause frostbite upon meeting skin or throat.

Breathing nitrous oxide without an adequate supply of oxygen can be fatal; a little in a closed space or a lot from a face mask can suffocate a user. Although nitrous oxide is called nonflammable, when inhaled it can seep into the abdominal cavity and bowels, mixing with body gases to create a flammable combination. If ignited the result would be like setting off an explosive inside the body; the danger is real enough that surgical personnel administering
nitrous oxide as an anesthetic have been warned about it.

As with many other drugs, effects of nitrous oxide can be influenced by changes in setting. For example, volunteers who knew what to expect performed better on tests than persons who had no information about what nitrous oxide would do to them.

Abuse factors.
In tests of the drug’s appeal, people in general chose nitrous oxide no more often than placebo; such lack of preference is a classic sign of low addictive potential. One experiment revealed a catch to such findings, however: Volunteers who enjoyed nitrous oxide effects chose it more often than placebo, and volunteers who disliked the drug actions chose it less often
than placebo. Thus, overall in the general population the drug might be no more attractive than placebo, but nonetheless some persons may find it captivating.

Such a finding is consistent with drugs having high abuse potential, such as heroin; so the fact that persons typically find no attraction in nitrous oxide does not prove low abuse potential for nitrous oxide. Its nickname “hippie crack” suggests that users have recognized an abuse potential. Nonetheless, a medical practitioner who administered the gas as a drug addiction
treatment said that in 15,000 cases not a single addict indicated subsequent craving for nitrous oxide; such a patient population would be expected to show particular susceptibility if given a substance with abuse potential. The same practitioner notes that regardless of theoretical possibilities, 200 years of experience demonstrate that nitrous oxide is among the least abused drugs.

Tolerance develops in rats. Human experimentation documents tolerance developing to some effects (such as euphoria and pain relief) but not necessarily to all.

Drug interactions.
In an experiment comparing light drinkers of alcohol to moderate drinkers, the moderate drinkers found nitrous oxide more appealing. One group of researchers found that alcohol boosts nitrous oxide effects and that the drug combination creates effects produced by neither substance alone. Those researchers concluded, however, that the combination was not
potent enough to have more appeal than nitrous oxide alone. That conclusion assumes, of course, that drug abusers base their conduct on rational analysis of scientific findings. In a similar experiment comparing users and nonusers of marijuana, when given a choice neither group preferred nitrous oxide more than a placebo, but nitrous oxide effects felt stronger to marijuana users. In rats ketamine boosts effects from nitrous oxide. In a human medical context
that combination is routine and appears safe, but the combination causes brain damage in rats. Persons using morphine or other opiates can experience muscle rigidity when inhaling nitrous oxide, a situation that can interfere with breathing.

Cancer.
Studies do not indicate that nitrous oxide causes cancer in animals. Whether the drug causes cancer in humans is unknown. Genetic damage similar to the amount from daily smoking 10 to 20 cigarettes has been found in health care workers routinely exposed to minuscule amounts of nitrous oxide; such damage might have a potential for causing cancer.

Pregnancy.
Fertility is lower in female rats exposed to nitrous oxide than in rats having no exposure. Lower fertility has also been observed among female health care workers with occupational exposure to the gas, and reduced fertility is also reported for males. Offspring of male mice exposed to nitrous oxide have weighed less than normal and have not matured as fast as normal.

Birth defects resulted from an experiment exposing pregnant rats to the gas for 24 hours. When given to pregnant women during childbirth the drug builds up in the fetal blood and brain; one authority recommends administering oxygen to any newborn whose mother received nitrous oxide while giving birth. As the twenty-first century began researchers reported that the
gas might cause permanent fetal and newborn brain damage, a finding in contrast to previous understanding of the drug. Occupational exposure to nitrous oxide is associated with smaller infants and lower birth weight and may increase likelihood of spontaneous abortion. Pregnant and breast-feeding health workers are advised to avoid rooms where nitrous oxide residues may
contaminate the air. Sperm abnormalities and lower fertility have been noted in male rats exposed to nitrous oxide. Wives of men exposed to the gas have shown a higher spontaneous abortion rate, compared to wives of men with no exposure. The compound is not detected in milk of nursing mothers.

Additional information.
“Nitrous acid” is an unstable nitrite substance. The nickname “nitrous acid” is sometimes used for nitrous oxide, but they are different substances.

Additional scientific information may be found in:
Block, R.I., et al. “Psychedelic Effects of a Subanesthetic Concentration of Nitrous Oxide.”
Anesthesia Progress 37 (1990): 271–76.

Danto, B.L. “A Bag Full of Laughs.” American Journal of Psychiatry 121 (1964): 612–13.

Dohrn, C.S., et al. “Subjective and Psychomotor Effects of Nitrous Oxide in Healthy
Volunteers.” Behavioural Pharmacology 3 (1992): 19–30.

Linden, C.H. “Volatile Substances of Abuse.” Emergency Medicine Clinics of North America
8 (1990): 559–78.

Temple, W.A., D.M. Beasley, and D.J. Baker. “Nitrous Oxide Abuse from Whipped
Cream Dispenser Chargers.” New Zealand Medical Journal 110 (1997): 322–23.

Yagiela, J.A. “Health Hazards and Nitrous Oxide: A Time for Reappraisal.” Anesthesia
Progress 38 (1991): 1–11.

Zacny, J.P., et al. “Examining the Subjective, Psychomotor and Reinforcing Effects of
Nitrous Oxide in Healthy Volunteers: A Dose-Response Analysis.” Behavioural
Pharmacology 7 (1996): 194–99.

Nitrite (Amyl Nitrite, Butyl Nitrite, Cyclohexyl Nitrite, Isoamyl Nitrite, Isobutyl Nitrite, Nitrous Acid)

2009-03-08T18:30:00.000-07:00

Pronunciation: NIGH-tright
Chemical Abstracts Service Registry Number: 8017-89-8 (amyl nitrite); 542-56-3
(isobutyl nitrite)
Formal Names: Amyl Nitrite, Butyl Nitrite, Cyclohexyl Nitrite, Isoamyl Nitrite,
Isobutyl Nitrite, Nitrous Acid
Informal Names: Aimes, Aimies, Ames, Amys, Army, Aroma of Men, Blackjack, Blue Heaven, Bolt, Boppers, Buds, Bullet, Buzz Bomb, Climax, Dixcorama, Hardware, Heart-On, High Ball, Liquid Gold, Liquid Incense, Locker Room, Man Aroma, Oz, Ozone, Pearls, Poppers, Quicksilver, Ram, Rush, Snappers, Thrust, Whiteout
Type: Inhalant.
Federal Schedule Listing: Unlisted, but may be in state schedules
USA Availability: Prescription for some formats; nonprescription for others
Pregnancy Category: X (amyl nitrite, also called isoamyl nitrite)

Uses.
Various chemical subvarieties of nitrite inhalants exist. Isobutyl nitrite is popular in some teenager circles and has been called “the cocaine of poor people.” Although anyone is physically free to use any drug, authorities find that nitrite sniffing has particular appeal to male homosexuals, especially during sexual activity. Aphrodisiac qualities are claimed for the substance. Amyl nitrite sniffers report euphoria and muscle relaxation. Isobutyl nitrite users
report losing their sense of who they are and also becoming calm or, in contrast, becoming prone to wild conduct—differences that may illustrate the impact that someone’s personality and surroundings have on drug experiences.

Regardless of exact content of a nitrite experience, sensations are brief. Some persons have confused nitrites with nitrates; they have a similar spelling but are different substances.

Drawbacks.
Nitrite inhalants have brief action but may incapacitate a person during that time and thus should not be used while engaged in dangerous activity such as driving a car. Unwanted actions of nitrites include feelings of falling and spinning, headache, facial flushing, rapid heartbeat, generalized throbbing feelings, and low blood pressure (low enough to make a person
faint). Less common are nausea, vomiting, agitation, sweating, loss of energy and strength, and loss of bladder and rectal control. In mice experiments involving single and multiple exposures, inhaling isobutyl nitrite can cause anemia, harm the immune system, create nose and lung abnormalities, and disturb the spleen. Similar results are seen with rats. Blood and spleen abnormalities developed in a mice experiment using cyclohexyl nitrite. In a human patient, sniffing isobutyl nitrite caused bronchitis severe enough to affect the trachea. Amyl nitrite (which has a long medical history as a heart medicine) and isobutyl nitrite may each cause methemoglobinemia, a sometimes fatal blood disease interfering with the body’s use of oxygen; this affliction is particularly likely if a person drinks isobutyl nitrite instead of inhaling the
vapor. Isobutyl nitrite interference with the body’s ability to use oxygen may be perilous for persons with inadequate oxygen supply to the heart.

In the early days of AIDS (acquired immunodeficiency syndrome) research, scientists noticed that many victims were nitrite sniffers. Because of this association, at one time nitrite sniffing was suspected to be the cause of AIDS, an excellent example of why association of a chemical with a disease cannot be assumed to demonstrate a cause-effect relationship. The substance is still, however, suspected of worsening the progression of AIDS once the disease strikes. In addition, damage to the immune system caused by nitrite inhalation is suspected of making a user more susceptible to AIDS and to a type of cancer called Kaposi’s sarcoma.

Abuse factors.
Tolerance to amyl nitrite can develop.

Drug interactions.
Although amyl nitrite is used as an antidote for cyanide poisoning, isobutyl nitrite can interact with coffee in a way that produces enough cyanide to poison someone who drinks the combination beverage. Using amyl nitrite with alcohol can cause heart failure. Nitrites are flammable, making them hazardous around flames or lit cigarettes. Persons with glaucoma
are supposed to avoid amyl nitrite. People report burns caused by isobutyl nitrite splashing on skin.

Cancer.
Laboratory tests and animal experiments (the latter involving longterm exposure) indicate that isobutyl nitrite liquid and vapor each cause cancer.

Pregnancy.
In the body nitrite breaks down into chemicals that may promote birth defects. The lower blood pressure produced by amyl nitrite is believed harmful to a fetus. Whether amyl nitrite passes into the milk of nursing mothers is unknown.

Additional scientific information may be found in:
Bradberry, S.M., et al. “Fatal Methemoglobinemia Due to Inhalation of Isobutyl Nitrite.”
Journal of Toxicology: Clinical Toxicology 32 (1994): 179–84.

Covalla, J.R., C.V. Strimlan, and J.G. Lech. “Severe Tracheobronchitis from Inhalation
of an Isobutyl Nitrite Preparation.” Drug Intelligence and Clinical Pharmacy 15
(1981): 51–52.

Haverkos, H.W., and J. Dougherty. “Health Hazards of Nitrite Inhalants.” American
Journal of Medicine 84 (1988): 479–82.

Haverkos, H.W., et al. “Nitrite Inhalants: History, Epidemiology, and Possible Links
to AIDS.” Environmental Health Perspectives 102 (1994): 858–61.

Israelstam, S., S. Lambert, and G. Oki. “Use of Isobutyl Nitrite as a Recreational Drug.”
British Journal of Addiction to Alcohol and Other Drugs 73 (1978): 319–20.

Lange, W.R., and J. Fralich. “Nitrite Inhalants: Promising and Discouraging News.”
British Journal of Addiction 84 (1989): 121–23.

Soderberg, L.S. “Immunomodulation by Nitrite Inhalants May Predispose Abusers to
AIDS and Kaposi’s Sarcoma.” Journal of Neuroimmunology 83 (1998): 157–61.

Nicotine (Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco)

2009-03-08T18:27:00.000-07:00

Pronunciation: NIK-uh-teen (also pronounced NIK-uh-tin)
Chemical Abstracts Service Registry Number: 54-11-5
Formal Names: Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco
Informal Names: Chip (cigarette mixed with PCP), Fry Daddy (cigarette mixed with crack cocaine)
Type: Stimulant (pyridine alkaloids class).
Federal Schedule Listing: Unlisted
USA Availability: Generally available to adults as a component of tobacco products;
nonprescription and prescription in pharmaceutical format
Pregnancy Category: C or D (depending on pharmaceutical format)

Uses.
Tobacco’s history is mentioned on page 18. Nicotine is the addictive drug component of tobacco and is found in other plants as well. Nicotine is one of the more hazardous drugs, and dosage via tobacco smoke adds still more peril. Although nicotine has medical uses, characteristics of the natural product tobacco fall within the criteria of a Schedule I controlled substance. Nonetheless, federal law explicitly excludes tobacco from such control, making the tobacco industry legal. At the time this book was written debate was under way about limiting adult access to nicotine products, a restrictive effort requiring changes in law.

Traditional medical uses of the drug include treatment of insect bites, skin and intestinal parasites, vomiting, earache, toothache, runny nose, hernia, and heart pain. Although tobacco smoking worsens a gastrointestinal inflammation called Crohn’s disease, medical practice uses nicotine skin patches, oral capsules, or suppositories to treat inflammation of the colon and rectum caused by ulcerative colitis. Nicotine chewing gum has been used successfully to treat finger or toe sores deriving from Buerger’s disease, an affliction in which blood vessels get blocked off (and which, despite the usefulness of pharmaceutical nicotine, seems to be worsened by smoking). Pharmaceutical nicotine helps some persons suffering from the tics of Tourette’s syndrome.

Researchers have found cigarette smoking to reduce the likelihood of getting preeclampsia, a potentially serious disease of late pregnancy in which women suffer fluid retention, high blood pressure, and too-high urine protein levels.

Cigarette smoking is also associated with a lower probability of getting Parkinson’s or Alzheimer’s disease. Even though “association” does not demonstrate cause and effect, some experiments using pharmaceutical nicotine to treat those afflictions show positive results. Such results, however, have not yet given nicotine a generally accepted role in treating those diseases. Nicotine reduces hunger pains and raises blood sugar, effects that help users eat less (Native Americans have traditionally chewed tobacco to better endure circumstances involving little food, water, or rest). Nicotine initially raises blood pressure, but continued dosage will lower it.

Drawbacks.
Tobacco smoking can lead to lung cancer and heart disease. Many other afflictions are attributed to tobacco smoking: bronchitis, emphysema, cataracts, mouth cancer, pancreas cancer, bone density loss (making broken bones more likely), abdominal aortic aneurysm (a sac ballooning out from the blood vessel wall), brain aneurysm, and gastroesophageal reflux (recurrent backward flow of acid and partially digested food from the stomach to the esophagus, making esophageal cancer more likely). One study noted that smoking tends to produce changes causing women to go through menopause at a younger age than nonsmokers. Laboratory tests imply that smokeless tobacco promotes tooth decay. Still more unwanted actions are known, partly because tobacco has simply been studied so intensively that more is known about it than is known about many other substances. Whether nicotine itself causes afflictions produced by tobacco is uncertain. For example, some investigators suspect that heart disease in smokers comes from carbon monoxide and tar constituents of smoke rather than the nicotine.

In adults 40 mg to 100 mg of pharmaceutical nicotine can produce fatal poisoning; an equivalent dose through cigarettes would require a person to quickly smoke several packs. Smaller dosages can be dangerous for children who play with nicotine patches or gum or who consume tobacco.

Abuse factors.
As with many drugs, persons often find nicotine unpleasant at first but learn to ignore bad sensations and focus upon effects that are enjoyed. Experiments examining differences that users perceive in various drugs find that some sensations from nicotine, amphetamine, and cocaine are similar, so similar that in one experiment persons receiving injections of nicotine typically identified it as cocaine. A user can establish a physical dependence
with nicotine, causing withdrawal symptoms if dosage stops:
nervousness, tenseness, crankiness, lightheadedness, broken sleep, weariness, distractedness, tremors. These symptoms often last a few days, sometimes longer, and can relate to a person’s expectations (a psychosomatic component).

Debate exists about how addictive nicotine is. A study published in 1994 noted that about 33% of tobacco smokers become addicted. A study published in 2000 found that 20% to 60% of adolescent smokers are addicted. Many smokers with no interest in quitting can nonetheless substantially reduce their cigarette consumption with little difficulty. In contrast, many smokers wanting to stop find themselves unable to cease, and for them even pharmaceutical
nicotine can be an insufficient replacement for tobacco. Among such persons the persistence of a smoking habit suggests that something more than the drug nicotine is involved. Tobacco smoke contains thousands of chemical ingredients besides nicotine; perhaps some of the less-studied ones are important. In addition, the paraphernalia and mechanics of cigarette smoking provide a psychological buffer to users, allowing continual brief respites in interactions with other persons (such as breaking eye contact during a puff). Nicotine itself is a mild stimulant able to release adrenaline and increase pulse rate and blood pressure, with the physiological arousal produced by the drug masking physical arousal provoked by life’s tensions, thereby making smokers feel less nervous despite the stimulant effects. Smokers tend to have lower levels of body chemicals that are supplemented by antianxiety and antidepressant drugs.

Such pharmaceuticals, unfortunately, seemingly have little ability to help smokers quit their tobacco addiction.

As with any addiction, the power of nicotine and tobacco depends upon needs met by those substances. People do not smoke simply to avoid temporary withdrawal symptoms. If a person’s life is filled with situations that smoking eases like nothing else can, breaking the addiction is hard. If a person finds other ways of dealing adequately with those situations, desire for cigarettes can go away and never be bothersome again. Contrary to expectations of researchers, a laboratory test found nicotine to be no more appealing to exsmokers than to persons who have never smoked—a finding implying that life circumstances, and not just chemistry, determine this drug’s appeal.

Alcohol and illicit drug abusers reliably tend to be tobacco cigarette smokers, so reliably that the amount of tobacco use can be used to estimate the amount of cocaine and opiate usage by persons in drug abuse treatment programs.

An experiment found that persons smoked less tobacco when they had access to marijuana, suggesting that those persons used the two substances for similar purposes. Nonsmokers tend to avoid drug abuse, implying that smokers and nonsmokers use different strategies to cope with life’s challenges.

Cigarette smoking is more prevalent among schizophrenics, seriously depressed persons, and persons with low-grade psychiatric disturbance that may lack outward symptoms. Almost two thirds of smokers in one research project turned out to have a history of present or past psychiatric abnormality.

Among such individuals smoking may be a strategy of self-medication. One study found that withdrawal symptoms can depend on the extent to which the drug is used for self-medication.

Improvement has been measured in alertness, energy, and happiness as cigarette smokers start their day’s consumption in the morning. Conversely, cutting off a smoker’s supply of cigarettes produces measurable increases in fatigue, irritation, sadness, stress, and disorientation. New users do not get favorable effects sought by experienced users but instead have measurable nausea and general uneasiness. Among new users nicotine reduces job performance skills such as physical coordination and accuracy in memory tasks the opposite of what happens with experienced users.

Although pharmaceutical nicotine has various medical applications, its main use is for treatment of addiction to tobacco smoking. One authority aptly described nicotine chewing gum as the methadone of cigarettes, meaning that such a treatment strategy is intended to switch addicts from tobacco to pharmaceutical nicotine, just as treatment personnel seek to switch heroin addicts to methadone. Although such programs may have an official goal of eliminating a person’s addiction, in practice simply switching a person from a more harmful drug to a less harmful drug is often considered a success.Drug interactions. Nicotine interacts with commonly used medical drugs.

Antipsychotic drugs and the anti–blood clot medicine heparin flush from the body faster if a person uses nicotine. Nicotine also reduces the sedative effect of benzodiazepines and reduces pain relief from various opioids. Cigarette smoke acts as a monoamine oxidase inhibitor (MAOI), a type of chemical found in some antidepressants and that can have serious adverse effects when
used simultaneously with some medicines (though acute danger from cigarette interactions may be small). Caffeine seems to make nicotine more pleasurable.

Rat studies show that nicotine increases alcohol’s appeal and worsens pancreas inflammation caused by both drugs. Birth control pills increase the boost that nicotine gives to pulse rate, and some researchers speculate that such increase is related to the elevated risk of heart disease found among smokers who use birth control pills.

Cancer.
Tests indicate that pure nicotine (as opposed to smoke containing nicotine) does not cause cancer.

Pregnancy.
Smoking reduces female fertility according to most studies of the topic, and studies of Canadian farm couples and of men in the Netherlands found an apparent reduction in male fertility as well. Pregnant women who smoke tobacco increase the chance of miscarriage, premature birth, smaller full-term infants, and sudden infant death syndrome (SIDS or “crib death”).

The children are more likely to have muscle tone abnormalities. Smoking harms male and female gametes, damages chromosomes, and can change DNA in ways linked with childhood cancer. Nicotine usage by a pregnant woman changes movements and heart action of a fetus. One researcher warns that nicotine patches or chewing gum may deliver even more nicotine to a
fetus than smoking would. Nicotine enters the milk of nursing mothers. Rat experiments indicate that fetal exposure to nicotine combined with newborn exposure to nicotine in milk increases the risk of offspring developing lung trouble similar to emphysema. Human birth defects have been attributed to tobacco smoking. Although a study of teenage tobacco smokers did not see
any increased incidence of birth defects in their infants, research based on animal experimentation and published in 1998 declared that nicotine causes defects in fetal brain development leading to problems in thinking and learning that may not become apparent until years after birth. The children tend to have lower scores on psychological measurements, somewhat reminiscent of “cocaine babies,” deficits that continue for years. Some investigators see a link between pregnant smokers and offspring with psychological problems.

Investigators tracking mothers and daughters for three decades found that daughters were more likely to take up smoking if their mothers smoked during pregnancy.

Additional information.
Scientific studies find that “passive smoking” threatens health of bystanders who inhale smoke from tobacco products and exhalations of smokers. A study of spontaneous abortions found them more likely in pregnant nonsmoking women who inhale environmental smoke and use a lot of caffeine or a moderate amount of alcohol. Infants from nonsmoker women who were exposed to tobacco smoke during pregnancy are more likely to have lower birth weight and persistent pulmonary hypertension. Offspring also exhibit the same kinds of lower psychological test scores that are seen in children of active smokers. Inhalation of smoke by infants is suspected of
contributing to SIDS. For sure, compared to children in nonsmoking households, infants of smokers are hospitalized more often for pneumonia and bronchitis. The level of environmental smoke necessary for ill effects is often unclear in scientific studies; a person working in a poorly ventilated smokey bar for eight hours a day will have a considerably different exposure than
someone in a nonsmoking household who sits outside once a week with a friend who smokes a couple of cigarettes.

Additional scientific information may be found in:
Brown, C. “The Association between Depressive Symptoms and Cigarette Smoking in an Urban Primary Care Sample.” International Journal of Psychiatry in Medicine 30 (2000): 15–26.

Brown, K.G. “Lung Cancer and Environmental Tobacco Smoke: Occupational Risk to Nonsmokers.” Environmental Health Perspectives 107 (1999, Suppl. 6): 885–90.

Colby, S.M., et al. “Are Adolescent Smokers Dependent on Nicotine? A Review of the
Evidence.” Drug and Alcohol Dependence 59 (2000, Suppl. 1): S83–S95.

Dursun, S.M., and S. Kutcher. “Smoking, Nicotine and Psychiatric Disorders: Evidence
for Therapeutic Role, Controversies and Implications for Future Research.” Medical
Hypotheses 52 (1999): 101–9.

Haustein, K.O. “Cigarette Smoking, Nicotine and Pregnancy.” International Journal of
Clinical Pharmacology and Therapeutics 37 (1999): 417–27.

Parrott, A.C., and F.J. Kaye. “Daily Uplifts, Hassles, Stresses and Cognitive Failures:
In Cigarette Smokers, Abstaining Smokers, and Non-smokers.” Behavioural Pharmacology
10 (1999): 639–46.

Robinson, J.H., and W.S. Pritchard. “The Role of Nicotine in Tobacco Use.” Psychopharmacology
108 (1992): 397–407.

Stolerman, I.P., and M.J. Jarvis. “The Scientific Case That Nicotine Is Addictive.” Psychopharmacology 117 (1995): 2–10.

Van Gilder, T.J., P.L. Remington, and M.C. Fiore. “The Direct Effects of Nicotine Use
on Human Health.” Wisconsin Medical Journal 96 (1997): 43–48.

Nandrolone (Anabolin LA-100, Androlone D, Deca-Durabolin, Demalon, Dexatopic, Durabolin, Hybolin Decanoate, Nandrolin, Nortestosterone)

2009-03-08T18:24:00.000-07:00

Pronunciation: NAN-droh-lohn
Chemical Abstracts Service Registry Number: 434-22-0. (Decanoate form 360-70-3; furylpropionate form 7642-64-0; phenpropionate form 62-90-8)
Formal Names: Anabolin LA-100, Androlone D, Deca-Durabolin, Demalon, Dexatopic, Durabolin, Hybolin Decanoate, Nandrolin, Nortestosterone
Type: Anabolic steroid.
Federal Schedule Listing: Schedule III (DEA no. 4000)
USA Availability: Prescription
Pregnancy Category: X

Uses.
Nandrolone is used to treat breast cancer and anemia, and the drug has improved asthma and Sjo¨gren’s syndrome, a disease that destroys salivary, sweat, and tear glands. Healing action on cornea afflictions has been observed, and rat experiments have explored nandrolone’s potential for speeding recovery from tooth extractions. A skin cream containing nandrolone is used against eczema. Human research indicates that the drug can improve osteoporosis, a disease causing brittle bones, although results conflict on how long the improvement lasts. Among some diabetics with a kidney condition called Kimmelstiel-Wilson syndrome, nandrolone has helped both renal and eyesight difficulties. In kidney dialysis, patients’ experimental use of nandrolone was able to improve weariness, increase muscle mass, and fight malnutrition.

The compound has helped AIDS (acquired immunodeficiency syndrome) patients build up weight, muscles, and strength. The substance has also been given in hopes of stimulating appetite in malnourished cancer patients, although animal cancer research indicates that any weight gain may simply be due to water retention rather than improved nutrition (in contrast
to research with healthy animals that produced weight increase associated with protein gain—some livestock raisers illegally dose animals with nandrolone to promote growth). After administration of the drug, improvement occurred in a case of anorexia nervosa, a psychological condition in which people with normal or low weight misperceive themselves as fat.

Drawbacks.
Typically, but not always, studies of humans who use nandrolone have measured declines in cholesterol levels (including HDL, the socalled good cholesterol) and elevation of triglycerides (associated with body processes leading to heart attack and stroke). In monkeys, coronary arterydamage appeared after long-term administration of nandrolone. After the drug was given for a year or more to female monkeys they showed abnormalities in the uterus. Female reproductive behavior was disrupted in a rat experiment using doses comparable to what humans take. In humans the substance can promote male characteristics in females (such as facial hair and deeper voice), and in men it can enlarge breasts while diminishing sexual
organs. Other unwanted effects may include acne, aggressive conduct, urinary difficulty, and fluid retention causing tissues to swell. Nandrolone is supposed to be avoided by males suffering from breast or prostate cancer and by anyone with porphyria, liver disease, heart failure, or kidney failure. The drug may interfere with children’s growth and their gender differentiation.

Taking nandrolone without watchful medical supervision can be hazardous. A bodybuilder’s use of nandrolone and other steroids is suspected of transforming a routine case of chickenpox into a nearly fatal experience, requiring over a month of hospitalization in an intensive care unit. Daily nandrolone is suspected of leading to kidney and bone marrow disease that paralyzed a 29-
year-old bodybuilder, although eventually he recovered enough to walk without help.

Abuse factors.
Nandrolone can improve muscle mass, and some athletes use it for that purpose even though sports regulatory agencies forbid use of the compound by competitors. Among athletes tested by the International Olympic Committee in the 1980s nandrolone was the most frequently found
illicit anabolic steroid. The sports ban extends beyond human competitions and includes horse racing; however, an experiment testing thoroughbred racing performance found no effect from the drug.

Research demonstrates that consuming boar meat or taking the nonprescription steroid androstenedione can produce false-positive tests for nandrolone. In theory consumption of horse meat might also produce a false positive, as natural body processes in a horse may produce enough nandrolone to be measurable.

Drug interactions.
The substance can alter the amount of insulin needed by diabetics. Some experimentation on rats found that nandrolone can boost heart rate acceleration caused by cocaine; in other rat work the combination apparently lowered pulse rate. Nandrolone boosts actions of anti–blood clot medicines, putting patients at risk of excessive bleeding.

Cancer.
Judging from decades of medical experience, the compound does not seem to cause cancer.

Pregnancy.
Due to danger of masculinization of offspring, nandrolone is supposed to be avoided by women who are pregnant or nursing.

Additional scientific information may be found in:
Gerritsma, E.J., et al. “Virilization of the Voice in Post-Menopausal Women Due to the
Anabolic Steroid Nandrolone Decanoate (Decadurabolin). The Effects of Medication
for One Year.” Clinical Otolaryngology and Allied Sciences 19 (1994): 79–84.

Gold, J., et al. “Safety and Efficacy of Nandrolone Decanoate for Treatment of Wasting
in Patients with HIV Infection.” AIDS 10 (1996): 745–52.

Johansen, K.L., K. Mulligan, and M. Schambelan. “Anabolic Effects of Nandrolone De canoate in Patients Receiving Dialysis: A Randomized Controlled Trial.” Journal
of the American Medical Association 281 (1999): 1275–81.

“Nandrolone Decanoate.” In Therapeutic Drugs, ed. C. Dollery. 2d ed. New York: Churchill
Livingstone, 1999. N28–N30.

Radis, C.D., and K.P. Callis. “Systemic Lupus Erythematosus with Membranous Glomerulonephritis and Transverse Myelitis Associated with Anabolic Steroid Use.”
Arthritis and Rheumatism 40 (1997): 1899–1902.

Nalbuphine (Nubain)

2009-03-08T18:22:00.000-07:00

Pronunciation: nal-BYOO-feen
Chemical Abstracts Service Registry Number: 20594-83-6. (Hydrochloride form 23277-43-2)
Formal Names: Nubain
Type: Depressant (opioid class).
Federal Schedule Listing: Unlisted
USA Availability: Prescription
Pregnancy Category: B

Uses.
This opioid is considered about as effective as morphine at pain relief and is also used in anesthesia and for sedation. Nalbuphine is used to control substantial pain in conditions ranging from surgery and broken bones to heart attack and sickle cell anemia crisis. Women seem to get more pain relief from the drug than men do. The compound’s anesthetic capabilities have been used in military medicine; one scientific report1 blandly describes nalbuphine usage in cases of “large, multiple gunshot wounds of the trunk and extremities, as well as injuries caused by fragments of projectiles and explosive devices.” The drug is also used in dentistry.

Nalbuphine is a narcotic agonist-antagonist, meaning it has opiate properties itself but can counteract other opiates/opioids, a counteraction sometimes strong enough to cause a withdrawal syndrome if someone has dependence on the other opiate/opioid.

The drug’s safety for administration to children is considered unproven in the United States, but nalbuphine is given to youngsters in America and elsewhere.

Drawbacks.
Unwanted effects include dizziness, perspiration, itching, constipation, nausea, vomiting, and breathing impairment. Hallucinations and euphoria are reported. The drug may interfere with physical and mental abilities needed to operate automobiles or other dangerous devices; tests have demonstrated slower reaction times and impaired decision making among users. The drug can make a person act drunk.

Abuse factors.
Research indicates that nalbuphine injections briefly increase blood levels of growth hormone, an increase that may lead some people to think the drug promotes muscle mass. Reports circulating in bodybuilder circles claim the drug can promote muscle mass in another way also, by reducing
blood levels of a hormone called cortisol. In the 1990s nalbuphine was popular among bodybuilders using anabolic steroids. These individuals mainly used nalbuphine to reduce pain caused by exercise regimens. Interviews with such users revealed that many were suffering unwanted physical and mental effects from nalbuphine and that many of these persons were abusing other drugs as well. A case report tells of illicit nalbuphine injection causing muscle damage— the opposite of what bodybuilders seek.

In low amounts nalbuphine can produce morphine effects. High doses tend to make users feel nervous and uncomfortable, however, reducing nalbuphine’s attractiveness for illicit recreational use. At those higher dosage levels people can experience vision trouble, sleep disturbance, weird dreams, and thoughts running out of control. The drug is generally considered to have a
low potential for abuse, lower than propoxyphene or codeine. Some researchers, however, describe the abuse liability as about equivalent to pentazocine, a drug with a notorious reputation for illicit misuse and that has effects similar to those of nalbuphine. Tolerance and dependence may develop if a person uses nalbuphine in amounts higher than normal medical doses. Withdrawal symptoms are described as those of mild opiate withdrawal.

Drug interactions.
Not enough scientific information to report.

Cancer.
Standard laboratory tests do not indicate the drug has potential for causing cancer. Long-term experiments with rats and mice have failed to produce cancer.

Pregnancy.
Animal research using nalbuphine at high doses has not produced birth defects attributable to the drug. It passes from a pregnant woman into the fetus and can build up there; one study found that newborn levels could be six times higher than maternal levels. Due to effects on the newborn’s heartbeat and breathing, controversy exists about the drug’s appropriateness
for easing pain of childbirth. Some researchers believe the substance is risky during childbirth; some believe nalbuphine is safer than combinations of other drugs. Nalbuphine passes into milk of nursing mothers but is not believed to harm breast-feeding infants.

Additional scientific information may be found in:
Jasinski, D.R., and P.A. Mansky. “Evaluation of Nalbuphine for Abuse Potential.” Clinical
Pharmacology and Therapeutics 13 (January–February 1972): 78–90.

Miller, R.R. “Evaluation of Nalbuphine Hydrochloride.” American Journal of Hospital
Pharmacy 37 (1980): 942–49.

Saarialho-Kere, U. “Psychomotor, Respiratory and Neuroendocrinological Effects of
Nalbuphine and Haloperidol, Alone and in Combination, in Healthy Subjects.”
British Journal of Clinical Pharmacology 26 (1988): 79–87.

Schmidt, W.K., et al. “Nalbuphine.” Drug and Alcohol Dependence 14 (1985): 339–62.
Stambaugh, J.E. “Evaluation of Nalbuphine: Efficacy and Safety in the Management of
Chronic Pain Associated with Advanced Malignancy.” Current Therapeutic Research:
Clinical and Experimental 31 (1982): 393–401.

Wines, J.D., et al. “Nalbuphine Hydrochloride Dependence in Anabolic Steroid Users.”
American Journal on Addictions 8 (1999): 161–64.

Zacny, J.P., K. Conley, and S. Marks. “Comparing the Subjective, Psychomotor and
Physiological Effects of Intravenous Nalbuphine and Morphine in Healthy

Volunteers.” Journal of Pharmacology and Experimental Therapeutics 280 (1997):
1159–69.

Note
1. Rakaric-Poznanovic, M., Z. Boljevic, and D. Marcec. “Anestezija Nalbufin/Propofol
u Kirurskom Zbrinjavanju Ratnih Ozljeda [Nalbuphine/Propofol Anesthesia in
the Surgical Treatment of War Injuries].” Lijecnicki Vjesnik 115 (1993): 303–305. Abstract
in English.

Mothballs

2009-03-08T18:21:00.000-07:00

Pronunciation: MOTH-ballz
Chemical Abstracts Service Registry Number: None
Formal Names: Naphthalene, Paradichlorobenzene
Type: Inhalant.
Federal Schedule Listing: Unlisted
USA Availability: Generally available nonprescription product
Pregnancy Category: None

Uses.
Mothballs typically contain naphthalene or paradichlorobenzene. Neither persons who use mothballs recreationally nor their medical caregivers are always aware of which kind of mothballs have been used. Diaper pail and toilet deodorizers may contain one or the other of those chemicals. Naphthalene varieties look dry, and paradichlorobenzene products appear oily. Normally people inhale fumes, but cases of oral ingestion are known. Naphthalene
can also be absorbed through the skin; an infant died from using diapers and blankets contaminated with the substance. Some glues contain naphthalene, but sensations from glue sniffing are normally considered a result of toluene.

Drawbacks.
Naphthalene may create agitation and tiredness, fever, skin paleness, headache, appetite loss, abdominal discomfort, nausea and vomiting, diarrhea, cataracts, and kidney failure.
Blood disorders serious enough to prevent the body from utilizing enough oxygen from the lungs may arise. The kidney failure can create excessive blood potassium levels, which in turn can cause heart failure. Seizures and coma may also occur. Jaundice is a known
affliction from naphthalene, and a case report notes fatal liver damage.

A case report tells about difficulty with control of fingers due to inhaling mothball fumes. Paradichlorobenzene is not associated with such an affliction, so the problem is assumed to have come from naphthalene mothballs. Compared to naphthalene, harm from paradichlorobenzene normally takes longer to appear but may include liver and kidney malfunction. A case of anemia is known from eating two paradichlorobenzene toilet freshener blocks per week.

Abuse factors.
One person experienced tremors and weariness upon stopping daily oral ingestion of paradichlorobenzene mothballs (which suggests dependence may have developed).

Drug interactions
Not enough scientific information to report.

Cancer.
Naphthalene has not been found to cause cancer. Paradichlorobenzene fumes failed to produce cancer in a short animal test. The disease did develop in mice and rats that received oral dosage, and paradichlorobenzene caused cell mutations (a possible indication of cancer-causing potential) in fungi but not in bacteria. Human risk is unknown.

Pregnancy.
A normal infant was born to a woman who ate one or two paradichlorobenzene toilet fresheners a week during her pregnancy. A pregnant woman who sniffed naphthalene, however, produced a child with skin color typical of naphthalene poisoning and an enlarged liver and spleen. The organs became normal after treatment.

Additional scientific information may be found in:
Athanasiou, M., et al. “Hemolytic Anemia in a Female Newborn Infant Whose Mother
Inhaled Naphthalene Before Delivery.” Journal of Pediatrics 130 (1997): 680–81.
Santucci, K., and B. Shah. “Association of Naphthalene with Acute Hemolytic Anemia.”
Academic Emergency Medicine 7 (2000): 42–47.
Siegel, E., and S. Wason. “Mothball Toxicity.” Pediatric Clinics of North America 33
(1986): 369–74.
Weintraub, E., D. Gandhi, and C. Robinson. “Medical Complications Due to Mothball
Abuse.” Southern Medical Journal 93 (2000): 427–29.

Morphine (Astramorph, Duramorph, Infumorph, Kadian, Kapanol Sevredol, Morphine Sulfate, MS Contin, MSIR, MST Continus, MXL, Oramorph, Roxanol)

2009-03-08T11:20:00.000-07:00

Pronounciation: MOR-feen
Chemical Abstracts Service Registry Number: 57-27-2
Formal Names: Astramorph, Duramorph, Infumorph, Kadian, Kapanol Sevredol, Morphine Sulfate, MS Contin, MSIR, MST Continus, MXL, Oramorph, Roxanol
Informal Names: Cube Juice, Dope, Dreamer, Emsel, First Line, God’s Drug, Hard
Stuff, Hocus, Hows, Lydia, Lydic, M, Miss Emma, Mister Blue, Monkey, Morf,
Morph, Morphide, Morphie, Morpho, Mother, MS, Ms. Emma, Mud, New Jack
Swing (with heroin), Sister, Tab, Unkie, Unkie White, Stuff
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9300)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Morphine was identified as opium’s main active ingredient in the early 1800s. The body transforms a heroin dose into morphine. If stored too long in a water solution, morphine will eventually transform into other chemicals including morphine-N-oxide, a Schedule I controlled substance. Although pharmaceutical supplies of morphine come from opium harvests,
mammals produce small amounts of morphine in their bodies. Thus the substance is a natural product in both the plant and animal kingdoms. The drug can also be created entirely in a laboratory.

Morphine’s role in medicine did not become prominent until the hypodermic needle was introduced in the 1850s. Injection was long the main means of administration, but other delivery systems (such as absorption by the nasal lining and through rectal suppositories) have since been developed. Oral dosage formats are also available.

Morphine is widely used to sedate people and to ease anxiety. The drug is commonly given to treat acute pain from injury or surgery and chronic pain from assorted afflictions. The hurting does not actually go away, but people become less aware of it. In addition to pain control, morphine also has antiinflammatory actions and can suppress coughing.

The drug tends to produce better pain relief in women than in men. A small study examined whether Chinese men respond to morphine differently than white men do: Doses lasted longer in the whites, interfered more with their breathing, and produced greater reduction in their blood pressure.

Drawbacks.
When used to reduce continual pain in serious disease, too much morphine can increase discomfort rather than relieve it and cause a condition in which a patient experiences pain from activity that should not be uncomfortable.

Morphine can make people drowsy, so they should avoid operating an automobile or other hazardous machinery until they know how the drug affects them. Despite morphine’s safety in a medical context, it can be hazardous when injected into fluid circulating through the spinal cord and brain, and if hospital staffs use this technique, they are advised to have resuscitation equipment on hand.

Nausea and vomiting are common unwanted effects from morphine. It promotes constipation and urine retention. Itching and hives can occur. The drug interferes with sexual activity by male rats and lowers testosterone levels in human males. Morphine can impede breathing and often is avoided if a person suffers from asthma. Rats dosed with morphine for six weeks developed a weakened immune system. People can experience seizures and accelerated
heart activity from a strong dose.

Abuse factors.
After several weeks of medical dosage a person can experience noticeable dependence with morphine. Such development should take longer with adulterated street supplies. Medical patients who were surveyed about their experience with morphine claimed to have experienced no difficulty in stopping the drug. Addiction from medical use is almost unheard of.

Normally withdrawal symptoms are a mild version of the opiate withdrawal syndrome. Tolerance is normally described as evidence of drug abuse, but morphine tolerance can develop in persons receiving the drug medically for pain relief. Symptoms of such tolerance include a need to take doses more often and at a higher strength in order to produce the same amount of pain relief. This is notable because tolerance to medical effects of a drug tends to be unusual; perhaps the development indicates a substantial psychological component in morphine’s pain management. Tolerance is commonly observed among addicts, but they do not continually increase their dosage. At some point they generally reach a level adequate to maintain the sensations they seek. In the 1980s a mice experiment indicated that vitamin C may prevent
morphine tolerance and dependence, but judging from subsequent absence of this technique in treating humans, apparently initial hopes for the therapy have not been fulfilled.

One of the main appeals in illicit use of morphine is the drug’s ability to induce calmness. People making unauthorized use of the drug for this purpose are not so much using the drug for recreation as for relieving mental suffering. In some people the drug can cause euphoria, a characteristic that can have appeal strictly for recreation but also for self-medication. In these and other respects, morphine and heroin will appeal to the same sorts of people for the
same sorts of reasons.

For decades morphine addiction was portrayed as the classic kind of drug abuse. Although the substance was unwelcome in the workplace as the twenty-first century began, a century earlier some workers used the drug to increase productivity in both manual and intellectual tasks by relieving tension that otherwise diminished performance. Other pharmaceuticals later superseded that antianxiety function of morphine. Somewhat surprisingly, given morphine’s depressant actions, researchers have found the drug can improve performance on a test of response time in decision making. Other researchers have found no effect on performance in tests of memory, reasoning, muscular coordination, and various additional skills basic to everyday living. Few ill effects seem to come from chronic use of pure morphine (as opposed to adulterated street supplies). Addicts with access to the pure product have lived healthy and productive lives into old age. As drug laws tightened over the past century, use of morphine by ordinary middle-class people declined, shifting the prevalence of nonmedical morphine usage from law-abiding persons into populations with more social deviance. Consequently, illicit use of morphine became more associated with society’s outcasts. That association, however, was caused by changes in laws and social attitudes (changes in setting), not by any chemical effect of the drug.

Drug interactions.
Animal and human experiments show that more pain relief can come from morphine if ephedrine is taken at the same time. Dextroamphetamine can improve pain relief provided by morphine. Alcohol, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs, found in some antidepressants and other medicine) can boost morphine effects. Rat experiments indicate that benzodiazepine class depressants lengthen the effect from a morphine dose. Researchers find that morphine and nicotine have cross-tolerance in mice.

Cancer.
Morphine is not known to cause cancer. Some laboratory tests and some studies of human users, however, detect cell damage that could lead to cancer. Some people smoke morphine, and the smoke is suspected of causing esophageal cancer. Evidence exists that naturally occurring morphine in lung tissue may constrain development of lung cancer, that nicotine counteracts
such protection, and that tobacco smokers have more naturally occurring morphine in their lung tissue than nonsmokers (perhaps because the body increases morphine production when challenged by nicotine). All this evidence, however, involves minute levels of naturally occurring morphine in the body and does not support taking the drug in hopes of avoiding lung cancer.

Pregnancy.
When given in amounts exceeding normal human medical doses by hundreds of times, morphine has caused animal birth defects. Malformations involving bones and soft tissues have been observed in animals. Pregnant rats and hamsters dosed on morphine produce male offspring that exhibit feminized behavior. When morphine was routinely given to male adolescent
rats, the drug seemed to interfere with sexual maturation. As their offspring reached adulthood, they appeared normal but had hormone abnormalities. In humans no increase in birth defects has been observed in offspring of women who used morphine during pregnancy. A morphine dose quickly passes from the woman into the fetus, however, and reaches a blood level
similar to the woman’s. A dose lasts longer in the fetus than elsewhere in a woman’s body. The drug reduces fetal motions. A baby born to a chronic morphine user can have dependence on the drug and exhibit withdrawal symptoms after birth. One study found that infants receiving morphine for medical purposes soon after birth show no ill effects five years later in conduct,
muscular coordination, or intelligence.

Morphine apparently passes into a mother’s milk. One case report described the amount as minimal and found no effect on the nursing infant, but another report tells of an infant receiving so much morphine from milk that dependence developed.

Additional scientific information may be found in:
Hamilton, G.R., and T.F. Baskett. “In the Arms of Morpheus, the Development of Morphine
for Postoperative Pain Relief.” Canadian Journal of Anaesthesia 47 (2000): 367–74.

Hill, J.L., and J.P. Zacny. “Comparing the Subjective, Psychomotor, and Physiological
Effects of Intravenous Hydromorphone and Morphine in Healthy Volunteers.”
Psychopharmacology 152 (2000): 31–39.

O’Neill, W.M., et al. “The Cognitive and Psychomotor Effects of Morphine in Healthy
Subjects: A Randomized Controlled Trial of Repeated (Four) Oral Doses of Dextropropoxyphene,
Morphine, Lorazepam and Placebo.” Pain 85 (2000): 209–15.

Walker, D.J., and J.P. Zacny. “Subjective, Psychomotor, and Analgesic Effects of Oral
Codeine and Morphine in Healthy Volunteers.” Psychopharmacology 140 (1998):191–201.

Zacny, J.P., et al. “Comparing the Subjective, Psychomotor and Physiological Effects of
Intravenous Pentazocine and Morphine in Normal Volunteers.” Journal of Pharmacology
and Experimental Therapeutics 286 (1998): 1197–207.

Morning Glory (Ipomoea hederacea, Ipomoea purpurea, Ipomoea sidaefolia, Ipomoea tricolor, Ipomoea violacea)

2009-03-08T11:16:00.000-07:00

Pronunciation: MOR-neen GLOH-ree
Chemical Abstracts Service Registry Number: None
Formal Names: Ipomoea hederacea, Ipomoea purpurea, Ipomoea sidaefolia, Ipomoea tricolor, Ipomoea violacea
Informal Names: Flying Saucers, Heavenly Blue, Pearly Gates, Tlitliltzin, Yaxce’lil
Type: Hallucinogen.
Federal Schedule Listing: Unlisted
USA Availability: Nonprescription natural product
Pregnancy Category: None

Uses.
Morning glory is a familiar flower. Many varieties exist, and some have drug properties. Although morning glory is an uncontrolled substance, the hallucinogenic varieties contain lysergic acid amide, a Schedule III depressant. Seeds and roots of the Ipomoea hederacea morning glory are used medicinally. The natural product works as a laxative and as a treatment against intestinal worms. Traditional applications include combating flatulence, easing excessive
feelings of fullness after a meal, and treating scabies (a skin disease caused by a parasite).

Albert Hofmann, the discoverer of LSD, became intrigued by accounts of seed called ololiuqui by the Aztecs. Folk medicine used its ointments or potions to treat flatulence, tumors, and venereal disease. Ingesting the seeds allowed Aztecs to commune with their gods, and native peoples still used ololiuqui for that purpose during the twentieth century. Hofmann found that the ololiuqui
seeds of Mexico came from two kinds of morning glory: from Ipomoea sidaefolia (also called Rivea corymbosa) and from Ipomoea violacea (also called Ipomoea tricolor, whose seeds are also known as badoh negro). Seeds from both plants contained ergot chemicals resembling LSD.

Although Ipomoea violacea is often viewed in a drug context, the plant has agricultural usage as a natural means of weed control. Ipomoea purpurea is sensitive enough to airborne chemicals that researchers use it to measure air pollution.

Drawbacks.
Morning glory seeds have been publicized as a substitute for LSD, but no less an authority than Hofmann himself found LSD and morning glory to have different effects. In particular he noted that morning glory emptied thoughts from the mind and made the world seem meaningless, while promoting unease, depression, and a weariness that transformed into sleep.

In addition to being a hallucinogen, LSD has powerful stimulant actions, but when morning glory seed was tested on rats, they became less active than normal and, contrary to what would be expected with a hallucinogen, they showed no change in perceptual abilities. A team of researchers who studied reactions of volunteers described morning glory’s active chemicals as unlike LSD. Those volunteers nonetheless felt some euphoria; they also had a distorted sense of time and a crossover of senses (in which colors might be smelled or sounds might be seen), but hallucinations or alteration of consciousness did not seem to develop. The research team likened morning glory to the drug ibogalin (which lacks significant psychological effect despite its
close relation to ibogaine) and to the drug scopolamine found in belladonna.

A case report about a person being treated for morning glory seed overdose said no hallucinations were present.

Those kinds of observations seem to differ from the effects experienced by the Aztecs and modern native peoples. Indeed, some recreational users (and their medical caregivers) report morning glory experiences quite similar to those of LSD, from hallucinations to philosophical insights—although one short series of case reports about such reactions argued that every instance involved a psychologically abnormal person. Some users describe cold extremities,
a possible sign of ergot poisoning. A case report noted other physical reactions: red face and abdominal discomfort eased by “explosive diarrheic bowel movements.” The patient also had lowered blood pressure and heart rate, opposite to accounts about LSD.

Morning glory seeds purchased from garden stores are not intended for human consumption and may contain fungicides that could harm a person who ingests them, although one investigator doubts a human stomach can hold enough morning glory seeds to cause fatal poisoning from the fungicide coating. Experimenters have fed uncontaminated seed to rats as various percentages
of their diet, from less than 1% up to 8%. After 90 days animals receiving the greatest amount showed a higher death rate than normal, with males more affected than females. Although the animals had less weight gain than would be expected on an ordinary diet, various internal organs enlarged. In addition, liver damage occurred, and blood abnormalities appeared.

Abuse factors.
In the 1960s the British government concluded that morning glory seeds were harmless, but American researchers did not reach a consensus about whether danger existed. Some authorities state that Ipomoea purpurea morning glory seeds lack psychedelic properties, but other authorities say otherwise.

Drug interactions.
Not enough scientific information to report.

Cancer.
The Ames test, a laboratory screen used to test substances for cancer-causing potential, reveals that morning glory seeds have that potential.

Pregnancy.
Lysergic acid amide has damaged embryo development in mice.
Pregnant women are advised to avoid Ipomoea hederacea because it is suspected
of causing birth defects.

Additional scientific information may be found in:
Blum, O., et al. “Ambient Tropospheric Ozone in the Ukrainian Carpathian Mountains
and Kiev Region: Detection with Passive Samplers and Bioindicator Plants.”
Environmental Pollution 98 (1997): 299–304.

Dungan, G.M., and M.R. Gumbmann. “Toxicological Evaluation of Morning Glory
Seed: Subchronic 90-Day Feeding Study.” Food and Chemical Toxicology 28 (1990):
553–60.

Fink, P.J., M.J. Goldman, and I. Lyons. “Morning Glory Seed Psychosis.” Archives of
General Psychiatry 15 (1966): 209–13.

Heim, E., H. Heimann, and G. Lukacs. “Psychotomimetic Effects of the Mexican Drug
‘Ololiuqui.’ ” Psychopharmacologia 13 (1968): 35–48.

Hofmann, A. “Teonanacatl and Ololiuqui, Two Ancient Magic Drugs of Mexico.” Bulletin
on Narcotics 23, no. 1 (1971): 3–14.

Ingram, A.L., Jr. “Morning Glory Seed Reaction.” Journal of the American Medical Association
190 (1964): 1133–34.

“Morning Glory and Hallucinosis.” South African Medical Journal 40 (1966): 1015–16.

Modafinil (Alertec, Modiodal, Provigil)

2009-03-08T11:12:00.000-07:00

Pronunciation: moh-DA-fih-nill
Chemical Abstracts Service Registry Number: 68693-11-8
Formal Names: Alertec, Modiodal, Provigil
Type: Stimulant.
Federal Schedule Listing: Schedule IV (DEA no. 1680)
USA Availability: Prescription
Pregnancy Category: C

Uses.
This drug is a medical treatment for narcolepsy and other conditions involving difficulty in staying awake. The substance also improves vigilance.

In the 1990s U.S. Air Force researchers called for exploration of the drug’s potential in assisting military missions. Investigators have found that the compound may assist aircraft pilots in maintaining a better performance level when deprived of sleep for extended periods. An experiment indicated that the drug can help military personnel engage in sustained operations for 64 hours without sleep, with fewer unwanted effects than amphetamine has. A French military experiment showed the drug could be used along with short naps to permit extended operations without normal sleep periods. Additional study has shown, however, that people using the compound are less aware of reduced quality of performance; in comparison, sleep-deprived individuals who use dextroamphetamine or a placebo have a more accurate assessment
of their capabilities. Thus, from a practical standpoint, sleep-deprived persons using modafinil may be overconfident and try to do things that should not be attempted.

Modafinil is used against obstructive sleep apnea, in which people have temporary breathing stoppages while asleep and which can make them sleepy the next day. Experiments find that although modafinil helps people stay awake, it does not interfere with the quality of their sleep, as dextroamphetamine does. Modafinil has helped patients respond better to antidepressant
therapy while also reducing their feelings of weariness. Favorable results have been seen in experiments using the drug against attention deficit hyperactivity disorder (ADHD) and against organic brain problems caused by alcoholism.

An animal study indicates the substance may have potential for treating Parkinson’s disease. Some authorities speculate that the compound may reduce brain problems caused by aging. Modafinil makes animals more active.

Drawbacks.
Modafinil can produce euphoria in humans. Headache, dry mouth, sore throat, appetite loss, nausea, diarrhea, uneasiness, depression, insomnia, fever, infection, and weakness have been reported by modafinil users. Among cardiac patients, unwanted actions may include heart palpitations, chest pain, and breathing difficulty. High doses have caused tremors, faster pulse rate, high blood pressure, peevishness, confusion, and aggression.

Although the compound is a stimulant, it has a risk of adversely affecting skills needed for operating dangerous machinery such as automobiles. A modafinil dose lasts a shorter time in young females than in young males.

Abuse factors.
Modafinil’s chemical properties reduce or even eliminate its effects if injected or smoked, reducing its convenience for abuse. Studies indicate the drug has less abuse potential than many other stimulants, but monkeys will self-administer modafinil, a traditional sign of addictive potential in a substance. Scientists running one monkey experiment noted, however, that
only massive doses would interest the animals; even an amount of modafinil 200 times the size of a dextroamphetamine dose was not enough to get them to self-administer the two drugs at the same rate. In a rat test the rodents acted like modafinil has some effects reminiscent of cocaine. In one scientific study persons with a history of drug abuse found modafinil’s actions pleasurable and similar to those of methylphenidate. People using modafinil daily
for 9 weeks showed no dependence; and a study of 140 patients who used the drug for varying amounts of time, ranging from 1 month to almost 10 years, revealed no dependence. Tests of humans taking modafinil daily for 40 weeks indicated no development of tolerance.

Drug interactions.
Modafinil can make birth control pills and implants less effective. A laboratory test indicated that the drug may reduce blood levels of cyclosporine, an immunosuppressant used to help organ transplant patients. Modafinil may raise blood levels of diazepam, tricyclic antidepressants, the
anti–blood clot medicine warfarin, and the epilepsy medicine phenytoin.

Cancer.
Laboratory tests have not found indications that modafinil causes cancer.

Pregnancy.
Fetal injury emerged in pregnant rats receiving 10 times the normal maximum human dose of modafinil, but pregnant rabbits receiving the same dosage did not show fetal damage attributable to the substance. At lower doses rat offspring appeared normal, and milk from nursing rats receiving the drug did not seem to harm the pups. Effects on human pregnancy
and milk are uncertain.

Additional scientific information may be found in:
Akerstedt, T., and G. Ficca. “Alertness-Enhancing Drugs as a Countermeasure to Fatigue
in Irregular Work Hours.” Chronobiology International 14 (1997): 145–58.

Baranski, J.V., and R.A. Pigeau. “Self-Monitoring Cognitive Performance during Sleep
Deprivation: Effects of Modafinil, D-Amphetamine and Placebo.” Journal of Sleep
Research 6 (1997): 84–91.

Lyons, T.J., and J. French. “Modafinil: The Unique Properties of a New Stimulant.”
Aviation, Space, and Environmental Medicine 62 (1991): 432–35.

“Modafinil for Narcolepsy.” Medical Letter on Drugs and Therapeutics 41 (1999): 30–31.
Rugino, T.A., and T.C. Copley. “Effects of Modafinil in Children with Attention-
Deficit/Hyperactivity Disorder: An Open-Label Study.” Journal of the American
Academy of Child and Adolescent Psychiatry 40 (2001): 230–35.

Midazolam (Dormicum, Hypnovel, Versed)

2009-03-08T11:09:00.000-07:00

Pronunciation: mid-AZ-ah-lam
Chemical Abstracts Service Registry Number: 59467-70-8. (Hydrochloride form
59467-96-8; maleate form 59467-94-6)
Formal Names: Dormicum, Hypnovel, Versed
Type: Depressant (benzodiazepine class).
Federal Schedule Listing: Schedule IV (DEA no. 2884)
USA Availability: Prescription
Pregnancy Category: D

Uses.
This quick-acting drug’s common medical uses are to reduce anxiety, calm people, and help them sleep. Naturalists use the substance to knock out wildlife ranging from foxes to aardvarks.

Effects do not last a long time, typically making the substance a good choice for weakened persons or animals who would be strained by a longer-acting drug. For example, weary mountaineers climbing Mt. Everest have used the drug to improve quality of sleep.

One study found the drug could help workers who must alter their sleep schedules for reporting to different work shifts. Experiments show the drug having potential for treating muscle spasms. Midazolam has been used successfully to alleviate status epilepticus, in which people have continual seizures, and to control seizures caused by high fevers in children.

The U.S. Army has tested midazolam experimentally, but with limited success, to counteract
seizures and other poisonous effects from the chemical warfare substance soman. A case report about treating a cobra snake bite victim notes that midazolam worked when another drug faltered. Midazolam reduces blood pressure. The compound is routinely given to people before surgical, dental, or uncomfortable medical procedures and is used to relieve pain in
afflictions and after surgery. Midazolam can produce amnesia about events that occurred while under the drug’s influence and may be able to interfere with remembering things that occurred shortly before the drug was received. That amnesia action can be beneficial in reducing stress from medical treatments but might also be used by unscrupulous persons wanting to exploit
someone.

Drawbacks.
When injected intravenously the drug can be so hazardous that in some instances a resuscitation specialist must be on hand with the exclusive duty of monitoring the patient’s condition at all times. Without that precaution people have suffered crippling brain damage or death from respiratory arrest caused by the drug while a medical procedure was being performed.

Respiratory emergencies have also occurred from oral dosage. Midazolam is not recommended for persons suffering from breathing trouble. Nonetheless, despite the drug’s potential hazards, examination of 5,439 records of patients receiving the drug at one hospital revealed only 3 instances of respiratory arrest. Examination of 9,842 medical records of persons who received midazolam in 14 hospitals did not reveal serious respiratory events caused by the drug; indeed, the study concluded that people were more likely to die from diazepam. That conclusion, of course, was based on administration of the drugs in a medical setting, not misuse on the street.

A rat study found the drug to have “minimal” ability to cause brain damage, and then only in older rats, even after four months of daily dosing. In a subsequent and related report investigators stated flatly that the drug does not cause brain damage, although once again slight differences were observed when older rats were compared to others.

Researchers have noted that midazolam harms white blood cells. Other unwanted effects include headache, coughing and hiccups, nausea, and vomiting. Less commonly, the drug can prompt euphoria, hallucinations, tremor, rapid heartbeat, discomposure, and aggression. Two researchers tracking violent deaths in Finland concluded that the drug was found in victims more often than would be expected through chance occurrence. Hallucinations by surgical patients have occurred often enough and can be realistic enough (such as patients perceiving imaginary sexual assault by medical personnel) that medical staff have been advised to have someone witness all contact with patients receiving the drug.

Midazolam lengthens reaction times, although two experiments found that users performed normally 4 hours after a dose such as a patient would receive for outpatient surgery. Those findings are supported by other studies as well, including one using test equipment to measure performance of commercial airline pilots. Nonetheless, persons are supposed to avoid activity requiring careful vigilance (such as driving) for at least 24 hours after taking midazolam.
A small study found that a dose of midazolam produces higher blood levels of the drug and lasts longer in ethnic Mexicans than in ethnic whites.

Abuse factors.
Among monkeys dependence has been established with the drug after 5 to 10 weeks of steady dosage. Sudden cessation of dosage can provoke a withdrawal syndrome: perspiration, tremors and cramps, vomiting, convulsions, and hallucinations. The syndrome can be avoided by gradually reducing drug use instead of stopping all at once. Some researchers believe tolerance has been demonstrated. The substance is considered to have at least the same addiction potential as diazepam, which is three or four times weaker than midazolam.

Drug interactions.
In some circumstances midazolam can lower blood pressure drastically and cause seizures; administering the drug with fentanyl or other opiates can increase the likelihood of such severe actions. Rat experiments unexpectedly found that the stimulant caffeine boosts difficulties in
movement caused by midazolam, and cocaine also worsened that performance.

Opiates or alcohol can deepen some midazolam effects in humans, and rat experiments find that midazolam makes alcohol more appealing. The HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) drug saquinavir and the antibiotic erythromycin increase midazolam levels in the body and make effects last longer. The antacid and ulcer medication cimetidine (such as Tagamet) can lengthen sedation from a midazolam dose. Some research indicates that drinking grapefruit juice increases midazolam’s ability to act upon a person, but other research does not support that finding. The tuberculosis medicine rifampin and the epilepsy drugs phenytoin and carbamazepine diminish midazolam’s effectiveness.

Cancer.
Rat and mice experiments have produced no cancer even when midazolam was given daily for two years at 25 times the recommended human dose. The same usage of the drug at about 225 times the recommended human dose, however, produced liver and thyroid tumors. Relevance of the latter outcome to human medical use, involving normal dosage and typically using the drug for one day, is unclear. Gene mutations are considered an element in causing cancer, and midazolam did not produce mutations in assorted standard tests, nor were they observed in a study of patients receiving the drug.

Pregnancy.
The drug has been given to mice, rats, and rabbits at 5 to 32 times the normal human dose without producing birth defects. Researchers conducting one experiment concluded, however, that the drug altered behavior of mice after fetal exposure (making males more uneasy and females less uneasy) while slowing their development. Tests indicate that the drug will
pass from a pregnant woman into the fetus. The substance has been successfully
used to treat eclampsia, a serious disease of late pregnancy involving convulsions, but midazolam is generally not desirable for pregnant women.

The drug passes into the milk supply of nursing mothers, and caution is recommended about breast-feeding in such circumstances.

Additional scientific information may be found in:
Curran, H.V., and B. Birch. “Differentiating the Sedative, Psychomotor and Amnesic
Effects of Benzodiazepines: A Study with Midazolam and the Benzodiazepine
Antagonist, Flumazenil.” Psychopharmacology 103 (1991): 519–23.

Dundee, J.W. “Fantasies during Sedation with Intravenous Midazolam or Diazepam.”
Medico-Legal Journal 58 (1990, pt. 1): 29–34.

Gupta, A., et al. “The Effects of Midazolam and Flumazenil on Psychomotor Function.”
Journal of Clinical Anesthesia 9 (1997): 21–25.

Kelly, D.J., et al. “The Effects of Midazolam on Pure Tone Audiometry, Speech Audiometry,
and Audiological Reaction Times in Human Volunteers.” Anesthesia and
Analgesia 88 (1999):1064–68.

Langlois, S., et al. “Midazolam: Kinetics and Effects on Memory, Sensorium, and Hemodynamics.” British Journal of Clinical Pharmacology 23 (1987): 273–78.

“Midazolam.” Medical Letter on Drugs and Therapeutics 28 (1986): 73–74.

Nordt, S.P., and R.F. Clark. “Midazolam: A Review of Therapeutic Uses and Toxicity.”
Journal of Emergency Medicine 15 (1997): 357–65.

Methyltestosterone (Android, Estratest, Methitest, Testred, Virilon)

2009-03-08T11:05:00.000-07:00

Pronunciation: meth-ill-tess-TOSS-ter-ohn
Chemical Abstracts Service Registry Number: 58-18-4
Formal Names: Android, Estratest, Methitest, Testred, Virilon
Type: Anabolic steroid.
Federal Schedule Listing: Schedule III (DEA no. 4000)
USA Availability: Prescription
Pregnancy Category: X

Uses.
Methyltestosterone is a synthetic drug manufactured from testosterone.
Methyltestosterone’s medical uses include supplementation of testosterone in males with low levels of that hormone and treatment of female breast cancer. Scientists report unsatisfactory results from a test of whether the compound might work as a male contraceptive and mixed results when the substance was used to treat male impotence. Impotence improvement was better when methyltestosterone was taken in combination with a yohimbe preparation.

Methyltestosterone has provided pain relief and occasionally fertility enhancement to women suffering from a reproductive disorder called endometriosis externa. Therapeutic regimens to build up bone strength in older women may include methyltestosterone, as may therapies designed to compensate for hormonal changes caused by menopause. In research projects
height increase occurred when the drug was administered to boys of short stature. Experimenters describe the drug as effective treatment for hereditary angioedema, an affliction involving tissue swelling. The drug also has agricultural uses such as illegally promoting pig and cattle growth.

Drawbacks.
Volunteers who took methyltestosterone in an experiment showed slight changes in thinking ability, and 2 of the 20 subjects had maniclike episodes that might be attributable to the drug. A report noted that someone receiving the drug experienced visual and auditory hallucinations,
and a case report indicated that methyltestosterone and methandrostenolone were likely causes of psychotic incidents experienced by two bodybuilders. A human experiment attempted to document the drug’s psychological effects but was unable to correlate behavioral changes with volunteers’ usage of the substance. The substance is suspected of causing liver damage, sometimes resulting in jaundice, lesions, tumors, or other conditions. The compound may
cause fluid retention, which can be risky for persons with kidney, liver, or heart malfunction.

Like many drugs of this type, methyltestosterone can cause females to develop masculine characteristics such as facial hair or coarser voice. Such effects can become permanent if dosage is not swiftly stopped upon first appearance of the changes. Other unwanted actions of the drug can include acne, headache, uneasiness, burning or prickling sensations, menstrual disturbances, nausea, and high blood levels of calcium and cholesterol. In rats high blood pressure has been traced to methyltestosterone.

Abuse factors.
Methyltestosterone is banned from athletic competitions, but some athletes are tempted to use it, nonetheless. Claims that the compound produces gains in weight and muscle strength have been difficult to document in humans, partly because experimenters cannot subject humans to experimental conditions that are as brutal as can be used with laboratory animals.

A robust experiment on rats demonstrated increased strength and stamina from methyltestosterone.

Drug interactions.
A case report mentions that a person using the hormone along with the anticholesterol medicine clofibrate developed extremely low levels of high-density lipoprotein (the so-called good cholesterol), a development attributed to methyltestosterone. A similar result occurred in an experiment tracking women using this anabolic steroid along with female hormones called esterified estrogens. Methyltestosterone interferes with blood clotting, which can be a serious problem for persons taking anticlotting medicine. A case report indicates that the substance interacts badly with cyclosporine, an immunosuppressive agent used to fight rejection of organ transplants. A small experiment using methyltestosterone to increase benefits from the tricyclic antidepressant imipramine went awry when almost all patients became paranoid, a condition that rapidly disappeared when methyltestosterone dosage stopped.

Cancer.
Researchers have noted liver cancer in mice that received methyltestosterone. Other case reports indicate strong suspicion that the drug causes human liver cancer. The substance has been associated with a person’s development of prostate cancer, but “association” is not the same as cause.

Pregnancy.
Women are advised to avoid the drug during pregnancy because the substance may masculinize a female fetus, a discovery made in the 1950s when methyltestosterone was a standard medication for reducing the likelihood of miscarriage. Nursing mothers are advised to avoid the drug because it might pass into milk and masculinize a female infant. These effects of the drug are powerful enough that methyltestosterone is used in tilapia farming to change females of this fish into males. The drug has also been used to change female flounder into male fish. Research on rats has demonstrated that masculinizing effects on females can persist into a subsequent generation that did not receive the drug. Human males who use the substance may produce
more male offspring than usual.

Additional scientific information may be found in:
Black, J.A., and J.F. Bentley. “Effect on the Fetus of Androgens Given During Pregnancy.”
Lancet 1 (1959): 21–24.

Greene, R., and L.S. Carstairs. “Effect of Anabolic Hormones on the Growth of Undersized
Boys.” British Journal of Clinical Practice 27 (1973): 3–7.

Regestein, Q.R., et al. “Neuropsychological Effects of Methyltestosterone in Women
Using Menopausal Hormone Replacement.” Journal of Women’s Health & Gender-
Based Medicine 10 (2001): 671–76.

Richardson, J.H., and S. Smith. “A Comparison of the Effects of Dianabol and Methyltestosterone
on Muscle Contraction and Fatigue.” Journal of Sports Medicine and Physical Fitness 21 (1981): 279–81.

Simon, J.A. “Safety of Estrogen/Androgen Regimens.” Journal of Reproductive Medicine
46 (2001 Supp. 3): 281–90.

Su, T.P., et al. “Neuropsychiatric Effects of Anabolic Steroids in Male Normal Volunteers.”
Journal of the American Medical Association 269 (1993): 2760–64.

Westaby, D., et al. “Liver Damage from Long Term Methyltestosterone.” Lancet 2
(1977): 261–63.

Wilson, I.C., A.J. Prange, and P.P. Lara. “Methyltestosterone with Imipramine in Men:
Conversion of Depression to Paranoid Reaction.” American Journal of Psychiatry
131 (1974): 21–24.

Methylphenidate (Concerta, Metadate CD, Metadate ER, Methylin, Ritalin)

2009-03-08T11:01:00.000-07:00

Pronunciation: meth-ill-FEN-i-dait
Chemical Abstracts Service Registry Number: 113-45-1. (Hydrochloride form 298-59-9)
Formal Names: Concerta, Metadate CD, Metadate ER, Methylin, Ritalin
Informal Names: Pellets, Rities, West Coast. Combination with pentazocine: Crackers, 1s & 1s, Poor Man’s Heroin, Ritz & Ts, Sets, Ts & Rits, Ts & Rs.
Combination with heroin: Speedball
Type: Stimulant (amphetamine class).
Federal Schedule Listing: Schedule II (DEA no. 1724)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Methylphenidate became available in the 1940s. The drug is fast acting and long lasting. Although not a true amphetamine, methylphenidate has properties similar to dextroamphetamine (including appetite suppression and sleep disruption) but is less potent.

Methylphenidate’s prime medical use is for managing attention deficit hyperactivity disorder (ADHD), a condition in which people are so excitable that they have severe problems with social interactions. The affliction is more common in children than adults, and methylphenidate seems more effective against ADHD in children, though one study finds the drug to have little influence on long-term outcome. Limited success is seen in experimental usage of the drug to help autistic children. A case report says a regimen of that drug and the antidepressant sertraline (Zoloft) cured a young kleptomaniac. Among adults methylphenidate is typically prescribed for narcolepsy and has also been used successfully against apathy and depression. Despite the drug’s occasional tendency to increase blood pressure, studies find the substance promising
for rehabilitation of persons recovering from stroke and other brain injuries, not only improving mood but also helping ability to move.

In volume of use, methylphenidate has been called the predominant medically prescribed psychoactive drug among American juveniles. A survey of approximately 200,000 prescription records of preschool children found about 1% of them to be receiving stimulants in the 1990s, and almost all those prescriptions were for methylphenidate. By the decade’s end, two medical authorities put the school-age population’s stimulant prescription figure as high as 6%. In the mid-1990s approximately 1.5 million American school-age children were taking stimulant medications just for ADHD, compared to 50 children receiving methylphenidate for any purpose in Great Britain in 1991.

Another comparison:
A 1999 report said 1.65% of students in one South African urban area were receiving methylphenidate, but none of these children were Afrikaans. Such dramatic differences in prescribing practices suggest strong cultural influence on what is considered acceptable medical treatment.

During the mid-1980s great debate arose in the United States about the custom of routinely prescribing methylphenidate to juveniles. The debate was based on ethical values rather than strictly medical concerns, with some persons arguing that the drug was being used as an agent of social control instead of treating disease. After a flurry of lawsuits, the controversy eased.

A review of 23 studies evaluating ADHD drug effectiveness found little distinction among methylphenidate, dextroamphetamine, and pemoline.

Drawbacks.
Children with ADHD may also experience muscle tics, which methylphenidate and other stimulants can worsen. Such a dual condition is challenging, but in short-term usage, methylphenidate has been found effective for lessening ADHD without increasing tics, even though one study found that almost 10% of ADHD children may develop temporary tics when taking methylphenidate. A case report notes that a child began stuttering when dosage
started, with the stutter ceasing when dosage ceased.

Amphetamine class drugs can promote psychosis and other psychiatric disability, and such unwanted results have been observed with methylphenidate, including paranoia and hallucinations. In youngsters methylphenidate has been known to bring on obsessive-compulsive behavior.

Among juveniles the compound has caused skin rash, stomach distress, mild headaches, and sleep difficulties. In juveniles the compound can at least temporarily reduce appetite, although in elderly users the drug has been observed to increase appetite. Controversy exists about whether the drug affects growth. The substance is associated with stroke suffered by two boys.

Methylphenidate is not recommended for persons suffering from seizures.
The drug has been reported to cause anemia and is suspected of worsening allergies. The substance has been known to impair vision and is not recommended for persons with glaucoma.

Methylphenidate tends to increase immune system activity; in theory that might affect vaccinations and also harm HIV (human immunodeficiency virus)-positive persons. In some humans abnormal liver activity has been seen, but whether the drug caused or revealed
the problem is uncertain. The drug appears to cause heart damage in rats and mice, and a human case has been reported.

Despite potential drawbacks, however, with proper precautions the drug is considered generally safe for medical utilization.

Abuse factors.
In primates cocaine and methylphenidate seem to work in similar ways; indeed, some illicit substance users have been unable to tell whether they received a dose of cocaine or methylphenidate. Although methylphenidate is a Schedule II substance, abuse of the drug is uncommon. Demand is small enough that the U.S. Drug Enforcement Administration reports
no illicit manufacturing. A large review of scientific literature covering the years 1966 to 1998 was unable to substantiate news media claims about wide abuse. A survey of 161 children receiving the medication found none who believed they were at risk of becoming abusers (a belief sustained by general experience nationwide), although about 25 had encountered situations where someone wanted access to their drug supply. The oral format has little ability
to produce euphoria. The drug has been called a more potent hallucinogen than LSD, but support for that claim seems nonexistent in scientific journals.

Adults suffering from ADHD are routinely found to be cocaine abusers. An experiment showed methylphenidate effective for improving both problems, but the treatment was also accompanied by several weeks of individual counseling, which in itself might have been a major factor in any improvement.

Some drug abuse treatments seek to switch abusers from one drug to another. Results of an experiment were unencouraging for shifting cocaine abusers to methylphenidate but had intriguing findings nonetheless. For example, cocaine addicts are generally considered particularly susceptible to addictive properties in other drugs, but methylphenidate had little appeal to subjects in this experiment. The experiment also found mental effects of methylphenidate to include irritability, worry, sadness, and a general mood of dissatisfaction.

Physical effects included quivering and accelerated pulse rate. Still, even though these cocaine users found methylphenidate unappealing, methylphenidate is not recommended for any medical treatment in persons with a history of substance abuse.

Experimenters using methylphenidate to help smokers give up tobacco found the results encouraging.

Methylphenidate abusers sometimes grind up oral tablets and inject the material. A preparation designed to go through the digestive system can have untoward consequences in the circulatory system. The talc in oral methylphenidate can lodge in small blood vessels, cutting off blood flow to portions of the lungs, eyes, or brain. Respiratory difficulty, vision damage, and crippling
paralysis can result. Studies of such injuries sometimes refer to autopsy results; such reference implies that this type of drug abuse is dangerous indeed.

Tolerance has been noted from illicit usage. Intense depression can emerge when an abuser stops using the drug.

Drug interactions.
Apparently methylphenidate interacts with valproic acid, a substance used to treat epilepsy in ADHD children; the interaction can cause teeth grinding and interfere with body movement. Interaction with serotonin reuptake inhibitors found in some antidepressants is suspected of causing heartbeat irregularity in a teenager, and methylphenidate is not recommended
for persons taking monoamine oxidase inhibitors (MAOIs, found in some antidepressants). High blood pressure can occur if tricyclic antidepressants are used with methylphenidate, and methylphenidate also seems to reduce time needed for tricyclic antidepressants to show results; lower doses of those drugs are advised when a person is taking methylphenidate. Interactions with phenobarbital have been observed. Methylphenidate has allowed terminal cancer patients to tolerate higher doses of opiates, thereby improving pain management.

Cancer.
Scientists looking for evidence that methylphenidate causes cancer in rats and humans have instead found lower-than-normal incidence of thedisease. In one experiment mice developed liver tumors after receiving many times the therapeutic dose, but the strain of mice used is prone to such tumors, so scientists are uncertain about what the experiment means.

Pregnancy.
An experiment using mice found the drug to have no effect on reproduction. Studies of pregnant women abusing methylphenidate find no birth defects associated with the drug, but babies tend to be small and premature. A one-year follow-up found the infants to be in the normal range of
development, although some were at the low end of normal. In one study all the pregnant women abusing methylphenidate were cigarette smokers; some were alcoholics; some had sexually transmitted disease; few received much prenatal care. In another study the methylphenidate-abusing mothers’ situations were so grim that over half the infants were put into immediate foster care after delivery and did not go home with their mothers. Such confounding factors cloud any conclusions about the drug’s effect on fetal development.
Whether levels in breast milk are safe for infants is unconfirmed.

Additional scientific information may be found in:
Cox, D.J., et al. “Effect of Stimulant Medication on Driving Performance of Young
Adults with Attention-Deficit Hyperactivity Disorder: A Preliminary Double-
Blind Placebo Controlled Trial.” Journal of Nervous and Mental Disease 188 (2000):
230–34.

Crutchley, A., and J.A. Temlett. “Methylphenidate (Ritalin) Use and Abuse.” South
African Medical Journal 89 (1999): 1076–79.

Debooy, V.D., et al. “Intravenous Pentazocine and Methylphenidate Abuse during
Pregnancy. Maternal Lifestyle and Infant Outcome.” American Journal of Diseases
of Children 147 (1993): 1062–65.

Efron, D., F.C. Jarman, and M.J. Barker. “Child and Parent Perceptions of Stimulant
Medication Treatment in Attention Deficit Hyperactivity Disorder.” Journal of
Paediatrics and Child Health 34 (1998): 288–92.

Jadad, A.R., et al. “Treatment of Attention-Deficit/Hyperactivity Disorder.” Evidence
Report/Technology Assessment, no. 11 (1999): 1–341. Issue no. 11 is available online
at: http://hstat.nlm.nih.gov/ftrs/dbaccess/adhd

Llana, M.E., and M.L. Crismon. “Methylphenidate: Increased Abuse or Appropriate
Use?” Journal of the American Pharmaceutical Association 39 (1999): 526–30.

Parran, T.V., Jr., and D.R. Jasinski. “Intravenous Methylphenidate Abuse. Prototype
for Prescription Drug Abuse.” Archives of Internal Medicine 151 (1991): 781–83.

Scarnati, R. “An Outline of Hazardous Side Effects of Ritalin (Methylphenidate).” International
Journal of the Addictions 21 (1986): 837–41.

Methcathinone (Ephedrone, Methylcathinone)

2009-03-08T10:56:00.000-07:00

Pronunciation: meth-KATH-i-nun
Chemical Abstracts Service Registry Number: 5650-44-2
Formal Names: Ephedrone, Methylcathinone
Informal Names: Bathtub Speed, C, Cadillac Express, Cat, Crank, Gager, Gagger, Go Fast, Goob, Jeff, Khat, Qat, Quicksilver, Slick Superspeed, Somali Tea, Star, Stat, Tweak, Tweek, Tweeker, Wild Cat (with cocaine), Wonder Star
Type: Stimulant (amphetamine class)
Federal Schedule Listing: Schedule I (DEA no. 1237)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
The substance is derived from cathinone (the most potent drug ingredient in khat) and is related to methamphetamine. A U.S. patent was granted for methcathinone in 1957, but because of adverse actions described below the drug never went into commercial medical production.

Despite methcathinone’s many drawbacks noted below, some drug abusers have found appealing aspects in the compound. These users experience euphoria accompanied by strong and prolonged feelings of sexual pleasure, along with an ability to use more alcohol than normal. Such characteristics can transform an otherwise unappealing substance into a party drug. Apparently
these characteristics were discovered in the Soviet Union; at least that is where the drug first surfaced as a popular item, accounting for perhaps one fifth of illicit drug use in that territory during the late 1980s and early 1990s. In the 1990s the drug took hold in Michigan and spread elsewhere in America.

Drawbacks.
At high doses the drug exhibits classic amphetamine effects: appetite loss, insomnia, hallucinations, paranoia, restlessness, and impaired ability to focus attention and to get along with people. Users have said methcathinone is more prone to produce paranoia than methamphetamine. In animal experiments methcathinone interferes with breathing, promotes trembling and epilepticlike seizures, and impedes limb control. In humans a dose may increase body temperature, cause irregular heart rate, excessively reduce blood pressure, bring on nosebleeds, produce red and blue spots in extremities accompanied by cold sweating, promote tics and cramps along with nausea and headaches, generate evidence of liver and kidney damage, and cause infected facial cysts that can leave scars. Heart impairment has been discovered
among current users. Examination of former users reveals brain damage that may lead to Parkinson’s disease. Autopsies find widespread blood vessel damage throughout the body, from skin to vital organs.

Abuse factors. When effects from a dose ebb, the drug’s initial elevation of mood converts into the opposite, and abusers lacking in self-confidence may rely more and more on additional doses of the drug to restore a positive mood instead of seeking to build and rely upon inner resources. As mental spirits level off or decline, abusers respond with binge behavior—rather than gradually increasing their dosage, they alternate between heavy use and no use.

They may take the drug every hour or so for days even though users report that effects of a dose can last for almost a week.

A group of 19 users compared methcathinone with other drugs. Those persons described methcathinone’s stimulation as more of a physical jolt and cocaine’s as more of a mental jolt. None of cocaine’s physical numbing was noticed with methcathinone. The latter drug was described as stronger, cheaper (at least in the 1990s), and having better duration than cocaine. The 19 persons all misused methcathinone in ways that added turmoil to their lives and said their need for the drug was psychological, not physical. The users mostly said the drug had ruined their lives. Those lives seemed troubled before methcathinone entered, however. Only 4 of the persons were employed when they started using the substance. Relationships with family and friends declined, but that decline was accelerated by explosive anger and by deliberately
avoiding friends and relatives. The employed persons got into conflicts with coworkers or stayed away from the workplace. All lost their jobs. No doubt the drug made things worse, but abusers seemed to be struggling with sad lives before adding methcathinone to other drugs they abused.
Drug interactions. Users claim that eating sugar can worsen methcathinone’s undesirable psychological effects.

Cancer.
Not enough scientific information to report.

Pregnancy.
Not enough scientific information to report.

Additional information.
“Qat” and “Somali tea” are nicknames for both methcathinone and khat, but those are different substances.

Additional scientific information may be found in:
Calkins, R.F., G.B. Aktan, and K.L. Hussain. “Methcathinone: The Next Illicit Stimulant
Epidemic?” Journal of Psychoactive Drugs 27 (1995): 277–85.

Emerson, T.S., and J.E. Cisek. “Methcathinone: A Russian Designer Amphetamine Infiltrates
the Rural Midwest.” Annals of Emergency Medicine 22 (1993): 1897–903.

Goldstone, M.S. “ ‘Cat’: Methcathinone—A New Drug of Abuse.” Journal of the American
Medical Association 269 (1993): 2508.

Zhingel, K.Y., et al. “Ephedrone: 2-Methylamino-1-Phenylpropan-1-One (Jeff).” Journal
of Forensic Sciences 36 (1991): 915–20.

Methaqualone (Dormutil, Hyminal, Mandrax, Melsed, Melsedin, Mequelone, Mequin)

2009-03-08T10:51:00.000-07:00

Pronunciation: meth-a-KWAY-lohn
Chemical Abstracts Service Registry Number: 72-44-6
Formal Names: Dormutil, Hyminal, Mandrax, Melsed, Melsedin, Mequelone, Mequin, Methadorm, Mozambin, Optimil, Parest, Quaalude, Revonal, Somnafac, Sopor, Toquilone Compositum, Triador, Tuazole

Informal Names: Bandits, Beiruts, Blou Bulle, Blue Bulls, Drunken Monkey, Ewings, Flamingos, Flowers, Four Strokes, Genuines, Germans, Golfsticks, Humbles, Knoppies, Lizards, Loss of Memory, Love Drug, Ludes, Luds, Lula, Magwheels, Mandies, Mind Benders (with heroin), Pressouts, Pupumala, Q, Randy Mandies, 714, Shiny Tops, Sopes, Sporos, Strawberries, Wagon Wheels, White Pipe (Mandrax and marijuana)

Type: Depressant.
Federal Schedule Listing: Schedule I (DEA no. 2565)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
Methaqualone was invented in India during the 1950s as part of a program seeking substances for treating malaria. Experiments suggest methaqualone has anticonvulsant properties. Although the substance does little to relieve pain, experimentation indicates it might boost pain relief provided by codeine. Methaqualone may have cough suppression qualities but has not
received general medical usage for that purpose. When introduced into American medicine in the 1960s, the compound was used to calm people and help them sleep and was welcomed as an alternative to barbiturates. The drug’s actions have been likened to those of pentobarbital.

A clinical experiment found that a bedtime dose of the drug did not affect users’ ability to move around after awakening the next morning, which is not always the case with insomnia medicine. Those results were supported by another experiment where volunteers did so well on tests the next day and the following day that the researchers optimistically speculated that job performance might improve among people using the drug against insomnia. Britain’s Royal Air Force even thought the drug had potential to help pilots get proper rest on long missions.

Drawbacks.
Unwanted actions of methaqualone may include tingling sensations in hands and feet, weariness, sweating, rashes, dry mouth, nausea, vomiting, and diarrhea. Instances are known of methaqualone causing people to act as if injury has occurred to nerves affecting the arms and legs. Poisoning by methaqualone is associated with bleeding, and a case report revealed that
an overdose can even cause bleeding inside the eye. Research with rats showed the drug impeded learning ability.

Although fatal overdose with methaqualone or any other drug is possible, a 1983 study found that methaqualone users in that era were primarily dying from accidents involving poor decisions while under the drug’s influence rather than from the poisonous effects of the drug itself. Also, if someone is intoxicated with the compound, driving skills are known to be impaired, an effect that does not involve poisoning but can have serious consequences. A study of emergency room admissions found that methaqualone poisoning cases typically involved some other substance as well, a finding indicating a certain recklessness among abusers. The same polydrug habit was observed among methaqualone abusers in the U.S. Army during the 1970s.

That finding is unsurprising; most drug abusers use more than one substance. The drug is fast acting, and persons unprepared for the speed with which methaqualone takes effect have been injured while engaged in ordinary activity that becomes dangerous if a person passes out, such as taking a bath or being near a fire. Methaqualone has the disturbing capability of causing flat
brainwave readings, a standard sign that medical caregivers rely upon to verify a person’s death and that could therefore cause them to stop efforts that are keeping the methaqualone patient alive.

Abuse factors.
In Europe methaqualone was initially a nonprescription item. In the United States the drug was first put in Schedule V, but as methaqualone became popular among illicit users seeking euphoria and relaxation, more restrictions were placed on its legal accessibility. The drug became a Schedule II substance in 1973. When President Jimmy Carter’s drug policy adviser Dr.
Peter Bourne wrote a methaqualone prescription that violated regulations, that incident started a series of events that hounded Bourne out of office. Eventually concern about the drug grew so high that it was reclassified in 1984 as a Schedule I substance having no recognized medical function.

One study found that patients using methaqualone against insomnia readily changed to some other drug on advice from a medical practitioner; apparently they did not find methaqualone particularly attractive. Tolerance and dependence can develop, although one study was able to confirm tolerance only among heavy abusers. Withdrawal symptoms are similar to those with barbiturates and can include weakness, nausea, vomiting, heartbeat abnormality, tremors, seizures, and delirium tremens.

In the 1970s researchers surveyed college students who were using methaqualone, a broader population group than persons who have so much trouble with the drug that they seek medical treatment. Survey answers showed drug use to be the main difference between students who used methaqualone and those who did not; as a whole the methaqualone users were ordinary people. Investigators found that a cross section of Midwestern users had positive attitudes
about themselves.

An exception to such a self-portrait emerged when someone interviewed users who claimed to be using methaqualone as an aphrodisiac. They turned out to be loners with a cold family background: Fully 10% said their closest family relationship was with the dog; 30% said they weren’t close to any family member at all. Almost all the persons using methaqualone as an “aphrodisiac” had previously been using other drugs for the same purpose. None of the persons seemed capable of intimacy while sober, and all used methaqualone and other substances simply to get intoxicated enough to permit some form of temporary superficial imitation of intimacy. Such drug use has an air of desperation and sadness inconsistent with the normal understanding of what an aphrodisiac does.

One study found that emergency psychiatric hospital patients who abused methaqualone (definitely not a population of ordinary individuals) tended to menace other persons.

Drug interactions.
Animal research shows that injection of THC, the main active component of marijuana, reduces the amount of methaqualone that is normally needed to get the drug’s effects, which can make an overdose more likely. Animal and human studies using alcohol have had the same effect on
a methaqualone dose—such findings are supported by examination of hospital emergency room cases, where analysis showed that methaqualone emergencies typically involved simultaneous ingestion of alcohol. Using alcohol and methaqualone simultaneously is a practice called “luding out.” Indulgers in that technique say it makes them feel relaxed, interferes with their ability to
move, makes them more tolerant of pain, and produces tingling in their fingers, lips, and tongue.

Tests can detect methaqualone in the body days after a dose, and alcohol lengthens the time that a methaqualone dose lasts. That combination can influence performance on various behavior and performance tests even three days after methaqualone is taken.

A woman’s menstrual cycle can affect her body’s ability to metabolize methaqualone; a dose can last a much shorter time when she is ovulating, but oral contraceptives can eliminate that effect.

Cancer.
Not enough scientific information to report.

Pregnancy.
The drug has produced birth defects in rats, and offspring had a death rate four times higher than that of a matched group receiving no drug.

Researchers doing that work cautioned that the results do not necessarily carry over to humans. In rabbit studies the rate of birth defects from pregnant females receiving methaqualone did not significantly differ from drug-free females, but there was a big difference in death rates of offspring. Rabbits with fetal exposure to methaqualone died three times as often as those without exposure, a 6% death rate for those with exposure and 2% for those without.
Analysts of such experiments note that in order to harm a fetus the methaqualone dose has to be high enough to poison the pregnant female, so the practical meaning of such results may be that normal doses of the drug are safe during pregnancy. Effects on human fetal development are unclear. Human reports tend to involve combinations with other drugs, making it hard
to determine methaqualone’s role. Given the uncertainties, pregnant women are advised to avoid the drug.

Combination products.
Mandrax and Toquilone Compositum contain both methaqualone and the antihistamine diphenhydramine. Some research indicates that diphenhydramine boosts the actions of methaqualone; some research indicates that the antihistamine lengthens the time that a methaqualone dose lasts. Adverse reactions have occurred when persons take the combination
along with tricyclic antidepressants.

Additional information.
Methaqualone and diazepam each have the nickname “Ludes,” but the drugs are different substances.

Additional scientific information may be found in:
Bailey, D.N. “Methaqualone Ingestion: Evaluation of Present Status.” Journal of Analytical
Toxicology 5 (1981): 279–82.

Brown, S.S., and S. Goenechea. “Methaqualone: Metabolic Kinetic and Clinical Pharmacologic
Observations.” Clinical Pharmacology and Therapeutics 14 (1973): 314–24.

“Evaluation of a Sedative-Hypnotic Agent; Methaqualone (Quaalude).” Journal of the
American Medical Association 199 (1967): 749.

Falco, M. “Methaqualone Misuse: Foreign Experience and United States Drug Control
Policy.” International Journal of the Addictions 11 (1976): 597–610.

Gerald, M.C., and P.M. Schwirian. “Nonmedical Use of Methaqualone.” Archives of
General Psychiatry 28 (1973): 627–31.

Ostrenga, J.A. “Methaqualone—A Dr. Jekyll and Mr. Hyde?” Clinical Toxicology 6
(1973): 607–9.

Perry, C.D., et al. “The South African Community Epidemiology Network on Drug
Use (SACENDU): Description, Findings (1997–99) and Policy Implications.” Addiction
97 (2002): 969–76.

Roden, S., P. Harvey, and M. Mitchard. “Influence of Alcohol on the Persistent Effects
on Human Performance of the Hypnotics Mandrax and Nitrazepam.” International
Journal of Clinical Pharmacology, Therapy and Toxicology 15 (1977): 350–55.

Wetli, C.V. “Changing Patterns of Methaqualone Abuse. A Survey of 246 Fatalities.”
Journal of the American Medical Association 249 (1983): 621–26.

Methandrostenolone (Anabolin, Dianabol, Methandienone, Nerobol)

2009-03-08T10:48:00.000-07:00

Pronunciation: meth-an-droh-STEN-oh-lohn
Chemical Abstracts Service Registry Number: 72-63-9
Formal Names: Anabolin, Dianabol, Methandienone, Nerobol
Type: Anabolic steroid.
Federal Schedule Listing: Schedule III (DEA no. 4000)
USA Availability: Prescription

Uses.
Medical uses of methandrostenolone include promoting growth in small boys, although with the risk of accelerating increase in height for awhile and then stopping further increase permanently.

The drug has also been used to bring on male puberty when that development is delayed. A research study found that the substance increases sexual desire in men while simultaneously
reducing their fertility. The drug has been given to control hereditary angioedema,
a disease producing giant hives on the skin. A lung disease called silicosis has been treated with the drug, and so have burns, cancer, and a type of anemia. Using the substance against a brittle bone condition called osteoporosis has been tried, with mixed results. Protection against lead poisoning was noted in a rat experiment. Levels of triglycerides, which are associated
with heart attack and stroke, declined in diabetic humans who received the drug.

The substance is forbidden in sports competitions, but some athletes continue to use it, either because they will not be tested for it or because they hope to evade tests. Experiments have compared athletes using methandrostenolone to others not receiving the drug (either two different groups of athletes were compared, or the same volunteers were tested under both drug and nondrug conditions). In one study the drug group showed higher increase in weight and strength. In another experiment the drug group gained more weight than the drug-free group, but the scientists noted that water retention could have been the reason. Blood pressure also increased in the drug group.

In still another comparison experiment the methandrostenolone users gained more weight and achieved more muscle development, but despite additional muscle mass their strength and performance did not differ from the drug-free group—scientists running those tests were unsure that anabolic steroid actions explained physical development in the drug group; as with an experiment mentioned above, a plausible alternative explanation was that methandrosten olone simply caused fluid swelling in tissues. Yet one more experiment measured increase in muscle mass among athletes using the substance but detected no increase in strength.
Stock raisers administer methandrostenolone to promote sheep and cattle growth.

Drawbacks.
A case report warns that using the substance on girls can produce male qualities in voice while reducing female sexual characteristics; these changes can be long-lasting and perhaps permanent. Although a skin cream containing nandrolone is used to combat eczema, the same use of a cream containing methandrostenolone has had serious consequences when applied
to girls, causing some female physical characteristics to diminish while masculine ones appeared.

A case report attributed a 28-year-old bodybuilder’s heart disease and hardening of the arteries to a dozen years of using methandrostenolone and other steroids. Another case report blamed methandrostenolone alone for blockage of blood vessels between heart and lungs in a 26-year-old bodybuilder. Attempts to treat the condition with the anti–blood clot drug warfarin became complicated when the steroid boosted that drug’s actions.

When taking methandrostenolone daily, a person experienced delusions and paranoia. Excessive self-confidence created by the drug inspired one user to buy a $17,000 automobile on credit despite his inability to make payments. After going off methandrostenolone the person sold the car, but upon resuming the drug, he purchased a $20,000 vehicle. Medical literature also records that a 22-year-old athlete using methandrostenolone and stanozolol developed
feelings of powerfulness and aggression, accompanied by impatience.

Methandrostenolone apparently causes acne and is suspected of worsening tics in Tourette’s syndrome. Men may experience urinary difficulty and lowered testosterone levels. The substance can bring on an attack of porphyria in persons who suffer from that body chemistry disease, an affliction that sometimes involves violence and sensitivity to light.

Abuse factors.
An opiatelike dependence was reported in a 23-year-old bodybuilder who had been on a steady regimen including methandrostenolone, oxymetholone, and oxandrolone. When given a drug that counteracts opiate actions he quickly exhibited nausea, chills, dizziness, and headache—
classic flulike opiate withdrawal symptoms. When his supply of steroids ceased he craved them and felt weary and depressed. Another case report notes a bodybuilder who dosed extensively on methandrostenolone and other steroids and experienced severe depression when he stopped.

Drug interactions.
Not enough scientific information to report.

Cancer.
Researchers examining reported deaths from a type of liver cancer called hepatic angiosarcoma found a total of 168 throughout the United States from 1964 to 1974, of which the investigators associated 1 with methandrostenolone (this individual was also a former alcohol abuser, conduct that is notoriously hard on the liver). Methandrostenolone and other steroids are suspected of causing kidney cancer in a 38-year-old bodybuilder.

Pregnancy.
Mice studies indicate that the drug can produce lethal mutations in sperm, causing pregnancy failure.

Additional scientific information may be found in:
Freed, D.L.J., et al. “Anabolic Steriods in Athletics: Crossover Double-Blind Trial on
Weightlifters.” British Medical Journal 2 (1975): 47–73.

Hervey, G.R., et al. “Anabolic Effects of Methandienone in Men Undergoing Athletic
Training.” Lancet 2 (1976): 699–702.

Holma, P.K. “Effects of an Anabolic Steroid (Metandienone) on Spermatogenesis.” Contraception
15 (1977): 151–62.

Johnson, L.C., and J.P. O’Shea. “Anabolic Steroid: Effects on Strength Development.”
Science 164 (1969): 957–59.

Kilshaw, B.H., et al. “Effects of Large Doses of the Anabolic Steroid, Methandrostenolone,
on an Athlete.” Clinical Endocrinology 4 (1975): 537–41.

Madea, B., and W. Grellner. “Long Term Cardiovascular Effects of Anabolic Steroids.”
Lancet 352 (1998): 33.

Robinson, R.J., and S. White. “Misuse of Anabolic Drugs.” British Medical Journal 306
(1993): 61.

Methandriol (Andris, Arbolic, Crestabolic, Drive, Durandrol, Filibol Forte, Geldabol, Hybolin, Methylandrostendiol, Methylandrostenediol, Novandrol)

2009-03-08T10:45:00.000-07:00

Pronunciation: meth-AN-dree-ol
Chemical Abstracts Service Registry Number: 521-10-8
Formal Names: Andris, Arbolic, Crestabolic, Drive, Durandrol, Filibol Forte, Geldabol,
Hybolin, Methylandrostendiol, Methylandrostenediol, Novandrol, Spectriol
Type: Anabolic steroid.
Federal Schedule Listing: Schedule III (DEA no. 4000)
USA Availability: Prescription

Uses.
Although the substance is banned from sports, some bodybuilders and other athletes use it. A rat study found augmented muscle protein among animals receiving the drug. Researchers have noted that chickens gain more weight when getting methandriol. Other researchers, however, found no weight alteration after giving the drug to mares daily for 18 months. The compound has been tested as a treatment for excessive menstrual bleeding, but results left investigators rather unimpressed.

Drawbacks.
Methandriol can masculinize women’s body signs and behavior, though to a lesser degree than many drugs of this type. Indeed, when tested on horses, no change was seen in mares’ conduct. Nonetheless, women’s voices can deepen, and facial hair can appear—effects that may be
permanent. Among bodybuilders there is a claim that the drug feminizes men’s body signs and behavior. Boys and girls receiving the drug may undergo premature sexual maturity and stop growing in height. Reduced fertility may occur in men. Unwanted effects can include acne, hair loss, and tissue swelling due to fluid retention. Researchers noted development of high blood
pressure in rats that steadily dosed on methandriol for several weeks. The drug is not recommended for persons with high blood pressure, heart trouble, or prostate disorder. Methandriol is suspected of causing liver damage. Abuse factors. Not enough scientific information to report on tolerance, dependence, withdrawal, or addiction.

Drug interactions.
Not enough scientific information to report.

Cancer.
Not enough scientific information to report.

Pregnancy.
Pregnant women are supposed to avoid methandriol. Bisexual fetal development in rats has been attributed to the drug. Other research has noted that genetic females can have outward male appearance after fetal exposure.
The drug may interfere with milk production.

Additional scientific information may be found in:
Rendina, G.M., and D. Patrono. “The Use of a Biological Preparation in the Treatment
of Some Gynaecological Diseases.” Current Medical Research and Opinion 4 (1976):
151–57.

Rogozkin, V. “Metabolic Effects of Anabolic Steroid on Skeletal Muscle.” Medicine and
Science in Sports 11 (1979): 160–63.

Turner, J.E., and C.H. Irvine. “Effect of Prolonged Administration of Anabolic and
Androgenic Steroids on Reproductive Function in the Mare.” Journal of Reproduction
and Fertility, no. 1 (1982, Suppl.): 213–18.

Methamphetamine (Anadrex, Desoxyn, Norodin, Pervertin, Stimulex

2009-03-08T10:39:00.000-07:00

Pronunciation: meth-am-FET-uh-meen
Chemical Abstracts Service Registry Number: 537-46-2
Formal Names: Anadrex, Desoxyn, Norodin, Pervertin, Stimulex

Informal Names: Bambita, Bathtub Crank, Batu, Blue Meth, Boo, Bump, Chalk, Chicken Feed, Crank, Crink, Cris, Cristina, Cristy, Croak, Crossles, Crypto, Crystal, Crystal Meth, Desocsins, Desogtion, Geep, Glass, Go-Fast, Granulated Orange, Hanyak, Hironpon, Hiropon, Hot Ice, Ice, Jet Fuel, Kaksonjae, L.A. Glass, L.A. Ice, Lemon Drop, Load of Laundry, Maui-Wowie, Meth, Methlies Quik, Mexican Crack, Motorcycle Crack, Nazi Vitamins, Peanut Butter, Quartz Smokable, Quill Cocaine, Red Devils, Redneck Cocaine, Schmiz, Scootie, Shabu Ice, Sketch, Smoke, Soap Dope, Sparkle, Speed, Spoosh, Stove Top, Super Ice, Tick Tick, Trash, Twisters, Water, Wet, White Cross, Working Man’s Cocaine, Yellow Bam, Yellow Powder

Type: Stimulant (amphetamine class).
Federal Schedule Listing: Schedule II (DEA no. 1105)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Methamphetamine was first manufactured in 1919. This stimulant of the central and sympathetic nervous systems is comparable to dextroamphetamine. Psychic effects are the same as for any amphetamine class drug.

Methamphetamine is used to treat narcolepsy, attention deficit hyperactivity disorder (ADHD), and adult obesity. Typically the drug is not recommended for juvenile obesity. Although patients lose more weight than if they use a placebo, the difference is only a few ounces per week.

Researchers do not know how the drug promotes weight loss. Scientists are even unsure if the
drug is responsible or if diet, coaching, attitude, and other factors explain the difference. In general, the longer patients take the drug, the lower their rate of weight loss. Standard practice is to stop the drug when weight benefits decline, rather than increase dosage.

To achieve top performance during World War II, pilots of the German Luftwaffe and the British Royal Air Force used methamphetamine. In 1953 Hermann Buhl was the first person to climb the mountain Nanga Parbat in the Himalayas, and during that feat he used methamphetamine tablets. Some observers wonder if that pharmaceutical aid was crucial. A person who climbed Mt. Everest without using supplementary oxygen noted, “Because mountaineering is, thank God, not an organized Olympic sport, there are no regulations about the use of drugs, so the choice is up to the individual.”

When methamphetamine was tested on champion cyclist athletes, they could not achieve a higher level of performance than normal, but they could extend top performance far longer than normal, a feat made possible in part by the drug’s apparent ability to mask the body’s normal signals of exhaustion. Researchers speculate that the drug could cause athletes to overextend themselves, collapse, and die. Another experiment found that the drug could improve work performance, but performing a few tasks under controlled conditions cannot be extrapolated to the whole world of real-life work.

The human body metabolizes assorted medical drugs into dextroamphetamine and methamphetamine, so if a body fluid test is used to accuse someone of unauthorized use, a blameless person should check whether any over-thecounter or prescribed drugs might be the explanation.

Drawbacks.
Measurements have found damage to brain neurons correlated with amount of methamphetamine abuse, damage that does not seem to recover upon cessation of drug dosage. Some of that damage may promote Parkinson’s disease. Tests show normal scores for methamphetamine abusers on some psychological perception tests, below normal scores on others. Animal experiments confirm that methamphetamine can alter DNA molecules,
and some researchers ask whether these changes may invalidate DNA identifications
made by law enforcement authorities.

Methamphetamine raises blood pressure; the most catastrophic consequence can be rupture of the aorta. The compound raises body temperature. Euphoria and overdose symptoms are similar to those of cocaine but last longer. Methamphetamine overdose can cause convulsions, heart attack, kidney failure, and stroke. Stroke can occur days after overdosage. Temporary blindness has developed. The drug can severely and permanently impair vision, apparently
by temporarily cutting blood flow to the optic nerve. Serious ulcers may develop in the cornea. Although methamphetamine can slightly stimulate breathing and help open lung airways, the substance can also produce temporary emphysema. Animal experiments and human experience indicate that concealed heart damage caused by the drug can repair itself if methamphetamine
administration ceases.

Methamphetamine’s smokable format is considered twice as strong as dextroamphetamine,
can produce pulmonary edema, and has been identified as causing skin affliction. Smoking methamphetamine can narrow blood vessels, which will increase blood pressure. Another suspected consequence of the narrowing is acidosis found among methamphetamine users, a condition in which levels of acid in blood rise high enough to make a person sick. Studies
of patients suffering from harm to bones and to skeletal muscles have found possible association with methamphetamine. Ischemic colitis, a bowel problem normally associated with old age, has been seen among young methamphetamine users. The substance is also associated with duodenal ulcers and malignant giant gastric ulcers. Inhaling the drug (as opposed to smoking, injecting, or swallowing) promotes excessive wear on teeth.

Methamphetamine affects insulin needs of diabetics. Persons with the same physical afflictions that make dextroamphetamine inadvisable should also avoid methamphetamine.

Abuse factors.
Experiments with intravenous injection of pure pharmaceutical methamphetamine found that recipients did not experience the almost instantaneous rush of effect that would normally be expected from such a path of administration. Recipients instead began experiencing significant effects hours later. A study of Japanese abusers receiving treatment for their drug habit compared injectors to smokers. Injectors had less schooling and more criminality and were more likely to have alcoholic parents. Such background is typical in persons having a bad relationship with drugs. Contented people rarely fall victim to drug abuse.

Methamphetamine flashbacks are possible. Someone who experienced a threatening situation while undergoing frightening psychosis brought on by methamphetamine can have a flashback when later confronted with a mildly stressful situation. In one study of abusers methamphetamine was blamed for long-term psychosis, in one case lasting 38 years after abuse stopped, but most of those patients also had other troubles (broken homes, criminality) promoting maladjustment.

Persons who abuse methamphetamine are typically disappointed with their lives. The drug is sometimes blamed for causing “amotivational syndrome” in which abusers lack much interest in life, but abusers typically have much to be discouraged about regardless of drug use. One study of Japanese alcoholics compared those who had also abused methamphetamine to those who
had not. The abusers were more afflicted with alcohol hallucinations, were much less likely to live together with someone, and were twice as likely to collect welfare and three times as likely to live in slums. (And about one fourth of the abusers had tattoos versus none of the nonabusers—the researchers called the variation “significant,” but that term was surely meant in its statistical sense.) Another study of Japanese abusers found that only 5% came from
an upper income background, in contrast to 71% of marijuana users. Still another study of Japanese abusers found that they ended their schooling early, hung out with gangs or other groups, and experienced effects typical of amphetamine class drugs (restlessness, irritability, low appetite, suspicion of other persons). Some negative aspects seemed to depend on how much the
drug users perceived themselves as victims of society. Pepped-up feelings and drug-induced happiness declined as methamphetamine abuse continued over the years. One authority has noted that persons who get drunk on alcohol every day are five times more prone to smoke methamphetamine than persons who consume alcohol either moderately or not at all. This does not mean that alcohol itself promotes methamphetamine use, but a person who is so miserable
as to get drunk daily will also be likely to seek additional ways to obliterate perception of problems. One of those choices may be methamphetamine.

Compared to persons who don’t abuse methamphetamine, abusers are known for more frequently engaging in risky sexual practices (no condoms, partners with sexually transmitted diseases, multiple casual partners). Less is known about whether such conduct is promoted by the drug or whether the drug is simply one component of a life filled with risk-taking.

Methamphetamine abusers tend to get injured more often in accidents than nonusers. That correlation, however, does not tell us whether the cause is the drug or a reckless lifestyle that happens to include drug abuse—one study of methamphetamine user deaths found that over 25% were murders. Types of accidents experienced by methamphetamine users are similar to those suffered by alcohol abusers, with road mishaps being most common. A study of violent
emergency room patients requiring “chemical restraint” (that is, involuntary administration of a sedating drug) found that 72% were intoxicated with methamphetamine, and many were also drunk on alcohol. Violent patients requiring restraint are, of course, a small minority; those figures do not mean that 72% of all patients were using methamphetamine. The figures do, however, indicate that persons who lose control of themselves cannot handle methamphetamine
well, or alcohol either.

As for the drug’s popularity, a 1999 analysis found that deaths related to methamphetamine in San Francisco had not particularly risen over a 13-year period. In contrast, toxicology tests at a California hospital (not involving all patients) showed 3% positive for either dextroamphetamine or methamphetamine or both in 1978, 10% in 1986 and 1987. Another California hospital
found that 7.4% of trauma patients had been using the drug in 1989, 13.4% in 1994. As the drug promotes medical problems, we can expect evidence of methamphetamine abuse to be higher in a hospital patient population (composed of people seeking medical help) than in the general population. When the twenty-first century began, about 2% of the general American population
was estimated to have used methamphetamine one or more times in their lives, and the percentage of regular users would be lower than that. Patients in medical cases examined in California, Taiwan, and Japan tend to be male, perhaps indicating a gender preference in use of this drug. Evidence exists for a gender difference in psychic reaction to the drug, with males feeling pepped up and happy while under the influence and postmenopausal women feeling
tired and sad. The substance causes more brain changes in male mice than in female.

Drug interactions.
Methamphetamine can have serious interactions with anesthesia and opioid drugs given in dentistry. Animal research indicates that smoking tobacco cigarettes can create a multiplier effect in which the nicotine and methamphetamine interact, boosting each other’s potency. Opiate addicts receiving oral methadone report that injecting themselves with methamphetamine produces a heroin-type high lasting a full 24 hours.

A hospital emergency room study found that persons admitted for the same cause of injury had lower alcohol level in their blood if they had also been taking methamphetamine. Combining the two drugs allows mice to tolerate a higher methamphetamine dose than normal, but research on humans finds just the opposite, that alcohol can transform a normal dose of methamphetamine
into a fatal one. Laboratory research on humans shows that using the two drugs together adds strain on the heart, while reducing pleasure gained from the alcohol and maintaining mental satisfaction from the methamphetamine. An unusual report tells of that drug combination rupturing a bladder, the alcohol helping to fill it up as the methamphetamine narrowed the bladder neck while taking away the normal sensation of pain that would warn a person
to seek medical help.

Cancer.
Not enough scientific information to report.

Pregnancy.
Pregnant methamphetamine abusers tend to produce full-term babies having characteristics of premature infants. While such a problem merits attention, a California study of 563,573 women who gave birth in 1992 helped put a perspective on the situation: Only 774 used methamphetamine during their pregnancies. Pooling results from seven California hospitals provided still another perspective. Among one group of mothers in 1996 and 1997, 0.5% had positive drug tests for methamphetamine during pregnancy, and those women typically used other drugs as well. And that percentage is not from the total population of pregnant women but only from those whose infants required assistance in breathing, a group where drug abuse was more prevalent.

Animal studies involving many times the normal human medical dose have produced birth defects. Confirming fetal harm from methamphetamine in humans is difficult because of other drugs the women use (particularly alcohol), nutrition, amount of prenatal care, and other factors that simultaneously affect fetal development. Methamphetamine accumulates in the fetus where blood level can be two and even six times higher than elsewhere in the woman’s body. One study measuring pregnancy outcome where umbilical blood showed misuse only of methamphetamine found the infants to be normal.

Additional scientific information may be found in:
Anglin, M.D., et al. “History of the Methamphetamine Problem.” Journal of Psychoactive
Drugs 32 (2000): 137–41.

Beebe, D.K., and E. Walley. “Smokable Methamphetamine (‘Ice’): An Old Drug in a
Different Form.” American Family Physician 51 (1995): 449–53.

Boe, N.M., et al. “Methamphetamine Use during Pregnancy Increases the Risk of Adverse
Maternal and Neonatal Outcomes.” American Journal of Obstetrics and Gynecology
180 (January 1999, pt. 2): S71.

Lan, K.C., et al. “Clinical Manifestations and Prognostic Features of Acute Methamphetamine
Intoxication.” Journal of the Formosan Medical Association 97 (1998): 528–33.

Logan, B.K. “Methamphetamine and Driving Impairment.” Journal of Forensic Sciences
41 (1996): 457–64.

Mayfield, D.G. “Effects of Intravenous Methamphetamine.” International Journal of the
Addictions 8 (1973): 565–68.

Mendelson, J., et al. “Methamphetamine and Ethanol Interactions in Humans.” Clinical
Pharmacology and Therapeutics 57 (1995): 559–68.

Simon, S.L., et al. “Cognitive Impairment in Individuals Currently Using Methamphetamine.”
American Journal on Addictions 9 (2000): 222–31.

Methadone (Amidone, Dolophine, Eptadone, Heptanal, Ketalgin, Mephanon, Methadose, Physeptone, Symoron, Tussol)

2009-03-08T10:35:00.000-07:00

Pronunciation: METH-a-dohn (also pronounced METH-a-don)
Chemical Abstracts Service Registry Number: 76-99-3. (Hydrochloride form 1095-90-5)
Formal Names: Amidone, Dolophine, Eptadone, Heptanal, Ketalgin, Mephanon, Methadose, Physeptone, Symoron, Tussol
Informal Names: Balloons, Breeze, Burdock, Buzz Bomb, Cartridges, Dollies, Dolls, Done, Fixer, Fizzies, Juice, Juicer, Jungle Juice, Medecina, Meth-A-Done, Mud, Phyamps, Pixie, Red Rock, Tootsie Roll, Wafers
Type: Depressant (opioid class).
Federal Schedule Listing: Schedule II (DEA no. 9250)
USA Availability: Prescription
Pregnancy Category: B

Uses.
This drug was invented by Germany’s Nazi regime in 1941 as a substitute for inadequate morphine supplies. Today methadone is best known as a legal substitute for heroin. In addition to that use in addiction treatment programs, methadone is given to adults and children as a pain reliever for surgery, cancer, burns, and other conditions. The substance is used as a cough
suppressant and also has calming qualities. In racehorses the drug can promote running ability and is banned from the sport. A human dose can last for 24 hours, rather long for a drug of this type and class. For pain relief a dose of methadone may be roughly 2.5 to 14.3 times stronger than morphine, depending on how and why the drug is administered.

Drawbacks.
Some persons experience euphoria from methadone. Unwanted effects can include vitamin deficiency, constipation, sleepiness, breathing difficulty, and low blood pressure. People may feel faint if they suddenly stand up from a sitting or prone position. Nausea, vomiting, constipation, urinary difficulty, sweating, lowered sex drive, and impaired sexual performance are
other well-known problems. Liver disease may allow dangerous buildup of methadone levels from normal doses.

Abilities to operate dangerous machinery such as automobiles may be reduced. Tests of persons undergoing methadone maintenance therapy indicate they may be able to drive satisfactorily if they use no other drugs, but most methadone maintenance patients also use other drugs that worsen driving performance and exhibit assorted types of personality problems that leak over
into driving habits.

In the 1970s methadone was suspected of causing memory trouble, but a group of researchers who investigated the question found no such difficulties. In 2000 a study reported significant memory problems in a group of methadone maintenance recipients, but the same group also had confounding conditions such as head injury and alcoholism that may have affected memory
test performance. Another 2000 study comparing methadone users to nonusers concluded that life factors other than methadone were the best explanation for differences in scores on thinking tests.

Abuse factors.
Although methadone is sometimes described as blocking heroin’s effects, the two drugs simply have cross-tolerance, meaning one of them can substitute for the other in some ways. In addition, persons who find one of the drugs pleasant will probably find the other one just as appealing. For those reasons, heroin addicts can often be switched to methadone in order to
maintain their drug habit legally, but the switch does not cure their drug addiction. Some heroin users even like methadone better; some methadone recipients continue using heroin on the side. On the basis of death statistics, some authorities feel methadone is more dangerous than heroin.

Addicts in methadone maintenance programs have chaotic lives. One study of program participants found 7% were likely to be pathological gamblers; another study of methadone program participants found 16% to be pathological gamblers and an additional 15% to have a gambling problem. Researchers have noted that violent traumas are more frequent among methadone program participants than among the average population. In one survey 34% of
patients said they received treatment for mental disorder, 64% of the women said they used psychoactive drugs during pregnancy, 80% of parents said they were arrested while their children were growing up, and parents reported that 30% of their children were suspended from school and 41% failed at least one grade in school and had to take that year of education again. For methadone maintenance patients and their families, drug abuse is simply one element
in multiproblem lifestyles.

A rhesus monkey experiment showed the animals having no preference between water and a methadone solution. Such lack of interest is consistent with human experience. Some persons find opiates or opioids attractive, but most do not. Personality and life circumstances have much to do with such choices.

Methadone’s calming qualities dissipate if tolerance occurs, so some other antianxiety medicine must then be used. Methadone’s abstinence syndrome is reminiscent of morphine’s but is generally described as more gradual in development and disappearance, longer lasting but with symptoms of lesser severity. Some research, however, has found no difference in morphine and
methadone withdrawal, and some addicts say withdrawal from methadone is more difficult than withdrawal from heroin. Evidence suggests that methadone withdrawal symptoms are harsher in nonblack infants than in blacks.

Drug interactions.
Using other depressants (including alcohol) or tricyclic antidepressants with methadone can increase the risk of a cumulative overdose— each individual dose may be safe, but all together may be dangerous.

Methadone should be used cautiously if a person is also taking monoamine oxidase inhibitors (MAOIs, found in some antidepressants and other medicine). Blood levels of methadone can be drastically altered by phenobarbital, by the epilepsy medicines phenytoin and carbamazepine, and by the tuberculosis medication rifampin. A case report notes that the HIV/AIDS (human
immunodeficiency virus/acquired immunodeficiency syndrome) drug ritonavir reduces methadone blood levels, and methadone interacts with other HIV/AIDS drugs as well. Taking doses of methadone along with the psychiatric medicine fluvoxamine (Luvox) can be fatal. Depending on how a person uses alcohol, that drug can raise or lower blood levels of methadone.
Data from one study showed that methadone did not decrease likelihood for alcohol abuse and that persons already abusing alcohol drank even more while on methadone. Other drug combinations common among illicit users can be hazardous with methadone, and methadone alone can be dangerous if a person who once had tolerance resumes usage at the old high-dose level.

Experiments have found that consumption and enjoyment of tobacco cigarettes increase after volunteers use methadone, and another experiment found that methadone consumption increases after volunteers use nicotine (in gum or cigarettes).

Cancer.
Chromosome damage is one measure of a drug’s potential for causing cancer. A study of persons receiving methadone for 40 weeks found no more chromosome damage than a nondrug population would have.

Pregnancy.
Safety for use during pregnancy is unknown. Researchers who gave various opioids to pregnant hamsters described methadone as one of the most powerful inducers of birth defects. Mice research shows that offspring are smaller than normal but have ordinary brain development.

Compared to morphine, much more of a maternal methadone dose reaches a fetus. One
group of investigators developed findings implying that methadone may harm human fetal central nervous system development. Those discoveries are consistent with research demonstrating abnormal development of neurons in rats that had prenatal methadone exposure; researchers speculate that such abnormalities may explain various behaviors in human infants who had prenatal methadone exposure. Use of methadone for easing pain of childbirth is
not recommended because newborns can suffer breathing difficulty after picking up the drug from the maternal blood supply. Infants from women who use methadone chronically can be born with dependence to the drug.

A study compared pregnant women on methadone maintenance to a pregnant group on morphine maintenance and discovered that the morphine group used fewer benzodiazepine class drugs and fewer opiates than the methadone program participants. Another study noted that pregnant addicts in a methadone program received better prenatal care than addicts who were
not in such programs, but program participants typically continued illicit drug use, their infants weighed no more than infants from pregnant addicts not in a methadone program, and infants from both those drug groups (program and nonprogram) weighed less than those of women who were not drug abusers. Such results have led more than one group of researchers to ask whether
methadone maintenance helps pregnancy outcomes, but those researchers do not offer an answer. Nonetheless, some authorities report that pregnancy outcomes are substantially better for addicts in methadone programs.

A group of clinical observations found that infants from mothers addicted to heroin had better sucking ability than infants from methadone addicts (including those in methadone maintenance programs). Research finds that breast-feeding by methadone-using mothers does no harm to infants, and one investigator concluded that methadone in the milk helps ease a dependent
child’s withdrawal symptoms. Investigators have found that infants with fetal exposure to methadone eat more than normal but do not gain more weight than normal, a finding that suggests defective ability to use nutrition from food. A study of two-year-old children found that fetal exposure to methadone had no influence on ability to focus attention. Examination of school-age children who had fetal exposure to methadone found them to have normal scores
in thinking tests and somewhat lower IQs than normal and to be more nervous and aggressive than typical children. How much of this is related to the drug and how much is related to tumultuous family life is uncertain. Another follow-up study found that girls had normal gender behavior, but boys had more female characteristics in their conduct.

A study found pregnancy outcomes to be much the same among methadone and cocaine users.

Additional scientific information may be found in:
Darke, S., et al. “Cognitive Impairment among Methadone Maintenance Patients.” Addiction
95 (2000): 687–95.

De Cubas, M.M., and T. Field. “Children of Methadone-Dependent Women: Developmental
Outcomes.” American Journal of Orthopsychiatry 63 (1993): 266–76.

Fainsinger, R., T. Schoeller, and E. Bruera. “Methadone in the Management of Cancer
Pain: A Review.” Pain 52 (1993): 137–47.

Jarvis, M.A., and S.H. Schnoll. “Methadone Treatment during Pregnancy.” Journal of
Psychoactive Drugs 26 (1994): 155–61.

Martin, W.R., et al. “Methadone—A Reevaluation.” Archives of General Psychiatry 28
(1973): 286–95.

Rossler, H., et al. “Methadone-Substitution and Driving Ability.” Forensic Science International
62 (1993): 63–66.
Schneider, J.W., and S.L. Hans. “Effects of Prenatal Exposure to Opioids on Focused
Attention in Toddlers during Free Play.” Journal of Developmental and Behavioral
Pediatrics 17 (1996): 240–47.
Specka, M., et al. “Cognitive-Motor Performance of Methadone-Maintained Patients.”
European Addiction Research 6 (2000): 8–19.

Mescaline (3, 4, 5-Trimethoxyphenethylamine)

2009-03-08T10:32:00.000-07:00

Pronunciation: MES-kuh-lin (also pronounced MES-kuh-leen)
Chemical Abstracts Service Registry Number: 54-04-6
Formal Names: 3, 4, 5-Trimethoxyphenethylamine
Informal Names: Beans, Big Chief, Blue Caps, Button, Cactus, Cactus Buttons, Cactus Head, Chief, Love Trip (combination with MDMA), Mesc, Mescal, Mescalito, Mescap, Mese, Mezc, Moon, Musk, Peyote, Topi
Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7381)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
This is the main active drug in the peyote cactus. In addition to being found in that natural product, mescaline can also be manufactured in a laboratory. Researchers have noted that mescaline, LSD, and psilocybin have similar actions even though the substances have significant chemical dissimilarities.

Effects are so alike that volunteers who took the drugs in experiments could not tell which of the three they received. Studies indicate cross-tolerance exists among the three. Mescaline is related to amphetamine.

Mescaline has been used to study mechanisms of schizophrenia, and at one time the substance was used in experimental psychotherapy. The drug encouraged self-examination in patients and helped them to see significance in ordinary things they had barely noticed before. Such effects have also been described by persons who took the drug simply to find out what it is like.

When mescaline was used as an experimental drug in psychotherapy, therapists reported that the substance helped people recall repressed memories.

Debate existed, however, about whether the apparent memories were real and whether the recollection experience turned out to have therapeutic benefit.

One experiment found that mescaline could help persons achieve creative answers to work-related problems that had resisted resolution for months. Research designed to measure whether the drug promotes creativity has found that volunteers’ feelings of increased creativity were supported in general and as a group by higher test scores on elements of creativity. “In general” and “as a group” may be important qualifiers about the results, however.

Users have reported expansion of color perception, but a test designed to detect such a phenomenon produced mixed results. A rabbit study found that mescaline could relieve pain. In a human experiment mescaline promoted growth hormone levels. In rats appetite may increase.

Drawbacks.
Individuals with a personal or family history of serious mental illness may be particularly vulnerable to lengthy psychosis from mescaline, although a study of former and current users of mescaline, LSD, or psilocybin found that they scored normally on psychological tests—with the exception that persons who engaged in current hallucinogen use were more depressed and nervous and prone to risk-taking.

Visual hallucinations during a mescaline dose are common; auditory ones less so. Aside from visual hallucinations, users not only may have trouble recognizing faces but may see startling transformations of their own faces in a mirror, viewing the image as not only something apart from themselves but as something ominous. People may feel like their bodies are changing in shape and be unable to detect portions of their bodies. Perceptions of time and space
may also change. The drug intoxication typically begins with euphoria, but in a laboratory setting, the euphoria often converts to nervousness and suspicion, possibly ending in depression.

Subjects have been known to say and do things they did not want to but were unable to stop themselves. Persons under the drug’s influence may be very open to suggestions, a state that could be exploited by unscrupulous persons.

Research shows that the drug can cause headache, perspiration, hot or cold sensations, feelings of prickling or burning, dizziness, cramps, nausea, and vomiting accompanied by small increases in pulse rate and blood pressure. In a sufficient dose mescaline can impair breathing, increase body temperature, and lower pulse rate and blood pressure. Hearing may become so sensitive
that ordinary noises are painful. Other senses may have abnormal reactions also.

Tests of reasoning and mental focus produce low scores while people use the drug. Mescaline-related deaths are usually not caused by the chemical itself but by things people did while their judgment was impaired. After rats receive mescaline they appear to forget how to navigate a maze and also take longer to solve problems (figuring out how to get past obstacles). The drug
promotes fighting among rats; one group of researchers described the aggression as “robust.” Debate exists about whether the drug makes rats fiercer or simply reduces inhibitions in stressful situations. Aggression and wild behavior are not seen as consequences of the drug among human users, and in some circumstances mescaline makes rats lethargic.

Dogs assume odd body stances after receiving the drug and act so lethargic as to be almost insensible. Monkeys seem fascinated as they look at ordinary objects, a reaction that may indicate visual hallucinations. Monkeys first act excitable after dosage, then lethargic. Rats, dogs, and monkeys all exhibit repetitive convulsivelike movements at high doses. In monkeys a fatal dose may not kill them until three or four days have passed.

Abuse factors.
A rat experiment found evidence of tolerance, but investigators surmised that the rats might simply have been learning how to compensate for drug effects on performance as the experiment continued. Rather than dosage effectiveness declining, the effects may have been unchanging as rats pushed through them by strength of will. Investigators running a rabbit experiment reported tolerance. Evidence exists for tolerance in animals and humans who receive the drug daily, but such tolerance dissipates quickly once the drug is stopped; two or three days later a dose can produce the same level of effects as before. Dependence does not seem to occur.

Drug interactions.
Not enough scientific information to report.

Cancer.
Not enough scientific information to report.

Pregnancy.
The drug will pass into the fetus of a pregnant monkey. In hamsters mescaline has caused birth defects and delayed development of bone structures, along with reducing the number of offspring in litters. Human birth defects are suspected.

Additional information.
“Mescal” is both a nickname for mescaline and the name of an alcoholic beverage; they are different substances.

Additional scientific information may be found in:
Adlaf, E.M., et al. “Nonmedical Drug Use among Adolescent Students: Highlights from
the 1999 Ontario Student Drug Use Survey.” CMAJ: Canadian Medical Association
Journal 162 (2000): 1677–80.

Hermle, L., et al. “Mescaline-Induced Psychopathological, Neuropsychological, and
Neurometabolic Effects in Normal Subjects: Experimental Psychosis as a Tool
for Psychiatric Research.” Biological Psychiatry 32 (1992): 976–91.

Hoch, P.H., J.P. Cattel, and H.H. Pennes. “Effects of Mescaline and Lysergic Acid (DLSD-
25).” American Journal of Psychiatry 108 (1952): 579–84.

Hollister, L.E., and A.M. Hartman. “Mescaline, Lysergic Acid Diethylamide and Psilocybin:
Comparison of Clinical Syndromes, Effects on Color Perception and
Biochemical Measures.” Comprehensive Psychiatry 3 (1962): 235–42.

Huxley, A. The Doors of Perception, and Heaven and Hell. New York: Harper and Row,
1963.

Kapadia, G.J., and M.B.E. Fayez. “Peyote Constituents: Chemistry, Biogenesis, and Biological
Effects.” Journal of Pharmaceutical Sciences 59 (1970): 1699–1727.
Unger, S.M. “Mescaline, LSD, Psilocybin and Personality Change.” Psychiatry: Journal
for the Study of Interpersonal Processes 26 (May 1963): 111–25.

Meprobamate (Deprol, Equagesic, Equanil, Micrainin, Miltown, Stopayne, Tenavoid)

2009-03-08T10:27:00.000-07:00

Pronunciation: meh-proh-BA-mait
Chemical Abstracts Service Registry Number: 57-53-4
Formal Names: Deprol, Equagesic, Equanil, Micrainin, Miltown, Stopayne, Tenavoid
Informal Names: Mother’s Little Helper
Type: Depressant.
Federal Schedule Listing: Schedule IV (DEA no. 2820)
USA Availability: Prescription
Pregnancy Category: D

Uses.
This drug became available in the 1950s as an alternative to barbiturates.
It works as a sleep aid and muscle relaxant, the latter property perhaps a result of the drug’s antianxiety property rather than a direct effect. Meprobamate’s muscle relaxant action improved breathing in experimental treatment of tetanus. A person’s appetite may get better with the drug, but again as a result of anxiety reduction rather than direct appetite stimulation—an agricultural experiment using meprobamate to encourage weight gain in
chickens was unsuccessful. The drug may lessen petit mal epilepsy seizures but worsen grand mal seizures. Meprobamate has also been used against neuroses and attention deficit hyperactivity disorder (ADHD), against a type of muscular discomfort called myofascial pain, and as part of therapy treating skin lesions brought on by worry. Meprobamate has helped improve stubborn cases of gastrointestinal afflictions, which may have a component of stress.

An experiment showed that persons using the drug can fool a lie detector test.
Meprobamate became perhaps the most highly regarded tranquilizer in the United States. In some research during that era of meprobamate’s popularity the question was no longer whether the drug worked but how much better it worked for some groups of people (married, widowed, overweight) than for others. Nonetheless, meprobamate’s medical uses declined after benzodiazepine class depressants became available. In retrospect skepticism arose about
whether meprobamate had ever been as beneficial as its reputation indicated.

Some experts decided that its muscle relaxant and antianxiety actions were no stronger than those inherent to any sedative. One team of scientific investigators concluded that in some circumstances patients’ therapeutic reactions to meprobamate were “no worse than to placebo”—faint praise indeed. Trans formation of the medical establishment’s attitude toward meprobamate is, however, a social history study beyond the scope of this book.

Drawbacks.
Meprobamate can cause euphoria and, even though it is a depressant, can have stimulant actions in some circumstances—indeed, mania has been known to occur after a dose. Unwanted actions include headache, vision trouble, nausea, diarrhea, dizziness, slurred speech, burning or prickling
sensations, rashes or other skin outbreaks, severely reduced body temperature, low blood pressure, accelerated heartbeat, fainting, and difficulty in moving around. Users should avoid operating dangerous devices such as automobiles.

Tests have measured worsened learning ability, physical coordination, and reaction time while a person is under meprobamate’s influence— although such problems are not found with all tests designed to detect them.

During meprobamate’s medical popularity in the 1960s military tests explored the drug’s influence on performance under stress. One test series simulated aircraft pilot situations involving simultaneous tracking of locations in two dimensions, monitoring changes in audio signals, and decoding messages— while exposed to reduced oxygen levels simulating altitudes up to 17,000 feet. In another test series civilian experimenters adapted techniques used by the Swedish air force in a task where persons had to push buttons, pull levers, and press pedals in response to lights and sounds. Investigators basically found that the drug acted as a distraction; people could perform adequately when low levels of skill were required, but as more and more tasks had to be accomplished at higher speeds, the drug interfered with performance.

Such a result was hardly surprising, although details may have been relevant to military decision makers.

In mice the drug promotes amnesia. Experimenters gave the drug to rats for 12 weeks and found it reduced the amount of DNA in brain cells. Meprobamate may aggravate porphyria, a blood chemistry disorder that can make people violent and sensitive to light. Although some persons use the drug for years without untoward effect, case reports note uncommon instances where the drug may have caused serious and sometimes fatal blood diseases such as agranulocytosis and aplastic anemia.

One disquieting effect of meprobamate is its ability to produce flat brainwave readings, which could cause medical personnel to cease vital treatment in a mistaken belief that the patient has died.

Abuse factors.
Meprobamate’s abuse potential has been described as similar to benzodiazepine depressants. Dependence on meprobamate can develop if excessive amounts are routinely used. Abuse of this drug is considered a particular risk with addicts to alcohol or other drugs. Symptoms of withdrawal from meprobamate have been likened to delirium tremens of alcohol withdrawal
and can include tremors and twitches, trouble in controlling movement, insomnia, headache, vomiting, anxiety, confusion, and hallucinations.

Convulsions are possible but uncommon. On rare occasion death has been attributed to withdrawal, but not all authorities agree that meprobamate is the sole cause. For sure, however, dogs that are dependent on the substance can go into convulsions and die if their supply is suddenly cut off.

Drug interactions.
In mice nicotine reduces the time they are physically uncoordinated after a meprobamate dose, just as we might expect when a stimulant (nicotine) is taken after a depressant. In contrast, injection of marijuana’s main active component THC increases the power of a meprobamate
dose in animals. Meprobamate has been used in combination with dextroamphetamine
for human weight loss, a combination that had uncertain effectiveness but that produced fewer unwanted actions than dextroamphetamine alone. Alcohol and meprobamate each have similar unwanted effects, and in that regard using both together can be the equivalent of taking extra
doses of one or the other. Among steady drinkers, however, blood levels of meprobamate decline faster than in nondrinkers, meaning a meprobamate dose lasts a shorter time in the drinkers. A mice study indicated that poisonous effects of meprobamate worsen if either alcohol or phenobarbital is also used. Phenobarbital and other barbiturates have cross-tolerance with meprobamate, meaning that the barbiturates can substitute for meprobamate in at least some respects.

Cancer.
Not enough scientific information to report.

Pregnancy.
Meprobamate administered into chicken eggs results in embryo malformations, and skeletal deformity has been observed with fetal development in rats exposed to the compound. The drug passes into a human fetus.

A study of over 50,000 pregnancies, including many women who used meprobamate,
found no evidence of birth defects linked to the drug, findings duplicated by another analysis of outcomes in more than 6,000 pregnancies. Nonetheless, meprobamate is suspected of causing birth defects. Indeed, in a study of almost 20,000 pregnancies, birth defects were over twice as common among women using meprobamate during early pregnancy than among women who used other antianxiety drugs and more than four times as common compared to women who took no drug at all in early pregnancy. One study found that congenital heart lesions occurred more often if meprobamate was used during pregnancy. Rats with fetal exposure to meprobamate show learning difficulties, and tests of five-year-old children who had prenatal exposure to the substance reveal impaired reasoning ability. The meprobamate level in milk of nursing mothers has been measured as up to four times higher than the level in their blood.

Additional scientific information may be found in:
Carson, J. “Meprobamate Revisited.” New York State Journal of Pharmacy 2 (1989): 45–46.

Gomolin, I. “Meprobamate.” Clinical Toxicology 18 (1981): 757–60.

Greenblatt, D.J., and R.I. Shader. “Meprobamate: A Study of Irrational Drug Use.” American Journal of Psychiatry 127 (1971): 1297–1303.

Logan, B.K., G.A. Case, and A.M. Gordon. “Carisoprodol, Meprobamate, and Driving Impairment.” Journal of Forensic Sciences 45 (2000): 619–23.

McNair, D.M. “Antianxiety Drugs and Human Performance.” Archives of General Psychiatry
29 (1973): 611–17.

“Meprobamate.” Medical Letter on Drugs and Therapeutics 7 (1965): 36.

Mephobarbital (Mebaral, Methylphenobarbital, Methylphenobarbitone)

2009-03-08T10:25:00.000-07:00

Pronunciation: mef-oh-BAR-bi-tal
Chemical Abstracts Service Registry Number: 115-38-8
Formal Names: Mebaral, Methylphenobarbital, Methylphenobarbitone
Type: Depressant (barbiturate class).
Federal Schedule Listing: Schedule IV (DEA no. 2250)
USA Availability: Prescription
Pregnancy Category: D

Uses.
Mephobarbital has both sedative and anticonvulsant effects. Anticonvulsant properties make the drug a standard treatment for epilepsy. When used for that condition, stoppage of the drug must be handled carefully lest a person start having a streak of seizures one after another (a potentially fatal condition called status epilepticus). Sedative qualities make mephobarbital an
effective tranquilizer, with users feeling lighthearted and mellow without getting very sleepy. Men metabolize the drug faster than women do, meaning a dose will last longer in women. After ingestion the drug metabolizes into phenobarbital, which seems to be a more potent sedative. Health care practitioners sometimes administer those two drugs together.

Drawbacks.
In an experiment comparing mephobarbital to phenobarbital in epileptic children, parents reported fewer unwanted behavioral effects with mephobarbital, and some pediatricians agree with that observation. The most typical behavior problem in such children is hyperactivity. A formal test comparing the two drugs, however, found no difference in either unwanted conduct
or therapeutic power.

Mephobarbital is to be avoided if a person has porphyria, a disease reflecting a body chemistry disorder and in which a person may be harmed by exposure to light. The drug should also be avoided if a person has a muscleweakening disease called myasthenia gravis, or a thyroid deficiency causing an affliction called myxedema.

Persons using this drug may need extra vitamin D, due to possible deficiency that might be caused by faster metabolism of the vitamin.

Abuse factors.
Not enough scientific information to report on tolerance, dependence, withdrawal, and addiction.
Drug interactions. Taking mephobarbital with acetaminophen (Tylenol and similar products) may promote liver injury. Mephobarbital can interfere with effectiveness of birth control pills and with actions of medicines used to control epilepsy and blood clotting. Drugs used to treat asthma, blood pressure, and heart ailment may not work as well if a person also takes mephobarbital.

Cancer.
Not enough scientific information to report.

Pregnancy.
Additional vitamin K is recommended for pregnant women using mephobarbital as childbirth approaches, in order to reduce bleeding in the women and offspring. Mephobarbital can help reduce fetal pulse rate irregularity but has been found to cause birth defects, with the risk malformations increasing if other antiepileptic drugs are also used. The drug is found
in breast milk of nursing mothers who use the substance.

Additional scientific information may be found in:
De Haan, J., and L. Stolte. “Drugs and the Fetal Heart Rate.” British Medical Journal 4
(October 16, 1971): 171.

Willis, J., et al. “Barbiturate Anticonvulsants: A Neuropsychological and Quantitative
Electroencephalographic Study.” Journal of Child Neurology 12 (1997): 169–71.

Young, R.S., et al. “A Randomized, Double-Blind, Crossover Study of Phenobarbital
and Mephobarbital.” Journal of Child Neurology 1 (1986): 361–63.

Meperidine (Centralgin, Demer-Idine, Demerol, Dolantin, Dolosal, Mepergan, Pethidine, Pethoid)

2009-03-08T10:22:00.000-07:00

Pronunciation: me-PER-i-deen
Chemical Abstracts Service Registry Number: 57-42-1. (Hydrochloride form 50-
13-5)
Formal Names: Centralgin, Demer-Idine, Demerol, Dolantin, Dolosal, Mepergan, Pethidine, Pethoid
Informal Names: Demmies
Type: Depressant (opioid class).
Federal Schedule Listing: Schedule II (DEA no. 9230)
USA Availability: Prescription
Pregnancy Category: B

Uses.
This drug has been used since the 1930s for easing pain in many conditions, including migraine headaches, surgery, gallbladder attack, sickle cell anemia crisis, childbirth, and emergency treatment of injury on mountaineering expeditions. The drug is also used to manage porphyria, a body chemistry disorder that can make a person extremely sensitive to light and that can include violent outbursts. The substance is used to bring persons out of a PCP psychosis.

Experimental usage of meperidine and dextroamphetamine together has reduced symptoms of mental depression, but the test was too brief to measure how long benefits might continue. Oral meperidine dosage can partly numb a person’s mucous membranes, and the drug is used as
one element of general and local anesthesia. The substance has a calming action but is not considered to be a sleep inducer at medical dosage levels. Upon prolonged usage the calming action can be replaced by depression and uneasiness. Depending on specifics of use, morphine is 6 to 10 times stronger than meperidine.

Drawbacks.
Meperidine can reduce blood pressure and can make a person feel faint upon suddenly standing up. Itching, perspiration, muscle tremors, nausea, and vomiting are other unwanted effects. Although constipation is a classic unwanted action of opiates/opioids, meperidine may produce less than morphine does. Meperidine can cause cardiac and breathing difficulty and has been known to cause seizures, delirium, and hallucinations. The drug may promote convulsions in persons who are already susceptible to such affliction. Some tests show the drug to have slight influence on eye-hand coordination and no effect on other voluntary physical movement. Tests oriented specifically toward driving skills, however, led researchers to conclude that people
should not operate a motor vehicle for 24 hours after an intramuscular injection of meperidine. Anyone with enlarged prostate, urinary difficulty, Addison’s disease, or underactive thyroid should be wary about using the drug.

An unusual case report tells of a patient developing Parkinson’s disease symptoms from meperidine; more commonly such reports arise from contaminated illicit substances related to meperidine. Another illicit peril occurs when persons grind up and inject oral meperidine tablets; the talc in those tablets can block tiny blood vessels throughout the body and also cause those vessels to bleed—serious business in the eyes or brain. Illicit intramuscular injection of
the drug over a period of years can cause muscle damage. Injecting into an artery can lead to gangrene.

Abuse factors.
Meperidine tolerance occurs. Dependence may develop faster than with morphine, but meperidine’s withdrawal syndrome may be briefer; symptoms also tend to be more limited than with morphine, perhaps just muscle spasms and unrest. When medical personnel are withdrawing addicts from heroin, meperidine has enough cross-tolerance to control withdrawal
symptoms.

Drug interactions.
Meperidine should be avoided by persons taking monoamine oxidase inhibitors (MAOIs, found in some antidepressants). That combination can be dangerous or even fatal. Alcohol and other depressants should be used carefully with meperidine in order to avoid cumulative overdose.
Amphetamines boost pain relief provided by meperidine. The HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) drug ritonavir is believed to lengthen a meperidine dose, meaning that too much of the opioid could build up in a person who is on a normal meperidine medication schedule. Experiments with the ritonavir-meperidine combination, however, have shown the risk to be less than expected. Air pressure affects a
meperidine dose; the higher the altitude, the longer a dose lasts. Phenobarbital, the antipsychotic drug chlorpromazine (Thorazine), and the heartburnulcer medicine cimetidine interfere with meperidine. Brewer’s yeast is said to produce a bad reaction with meperidine, such as raising blood pressure so high that a medical emergency occurs.

Cancer.
One analysis of medical records in Great Britain found a statistical association between receiving meperidine at birth and subsequent development of childhood cancer. A statistical association, however, simply provides guidance for future research and does not demonstrate cause and effect. Analysis of a different and smaller set of records found no association.

Pregnancy.
An experiment on pregnant mice produced no birth defects definitely attributable to the drug, but meperidine has caused congenital malformations in hamsters. Medical records from a few dozen women who used meperidine during pregnancy revealed no congenital malformations attributable to the substance. If a pregnant woman takes the drug, it will pass into the fetus, where the substance tends to build up. Difficulties have not been seen in infants from such women unless the drug has been administered during childbirth. In those latter cases a respiratory emergency can occur in infants who acquired the drug during birth, and less serious newborn behavioral abnormalities are common. Rhesus monkeys who received fetal exposure at time of birth were tested for perception and thinking ability. On one test they did worse than monkeys who had no meperidine exposure, and on another test they did better. In humans, meperidine enters the milk of nursing mothers, but the level is low enough to be considered safe for the infant.

Additional information.
An injectable format of the drug called Mepergan is intended for deep intramuscular administration. Intravenous injection can diminish breathing and stop the heart. Subcutaneous administration can cause sores at the injection site and even kill patches of skin. The product ingredients include sodium metabisulfite, to which some persons have a dangerous allergy.
Mepergan is to be used cautiously by asthmatics.

Additional scientific information may be found in:
Clark, R.F., E.M. Wei, and P.O. Anderson. “Meperidine: Therapeutic Use and Toxicity.”
The Journal of Emergency Medicine 13 (1995): 797–802.

Henderson, M.E. “Central Nervous System Effects of Meperidine.” Hospital Pharmacy
20 (1985): 934.

Korttila, K., and M. Linnoila. “Psychomotor Skills Related to Driving after Intramuscular
Administration of Diazepam and Meperidine.” Anesthesiology 42 (1975): 685–91.

Miller, R.R., and H. Jick. “Clinical Effects of Meperidine in Hospitalized Medical Patients.”
Journal of Clinical Pharmacology 18 (1978): 180–89.

Zacny, J.P., et al. “Subjective, Behavioral and Physiological Responses to Intravenous
Meperidine in Healthy Volunteers.” Psychopharmacology 111 (1993): 306–14.

MDMA or Ecstasy (Methylenedioxymethamphetamine, 3,4-Methylenedioxymethamphetamine)

2009-03-08T10:14:00.000-07:00

Pronunciation: em-dee-em-a¯
Chemical Abstracts Service Registry Number: 42542-10-9
Formal Names: Methylenedioxymethamphetamine, 3,4-Methylenedioxymethamphetamine

Informal Names: A, Adam, Baby Slits, B-Bomb, Bens, Benzedrine, Biphetamine, Blue Kisses, Blue Lips, California Sunrise, Chrystal Methadrine, Clarity, Cristal, Debs, Decadence, Dex, Dexedrine, Diamonds, Disco Biscuit, Doctor, Dolls, Domex, Draf, Drivers, E, E-Ball, E-Bomb, Ecstasy, Ekies, Elaine, Essence, Euphoria (combined with mescaline and methamphetamine), Everclear, Fastin, Gaggler, Go, Greenies, Hamburger, H-Bomb (with heroin), Honey Flip (with
2C-B), Hug Drug, Hydro, Iboga, Ice, Khat, Kleenex, Love Doctor, Love Drug, Love Potion Number 9, Lovers’ Speed, Love Doves, Love Trip (with mescaline), Lucky Charmz, M&M, MAO, MDM, Methedrine, Mini Beans, Mitsubishi, Molly, Monoamine Oxidase, Morning Shot, M25, New Yorkers, 19, Number 9, Orbit, Pikachu (mixed with PCP), Pink Studs, Pollutants, Rave, Road Runner, Rolling, Running, Scooby Snacks, Shabu, Slamming, Spivias, Strawberry Shortcake, Sweeties, 10, USP, Venus, Vitamin E, West Coast Turnarounds, Wheels, Whiffledust,
White Dove, Whiz Bombs, Wigits, X, XTC, Yuppie Drug, Zen

Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7405)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
MDMA was discovered and patented in Europe as World War I began, intended to make soldiers feel less hungry. In civilian usage the drug was supposed to help people lose weight, but other effects portended the product’s commercial failure, and it never went on the market. Those other effects attracted attention in the 1960s and 1970s among therapists and recreational
drug users alike.

MDMA intensifies sensory sensations (taste, touch, etc.), alters old understandings of what people observe, and allows people to feel distant from themselves. Some users experience self-insights and closer emotional attachment to other persons. Generally the drug does not appear to act as an aphrodisiac, but users report enhanced sexual experiences while under the
influence. In therapeutic doses, which may be lighter than those taken by recreational abusers, effects occur without hallucinations and without causing apparent mental cloudiness while intoxicated. Before being banned by the U.S. Drug Enforcement Administration (DEA), doses were given to encourage patients to participate more freely in psychotherapy discussions—a usefulness that still found advocates in the 1990s—and to facilitate understandings among patients, understandings that helped reduce their problems. Underground knowledge of psychiatric usage persists despite an absolute legal prohibition against using the compound:

Medical literature reports someone illegally taking the drug for self-medication of posttraumatic stress disorder. In the history of abused drugs, psychological benefits claimed by proponents
have often been deflated by scientific investigation. MDMA is no exception.

Psychological tests have compared polydrug users who have or have not taken MDMA and also persons who have abstained from any illicit drug. These tests find no difference among these groups in anger, anxiety, or mood. Whatever feelings of peacefulness that recreational MDMA users experience while intoxicated, those results do not seem to persist afterward. Indeed, experimenters who gave these tests found the MDMA group to have more psychological
trouble than the nondrug group. In such findings a key question is whether the drug caused psychic problems or whether problems caused the drug use. Staff members at a Spanish hospital’s psychiatric service reviewed a substantial amount of medical literature about MDMA users and observed that the case reports did not sustain a conclusion that MDMA was the primary cause of users’ psychiatric problems.

One significant exception exists in findings about MDMA’s limited value in promoting personal insight and healthy integration with the world. That exception comes with persons using the drug for spiritual purposes rather than recreationally. Here the all-important influence of set and setting are demonstrated.

Spiritual users tune in to certain kinds of psychic effect promoted by the drug and apparently are able to focus their attention so intensely that they can disregard and be unaffected by psychological effects that trouble recreational abusers. This situation appears to demonstrate a principle familiar to historians of drug use, who find that a substance can be beneficial in a
particular cultural context and yet have catastrophic consequences when used by someone who disregards that context. Any spiritual purpose for which MDMA may be used will, of course, have no impact on the drug’s physical actions, although persons who seldom use it may be spared various hazards documented by scientists.

MDMA is legally classified as a hallucinogen, but it is pharmacologically classified as an entactogen—a type of drug with both stimulant and hallucinogenic qualities. MDMA is recreationally used more for its hallucinogenic actions than for stimulant actions. It is an analog to MDA and related to MDEA, amphetamine, methamphetamine, and mescaline. MDMA is described as mellower than MDA, and some users experience MDMA as less potent than
mescaline. MDMA can alter perceptions of time and space and induce feelings of peacefulness. Users typically understand that MDMA hallucinations (such as floating in midair or seeing geometrical designs) are unreal; users normally do not undergo a temporary psychosis in which the sensations are misperceived as objective reality.

After recreational use became publicized, MDMA was made a Schedule I controlled substance. Despite that ban, during the 1990s MDMA was popular at high-energy all-night rave dance parties, not only for psychic actions but for enabling people to go without sleep, food, and drink while physically exerting themselves. A person using MDMA in that way will likely feel complete
exhaustion when the drug experience ends. The compound reduces pain and promotes talkativeness, factors that might be appealing at raves.

The Drug Abuse Warning Network (DAWN) tracks “mentions” of illicit drugs in hospital emergency room cases. A “mention” means that examination of a patient showed traces of a drug, not that the drug caused injury. DAWN thereby helps track a drug’s popularity. In 1993 MDMA had 196 DAWN mentions; in 1998 the total was 143,600. As the twenty-first century began, the DEA reported 750,000 doses being consumed each week in just the New Jersey
and New York City areas.

Drawbacks.
Scientific literature portrays MDMA as a drug of extremes, producing pleasures and afflictions that either enrapture or kill users. Compared to many other drugs, much more is known about MDMA’s hazards simply because so many persons have used it and received medical aid when things went badly. The volume of medical emergencies, however, is more than just a statistical phenomenon caused by sheer numbers of users. Some drugs used even more widely do not generate nearly as many medical complaints.

MDMA really is more dangerous than many other substances.
One problem in evaluating MDMA dangers, a problem openly acknowledged by some scientists, is the challenge of confirming that a sick person indeed ingested MDMA a month ago rather than a fake substitute. All sorts of substances can produce effects similar to those of MDMA, which is why illicit dealers can so easily sell fake merchandise. Nonetheless, researchers investigating
drug actions can often enough verify that MDMA is the actual substance. The following information reflects the scientific consensus about MDMA.

It has the physical and mental actions typical of amphetamine. A group of persons who at one time or another used amphetamine, LSD, and MDMA said they felt most pepped-up with amphetamine, least so with LSD, but had the greatest euphoria and contentedness with MDMA. Another group comparing amphetamine and MDMA reported MDMA to have fewer drawbacks.
The DEA considers the drug less addictive than cocaine or heroin.

The substance degrades thinking processes. In tests of alertness, memory, learning, and intelligence a group of marijuana users performed as well as nonusers of marijuana, while a group that had used both marijuana and MDMA did worse. MDMA causes persistent and even permanent organic changes in the brain. Grand mal brain seizures have been attributed to the
substance. Brain damage observed in MDMA users is consistent and is related to how much drug has been used (size of dose and frequency with which the drug is taken). Psychological tests verify that persons with such damage have trouble remembering things that are seen and heard, although the brain damage has not been proven to cause the memory difficulty. Whatever the precise cause, in memory tests polydrug users who have taken MDMA do worse than
those who have never taken the compound. Evidence exists that MDMA reduces attention span and interferes with reasoning.

The drug produces brain injury suspected of increasing someone’s impulsiveness. In tests comparing polydrug users who have used MDMA with those who have not, MDMA users show increased impulsiveness correlating with how much they have used the drug. Interviews comparing polydrug users find the MDMA group more prone to paranoia, to physical complaints lacking any apparent bodily cause, to nervousness and unfriendliness, to phobias, and to obsessing on various things. Panic disorder with agoraphobia (fear of open spaces) can occur.

MDMA has various influences on blood. The drug is suspected of causing anemia. Under the influence of MDMA, blood components may block vessels, having the effect of tiny clots that can cause internal bleeding, evidenced by purple spots on the skin. Blood clots in the brain and death of cerebral tissue have been credited to MDMA. Autopsies have shown massive blood clotting
throughout organs, accompanied by skeletal muscle deterioration.

Many other hazards exist. MDMA increases body temperature, sometimes enough to mimic heat stroke, and animal experiments indicate that temperatures in surroundings or inside the body can affect the amount of brain damage caused by MDMA. The drug boosts pulse rate. Initially a dose increases blood pressure (sometimes enough to burst vessels in the brain), but later, as the effects of a dose proceed, blood pressure falls below the user’s original reading (a decline that can promote fainting). MDMA can create heart malfunction, kidney failure, and liver disease. Liver cirrhosis and failure can result— sometimes treatable, sometimes fatal. Cramps and muscle tics have been observed, even including one case where Parkinson’s disease developed.

Cases are reported of MDMA causing pneumomediastinum, an ailment involving severe breathing difficulty. The drug promotes nausea. Hazy eyesight and a case of temporary double vision caused by MDMA have been reported. Jaw clenching and grinding after taking the drug result in excessive tooth wear; one study of teeth in MDMA users found enamel completely worn away from some areas, an affliction seen far less often in people who did not use the drug. MDMA can cause skin rash and pimples.

Gender difference in drug effect is possible. One survey of case reports noted that men tended to use more MDMA than women did, and an experiment found that at any given dose the drug seemed to harm verbal memory more in men than in women. Another experiment showed male users having more change in two measures of brain chemistry function than females did.
An experiment with rats showed males maintaining higher blood levels of the drug than females did, while females experienced more increase in body temperature than male rats did.

Abuse factors.
In a survey of 100 American university students, two thirds said that desirable actions declined and undesirable ones increased as MDMA use continued; similar results came from a survey of 100 users in Australia, and scientists studying the drug concur with those survey findings. As with other potent stimulants, abusers are known to use MDMA in binges, taking one dose after another before the previous ones wear off. Heavy MDMA users have scored low in measures of harm avoidance, and MDMA use correlates with unprotected male homosexual conduct. Such findings raise the question of cause and effect: Does MDMA promote reckless behavior, or are selfdestructive users simply indifferent about all sorts of life hazards, of which MDMA is only one?

Flashbacks are reported, with case reports mentioning time lengths ranging from less than one minute to two hours.

Drug interactions.
Taking MDMA together with the drug saquinavir (used against human immunodeficiency virus [HIV] in AIDS [acquired immunodeficiency syndrome]) may be dangerous; usage with the HIV/AIDS drug ritonavir can be fatal. Untoward reaction with the antidepressant fluoxetine
(Prozac) is suspected, and reaction with the antidepressant phenelzine sulfate (a monoamine oxidase inhibitor—MAOI) can produce excessive blood pressure, heavy sweating, muscle tics, and rigidity. Such perils are quite possible with any other MAOI. Keeping in mind the need to be cautious about extrapolating animal experiments to humans, we can note that taking MDMA with LSD (candyflipping) produces a multiplier effect intensifying MDMA actions in rats. Chloral hydrate permits some MDMA action in rats while reducing subsequent organic brain change. Also in rats MDMA boosts pain relief provided by morphine. In male rats the malaria and heart drug quinidine can increase MDMA’s tendency to raise body temperature. Alcohol allegedly reduces some effects sought by MDMA users, but that belief has not received general scientific sanction. Scientists have confirmed that alcohol increases MDMA’s reduction of immune system function, which may increase risk of infections. Physicians treating MDMA overdose find that water can worsen dangerous effects, and these doctors have concluded that people should not
drink much liquid of any sort while using the drug (hard advice for sweaty and overheated dancers).

Cancer.
Not enough scientific information to report.

Pregnancy.
Scientists who studied what happened with 49 women who used MDMA while pregnant were unable to reach any conclusions about influence on fetal development. The researchers did conclude that the women’s lifestyles routinely included assorted factors perilous to achieving healthy offspring— tobacco smoking, consuming alcohol to excess, unwanted pregnancy.

A study of 136 women who used MDMA while pregnant noted an incidence of birth defects much higher than normal (15.4% versus normal 2% or 3%), but the usual confounding factors, such as polydrug abuse and unwanted pregnancy, hindered conclusions about effect on fetal development. Rat experiments confirm maternal brain damage but have not found brain damage in offspring even though their behavior differs in some respects from rats whose mothers receive no MDMA during pregnancy. An experiment with chickens found no MDMA effect on measured aspects of embryo development.

Additional information.
“Benzedrine,” “biphetamine,” “dexedrine,” “iboga” (ibogaine), and “khat” are nicknames for MDMA, but none of those substances is MDMA.

Additional scientific information may be found in:
Downing, Joseph. “The Psychological and Physiological Effects of MDMA on Normal
Volunteers.” Journal of Psychoactive Drugs 18 (1986): 335–39.

Gouzoulis-Mayfrank, E., et al. “Impaired Cognitive Performance in Drug Free Users
of Recreational Ecstasy (MDMA).” Journal of Neurology, Neurosurgery, and Psychiatry
68 (2000): 719–25.

Greer, G., and R. Tolbert. “Subjective Reports of the Effects of MDMA in a Clinical
Setting.” Journal of Psychoactive Drugs 18 (1986): 319–27.

McGuire, P. “Long Term Psychiatric and Cognitive Effects of MDMA Use.” Toxicology
Letters 112–13 (2000): 153–56.

Rochester, J.A., and J.T. Kirchner. “Ecstasy (3,4-Methylenedioxymethamphetamine):
History, Neurochemistry, and Toxicology.” Journal of the American Board of Family
Practice 12 (1999): 137–42.

Shulgin, A.T. “The Background and Chemistry of MDMA.” Journal of Psychoactive
Drugs 18 (1986): 291–304.

Vollenweider, F.X., et al. “Psychological and Cardiovascular Effects and Short-term
Sequelae of MDMA (“Ecstasy”) in MDMA-Naive Healthy Volunteers.” Neuropsychopharmacology
19 (1998): 241–51.

MDEA (3,4-Methylenedioxyethylamphetamine, MDE)

2009-03-08T10:12:00.000-07:00

Pronunciation: em-dee-ee-a¯
Chemical Abstracts Service Registry Number: 82801-81-8
Formal Names: 3,4-Methylenedioxyethylamphetamine, MDE
Informal Names: Eve, Intellect
Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7404)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
This substance is related to MDA, MDMA, amphetamine, and methamphetamine. Drug laws call MDEA a hallucinogen, but it has stimulant effects also. Those dual properties put it in the entactogen pharmacological group, a type of drug with both stimulant and hallucinogenic qualities. Effects are similar to those from MDA and MDMA.

MDEA can create contentedness and feelings of intimacy with other persons. It may promote self-insight, gesturing, and articulate talking. Hallucinations can occur, described as less intense than those brought on by psilocybin. Volunteers had normal results in tests of numerical ability while using MDEA, indicating that people can force themselves to overcome at least some of the drug’s effects if necessary. Even though users feel more relaxed after taking the substance, it has general stimulant effects—raising the pulse rate, blood pressure, and body temperature. It also elevates the level of cortisol, a hormone that increases blood sugar.

Drawbacks.
Apparently MDEA inhibits secretion of human growth hormone. The drug disrupts sleep and dreaming. Psychosis is possible. In experiments with normal volunteers a minority had mental aftereffects including nervousness and discontent.

Some researchers describe MDEA as less toxic than MDMA, but damage is still possible to kidneys, liver, brain, and heart. Persons with heart disease may be in particular danger from MDEA. Overdose symptoms include hallucinations, excessive body temperature, massive perspiration, violent conduct, muscle spasms, difficulty moving arms and legs, convulsions, distress in breathing, and passing out. Fatalities have shown blood clots throughout the body and damage to skeletal muscle. Although deaths from “normal” doses are unlikely among healthy users, the same dose can have stronger effects on some users than on others.

In rat experiments comparing the strength of MDMA to MDEA, about twice as much MDEA is needed to induce excessive body temperature and about four times as much to cause one kind of organic brain damage. The experimenters note, however, that these findings do not extrapolate well to humans because people might take greater doses of MDEA than MDMA to get the
desired psychological effects, so any net difference in harm to abusers may be nil despite difference in drug potency.

Abuse factors.
Not enough scientific information to report about tolerance, dependence, withdrawal, or addiction.

Drug interactions.
Medical investigators suspect that heroin and MDEA counteract each other’s effects in humans.
Cancer. Not enough scientific information to report.

Pregnancy.
Not enough scientific information to report.

Additional scientific information may be found in:
Gouzoulis, E., et al. “Neuroendocrine and Cardiovascular Effects of MDE in Healthy
Volunteers.” Neuropsychopharmacology 8 (1993): 187–93.

Gouzoulis-Mayfrank, E., et al. “Psychopathological, Neuroendocrine and Autonomic
Effects of 3,4-Methylenedioxyethylamphetamine (MDE), Psilocybin and DMethamphetamine
in Healthy Volunteers. Results of an Experimental Double-Blind Placebo-Controlled Study.” Psychopharmacology 142 (1999): 41–50.

Hegadoren, K.M., G.B. Baker, and M. Bourin. “3,4-Methylenedioxy Analogues of Amphetamine:
Defining the Risks to Humans.” Neuroscience and Biobehavioral Reviews 23 (1999): 539–53.

Hermle, L., et al. “Psychological Effects of MDE in Normal Subjects. Are Entactogens
a New Class of Psychoactive Agents?” Neuropsychopharmacology 8 (1993):
171–76.

MDA (Amphedoxamine, 3,4-Methylenedioxyamphetamine)

2009-03-08T10:03:00.000-07:00

Pronunciation: em-dee-a¯
Chemical Abstracts Service Registry Number: 4764-17-4
Formal Names: Amphedoxamine, 3,4-Methylenedioxyamphetamine
Informal Names: Chocolate Mescaline, Hug Drug, Love, Love Pill, Mellow Drug of America
Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7402)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
This drug is a derivative of amphetamine and an analog to MDMA, with effects similar to the latter and to MDEA. MDA is stronger than those two hallucinogens. Researchers also report it to be three to five times stronger than mescaline, to which it is chemically related. MDA is legally defined as a hallucinogen, but its stimulant qualities put it in the entactogen pharmacological
class—a type of drug with both stimulant and hallucinogenic qualities.

MDA is an illicit drug designer’s delight; by the 1970s thousands of offshoots had been made.
First produced in a laboratory in 1910, MDA was intended to help people lose weight. One authority believes the drug has potential for stopping allergic reactions to a variety of allergens. As the 1960s arrived the drug had been patented as a cough suppressant and as a tranquilizer, but MDA never went into legal commercial manufacture.

Reports of MDA’s psychological effects date back to the 1930s, but not until three decades later did the substance become a recreational drug. It has the capability to change how a person views time and space. While under the influence a user’s hearing and sense of touch can become more sensitive, and a person’s sense of identity can alter. Emotions and caring about other persons
can intensify, as can ability to communicate feelings. Such aspects allowed MDA to find a niche in psychotherapy as well as on the street. Strong doses can bring on hallucinations, with experiences so similar to LSD and mescaline that users cannot tell whether they were dosed with the latter drugs or with MDA.

Drawbacks.
MDA raises heart rate, blood pressure, body temperature, and salivation. The substance can cause nausea, along with high acid levels in blood. Although one authority notes that the drug can relax muscles, nonetheless tremors and seizures are also possible; MDA is known to worsen Parkinson’s disease. MDA can tense up jaw muscles and cause grinding of teeth.

As drug effects go away, users may experience weariness and muscle aches accompanied by depression. Users coming off the drug may also be shorttempered, suspicious of others, and nervous. Typically the effects desired by a user decline with repeated use of the drug, while undesired postintoxication effects increase. MDA can cause organic brain damage in rats, in some aspects worse than what MDMA does.

Overdose symptoms resemble those of amphetamine and MDMA, including massive perspiration and strange conduct prone to combativeness. The percentage of fatalities among abusers is small, but the size difference between a recreational dose and a serious overdose can vary tremendously between individuals. What one person can tolerate without apparent ill effect can send another person to a hospital. Blood and urine tests in one fatal overdose case
showed only MDA, demonstrating that this drug can be lethal even when it is not part of a polydrug abuse mix.

Men may suffer fewer ill effects from MDA than women do. In one animal study documenting a gender difference in effects, male rats showed a higher body temperature increase than female rats did, but blood levels of MDA stayed higher in the female.

Abuse factors. Not enough scientific information to report about tolerance, dependence, or withdrawal. In animal experiments self-administration is a traditional sign of addictive potential; rats show mild interest in selfadministration of MDA.

Drug interactions.
Animal experiments suggest that taking certain drugs along with MDA can reduce its toxicity.

Cancer.
MDA causes cancer in mice and rats, with males being more susceptible than females.

Pregnancy.
Not enough scientific information to report.

Additional information.
At one time MDA was nicknamed Ecstasy, but that street name was later transferred to MDMA. An industrial chemical called MDA (methylene dianiline) is not the drug of abuse.

Additional scientific information may be found in:
Climko, R.P., et al. “Ecstacy: A Review of MDMA and MDA.” International Journal of Psychiatry in Medicine 16 (1986–1987): 359–72.

Hegadoren, K.M., G.B. Baker, and M. Bourin. “3,4-Methylenedioxy Analogues of Amphetamine:
Defining the Risks to Humans.” Neuroscience and Biobehavioral Reviews 23 (1999): 539–53.

Poklis, A., M.A. Mackell, and W.K. Drake. “Fatal Intoxication from 3,4-Methylenedioxyamphetamine.” Journal of Forensic Sciences 24 (1979): 70–75.

Richards, R.N. “Experience with MDA.” Canadian Medical Association Journal 106 (1972):
256–59.

Richards, K.C., and H.H. Borgstedt. “Near Fatal Reaction to Ingestion of the Hallucinogenic
Drug MDA.” Journal of the American Medical Association 218 (1971): 1826–27.

Mazindol (Mazanor, Sanorex, Teronac)

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Pronunciation: MA-zin-doll (also pronounced MAYZ-in-dohl)
Chemical Abstracts Service Registry Number: 22232-71-9
Formal Names: Mazanor, Sanorex, Teronac
Type: Stimulant (anorectic class).
Federal Schedule Listing: Schedule IV (DEA no. 1605)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Mazindol reduces appetite, and the drug’s main medical usage is short-term promotion of weight loss. For that purpose one study showed mazindol having about 10% to 20% of dextroamphetamine’s strength; another study noted that regardless of relative strength per milligram, patients on mazindol shed about twice as many pounds as those on dextroamphetamine.

In studies examining diet drugs, persons using mazindol lost as many or even more pounds compared to persons using phenmetrazine. One 12-week experiment found mazindol considerably more effective than diethylpropion for human weight loss, although a rat study found those two drugs’ effectiveness comparable. Some human studies put mazindol as about equal to fenfluramine for weight loss. Still other studies call mazindol’s performance the same
as a placebo. Perhaps these various findings are less a commentary on mazindol than on the unclear effectiveness of diet drugs in general.

Although mazindol appears to produce depression among some users, in others the drug works as an antidepressant. This antidepressant characteristic is considered helpful in promoting weight loss, as some overweight persons use food to compensate for sadness. As one condition improves, generally the other one does also. Mazindol’s dual action as an anorectic and antidepressant can make it especially appropriate for persons struggling to lose both melancholy
and weight.

Some mazindol effects are like those of amphetamine, but the two substances are described as chemically unrelated. Mazindol seems to pep up rats.

In rat experiments the drug increases tendency to move around, more in females than in males. In humans the compound is used to combat narcolepsy and the decline of muscle tone sometimes associated with that affliction. Mazindol acts as a pain reliever in mice. One study found the drug made humans more sensitive to pain, but other experimental usage reduced pain in terminal cancer patients. Researchers believe mazindol can aid sufferers from Parkinson’s
disease. A case is reported of the drug acting as an aphrodisiac in a human female. The compound can reduce cholesterol levels.

Drawbacks. Mazindol increases pulse rate, may cause hallucinations, and disrupts sleep. In one study users complained of headache, skin rash, dry mouth, perspiration, tremor in heart and other muscles, nausea, and difficult urination and bowel movements. Users also report being wired, edgy, and dizzy. In human males mazindol can make the testes painful, interfere with
erection and ejaculation, and cause urine retention. The latter effect has been exploited to treat incontinence. Mazindol may interfere with production of human growth hormone, a consideration when juveniles take the drug. When tested as a treatment for schizophrenia the drug at best had no effect and even worsened some symptoms. A medical journal article published in 2000 linked mazindol to pulmonary hypertension, the first time such an association was reported. Earlier reports noted development of heart disorder after taking mazindol
in combination with fenfluramine or dexfenfluramine, but such affliction has been attributed to those latter two drugs by themselves, so mazindol’s role is uncertain.

Abuse factors.
In rhesus monkey experiments the animals show a liking for mazindol, but a review of clinical studies found no instances of patients becoming addicted. Although reports exist of mazindol inducing euphoria, human users show no particular liking for the drug. Volunteers comparing
several diet drugs found mazindol to have the least appeal by far. Scientists evaluating another experimental study of the drug described it as a “punisher” that persons wanted to avoid.

Drug interactions.
Researchers say mazindol and alcohol have a multiplier effect when used together, boosting each other’s potency and producing an extra buzz for recreational users. Mazindol interferes with some cocaine effects, but studies examining mazindol’s potential for treating cocaine addiction
find a placebo to be about as good. One study even found the two drugs to have a hazardous multiplier effect raising blood pressure and pulse rate, and rat experiments find that mazindol reduces the size of a cocaine dose needed to cause death. Mazindol can react adversely with antimania drug lithium and can counteract drugs intended to lower blood pressure.

Cancer.
Laboratory experiments show mazindol promoting cell mutations and chromosome breaks (traditional signs of cancer-causing potential), but that finding’s real-life meaning is unclear.

Pregnancy.
The drug’s influence on fetal development is unestablished.

Whether the drug passes into milk of nursing mothers is unknown. Doses that kill female rats while pregnant or after giving birth can leave males and nonpregnant females unscathed. Whether such findings mean that pregnancy increases human sensitivity to the drug is unknown.

Additional scientific information may be found in:
Alvarez, B., et al. “Mazindol in Long-Term Treatment of Narcolepsy.” Lancet 337 (1991):
1293–94.

Bierger, P., F. Gawin, and T.R. Kosten. “Treatment of Cocaine Abuse with Mazindol.”
Lancet 1 (1989): 283.

Chait, L.D., E.H. Uhlenhuth, and C.E. Johanson. “Reinforcing and Subjective Effects of Several Anorectics in Normal Human Volunteers.” Journal of Pharmacology and Experimental Therapeutics 242 (1987): 777–83.

Hagiwara, M., et al. “Delayed Onset of Pulmonary Hypertension Associated with an Appetite Suppressant, Mazindol: A Case Report.” Japanese Circulation Journal 64 (2000): 218–21.

Preston, K.L., et al. “Effects of Cocaine Alone and in Combination with Mazindol in Human Cocaine Abusers.” Journal of Pharmacology and Experimental Therapeutics 267 (1993): 296–307.

Marijuana (Cannabis, Cannabis sativa, Hashish, Marihuana, Sinsemilla)

2009-03-08T09:44:00.000-07:00

See also Dronabinol
Pronunciation: mair-i-WAHN-uh (also pronounced mah-ri-HWAH-nuh)
Chemical Abstracts Service Registry Number: 8063-14-7
Formal Names: Cannabis, Cannabis sativa, Hashish, Marihuana, Sinsemilla

Informal Names: A-Bomb (with opium or heroin), Acapulco Gold, Acapulco Red, Ace, Afgani Indica, African Black, African Bush, Airplane, Alamout Black Hash (with belladonna), Alice B. Toklas (baked in brownie), AMP (with PCP, formaldehyde, or other substance), Angola, Ashes, Assassin of Youth, Astro Turf, Atomic Bomb (with heroin), Atshitshi, Aunt Mary, Baby, Baby Bhang, Bad Seed, Bamba, Bambalacha, Bammy, Banano (mixed with cocaine), Bar, Bash, Bazooka (with coca paste), Belyando Spruce, B-40 (mixed with tobacco and alcohol), Bhang, Black, Black Bart, Black Ganga, Black Gold, Black Gunion, Black Mo, Black Moat, Black Mote (with honey), Blanket, Blast, Block, Blonde, Blue de Hue, Blue Sage, Blue Sky Blond, Blunt, Bo, Bo-Bo, Bobo Bush, Bohd, Bomb, Bomber, Bone, Boo, Boo Boo Bama, Boom, Broccoli, Bud, Buda, Buddha (with opium), Burnie, Bush, Butter, Butter Flower, Cambodian Red, Cam Red, Cam Trip, Can, Canade (with heroin), Canadian Black, Canappa, Cancelled Stick, Candy Blunt (with codeine), Carmabis, Catnip, Caviar (with cocaine), Cavite All Star, Cest, Chamba, Champagne (with cocaine), Charas, Charge, Cheeba, Cheeo, Chiba Chiba, Chicago Black, Chicago Green, Chips
(with PCP), Chira, Chocolate, Christmas Tree, Chronic, Chunky, Churus, Citrol, Clicker (with formaldehyde), Clickums (with PCP), Climb, Cochornis, Coli, Coliflor Tostao, Colombian, Colorado Cocktail, Columbus Black, Cosa, Crack Back (with crack cocaine), Crazy Weed, Cripple, Crying Weed, Cryppie, Cryptonie, CS, Cube (tablet form), Culican, Dagga, Dawamesk, Dew, Diablito (with crack cocaine), Diambista, Dimba, Ding, Dinkie Dow, Dirt Grass, Dirty Joint (with
crack), Ditch, Ditch Weed, Djamba, Domestic, Dona Juana, Dona Juanita, Don Jem, Don Juan, Donk (with PCP), Doob, Doobee, Doobie, Doradilla, Draf, Drag Weed, Dry High, Dubbe, Dube, Duby, Durong, Duros, Dust (combined with other substances), Earth, El Diablito (with cocaine, heroin, and PCP), El Diablo (with cocaine and heroin), Elephant, Endo, Esra, Fallbrook Redhair, Fatty, Feeling, Fine Stuff, Finger, Finger Lid, Fir, Flower, Flower Tops, Fraho, Frajo, Frios
(with PCP), Fry (with PCP or other substances), Fry Daddy (with crack cocaine), Fry Sticks (with PCP), Fu, Fuel (with insect poison), Gage, Gange, Gangster, Ganja, Garbage, Gash, Gasper, Gauge, Geek (with crack cocaine), Ghana, Giggle Smoke, Giggle Weed, Gimmie (with crack cocaine), Goblet of Jam, Gold,Golden, Golden Leaf, Gold Star, Gong, Gonj, Good Butt, Good Giggles, Goody- Goody, Goofy Butt, Grass, Grasshopper, Grata, Green, Green Buds, Green Goddess, Greeter, Gremmies (with cocaine), Greta, Griefo, Griefs, Grifa, Griff, Griffa, Griffo, Gunga, Gungeon, Gungun, Gunja, Gyve, Haircut, Hanhich, Happy Cigarette, Harsh, Has, Hash, Hawaiian, Hawaiian Black, Hawaiian Homegrown Hay, Hay, Hemp, Herb, Herba, Hit, Hocus, Homegrown, Hooch, Hooter, Hot Stick, Hydro, Illies (with PCP), Illing (with PCP), Indian Boy, Indian Hay, Indian Hemp, Indo, Indonesian Bud, Instaga, Instagu, J, Jamaican Gold, Jane, Jay, Jim Jones (with cocaine and PCP), Jive, Joint, Jolly Green, Joy Smoke, Joy Stick, Juanita, Juan Valdez, Juice Joint (with crack cocaine), Juja, Ju-Ju, Jumbo (with crack), Kalakit, Kali, Kansas Grass, Kate Bush, Kaya, Kee, Kentucky Blue, Key, KGB (Killer Green Bud), Ki, Kick Stick, Kief, Kiff, Killer Weed (with PCP), Kilter, Kind, King Bud, Kumba, Lace (with cocaine), Lakbay Diva, Laughing Grass, Laughing Weed, Leaf, Leak (with PCP), Leno, Lid (quantity), Light Stuff, Lima, Liprimo (with crack), Little Smoke, LL, Llesca, Loaf, Lobo, Loco, Locoweed,
Log, Love Boat (with formaldehyde or heroin), Love Leaf (with PCP), Lovelies (with PCP), Love Weed, Lubage, M, Machinery, Macon, Maconha, Mafu, Magic Smoke, Manhattan Silver, Mari, Marimba, Mary, Mary and Johnny, Mary Ann, Mary Jane, Mary Jonas, Mary Warner, Mary Weaver, Matchbox (quantity), Maui Wauie, Maui-Wowie, Meg, Megg, Meggie, Messorole, Mexican Brown, Mexican Green, Mexican Locoweed, Mexican Red, Mighty Mezz, M.J., M.O., Mo, Modams, Mohasky, Mohasty, Monte, Mooca, Moocah, Mooster, Moota, Mooter, Mootie, Mootos, Mor A Grifa, Mota, Mother, Moto, M.U., Mu, Muggie, Muggle, Muta, Mutah, Mutha, Nail, Nigra, Number, O.J., Oolies (with crack), Ozone (marijuana alone or with PCP and crack), Pack, Pakalolo, Pakistani Black, Panama Cut, Panama Gold, Panama Red, Panatella, Parsley, Pasto, Pat, P-Dogs (with crack), Pin, Pocket Rocket, Pod, Poke, Pot, Potlikker, Potten Bush, Prescription, Pretendica, Pretendo, Primo (with crack), Queen Ann’s Lace, Ragweed, Railroad Weed, Rainy Day Woman, Rangood, Rasta Weed, Red Bud, Red Cross, Red Dirt, Reefer, Righteous Bush, Rip, Roach, Roacha, Rockets, Rompums (with horse tranquilizer), Root, Rope, Rose Marie, Rough Stuff, Rubia, Salt & Pepper, Sandwich Bag (quantity), Santa Marta, Sasfras, Scissors, Seeds, Sen, Sess, Sezz, Shake, Siddi, Sinse, Skunk, Smoke, Smoke Canada, Snop, Speedboat (mixed with crack cocaine and PCP), Spliff, Splim, Square Mackerel, Squirrel (with crack and PCP), Stack, Stems, Stick, Stinkweed, Stoney Weed, Straw, Sugar Weed, Super Grass (marijuana alone or with PCP), Super Pot, Sweet Lucy, Swishers, T, Taima, Takkouri, Tea, Texas Pot, Texas Tea, Tex-Mex, Thai Sticks, 13, 38 (combination with crack cocaine), 3750 (with crack), Thumb, Toke, Torch, Torpedo (with crack), Tray (quantity), Turbo (with crack), Tustin, Twist, Twistum, Unotque, Vega, Viper’s Weed, Wac (with PCP), Wacky Weed, Wake
& Bake, Water (with other substances), Water-Water (with embalming fluid or PCP), Weed, Weed Tea, Wet (with PCP), Whack (with insect poison), Whackatabacky, Wheat, White-Haired Lady, Wicky Stick (with crack and PCP), Wollie (with crack), Woolah (with crack), Wooly (with crack or PCP), X, Yeh, Yellow Submarine, Yen Pop, Yeola (with crack), Yerba, Yerba Mala (with PCP), Yerhia, Yesca, Yesco, Zacatecas Purple, Zambi, Zay (with other substances), Zig Zag
Man, Zol, Zoom (with PCP)

Type: Hallucinogen.
Federal Schedule Listing: Schedule I (DEA no. 7360)
USA Availability: Illegal to possess
Pregnancy Category: None

Uses.
As the twenty-first century began, the recreational use of marijuana was mainly for relaxation. The drug is often used in a social setting of mellow geniality. The drug can produce euphoria; in that context recreational usage can leak over into self-medication easing depression. One authority has said that psychological effects are facilitated by the substance, not caused by it. In
other words, marijuana may help people achieve states of consciousness that they can learn to achieve in other ways.

When the federal government’s drug scheduling system was adopted in the 1970s, marijuana was classified as Schedule I, certifying it as having no medical value. Like many other substances, over the years marijuana had been used for medical purposes that became obsolete as better treatments were discovered. Then, by accident, a glaucoma sufferer discovered that his condition improved when he smoked marijuana, and subsequent scientific tests confirmed that the natural product had a hitherto unknown ability to relieve that devastating eye disease that can cause blindness. Marijuana’s long-known antinausea and appetite enhancement qualities also became publicized as a help to patients undergoing the rigors of AIDS (acquired immunodeficiency syndrome) and cancer treatments. As researchers began discovering other potential therapeutic actions of marijuana (including treatment of pain, multiple sclerosis, muscle spasticity, ulcerative colitis, and hiccups), medical use became a controversial issue in the 1990s.

Among the debated points was whether the natural product had advantages over harmaceutical dronabinol (containing delta-9-tetrahydrocannabinol, also called THC, which is marijuana’s
main active ingredient). Instead of swallowing dronabinol capsules, some patients prefer to smoke marijuana because they can fine-tune the THC dosage more easily, puffing just enough instead of taking a capsule that might have more THC than they need. Marijuana smoke may also reduce some of the unwanted actions of THC. Although belladonna and jimson weed cigarettes were used for many years to treat asthma, given what is known about the hazards of both tobacco and polluted air, few medical caregivers today are likely to favor inhaling any kind of smoke. Ancient Greeks reportedly put marijuana seeds on hot stones to release vapor, and modern efforts are devising other ways to produce vapor without igniting the substance, providing aerosol delivery without smoke.

Scientific debate aside, controversy about medical marijuana also had political components. Many powerful individuals and institutions had a vested interest in maintaining marijuana’s Schedule I status. Also, many persons saw legalization for medical purposes as the first step toward lifting the ban on recreational use. Passionate claims and counterclaims about marijuana’s medical value swirled as this book was written, and doctors could not prescribe
marijuana.

Drawbacks.
Although calling marijuana a hallucinogen stretches the definition of that type of drug, this book follows the governmental custom of classifying marijuana in that category. Despite that official classification, reports of hallucinations from marijuana are uncommon.

Physical effects can include reddened eyes, accelerated heartbeat, higher body temperature, lower testosterone level, and arousal of senses. In the 1970s reports began appearing from laboratory and animal experiments indicating that marijuana’s active ingredient THC harms immune system functions, meaning infections may become more likely. Those experiments frequently involved conditions that are not duplicated in the human body, however, and
by the 1990s fears about damage to the human immune system had quieted.

Marijuana is sometimes described as making people less interested in accomplishing tasks in life. Someone jokingly suggested that the substance instead creates insatiable ambition to hold elective office. In reality, marijuana does not make people unambitious. Such persons may be attracted to heavy marijuana use, but probably they were unambitious before using the substance.

One research study found that marijuana users who lack ambition tend to be depressed and concluded that depression (not marijuana) was the underlying cause for these persons’ diminished motivation. Case studies indicate that marijuana can worsen psychoses, neuroses, and phobias.

In one study a battery of thinking tests given to groups of marijuana users and nonusers found no difference in performance; in another study daily users did worse than occasional users. Long-term memory (the ability to recall many long-known things, such as remembering the year Columbus sailed to America) has been unaffected in experiments. Short-term memory performance (brief ability to recall a few newly known things, such as a list of random
words) can decline during intoxication but afterward returns to normal. Some researchers have found marijuana to have no influence on muscular coordination, sensory perception, mental ability, or learning; other researchers have found that marijuana impedes muscular coordination and mental abilities.

Driving skill tests have shown similar variation; some studies find that marijuana harms such skill, and some do not. Some research shows marijuana having no effect on users’ performance the next day; some research shows impairment 24 hours after use. Such differing results may relate to intoxication levels, to volunteers’ experience with handling the substance, and to how long persons have been using it (some researchers believe that long-term use produces
long-erm effects extending beyond the time of acute intoxication).

The most obvious unwanted physical effects of marijuana are caused or promoted by inhaling smoke, afflictions caused by the manner of dosing rather than by the substance itself. In an animal experiment primates that inhaled marijuana smoke were compared to those in a smoke-free group; the marijuana group developed lung damage that could have led to bronchitis or emphysema, had the smoking continued long enough. Among humans frequent marijuana smoking is known to produce coughing, wheezing, and sputum.

Marijuana smoking reduces lung function in ways suggesting that chronic obstructive pulmonary disease (COPD) might develop if a person smokes four or five marijuana cigarettes daily for 30 years (with a lesser amount needed if a person also smokes tobacco). Certain kinds of lung damage have been seen in marijuana smokers but not in tobacco smokers. Marijuana smokers typically use big puffs and deep inhalations, held for a long period of time. Such a technique deposits larger quantities of damaging materials in lungs than the ordinary tobacco-smoking technique. Efforts to document lesser-known health risks have been flawed or outright unsuccessful.

Reports of physical disease in marijuana users often fail to account for other possible (and perhaps more likely) causes.

Despite conceivable health hazards from marijuana, it seems safe in moderation, no more dangerous than many foods (such as items high in sugar, salt, fat, and cholesterol). The natural product is extraordinarily safe from a dosage standpoint.1 No human fatality has been confirmed, although cattle deaths have been reported after consuming bales of dried marijuana.
Abuse factors. Tolerance and dependence have been reported. A marijuana abstinence syndrome is described as including physical and mental tenseness, peevishness, less happiness, and diminished appetite. Such symptoms, however, sound much like the reasons many persons use marijuana. If a chronic headache sufferer reported discomfort when pain relievers were unavailable, that would not be considered evidence of dependence on and withdrawal from pain relievers. Self-administration of a drug by laboratory animals is a traditional sign of addictive potential, but researchers have mixed success in getting animals to self-administer THC.

Drug interactions.
Not enough scientific information to report, although it is reasonable to assume interactions could be similar to those occurring with dronabinol.

Cancer.
Laboratory tests indicate that marijuana smoke can cause cancer. Oral and lung cancer is reported among marijuana users, although we must remember that typical users also smoke tobacco. One study did find that marijuana, even when tobacco use is accounted for, increases chances of getting head and neck cancer. One of the more impressive studies of marijuana’s
cancer-causing potential involved medical records of 64,888 persons and discovered that people who used marijuana, whether frequently or infrequently, were in general no more likely to get cancer than anyone else. That study did find evidence, however, that marijuana promotes prostate and cervical cancer.

Researchers have found that children are more likely to develop acute nonlymphocytic leukemia if their mothers used marijuana during pregnancy. This is a rare disease; in a population of 1 million children, about 5 will have the affliction. The disease is also associated with pesticide exposure, and investigators are uncertain whether pesticide contamination of marijuana is a more important factor than marijuana itself.

Chromosome damage can indicate a potential for development of cancer. Some laboratory and animal experiments indicate marijuana causes chromosome damage, but a study found human chromosome abnormalities to be about the same in moderate users of marijuana and nonusers.

Researchers conducting one human study sent the same samples to two laboratories, but
neither lab was able to find chromosome damage attributable to marijuana.

Pregnancy.
Normally we think of marijuana as a recreational substance, but some women use it to ease discomforts of pregnancy and childbirth. Marijuana chemicals pass from a pregnant woman into the fetus. Almost all research finds no evidence that marijuana causes human birth defects. A study examining infants of adolescent mothers who used marijuana during pregnancy
noted some “minor” birth defects, but even these researchers did not conclude that marijuana was necessarily the cause. Studies of newborns’ birthweights have been inconclusive about an impact from prenatal marijuana exposure.

No major effect on muscular coordination and balance turned up in an examination of preschool children having prenatal marijuana exposure, but investigators cautioned that the tests lacked measures of subtle skills. Behavior problems have been reported among children who had prenatal marijuana exposure, but we do not know whether those problems were caused by marijuana or by years of exposure to a particular type of parent. Investigators watching development of children up to age 5 found no difference attributable to maternal marijuana use during pregnancy; differences existed but were ascribed to home environment and schooling.

Examination of reading and language abilities in children aged 9 to 12 years found no significant impact from prenatal marijuana exposure. Some researchers believe they have found problems caused by prenatal marijuana, but most research is consistent with marijuana being benign.

Marijuana’s THC passes into human milk, and researchers report deficient development of muscle and limb coordination among infants nursed on suchmilk. One case report noted the THC level in milk was eight times higher than the mother’s blood level.

Additional information.
Marijuana and hemp come from different portions of the same plant, Cannabis sativa. Leaves, flowers, and resin are the illegal drug marijuana; the resin is also called hashish. Stalks and seed (if processed so it will not germinate) are the legal commercial product hemp. The terms
hemp and marijuana are sometimes used interchangeably, but such use is incorrect.

After marijuana was outlawed in the 1930s, hemp raising continued to thrive because law enforcement authorities of the era were familiar with the industry and understood that crops were not entering the illegal drug market even though the plants had leaves and flowers and resin. During World War II the federal government subsidized hemp farming to replace
natural fiber supplies cut off by the war. In the 1950s subsidies finally stopped, and the American hemp industry also stopped because it could no longer make money at the unsubsidized world market price.

Some food products contain hemp components and can cause false positives for marijuana in urine drug screen tests. Hemp lotions and creams rubbed on the skin produce marijuana chemicals in urine, but not enough to cause false positives in a drug screen.

“Locoweed” and “stinkweed” are nicknames for both jimson weed and marijuana, but the substances are different.

Additional scientific information may be found in:
Carlson, B.R., and W.H. Edwards. “Human Values and Marijuana Use.” International
Journal of the Addictions 25 (1990): 1393–401.

Fried, P., et al. “Current and Former Marijuana Use: Preliminary Findings of a Longitudinal
Study of Effects on IQ in Young Adults.” CMAJ: Canadian Medical Association Journal 166 (2002): 887–91.

Gruber, A.J., H.G. Pope, and P. Oliva. “Very Long-Term Users of Marijuana in the United States: A Pilot Study.” Substance Use and Misuse 32 (1997): 249–64.

Hendin, H., et al. “The Functions of Marijuana Abuse for Adolescents.” American Journal
of Drug and Alcohol Abuse 8, no. 4 (1981–1982): 441–56.

Iversen, L. “Marijuana: The Myths Are Hazardous to Your Health.” Cerebrum 1, no. 2 (1999): 37–49.

Labouvie, E.W. “Alcohol and Marijuana Use in Relation to Adolescent Stress.” International
Journal of the Addictions 21 (1986): 333–45.

Reilly, D. “Long-Term Cannabis Use: Characteristics of Users in an Australian Rural
Area.” Addiction 93 (1998): 837–46.

Sidney, S., et al. “Marijuana Use and Mortality.” American Journal of Public Health 87
(1997): 585–90.

Solomon, D., ed. The Marihuana Papers. Indianapolis, IN: Bobbs-Merrill, 1966.

Taylor, D.R., et al. “A Longitudinal Study of the Effects of Tobacco and Cannabis
Exposure on Lung Function in Young Adults.” Addiction 97 (2002): 1055–61.

Thompson, K.M. “Marijuana Use among Adolescents: Trends, Patterns, and Influences.”
Minerva Pediatrica 53 (2001): 313–23.

U.S. Commission on Marihuana and Drug Abuse. Marihuana, a Signal of Misunderstanding.
Washington, DC: Government Printing Office, 1972.

Von Sydow, K., et al. “The Natural Course of Cannabis Use, Abuse and Dependence
over Four Years: A Longitudinal Community Study of Adolescents

Mandrake (Mandragora officinarum)

2009-03-08T09:42:00.000-07:00

Pronunciation: MAN-draik
Chemical Abstracts Service Registry Number: None
Formal Names: Mandragora officinarum
Informal Names: Satan’s Apple
Type: Depressant.
Federal Schedule Listing: Unlisted
USA Availability: Nonprescription natural product
Pregnancy Category: None

Uses.
In some cultures European mandrake has traditional association with the devil, perhaps because a little imagination can envision the plant’s root as a small humanoid figure. The plant’s ominous connotation is illustrated in Romeo and Juliet as Juliet approaches death and shudders about hearing “shrieks like mandrakes’ torn out of the earth,” referring to a belief that the plant screams if harvested. Witches reputedly made preparations from the plant that enabled them to fly.

Medicinal usage of European mandrake may date back as far as ancient Egypt, but in twenty-first-century Western medicine, only practitioners of homeopathy use the substance for healing. (Homeopathy uses extremely weak preparations of medicines.) Folk practitioners have given European mandrake to fight depression, asthma, hay fever, whooping cough, colic, and stomach
ulcers. The plant has also been administered as a folk treatment to promote fertility, perhaps inspired by the story in Genesis 30: 14–17. Such usage is referred to by the line “Get with child a mandrake root” from John Donne’s sonnet “Song: Go and Catch a Falling Star.” The plant is linked with romance (Song of Solomon 7:13) and is a traditional aphrodisiac, although such a characteristic has not received scientific confirmation. Sedative and pain relief actions made the plant one of the first surgical anesthetics, and an image of it appears on the coat of arms of the British Association of Anaesthetists. European mandrake contains the so-called belladonna alkaloids atropine, hyoscyamine, and scopolamine; therefore, European mandrake produces actions similar to those of belladonna.

Drawbacks.
Unwanted effects can include rapid heartbeat, elevated body temperature, decrease in sweat and salivation, and difficulty with urination and bowel movements. The natural product initially acts as a sedative, but a strong enough dose converts mandrake into a stimulant that can cause manic behavior, delirium, and hallucinations. An amount sufficient to bring on those latter effects may be an amount sufficient for dangerous poisoning. Expert guidance is recommended for anyone using the plant.

Abuse factors.
Not enough scientific information to report about tolerance, dependence, withdrawal, or addiction.

Drug interactions.
Not enough scientific information to report.

Cancer.
Not enough scientific information to report.

Pregnancy.
Not enough scientific information to report.

Additional information.
Podophyllum peltatum (CAS RN 9000-55-9 for resin) is the American mandrake, a different plant from the European one and one that persons sometimes use accidentally when they are seeking the European variety. The American version is also known as Devil’s Apple, Duck’s Foot,
Ground Lemon, Hog Apple, Indian Apple, May Apple, Peca, Raccoon Berry, Umbrella Plant, Vegetable Calomel, Vegetable Mercury, Wild Jalap, Wild Lemon, Wild Mandrake, and Yellowberry. American mandrake is not a controlled substance.

Odor from the flowers may be unpleasant, yet the small fruit is not only edible but enjoyed by some persons. Leaves and stems are described as poisonous.

American mandrake is a traditional Native American medicine, and in former times it was considered a substitute for mercury’s medical employment.

Folk medicine uses the plant to treat fever, worms, constipation, warts, syphilis, jaundice, liver disease, and cancer. Etoposide, a substance derived from the plant, is scientifically known to work against cancer. American mandrake contains podophyllotoxin, a substance that acts against viruses causing measles and herpes simplex type I. A study found podophyllotoxin and podophyllin (another American mandrake substance) to be effective against a type of wart. Application of American mandrake natural product preparations to the skin must be skillful because the plant can injure the skin and even be fatal if too much drug content is absorbed.

Animal experiments with the natural product have produced salivation, vomiting, pain, and straining to defecate. Those unwanted effects also appear in humans, with enough force to cause hemorrhoids and displacement of the rectum. One authority warns that if someone eats too much of the fruit, its laxative effect can become overpowering. Ulcers of the small intestine have
developed in animals that ingest American mandrake. A case is known of damage to nerves providing sensation to limbs after a person drank an American mandrake preparation. Persons working in an environment containing American mandrake dust have suffered irritated eyes and noses, along with coldness in their hands and feet.

The plant is suspected of causing birth defects, and usage is supposed to be avoided during pregnancy. A case report tells of fetal death after American mandrake was used to treat warts on a pregnant woman.

Additional scientific information may be found in:
Frasca, T., A.S. Brett, and S.D. Yoo. “Mandrake Toxicity: A Case of Mistaken Identity.”
Archives of Internal Medicine 157 (1997): 2007–9.

Lust, J.B. The Herb Book. New York: Benedict Lust Publications, 1974. 259–60.

Millspaugh, C.F. American Medicinal Plants. Philadelphia: John C. Yorston & Company,
1892. Reprint, New York: Dover Publications, Inc., 1974. 61–64.

Morton, J.F. Major Medicinal Plants: Botany, Culture and Uses. Springfield, IL: Charles C.
Thomas, 1977. 87–89.

Vlachos, P., and L. Poulos. “Case of Mandrake Poisoning.” Journal of Toxicology: Clinical
Toxicology 19 (1982): 521–22.

Weiner, M.A. Weiner’s Herbal. New York: Stein and Day, 1980. 124–25.

Ma Huang (Ephedra sinica, Herbal Ecstasy)

2009-03-08T09:38:00.000-07:00

See also Ephedrine
Pronunciation: mah-hwahng
Chemical Abstracts Service Registry Number: None
Formal Names: Ephedra sinica
Informal Names: Chinese Ephedra, Chinese Jointfir, Desert Tea, Herbal Ecstasy, Mexican Tea, Miner’s Tea, Mormon Tea, Popotillo, Sea Grape, Squaw Tea, Teamster’s Tea, Whorehouse Tea, Yellow Horse
Type: Stimulant (amphetamine class).
Federal Schedule Listing: Unlisted
USA Availability: Nonprescription natural product
Pregnancy Category: None

Uses.
Ephedra sinica is one of several Ephedra species classified as the Chinese medical herb ma huang (loosely translated as “yellow drug that constricts the tongue”). Each species is a plentiful source of ephedrine and pseudoephedrine. A study found that the proportion of ephedrine to other mahuang components increased if the herb was boiled for two hours. A test comparing the natural herb to synthetic ephedrine (such as commonly found in medicines) revealed little difference in how the human body used ephedrine from those two different sources; investigators concluded that effects depend more on size of dose than source of drug.

The herb has been used in China for 5,000 years, principally to treat respiratory ailments. Ancient Greek utilization of Ephedra varieties is also noted.

More recently ma huang has been used against narcolepsy. Though thought of as a Chinese herb, varieties of Ephedra plants also grow in Mexico and the American Southwest where they were once used to treat venereal disease.

Mormon pioneers used the plants as alternatives to tea and coffee. Almost nothing is said of using the plants for food, although reports exist about bread made from the plants and about eating the berries, which are supposed to be a good source of vitamin C.

In Eastern medicine ma huang is administered as a tea to fight fever, asthma, and the common cold but has become popular in the Western world as a stimulant and for promotion of weight loss. One study found that people using a ma huang and cola nut combination lost over four times more weight than persons using a placebo. Ma huang is marketed as a muscle builder, as a means of improving sexual performance, and also as a legal substitute for MDMA. How well the product lives up to such advertising is debatable. In the 1990s retail gross sales of ma huang products was estimated at over a half billion dollars a year. In the year 2000 surveys from 755 persons undergoing outpatient surgery were reported, saying that 18% were using ma huang.

Drawbacks.
Purity of ma huang products is uncertain. Examination of 20 ma huang dietary supplements found them to vary widely in content of ephedrine and pseudoephedrine, and 4 even had inconsistency among various batches of the same product. One examined product lacked any ephedrine or pseudoephedrine at all. Many contained cathine, a Schedule IV prescription
drug found in khat. Perhaps the most alarming finding was that actual contents of half the products did not match the label description. Another study of 9 ma huang products had similar results. In a separate instance, undeclared contents of a ma huang product was a factor causing an athlete to flunk when tested for drugs banned from competitive sports.

The herb is known to cause paranoia, delusions, combativeness, mania, and hallucinations similar to what amphetamine abuse can do. Someone with such behavior was diagnosed and medicated for mental illness because no one suspected ma huang use. Case studies offer vivid accounts of overdose causing users to direct violence against themselves and others. Psychiatric problems
can persist for quite some time after drug use stops.

A study found that ephedrine did not account for all of ma huang’s adverse effects and that unwanted actions increased if the herb was ground up. Herbalists commonly prescribe 5 or 6 grams of ma huang for steeping as one dose of tea, yielding (depending on potency) perhaps 38 to 75 mg of ephedrine.

The U.S. Food and Drug Administration (FDA) has found many examples of hazard in an ephedrine dose exceeding 10 mg. Two studies found the substance to be safe in that amount, although one of those studies and a third one noted heartbeat irregularity, reduced salivation, and difficulty with sleep.

Headache, dizziness, nausea, vomiting, skin rash, urinary retention, kidney stones, and heart inflammation have been associated with using ma huang. Persons with glaucoma should avoid the substance. Ma huang is suspected of causing liver disease, but investigators are uncertain. Stroke, heart attack, and death have been attributed to the substance, but those claims are disputed.

An experiment measuring heart rate and blood pressure yielded unclear results about ma huang’s influence. The herb may cause adverse reaction with monoamine oxidase inhibitors (MAOIs, commonly found in antidepressants).

Persons with diabetes or thyroid disease should consult with a physician before using ma huang. Aircraft pilots have been advised to avoid the natural product.

Abuse factors.
Stopping the usage of ma huang can cause a person to be tired, sleep a lot, be sad, and have trouble concentrating. Those are opposite of typical effects that the substance has, suggesting that a user’s body has developed a dependence on ma huang (because withdrawal from dependence often produces effects opposite to what a drug does). Dependence is a traditional
sign that a substance is addictive.

Drug interactions.
The FDA considers combining ma huang with cola nut to be dangerous. The two prime drug components of those natural products are ephedrine and caffeine, and caffeine boosts ephedrine effects. Scientific study finds that ma huang with caffeine, but not ma huang alone, can improve
functioning in physical exercise. The combination of ma huang with another medicinal herb called guarana may be particularly poisonous to dogs.

Cancer.
Not enough scientific information to report.

Pregnancy.
Ma huang is supposed to be avoided during pregnancy.

Additional scientific information may be found in:
Chen, K.K., and C.F. Schmidt. “Ephedrine and Related Substances.” Medicine 9 (1930):1–117.

Grauds, C. “Herbal Ephedra and the Pharmacist.” Pharmacy Times 64 (March 1998):60, 62.

Jacobs, K.M., and K.A. Hirsch. “Psychiatric Complications of Ma-Huang.” Psychosomatics
41 (2000): 58–62.

Mack, R.B. “ ‘All But Death, Can Be Adjusted.’ Ma Huang (Ephedrine) Adversities.”North Carolina Medical Journal 58 (1997): 68–70.

Powell, T., et al. “Ma-Huang Strikes Again: Ephedrine Nephrolithiasis.” American Journal of Kidney Diseases 32 (1998): 153–59.

Sprague, J.E., A.D. Harrod, and A.L. Teconchuk. “Pharmacology and Abuse Potential of Ephedrine.” Pharmacy Times 64 (May 1998): 72–80.