Chapter 2: Drug use: Yesterday and Today

Methylenedioxymethamphetamine (MDMA)

(street names: Ecstasy, Molly, XTC, X, Adam, clarity, lover's speed). -MDMA is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. - MDMA can produce both stimulant and psychedelic effects and can be extremely dangerous when taken in large doses

Lysergic acid diethylamide (LSD)

(street names: acid, boomers, purple haze, yellow sunshines). -LSD is a hallucinogen; it induces abnormalities in sensory perceptions. -The effects of LSD are unpredictable, depending on the amount taken; on the surround- ings in which the drug is used; and on the user's personality, mood, and expectations. -Two long-term disorders sometimes associated with LSD are persis- tent psychosis and hallucinogen persisting perception disorder (which used to be called "flashback

Gamma hydroxybutyrate (GHB)

(street names: grievous bodily harm, G, liquid Ecstasy, Georgia homeboy, bedtime scoop). -GHB can be produced in clear liquid, white powder, tablet, and capsule forms, and it is often used in combination with alcohol, making it even more dangerous. -GHB has been increasingly involved in poisonings, overdoses, rapes, and fatalities. -GHB is often manufactured in homes with recipes and ingredients found and purchased on the Internet. It is usually abused either for its intoxicating, sedative, or euphoriant properties or for its growth hormone-releasing effects, which can build muscle. -When taken in smaller doses, GHB can relieve anxiety and produce relaxation; however, as the dose increases, the sedative effects may result in sleep and eventual coma or death.

Rohypnol

(street names: roofies, rophies, roche, forget-me pill). - Rohypnol (flunitrazepam) belongs to the class of drugs known as benzodiazepines. -It is not approved for prescription use in the United States, although it is approved in Europe and is used in more than 60 countries as a treatment for insomnia, as a sedative, and as a presurgery anesthetic. -Rohypnol is tasteless and odorless, and it dissolves easily in carbonated beverages. - The drug can cause profound "anterograde amnesia"; that is, individuals may not remember events they experienced while under the effects of the drug.

Ketamine

(street names: special K, K, vitamin K, cat valiums, jet). Ketamine is an injectable anesthetic that has been approved for both human and animal use in medical settings since 1970. -Ketamine is produced in liquid form or as a white powder that is often snorted or smoked with marijuana or tobacco products. -Taken in larger doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems. -Low-dose intoxication from ketamine results in impaired attention, learning ability, and memory.

Methamphetamine

(street names: speed, ice, chalk, meth, crystal, crank, fire, glass). -Methamphetamine is a toxic, addictive stimulant that affects many areas of the central nervous system. -The drug is often made in clandestine laboratories from relatively inexpensive over-the-counter ingredients. -Available in many forms, methamphetamine can be smoked, snorted, injected, or orally ingested. -Its use is associated with serious health consequences including memory loss, aggression, violence, psychotic behavior, and potential cardiac and neurological damage. -Methamphetamine abusers typically display agitation, excited speech, decreased appetite, and increased physical activity levels.

the San Francisco ordinance

-The only notable law regarding drug use in the 19th century that had any effect was a city ordinance passed in San Francisco in 1875. -Most of these immigrants worked on the building of the railways. When this construction was finished, many of the laborers made their way back to San Francisco, where they frequented "opium dens"—places where people could smoke opium. ^Although this drug use had little negative effect on the San Francisco community per se, some thought the practice was sinister. - Only opium dens were banned, however, not the smoking of opium. -Conviction for operating or frequenting an opium den carried a fine of $50 to $500 and/or a jail sentence of 10 days to 6 months. -The actual impact of the ordinance was not great; the larger and more obvious opium dens closed, and the number of smaller dens increased. -The effect was greater in the sense of setting the stage for drug regulation in other parts of the country, as a number of other cities and states passed similar ordinances in later years. -Not until 1909 did Congress pass a law banning the importation of opium for smoking.

State drug laws

-each state has the opportunity to modify current drug laws according to its own needs and preferences. -Most states have adopted guidelines, but many have changed certain components. ex./ For example, marijuana is classified as a Schedule I substance, but the penalties for possession in many states are less severe than those applied to other Schedule I substances. In fact, a number of states at some time have passed legislation to decriminalize, and in some recent cases to outright legalize, marijuana possession.

History of Psychoactive drugs

A historical view of psychoactive substance use might show the 1960s as the era of lysergic acid diethylamide-25, commonly known as LSD. -The drug had been used in various tests during the 1950s (for example, as an adjunct to psychotherapy) but did not reach the height of its popularity until the mid-1960s, when Dr. Timothy Leary, a Harvard psychologist, began to expound on what he found to be its mind-altering advantages. - LSD was banned in 1967, and its use waned considerably until a recent resurgence in its popularity, particularly in the context of the "rave" culture. ^The last several years have witnessed clinical trials studying the use of LSD in palliative care and in the treatment of several disorders, including anxiety, depression, posttraumatic stress, cluster headaches, and substance use disorders

Peyote

A cactus plant, the top of which (a "button") is dried and ingested for its hallucinogenic properties - The Indians who inhabited this land also introduced Columbus and the later explorers and settlers to a wide variety of psychoactive plants, including peyote. ^The Europeans, in turn, introduced distilled spirits, a major staple on the long and arduous voyage across the Atlantic. The Pilgrims, for example, brought with them large stores of alcoholic beverages

Narcotic

A central nervous system depressant that contains sedative and pain-relieving compounds - Not until the beginning of the 20th century was this trade reduced and eventually terminated, dovetailing with a growing international recognition of narcotic drug abuse. -In the 20th century, few differences existed between Europe and North America in the types of drugs being used. What is of interest is that a large number of new or "rediscovered" drugs were first popularized in the United States and later became popular in other countries, making the United States something of a trendsetter in drug use.

Fermentation

A combustive process in which yeasts interact with the sugars in plants such as grapes, grains, and fruits to produce an enzyme that converts the sugar into alcohol

Morphine

A derivative of opium best known as a potent pain- relieving medication. - Into the mid-1800s, few restrictions were placed on drugs. Drugs such as opium, morphine, marijuana, heroin (at the end of the century), and cocaine were easy to obtain without prescription, often at grocery stores or through mail order. ^ Morphine was commonly used, especially during and after the Civil War, and opium, morphine, and cocaine could be obtained in a variety of patent medicines readily available in stores. ex./ Examples were Godfrey's Cordial, Swaim's Panacea, Ayer's Sarsaparilla, and Mrs. Wilson's Soothing Syrup. Opium was frequently taken in liquid form in mixtures such as laudanum (which contained 1 grain of opium to 25 drops of alcohol), and one of its common uses was in calming and quieting crying babies - Morphine, the active agent in the opium poppy, was isolated in 1806. It was named after Morpheus, the god of sleep and dreams, and was used widely during and after the Civil War, its administration greatly facilitated by the introduction of the hypodermic needle in the late 1840s. ^In fact, the widespread use of morphine during the Civil War is generally considered responsible for large numbers of soldiers developing the "soldier's disease"—morphine addiction.

hashish

A drug produced from the resin that covers the flowers of the cannabis hemp plant. The resin generally contains a greater concentration of the drug's psychoactive properties.

Cocaine

A drug whose popularity has fluctuated among drug users in this country is cocaine. -Cocaine was widely used in various "tonics" and patent medicines in the late 1800s and early 1900s, despite concerns over negative effects associated with its extended use; not until 1914 was cocaine brought under strict legal controls and penalties. Its use was apparently limited in the United States until the 1960s. In the late 1960s and up to now, it has been in much wider use in various forms. ex./ For example, crack cocaine (a free-based form of cocaine made by cooking cocaine powder, water, and baking soda until it forms a solid) first appeared in large cities in the mid-1980s. Some experts believe that cocaine (along with heroin and methamphetamine) will be a drug of choice for many drug users in upcoming

Psychedelic substances

A more recent psychedelic substance to appear on the scene is methylenedioxymethamphetamine, better known as MDMA or "Ecstasy." -MDMA is one of a cluster of drugs collectively referred to as "club drugs" (others include methamphetamine, GHB, LSD, and ketamine; they are discussed in greater detail in Contemporary Issue Box 2.1

opium poppy

A plant cultivated for centuries, primarily in Eurasia, for opium—a narcotic that acts as a central nervous system

synthetic marijuana

A psychoactive "designer drug" comprised of natural plants that are sprayed with synthetic chemicals that mimic the effects of cannabis when consume - The second example, quite profoundly, is the recent increased use of fentanyl, a synthetic opioid being used alone or mixed with heroin. ^An anesthetic used in surgery settings, fentanyl can be 50-100 times more potent than morphine. ^In many communities, fentanyl fatalities are exceeding those associated with heroin. >More broadly, the rapid rise in heroin and fentanyl use, and the associated negative consequences and deaths, have been widely cited as a national epidemic. >The only thing that can be said with confidence is that drugs will continue to be used and that some drug abuse will be associated with any given psychoactive substance. -Synthetic marijuana is another relatively new drug. Here, cannabinoids are synthesized and sprayed onto an appropriate plant and smoked like regular cannabis. -It is best known by the brand names Spice and K2. Synthetic marijuana, like "bath salts," has caused a surge in visits to emergency rooms and has similarly been banned in a number of states.

Speakeasy

A slang expression used to describe a saloon operating without a license; popularly used during Prohibition. -The greatest decrease in alcohol consumption was among the working population, and this made the legislation vulnerable to widespread criticism that it was a biased law. -Unfortunately, a variety of other undesired consequences were associated with Prohibition, including more extensive use of marijuana, a shift in drinking habits away from beer to distilled spirits, the advent of the speakeasy, and the takeover of alcohol distribution by criminal groups. -Thus, although Prohibition was successful in achieving some of its intended effects, these outcomes were tempered by other undesired results.

Solvent

A substance, usually a liquid or gas, that contains one or more intoxicating components; examples are glue, gasoline, and nonstick-frying pan sprays. -. The 1950s are also associated with the contemporary appearance of solvent inhaling. ex./ The first report of such abuse was in 1951, by Clinger and Johnson, who described the intentional inhalation of gasoline by two boys. -Solvent abuse tended to be more common with other substances, however, such as model cements, lighter fluids, lacquer thinner, cleaning solvents, and more recently the propellant gases of aerosol products. -The problem was marked in the early 1960s, with solvent inhaling causing deaths and leading hobby glue producers to remove the two most toxic solvents—benzene and carbon tetrachloride—from their products (Blum, 1984). - A more recent example has been the sniffing of correction fluids that contain the solvent trichloroethane. ^Manufacturers of correction fluid have replaced trichloroethane with other solvents or added unpleasant substances to the fluid, such as mustard oil. -Solvent inhalant abuse (such as the current "huffing" of propane and spray paint fumes) is still a serious problem, especially among boys in their teens. ^Indeed, there have been recent reports of teenagers using aerosol products and then diving into a swimming pool because they had heard that the underwater pressure would increase the rush. > Instead, doing so has sometimes resulted in "sudden sniffing death syndrome," whereby users have a heart attack and drown.

Alcohol Prohibition

Alcohol prohibition was enacted several years later when, in 1920, Congress passed the Eighteenth Amendment to the Constitution. - The legislation was a victory for the forces that viewed alcohol as evil and destructive, notably the Anti-Saloon League and the Women's Christian Temperance Union. -The amendment was not vague about its intent: It prohibited the production, sale, transportation, and importing of alcohol in any part of the United States. -The only exception was that alcoholic beverages kept in the home, such as naturally fermented hard cider, could be consumed but not offered for sale

Club Drugs

All indications are that club drugs can cause serious health problems and even death in some cases. -Some of these drugs are stimulants, some are depressants, and some are hallucinogens. -When used in combination with alcohol, these drugs can be even more dangerous. ^Because some club drugs are colorless, tasteless, and odorless, individuals who want to intoxicate or sedate others (often to commit sexual assaults) can unobtrusively add them to beverages. Following is some information on the leading club drugs.

federal Drug Enforcement Agency

Along with the actions taken by individual states, the federal Drug Enforcement Agency in 2011 added several of the ingredients most commonly used in "bath salts" and synthetic marijuana to the con- trolled substances schedule. -In 2012, the Synthetic Drug Abuse Prevention Act was passed to ban these ingredients at the federal level. -In addition to adding these latest ingredients to the controlled substances schedule, the new law closed a loophole that was associated with the 1986 Controlled Substances Ana- logue Enforcement Act. -In this regard, "bath salts" and synthetic marijuana came in packages labelled as "not for human consumption," which helped them avoid the provisions of the Analogue Enforcement Act, under which any substance substantially similar to a banned drug was deemed illegal if intended for human consumption.

harrison Narcotics tax act

Another major piece of federal legislation, the Harrison Narcotics Tax Act, was passed in 1914. - The Harrison Narcotics Tax Act strictly regulated, but did not prohibit, the legal supply of certain drugs, particularly the opiates. The law stated that marketing and prescribing these drugs required licensing. - The physician was directed to prescribe narcotics only "in the course of his professional practice." ^This phrase is certainly general and open to interpretation, and controversy between law enforcement agencies and physicians ensued. >The central debate was whether the prescribing of an opiate for an addict was part of a treatment plan or merely served to maintain the addict's dependence on the drug. Although this confusion of the act's intent led to more restrictions on prescribing and supplying opiates, the act had little effect on opiate abuse (even when subsequent amendments mandated more severe penalties for possession). -Three other facets of the Harrison Narcotics Tax Act should be mentioned: 1. First, the act did not restrict manufacturers of patent medicines, with the exception that their preparations could "not contain more than two grains of opium, or more than one fourth of a grain of morphine, or more than one eighth of a grain of heroin . . . in one avoirdupois ounce" (U.S. Pure Food and Drug Act of 1906, cited in Brecher, 1972). 2. A second interesting aspect of this narcotic control act was its inaccurate inclusion of cocaine as a narcotic. 3. Finally, one treatment-related result of the Harrison Narcotics Tax Act was that treatment centers for addicts began to open in some of the larger cities (Morgan, 1981). Most of these centers, however, were open for

Brechner

Brecher (1986) argued that the act was actually counterproductive of the Harrison Narcotics Tax Act. -Brecher maintained that, in the years since its passage, the law actually has served to shift opium and morphine addicts to heroin (which became easier to obtain on the black market) and overall to double the number of addicts in the United States. -This occurred despite more than 50 modifications to the act during the 50 years following its passage, each change designed to toughen the law (Brecher, 1972)

Amphetamines

Central nervous system stimulants that act like naturally occurring adrenaline ex./ for example, were widely used to treat depression in the 1930s. In addition, they were given to soldiers during World War II in the belief that the drug would enhance alertness (O'Brien & Cohen, 1984). -Obtaining amphetamines through medical outlets such as physician prescriptions was not particularly difficult. -As concern arose about the dangers inherent in the continued use of these drugs, restrictions on their availability became much tighter. -At this juncture, the stage was set for a much greater production and distribution of amphetamines through illicit channels. Later, in the 1960s and 1970s, amphetamines went through another period of heavy use when they were overprescribed for weight control. -Amphetamines also became widely available on the street during this time. The abuse of amphetamines remains a significant problem today, particularly when these drugs are taken intravenous

History of Drug laws

Describing the history of drug laws in the United States will provide an example of one society's response to drug use and abuse. Interestingly, the implementation of drug laws in the United States did not really begin until the turn of the 20th century. -This made the United States one of the last industrialized nations to formally implement drug legislation. -Various efforts were mounted to regulate opiates in the second half of the 19th century, but these were largely half-hearted and ineffective. -That is not to say that sanctions on drug abuse did not exist, but rather there were no legal penalties to speak of. -At different times and in different locations, varying degrees of social sanctions existed, such as the ostracism of citizens who displayed certain forms of drunkenness in Colonial times

Current Drug laws

Drug classifications for law enforcement purposes are rooted in the 1970 Controlled Substances Act. -Under this measure, drugs are not classified according to their pharmacological action but according to their medical use, their potential for abuse, and their likelihood for producing dependence. -Several substances that have little or no potential for abuse or dependence are not classified. These include: 1. The major tranquilizers, such as chlorpromazine (trade name Thorazine), thioridazine (Mellaril), and haloperidol (Haldol); 2. and the antidepressants, such as imipramine (Tofranil) and amitriptyline (Elavil). -The Controlled Substances Act contains provisions for adding drugs to the schedules and for rescheduling drugs. ex./ For example, diazepam (Valium) and other benzodiazepines were unscheduled when the act was passed but were classified as Schedule IV drugs in 1975. - Similarly, phencyclidine (PCP, or "angel dust") was ini- tially unscheduled but then classified as a Schedule II substance in 1978 when it began to be abused. -A variety of Schedule III substances were reclassified into Sched- ule II during the early 1970s, including amphetamine (Benzedrine), methylphenidate (Ritalin), and secobarbital (Seconal). Methcathinone was classified as a Schedule I drug in 1992 - Many of these penalties, particularly those for drug trafficking, were increased during the 1980s and 1990s, through legislation such as the 1988 Anti-Drug Abuse Act. ^The penalties are greatest for trafficking Schedule I and II drugs (excluding marijuana, hashish, and hashish oil, for which the penalties are only slightly less severe), and the penalties increase with the quantity involved and the number of previous offenses. ex./ For example, a first conviction for trafficking 100 to 999 grams of heroin mixture or 500 to 4,999 milligrams of cocaine mixture carries a sentence of not less than 5 years (up to 40 years) and a fine of up to $2 million. If a death or serious injury is associated with the drug trafficking, the sentence is not less than 20 years imprisonment. - Larger quantities carry greater penalties, as do subsequent offenses. -Penalties for the possession of lesser amounts of a drug without intent to distribute are less severe, though still substantial. ^As part of the "zero-tolerance" feature of the "war on drugs" implemented in the late 1980s, law enforcement agencies may seize the assets of people who possess or sell drugs ex./ individuals caught with drugs in their cars or boats have had their vehicles seized and sold by government agencies, such as Customs, or local authorities

Drug Laws

Drug laws for the most part have had limited effectiveness in reducing overall illicit drug availability and use. -In fact, the more restrictive the laws, the less effective they have tended to be in the long run. -The only time these laws seem to be more effective is when drug use or abuse is particularly unpopular. ^However, the duration of these periods and the time between them are variable. >Nevertheless, legislation remains society's central means for addressing its concerns about drug

Heroin

Heroin is another drug with a long history of use in the United States. -Heroin was first synthesized in the late 1890s, and it has been available for use since the early 1900s. ^The extent of use traditionally has been greater among two populations: lower and higher socioeconomic groups (O'Brien & Cohen, 1984). -During the Vietnam War, the high incidence of heroin use among U.S. soldiers in Vietnam was a significant concern, but soldiers who used the drug overseas did not tend to continue its use following their return to the States. - In recent years, heroin has been showing a renewed popularity. The same factors that contributed to the spread of crack—low price and easy availability—appear to be behind this increase in heroin use. However, there are some new wrinkles and concerns. 1. First, the level of purity of the currently available heroin is higher than in the past. In the 1980s, the purity of heroin sold on the street was less than 10%; it is now estimated at more than 60% and can be as high as 80%. 2. Second, fewer users are injecting the drug. - Instead, users have been snorting or smoking it, or mixing heroin and crack and smoking the combination. Third, heroin was a drug historically used by adults. -However, early use and experimentation with heroin by U.S. teenagers have been an ongoing concern. Among those using heroin for the first time, approximately 25% are under the age of 18.

Historical overview

Indications of psychoactive substance use date back to the beginnings of recorded history and revolve around the use of alcohol and plants with psychoactive properties - Alcohol probably was discovered following accidental fermentation. (Grape wine, incidentally, did not appear until 300 b.c. to 400 B.C. - Also, various plants were used for the physical and psychological changes they produced, usually in religious or medicinal contexts. ex./ As an example, what probably was the opium poppy was used in Asia Minor about 5000 b.c. as a "joy plant" (Blum, 1984; O'Brien & Cohen, 1984). -The use of Cannabis sativa (brewed as a tea) dates to around 2700 b.c. in China. ^Emperor Shen Nung recommended it to his citizens for the treatment of gout and absentmindedness, among a host of other ailments. -People in the Stone Age are thought to have been familiar with opium, hashish, and cocaine, and to have used these drugs to produce altered states of consciousness (typically in a religious context) or to prepare themselves for battle (Government Printing Office [GPO], 1972). -Chewing coca leaves (one way to ingest cocaine) is recorded among Indian burial sites in Central and South America as far back as 2500 b.c. * Something to keep in mind is that the use of a drug in one culture does not necessarily mean people in another culture were at the same time exposed to or using that substance. ^Instead, cultures (now as well as then) are characterized by both diversity and similarity in their patterns of drug -Throughout history, contact between distant cultures has often been forced by trade agreements or by wars or other hostilities. ex./ For example, the Crusades and the expeditions of Marco Polo exposed Europeans to the drugs, particularly opium and hashish, that were popular in Asian cultures. -Other contacts were opened later through the travels of European explorers (particularly from England, France, Portugal, and Spain) to the Americas. The predominant psychoactive substances brought to Europe from the Americas were cocaine (from South America), various hallucinogens (from Central America), and tobacco (from North America). -There were relatively few restrictions on drug availability or drug use prior to the beginning of the 20th century (an exception is Islamic law's edicts on alcohol consumption). ^ Occasional efforts were made to decrease or eliminate certain substances, but these efforts tended to be short-lived or ineffective. ex./ For example, initial introductions of tobacco, coffee, and tea to Europe all met some resistance. Rodrigo de Jerez, a colleague of Columbus and the first European thought to smoke tobacco, was jailed in Spain because the authorities felt the devil had overtaken him (Whitaker, 1987). Also, at different times, efforts were made to ban the use of coffee and tea.

Future legislation

It is important to recognize that new legislation is always on the horizon, whether in response to the latest trends in drug use and abuse or reflecting emergent political mandates. -. A likely candidate for upcoming legislation is salvia divinorum, a hallucinogenic member of the sage family. Known as "magic mint" or "Sally-D," salvia has been used historically by Mazatec Indians in Mexico for ailments such as diarrhea, headaches, and rheumatism and for interacting with the supernatural world. ^Although salvia is legal to buy, sell, and smoke in most states, concerns over its use, growing popularity, and effects have led a rapidly growing number of states and also other countries to restrict or criminalize the sale and possession of salvia. >The Drug Enforcement Administration is considering classifying salvia as a controlled substance, and such an action appears likely in the near future -The legislation provided the FDA with broad control over how tobacco (a product with no medical use) in its various forms is marketed and sold, and over claims made about tobacco products, although it does not provide the authority to impose an outright ban on tobacco products. ^A number of FDA actions were mandated in the legislation. These include the banning of candy- flavored cigarettes (within 3 months of the passage of the law), the banning of the marketing of cigarettes as "light," "mild," or "low-tar" (within 12 months), implementing stronger warnings on smokeless tobacco products that will cover 30% of the front and back package panels (within 12 months), and graphic warnings on cigarette packages covering 50% of the top front and top back of the packages (within 39 months). >The mandated restrictions on marketing also included limiting advertisements and promotions to a black-and-white text-only format in stores that children can enter. >The bill overall contains a strong focus on deterring young people from smoking. ^Because an estimated 9 out of 10 smokers begin smoking before age 18, the bill may have the effect of hindering tobacco companies' access to youth and thus dramatically reduce the number of smokers in the longer term. -The most recent notable legislative actions are the Fair Sentencing Act of 2010 and the Synthetic Drug Abuse Prevention Act of 2012. ^The primary feature of the sentencing act was to reduce long-standing disparities between those arrested with crack cocaine versus those arrested with powder cocaine (with much more severe penalties associated with crack arrests). ^ In addition, the act allows judges to consider mitigating factors when sentencing convicted individuals, reversing the mandatory minimum sentences previously in place.

post-prohibition Legislation

Legislative action taken in 1930 provided independent status for narcotic control agents through the establishment of the Federal Bureau of Narcotics (later to be called the Bureau of Narcotics and Dangerous Drugs and now the Drug Enforcement Administration). -A major thrust of the Federal Bureau of Narcotics, spearheaded by Commissioner Harry J. Anslinger, was the eradication of marijuana use. Anslinger's crusade resulted in the Marijuana Tax Act of 1937. - Like the Harrison Narcotics Tax Act, this measure did not ban marijuana but instead required authorized producers, manufacturers, importers, and dispensers of the drug to register and pay an annual license fee. Only the nonmedical possession or sale of marijuana was outlawed (Brecher, 1972). ^Some medical uses for marijuana were still recognized. -Legislative actions regarding marijuana use gradually grew more restrictive and provided for greater penalties until the decriminalization movement began in the latter part of the 1970s. Two trends are worth noting: 1. The first is increased attention to nonnarcotic drug use, whereby stimulants, depressants, and hallucinogenic substances became regulated under legislation such as the Drug Abuse Control Amendment of 1965. 2. The second notable change in federal legislation was a shifting of at least some attention to the treatment of drug abuse through such measures as the Community Mental Health Centers Act of 1963 and the Narcotic Addicts Rehabilitation Act of 1966.

Comprehensive Drug Abuse Prevention and Control Act, was passed in 1970

More commonly known as the Controlled Substances Act, this legislation is the basis for drug regulation in the United States today.

Medical Science and Drug Use

Numerous other examples can be cited. Chloroform and ether were developed as anesthetics, but each also went through a period in the 1850s when its nonmedical use was quite fashionable. -At one time, cocaine was used to treat complaints such as depressed mood and pain. In fact, one of its uses was as a treatment for opiate addiction. -In the latter half of the 19th century, physicians recognized an array of uses for cannabis, including treatment of insomnia and nervousness, although its prescribed use was not nearly as extensive as with the opiates. -The 20th century witnessed the development of the synthetic stimulant amphetamines, some of which initially were available without prescription -We could provide additional examples, but the important point is that medicinal uses of psychoactive substances (whether folk medicine or more contemporary medicine), medical science, and nonmedical drug use and abuse will always be closely intertwined. In the past, folk or cultural use of a substance often became incorporated into the practice of medicine. -More common today is the incorporation of a substance developed for the practice of medicine into the array of drugs that can be used in nonmedicinal ways. -The reverse can still occur, however, as shown by the attention being given to the medical uses of marijuana. In any event, keeping the medical and nonmedical uses of drugs separate is impossible

National Organization for the Reform of Marijuana Laws (NORML)

Organizations active in this effort include the National Organization for the Reform of Marijuana Laws, or NORML, and the Drug Policy Alliance. -Some advocacy groups have focused their efforts on legalizing marijuana for medical uses. ^Via Proposition 215 in 1996, California was the first state to legalize medical marijuana. - By 2017, medical marijuana use was legal in some form in 29 states, although this number fluctuates as a function of ballot initiatives and changes in state laws. -And in 2012, voters in two states—Colorado and Washington— approved regulating, taxing, and controlling marijuana in a manner similar to that in place for alcohol. Recreational marijuana use has since been legalized in six more states and in the District of Columbia.

Patient medicines

Products that were sold, most often in the 19th century, as medicines that would cure a host of illnesses and diseases -Most narcotic use throughout this period was legal—whether through over-the- counter "tonics" or prescription. ^Physicians recommended these substances widely and referred to opium and morphine as "God's own medicine," or "G.O.M." (Morgan, 1981). Indeed these were effective calming agents. ^Opium was recommended for a nearly endless list of ailments. A short list includes dysentery, pain, swelling, delirium tremens (associated with withdrawal from alcohol), headache, and mental illness in certain cases. - The smoking of opium was introduced in the United States by Chinese laborers and was a widespread practice in the mid-1800s, especially on the West Coast. ^However, increased recognition by medical experts and others of the addictive nature of opium poppy products— opium, morphine, and heroin—triggered efforts to control their use and availability.

avoirdupois

Something sold or measured by weight based on 1 pound equaling 16 ounces.

Cannabis sativa

The Indian hemp plant popularly known as marijuana; its resin, flowering tops, leaves, and stem contain the plant's psychoactive substances. -Marijuana is another substance with a long history of use. In the 1800s, physicians used a liquid extract of the Cannabis sativa plant as a general all-purpose medication (Nahas, 1973). - Its nonmedical use was much wider in the 1920s, probably in part a reaction to alcohol Prohibition (Brecher, 1972). ^The use of marijuana was fairly constant in the 1930s through the 1950s, but was generally limited to urban areas and to the rural areas in which marijuana was grown and harvested. In the 1960s, its popularity soared, and that popularity has remained strong. >Coinciding with this popularity have been efforts to decriminalize or legitimize marijuana sale and use.

Volstead Act

The National Prohibition Act subsequently was passed to provide the means to investigate and punish violators of the Eighteenth Amendment. -The legislation, which was passed over the veto of President Woodrow Wilson, is better know the Volstead Act because Minnesota Representative Andrew Volstead introduced it. Scheduled to take effect in 1920, the act defined an "intoxicating beverage" as one containing more than 0.5% alcohol.

pure Food and Drug act

The first federal legislation of note was the Pure Food and Drug Act passed in 1906 (see Figure 2.1). - This act, which was designed to control opiate addiction, legislated that producers of medicines must indicate on the packaging the amount of drug contained in their products. - The law focused particularly on the opiates opium, morphine, and heroin, but also mandated the accurate labeling of products that contain alcohol, marijuana, and cocaine. -The overall effect of the act was mixed: It did not ban opiates in patent medicines and thus had little impact on the addicts at the time, but the legislation may have served to decrease the number of new addicts, given the subsequent political and educational efforts to describe the addictive potential of patent medicines containing opiates

Prohibition

The legislative forbidding of the sale of a substance, as in the alcohol Prohibition era in the United States, 1920-1933 ex./ . The best example was armed conflicts between China and Great Britain in the mid-19th century. -These conflicts, because they dealt with British traders bringing opium into China, are now known as the Opium Wars. -By the mid-1800s, millions of Chinese men had become addicted to opium. In fact, China appears to have had the highest national use of opium at that time. -Most of the opium used in China was cultivated in India and brought to China by British traders. -Chinese officials passed a variety of laws to control or eliminate opium imports, but none (including prohibition) had the desired effect of reducing opium use or the prevalence of addiction. --Furthermore, the British were unwilling to curtail the trade of opium into China, in part for financial reasons and in part because they did not witness such a degree of addiction among users in England - The opium trade continued until 1856, when the Second Opium War commenced. The war ended in 1858, and the Treaty of Tientsin mandated that China would continue to import opium but could impose heavy taxes.

Tranquilizers

Use of the minor tranquilizers became popular, and that trend continues today. As we discuss in Chapter 13, minor tranquilizers are among the most commonly prescribed psychiatric drugs in this country.

Bath Salts

pychoactive "designer drug" that is synthesized from various amphetamine- like chemicals and can be inhaled, swallowed, smoked, or injected. -"Bath salts" in the present context are not the bath salts you are more familiar with, those fra- granced salts added to bath water. Instead, the drug "bath salts" is synthesized from various amphet- amine-like chemicals. ^The formulation varies, and it can be snorted, swallowed, smoked, or injected. Frequently, "bath salts" contain the compounds MDPV (3, 4-methylenedioxy-pyrovalerone) and/or mephedrone, known as synthetic cathinones. -As the popularity of "bath salts" spread, more and more cases of emergency room visits by "bath salt" users were recorded, with users typically presenting with extreme agitation, violent behaviors, and psychotic symptoms. -In response, a number of states passed laws banning "bath salts," which were typically being sold for $25 to $50 per 50 milligram packets at conve- nience stores and head shops. -The "bath salts" were packaged under names like Aura, Ivory Wave, Blue Silk, Loco-Motion, Vanilla Sky, and Ocean Burs