Amphetamines / Methamphetamine

Amphetamine, dextroamphetamine, methamphetamine, and their various salts, are collectively referred to as amphetamines. In fact, their chemical properties and actions are so similar that even experienced users have difficulty knowing which drug they have taken.

Amphetamine was first marketed in the 1930s as Benzedrine® in an over-the-counter inhaler to treat nasal congestion. By 1937, amphetamine was available by prescription in tablet form and was used in the treatment of the sleeping disorder narcolepsy and the behavioral syndrome called minimal brain dysfunction, which today is called attention deficit hyperactivity disorder (ADHD). During World War II, amphetamine was widely used to keep the fighting men going; both dextroamphetamine (Dexedrine®) and methamphetamine (Methedrine®) became readily available.

As use of amphetamines spread, so did their abuse. In the 1960s, amphetamines became a cure-all for helping truckers to complete their long routes without falling asleep, for weight control, for helping athletes to perform better and train longer; and for treating mild depression. Intravenous amphetamines, primarily methamphetamine, were abused by a subculture known as "speed freaks." With experience, it became evident that the dangers of abuse of these drugs outweighed most of their therapeutic uses.

Increased control measures were initiated in 1965 with amendments to the federal food and drug laws to curb the black market in amphetamines. Many pharmaceutical amphetamine products were removed from the market including all injectable formulations, and doctors prescribed those that remained less freely. Recent increases in medical use of these drugs can be attributed to their use in the treatment of ADHD. Amphetamine products presently marketed include generic and brand name amphetamine (Adderall®, Dexedrine®, Dextrostat®) and brand name methamphetamine (Desoxyn®). Amphetamines are all controlled in Schedule II of the CSA.

To meet the ever-increasing black market demand for amphetamines, clandestine laboratory production has mushroomed. Today, most amphetamines distributed to the black market are produced in clandestine laboratories. Methamphetamine laboratories are, by far; the most frequently encountered clandestine laboratories in the United States. Law enforcement personnel routinely raid both large and small ("mom and pop") laboratories. The ease of clandestine synthesis, combined with tremendous profits, has resulted in significant availability of illicit methamphetamine, especially on the West Coast where abuse of this drug has increased dramatically in recent years. Large amounts of methamphetamine are also illicitly smuggled into the United States from Mexico.

Amphetamines are generally taken orally or injected. However, the addition of "ice," the slang name for crystallized methamphetamine hydrochloride, has promoted smoking as another mode of administration. Just as "crack" is smokable cocaine, "ice" is smokable methamphetamine. Methamphetamine, in all its forms, is highly addictive and toxic.

The effects of amphetamines, especially methamphetamine, are similar to cocaine, but their onset is slower and their duration is longer. In contrast to cocaine, which is quickly removed from the brain and is almost completely metabolized, methamphetamine remains in the central nervous system longer, and a larger percentage of the drug remains unchanged in the body, producing prolonged stimulant effects. Chronic abuse produces a psychosis that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with one's own thoughts, and auditory and visual hallucinations. These psychotic symptoms can persist for months and even years after use of these drugs has ceased and may be related to the neurotoxic effects of these drugs. Violent and erratic behavior is frequently seen among chronic abusers of amphetamines, especially methamphetamine.

METHAMPHETAMINE TRAFFICKING

Domestic methamphetamine production, trafficking, and abuse are concentrated in the western, southwestern, and midwestern United States. Methamphetamine is also increasingly available in portions of the South and eastern United States, especially Georgia and Florida. Clandestine laboratories in California and Mexico are the primary sources of supply for methamphetamine available in the United States.

Over the last decade, the methamphetamine trafficking and abuse situation in the United States changed dramatically. In 1994, ethnic Mexican drug trafficking organizations operating "super labs" (laboratories capable of producing in excess of 10 pounds of methamphetamine in one 24-hour production cycle) based in Mexico and in California began to take control of the production and distribution of methamphetamine domestically. Independent laboratory operators, including outlaw motorcycle gangs, previously maintained control of methamphetamine production and distribution within the United States, and continue to operate today on a lesser scale. The entry of ethnic Mexican traffickers into the methamphetamine trade in the mid-1990s resulted in a significant increase in the supply of the drug. Mexican criminal organizations, based in Mexico and California, provided high-purity, low-cost methamphetamine originally to cities in the Midwest and West with Mexican populations.

In 2001, approximately 8,000 clandestine methamphetamine laboratories were seized and reported to the National Clandestine Laboratory Database at the El Paso Intelligence Center (EPIC). In 2001, 298 seized super labs were reported to EPIC. This represents a rise in the number of superlabs from 2000, in which the total number of superlabs totaled 168. Further, for all of calendar year 2000, the Tijuana Residence Office (TJRO) reported only two seized methamphetamine laboratories. During calendar year 2001, the number of clandestine laboratories seized in Baja California Norte increased substantially, with 24 clandestine laboratories seized as of December 2001. The majority of these laboratories have been seized in the cities of Tijuana and Mexicali. Due to the proximity of these laboratories to the United States, it is believed that the majority of the methamphetamine was bound for the United States.

According to EPIC, the methamphetamine seized annually in transit from Mexico to the United States has increased dramatically since 1992. Authorities seized 1,370 kilograms of methamphetamine along the border in 2001, compared with only 6.5 kilograms in 1992. The primary points of entry into the United States for methamphetamine produced in Mexico have traditionally been California ports of entry, particularly San Ysidro. Although a great amount of methamphetamine still transits this area, ports of entry in South Texas have experienced increases in smuggling activity, although this activity appears to be stabilizing. The most common method of transporting methamphetamine is within concealed compartments in passenger vehicles.

The supply of methamphetamine in the United States also stems from multiple small-scale laboratories, often operated by independent cooks who obtain the ingredients necessary for manufacture from retail and convenience stores. Methamphetamine produced in these "mom-and-pop" laboratories is generally for personal use or limited distribution. A clandestine laboratory operator can use relatively common items, such as mason jars, coffee filters, hot plates, pressure cookers, pillowcases, plastic tubing, and gas cans to substitute for sophisticated laboratory equipment. The growing use of the Internet, which provides access to methamphetamine "recipes," coupled with increased demand for high-purity product, has resulted in a dramatic increase in the number of mom-and-pop laboratories throughout the United States. In 2001, the number of labs with capacities under ten pounds totaled over 7,700.

Methamphetamine precursor chemicals diverted to large clandestine laboratories in the United States are usually dosage-form pseudoephedrine or ephedrine drug products. Because of law enforcement attention and strong state precursor control laws in California, traffickers have now diversified to pseudoephedrine suppliers nationwide, buying at relatively lower prices in other parts of the country and trafficking the product to California, where the black market price can bring up to $5,000 per pound of product.

Nationwide networks of suppliers, working together, now provide ton quantities of pseudoephedrine tablet products to the market in California and to distributors in other states. The latter divert the product to local methamphetamine laboratories. Small-scale lab operators commonly buy over-the-counter pseudoephedrine products in small amounts from legitimate retailers. Recent reporting indicates that Canadian companies are a major source of supply for pseudoephedrine destined for U.S. laboratories because of minimal chemical controls in Canada. On March 7, 2002, search warrants were served on two residences, one in Paramount and the other in Lynwood, California. Four hundred containers of 25,000 count pseudoephedrine jars, or "pickle jars," (approximately 10,000,000 tablets) and $1,502,000 USC were seized. The pseudoephedrine is believed to have originated in Canada.

Pseudoephedrine and ephedrine are also purchased from unscrupulous U.S. distributors who sell case quantities of the tablets. Ultimately, the tablets are destined for California where they are manufactured into multiple pounds of methamphetamine. The finished methamphetamine is then distributed throughout the United States through preexisting smuggling methods to the traffickers.

In addition, the use of methylsulfonylmethane (MSM) has been encountered as a "cut" in methamphetamine produced primarily by Mexican organizations. Legitimately used as a dietary supplement for horses and humans, MSM is readily available at feed and livestock stores, as well as health and nutrition stores. The addition of MSM can be used to add volume to the finished methamphetamine, thus increasing the profit. Increases in the use of MSM may be a signal of difficulty in obtaining precursors, or a simple marketing method to meet demand while increasing profit.

The crystalline form of methamphetamine, known as "ice," "glass," or "crystal," is gaining popularity. Converted from powder by criminal elements in Southeast Asia, Mexico, and the United States, ice traditionally was used in Hawaii and southern California. More recently, its use has spread along the West Coast and Southwest border areas.

The importation of methamphetamine tablets from Southeast Asia, primarily via the mail system, remains a potential threat. Produced mainly by the United Wa State Army, the largest heroin and methamphetamine trafficking group in Burma, the tablets, which weigh approximately 90 milligrams (mg), typically contain 25 to 30 mg of methamphetamine, and 45 to 65 mg of caffeine. Although it is believed that the tablets are trafficked primarily by ethnic Thais or Laotians for use in the Asian community, it is possible that larger amounts will be smuggled into the United States if demand increases outside that community.

Purity
Until 1999, the methamphetamine problem was increasing at an alarming rate. International chemical control efforts reduced the supply of those chemicals needed to produce high-quality methamphetamine. As a result, the national purity level for methamphetamine has decreased dramatically. The average purity of methamphetamine exhibits seized by DEA dropped from 71.9 percent in 1994 to 30.7 percent in 1999. The average purity of methamphetamine exhibits seized by DEA in 2000 rose slightly to 35.3 percent and 40.1 in 2001.

Prices
Methamphetamine prices vary throughout different regions of the United States. At the distribution level, prices range from $3,500 per pound in parts of California and Texas to $21,000 per pound in southeastern and northeastern regions of the country. Retail prices range from $400 to $3,000 per ounce.

Seizures
According to the FDSS, U.S. federal authorities seized a total of 2,807 kilograms of methamphetamine in 2001 compared to 3,373 kilograms in 2000.
In 2000, authorities seized 301,697 SEA methamphetamine tablets in U.S. Postal Service facilities in Oakland, Los Angeles, and Honolulu. This represents an 656-percent increase from the 1999 seizure total of 39,917.

Anorectic Drugs

A number of drugs have been developed and marketed to replace amphetamines as appetite suppressants. These anorectic drugs include benzphetamine (Didrex®), diethylproprion (Tenuate®, Tepanil®), mazindol (Sanorex®, Mazanor®), phendimetrazine (Bontril®, Prelu-27®), and phentermine (lonamin®, Fastin®, Adipex®). These substances are in Schedule III or IV of the CSA and produce some amphetamine-like effects. Of these diet pills, phentermine is the most widely prescribed and most frequently encountered on the illicit market. Two Schedule IV anorectics often used in combination with phentermine (phen-fen combo), fenfluramine and dexfenfluramine, were removed from the U.S. market due to heart valve problems.

Depressants

Historically, people of almost every culture have used chemical agents to induce sleep, relieve stress, and allay anxiety. While alcohol is one of the oldest and most universal agents used for these purposes, hundreds of substances have been developed that produce central nervous system depression. These drugs have been referred to as downers, sedatives, hypnotics, minor tranquilizers, anxiolytics, and anti-anxiety medications. Unlike most other classes of drugs of abuse, depressants are rarely produced in clandestine laboratories. Generally, legitimate pharmaceutical products are diverted to the illicit market. A notable exception to this is a relatively recent drug of abuse, gamma hydroxybutyric acid (GHB).

Choral hydrate and paraldehyde are two of the oldest pharmaceutical depressants still in use today. Other depressants, including gluthethimide, methaqualone, and meprobamate have been important players in the milieu of depressant use and abuse. However, two major groups of depressants have dominated the licit and illicit market for nearly a century, first barbiturates and now benzodiazepines.

Barbiturates were very popular in the first half of the 20th century. In moderate amounts, these drugs produce a state of intoxication that is remarkably similar to alcohol intoxication. Symptoms include slurred speech, loss of motor coordination, and impaired judgment. Depending on the dose, frequency, and duration of use, one can rapidly develop tolerance, physical dependence, and psychological dependence to barbiturates. With the development of tolerance, the margin of safety between the effective dose and the lethal dose becomes very narrow. That is, in order to obtain the same level of intoxication, the tolerant abuser may raise his or her dose to a level that may result in coma or death. Although many individuals have taken barbiturates therapeutically without harm, concern about the addiction potential of barbiturates and the ever-increasing number of fatalities associated with them led to the development of alternative medications. Today, less than 10 percent of all depressant prescriptions in the United States are for barbiturates.

Benzodiazepines were first marketed in the 1960s. Touted as much safer depressants with far less addiction potential than barbiturates, today these drugs account for about one out of every five prescriptions for controlled substances. Although benzodiazepines produce significantly less respiratory depression than barbiturates, it is now recognized that benzodiazepines share many of the undesirable side effects of the barbiturates. A number of toxic central nervous system effects are seen with chronic high-dose benzodiazepine therapy, including headaches, irritability, confusion, memory impairment and depression. The risk of developing over-sedation, dizziness, and confusion increases substantially with higher doses of benzodiazepines. Prolonged use can lead to physical dependence even at doses recommended for medical treatment. Unlike barbiturates, large doses of benzodiazepines are rarely fatal unless combined with other drugs or alcohol. Although primary abuse of benzodiazepines is well documented, abuse of these drugs usually occurs as part of a pattern of multiple drug abuse. For example, heroin or cocaine abusers will use benzodiazepines and other depressants to augment their "high" or alter the side effects associated with over-stimulation or narcotic withdrawal.

In recent years, GHB has emerged as a significant drug of abuse throughout the United States. Abusers of this drug fall into three major groups: (1) users who take GHB for its MDMA-like hallucinogenic effects or as an intoxicant or euphoriant; (2) bodybuilders who abuse GHB for its alleged utility as an anabolic agent or as a sleep aid; and (3) individuals who use GHB as a weapon for sexual assault. These categories are not mutually exclusive and an abuser may use the drug illicitly to produce several effects. GHB is frequently taken with alcohol or other drugs that heightens its effects and is often found at bars, nightclubs, rave parties, and gyms. Teenagers and young adults who frequent these establishments are the primary users. Like flunitrazepam, benzodiazepine is often referred to as a "date-rape" drug, and GHB involvement in rape cases is likely to be unreported or unsubstantiated. GHB is quickly eliminated from the body making detection in body fluids unlikely; and its fast onset of depressant effects may render the victim with little memory of the details of the attack.

There are marked similarities among the withdrawal symptoms seen with most drugs classified as depressants. In the mildest form, the withdrawal syndrome may produce insomnia and anxiety, usually the same symptoms that initiated the drug use. With a greater level of dependence, tremors and weakness are also present, and in its most severe form, the withdrawal syndrome can cause seizures and delirium. Unlike the withdrawal syndrome seen with most other drugs of abuse, withdrawal from depressants can be life threatening.

Narcotics

The term "narcotic," derived from the Greek word for stupor, originally referred to a variety of substances that dulled the senses and relieved pain. Today, the term is used in a number of ways. Some individuals define narcotics as those substances that bind at opiate receptors (cellular membrane proteins activated by substances like heroin or morphine) while others refer to any illicit substance as a narcotic. In a legal context, narcotic refers to opium, opium derivitives, and their semi-synthetic substitutes. Cocaine and coca leaves, which are also classified as "narcotics" in the Controlled Substances Act (CSA), neither bind opiate receptors nor produce morphine-like effects, and are discussed in the section on stimulants. For the purposes of this discussion, the term narcotic refers to drugs that produce morphine-like effects.

Narcotics are used therapeutically to treat pain, suppress cough, alleviate diarrhea, and induce anesthesia. Narcotics are administered in a variety of ways. Some are taken orally, transdermally (skin patches), or injected. They are also available in suppositories. As drugs of abuse, they are often smoked, sniffed, or injected. Drug effects depend heavily on the dose, route of administration, and previous exposure to the drug. Aside from their medical use, narcotics produce a general sense of well-being by reducing tension, anxiety, and aggression. These effects are helpful in a therapeutic setting but con tribute to their abuse.

Narcotic use is associated with a variety of unwanted effects including drowsiness, inability to concentrate, apathy, lessened physical activity, constriction of the pupils, dilation of the subcutaneous blood vessels causing flushing of the face and neck, constipation, nausea and vomiting, and most significantly, respiratory depression. As the dose is increased, the subjective, analgesic (pain relief), and toxic effect become more pronounced. Except in cases of acute intoxication, there is no loss of motor coordination or slurred speech as occurs with many depressants.

Among the hazards of illicit drug use is the ever-increasing risk of infection, disease, and overdose. While pharmaceutical products have a known concentration and purity, clandestinely produced street drugs have unknown compositions. Medical complications common among narcotic abusers arise primarily from adulterants found in street drugs and in the non-sterile practices of injecting. Skin, lung, and brain abscesses, endocarditis (inflammation (the fining of the heart), hepatitis, and AIDS are commonly found among narcotic abusers. Since there is no simple way to determine the purity of a drug that is sold on the street, the effects of illicit narcotic use are unpredictable and can be fatal. Physical signs of narcotic overdose include constricted (pinpoint) pupils, cold clammy skin, confusion, convulsions, severe drowsiness, and respiratory depression (slow or troubled breathing).

With repeated use of narcotics, tolerance and dependence develop. The development of tolerance is characterized by a shortened duration and a decreased intensity of analgesia, euphoria, and sedation, which creates the need to consume progressively larger doses to attain the desired effect. Tolerance does not develop uniformly for all actions of these drugs, giving rise to a number of toxic effects. Although tolerant users can consume doses far in excess of the dose they took, physical dependence refers to an alteration of normal body functions that necessitates the continued presence of a drug in order to prevent a withdrawal or abstinence syndrome. The intensity and character of the physical symptoms experienced during withdrawal are directly related to the particular drug of abuse, the total daily dose, the interval between doses, the duration of use, and the health and personality of the user. In general, shorter acting narcotics tend to produce shorter; more intense withdrawal symptoms, while longer acting narcotics produce a withdrawal syndrome that is protracted but tends to be less severe. Although unpleasant, withdrawal from narcotics is rarely life threatening.

The withdrawal symptoms associated with heroin/morphine addiction are usually experienced shortly before the time of the next scheduled dose. Early symptoms include watery eyes, runny nose, yawning, and sweating. Restlessness, irritability, loss of appetite, nausea, tremors, and drug craving appear as the syndrome progresses. Severe depression and vomiting are common. The heart rate and blood pressure are elevated. Chills alternating with flushing and excessive sweating are also characteristic symptoms. Pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms. Without intervention, the syndrome will run its course, and most of the overt physical symptoms will disappear within 7 to 10 days.

The psychological dependence associated with narcotic addiction is complex and protracted. Long after the physical need for the drug has passed, the addict may continue to think and talk about the use of drugs and feel strange or overwhelmed coping with daily activities without being under the influence of drugs. There is a high probability that relapse will occur after narcotic withdrawal when neither the physical environment nor the behavioral motivators that contributed to the abuse have been altered.

There are two major patterns of narcotic abuse or dependence seen in the United States. One involves individuals whose drug use was initiated within the context of medical treatment who escalate their dose by obtaining the drug through fraudulent prescriptions and "doctor shopping" or branching out to illicit drugs. The other; more common, pattern of abuse is initiated outside the therapeutic setting with experimental or recreational use of narcotics. The majority of individuals in this category may abuse narcotics sporadically for months or even years. Although they may not become addicts, the social, medical, and legal consequences of their behavior is very serious. Some experimental users will escalate their narcotic use and will eventually become dependent, both physically and psychologically. The younger an individual is when drug use is initiated, the more likely the drug use will progress to dependence and addiction.

Narcotics of Natural Origin

The poppy Papaver somniferum is the source for non-synthetic narcotics. It was grown in the Mediterranean region as early as 5000 B.C., and has since been cultivated in a number of countries throughout the world. The milky fluid that seeps from incisions in the unripe seedpod of this poppy has, since ancient times, been scraped by hand and air-dried to produce what is known as opium. A more modern method of harvesting is by the industrial poppy straw process of extracting alkaloids from the mature dried plant. The extract may be in liquid, solid, or powder form, although most poppy straw concentrate available commercially is a fine brownish powder. More than 500 tons of opium or its equivalent in poppy straw concentrate are legally imported into the United States annually for legitimate medical use.

Synthetic Narcotics

In contrast to the pharmaceutical products derived from opium, synthetic narcotics are produced entirely within the laboratory. The continuing search for products that retain the analgesic properties of morphine without the consequent dangers of tolerance and dependence has yet to yield a product that is not susceptible to abuse. A number of clandestinely produced drugs, as well as drugs that have accepted medical uses, fall within this category.

Benzodiazepines

The benzodiazepine family of depressants is used therapeutically to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. In general, benzodiazepines act as hypnotics in high doses, anxiolytics in moderate doses, and sedatives in low doses. Of the drugs marketed in the United States that affect central nervous system function, benzodiazepines are among the most widely prescribed medications. Fifteen members of this group are presently marketed in the United States, and about 20 additional benzodiazepines are marketed in other countries. Benzodiazepines are controlled in Schedule IV of the CSA.

Short-acting benzodiazepines are generally used for patients with sleep-onset insomnia (difficulty falling asleep) without daytime anxiety. Shorter-acting benzodiazepines used to manage insomnia include estazolam (ProSom®), flurazepam (Dalmane®), temazepam (Restoril®), and triazolam (Halcion®). Midazolam (Versed®), a short-acting benzodiazepine, is utilized for sedation, anxiety, and amnesia in critical care settings and prior to anesthesia. It is available in the United States as an injectable preparation and as a syrup (primarily for pediatric patients).

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

Benzodiazepines are classified in the CSA as depressants. Repeated use of large doses or; in some cases, daily use of therapeutic doses of benzodiazepines is associated with amnesia, hostility, irritability, and vivid or disturbing dreams, as well as tolerance and physical dependence. The withdrawal syndrome is similar to that of alcohol and may require hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering-down the dose eliminates many of the unpleasant symptoms.

Given the millions of prescriptions written for benzodiazepines (about 100 million in 1999), relatively few individuals increase their dose on their own initiative or engage in drug-seeking behavior. Those individuals who do abuse benzodiazepines often maintain their drug supply by getting prescriptions from several doctors, forging prescriptions, or buying diverted pharmaceutical products on the illicit market. Abuse is frequently associated with adolescents and young adults who take benzodiazepines to obtain a "high." This intoxicated state results in reduced inhibition and impaired judgment. Concurrent use of alcohol or other depressant; with benzodiazepines can be life threatening. Abuse of benzodiazepines is particularly high among heroin and cocaine abusers. A large percentage of people entering treatment for narcotic or cocaine addiction also report abusing benzodiazepines. Alprazolam and diazepam are the two most frequently encountered benzodiazepines on the illicit market.

Flunitrazepam (Rohypnol®) is a benzodiazepine that is not manufactured or legally marketed in the United States, but is smuggled in by traffickers. In the mid-1990s, flunitrazepam was extensively trafficked in Florida and Texas. Known as "rophies," "roofies," and "roach," flunitrazepam gained popularity among younger individuals as a "party" drug. It has also been utilized as a "date rape" drug. In this context, flunitrazepam is placed in the alcoholic drink of an unsuspecting victim to incapacitate them and prevent resistance from sexual assault. The victim is frequently unaware of what has happened to them and often does not report the incident to authorities. A number of actions by the manufacturer of this drug and by government agencies have resulted in reducing the availability and abuse of flunitrazepam in the United States.

Newly Marked Drugs

Zolpidem (Ambien®) and zaleplon (Sonata®) are two relatively new, benzodiazepine-like CNS depressants that have been approved for the short-term treatment of insomnia. Both of these drugs share many of the same properties as the benzodiazepines and are in Schedule IV of the CSA.

Steroids

As athletes gathered at the 2000 Olympic Games in Sydney, Australia, the issue of performance enhancing drugs, especially anabolic steroids, once again gained international attention. These drugs are used by high school, college, professional, and elite amateur athletes in a variety of sports (e.g. weight lifting, track and field, swimming, cycling, and others) to obtain a competitive advantage. Body builders and fitness buffs take anabolic steroids to improve their physical appearance, and individuals in occupations requiring enhanced physical strength (e.g. body guards, night club bouncers, construction workers) are also known to use these drugs.

Concerns over a growing illicit market, abuse by teenagers, and the uncertainty of possible harmful long-term effects of steroid use, led Congress in 1991 to place anabolic steroids as a class of drugs into Schedule III of the Controlled Substances Act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth.

Once viewed as a problem associated only with professional and elite amateur athletes, various reports indicate that anabolic steroid abuse has increased significantly among adolescents. For example, the National Institute on Drug Abuse 1999 Monitoring the Future survey reveals that more than a half million 8th and 10th grade students were using anabolic steroids. Abuse is higher among males than females, but is growing most rapidly among young women.

Most illicit anabolic steroids are sold at gyms, competitions, and through mail operations. For the most part, these substances are smuggled into the United States from many countries. The illicit market includes various preparations intended for human and veterinary use as well as bogus and counterfeit products. The most commonly encountered anabolic steroids on the illicit market include testosterone, nandrolone, methenolone, stanozolol, and methandrostenolone. Other steroids seen in the illicit market include boldenone, fluxoymesterone, methandriol, methyltestosterone, oxandrolone, oxymetholone, and trenbolone.

A limited number of anabolic steroids have been approved for medical and veterinary use. The primary legitimate use of these drugs in humans is for the replacement of inadequate levels of testosterone resulting from a reduction or absence of functioning testes. Other indications include anemia and breast cancer. Experimentally, anabolic steroids have been used to treat a number of disorders including AIDS wasting, erectile dysfunction, and osteoporosis. In veterinary practice, anabolic steroids are used to promote feed efficiency and to improve weight gain, vigor, and hair coat. They are also used in veterinary practice to treat anemia and counteract tissue breakdown during illness and trauma.

When used in combination with exercise training and high protein diet, anabolic steroids can promote increased size and strength of muscles, improve endurance, and decrease recovery time between workouts. They are taken orally or by intramuscular injection. Users concerned about drug tolerance often take steroids on a schedule called a cycle. A cycle is a period of between 6 and 14 weeks of steroid use, followed by a period of abstinence or reduction in use. Additionally, users tend to "stack" the drugs, using multiple drugs concurrently. Although the benefits of these practices are unsubstantiated, most users feel that cycling and stacking enhance the efficiency of the drugs and limit their side effects.

Another mode of steroid use is called "pyramiding." With this method users slowly escalate steroid use (increasing the number of drugs used at one time and/or the dose and frequency of one or more steroids), reach a peak amount at mid-cycle and gradually taper the dose toward the end of the cycle. The escalation of steroid use can vary with different types of training. Body builders and weight lifters tend to escalate their dose to a much higher level than do long distance runners or swimmers.

The long-term adverse health effects of anabolic steroid use are not definitely known. There is, however, increasing concern of possible serious health problems associated with the abuse of these agents, including cardiovascular damage, cerebrovascular toxicity, and liver damage.

Physical side effects include elevated blood pressure and cholesterol levels, severe acne, premature balding, reduced sexual function, and testicular atrophy. In males, abnormal breast development (gynecomastia) can occur. In females, anabolic steroids have a masculinizing effect, resulting in more body hair, a deeper voice, smaller breasts, and fewer menstrual cycles. Several of these effects are irreversible. In adolescents, abuse of these agents may prematurely stop the lengthening of bones, resulting in stunted growth.

With some individuals the use of anabolic steroids may be associated with psychotic reactions, manic episodes, feelings of anger or hostility, aggression, and violent behavior.

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

Over the last few years, a number of precursors to either testosterone or nandrolone have been marketed as dietary supplements in the United States. Some of these substances include androstenedione, androstenediol, norandrostenedione, norandrostenediol, and dehydroepiandrosterone (DHEA).

TRAFFICKING

The Anabolic Steroid Control Act was passed by Congress in the fall of 1990 and became effective on February 21, 1991. The Steroid Act classified 27 steroids as Schedule III substances under the CSA. Street prices of anabolic steroids have increased substantially as a result.

Fitness clubs have been, and continue to be, the primary distribution centers of steroids, since bodybuilders and weightlifters comprise a predominant portion of the user population. Once viewed as a problem strictly associated with professional athletes, a recent survey of students indicates increased steroid use among boys in the 8th and 10th grades. The percentage of 8th grade boys reporting past-year use of steroids increased from 1.6 percent in 1998 to 2.5 percent in 1999, and from 1.9 percent to 2.8 percent among 10th grade boys.

Anabolic steroids are illicitly smuggled from Mexico and European countries to the United States. Recent DEA reporting indicates that Russian, Romanian, and Greek nationals are significant traffickers of steroids and are responsible for substantial shipments of steroids entering the United States. The lack of international control over foreign sources of supply, however, makes it impossible to attack the trafficking at its source.

Stimulants

Stimulants are sometimes referred to as uppers and reverse the effects of fatigue on both mental and physical tasks. Two commonly used stimulants are nicotine, found in tobacco products, and caffeine, an active ingredient in coffee, tea, some soft drinks, and many non-prescription medicines. Used in moderation, these substances tend to relieve malaise and increase alertness. Although the use of these products has been an accepted part of U.S. culture, the recognition of their adverse effects has resulted in a proliferation of caffeine-free products and efforts to discourage cigarette smoking.

A number of stimulants, however, are under the regulatory control of the CSA. Some of these controlled substances are available by prescription for legitimate medical use in the treatment of obesity, narcolepsy, and attention deficit disorders. As drugs of abuse, stimulants are frequently taken to produce a sense of exhilaration, enhance self esteem, improve mental and physical performance, increase activity, reduce appetite, produce prolonged wakefulness, and to "get high." They are recognized as among the most potent agents of reward and reinforcement that underlie the problem of dependence.

Stimulants are diverted from legitimate channels and clandestinely manufactured exclusively for the illicit market. They are taken orally; sniffed, smoked, and injected. Smoking, snorting, or injecting stimulants produces a sudden sensation known as a "rush" or a "flash." Abuse is often associated with a pattern of binge use-sporadically consuming large doses of stimulants over a short period of time. Heavy users may inject themselves every few hours, continuing until they have depleted their drug supply or reached a point of delirium, psychosis, and physical exhaustion. During this period of heavy use, all other interests become secondary to recreating the initial euphoric rush. Tolerance can develop rapidly; and both physical and psychological dependence occur. Abrupt cessation, even after a brief two or three-day binge, is commonly followed by depression, anxiety, drug craving, and extreme fatigue known as a "crash."

Therapeutic levels of stimulants can produce exhilaration, extended wakefulness, and loss of appetite. These effects are greatly intensified when large doses of stimulants are taken. Physical side effects, including dizziness, tremor; headache, flushed skin, chest pain with palpitations, excessive sweating, vomiting, and abdominal cramps, may occur as a result of taking too large a dose at one time or taking large doses over an extended period of time. Psychological effects include agitation, hostility, panic, aggression, and suicidal or homicidal tendencies. Paranoia, sometimes accompanied by both auditory and visual hallucinations, may also occur. In overdose, unless there is medical intervention, high fever, convulsions, and cardiovascular collapse may precede death. Because accidental death is partially due to the effects of stimulants on the body's cardiovascular and temperature-regulating systems, physical exertion increases the hazards of stimulant use

Flunitrazepam - Rohypnol

Flunitrazepam, which is marketed under the brand name Rohypnol and is commonly known as roofies, belongs to the benzodiazepine class of drugs. Flunitrazepam has never been approved for medical use in the United States, therefore, doctors cannot prescribe it and pharmacists cannot sell it. However, it is legally prescribed in over 50 other countries and is widely available in Mexico, Colombia, and Europe where it is used for the treatment of insomnia and as a pre-anesthetic. Therefore, it was placed into Schedule IV of the Controlled Substances Act in 1984 due to international treaty obligations and remains under that classification. Like other benzodiazepines (such as Valium, Librium, Xanax, and Halcion), flunitrazepam's pharmacological effects include sedation, muscle relaxation, reduction in anxiety, and prevention of convulsions. However, flunitrazepam's sedative effects are approximately 7 to 10 times more potent than diazepam (Valium). The effects of flunitrazepam appear approximately 15 to 20 minutes after administration and last approximately four to six hours. Some residual effects can be found 12 hours or more after administration.

Flunitrazepam causes partial amnesia; individuals are unable to remember certain events that they experienced while under the influence of the drug. This effect is particularly dangerous when flunitrazepam is used to aid in the commission of sexual assault; victims may not be able to clearly recall the assault, the assailant, or the events surrounding the assault.

It is difficult to estimate just how many flunitrazepam-facilitated rapes have occurred in the United States. Very often, biological samples are taken from the victim at a time when the effects of the drug have already passed and only residual amounts remain in the body fluids. These residual amounts are difficult, if not impossible, to detect using standard screening assays available in the United States. If flunitrazepam exposure is to be detected at all, urine samples need to be collected within 72 hours and subjected to sensitive analytical tests. The problem is compounded by the onset of amnesia after ingestion of the drug, which causes the victim to be uncertain about the facts surrounding the rape. This uncertainty may lead to critical delays or even reluctance to report the rape and to provide appropriate biological samples for toxicology testing.

While flunitrazepam has become widely known for its use as a date-rape drug, it is abused more frequently for other reasons. It is abused by high school students, college students, street gang members, rave party attendees, and heroin and cocaine abusers to produce profound intoxication, boost the high of heroin, and modulate the effects of cocaine. Flunitrazepam is usually consumed orally, is often combined with alcohol, and is abused by crushing tablets and snorting the powder.

Flunitrazepam abuse causes a number of adverse effects in the abuser, including drowsiness, dizziness, loss of motor control, lack of coordination, slurred speech, confusion, and gastrointestinal disturbances, lasting 12 or more hours. Higher doses produce respiratory depression. Chronic use of flunitrazepam can result in physical dependence and the appearance of withdrawal syndrome when the drug is discontinued. Flunitrazepam impairs cognitive and psychomotor functions affecting reaction time and driving skill. The use of this drug in combination with alcohol is a particular concern as both substances potentiate each other's toxicity.

TRAFFICKING

Flunitrazepam is sold under the trade name Rohypnol, from which the street name "Rophy" is derived. Other street names include "circles," "Mexican valium," "roofies," and "R-2." Flunitrazepam is a depressant used in the treatment of short-term insomnia and as a hypnotic sedative and pre-anesthetic medication.

Flunitrazepam is manufactured worldwide, particularly in Europe and Latin America, where it is sold legally by prescription. This drug is neither manufactured nor approved for medical use in the United States. Distributors in Texas allegedly travel to Mexico to obtain the drug. In addition, Colombian sources of supply smuggle flunitrazepam into South Florida via international mail services and/or couriers using commercial airlines.

According to law enforcement officials in south Florida, flunitrazepam is routinely referred to as a "club drug," since it is popular in local nightclubs. It is also referred to as the "date rape drug," characteristically causing the victim to experience short-term memory loss after ingestion. It is ingested orally, frequently in conjunction with alcohol or other drugs. High school and college students are the most frequent users of flunitrazepam, commonly using it as an "alcohol extender." Young people also have the misconception that flunitrazepam is unadulterated, and, therefore, "safe" because of pre-sealed bubble packaging

Hydromorphone - Dilaudid

Hydromorphone (Dilaudid®) is marketed in tablets (2, 4, and 8 mg), rectal Suppositories, oral solutions, and injectable formulations. All products are in Schedule II of the CSA. Its analgesic potency is from two to eight times that of morphine, but it is shorter acting and produces more sedation than morphine. Much sought after by narcotic addicts, hydromorphone is usually obtained by the abuser through fraudulent prescriptions or theft. The tablets are often dissolved and injected as a substitute for heroin.

Pentazocine - Talwin

The effort to find an effective analgesic with less dependence-producing consequences led to the development of pentazocine (Talwin®). Introduced as an analgesic in 1967, it was frequently encountered in the illicit trade, usually in combination with tripelennamine and placed into Schedule IV of the CSA in 1979. An attempt at reducing the abuse of this drug was made with the introduction of Talwin Nx®. This product contains a quantity of antagonist (naloxone) sufficient to counteract the morphine-like effects of pentazocine if the tablets are dissolved and injected.

Oxycodone - Oxycontin

Oxycodone is synthesized from thebaine. Like morphine and hydromorphone, Oxycodone is used as an analgesic. It is effective orally and is marketed alone in 10, 20, 40, 80, and 160 mg controlled-release tablets (OxyContin), or 5 mg immediate-release capsules (OxyIR®), or in combination products with aspirin (Percodan®) or acetaminophen (Percocet®) for the relief of pain. All oxycodone products are in Schedule II. Oxycodone is abused orally or the tablets are crushed and sniffed or dissolved in water and injected. The use of oxycodone has increased significantly. In 1990, nearly three tons of Oxycodone were manufactured in the United States. In 2000, about 47 tons were manufactured.

Historically, oxycodone products have been popular drugs of abuse among the narcotic abusing population. In recent months, concern has grown among federal, state, and local officials about the dramatic increase in the illicit availability and abuse of OxyContin products. These products contain large amounts of oxycodone (10 to 160 mg) in a formulation intended for slow release over about a 12-hour period. Abusers have learned that this slow-release mechanism can be easily circumvented by crushing the tablet and swallowing, snorting, or injecting the drug product for a more rapid and intense high. The criminal activity associated with illicitly obtaining and distributing this drug, as well as serious consequences of illicit use, including addiction and fatal overdose deaths, are of epidemic proportions in some areas of the United States.

Ketamine

Ketamine is a rapidly acting general anesthetic. Its pharmacological profile is essentially the same as phencyclidine. Like PCP, ketamine is referred to as a dissociative anesthetic because patients feel detached or disconnected from their pain and environment when anesthetized with this drug. Unlike most anesthetics, ketamine produces only mild respiratory depression and appears to stimulate, not depress, the cardiovascular system. In addition, ketamine has both analgesic and amnesic properties and is associated with less confusion, irrationality, and violent behavior than PCP. Use of ketamine as a general anesthetic for humans has been limited due to adverse effects including delirium and hallucinations. Today, it is primarily used in veterinary medicine, but has some utility for emergency surgery in humans.

Although ketamine has been marketed in the United States for many years, it was only recently associated with significant diversion and abuse and placed in Schedule III of the CSA in 1999. Known in the drug culture as "Special K" or "Super K," ketamine has become a staple at dance parties or "raves." Ketamine is supplied to the illicit market by the diversion of legitimate pharmaceuticals (Ketaset®, Ketalar®). It is usually distributed as a powder obtained by removing the liquid from the pharmaceutical products. As a drug of abuse, ketamine can be administered orally, snorted, or injected. It is also sprinkled on marijuana or tobacco and smoked. After oral or intranasal administration, effects are evident in about 10 to 15 minutes and are over in about an hour.

After intravenous use, effects begin almost immediately and reach peak effects within minutes. Ketamine can act as a depressant or a psychedelic. Low doses produce vertigo, ataxia, slurred speech, slow reaction time, and euphoria. Intermediate doses produce disorganized thinking, altered body image, and a feeling of unreality with vivid visual hallucinations. High doses produce analgesia, amnesia, and coma.

Meperidine

Introduced as an analgesic in the 1930s, meperidine produces effects that are similar, but not identical, to morphine (shorter duration of action and reduced antitussive and antidiarrheal actions). Currently it is used for pre-anesthesia and the relief of moderate to severe pain, particularly in obstetrics and post-operative situations. Meperidine is available in tablets, syrups, and injectable forms under generic and brand name (Demerol®, Mepergan®, etc.) Schedule II preparations. Several analogues of meperidine have been clandestinely produced. During the clandestine synthesis of the analogue MPPP, a neurotoxic by-product (MPTP) was produced. A number of individuals who consumed the MPPP-MPTP preparation developed an irreversible Parkinsonian-like syndrome. It was later found that MPTP destroys the same neurons as those damaged in the Parkinsonian-like syndrome. It was later found that MPTP destroys the same neurons as those damaged in Parkinsons Disease.

Meprobamate - Carisoprodol (Soma®)

Meprobamate was introduced as an anti-anxiety agent in 1955 and is prescribed primarily to treat anxiety, tension, and associated muscle spasms. More than 50 tons are distributed annually in the United States under its generic name and brand names such as Miltown® and Equanil®. Its onset and duration of action are similar to the intermediate-acting barbiturates; however, therapeutic doses of meprobamate produce less sedation and toxicity than barbiturates. Excessive use can result in psychological and physical dependence. Carisoprodol (Soma®), a skeletal muscle relaxant, is metabolized to meprobamate. This conversion may account for some of the properties associated with carisoprodol and likely contributes to its abuse.

Methadone

German scientists synthesized methadone during World War II because of a shortage of morphine. Although chemically unlike morphine or heroin, methadone produces many of the same effects. Introduced into the United States in 1947 as an analgesic (Dolophinel), it is primarily used today for the treatment of narcotic addiction. It is available in oral solutions, tablets, and injectable Schedule II formulations, and is almost as effective when administered orally as it is by injection. Methadone's effects can last up to 24 hours, thereby permitting once-a-day oral administration in heroin detoxification and maintenance programs. High-dose methadone can block the effects of heroin, thereby discouraging the continued use of heroin by addicts under treatment with methadone. Chronic administration of methadone results in the development of tolerance and dependence. The withdrawal syndrome develops more slowly and is less severe but more prolonged than that associated with heroin withdrawal. Ironically, methadone used to control narcotic addiction is frequently encountered on the illicit market and has been associated with a number of overdose deaths.

Morphine

Morphine is the principal constituent of opium and can range in concentration from 4 to 21 percent. Commercial opium is standardized to contain 10-percent morphine. In the United States, a small percentage of the morphine obtained from opium is used directly (about 15 tons): the remaining is converted to codeine and other derivatives (about 120 tons). Morphine is one of the most effective drugs known for the relief of severe pain and remains the standard against which new analgesics are measured. Like most narcotics, the use of morphine has increased significantly in recent years. Since 1990, there has been about a 3-fold increase in morphine products in the United States.

Morphine is marketed under generic and brand name products including "MS-Contin®," Oramorph SR®," MSIR®," Roxanol®," Kadian®," and RMS®." Morphine is used parenterally (by injection) for preoperative sedation, as a supplement to anesthesia, and for analgesia. It is the drug of choice for relieving pain of myocardial infarction and for its cardiovascular effects in the treatment of acute pulmonary edema. Traditionally; morphine was almost exclusively used by injection. Today, morphine is marketed in a variety of forms, including oral solutions, immediate and sustained-release tablets and capsules, suppositories, and injectable preparations. In addition, the availability of high-concentration morphine preparations (i.e., 20-mg/ml oral solutions, 25-mg/ml injectable solutions, and 200-mg sustained-release tablets) partially reflects the use of this substance for chronic pain management in opiate-tolerant patients.

Opium

There were no legal restrictions on the importation or use of opium until the early 1900s. In the United States, the unrestricted availability of opium, the influx of opium-smoking immigrants from East Asia, and the invention of the hypodermic needle contributed to the more severe variety of compulsive drug abuse seen at the turn of the 20th century. In those days, medicines often contained opium without any warning label. Today, there are state, federal, and international laws governing the production and distribution of narcotic substances.

Although opium is used in the form of paragoric to treat diarrhea, most opium imported into the United States is broken down into its alkaloid constituents. These alkaloids are divided into two distinct chemical classes, phenanthrenes and isoquinolines. The principal phenanthrenes are morphine, codeine, and thebaine, while the isoquinolines have no significant central nervous system effects and are not regulated under the CSA.

Thebaine

Thebaine, a minor constituent of opium, is controlled in Schedule II of the CSA as well as under international law. Although chemically similar to both morphine and codeine, thebaine produces stimulatory rather than depressant effects. Thebaine is not used therapeutically, but is converted into a variety of substances including oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, and buprenorphine. The United States ranks first in the world in thebaine utilization.

LAAM - ORLMM®

Closely related to methadone, the synthetic compound levo alphacetylmethadol, or LAAM (ORLMM®), has an even longer duration of action (from 48 to 72 hours) than methadone, permitting a reduction in frequency of use. In 1994, it was approved as a Schedule II treatment drug for narcotic addiction. Both methadone and LAAM have high abuse potential. Their acceptability as narcotic treatment drugs is predicated upon their ability to substitute for heroin, the long duration of action, and their mode of oral administration.

Methcathinone

Methcathinone, known on the streets as "Cat," is a structural analogue of methamphetamine and cathinone. Clandestinely manufactured, methcathinone is almost exclusively sold in the stable and highly water soluble hydrochloride salt form. It is most commonly snorted, although it can be taken orally by mixing it with a beverage or diluted in water and injected intravenously. Methcathinone has an abuse potential equivalent to methamphetamine and produces amphetamine-like activity. It was placed in Schedule I of the CSA in 1993.

Methylphenidate

Methylphenidate, a Schedule II substance, has a high potential for abuse and produces many of the same effects as cocaine or the amphetamines. The abuse of this substance has been documented among narcotic addicts who dissolve the tablets in water and inject the mixture. Complications arising from this practice are common due to the insoluble fillers used in the tablets. When injected, these materials block small blood vessels, causing serious damage to the lungs and retina of the eye. Binge use, psychotic episodes, cardiovascular complications, and severe psychological addiction have all been associated with methylphenidate abuse.

Methylphenidate is used legitimately in the treatment of excessive daytime sleepiness associated with narcolepsy, as is the newly marketed Schedule IV stimulant, modafinil (Provigil®). However; the primary legitimate medical use of methylphenidate (Ritalin®, Methylin®, Concerta®) is to treat attention deficit hyperactivity disorder (ADHD) in children. The increased use of this substance for the treatment of ADHD has paralleled an increase in its abuse among adolescents and young adults who crush these tablets and snort the powder to get high. Youngsters have little difficulty obtaining methylphenidate from classmates or friends who have been prescribed it. Greater efforts to safeguard this medication at home and school are needed.

Paraldehyde - Paral®

Paraldehyde (Paral®) is a Schedule IV depressant used most frequently in hospital settings to treat delirium tremens associated with alcohol withdrawal. Many individuals who become addicted to paraldehyde have been initially exposed during treatment for alcoholism and, despite the disagreeable odor and taste, come to prefer it to alcohol. This drug is not used by injection because of tissue damage, and taken orally, it can be irritating to the throat and stomach. One of the signs of paraldehyde use is a strong, characteristic smell to the breath

Fentanyl

First synthesized in Belgium in the late 1950s, fentanyl, with an analgesic potency of about 80 times that of morphine, was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze®. Thereafter; two other fentanyl analogues were introduced; alfentanil (Alfenta®), an ultra-short (5-10 minutes) acting analgesic, and sufentanil (Sufenta®), an exceptionally potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery. Today, fentanyls are extensively used for anesthesia and analgesia. Duragesic®, for example, is a fentanyl transdermal patch used in chronic pain management, and Actiq® is a solid formulation of fentanyl citrate on a stick that dissolves slowly in the mouth for transmucosal absorption. Actiq® is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil®) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals.

Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical community and continues to be a problem in the United States. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are indistinguishable from those of heroin, with the exception that the fentanyls may be hundreds of times more potent. Fentanyls are most commonly used by intravenous administration, but like heroin, they may also be smoked or snorted.

Gamma Hydroxybutyric Acid

Gamma hydroxybutyric acid (GHB) produces a wide range of central nervous system effects, including dose-dependent drowsiness, dizziness, nausea, amnesia, visual hallucinations, hypotension, brady-cardia, severe respiratory depression, and coma. The use of alcohol in combination with GHB greatly enhances its depressant effects. Overdose frequently requires emergency room care and many GHB-related fatalities have been reported.

Gamma butyrolactone (GBL) and 1,4-butanediol are GHB analogues that can be used as substitutes for GHB. When ingested, these analogues are converted to GHB and produce identical effects. GBL is also used in the clandestine production of GHB as an immediate precursor. Both GBL and 1,4-butanediol have been sold at health food stores and on various internet sites.

The abuse of GHB began to seriously escalate in the mid-1990s. For example, in 1994, there were 55 emergency department episodes involving GHB reported in the Drug Abuse Warning Network (DAWN; a statistical record of times a drug is involved in a drug abuse episode in emergency rooms in the United States). In 1999, there were 2,973 GHB episodes. DAWN data also indicated that most users were males, less than 25 years of age, taking the drug orally for recreational use.

GHB was placed in Schedule I of the CSA in March 2000. Gamma butyrolactone (GBL) was made a List I Chemical in February 2000. While not approved for marketing in the United States, GHB is being evaluated for its possible use in the treatment of cataplexy associated with some types of narcolepsy.

TRAFFICKING

GHB (gamma hydroxybutyrate), a central nervous system depressant, was banned by the FDA in 1990. On February 18, 2000, President William J. Clinton signed the Hillory J. Farias and Samantha Reid Date-Rape Prohibition Act of 2000. This legislation makes GHB a Schedule I drug under the Controlled Substance Act (CSA).

GHB generates feelings of euphoria and intoxication. It is often combined in a carbonated, alcohol, or health food drink, and is reportedly popular among adolescents and young adults attending raves and nightclubs. At lower doses, GHB causes drowsiness, nausea, and visual disturbances. At higher dosages, unconsciousness, seizures, severe respiratory depression, and coma can occur.

GHB has been used in the commission of sexual assaults because it renders the victim incapable of resisting, and may cause memory problems that could complicate case prosecution. GHB recipes are accessible over the Internet; the drug is simple to manufacture, and can be made in a bathtub or even a Pyrex baking dish. DEA, along with state and local law enforcement agencies, seized 13 GHB laboratories in 2001, 5 of which were located in California, compared to 20 GHB laboratories in 2000 with 12 of these seized in California.

GBL (gamma butyrolactone), an analog of GHB, is also abused. GBL is a chemical used in many industrial cleaners and it also has been marketed as a health supplement. GBL is synthesized by the body to produce GHB. One 55-gallon drum yields 240,000 capfuls of GBL. One capful sells for $8.00, potentially yielding 1.9 million dollars per 55-gallon drum.

Codeine

Codeine is the most widely used, naturally occurring narcotic in medical treatment in the world. This alkaloid is found in opium in concentrations ranging from 0.7 to 2.5 percent. However, most codeine used in the United States is produced from morphine. Codeine is also the starting material for the production of two other narcotics, dihydrocodeine and hydrocodone.

Codeine is medically prescribed for the relief of moderate pain and cough suppression. Compared to morphine, codeine produces less analgesia, sedation, and respiratory depression, and is usually taken orally. It is made into tablets either alone (Schedule II) or in combination with aspirin or acetaminophen (i.e., Tylenol with Codeine, Schedule III). As a cough suppressant, codeine is found in a number of liquid preparations (these products are in Schedule V). Codeine is also used to a lesser extent as an injectable solution for the treatment of pain. Codeine products are diverted from legitimate sources and are encountered on the illicit market.

Buprenorphine

This drug is a semi-synthetic narcotic derived from thebaine and is currently being investigated for the treatment of narcotic addiction. Like methadone and LAAM, buprenorphine is potent (30 to 50 times the analgesic potency of morphine), has a long duration of action, and does not need to be injected. The buprenorphine products under development are sublingual tablets. Unlike the other treatment drugs, buprenorphine produces far less respiratory depression and is thought to be safer in overdose. Buprenorphine is currently available in the United States as an injectable Schedule V narcotic analgesic (Buprenex®) for human and veterinary use.

Hydrocodone - Anexsia® - Hycodan® - Hycomine® - Lorcet® - Lortab® - Tussionex®, Tylox® - Vicodin® -Vicoprofen®

Hydrocodone is an orally active analgesic and antitussive Schedule II narcotic that is marketed in multi-ingredient Schedule III products. Hydrocodone has an analgesic potency similar to or greater than that of oral morphine. Sales and production of this drug have increased significantly in recent years (a four-fold increase between 1990 and 2000), as have diversion and illicit use. Trade names include Anexsia®, Hycodan®, Hycomine®, Lorcet®, Lortab®, Tussionex®, Tylox®, Vicodin®, and Vicoprofen®. These are available as tablets, capsules, and/or syrups. Generally; this drug is abused by oral rather than intravenous administration. Currently, about 20 tons of hydrocodone products are used annually in the United States.