in American Society, 5th, 6th, 7th, and 8th editions, Erich Goode, McGraw-Hill,
1999/2005/2008/2012. Chapter 8 and 11
and Drugs, Society, and Human Behavior, Ray and Ksir, Mosby,
1993. Chapters 7and 13)
- Legal Instrumental Use: Physiological
and Psychological Medicine
- Used to ease lives
- Wide range: common-unusual, non-problematic-severe
- Sedatives and Tranquilizers, Anti-depressants,
- The DASIS Report: Prescription
and Over-the-Counter Drug Abuse Admissions
- 1997 NHS: "The estimated
prevalence rate of non-medical use of psychotherapeutics (tranquilizers, sedatives,
analgesics, or stimulants) in the past month for those 12 and older was 1.4
percent in 1996 and 1.2 percent in 1997, not a statistically significant change.
was some variation in rates of use by specific drug category and by age group."(1)
- 1998 NHS: "The estimated
prevalence rate of nonmedical use of psychotherapeutics (tranquilizers, sedatives,
analgesics, or stimulants) in
the past month for those 12 and older was 1.2 percent in 1997 and 1.1 percent
in 1998, not a statistically significant change." (2)
- Shopping for Drugs: http://www.ncpa.org/pub/st/st262/
- Current MTF (all ages) Data
- 2007: Spending
on Psychotherapeutic Drugs Soars
- General depressants
- Low doses reduce anxiety
- Higher doses sedate
- Sedatives: Hypnotics (sleep aids)
- Tranquilizers: Old designation-
Major: Serious psychological problems
- No high
- Rarely used recreationally
- Defining Neuroleptica
Minor: Less serious problems
- Reduce anxiety
Sedatives vs. Tranquilizers: Sedatives
can do the same thing as tranquilizers, but therapeutic doses tend to produce
clouding, intoxication, dis-coordination and dependence. Experience with tranquilizers
showed later that dependence was a reality with them, too.
Types of Sedatives
- Knock out drops, "Mickey
- Synthesized in 1832, first used
- By 1871- 'recreational use' noted
- Short onset: 30 minutes; sleep
within 1 hour
- Not as problematic as the barbiturates:
not as much depression of respiration, CVS, and fewer after effects
- But addictive, coupled with gastric
irritant, and other side effects
- Synthesized in 1829; first used
clinically in 1882
- Very effective
- Wide margin of safety
- Widespread use in the 1950's
- Problem: Horrible taste and odor
that effects the breath of the user.
- Use as part of alcoholism
- Widely used in 19th Century: Sleeping
- Patent Medicines
- A "bromide" was a tiresome,
- Dangerous: accumulate in the body,
depression develops, toxicity with repeated doses, dermatitis, and constipation
- Low (ineffective) doses were part
of OTC preparations up to 1960's
- 2500 types
- First: Barbital (Veronal), 1903--
- Barbituratic Acid: Named after
a girl named Barbara or celebration of discovery on St. Barbara's
Day in a tavern with artillery officers
- Practice, still today: All end
- 1912: Phenobarbital (Luminal)-
- 1923: Amobarbital (Amytal)- short
acting; street name- "Ammies"
- 1930: Pentobarbital
short acting; street name- "Yellow Jackets"
- 1930: Secobarbital (Seconal)-
short acting; street name- "Reds" or "Sekkies"
- Also: Tuinal- short acting; street
name- "Tooies" or "Christmas Trees"
- Long acting: 1 hour for onset,
effects last 6-10 hours. Low doses (50 mg) as daytime calmative. Rarely used
- Short acting: 15-30 minute onset,
effects last 2-6 hours. High dose (200 mg) as sleeping pill. Higher doses:
400-600 mg used recreationally
- Widely prescribed during the 1950's
- Metabolized in the liver: stimulates
the activity of the microsomal enzymes (alcohol); tolerance develops and impacts
the metabolism of other drugs.
- Problems: Tolerance, Psychological
and Physiological dependence (severe- 5% death on withdrawal), depress respiration,
and in combination with alcohol- synergy-- OD. Drug of choice for suicide.
LD50=> 10x ED50. Cross-tolerance, Interferes with REM sleep, cumulative
toxic effect, and amnesiac effect.
- 800-1000 mg per day over a period
of 4-6 weeks: severe dependence
- Prescription use of short acting
barbiturates- down ~90%
- Street use down, DAWN reports
down ~65%, deaths from OD, etc. down 46%
- Use during the 1960's
- Hundreds of thousands addicted
- The "Hidden Addiction"
- Older, Respectable, Middle-class
- Legal supply- quasi-therapeutic
- Social tolerance- use was
not viewed as problematic
Recreational use significant too.
- The "Downer Freak"
- Obliteration of Awareness
- Juveniles and VIOLENCE especially
with alcohol; 78% rank SECONAL as producing assaultiveness (11% rank
alcohol): Not all barbiturates equal. Potentiation vs. Causation.
- First of the modern anti-anxiety
agents. Developed from muscle relaxant called mephenesin in the 1950's.
- Brand names: Miltown, also Equanil.
- Drug revolution of the 1950's
(1955): Sales in May- $7500; by December- $500,000.
- "Happy Pills"
- Concern about over-prescribing
grew; gradually awareness developed that psychological and physiological dependence
did occur within two months at twice the typical dose.
- Placed on Schedule IV in 1970,
still available- but replaced by Benzodiazepines
- 1957: First clinical use=>
- "Breakthrough" in behavioral
research: Give mouse barbiturate=> it falls asleep; Give mouse Librium->
it loosens its grip on inclined wire screen, fall to floor and walk around,
- Marketed as a selective ant-anxiety
agent, with fewer problems than all of the above. Quickly became #1 seller.
- Originally thought to have a high
margin of safety, but: OOPS
- Tolerance (although little escalation
of use or "craving"), and physical and psychological dependence.
Therapeutic dose=> 25 mg; @ 300 dependency
- 1970: Diazepam (Valium). More rapid onset, metabolized slower, longer acting. Therapeutic
dose=> 2-10 mg @ 120 dependency. Became #1 and stayed there through 1978. Current Top 200 Drugs-- not
- For the most part, most users
do not use in sufficient quantities to produce serious problems
- Frequently used, yet few DAWN
- Doctors began to limit prescriptions:
Street users, multiple "scripts," and diverted production. Recreational
use at much larger doses.
- Placidyl another brand name
- Now Xanax
(Alprazolam) (see also)
- Thought to be less problematic.
- Concern: Rushed through
testing without adequate controls or review in order to get to the market--
Profit potential very high.
dependency, memory loss, rage?
- Another: Rohypnol
also)(late 1990s)- Date rape........
- And coming up: Ativan (Lorazepam),
Serax (Oxazepam), and a variety of others.
- Sedative-hypnotic: Halcion
(triazolam) (see below)
- After introduction of "tranks,"
barbiturates were still used for sleep: Market-
- Everything seems to have gone
wrong with this drug: FDA, DEA, Press, and Doctors
- Developed in India as an anti-malaria
medication, but found ineffective
- After Thalidomide disaster, Europeans
were looking for a safe sleeping pill.
- England- 1965: Mass Advertising,
"Mandrax," by 1971, 2 million prescriptions being written
- Long before that: Hits the streets.
Quickly becomes "drug of choice" for downer freaks. Stiffer controls,
gradually replaced by other drugs
- Introduced in Germany in 1960,
non-prescription. First OD- 1962, discovered that ~15% drug OD's related.
- 1960-1964: Japan; 40% of all OD's
- USA: No one paid attention???
After 3 years of tests, introduced in 1965: Quaalude and Sopor brand names:
"Addiction potential not established"
- Not Scheduled, monitored, or refill
limitations. "No evidence of abuse potential"
- By 1970: "Ludes" and
"Sopors" were the on the streets.
"Love Drug" and/or "Wallbanger"
- Prescriptions continued to soar,
production diverted to streets, Sales increased
- Finally in 1973 (4 years after
it was recognized as addicting: dependency as easy as with barbiturates) Methaqualone
was placed on Schedule II. By 1985: No longer available. Now: Schedule I
All of the above drugs apparently
enhance the inhibitory effects of GABA . Seems there are GABA-Receptor Complexes
which attract the variety of drugs described. Now work is on to develop new
drugs that work on this complex: Xanax
- Drive for profit-Capitalism
- Competition: Advertising
- Even with FDA review: often little
known about potential problems in large user population, or street level use.
- Instrumental use==> Street
use, as properties become known
- Widespread recreational use:
- Scare stories
- Government investigations
- Tightening controls
- Illicit/deviant use=> Impetus:
- Search for the next drug
and deviance as converted form of Conventional behavior
- Morgan and Kagan: Media myths
and realities. Dangerous, yes- But: with each "new" drug explosion
of negative publicity feed itself to create overblown vision of danger. Use
and "morbidity of PCP declining. Culture has "adjusted."
- Parke, Davis and Co. In the 1950's:
New intravenous anesthetic-- Phencyclidine.
- Not a very good product, but animals
did seem to become "disassociated"
- Use in humans: unpredictable psychological
effects-- feelings of unreality, depersonalization, persecution, depression,
and intense anxiety.
- By 1960: seen as useful as anesthetic
for animals; medically safe, but problematic for humans; and a hallucinogen
of a "different sort."
- Used in veterinary medicine to
"stun" animals (not a tranquilizer)
- Similar drug marketed:
- Appears on the streets- late 1960's-1970's:
"Hog," "garbage," "Angel Dust."
- Use to "beef" up poor
quality marijuana, sold as a substitute for just about everything
- Linked to violence (especially
- Little used today, typical user-
Older than late 1970's
- Major Tranquilizers
- No "high" associated
- Little to no recreational use
- Phenothiazines: Thorazine,
- Psychotherapeutic Revolution:
Depopulation of Mental Hospitals
1946: 525,000 patients (220,000
1955: 680,000 patients (350,00
admit/year) (Chlorpromazine: Thorazine introduced)
1993: 120,000 patients (750,000
1998: 90,000 patients (no data
Admissions up steadily, census
peaks in 1955 and then steady, dramatic decline
Stay earlier: 6 or more months,
Now: 2-3 weeks
- 85% of patients receive some type
of pharmacological therapy
- Produces significant improvement
in behavior and manageability
- No addiction, OD rare, side effects:
"ticks," shuffle, etc.
- Relapse if therapy terminated:
75-95%, ~15% can go back to normalcy
- Psychotics: Bizarre and delusional
behavior vs. Mood and Affective Disorder- Depression. Extreme sadness and/or
despair. 15% suicidal
- Stimulants don't seem to help
- ECT: effective, yet negative image.
Used more frequently in England, etc. Today, more precise, lower voltage;
Yet still viewed in negative light.
- Research on depression: neurochemical,
- Drugs: SSRIs:
Prozac, Tofranil, Elavil and Lithium (bipolar),
- No euphoria; for non-depressed:
- 2-3 week onset
- Most seem to be helped; ~5% problems
- Starting to produce a fair showing
in DAWN reports
- Introduced in 1987, by 1990 prescriptions
up 500%. Now in the top 10
- One million prescriptions filled
per month. More than one-half by non-psychiatrists.
- Psychologist James Goodwin of
Wenatchee, WA, has used himself since 1989, and virtually demands that all
his clients be prescribed the drug!
- Big $$$$$'s for Eli Lilly.
Testing. By 1990 reports of bizarre, violent and self-destructive behavior.
- "Prozac-Generated Syndrome."
Survivors: legal action.
- 1991: FDA rejected request by
above groups to remove Prozac.
- Continues to be one of the most
popular antidepressants (Zoloft and Paxil outsell now).
- Now "Sarafem."
Another Horror Story
(Pattern Continues): Halcion (triazolam) (1997
- Introduced in 1982 (Upjohn--Pharmacia)
- Rapidly became the best selling
sedative/hypnotic. 1991 profits ~$220 million.
- George Bush: Used to combat jet
lag--Vomits in lap of Japanese Prime Minister
- Utah: women shoots mother 8 times,
places birthday card on deceased's head. Drug defense-- Charges dropped, case
dismissed; Upjohn settles civil suit.
of all sorts of craziness begin to surface
- Researcher reanalyze test: Falsified,
Cover-up, Problems at three times the level reported
- Upjohn claims there were "mistakes,"
not intentional misrepresentation. Justice Department Review
- ?????: Profit motive????
- Some suggest that Upjohn railroaded
the drug through the FDA, Pharmacological-Industrial Complex: FDA and Psychiatrist
dependent on the drug companies?? Drug companies interest==> Profit. Lying
is means to an end.
- Taken off the market in Holland
and Great Britain, other countries: small doses
- USA: Still under consideration,
insert. Sales down.
- Now: Ambien (Zolpidem)
- More specific action
at one benzodiazapine site.
- Clinically: similar
to Halcion, rapid onset, short duration.
The "new" drug: Ambien
- AKA: Concerta
- Mild stimulant
of choice for treatment of ADHD
- Cause(s) of ADHD
not known, nor is how
Ritalin works fully understood: sensory deprivation, food additives, social
context, environment? Whatever, Ritalin seems to help (assumption--
since drug "fixes" cause must be neuro-chemical). Alternatives?
Recent (2004) research on how stimulants work in the treatment of ADHD: NIDA
NewScan for July 19, 2004. (local
- Question: Who
has the problem? Child (now adults, too) or control agents? For
adults, who decides "normal?"
- Problem: Indiscriminate
use. Estimate--750,000 to 1,000,000 school children being treated.
(198th out of top 200 drug in 1997)
- ADD Resources (www.addresources.org)
(a medicalized perspective)
(see also: Atomoxetine)
Strattera is a norepinephrine re-uptake inhibitor. See, Wikipedia on norepinephrine.
publishes warning on ADHD Drugs, June 29, 2005
- Drugs to Treat A.D.H.D. Reach the Preschool Set, NY Times, Health, The Consumer, Octoger 24, 2011 (Page D5 in the October 25, 2011 print edition)
Owner: Robert O. Keel firstname.lastname@example.org
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