Stimulants
(See: Drugs in American Society, 5th, 6th, 7th editions, Erich Goode, McGraw-Hill, 1999/2005/2008. Chapter 10 and Drugs, Society, and Human Behavior, Ray and Ksir, Mosby, 1993. Chapters 6, 11, and 12.)

Speed Kills!

Xanthines

Caffeine, Theophylline, Theobromine

• Most widely used stimulants worldwide
• Typical form, especially in USA: Coffee, Tea and Chocolate
• Other sources: OTC preparations, soft drinks.

Coffee: History

• Legend: Arabian goatherd noticed the effects on his goats after they consumed the red berries of the shrub.
• 900 AD: Included in the medical practice of Arabian physicians: "Good for what ails you."
• 1674: England- Women rallied against its use=> Made men "unfruitful."
• Coffee houses linked to political dissent: Sedition. Charles II outlaws.
• A.K.A. "Penny Universities"
• Lloyds of London: Originally; Edward Lloyd's Coffee House
• In the USA: Replaces tea as the "national drink" after taxation issue.
• Commercial roasting (NY): unstable- deteriorates 2-3 weeks
• Maxwell House blend introduced as first real commercial variety in 1892
• Vacuum packing circa 1900
• Use continues to increase. Peaks 1946: 20 lbs. Per person per year.
• Current use: ~10 lbs.-- lifestyle changes and health consequences, although interesting revival of the "coffee house" in many metropolitan areas.
• #2 export worldwide, behind oil.
• Price increases during the 1950's led to a shift towards lighter brews (from 40 cups/lb to 60)

A few links:

Wikipedia on Caffeine

Too Much Coffee Man

Signs you have had too much coffee

Erowid: Caffeine

Ode to Coffee

McD and Starbucks Invade the world: http://www.princeton.edu/~ina/infographics/starbucks.html

Tea

• Legend: Founder of Zen, Daruma, fell asleep while meditating, cut off his eyelids, where they fell-- tea plant grew. A brew of its leaves would keep you awake.
• 350 A.D.- China: primarily a medicinal herb. Widely used by 780 A.D. (Tax levied)
• First mention in Europe: 1559
• 1610: Dutch began importing
• Trade wars during the 17th Century between Holland and England over the tea business.
• Begins to replace coffee as a drink in England. "Drink Tea Campaign." English East India Company: Profits helped colonize India, led to Opium Wars with China. Linked tea drinking to patriotism, coupled with low tax on tea and high tax on alcohol-- Becomes the national drink

Tea Plant

• The bud-leaf (flowering orange pekoe) and the first two leaves (orange pekoe and pekoe) are used.
• Dried, crushed: oxidizes (ferments)=> Black tea
• Quality controls were established in USA: 1897. FDA taste test: 7 types/grades
• 1904: Iced tea introduced at the World's Fair in St. Louis. Tea bags introduced in NYC.
• Pound for pound- more caffeine than coffee; but brew more cups per pound.
• Theophylline is found in small quantities: Broncho-dilation, and Cardio-vascular stimulant

The Way of  Tea

Wikipedia on Theophylline

Chocolate

• From the Cacao tree (Theobroma cacao) (cocoa is the dried seed)
• History
• Aztec drank the nectar without sugar, named the tree Theobroma "food of the gods"
• 1828 the Dutch produce powered chcolate by removing the cocoa butter (fat).
• Mix the cocoa butter with sugar and some of the power==> Chocolate bar (1847)
• Swiss add milk to the recipe: Milk Chocolate (Milka)
• Also contains Theobromine (typical cup of cocoa ~200mg.) Similar to, but less potent than caffeine.
• Erowid on chocolate
• Wikipedia on chocolate
• Chocolate and Cannabinoids (see also)

Focus on Caffeine (see Ray, p. 303) (See also: Erowid)

Consumption

• Over a 72 hour period, typical male=> 1150 mg. Typical female==>1273 (from Ray)
• ED=> 200 mg (for regular user)
• Impact: CNS stimulant, Nervousness, increased heart rate and respiration, periphial dilation (but vessels in brain constrict: tends to relieve migraines and headaches in non-users), offsets fatigue, DOES NOT sober up a drunk.

1. Cancer (not at normally consumed levels)
2. Breast lumps (benign) (again no firm link)
3. Large doses seem to be related to birth defects in lab animals
4. Heart problems: could increase risks
5. Caffeinism: little real concern for OD, but dependence is common.
6. Withdrawal: headaches, fatigue, depression.  APA-- considering adding Caffeine dependence Syndrome to list of disorders (Ray, p. 306)
7. Caffeine and the new "problem drug" for 1999
8. 2006: Concern developing over consumption of energy drinks
9. Medicinal use: for premature infants
10. Most caffeinated city in the USA?

Nicotine

• Columbus received tobacco as a birthday present in 1492
• 1497: Monk records the habit of natives for "drinking" (smoking) tobacco. In the early years of use one "drank" (smoked) or "took" (used snuff).
• Spain develop a monopoly and made huge profits on their trade.
• England looked to the American colonies to compete: It grew well and became a major cash crop.
• 17th Century: 30 Years War-- smoking spread throughout Europe. There were a variety of legal measures that attempted to control smoking, for economic and other reasons: Russia (1634) noses cut off; China (1638) decapitation.
• Throughout the 18th Century the typical usage was in the form of snuff, associated with nobility and elite status. Pipe smoking was also common.
• Chewing tobacco became popular in post revolutionary America
• By 1911 smoking: Pipe and cigars and chewing were the dominant forms of consumption. 1920- 3 out of 4 lbs. Today 1 of 7 lbs. 1945 Regulation passed ordering cuspidors to be removed from federal buildings.
• Cigars: Sort of between chewing and cigarettes. Hand rolling: one person- about 200 a day. Use peaked in 1920: 8 billion cigars sold. "What America needs is a good 5 cent cigar." Aside by the Vice-President during a Senate discussion on the needs of America.
• Cigarettes: 1850's Phillip Morris begins producing handmade cigarettes.
  • 1881: machine rolling introduced; popularity increases. 1885: sales at 1 billion a year
  • 1913: Camels and advertising "Turkish blend," yet used mostly domestic tobacco- reducing cost. By 1918: 40% of market.
  • Ensuing years: rapid growth in sales.
  • End of WW II: 340 billion sold- 175 packs per person per year.
  • Filter cigarettes: 1954-- Winstons. Remained number 1 seller through the 1970's.
  • Consumption peaks in 1963: 217 packs per person per year.
• 1964: Surgeon General's report on smoking and health: Decline begins. 1990 150 packs per year.
• Today, adult consumption is down, yet smoking for children showed increases throughout the 1990s. Up to 1990, reality was that young people were less likely to start, yet by 1997 36.5% % of high school seniors reported monthly smoking.  Over the past 9 years, smoking has steadily decline for the adolescent population: 21.6% of 12th graders report monthly use in 2006. However, data from SAMHSA indicate that the federal government has been unable to significantly reduce adult cigarette use during the 1990s.   The goal was to lower use to 15%, yet throughout the 1990s, and currently, the rate is about 25%.
• Tobacco: $80.3 Billion in sales for 2002, Globally: http://www.princeton.edu/~ina/infographics/smoking.html

Correlates of Smoking

• Probability of smoking in inversely related to social class, level of education, and occupational status.
• Smoking is also correlated with race, with African-Americans having a rate slightly higher than Whites.

Smoking and Problems

• Few think of tobacco and cigarette smoking as a drug/drug use. If smoked like marijuana, one would experience a significant high (Zinberg and tobacco as a placebo in studying the effects of marijuana
• Nicotine is quite toxic: LD: 60mg.    A cigar contains 100-120 mg. (p. 195)
• Powerful dependence. Considered to be the most "addicting" drug available: 80% return within 4 years of quitting (comparable to heroin)
• "Gateway" drug????
• Significant role of government involvement: subsidies and prosed new controls.
• More people use tobacco than all other illicit drugs combined. It is used more frequently by regular users than any other drug. And, many consider it (nicotine, used in the form of cigarettes) to be one of the most addicting (careful how you interpret this term) substances available.
• Politics and science: Debate over causation and addiction and health problems.
• Reality: smokers have rate of death by 65 three times higher than non-smokers, and are twice as likely to die by age 75.
• Cancer rates: 4 times higher for pack; 10 times higher for 1 pack; 17 times higher for 1 and pack; 23 times higher for 2 pack.
• Significantly higher rates of bronchitis, emphysema and heart disease. Impact on fetus.
• Use is down (25% smoke) among the general population, but increased in mid-1990s, and now decreasing among adolescents (31.4% 12th grade at 30 day prevalence (down 3.2%): Current MTF).
• Problems are up (chronic effects): About 434,000 PREMATURE deaths can be associated with the use of tobacco, perhaps 53,000 more from passive smoking.

Cigarette and Tobacco Use 2005 (http://oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#Ch4)

• In 2005, an estimated 71.5 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 29.4 percent of the population in that age range. In addition, 60.5 million persons (24.9 percent of the population) were current cigarette smokers; 13.6 million (5.6 percent) smoked cigars; 7.7 million (3.2 percent) used smokeless tobacco; and 2.2 million (0.9 percent) smoked tobacco in pipes.
• The rates of current use of cigarettes, smokeless tobacco, cigars, and pipe tobacco were unchanged between 2004 and 2005. However, between 2002 and 2005, past month use of a tobacco product declined from 30.4 to 29.4 percent, and past month cigarette use decreased from 26.0 to 24.9 percent.
• There was a statistically significant decrease in current cigar use between 1999 and 2000, from 5.5 percent to 4.8 percent for the population aged 12 and older. Rates of use of smokeless tobacco and pipes were unchanged between 1999 and 2000.

• Current NHS Data
• 2005 MTF Data

Current Issues:

• 1997: April- Court decision that FDA could regulate Tobacco as a drug.
• Talks with tobacco companies begin, memo leaked demonstrating industry knowledge of addictiveness and aother dangers, and their attempt to "bury it."
• June: Agreement with industry
• July: Decision that agreement "could not be implemented since it restricted the constitutional rights of Americans to sue..." (p. 203)
• Tobacco Settlement
• 2000: The Supreme Court rules against the Food and Drug Administration finding that the agency lacks the authority to regulate tobacco.
• Selected Actions of the U.S. Government Regarding the Regulation of Tobacco Sales, Marketing, and Use
• The Tobacco Settlement: Issues
• Brown and Williamson Collection
• Legacy Tobacco Documents Library
• The Global Tobacco Trade
• Nicotine Vaccine?
• Nicotine Drink
• Nicotine and your Genes (2007)

Yahoo Tobacco Listings

Amphetamines

(Erowid.org, from Indianan University)

• High abuse potential=> Sensuous appeal
• Benzedrine (first) discovered in 1887: nasal decongestion. Later used for the treatment of narcolepsy, depression, alcoholism, schizophrenia, obesity, hyperkinesis, and fatigue. Since 1970, amphetamines have been recommended for use in the treatment of narcolepsy, short-term weight loss (this is even uncommon) and most commonly (and currently), hyperactivity and attention deficient disorder (second only to Ritalin). The military still uses amphetamines (see also) (versus) to enhance alertness for pilots and others. Effects last 4-6 hours, depending on dose.
• Related compound: Ephedrine (ma huang).
• Molecule is both "left" and "right" handed: l and d forms. d is several times more potent: Marketed as Dexidrine. Methamphetamine has methyl group added on ("Crystal Meth", "Ice").   Added methyl group speeds passage across blood-brain barrier.  (duration: 6-12 hours, when smoked, depending on dose). Street price: $100-$250 per gram.

Powder methamphetamine is the hydrochloride salt form which is strongly hydrophilic (absorbs water from the air quickly). The HCl salt is smokable as is. "Crystal Meth" or "Ice" refer to methamphetamine grown into crystals. Though many people believe that Crystal Meth is the freebase form of methamphetamine HCl, this is not true. Methamphetamine is smokable in its normal HCL form, but taking the time to grow it into crystals makes it easier to smoke. Meth in visible crystals (rather than powder) is likely to be relatively pure as it is difficult to grow crystals from impure material. Methamphetamine freebase is an oil and is uncommon on the street.

From Erowid, Methamphetamine Basics, Mon, Oct 1, 2001.

• Multiple drug users: mix with a variety of other drugs to expand/heighten the effects. Used to modify the "down" period associated with other drugs, and/or used to avoid sleep in order to use other drugs.
• Recreational dosage: 20-40 mg.
• High dose IV use: Methamphetamine- more easily crosses the blood-brain barrier. Typical available as a liquid=> "Crank" Now crystals: ICE. Smoked or intranasal. Brief surge reported in use, appears to be "media hype" again. 1993: Lifetime use- 3.1%, Past 30 days- .6% (High School population).
• Use of amphetamines followed the downward tend for other drugs through the 1980's: Current rates- 12% H.S., 19% young adults report lifetime use, 3.6 and 1.5% report thirty day use (significant increase at H.S. level), daily use is very low~ .1-.3%
• Still, a popular drug. Lots of "look-alikes."
• Prescription use is DOWN 90%!!!

Speed Scene: Late 1960s

• Prescriptions for Methedrine began significant decline in 1967, placed on Schedule I: 1970.  Other varieties of methamphetamine are available on Schedule II.
• Use is sporadic now and typically at lower doses
• Recent indications of use rising among ethic minorities and middle class whites, especially in the West and Southwest: Affordable=> longer lasting.

Methamphetamine, Crystal, Ice, and Speed: Mid 1990s--2004

1. New York Times Report on Methamphetamine and Crime
2. Another New York Times Report on Methamphetamine and Crime
3. NIDA: Information on Methamphtamine
4. DEA: Information an Methamphetamine
5. Drug-Free America's Information on "Ice"
6. NHS: In 2000, the estimated number of persons who have tried methamphetamine in their lifetime was 4.0 percent of the
   population. The estimate has increased significantly since 1994, when 1.8 percent of the population had ever used methamphetamine (yet this is down from 4.3% in 1999).
7. Current MTF Data
8. DOJ/DEA Diversion Control
9. Missouri's Methamphetamine Initiative (Policy Brief- Methamphetamine in Missouri 2004)
10. The Methamphetamine Project (2005)
    • The History of Methamphetamine (PowerPoint)
    • The Epidemiology of Methamphetamine Use (PowerPoint)
    • The Pharmacology of Crystal Meth (PowerPoint)
    • What's Speed Got to Do With It? (PowerPoint)

Related Substance: Methcathinone (Cat, Kat). Schedule I since 1993.

Amphetamine users in Amsterdam: Patterns of use and modes of self-regulation
by Justus Uitermark and Peter Cohen (http://www.cedro-uva.org/lib/uitermark.amphetamine.html), 2004.

After identifying some omissions in existing literature on research on amphetamine use, this paper sets forth to answer some questions with respect to (1) use patterns, (2) advantages and disadvantages of amphetamine use as experienced by users (3) the formal and informal modes of control that users employ to reduce or negate negative side-effects of amphetamine use, and (4) the role of context variables in fostering in facilitating these modes of control. The paper draws on a sample of 109 experienced and recent amphetamine users in Amsterdam and a follow-up sample of 67 respondents of the original 109.

Conclusion: Although there is no easy way to summarize the findings presented in this paper, we can provide general answers to the five questions posed at the outset. With respect to use patterns, most respondents did not report escalating levels of use over a period of approximately five years. In a clear majority of cases, respondents reduced their level of use or stop using amphetamine altogether after a relatively brief period of time. This helps to explain why most respondents reported only limited negative side effects of amphetamine use, despite their levels of use. Data from our follow-up survey suggest that users tend to develop mechanisms of self-regulation, even those who at some point showed signs of ‘losing control’; respondents either quit or diminish their use or, in rare cases, accommodate high-level amphetamine use within their daily lives.

NHSDUH 2004-2005 Use Rates

MTF: 12th Grade (methamphetamine annual use): (see also, long-term trends)

Cocaine

(Erowid.org, By Pedro Luz)

• In comparison to the Amphetamines, the effects of Cocaine impact the mind, more than the body
• Cocaine is also shorter in duration

History

• Native tribes of the Andes have chewed the coca leaf for centuries. Records indicate use by the Inca's: The coca plant was considered as divine. (Leaves contain 1% cocaine)
• Erythroxylon coca grows at higher elevations, with substantial rainfall. Some existing cocals (2-3 acre plots) have been under cultivation for 800 years.
• Mountain natives chewed ball of leaves almost continually, distances were measured by the number of stops required to maintain dose level.
• Cocaine Hydrochloride was isolated about 1860. Not a synthetic drug- derived from the plant.
  • Cocaine was hailed as a miracle: S. Freud, et al.
  • Recognized as being able to "fortify" soldiers (Germany, 1880s)
• Anesthetic properties documented (1884)
• Cocaine and Toothaches (An 1885 advertisement for cocaine toothache drops from erowid)
• Major ingredient in popular drinks: Coca Tea, "Vin Mariani Coca Wine" was endorsed by the President, the Pope, and world royalty.

• Yes, it was found in Coca-Cola for a short time, until fear of southern Blacks using cocaine led to its removal (1903-6). (History)(see also)
• Even Sherlock Holmes was a "user."
• Between 1887 and 1914 46 states passed legislation regulating cocaine. Use associated with Blacks, lower class whites and criminals
• Legacy of racism: Literary Digest (1914) " ...most attacks upon white women of the South are a direct result of a cocaine-crazy Negro brain." New York Times (1914): "Negro Cocaine Fiends Are a New Southern Menace."
• Included as a regulated narcotic in the Harrison Narcotics Act of 1914.
• During the 1920's associated with the "hip, swinging" lifestyles of the wealthy: Songs- "Cocaine Lil" and Cole Porters: "I get a Kick out of You"
• 1930-50's described as the "Great Drought," cheaper and readily available amphetamine seems to have replaced cocaine
• During the 1960's and 1970's : popularity resurfaced. Substantial decline in use during the 1980's and through the 1990's: although frequent, chronic use is stable and/or slightly increasing.
• Crack hits streets in the early 1980's and becomes "widely" available by mid decade, its use is in decline.

2005 National Household Survey

Current NHSDUH Data

• In 2005, an estimated 2 million Americans were current (past month) cocaine users. This represents 0.8 percent of the population aged 12 and older. The estimated number of current crack users in 2000 was 467,000, .2% of the population. In 2005 the figure was 682,000 (.3%) (this indicates a significant increase from the 2000 survey (.1%))

1997 MTF High school Seniors (30 day):

• Cocaine 1980: 5.2%, 1990: 1.9%, 1997: 2.3%, 2004: 2.3%
• Crack 1987: 1.3%, 1990: .7%, 1997: .9%, 2004: 1.0%
• Current MTF Data

Types, Route of Administration, and Effects

• Coca leaves are mixed with a solvent such as kerosine or gasoline, after mixing and mashing the fluid is filter off and the substance left is "Coca Paste" or "Basuco." This is sometimes used by locals: its smokable.

(Erowid.org, from Indianan University)

• The paste is further refined into the powder Cocaine Hydrochloride: Snorted intranasally, mixed with water and injected, and sometimes smoked (loses potency)
• "Freebasing" developed in the early 1980's: using ammonia and a solvent such as ether removes the hydrochloride and produces a very potent, smokable "Base" (Richard Pryor accidentally or purposively set himself on fire in 1980 while making/using freebased cocaine).
• Another method of freebasing using baking soda and water emerged=> lumps precipitate and can be heated and the vapors inhaled: "Rock" or "Crack" (sound produced through heating). Crack is not pure like "base," but does produce a vapor that is very potent.
• Both IV use and smoking produce an immediate, intense high. Smoking (although IV use, too) seems to especially initiate a continuing cycle of reinforcement. Both routes produce a high of relatively short duration, followed by an "after glow" and the relative depression. Immediacy of effects leads to a desire to repeat.
• Street cocaine usually "cut" three or more times, increasing the volume and profits, but decreasing purity. The process ends up with approximately a 1,700% value added for cocaine. The base price for a kilogram of cocaine: $610 and ends up on the street at $110,000. (Faupel, et al, The Sociology of Ameican Drug Use, 2004, page 289)
• Cost of cocaine has remained relatively stable, and marketing of Crack makes it easily accessible.
• Seems to act as a blocking agent: blocking the reuptake of dopamine and serotonin.
• Produces=> Extremely pleasurable sensation, Immediate Sensuous Appeal (no learning necessary), Confidence, and Energy: Robert Lewis Stevenson wrote Dr. Jekyll and Mr. Hyde, a 60,000 word novel, in 3 days. He tore it up and did it again.
• Little tolerance is produced (depending on mode of use, frequency of use, and dose), No "classic" addiction; but, extreme behavioral and, perhaps, physiological dependency.
• Occasional use, especially intranasal, seems to have no significant detrimental effect. Used extensively as a local anesthetic in surgery in the nasal, laryngeal, and esophageal regions (it's absorbed so well by mucous membranes).
• Frequent, chronic use does produce problems and requires a substantial economic investment.
• With pattern of frequent use levels still significant, cocaine is a significant factor in DAWN reports. Significant showing and increase in reports over the past few years.
• Crack continues to play a significant role in calls to the Cocaine Hotline, rapidly out paced powdered cocaine.

Crack in the News?

• First reported in the New York Times, November 1985
• Within a year: 1000 stories, 400 television broadcasts
• Factual Distortions and Sensationalism, Myths:
  • "Tidal Wave" and a "plague."
    • Use levels never high (peak: 5% of HS seniors report ever using, ~.1% past month)
    • Use levels have been declining throughout the 1990s
  • Use is "universal"
    • Use inversely correlated with social class, education, etc.
  • "Crack Babies" (see also: Prenatal Exposure to Cocaine)

Immunization for Cocaine Addiction?

• High Times Article on Cocaine Immunizations
• NIDA Notes: Immunizing Rats
• Cocaine Vaccine (or) (released in USA, 2008)

Cocaine and Crack Use Patterns

Ronald Siegel

• Big difference between "snorters" and "smokers," with Smokers reporting many negative reactions and cycles of dependency. Socio-recreational users: stable. Dependency seems highly correlated with mode of use.

Murphy, Reinarman, and Waldorf

• 11 year study of 19 "controlled," socio-recreational users: 6 used in a controlled fashion throughout the time frame; 7 escalated use patterns, but returned to stable use; 2 were controlled users, but ended up abstaining, 3 escalated to heavy use and became abstainers; 1 became and remained a heavy user.
• Study may not be typical of cocaine use in general, but does point out the fact that use does not inevitably lead to addiction.
• "Pharmaco-economic determinism" versus the Power of Human Free Will.
• Cohen and Sas, "Ten Years of Cocaine: A follow-up study of 64 cocaine users in Amsterdam" (1993)
• Cohen, "Cocaine use in Amsterdam In non-deviant subcultures"(1994)
• Morningstar and Chitwood: Cocaine, Sex, and Stereotypes- Cocaine Cowboys and Coke Whores. Reflections of general gender patterns of control and dominance.

The social and health consequences of cocaine use
by Peter Cohen

Presentation held at the Nationale Designerdrogen-und Kokainkonferenz, 3-4 June, 2004, Bern, Switzerland.

<http://www.cedro-uva.org/lib/cohen.social.html>

Crack in the Future?

• McCoy, Miles and Inciardi: "Survival Sex"- Women growing up in depressed urban areas, alienated from homes=> boyfriends drug use, drugs as payment, sex as medium of exchange, prostitution. Crack as "functional" in the short term as increasing sexual abilities and enjoyment (long-term, negative impact on sexual functioning)
• Media hype and the "new" epidemic"-- Impressive surge in use, yet confined to a rather small population. "Crack Babies"???
• Political response: penalties created based on media image. Latent racism.
• Addiction?? Inciardi study: 308 users, 12-17 years of age. 96% had used crack more than once; 87% used on a regular basis; of the latter group, only 30% used daily and 50% used once or more per week- but not daily. Majority of daily users limited themselves to one or two "hits". Compulsive users: extremely small percentage.
• Still, NOT a "safe" drug; yet, NOT the Devil incarnate.
• As with cocaine, use trend was downward, now stablizing. Typical user today is older, typically having a long history of use.
• As sales decline, violence associated with subculture appears to increase. Secondarily, long-term impact of problems of use: AIDS
• Subculture returns to "old standby"-- HEROIN (Narcotics)

DrugsText Information on Cocaine

URL: http://www.umsl.edu/~keelr/180/speed.html
Owner: Robert O. Keel rok@umsl.edu
References and Credits for this Page of Notes
Last Updated: Thursday, August 28, 2008 1:35 PM