APPENDIX

KINDS OF DRUGS AND METHODS OF USE

The drugs of addiction that are related to or derived from the twenty or so opium alkaloids are too numerous to be listed, and it would be pointless and tedious to attempt to do so. In addition to the hundreds of compounds derived from opium and its alkaloids, there is a great variety of synthetic drugs that have analgesic effects like those of morphine and which are also addicting. Morphine was the first alkaloid of opium to be isolated (in 1803), and it serves as a standard of comparison because it remains the most satisfactory pain-relieving agent in medical practice.

In the annual report of the Federal Bureau of Narcotics for 1965 (PP. 11-14) 57 kinds of synthetics alleged to be habit forming are listed. Two of these are: (1) pethidine, also known as Demerol or meperidine and by more than forty other Dames, and (2) methadone, also known as amidone and dolopbine. Both are addicting, and both are in reality representatives of families of related drugs with similar molecular structures. Pethidine, the oldest of the syntbetic equivalents, which was produced in Germany in 1939, is accompanied in the bureau's list by 8o other names and methadone by 62these are alternative names for the drug or the names of other drugs of the same series.

Opium is obtained by drying the juice from the unripe seed capsule of the opium poppy or Papaver somniferum. Morphine constitutes about 10 per cent of opium and is mainly responsible for its physiological effects and its addictive potential. It, its derivatives, and the related synthetics are thus of central relevance in the consideration of contemporary addiction to the "manufactured drugs" as contrasted with opium as such. Heroin (diacetylmorphine) is the best-known chemical derivative of morphine and the drug of choice for most American users. It was first produced in 1898. It does not naturally appear as such in opium. Codeine, which is found in opium, is much less potent than morphine and is a derivative of it. It, like morphine, has numerous derivatives. It is not popular with addicts but may be used to maintain addiction when nothing better is available. Drugs of the morphine type range from a recent derivative known as Bentley's compound, which is about lo,ooo times as powerful as morphine, to those of the codeine class, which have a relatively slight analgesic and addicting potential. In addition to heroin, the following drugs are among those that are more potent than morphine: Dilaudid (dihydromorphinone hydrochloride), Numorphan (oxymorphinone hydrochloride), methyldilaudid (metopon hydrochloride), levorphan, a highly addicting member of a family known as the morphinan series, and pbenazocine, a member of a group known as the benzomorphans. The significant fact concerning morphine-like compounds, from the addict's point of view, is that they are interchangeable by substitution for morphine or heroin in the maintenance of addiction. The drug user is rarely acquainted with more than a very small percentage of the total range of these compounds.

Many of the opiate drugs and the related synthetics were proclaimed as non-addicting when they were first introduced, This was true, for example, of morphine, which was hailed as a substance having all the virtues of opium and none of its defects. Heroin was similarly characterized as non-addicting and was sometimes used as a cure for morphine addiction. Demerol, which was synthesized in 1939, was also originally acclaimed as non habit-forming.

Prior to the isolation of morphine, opiate addicts satisfied their habits by smoking opium or by drinking or eating the numerous preparations that contained it. DeQuincey, for example, drank laudanum or tincture of opium. Paregoric is a modern equivalent of laudanum. Addicts sometimes drink it and sometimes boil it down and inject the concentrated residue hypodermically. Pantopon is a mixture of opium alkaloids like that naturally present in opium.

At about the middle of the nineteenth century the hypodermic method of injecting morphine was invented, allegedly by a Scottish physician in Edinburgh. It was at first proclaimed that this method of administration bad the double advantage of being more efficient and also non-habit forming. The use of the hypodermic was widely disseminated in the United States during the Civil War.

American addicts during the latter half of the nineteenth century began to adopt the hypodermic method but at first injected the drug only into the muscles, regarding intravenous injections, which sometimes happened by accident, as dangerous and painful. The technique of "mainlining" or taking intravenous injections, was popularized among users during the twentieth century. It involves the use of an improvised hypodermic outfit which is, from the user's viewpoint, both more efficient and less expensive than the physician's syringe. It consists of a medicine dropper that is fitted into a hypodermic needle. The drug is placed in a small metal container such as a spoon, a bottle top, or the cover of a tobacco can. AD appropriate quantity of water is added with the medicine dropper, mixed with the drug, heated with a match or two to dissolve it, and then drawn up into the medicine dropper. A small bit of cotton is used to filter or strain impurities from the solution when it is drawn into the ropper. When the latter is filled to the desired level it is fitted into the hypodermic needle by means of a "collar" or "gasket" and the user is then ready to take his fix.

Preparation for the fix involves, for the usual right handed addict, tying Lip the left arm between the shoulder and the elbow so as to distend the veins below that point. When the needle appears to have been inserted into the vein the user may check this fact by Doting the appearance of small quantities of blood in the lower part of the medicine dropper. The injection is made by squeezing the rubber bulb of the medicine dropper with the right hand. The needle is then withdrawn and the arm untied. The injections are usually made in the veins on the inside of the arm, but those on the back of the hand may also be used. Similar techniques may be employed to make injections into the veins of the legs. It is reported that an occasional user will make injections directly into the jugular vein when he is unable to locate others (for example, because they have collapsed).

A small number of addicts who object to the intravenous route may use the simpler one of intra muscular injection. Others who dislike the hypodermic method altogether may take their drug in the form of pills or even sprinkle it over their food like salt. In some foreign countries it is reported that suppositories are used. In the Far East, a popular method of heroin use is by inhalation of its fumes when it is heated, on a piece of tinfoil, for example. This particular method is known as "chasing the dragon" from the fact that the relatively heavy fumes are said to form dragon like shapes in the depressions of the tinfoil.

During the first decades of the century, morphine and heroin competed with each other in the American illicit market, with the latter gradually replacing the former, probably because it is easier to dilute and easier to handle and to conceal as well as being more potent. Since World War 11 when synthetic equivalents such as methadone and pethidine or Demerol began to be used extensively by physicians, addicts have acquired some acquaintance with these and related drugs which also occasionally turn up in the illicit trade. Under emergency conditions, as already indicated, addicts may resort to a wide variety of inferior substitutes. There are, for example, cough remedies or mixtures, such as terpin hydrate, that contain codeine. Another cough suppressant, Percodan, contains the drug oxycodone hydrochloride, which is more potent than codeine. Addicts in some regions arc said to have taken up the use of Darvon (propoxyphene hydrochloride), an analgesic that is not as powerful as codeine and has the disadvantage of producing undesirable side-effects. Under pressure, addicts may also try non-addicting drugs or addicting drugs unrelated to morphine or the opiates, such as the barbiturates, the amphetamines, and others.

While the main methods of taking drugs have been touched upon, there are others of an emergency type that may be resorted to when the circumstances require it. Thus, a user may gouge or cut a wound in his skin and either inject the solution directly with a medicine dropper or simply put the powdered drug into the wound so that it may be absorbed. If a medicine dropper is at band and hypodermic needles are not, in prison for example, the hollow end of a sewing machine needle may be inserted into the vein and the injection made by sliding the medicine dropper over it and pressing it against the skin. A user, reporting on his experience with this technique, said that on one occasion when be withdrew the medicine dropper the point of the sewing machine needle bad vanished into the vein and was never seen again. Reference should also be made to "sniffing" or "snorting," in which the drug in powdered form is inhaled into the nostrils. Heroin and cocaine were formerly used in this way, and the practice is still encountered.

it seems reasonable to suppose that, as new drugs are produced, other addicting substances not presently known will be found and that some of these, as well as some of those already known to pharmacologists, will become known to addicts. Should the international campaign to restrict the cultivation of the poppy and the production of opium ever begin to show signs of reaching its goal, it seems reasonable to suppose that the natural opiates and heroin which now flow in the world's channels of illicit distribution may be replaced or supplemented by synthetics manufactured in secret illegal laboratories.