2. The Confusion with Other Drugs

Almost all medicines are drugs which a doctor prescribes for us when we are ill and which we get from a chemist's shop or a drug store. But in this book it is more convenient to limit the definition to what might be called recreational drugs, and this would include alcohol, tobacco and even tea and coffee. Most people would now agree that alcohol and tobacco are both dangerous, but they are not normally included in the list when people talk about dangerous drugs.

To the general public, drug addicts are people who take heroin, reefers, pep pills and LSD.  The law, the press and the public tend to think all these drugs are similar. This leads to considerable confusion and misunderstanding. There are five main groups of psychoactive drugs and it is important to discriminate between the different types. In this chapter I shall concentrate on the main medical effects, legal position and social implications of the other drugs that are so often confused with cannabis.

Amphetamines

These are stimulant drugs usually taken orally and known to the ' public at pep pills. Well-known amphetamines are Benzedrine, Dexedrine, Methedrine, Durophet, the once famous purple hearts, french blues and many others. Amphetamines increase energy and confidenct, and induce a feeling of well-being. The really important fact about these drugs is that the user rapidly develops what is known as tolerance so that the pills have to be taken in ever increasing quantities to get the same effect. So there are cases when boys and girls have taken a hundred or more pills in an evening. A hundred tablets of almost anything — even sweets — would put quite a strain on the system. Connell (1958) first drew attention to the dangers of' amphetamine psychosis', a mental condition caused by excessive use of these pills and said to be clinically similar to paranoid schizophrenia.

Possession of amphetamines is illegal except for those who have prescriptions and offenders may receive prison sentences of up to two years. There were 1,685 convictions for misuse of amphetamines in the first six months of 1969.

Although these are dangerous drugs, their use has increased year by year. Many young people take them only at week-ends to help them stay awake at all-night parties. When the idea of staying up all night loses its charm these drugs become less Useful, and eventually most people stop using them altogether as they get older, marry, and settle down.

But it is not just a teenage problem. These pills are used extensively by adults, especially women, to relieve depression or fatigue, and to help them lose weight. You may remember the song by the Rolling Stones about mother's little helper'. In fact the amphetamines are one of the most widely used drugs in medical practice. Over the last three years there were over eight million prescriptions — about one in fifty of the total number of all National Health Service prescriptions.

In March 1970 the Government Advisory Committee on Drug Dependence produced a report on amphetamines and blamed over-prescribing by doctors for the increased use of pep pills. Most of their recommendations were incorporated into the new Misuse of Drugs Bill, and it is expected that amphetamines will be much more strictly controlled in future. Many physicians feel that the use of amphetamines can no longer be justified because there are less harmful substitutes. But a family doctor who has been prescribing amphetamines to a patient who is now dependent on them is going to have a hard time explaining why he must now stop taking them.

Although most of the amphetamines being taken are obtained quite legally on the Health Service, there is also a black market in amphetamines which are stolen from manufacturers and chemists, and there is a certain amount of smuggling of pills made overseas. It is possible for a person to be found guilty of a drug offence for possessing pills which he bought quite legally in a foreign country.

In 1967-8 there was a marked increase in the amount of liquid methedrine, which was injected with a syringe, but supplies have now been reduced as a result of an agreement between the medical profession, the manufacturers and the Department of Health, limiting supplies of this drug to hospitals.

Cocaine is not an amphetamine but it is a powerful stimulant drug which leads to very strong psychic dependence. It is very ' Uncommon for cocaine to be taken alone and it is most often used ., by heroin addicts.

Barbiturates

These are sleeping pills which can produce a dependence similar to ' that of alcohol. Someone who is intoxicated by barbiturates , becomes drowsy and confused, unable to think clearly, or co-ordinate his muscular action, until he reaches the point of collapse — :just like a drunk. His emotional control is unstable and his attitude is sometimes hostile. A person even mildly under the effects of barbiturates is a great safety hazard when driving. They are fre' quently used to commit suicide and there are also many accidental deaths due to taking an overdose by mistake because of the confused state of the barbiturate taker. Deaths from barbiturates by suicide have risen from 515 in 1956 to 1,490 in 1966, and deaths ' from these drugs by accident have risen in these years from 140 to 525 (Glatt, 1967). But there is hardly any illegal traffic in barbiturates because general practitioners prescribe it very freely and legal supplies are plentiful. Last year there were over fifteen milion prescriptions for barbiturates. Barbiturates are listed as a poison and may be sold only by a registered pharmacist against prescription. It is not an offence to be in possession of this drug, nor is it included in the new Misuse of Drugs Bill, although some addicfs inject barbiturates intravenously.

This is an example of a highly dangerous drug which has already become socially acceptable. It is used by the older section of the population more extensively than any drug is used by younger people. Although a large number of people use it without medical supervision, we must recognize that it helps many old people to cope with anxiety, and its control is a matter for the medical profession, not the law.

Another depressant drug which is becoming a problem is Mandrax.1 On the drug scene a few people claim that a combination of Mandrax and alcohol can give an effect similar to LSD. But there have been many accidental deaths and suicides using this drug. The difficulty is that Mandrax poisoning looks like barbiturate poisoning, but the antidote for the latter (use of stomach pump, etc.) may be fatal if given to someone who has taken an overdose of Mancirax.

Amphetamine/barbiturate compounds (e.g. Drinamyil and many others) are very popular because they produce more euphoria and less anxiety than amphetamines taken alone, but these compounds produce many of the ill-effects of barbiturates taken on their own. Tranquillizers (e.g. Largactril, Librium) are widely used in everyday life to calm and reduce anxiety. These are not often misused. But with the possible exception of alcohol, more people are dependent on barbiturates than upon any other drug.

LSD-25

Lysergic acid diethylamide is a colourless, odourless substance which is taken orally, usually in a pill, sometimes on blotting paper or in sugar. It is a derivative of ergot, a rye fungus, and was discovered by Albert Hofmann, a Swiss chemist, who accidentally took some of this compound and experienced heightened awareness and weird distortions of colour and sound. LSD is known to pharmacologists as a hallucinogen and to users as 'acid'.

It has been used in psychiatric practice for the treatment of some types of mental illness, but only a few doctors now use this drug for therapy in this country. In recent years it has been taken illicitly by non-conformists of all kinds including some talented writers, painters and musicians. The effect of LSD is to produce profound emotional reactions; for example, intense beauty mingled with intense horror. Timothy Leary (1964) describes the effects of LSD as ecstasy, sensual unfolding, religious experience, revelation, and contact with nature. These vivid hallucinations can precipitate ; severe mental disorders. There are several horror stories about people under the influence of LSD who have jumped out of windows because they think they can fly; but the number of _ extreme psychotic reactions may well be exaggerated.

There is considerable controversy about the ways in which L SD may damage chromosomes of living cells and even embryos in the course of development. Despite a fair amount of research and animal experiments, the evidence is not conclusive.

Unauthorized possession of L SD is now a criminal offence - under the 1964 Act, and the new legislation proposes an increase of the maximum penalty from two to seven years. This drug is relatively easy to synthesize, but the raw material is difficult to obtain. Police raids confirm that it is manufactured illegally in this country, but users say the local product is often impure and prefer LSD smuggled in from the United States. It will be almost impossible to stop smuggling. Only very small amounts are needed for each trip; it is light and compact and easy to transport. Furthermore, new hallucinogens are being produced and distributed and some of these are more powerful than LSD. It is quite likely that the sellers of hallucinogens will always be able to keep one step ahead of the law.

The difficulty with LSD is that it produces such variable reactions. Even regular users occasionally have ,bad trips. It may be possible some time in the future to isolate the factors that pro--duce these fearful reactions in particular people, and in regular users in particular circumstances. Until more is known about these severe reactions, leading in some cases to psychoses, this drug must be treated with caution.

Opiates

These drugs are derived from the opium poppy. In 1806 morphine was first extracted from opium and in 1898 heroin was made from morphine. These are the so-called hard drugs, described as junk and the users as junkies. These drugs are nearly always injected with a syringe, either intravenously into the blood stream ('main line') or subcutaneously (' skin popping').

The opiates are depressant drugs, still widely used to kill pain. Repeated use leads to psychic and physical dependence with unpleasant symptoms on withdrawal and a marked development of tolerance so that a continually increasing dosage is required to obtain the same effect. At first the effects of heroin are relaxation and a pleasant state of stupor, but to those who are dependent on the drug, the next fix merely banishes the terrors of withdrawal. At this stage the junkie no longer takes the drug for pleasure but as a necessity to avoid becoming physically ill. There is a high relapse rate after treatment and heroin is also physically dangerous because most users suffer from ill-health and some die from pneumonia, malnutrition, liver disease and infection due to dirty syringes.

The Dangerous Drugs Act of 1967 provides for the official notification to the Home Office of all users of heroin and other opiates. This Act also restricted the prescription of heroin to licensed doctors working through treatment centres attached to hospitals. So far these places have not got much beyond acting as containment centres and they appear to have had little success as treatment centres.

Since the restriction of prescription to licensed doctors, serious over-prescription has been avoided, supplies of illicit heroin have decreased and the price has increased considerably. Only a small amount of heroin is smuggled into the country, but it is possible to get powdered heroin (Chinese heroin) in some quarters. The heroin user frequently gets drawn into a junkie group until obtaining the drug and all that goes with it becomes his only interest and his way of life.

By now it will be clear that heroin is the addictive drug that you have read about, seen on TV and in the cinema. The junkie is the stereotype for all drug users. When people talk generally about drugs, the picture that immediately comes to mind is that dirty ill-kempt junkie living and sleeping rough with other junkies. But it is important to note that the actual number of heroin users is still small. Although the medical and social effects of heroin dependence are obviously very severe, there were less than 500 heroin addicts2 known to the Home Office in 1969. The importance of heroin dependence has been exaggerated out of proportion to the actual numbers involved, and the attitude to other drugs and drug users has been distorted by this. Even people who now know that there is a vast difference between the effects of heroin and the effects of the other drugs still seem to regard the so-called soft drugs with the same fear as the hard drugs and speak as if all the young people in this country are in danger of becoming heroin addicts.

The last of the five main groups of drugs is, of course, cannabis. This will be considered in detail in the next two chapters when it will be possible to compare cannabis with the drugs noted in this chapter. A summary of the use, effects and illicit sources of all five groups of drugs is given on the next page.

1. Mandrax is not strictly a barbiturate; it contains methaqualone combined with an antihistamine, diphenhydramlne hydrochloride.

2. In 1969 the total number of all narcotic drug addicts was 1,466, of which 499 were receiving heroin (either alone or in combination with other drugs) and 716 were receiving methadone; a further 251 (whose addiction is of therapeutic origin) were receiving morphine or pethidine.