textbook on recreational drugs has come close to Drugs, Society, and Human Behavior. I was fortunate to have this as my textbook back in 1980 for a class interdisciplinary
class on drugs. I came to the class with extensive knowledge of the materials
covered and so was quite qualified to evaluate this textbook. I found scarce
a statement for me to scribble in its margins overa thing I do habitually even over trifling.
then I had checked several library collections and several university bookstores for their holdings and found them well below
the standards of this book. No gap between textbook have I ever observed so wide. This explains its success, 3 editions, 300,000 copies, and used in more than 250 colleges
and universities in the 11 years since its publication in 1972 (I got a second copy from a used bookstore). Professor Oakley Ray has done well, and it is still in print! Oh,
and there is Audio Cassette and Audio CD versions.
I have included two pieces from
the book, reversed their order. The methaqualone section I put first because
the purpose was to expose how drug companies for profits abuse their position. However,
I added as an afterthought, at the bottom the historical introduction on the first downers.
This book is simply good; it is hard for me to stop reading it again.
Methaqualone. My daddy was right: If you miss a streetcar, dont worry, another
one just like it will be along in a little while. That seems also to be true
of drug use crises. Illegal use of methaqualone hit a peak in the early seventies
and then declined. From 1978 to 1979 it increased again and has persisted
into the early 1980s. New generations of drug users have to rediscover the wheel
and see for themselves! In 1980 about 4 tons of methaqualone was made and distributed legally in the United States. One guesstimate was that 100 million tons were smuggled in during that year. And that must not be enough. There may be honor among thieves,
but there is none between an illegal drug producer and those who buy the product: there are an increasing number of tablets
that look like legal methaqualone being sold on the street that contain OTC sedatives!
The legal but unethical distribution of methaqualone is under attack but difficult to stop. Some believe the only step now is
to make the drug Schedule Isince it really isnt a unique contribution to the therapeutic
armamentarium. Maybe we got ourselves into this mess because of sloppy thinking
methaqualone boom should make an interesting case study in future medical textbooks: How skillful public relations and
advertising created a best sellerand helped cause a medical crisis in the process.
The methaqualone story is one where everyone was wrongthe pharmaceutical industry, the FDA, the
DEA, the press, the physicians. No one can say he was without sin. Methaqualone was originally synthesized in India, tested, and found to be ineffective as an anti-malaria
drug. But it was a good sedative, so in 1959 it was introduced as a prescription
drug in Great Britain. It never sold well, but after the thalidomide disaster
there was increased interest in a safe nonbarbiturate sleeping pill. Mandrax,
250 mg methaqualone and 25 mg of an antihistamine, promised to be that when it was introduced in 1965 in a massive advertising
campaign to physicians. The campaign worked, and there were 2 million prescriptions
issued for Mandrax in 1971 in Great Britain. Even before that the drug had
found its way into the street where it was widely abused: by heroin users, by high school students, by anyone who wanted a
cheap but potent down. Misuse was so great by 1968 that Great Britain tightened
controls on it in 1979 and then again in 1973. After that the methaqualone problems
subsided as other drugs came to prominence.
Germany introduced methaqualone
in 1960 as a nonprescription drug, had its first methaqualone suicide in 1962, and discovered that 10% to 22% of the drug
overdoses treated in this period were a result of this drug. In 1963 Germany
reduced the problem by making methaqualone a prescription drug. In this 1960-1964
period Japan experienced a major epidemic of methaqualone abuse, causing over 40% of all overdoses admitted to mental hospitals. Japan tightened controls almost to the maximum possible on methaqualone and stemmed
the tide. This happened even though they never took the final step of making
it a prescription drug!
same kinds of incidents followed around the world. By 1965 both Germany and Japan
had experienced some very traumatic times with methaqualone. In 1965,
after 3 years of testing, Quaalude and Sopors, brand names for methaqualone, were introduced in the United States as prescription
drugs with the package insert, Addiction potential not established. Methaqualone was not a scheduled drug: there
were no monitoring rules or restrictions on the number of times the prescription could be refilled. In June 1966, the FDA Committee on the Abuse Potential of Drugs decided that there was no need to
monitor methaqualone, since there was no evidence of abuse potential! Thus, from 1967 to 1973, the package insert read, Physical
dependence has not clearly been demonstrated, although by 1969 the evidence was very clear that methaqualone was an addicting
the early 1970s in this country, ludes and sopors (from Quaaludes and Sopors) were familiar terms in the
drug culture and in drug treatment centers. Physicians were over prescribing
what they believed to be a drug that was safer than the barbiturates as well as nonaddicting. Most of the methaqualone sold on the street was legally manufactured and then either stolen or
obtained through prescriptions. At any rate, sales zoomed, and front-page reporting
of its effects when misused helped build it as a drug of abuse.
8 years after it was introduced into this country, 4 years after American scientists were saying it was addicting, 11
years after the first suicide, methaqualone was put on Schedule II October 4, 1973: quite a jump from not being scheduled
to Schedule II. Really stupid. Maybe
someday someone will write a more comprehensive report on this tale of bureaucratic boondoggling, but the one published
in 1975 by the Drug Abuse Council93 suffices for now.
Addiction can develop to methaqualone as easily and rapidly as with the other barbiturates. The high or down you get with methaqualone is very similar to that obtained with all
other sedative-hypnotics. There is, possibly, one difference: loss of motor coordination
seems to be greater with this drug; the resulting loss of control, including walking into walls, is why one of the slang
terms for methaqualone is wallbanger. Methaqualone has had a better press than the other drugs in this class, and it was called
heroin for lovers, an aphrodisiac. Hardly.
As the director of Clinical Activities of the Haight-Ashbury Clinic said in 1973:
What a drug to take. It has all the possible
disadvantages a drug can have. Its a garbage drug, a real drug of abuse.
As mentioned at the beginning of this chapter, Sedatives and hypnotics are both depressants of the central nervous system,
but in one case the intention is to relieve anxiety or restlessness and in the other it is to induce sleep. Many
drugs may therefore be used in either capacity, depending upon the dose and the time of day that they are given.~ The most
widely used drug in this general category is alcohol. The second most commonly
used depressant drugs are the barbiturates.
There are three CNS depressants with a longer history than
the barbiturates that are rarely prescribed today. Chloral hydrate and paraldehyde
have chemical and pharmacological characteristics much like alcohol, while the bromides are different.
Chloral hydrate was synthesized in 1832 but was not used clinically
until about 1870. It is rapidly metabolized to trichioroethanol, which is the
active hypnotic agent. When taken orally, chloral hydrate has a short onset period
(30 minutes), and 1 to 2 g will induce sleep in less than an hour. This agent
does not cause as much depression of the respiratory and cardiovascular systems as a comparable dose of the barbiturates
and has fewer aftereffects.
1869 Dr. Benjamine Richardson introduced chloral hydrate to Great Britain. Ten years later he called it in one sense a beneficient,
and in another sense a maleficient substance, I almost feel a regret that I took any part whatever in the introduction of
the agent into the practice of healing. He had learned that what man can misuse,
some men will abuse. As early as 1871 he referred to its non-therapeutic use
as toxical luxury and lamented that chloral hydrate addicts had to be added to alcohol intemperants and opium-eaters.88
Chloral hydrate addiction is a tough way to go, since its major disadvantage is that it is a gastric irritant, and repeated
use causes considerable stomach upset. A solution of chloral hydrate was used before 1900 as the famous knockout drops
or Mickey Finna few drops in a sailors drink, and before he woke up, he was shanghaied onto a boat at sea for a long trip
to the Orient.
such use ever occurred with paraldehyde, which was synthesized in 1829 and introduced clinically in 1882. Paraldehyde would probably be in great use today because of its effectiveness as a CNS depressant with
little respiratory depression and a wide safety margin, except for one characteristic.
It has a most noxious taste and odor that permeates the breath of the user.
bromides are little used today, now that they have been removed from OTC sleep preparations.
Bromides accumulate in the body, and the depression they cause builds up over several days of regular use. There are serious toxic effects with repeated hypnotic doses of these agents. Dermatitis and constipation are minor accompaniments; with increased intake, motor
disturbances, delirium, and psychosis develop.
ON DRUG USAGE: THEY RE WET BEHIND THE EARS.
A standard criticism of drug researchers who bioassay drugs is that they lose their objectivity. That should be made of people of faith who translate works of their faith, of archaeologists
who interpret finds, and of historians. Only with science there is a long tradition
of self-experimentation. And usage of the drug, rather than being a hindrance
(it can be if they have gotten caught up in its culture), can be quite insightful.
I have observed
that the usage of stimulants (coke and amphetamines) rather has a short-term pleasurable dimension; it also has an equally
compelling long-term vector; namely, the relief and prevention of boredom. In
fact I have observed that repeated usage of small amounts would produce this effect with producing the deleterious behavioral
consequences. I have known a number of people to use amphetamines in moderation
for yearssupposedly for weight control.