Drug Use and Classification
Question 1: What are some of the earliest known human uses of
psychoactive drugs?
Answer 1: It is thought that humans have used psychoactive drugs for tens
of thousands of years. Plants such as poppies, coca, and cannabis were
available near populated areas and most likely were sampled by humans.
Drugs may have been used in early societies for medicinal, recreational, and
religious purposes. In some societies, religious leaders guarded their
knowledge of the healing properties of different plants. The hallucinogenic
properties of certain plants were used as part of a shaman’s rituals and
religious ceremonies. In the early Middle Ages, Viking warriors were known to
consume a mushroom, Amanita muscaria, before battle because it increased
their energy and produced violent, reckless behavior (Levinthal, 2008).
Question 2: What were the attitudes towards drugs in the United States
during the 1800s?
Answer 2: Drugs were not regulated, for the most part, until the end of the
1800s and early 1900s. The medical profession introduced a number of new
medical drugs during the 19th century, such as morphine (the active
ingredient in opium) and cocaine, which became widely used in Europe and
North America. Cocaine, derived from the coca plant, was initially used as an
anesthetic and was recommended as a “magical drug” by Sigmund Freud in
1884 (Levinthal, 2008). Medicines were not regulated during this time, and
remedies containing opium, alcohol, and cocaine were sold by disreputable
snake-oil salesmen as cures for every ill. Opium was inexpensive and easily
obtained. Unlike the image of the typical drug user today, the typical users of
morphine and laudanum, another opium derivative, were middle-class
women. By 1900, it is estimated that between 5–10% of Americans abused
drugs (Whitebread, 1996). As the dangers of addiction and drug abuse
became more apparent toward the end of the century, there were increasing
efforts to restrict the sale and use of drugs.
Question 3: How do psychoactive drugs affect health?
Answer 3: There is such a wide range of types of drugs that can be included
within the category of psychoactive drugs that it is difficult to answer this
question. The effects of psychoactive drugs on health depend upon the nature
and form of the drug and the way in which the drug is being used. Many
psychoactive drugs have medicinal uses, such as lithium’s use as a mood
stabilizer for individuals who have bipolar disorder, but many psychoactive
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Drug Use and Classification
drugs also have potential to be abused. Psychoactive drugs alter brain
chemistry and can produce changes throughout the body. For example, the
coca plant, from which cocaine is produced, has been used in traditional
medicines in South American countries for many centuries, relieving
stomachaches, headaches, or altitude sickness, among other ills (Levinthal,
2008). Cocaine was initially used as an anesthetic and has additional
medicinal uses today (McKim, 2003). Cocaine blocks the reuptake of
dopamine, a neurotransmitter within the brain, and increases heart rate and
blood pressure (McKim, 2003). Abuse of cocaine can result in liver damage,
psychosis, blurred vision, heart damage, and antisocial behavior, among
other health problems.
One can divide health problems caused by drugs into chronic health problems
(such as long-term liver damage), deaths due to the drug’s effects on
judgment and risk-taking behavior, and the social consequences of drug use
(World Health Organization, 2004). Alcohol and nicotine, both of which are
legal drugs, account for the most chronic health problems and deaths caused
by drugs in the United States (Robinson 2005). In 2000, tobacco use and
alcohol use were the first and third leading causes of death in the U.S.
Tobacco was estimated to have caused 435,000 deaths, and alcohol
consumption was estimated to have caused 85,000 deaths (Mokdad, James,
Stroup, & Gerberding, 2004). Illicit drug use was believed to have been the
cause of 17,000 total deaths in 2000 (Mokdad et al., 2004). In most cases,
deaths related to illicit drugs occur when multiple drugs have been ingested
(Levinthal, 2008).
Question 4: How many people use illicit drugs?
Answer 4: Worldwide, it is estimated that about 200 million people use some
form of illicit drug. The most commonly used illicit drug worldwide is by far
cannabis (marijuana), followed by amphetamines, cocaine, and opiates
(World Health Organization, 2004).
In the United States, a 2003 study found that about 7.1% of Americans aged
12 and older had reported using an illicit drug in the past 30 days, 12%
reported illicit drug use in the past year, and 41% reported illicit drug use
during their lifetime (Drug Data, 2003).
Question 5: What are club drugs?
Answer 5: The term club drugs refers to illicit drugs typically used at dance
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Drug Use and Classification
parties, clubs, and bars (Levinthal, 2008). MDMA/ecstasy
(methylenedioxymethamphetamine), rohypnol (flunitrazepam), GHB (gamma
hydroxybutyrate), and ketamine (ketamine hydrochloride) are the most
commonly known club drugs (InfoFacts, 2006). These drugs can carry health
risks, especially when used in combination with alcohol. Rophynol and GHB,
which are odorless and colorless, can be slipped into the drinks of
unsuspecting individuals and used for the commission of sexual assaults
(Levinthal, 2008). MDMA can interfere with the body’s regulation of
temperature and result in kidney, liver, and cardiovascular failure (InfoFacts,
2006). Ketamine, an animal tranquilizer, can produce hallucinations and
induce heart rate abnormalities and respiratory depression (InfoFacts, 2006).
Under the federal Controlled Substances Act, MDMA and GHB are Schedule I
drugs, Rophynol is a Schedule IV drug, and ketamine is a Schedule III drug
(InfoFacts, 2006).
Question 6: How does the Federal Government decide to categorize drugs
for the Controlled Substances Act?
Answer 6: Under the Controlled Substances Act, Title II of the
Comprehensive Drug Abuse Prevention and Control Act of 1970, the Federal
Government classifies drugs into five categories, which it calls schedules. The
main factors that the Federal Government uses for these classifications are
potential for abuse and accepted medical uses (Robinson, 2005). The Drug
Enforcement Agency evaluates medical and scientific data on drugs and may
initiate hearings to add, delete, or change the scheduling of a drug.
In deciding whether a drug has a potential for abuse, the DEA evaluates
whether the drug presents a significant health risk and if the drug is being
used outside of medical or other legitimate drug channels (The Controlled
Substances Act, 2006). The historical and current patterns of use as well as
information on the pharmacological effects and medical uses of the drug are
considered. Even in some cases, such as with marijuana where the drug has
been used for medicinal purposes, the DEA will look closely at whether these
medical uses are accepted within the scientific community (Robinson, 2005).
Drugs that are considered to have the highest potential for abuse and no
accepted medical uses, such as heroin, LSD, and marijuana, are placed within
Schedule I and have the most limitations placed on their possession and
distribution. Drugs that have high potential for abuse but some accepted
medical uses are placed in Schedule II. These Schedule II drugs, such as
cocaine, morphine, and methamphetamine, can be used but are subject to
severe restrictions. Schedule III drugs have some potential for abuse,
accepted medical uses, and may be prescribed with some restrictions.
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Drug Use and Classification
Examples of Schedule III drugs are barbiturates, codeine, and anabolic
steroids. Valium and alprazolam are examples of Schedule IV drugs that have
lower potential for abuse than Schedule II and may be used for medical
treatment with prescription. Schedule V drugs are considered to have low
potential for abuse and accepted medical use for treatment. Over-the-counter
cough medicines with codeine are Schedule V (Robinson, 2005).
Question 7: What does it mean to describe a drug’s potency and
effectiveness?
Answer 7: A drug’s potency and effectiveness are two different qualities. A
drug’s potency is the amount of the drug that is needed to produce its effect.
If it only takes 5 milligrams of drug A to produce its effect, but it takes 10
milligrams of drug B to produce an effect, one would say that drug A is twice
as potent as drug B. The lower the amount of a drug that is needed to
produce its effect, the more potent that drug is considered (McKim, 2003).
In contrast, effectiveness refers to the differences in the maximum effect that
a drug produces at any dose. For example, both aspirin and morphine are
painkillers, but even the most effective dose of aspirin is still not as effective
as morphine at relieving pain; thus, morphine would be considered the more
effective painkiller (McKim, 2003). Potency and effectiveness are only two of
a number of factors that doctors would consider in prescribing a painkiller.
For example, even though morphine is more effective than aspirin at relieving
pain, morphine is also highly addictive, which would discourage doctors from
prescribing it in many cases.
Question 8: What is the difference between the primary effect and side
effect of a medication?
Answer 8: One might ask, why not just discuss a drug in terms of all of its
effects, instead of separating it into primary effect, also called main effect,
and side effect? In some cases, the distinction may seem arbitrary. The
primary effect of a drug refers to the effect of the drug on a particular disease
symptom that it is meant to address; thus, the primary effect of an
antipsychotic medication that is prescribed to an individual who has
schizophrenia would be a reduction in psychotic symptoms (McKim, 2003).
The side effect refers to all of the other effects of the medication beyond its
intended effect on the disease symptom (McKim, 2003). The side effects of
an antipsychotic drug might be weight gain, movement problems, or
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Drug Use and Classification
diabetes.
Question 9: What is the difference between pharmacological violence,
systemic violence, and economically compulsive violence?
Answer 9: Even though there is clearly an association between drug use,
violence, and crime, it can be very difficult to assess the exact dimensions of
that association. For example, it can be difficult to distinguish to what extent
illicit drug use causes violent behavior or to what extent people with a
propensity for violent behavior also happen to be more likely to use illicit
drugs. Dividing violence into pharmacological violence, economically
compulsive violence, and systemic violence is one method that William McKim
(2003) uses to examine the association between drugs and violent, criminal
behavior.
Pharmacological violence refers to acts of violence that are committed by a
person who is currently under the influence of a psychoactive drug (Levinthal,
2008). Certain drugs such as crack cocaine may have psychological effects
like increasing aggression and irritability in some people that may contribute
to an increased tendency to commit pharmacological violence.
Economically compulsive violence refers to crimes that are committed by drug
users to obtain money to buy more drugs. Some studies support a link
between property crimes and users of illicit drugs, but the strength of this link
is still not proven (Levinthal, 2008).
Systemic violence refers to the violent behaviors that arise within the criminal
drug distribution organizations (Levinthal, 2008). Systemic violence may
result from disputes over territory or drug quality.
References
Drug data summary. (2003). Retrieved from the Office of National Drug
Control Policy Web site:
http://www.whitehousedrugpolicy.gov/publications/factsht/drugdata/i
ndex.html
Levinthal, C. (2008). Drugs, behavior, and modern society (5th ed.). Boston,
MA: Allyn and Bacon.
McKim, W. (2003). Drugs and behavior: An introduction to behavioral
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Drug Use and Classification
pharmacology (5th ed.). Upper Saddle River, NJ: Prentice Hall.
InfoFacts: Club drugs. (2006). Retrieved from the National Institute on Drug
Abuse Web site:
http://www.whitehousedrugpolicy.gov/drugfact/club/index.html
Mokdad, A. H., James, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual
causes of death in the United States, 2000. Journal of the American
Medical Association, 291(10), 1238–1241.
Robinson, M. (2005). The drug trade and the American criminal justice
system. Boston, MA: Pearson Custom.
The Controlled Substances Act. (2006). Retrieved March 23, 2007, from Drug
Enforcement Administration Web site:
http://www.usdoj.gov/dea/pubs/abuse/1-csa.htm
Whitebread, C. (1996). The history of non-medical drugs in the United States.
Retrieved from
http://www.druglibrary.org/schaffer/History/whiteb1.htm
World Health Organization. (2004). Neuroscience of psychoactive substance
use and dependence. Geneva, Switzerland: Author.
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