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.