No college 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 an 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 that would cause me to scribble in its margins--a thing I do habitually even over trifling errors.
Since 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 I--since it really isn't a unique contribution to the therapeutic
armamentarium. Maybe we got ourselves into this mess because of sloppy thinking
The 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 wrong--the 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 non-barbiturate 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.
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!
The 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 drug.
In 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.
Finally, 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.
COMMENT ON DRUG USAGE: THEY RE WET
BEHIND THE EARS.
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.
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.