Newsgroups: alt.drugs
From: an13187@anon.penet.fi (H-Man)
Subject:  mdma article #10 (final)
Message-ID: <1993Jul4.032822.25782@fuug.fi>
Date: Sat, 3 Jul 1993 17:53:19 GMT

                            JAMA(R) 1988; 260: 1791
 
                    September 23, 1988 / September 30, 1988
 
SECTION: BOOKS
 
LENGTH: 500 words
 
TITLE: Designer Drugs, By M. M. Kirsch, 176 pp. $ 7.95, Minneapolis, CompCare
Publications, 1986.
 
AUTHOR: Peter L. Putnam, MD, MPH, Washington, DC
 
ED/SECT: Edited by Harriet S. Meyer, MD, Contributing Editor; adviser for
software, Robert Hogan, MD, San Diego.
 
TEXT:
   Designer drugs, like designer clothes, are produced to sell.  They are
created and marketed to a clientele of growing size that is looking for an ever
more varied or specific experience in a recreational drug.  The designer
drug is usually a variation on a previously controlled substance.
 
   These drugs, which are manufactured by altering the chemical structure of
narcotics, stimulants, or other recreational drugs, produce similar effects.
Often, as in the case of " Ecstasy, " the effect is preferred to that of the
original drug.
 
   Crack has been successfully marketed because its use replaces free-basing
in convenient form.  It is easily produced from cocaine with little
equipment. Similarly, phencyclidine (PCP) can be produced in almost any home
or garage laboratory by anyone who is willing and able to follow a simple
cookbook. 
 
   Synthetic narcotics many times as potent as natural narcotics can be
produced by a chemist who has a little skill and ingenuity.  This book, in
fact, describes one such chemist who apparently grew tired of working for
the salary he received from a large chemical company.
 
   It is clear that the drugs described, such as "Ectasy," "crack," "dust,"
"china white," and MPTP (methylphenyltetrahydropyridine), represent a serious
health menace -- some because of the unknown potency and ease of overdose (such
as the fentanyl derivatives), some because of the inherent quality of the drug
itself (such as PCP), and others because of poor manufacturing techniques (such
as the fenantyl derivatives) that produce toxic analogues.
 
   The book uses generous excerpts from a variety of sources, including the
producers, distributors, users, and law enforcement officers.  Even though
there are vivid descriptions of the risks involved in the use of such drugs,
it will come as no surprise to the reader that there is convincing evidence
in this book that the manufacture, distribution, and sales of these drugs
are a well-established business worth billions of dollars.
 
   This business has grown despite all attempts at federal and local
interdiction.  It is not surprising, therefore, that the authors have
concluded that the way to stop the drug trade is not by increased police and
military action to halt manufacture and distribution but by means that will
reduce the demand.  The book goes so far as to suggest that the most important
thing that prohibition has done has been to increase the price and profit in
the drug trade.  The focus of intervention would be on increasing a sense of
individual responsibility and public awareness of the risks involved in drug
use.
 
   This is not a clinical handbook and is of little value in the recognition
and treatment of chemical dependence.  It is of significance in that it might
promote a rational debate about the issues.  Certainly on these issues, as
physicians, we should be part of an informed electorate.  It is quite clear
that the rhetoric of our representatives is often more emotional than
rational.
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