Phenmetrazine (Preludin) and Methylphenidate (Ritalin)

The medical indications, patterns of abuse, and adverse effects of phenmetrazine (Preludin) and methylphenidate (Ritalin) compare closely with those of the other stimulants. They have been subject to abuse in countries where freely available, as they are here in localities where medical practitioners write prescriptions on demand. While the abuse of phenmetrazine involves both oral and intravenous use, most of that associated with methylphenidate results from injection after the drug in tablet form is dissolved in water. Complications arising from such use are common since the tablets contain insoluble materials that, upon injection, block small blood vessels and cause serious damage, especially in the lungs and retina of the eye.

Anorectic Drugs

In recent years a number of drugs have been manufactured and marketed to replace amphetamines as appetite suppressants. These so-called anorectic drugs include benzphetamine (Didrex), chlorphentermine (Pre-Sate, and so on), clortermine (Voranil), diethylpropion (Tenuate, Tepanil, and so on), fenfluramine (Pondimin), mazindol (Sanorex), phendimetrazine (Plegine, Bacarate, Melfiat, Statobex, Tanorex, and so on), phentermine (Lonamin, Adipex-P, and so on). They produce many of the effects of the amphetamines, but are generally less potent. Abuse patterns of some of them have not yet been established, but all are controlled because of the similarity of their effects to those of the amphetamines. Fenflurarnine differs somewhat from the others in that at low doses it produces sedation.

HALLUCINOGENS

Hallucinogenic drugs, both natural and synthetic, distort perception of objective reality. They induce a state of excitation of the central nervous system, manifested by alterations of mood, usually euphoric, but sometimes severely depressive. Under the influence of hallucinogens, the pupils dilate and body temperature and blood pressure rise. The senses of direction, distance, and time become disoriented. A user may speak of "seeing" sounds and "hearing" colors. If taken in a large enough dose, the drug produces delusions and visual hallucinations. Occasionally, depersonalization and depression are so severe that suicide is possible. The most common danger is impaired judgment, leading to rash decisions and accidents. Persons in hallucinogenic states should, therefore, be closely supervised and upset as little as possible to keep them from harming themselves and others. Acute anxiety, restlessness, and sleeplessness are common until the drug wears off.

Long after hallucinogens are eliminated from the body, users may experience flashbacks-fragmentary recurrences of psychedelic effects-such as the intensification of a perceived color, the apparent motion of a fixed object, or the mistaking of one object for another. Recurrent use produces tolerance, which tends to encourage resorting to greater amounts. Although no evidence of physical dependence is detectable when the drugs are withdrawn, recurrent use tends to produce psychic dependence, varying according to the drug, the dose, and the individual user. It should be stressed that the hallucinogens are unpredictable in their effects each time they are used.

LSD (LSD-25, Lysergide)

Lysergic acid diethylamide (LSD) is derived from the lysergic acid present in ergot, a fungus that grows on rye. The only legitimate supply of LSD for scientific research is available through the National Institutes of Mental Health, Bethesda, Maryland.

LSD is a tasteless, odorless, colorless liquid in its pure state and is normally taken orally. On the illicit

Figure 7-16.-LSD blotter paper (100 hits per square). 7-30

market it can be found as a tablet, thin squares of gelatin (windowpanes), crystalline powder in various capsules, spots on paper squares (blotter acid) (fig. 716), or in liquid form in ampules. It is often impregnated in sugar cubes, cookies, or crackers and can be put on the back of postage stamps or on letter paper to be eaten by the receiver.

LSD is an extremely potent hallucinogen. One ounce of LSD contains a sufficient amount for about 300,000 doses or LSD experiences. A dose of 50 to 200 micrograms (or a quantity no larger than what may be put on the tip of a pin) would be sufficient for several trips. The average effective oral dose is from 30 to 50 micrograms but the amount of dosage in a unit varies greatly. The effects of higher doses persist for 10 to 12 hours.

LSD primarily affects the central nervous system by producing changes in mood and behavior and may cause central nervous system malfunctions. It may also dilate eye pupils, cause tremor, elevate temperature and blood pressure, and produce hyperactive reflexes in the user. Tolerance to behavioral effects of LSD develops quickly with several days of continued use. As with the other hallucinogens, physical dependence may not occur but minor mental dependence may develop.

Other manifestations of LSD include hallucinations, panic or paranoia, extreme anxiety, mental depression with suicidal thoughts or attempts, and "release" from reality to the point that the user does not know who or what he or she is. These are unpredictable reactions that may not be experienced by all users.