Chapter 11One of the ways that governments attempt to control drugs is to require medical prescriptionsfor their purchase and distribution.Most pharmaceutical drugs—roughly 8 out of 10—have no psychoactive effect whatsoever;they are prescribed exclusively to treat bodily ailments such as heartburn, highblood pressure, high blood sugar, and asthma.All brand-name drugs decline in sales after their peak in popularity, and for severalreasons. The fi rst is that the patent held by the pharmaceutical company that initiallymarkets a prescription drug is valid for only 20 years from the time of fi ling, and it maytake as many as 10 years for the drug to reach the market.A second reason nearly all psychoactive prescription drugs decline in popularity overthe long run is that physicians become aware of some of their undesirable side effectsand search for less toxic substances.Sedative-Hypnotics- An Introduction-Some of us are often too anxious and agitated to be capable of properly functioning;some of us are even too troubled to fall asleep at night. Sedatives or sedativehypnoticsare downers or general depressants; they retard, dull, or obtund signalspassing through the central nervous system.-The sedative-tranquilizer-hypnotic dimension isa spectrum or continuum; the precise point along this dimension that defi nes asubstance’s action is determined by the dose taken rather than the specifi c drug used.-In the 1600s, a chemist dissolved opium powder in alcohol, thereby inventing laudanum;a 10 percent solution seemed to be about the right mixture to produce in mostpatients a sleep-inducing effect without causing serious damage. In mixing up this concoction,chemists had devised a narcotic to serve as a sleep aid. However, laudanum’ssoporifi c properties also brought on, in some patients, addiction, along with night terrors.-In the 1840s, chemistsdiscovered the calming effect of potassium bromide, and the drug became popular forseveral generations. However, the side effects of this substance included depression,discoordination, lethargy, a loss of concentration and memory, tremors, and, sometimes,delirium and heart ailments.-In the 1860s, a German chemist discovered, and published a scientifi c paper on, thesedative properties of a recently developed substance named chloral hydrate. It immediatelyfound its way into clinical medicine for this very purpose, being touted as the only“safe” hypnotic-sedative. But soon after it was introduced as a pharmaceutical, patientsbegan experiencing undesirable side effects: slurred speech, confusion, vomiting, an involuntaryloss of consciousness, amnesia, anesthesia, sometimes convulsions, even coma.-Recreational use soon became fashionable among poets, writers,and painters; apparently, some daring, risk-taking, adventurous members of the avantgardeenjoyed that hazy, luminous, twilight state that the substance induced. Criminalsand other shady characters discovered that chloral hydrate, when introduced into an alcoholicdrink, served well as a “knockout drop”; thus, the “Mickey Finn” was born.BarbituratesBarbiturates are defined as central nervous system depressants that are derived frombarbituric acid. Barbital, the fi rst barbiturate, was marketed under the brand name Veronal.After Veronal was commercially introduced in 1903, the medical use of chloral hydrate,the sedative supreme with the many distressing side effects, shrank into near-oblivion.Barbiturates are classified according to the speed of their action. The ultra-shortactingbarbiturates include Brevital, Surital, and pentothal (“truth serum”). They areadministered IV and produce unconsciousness and anesthesia within a minute, and theireffects last two or three hours.The short- and intermediate acting barbiturates are used for sedation and as sleep aids; they include Tuinal (known on the street as “tooies,” “rainbows,” or “Christmas trees”), Seconal or secobarbital(“sekkies,” “seggies,” “reds,” or “red devils”), Nembutal (“yellow jackets,” “nimmies,” or“nimbies”), Fiorinal, and Amyta or amobarbital (“ammies”). The long-acting barbituratesinclude Luminal (or phenobarbital) and mephobarbital (Mebaral); they are used asanti-anxiety agents as well as anti-epileptic drugs, do not produce a high, are rarely usedrecreationally, and need not be discussed here.Except as sedatives, barbiturateshave been replaced by the benzodiazpam drugs, which physicians regard as much safer. In terms of their effects, the barbiturates are remarkably like alcohol; alcohol issometimes referred to by pharmacologists as a “liquid barbiturate.”It ispossible to die of barbiturate withdrawal, whereas death from withdrawal from the narcoticsis quite rare.Methaqualone Aka- Quaˉaˉlude Was developed as a nonaddicting alternativeto barbiturates; at fi rst, scientists and physicians thought the drug was not habitforming and produced no ataxia (discoordination) or mental clouding and no overdoses.Alas, the doses whose effects researchers originally observed were unrealisticallysmall; at larger doses, the same harmful side effects as with barbiturates appeared. Infact, in the 1970s, the press seized upon methaqualone partly as a result of its alleged“sex drug” properties and partly because of a few much-ballyhooed overdoses, and soit became the most notorious drug of the 1970s. Methaqualone is currently consideredso problematic that it is never prescribed; even its recreational use has fallen intosemioblivion.BenzodiazepinesThe benzodiazepines are the Valium-type “tranquilizers.” Initially released in 1963,between 1969 and 1982, Valium was the most frequently prescribed drug in America.The benzodiazepines remain extremely popular, with more than a half-dozen representativeson the list of the top 200 pharmaceuticals.AntipsychoticsIn the mid-1950s, more than half a million patients were institutionalized in mentalhospitals; with the development of antipsychotics (the fi rst was Thorazine), residencein these institutions is now at an “irreducible minimum”—a small number ofpatients who cannot be released into the community. Most outpatients take one or moreof the anti-schizophrenic agents, which allows them to live in the community withoutmajor disruption. The antipsychotics are not addictive (they do not cause withdrawalsymptoms), and it’s impossible to overdose on them. But antipsychotics do cause sideeffects, including diminished mental capacity,
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