BARBITURATES

OFFICIAL NAMES: Methohexital (Brevital), thiamylal (Surital), thiopental (Pentothal), pentobarbital (Nembutal), secobarbital (Seconal), amobarbital (Amytal), bubalbital (Florinal, Fioricet), butabarbital (Butisol), talbutal (Lotusate), aprobarbital (Alurate), amobarbital and secobarbital (Tuinal), phenobarbital (Luminal), mephobarbital (Mebaral)

STREET NAMES: Barbs, downers, red devils, Mexican reds, red birds, blue devils, blue heavens, goof balls, yellow jackets, block busters, reds, blues, pinks, Christmas trees, Amys, rainbows, purple hearts

DRUG CLASSIFICATIONS: Schedule II, III, IV; depressant

OVERVIEW

Barbiturates are among the drugs classified as central nervous system (CNS) depressants. These drugs depress or slow down the activity of nerves that control emotions and bodily functions such as breathing. Barbiturates are prescribed as a sedative that calms the patient or as a hypnotic that helps a person sleep. Other uses include epilepsy treatment and anesthesia before surgery.

Barbiturates are compounds derived from barbituric acid, a substance discovered in 1863 by German chemist Adolf von Baeyer. The year after von Baeyer's discovery, German scientists von Mering and Fischer synthesized the first barbiturate. Production began on the drug called barbital, and medical practices began using it in treatment in 1882.

In 1903, barbital with the brand name of Veronal was marketed as a sleeping pill. Before that time, remedies for insomnia included drinking alcohol or taking bromides, chloral hydrate, or opiates.

In 1912, phenobarbital was introduced under the trade name Luminal. Since 1912, several thousand barbituric acid derivatives have been synthesized. At the beginning of the twenty-first century, only about 12 were on the market.

During the 1930s, many Americans received barbiturate prescriptions to help them sleep or relax. However, people discovered that barbiturates produced an intoxicating effect similar to that produced by drinking alcohol. People took barbiturates to get drunk. They combined the pills with alcohol to become more intoxicated.

The sedative becomes a "thrill pill"

German chemists knew in the 1900s that barbiturates could be addictive. However, people who took barbiturates did not always exhibit symptoms of drug dependence or withdrawal. By the 1940s, the addictive nature of barbiturates alarmed groups ranging from the American Medical Association (AMA) to the United States Food and Drug Administration (FDA).

The 1938 Food, Drug, and Cosmetic Act gave regulatory powers to the FDA. The federal agency used those powers to restrict access to drugs that had a potential for abuse or misuse. The FDA placed barbiturates and amphetamines in that category of drugs that could only be obtained with a prescription from a doctor or dentist. In several decades, the federal government would classify barbiturates and amphetamines as the most abused prescription drugs in the country.

During the 1940s, research indicated that barbiturates produced intoxication and were addictive. People showed signs of withdrawal when they stopped taking barbiturates.

The AMA began warning people about barbiturate abuse in articles with titles like "1,250,000 Doses A Year." That article appeared in a 1942 issue of Hygeia, an AMA magazine published for a general audience.

Warnings about the dangers of nonprescription use of barbiturates did not have the intended effect. Instead of taking precautions about barbiturates, people wanted to try the drug that some called a "thrill pill."

A popular drug combination

The barbiturate became one half of a polydrug habit that became acceptable throughout America. People took barbiturates to sleep at night. In the morning, the barbiturate might make them feel sleepy, so they took an amphetamine.

Amphetamines are central nervous system stimulants. People called them "uppers" because amphetamines gave them energy. Amphetamines cut a person's appetite, so people also used them as diet pills. In the evening a person still "up" from an amphetamine took a "downer" (barbiturate) to sleep at night. In the morning, the drug-taking cycle would start again.

Polydrug use was so widespread by the 1950s that the federal government classified barbiturates and amphetamines as the most abused drugs in the country. The abuse problem grew even though barbiturates were prescription drugs.

Prescription abuse

The FDA discovered the scope of the abuse problem after a 1948 Supreme Court ruling gave the agency the authority to investigate drug sales at the pharmacy level. According to an FDA report, barbiturate transactions included:

• A prescription refilled 61 times, with three refills after the patient died from barbiturate intoxication.
• A Kansas City woman obtained 40 refills for a prescription. Her doctor prescribed refills. Other refills came by mail order. The woman died from barbiturate intoxication.
• The staff at a Tennessee drug store could not explain what happened to more than 180,000 barbiturates sent to the store by manufacturers and wholesalers.

According to the FDA report, enforcement action during the 1940s and 1950s centered primarily on pharmacies. Those involved in the illegal sales of barbiturates included pharmacists as well as drug store owners and employees.

As pharmacies complied with the law, the FDA targeted black market sales of barbiturates from 1960 through 1965. Meanwhile, a new generation discovered barbiturates.

Drug use during the 1960s

During the 1960s, youths began to experiment with drugs on a wider scope. Middle-class and upper-class youths discovered that it was easy to obtain barbiturates; they often found them in their parents' medicine chests.

A United States Senate Subcommittee heard about the severity of the problem from a Dr. Sidney Cohen. He said that 10 billion barbiturate doses would be produced in 1969. That figure represented an 800% increase in the amount produced in 1942, according to the 1972 Consumers Union Report on Licit and Illicit Drugs.

The 1970s bring restricted access to barbiturates

According to the FDA, barbiturate abuse continued during the 1970s and 1980s. However, the adoption of the federal Comprehensive Drug Abuse Prevention and Control Act in 1970 would limit access to highly addictive drugs like barbiturates. The act placed barbiturates on a list of controlled substances that were subject to abuse. The act limited the number of prescriptions a person could receive. It also set annual quotas for the amount of drugs that pharmaceutical companies could manufacture.

As access to barbiturates was limited, benzodiazepines were promoted as a safer alternative. Benzodiazepines went on the market during the 1960s and were thought to be less addictive than barbiturates.

With barbiturates less available, drug abusers turned to other illegal substances during the 1970s and 1980s. One indication of drug demand was the record of drugs seized by the United States Customs Service. Customs confiscated greater quantities of marijuana, heroin, and cocaine. As a result, Customs recorded seizures of each drug separately.

Barbiturates in the late twentieth century

At the close of the twentieth century, the DEA reported that barbiturates represented about 20% of all depressant prescriptions in the United States. Uses ranged from epilepsy treatment to assisted suicide in Oregon. In 1997, Oregon voters approved the Death with Dignity Act, which allows doctors to prescribe lethal dosages of barbiturates to terminally ill people.

Furthermore, the late 1990s brought concerns about benzodiazepines, the drugs thought to be a safe alternative to barbiturates. Benzodiazepines produced side effects similar to those produced by barbiturates. These included the risk of addiction when high doses were taken. Benzodiazepines accounted for 30% of all prescriptions for controlled substance, according to the DEA.

CHEMICAL/ORGANIC COMPOSITION

Barbiturates are compounds derived from barbituric acid. These drugs are classified in four categories that are defined by the amount of time that it takes for barbiturate to produce results and how long those results last.

The ultrashort-acting barbiturates methohexital, thiamylal, and thiopental produce unconsciousness within several minutes. These drugs are used for anesthesia before surgery.

Short and intermediate-acting barbiturates take effect within 15 to 40 minutes. The effects of these barbiturates last from five to six hours. These medications are prescribed for sedation or to help people sleep. The barbiturates in this category are amobarbital, pentobarbital, secobarbital, bubalbital, butabarbital, talbutal, and aprobarbital.

Mephobarbital and phenobarbital are long-acting barbiturates that take effect within approximately one to two hours. These effects last approximately 12 hours.

According to the United States Drug Enforcement Agency (DEA), drug abusers favor short and intermediate-acting barbiturates. Barbiturate users often refer to the pills they take in terms of the color of the capsule. These street names include blues or blue devils for Amytal; reds, red birds; and red devils for Seconal; yellow jackets for Nembutal; purple hearts for Luminal; and rainbows and Christmas trees for Tuinal.

INGESTION METHODS

In the United States, barbiturates are manufactured in various forms. Most barbiturates come in pills and capsules that patients swallow. Some barbiturates are manufactured as an elixir, a liquid form of the drug that patients swallow.

Other barbiturates are manufactured as a powder that is injected into the patient's vein. In addition, pentobarbital is manufactured as a suppository that is inserted in the rectum. Pentobarbital is also available in capsule, tablet, elixir, and injection dosages. Phenobarbital is produced in capsule, tablet, injection, and elixir dosages.

Amobarbital is manufactured in pill, capsule, and injection dosages. Butabarbital is manufactured in capsule, tablet, and elixir dosages. Secobarbital is produced in capsule and injection dosages.

Aprobarbital is an elixir, mephobarbital is a tablet, and the drug containing secobarbital and amobarbital is a capsule. Legally prescribed barbiturates and those used in medical procedures are used in the form that the drug is produced. Some drug abusers will inject powder from capsules or ground-up tablets.

THERAPEUTIC USE

Barbiturates produce forms of central nervous system depression. Reactions to these drugs range from mild sedation (producing sleep) to a coma. Doctors may prescribe barbiturates as sedatives to calm patients' nerves, reduce tension or help them sleep. The drugs are also used as an anticonvulsant to control epileptic seizures.

In addition, the sleep-producing action of barbiturates is used to relax and partially anesthetize patients before some surgical procedures. Before some major brain surgeries, barbiturates (usually pentobarbital or thiopental) are used to temporarily induce coma in an effort to protect the brain; these drugs can reduce the metabolic rate of brain tissue and control cerebral blood flow.

Ultrashort-acting barbiturates

The ultrashort-acting barbiturates methohexital (Brevital), thiamylal (Surital), and thiopental (Pentothal) are administered as an anesthetic before surgery. The barbiturate is injected into the patient's vein to induce anesthesia. The patient then receives a longer-acting anesthetic like nitrous oxide. The drugs are used in hospital settings and are not subject to abuse, according to the DEA.

Short-acting and intermediate-acting barbiturates

The barbiturates in these categories are pentobarbital (Nembutal), secobarbital (Seconal, Amatyl), a combination of amobarbital and secobarbital (Tuinal), bubalbital (Florinal, Fioricet), butabarbital (Butisol), talbutal (Lotusate), and aprobarbital (Alurate).

Short-acting and intermediate barbiturates are prescribed as sedatives and sleeping pills. In addition, veterinarians use pentobarbital to anesthetize animals. This barbiturate is also used to euthanize or put animals to sleep.

Long-acting barbiturates

The long-acting barbiturates phenobarbital (Luminal) and mephobarbital (Mebaral) are used medically to help a patient sleep. Another use is day-long sedation, a procedure that treats tension and anxiety. Furthermore, long-acting barbiturates are used with other drugs in the treatment of convulsive conditions like epilepsy.

Phenobarbital is the oldest antiepileptic drug in common use and has a solid efficiency record for the control of seizure. However, due to some side effects (hypertension, depression, dizziness, rash, memory lapses) and drug interactions (primarily other anticonvulsants), phenobarbital is now generally used as a second-line treatment.

Assisted suicide

After Oregon voters in 1997 approved the Death with Dignity Act, terminally ill people could receive prescriptions for lethal dosages of drugs so that they could end their lives. To be eligible for the Death with Dignity drugs, the person needed a diagnosis of less than six months to live. That diagnosis would be verified by two physicians, who would also determine that the person was competent when the decision was made.

Secobarbital was prescribed to 67 out of 70 patients during 1998 through 2000, according to an Oregon Public Health Services report.

USAGE TRENDS

Passage of the federal Controlled Substances Act in 1970 restricted access to barbiturates. That action led to an eventual decline in the use and abuse of one of the most widely prescribed drugs of the twentieth century.

Scope and severity

In 1977, pharmacists filled approximately 7.9 million prescriptions for Luminal (phenobarbital), according to the National Institute of Drug Abuse (NIDA). NIDA estimated that approximately 1.7 million Nembutal prescriptions were filled, along with an estimated 1.5 million Seconal prescriptions, and 375,000 Amytal prescriptions.

NIDA research included estimates of deaths linked to use of a barbiturate. The federal agency estimated that 250 deaths were related to secobarbital, the same number for pentobarbital, 110 phenobarbital fatalities, and 30 deaths were connected to amobarbital.

At the start of the twenty-first century, the United States Drug Enforcement Agency said that barbiturates accounted for 20% of depressant prescriptions. Barbiturate use had declined so much that researchers no longer compiled separate statistics about the drug. Instead, barbiturates were placed in the sedative category that included tranquilizers.

Age, ethnic, and gender trends

During the 1950s, barbiturates were popular with the middle and upper classes. By the 1960s, barbiturate users spanned the generations from youths to older adults. However, recent surveys of illicit drug abuse illustrated the sharp decline in barbiturate abuse. In the National Household Survey on Drug Abuse for 2000, sedatives were placed in a category of psychotherapeutic drugs. This category included pain relievers, tranquilizers, stimulants, and pain relievers.

The survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) focused on the 14 million Americans who were current illicit drug users. Current use was defined as having used the drug the month before the survey. Those surveyed were age 12 and older.

Of that total, 1.8% of men and 1.7% of women had taken a psychotherapeutic drug for nonmedical reasons during the month before the survey. Of youths between the ages of 12 and 17, 7.7% of girls and 3.3% of girls were "likely" to use a illicit psychotherapeutic drugs.

Typically, women are more likely then men to receive barbiturate prescriptions because they are more likely to seek help for anxiety, depression, and insomnia. Barbiturates are also widely prescribed to older adults. Elderly persons use these drugs as sedatives, and again women receive the majority of the prescriptions.

MENTAL EFFECTS

The mental effects of barbiturates depend on the amount of the drug taken and the strength of the dosage. Generally, a person falls asleep when taking a prescribed dosage at bedtime.

Intoxication

A person experiences intoxication after taking a larger dose of a barbiturate. A mild state of intoxication brings a feeling of euphoria (happiness) that frequently leads to increased self-esteem and a lowering of inhibitions.

As intoxication increases, the person exhibits behavior similar to that displayed by a person intoxicated by alcohol. The person may be short-tempered, aggressive, and possibly violent. Other possible symptoms are impaired judgement and mood swings.

Upon waking, the person may experience "hangover" sensations that include dizziness. The person may still be sleepy and behave in a clumsy manner. Depression may be experienced.

Dependence

Barbiturate use can lead to both psychological and physical dependence. Psychological addiction can occur quickly. Signs of drug dependence include relying on the drug for a desired effect. The addicted abuser believes he or she must take a barbiturate to sleep, relax, or have a feeling of well-being. As the person relies emotionally on the drug, continued use of barbiturates leads to physical dependence.

As people develop tolerance for barbiturates, they may think they need more of the drug or a higher dosage to get the desired effect. This can lead to an overdose, which results from a person taking a larger than prescribed dose of a drug. Psychological symptoms of a barbiturate overdose include extreme drowsiness, intense confusion, and impaired judgement.

PHYSIOLOGICAL EFFECTS

Barbiturates act on the central nervous system, and use of these drugs can bring about changes ranging from mild sedation to a coma. Furthermore, an overdose or an attempt to withdraw abruptly from barbiturates can be fatal.

Short-term effects

Barbiturates help a person to sleep. However, this slumber differs from normal sleep. Barbiturate use decreases the amount of the dream phase of sleep known as the rapid eye movement (REM) stage. This phase of sleep is necessary for maintaining good health.

Barbiturates produce reactions similar to those of alcohol. A person may experience "hangover" symptoms including headache and dizziness. They may still feel tired and less alert as well. A person experiencing these symptoms should not drive or operate machinery. These hangover symptoms may last for hours.

Like alcohol, barbiturates are intoxicating. During the stage after mild intoxication, the person's speech may be slurred. The person may stagger and lose muscular control. Other symptoms of intoxication include irritability, shallow breathing, and fatigue.

At-risk groups

Older adults and pregnant women should consider the risks associated with barbiturate use. When a person ages, the metabolization rate for drugs decreases. As a result, people over age 65 are at higher risk of the harmful effects of barbiturates. There is also greater risk for drug dependence.

When barbiturates are taken during pregnancy, the drug passes through the mother's bloodstream and through the placenta into the fetus. After the baby is born, it may experience withdrawal symptoms and have trouble breathing. Other withdrawal symptoms include troubled sleep patterns, fever, and irritability. Furthermore, nursing mothers who take barbiturates may transmit the drug in their breast milk.

Harmful side effects

An individual using CNS depressants like barbiturates can develop a tolerance for the drugs. Over time, the body becomes used to the presence of barbiturates in the system. When this happens, the prescribed dose of the drug does not produce a desired result and the individual may take more pills or stronger dosages of barbiturates. A tolerance to that level can develop, requiring even more barbiturates or a stronger dosage. As tolerance continues to increase, the individual may take a fatal dose in their attempt to get the desired effect.

Overdose occurs when a drug is consumed in a dose that is greater than the body can handle. Symptoms of an overdose include intense tiredness, confusion, irritability, and fever or a low body temperature. The person may experience shortness of breath, sleepiness or difficulty getting to sleep, and weakness. Other signs of overdose are slurred speech, a slow heartbeat, and uncommon eye movements.

An overdose may be triggered by drinking alcohol or taking a drug like an amphetamine while using barbiturates. In an effect called synergy, the two drugs intensify the effects of each other. As a result, the prescribed dose of one drug could be fatal if taken with another drug.

The amount of a fatal dosage of barbiturate will vary with the individual. However, the lethal dose is usually 10 to 15 times as large as a usual dose. A fatal overdose starts with cardiovascular collapse followed by respiratory depression. The person then falls into a coma and dies.

Long-term health effects

Barbiturates are addictive. A person may develop a physical dependency after taking more than 400 mg of pentobarbital or secobarbital a day over an approximately 90-day period.

Long-term use of other barbiturates can also lead to physical and psychological dependence. Symptoms of dependence include the feeling that a person cannot relax or sleep without taking a barbiturate. Another sign of addiction is a tendency to increase the dosage.

People at risk of barbiturate abuse and addiction include alcoholics and abusers of opiates, sedative-hypnotics, and amphetamines.

Withdrawal

When a person stops taking barbiturates, the body begins to adapt to the lack of drugs in the system. If a person has used barbiturates in large doses or for an extended period of time, a physician should be consulted about the withdrawal process.

Onset of withdrawal symptoms usually begin eight to 16 hours after the last pill was taken. Symptoms may last up to 15 days if the person was a long-term barbiturate user or took large doses of the drug.

During this time, the person feels weak, dizzy, and anxious. Withdrawal brings tremors and shakes. The person may hallucinate, experience delusions, or become violent and hostile. Withdrawal symptoms generally diminish over time.

In some cases, withdrawal symptoms can be fatal, so a person cannot just stop taking barbiturates. The physician will establish a plan of gradual withdrawal from barbiturates.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

From the 1940s on, people took amphetamines, the highly addictive drugs referred to as "uppers," during the day. They used amphetamines to increase their energy and to relieve the effects of barbiturates. Those effects could include sleepiness and hangover symptoms.

By evening, people who still experienced the effects of the amphetamines turned to "downers," the street name for barbiturates. People took downers to slow down and sleep. In the morning, the drug-taking cycle started again. The person took an upper to counteract the effects of the downer.

Barbiturates are frequently taken in combination with amphetamines. Amphetamines are highly addictive drugs known as "uppers" since they increase energy. They are used to counteract the "downer" effect of barbiturates that induce sleep. This cycle is very dangerous. Both types of drug are addictive and can lead to tolerance. The combination of amphetamine use during the day and barbiturate use as night results in a synergy of the two drugs, which lowers the amount of the drug that is fatal. There is also synergy when a person uses barbiturates and consumes alcohol.

The person combining drugs does not know what dosage of the combination will be lethal. As a result, someone using a barbiturate could die after taking a prescribed dose of an amphetamine.

Barbiturates and other medications

Medications can cause adverse reactions for the person taking barbiturates. Tranquilizers and antihistamines depress the brain's control over breathing. This could increase the chance of respiratory failure when someone uses barbiturates.

Barbiturates may counteract the effects of birth control pills that contain estrogen. A woman taking those oral contraceptives may become pregnant after taking barbiturates.

TREATMENT AND REHABILITATION

Barbiturates act so powerfully on the nervous system that a person must gradually withdraw from these drugs. To suddenly stop taking barbiturates could result in serious medical complications or death. This withdrawal process, known as detoxification, is part of the treatment process for people dependent on barbiturates.

Medically supervised detoxification reduces the risk of death as the person's body adapts to reduced amounts of barbiturates. This treatment starts with the person receiving the usual amount of the barbiturate and then less and less of the drug over time. The person still endures withdrawal symptoms. However, the more serious symptoms may be less severe.

To lessen the REM rebound effect, it is recommended that a person reduce barbiturate consumption by one therapeutic dosage over a period of five or six days, according to Physicians' Desk Reference. Another method is to take two doses instead of three for a week.

Detoxification may occur in a hospital, or treatment may be given on an outpatient basis. Counseling is also part of the treatment regimen. After the person is successfully treated for physical addiction, he or she must follow through with psychological rehabilitation.

Behavioral treatment helps a person avoid barbiturates by providing guidance about how to function without drugs and how to cope with cravings. The behavior-modification treatments can be set up as one-on-one counseling sessions, group therapy, family counseling, or other types of therapies. For the person wanting to remain drug-free, ongoing support can be found in 12-step programs and other groups that meet regularly.

PERSONAL AND SOCIAL CONSEQUENCES

Barbiturates harm more people than those who take them. People who drive while intoxicated by barbiturates risk the lives of others. A pregnant woman who takes barbiturates passes the drugs along to her unborn baby. After the baby is born, the infant will have to undergo withdrawal from the barbiturate.

Barbiturates can also affect relationships. The drugs have been compared to alcohol in terms of the intoxicating effects. Both drugs produce a euphoric feeling during the mild intoxication stage. People may enjoy being around the person at that point.

As the intoxication increases, the person may become belligerent. He or she may provoke an argument. There is a possibility of violence. Judgement is impaired, so the person might make an unsafe decision like trying to drive home.

Some people who abuse barbiturates do not worry about driving under the influence. The reason is not because they are confident about their ability to drive, but because they know that police will not smell alcohol on their breath.

In some ways, the effects of barbiturates are predictable. Prolonged barbiturate use can shorten a person's attention span. The person may suffer memory loss. Both conditions would make it difficult for a person to do well in school or perform on a job.

In addition, barbiturates make a person tired, anxious, and depressed. The person who took barbiturates to feel better finds that the drugs only deepen the depression.

As a person takes more or higher doses of a barbiturate, he or she does not know if that dose will be fatal. And with increased tolerance, the difference diminishes between an intoxicating dose and a fatal dose.

Furthermore, the method of withdrawing from barbiturates is not as simple as stopping completely. Barbiturates slow the brain's activity, so there could be a rebound when a person stops taking the drug. This rebound activity could lead to seizures and other harmful consequences.

LEGAL CONSEQUENCES

When barbiturates first went on the market during the 1930s, people in the United States did not need a prescription to buy them. Lawmakers soon realized that barbiturates were addictive. Some states adopted laws that banned the sale of nonprescription barbiturates. The federal government took similar action after the Food and Drug Administration gained regulatory power in1938. That set the stage for a 40-year battle against barbiturate abuse.

Legal history

The federal Food, Drug, and Cosmetics Act of 1938 gave regulatory powers to the Food and Drug Administration (FDA). Pharmaceutical companies apply to the FDA for approval to manufacture a new drugs. The approval process includes research, testing, and hearings. Once a drug is approved, the FDA determines whether a prescription is required.

FDA regulations about prescription drugs apply to how the manufacturer promotes or advertises the medications. Unless specified by other regulations such as the Controlled Substances Act (CSA), there are no restrictions on the condition for which the doctor prescribes the pill, the dosage prescribed, or the amount of time that the patient will take the pill.

Federal guidelines, regulations, and penalties

The Controlled Substances Act (CSA) portion of the 1970 Comprehensive Drug Abuse Prevention and Control Act classified drugs in five categories based on the effect of the drug, its medical use, and potential for abuse. Schedule I contains drugs like heroin, which have no medical use but may be used in research. It is the most tightly controlled category.

Schedule II drugs have a high potential for abuse. They are accepted for medical use with restrictions. These drugs may lead to severe psychological or physical dependence. Barbiturates in this category are amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal, Tuinal).

Schedule III drugs have less of a potential for abuse than drugs in Schedules I and II. The drugs have a medical use. Abuse of these drugs may lead to "moderate or low psychological dependence or high psychological dependence," according to the CSA. Barbiturates in this category are aprobarbital (Alurate) butabarbital (Busitol, Bubatel), and butibal (Fiorinal). A prescription may be filled up to five times during the six months after the first prescription was written.

Schedule IV drugs have a low abuse potential as compared to Schedule III drugs. These substances have an accepted medical use. They could lead to limited psychological or physical dependence, according to the CSA. The Schedule IV barbiturates are barbital (Veronel), mephobarbital (Mebaral), and phenobarbital (Luminal). Five prescription refills are allowed during the six months after the patient received the first prescription.

Penalties. Federal law prohibits the possession, use, and distribution of illegal drugs. The Controlled Substances Act established tighter controls on the manufacture and distribution of drugs like diet pills. Limits were set on the amounts of Schedule II pills that could be manufactured.

Procedure for the legal distribution of pills included the requirement of a written prescription for Schedule II drugs. An exception is made in emergencies.

For Schedule III and IV drugs, the prescription may be written or called into the pharmacy. Both the health care practitioner and pharmacist are required to keep records when prescriptions are filled for controlled drugs.

Trafficking. Trafficking is the illegal distribution of controlled drugs. Federal penalties for this crime can include fines and imprisonment. Sentencing is based on factors such as whether the trafficker is a first-time offender. Penalties are higher for a second offense. In addition, if the illegal distribution of a Schedule II drug results in death or serious injury, the convicted offender faces a prison term of from 20 years to life.

In cases where there is no serious injury or death, the penalties for a first-time offense are:

• Schedule II: Trafficking 100 grams or more of methamphetamine carries a prison term of from 10 years to life and a fine of up to $4 million.
• Schedule III drugs: Trafficking any quantity of these drugs is punishable by up to five years in prison and a maximum fine of $250,000.
• Schedule IV drugs: Illegally distributing any quantity of these drugs carries a prison term of up to three years and a fine of up to $250,000.

Penalties for drug abusers. The federal penalty for the first-time offense of illegally possessing a controlled substance is up to one year in prison and a fine of from $1,000 to $100,000. Penalties are generally doubled for a second offense.

In some cases, a person may not receive a prison sentence. The Anti-Drug Abuse Act of 1988 imposes a civil penalty on the minor drug offender, the person possessing a small quantity of an illegal controlled substance. Possession of this quantity known as a "personal use amount" carries a fine of up to $10,000.

Drug laws in the United Kingdom. In the United Kingdom, substances are regulated by the 1971 Misuse of Drugs Act and the 1986 Medicines Act. The 1971 act placed drugs in categories of A, B, or C. The A category contains the most dangerous drugs. The least dangerous drugs are in Category C.

The 1986 act established five medical schedules that are based on factors such as the therapeutic value of the drug. Another consideration is whether a prescription is required. Schedule 1 is the most strictly controlled category.

Barbiturates are a Class B drug unless the barbiturate is used in an injectable form. It then becomes a Class A drug.

The maximum penalty for possession of a Class B drug is five years of prison, an unlimited fine (of any amount), or prison and a fine. The maximum fine for supply (trafficking) is a 14-year prison term, an unlimited fine, or both penalties.

For Class A drugs, the penalty for possession is seven years in prison, an unlimited fine, or both. The supply penalty for this class, which includes cocaine and heroin, is life imprisonment, an unlimited fine, or both penalties.

See also Amphetamines; Antidepressants; Benzodiazepine; Diet pills; Tranquilizers

RESOURCES

Books

Breacher, Edward M., et al. The Consumers Union Report on Licit and Illicit Drugs. Boston: Little Brown & Co., 1972.

Dorsman, Jerry. How to Quit Drugs for Good. Rocklin, CA: Prima Publishing, 1998.

Hughes, Richard and Robert Brewin. The Tranquilizing of America. New York: Harcourt Brace Jovanovich, 1979.

Medical Economics. Physicians' Desk Reference 2001. Montvale, NJ: Medical Economics, 2001.

Wolfe, Sidney. Worst Pills, Best Pills. New York: Pocket Books,1999.

Organizations

National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Blvd., Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, <http://www.nida.nih.gov>.

U.S. Drug Enforcement Administration, 2401 Jefferson Davis Highway, Alexandria, VA, USA, 22201, (800) 882-9539, <http://www.dea.gov>.

U.S. Food and Drug Administration (FDA), 560 Fishers Lane, Rockville, MD, USA, 20857-0001, (888) 463-6332, <http://www.fda.gov>.

Liz Swain