OFFICIAL NAMES: Methaqualone
STREET NAMES: Quaaludes, ludes, quads, quay, sopors, 714s, mandrax, mandrakes, mandies, buttons, disco biscuits, love drug
DRUG CLASSIFICATIONS: Schedule I, non-narcotic depressant
Methaqualone is an addictive, or habit-forming, synthetic drug that alters brain function. In their search for new medications to fight malaria, a potentially deadly tropical disease spread by mosquitoes, scientists in India first synthesized methaqualone in 1955. The drug was found to be hypnotic and a potent sedative, but it was then thought to be non-addictive.
Pharmaceutical manufacturers in the United Kingdom (UK) began marketing the drug in the 1960s. Despite emerging international medical reports of possible dependence and abuse problems, the U.S. Food and Drug Administration (FDA) also approved methaqua-lone use by prescription. In 1965 U.S. manufacturers introduced methaqualone to the medical community for the treatment of anxiety and sleep disorders. Although it was available under a number of trade names, the drug would be known by its most popular and notorious brand name, Quaalude.
Methaqualone enjoyed immense popularity as a prescription drug, with over four million prescriptions written in 1973 at the height of its popularity. Its rise as an illicit street drug was fast and furious as Quaaludes permeated popular culture. Their use was widespread on college campuses; many celebrities openly took them; and the media and word of mouth passed along the drug's erroneous reputation as an aphrodisiac (or "love drug"). In response to the growing abuse, the federal government took measures at the end of 1973 to tighten controls on its access.
In the 1970s and early 1980s, however, so-called "stress clinics" started to appear across America, providing an easy source of prescriptions for Quaaludes with just a cursory physical examination. In addition to the abuse of legal prescriptions, an estimated one billion tablets of counterfeit Quaaludes flowed into the United States each year.
The addictive quality and the speed with which tolerance to the drug developed was becoming apparent, and in the 1970s medical literature issued frequent reports of methaqualone abuse, dependence, and withdrawal. Hospital admissions and fatalities related to methaqualone grew exponentially. In 1982, there were a reported 2,764 emergency room visits attributed to Quaalude use.
In the 1980s, the FDA, attempting to curtail its use again, reclassified methaqualone as a Schedule I drug, a highly addictive substance with no current medical necessity in the United States. Its production as a legal medication was halted. The reclassification along with an aggressive campaign by the Drug Enforcement Agency (DEA) against illegal labs and overseas supplies finally slowed the Quaalude flood to a trickle.
Today, methaqualone use has dropped dramatically in the United States, and just a handful of cases are reported annually to the Drug Abuse Warning Network (DAWN) of the Substance Abuse Mental Health Services Administration (SAMHSA). Counterfeit Quaaludes sold on the street often contain sedatives other than methaqualone. However, methaqualone abuse and trafficking in South Africa is widespread.
The chemical name for methaqualone is 2-methyl-3-O-tolyl-4(3H)-quinazolinone (C16H14N2O). It is a white, crystalline, odorless substance with a bitter taste.
The key precursors, or ingredients, in the manufacture of methaqualone are the chemicals N-acetylanthranlic acid and anthranilic acid. Because methaqualone is produced illegally, the drug is frequently cut, or adulterated, with other substances called fillers, ranging from talcum powder to heroin.
Before methaqualone's legal production and marketing was stopped worldwide, the drug was manufactured in both tablet and capsule form in various strengths.
Counterfeit versions of the drug are still produced in South Africa, India, and other parts of the world today. The drugs look remarkably similar to the original pharmaceutical tablet versions, including the manufacturer's markings. Methaqualone is also found in illicit capsule and powder forms.
During the 1970s, a popular method of recreational methaqualone use was to take the drug with a glass of wine. The practice was known as "luding out" (in reference to the brand name Quaalude). Taking methaqualone with alcohol, another depressant of the central nervous system (CNS), increased the sedative effect of the drug. It could also prove to be deadly if the potent depressant combination caused respiratory failure. Mandrax, also the brand name for the now-illegal UK version of methaqualone, is made by combining the drug with small amounts of antihistamine. In South Africa, where methaqualone abuse has become a serious public health problem, Mandrax is sometimes mixed marijuana.
Methaqualone was originally prescribed for the treatment of insomnia and anxiety disorders. It was also prescribed as an alleged "stress reducer."
Today, there are no recognized therapeutic uses for methaqualone. Because the drug is so highly physically and psychologically addictive, it has been given a Schedule I status by the United States Drug Enforcement Agency (DEA). Schedule I drugs are substances that have a high potential for abuse, have no current medical necessity in the United States, and are considered unsafe for use even under a physician's supervision. Other Schedule I drugs include heroin, mescaline, and LSD. Methaqualone is a banned substance internationally as well and is not used as a therapeutic prescription drug overseas.
Methaqualone use and abuse in the United States dropped significantly after its reclassification to an illicit Schedule I drug. Fatalities and injuries related to the drug's use have also declined accordingly. According to the National Narcotics Intelligence Consumers Committee, annual U.S. emergency room visits related to methaqualone fell from 2,764 in 1982 to just 163 in 1988.
Scope and severity
The DAWN survey shows a definite downward trend in the number of methaqualone-related emergency room visits in the United States, with a total of 574 incidents in 1998, 271 in 1999, and 127 in 2000.
Age, ethnic, and gender trends
When methaqualone was legal in the United States, its status as a prescription drug meant its abuse could and cross lines of race, culture, and class status.
Illicit Quaalude use and abuse on college campuses was widespread in the 1970s and rose dramatically between 1978 and 1981. The National Institute of Drug Abuse (NIDA) and the University of Michigan reported that by 1981, 6.5% of college students reported having used methaqualone without a prescription at least once in the previous year. By 1989, five years after the drug's reclassification as a Schedule I substance, only 0.2% of college students reported use of methaqualone within the previous year. Data also shows that in 1981, 10.4% of college students had tried methaqualone at least once in their lifetime compared to 8.7% of young adults (ages 19 to 28) in 1989.
Among American high school students, methaqualone use has dropped to record low levels. According to "Monitoring The Future: National Survey Results on Drug Use, 1975-2000," a U.S. survey of drug use patterns of secondary school students, use of the drug in 2000 was a mere 0.3% compared to 8% in 1981. Even for those adolescents who try Quaaludes, the drug may not have the allure it did in past decades. The "Monitoring the Future" survey reports that 63% of high school seniors who try methaqualone one or more times did not continue use of the drug (in the 12 months prior to the 2000 survey). Rates for methaqualone use were higher for whites than for any other racial or ethnic group among high school seniors.
Methaqualone grew in popularity due to its ability to lower inhibitions and heighten a sense of well-being. However, psychological addiction to methaqualone can occur quickly, even in what was once considered to be a therapeutic dose. When the drug was still available by prescription, pharmaceutical manuals discouraged its use for more than three months due to its addictive qualities. Psychological dependence on and abuse of the drug can lead to physical tolerance and the need to increase dosages. Common features of psychological dependence on methaqualone are memory loss; difficulties with work or school; cognitive impairment or learning problems; and preoccupation with obtaining the drug.
Methaqualone is also classified as a sedative-hypnotic drug. It reaches peak levels in the bloodstream one to two hours after ingestion, and the user can feel its effects four to eight hours after taking the drug. Like alcohol, methaqualone is a CNS depressant. It is called a depressant because it decreases neurotransmitter levels in the brain and central nervous system. Neurotransmitters are CNS chemicals that allow signals to travel between neurons, or brain cells, and regulate thought processes, behavior, and emotion. Due to its depressant action on the central nervous system, methaqualone suppresses coughs and spasms.
Methaqualone also affects involuntary body functions that are controlled by the autonomic nervous system, lowering blood pressure, breathing rate, and pulse and bringing about a state of deep relaxation. Though thought to be an aphrodisiac because it lowers inhibitions, methaqualone, as a CNS depressant, usually impairs sexual performance, inhibiting arousal and climax.
Harmful side effects
Methaqualone abusers rapidly build up a tolerance to the drug, and need increasingly larger doses to achieve the same physical and mental effects. However, the user's body and nervous system do not build up a resistance to the drug at the same rate. For this reason, tolerance can easily lead to unintentional overdose as the central nervous system is overwhelmed and shut down by increased doses of the drug. Coma and death can result. Ingestion of more than 800 mg of methaqualone in an adult and 150 mg in a child is considered toxic. The average lethal oral dose is 8–20 grams (100–200 mg/kg), and coma can occur after ingestion of 2.4 grams, according to the National Library of Medicine (NLM) Hazardous Substance Database. However, methaqualone can cause coma or death at lower levels if it is taken with another CNS depressant such as alcohol. Because methaqualone is a street drug of varying quality, the rate at which tolerance progresses depends on the strength of the product. In addition, dangerous and even fatal delays in proper treatment can occur when health care personnel do not know what other substances to consider.
Reported side effects of methaqualone include gastrointestinal distress (nausea, vomiting, stomach cramps, diarrhea), headache, chills, sweating, irregular heartbeat, slurred speech, skin rash and itching, seizures, and fatigue. Because methaqualone induces sleep, there is a danger of users vomiting in their sleep and choking to death.
Methaqualone affects muscle movement and proper functioning of nerve sensation. Users experience paresthesia, which is a numb tingling, or "pins and needles" sensation, most commonly in the fingers and face. Individuals who take heavy doses of methaqualone also have a heightened pain threshold. The coordination of brain and body becomes disconnected, and nerve signals are slowed or stopped on their way to the brain's command center. While under the influence of methaqualone, users may hurt themselves without realizing it.
Methaqualone also causes ataxia, or uncontrolled muscle twitching and movement. Users are sometimes referred to as "wallbangers" because they can appear as though they have lost control of their bodies, and may also repeatedly run into things for lack of feeling the painful effects. This side effect, combined with the impaired judgment and lowered inhibitions that accompany with methaqualone use, can result in serious injury, accidents, and death.
Driving or operating heavy machinery is particularly dangerous for anyone under the influence of methaqualone due to ataxia and slowed reflexes. According to a study published in the Journal of the American Medical Association, of the 246 methaqualone-related deaths reported between 1971 and 1981, one-third of the deaths caused by trauma were associated with auto accidents.
Long-term health effects
Liver damage can result from long-term abuse of methaqualone or from ingestion of heavily adulterated methaqualone. The liver is responsible for metabolizing, or processing, drugs in the body, and impurities in the drug can cause irreversible damage to the organ.
Peripheral neuropathy, or damage to the nerves of the extremities (hands and feet) is also associated with methaqualone abuse. Typically this disorder, which is characterized by numbness in the hands and feet, reverses itself after abuse has stopped, but it has been reported to last up to five months in some long-term methaqualone abusers.
Methaqualone passes through to breast milk in lactating women. Animal studies have shown the drug to cause birth defects when used during pregnancy.
REACTIONS WITH OTHER DRUGS OR SUBSTANCES
The sedative and hypnotic effects of methaqualone are greatly increased when the drug is mixed with other CNS depressants such as alcohol or marijuana and can result in coma or death.
Because methaqualone is illegal in the United States and around the world, the only available supplies of the drug are illicitly produced. Bootleg methaqualone may contain a number of other substances, from harmless sugar fillers to potentially deadly chemicals. Talcum powder, flour, baking soda, heroin, decongestants, analgesics, diuretics, laxatives, and of other substances are commonly used to cut methaqualone. Depending on the filler used and impurities that can enter the drug in the manufacturing process, an array of damaging side effects can result. These range from mild gastrointestinal problems to a serious condition known as necrotizing cystitis that causes irreversible damage to the bladder.
TREATMENT AND REHABILITATION
When a depressant drug like methaqualone is stopped abruptly, the body responds by overreacting to the substance's absence. Functions such as heart rate that were slowed by the depressant will suddenly accelerate, often erratically. Conversely, withdrawal of a stimulant drug can cause an overall sluggishness that results in depression and extreme fatigue. These changes result in very uncomfortable and potentially life-threatening physical symptoms, called withdrawal syndrome.
The length of time detoxification takes depends on the patient and his or her pattern of methaqualone abuse. Seven to 10 days is an average detox time for someone dependent on methaqualone. Withdrawal symptoms usually begin approximately 12 to 24 hours after individuals have taken their last dose, and peak 24 to 72 hours after. Methaqualone abusers in withdrawal typically suffer from potentially serious symptoms, including nausea, vomiting, tremors, tachycardia (irregular heartbeat), excessive perspiration, anxiety, insomnia, delirium, convulsions, and grand mal seizures. For this reason, methaqualone detoxification should always take place under the supervision of a healthcare professional in a hospital or rehabilitation setting, so withdrawal symptoms can be treated appropriately.
A physician may also prescribe another sedative to ease the withdrawal symptoms during the initial detoxification period. Antidepressants are sometimes prescribed for patients with anxiety and sleep disorders.
In addition to providing a controlled environment for detoxification, inpatient treatment is helpful in cases where there is a risk that patients might harm themselves or others or if there is another physical or mental illness that requires a doctor's observation and care.
Outpatient, or ambulatory, treatment is another option for substance abusers. Patients in outpatient substance abuse treatment spend their days, or a portion of their days, in a rehab facility while returning home at night.
Once detoxification is complete, the drug abuser can start the rehabilitation and long-term recovery process with a clear head. Research shows that detoxification alone is not an effective treatment, and addicts who leave rehab immediately after detox with no further counseling or interventions soon abuse methaqualone or another mind-altering substance again.
An effective drug rehabilitation program removes the drug of choice from the abuser's body and surroundings. It also focuses on changing patterns of the abuser's behavior and dealing with the underlying emotional issues surrounding his or her drug use. Drug education on the long-term effects of substance abuse is also typically part of a rehab program.
Recovery refers to the life-long process of avoiding substance use and the mental and physical rehabilitation of the damage done during active substance abuse. An individual in recovery must avoid not just methaqualone or another drug of choice, but any mind-and mood-altering drug, including alcohol. Substance cravings can be strong, and may last indefinitely. Recovering addicts are always in danger of slipping back into substance use, and relapse can occur with a single dose or drink. Triggers, or common causes, for relapse include major life changes such as unemployment or career change, relationship and financial problems, and family stresses. Yet more subtle circumstances—seeing people or visiting places an addict associates with the drug use—can also prompt a relapse.
Therapy and individual or group counseling are key parts of rehabilitation as well. There are a number of different therapy approaches in substance abuse treatment, and often more than one therapeutic approach is used during the patient's stay in drug rehabilitation.
One-on-one counseling explores the emotional issues underlying a patient's drug dependence and abuse. Individual psychotherapy is particularly helpful when there is also some type of mental disorder, such as depression or an anxiety disorder, along with the drug abuse.
Behavioral therapy focuses on replacing unhealthy behaviors with healthier ones. It uses tools such as rewards (positive reinforcement for healthy behavior) and rehearsal (practicing the new behavior) to achieve a drug-free life.
Like behavioral therapy, cognitive-behavioral therapy (CBT) also tries teaching new behavioral patterns. However, the primary difference is CBT assumes that thinking is behind behavior and emotions. Therefore, CBT also focuses on—and tries to change—the thoughts that led to the drug abuse.
Family members often develop habits and ways of coping (called "enabling") that unintentionally help the addict continue their substance abuse. Group counseling sessions with a licensed counselor or therapist can help family members build healthy relationships and relearn old behaviors. This is particularly important for adolescents in drug treatment, who should be able to rely on the support of family.
Group therapy offers recovering drug abusers a safe and comfortable place to work out problems with peers and a group leader (typically a therapist or counselor). It also provides drug abusers insight into their thoughts and behaviors through the eyes and experiences of others. Substance abusers who have difficulty building healthy relationships can benefit from the social interactions in group therapy. Offering suggestions and emotional support to other members of the group can help improve their self-esteem and social skills.
Self-help and 12-step groups
Self-help organizations offer recovering drug abusers and addicts important support groups to replace their former drug-using social circle. They also help create an important sense of identity and belonging to a new, recovery-focused group.
Twelve-step groups, one of the most popular types of self-help organizations, have been active in the United States since the founding of Alcoholics Anonymous (AA) in 1935. Narcotics Anonymous (NA), a group that serves recovering drug addicts, was founded in 1953. Like AA and other 12-step programs, NA is based on the spiritual philosophy that turning one's will and life over to "a higher power" (i.e., God, another spiritual entity, or the group itself) for guidance and self-evaluation is the key to lasting recovery.
The accessibility of self-help groups is one of their most attractive features. No dues or fees are required for AA and NA, so they are a good option for the uninsured and underinsured. Meetings are held in public places like local hospitals, healthcare centers, churches, and other community organizations, and frequent and regular attendance is encouraged.
In addition, twelve-step groups work to empower members and promote self-esteem and self-reliance. NA meetings are not run by a counselor or therapist, but by the group or a member of the group. And the organization encourages sponsorship (mentoring another member), speaking at meetings, and other positive peer-to-peer interactions that can help reinforce healthy social behaviors. Today, the internet and on-line support communities have added a further degree of accessibility to those who live in rural or remote areas.
PERSONAL AND SOCIAL CONSEQUENCES
As an illegal, controlled substance, abuse of methaqualone can have serious social consequences for the user. Convictions carry heavy fines and possible jail time. Depending on the state, a conviction may also result in the suspension of the user's drivers license, and his or her constitutional right to vote may be revoked.
Criminal drug charges may have negative consequences for employment, career advancement, and educational opportunities as well. Amendments made to the Higher Education Act in 1998 require that anyone convicted of a drug offense be deemed ineligible for federal student loans from upwards of one year or even indefinitely. An individual convicted of a drug offense may also be denied access to state aid and employment based on his or her criminal history.
As with any highly addictive drug, methaqualone abusers become preoccupied with when and where they will be able to get their next dose. Interpersonal relationships with family and friends frequently deteriorate as drug use dominates the addict's life. Personal finances may also suffer as the drug user funnels more money towards his or her habit or becomes unemployed due to poor job performance resulting from drug impairment.
Substance abuse in general is a far-reaching societal problem, impacting personal relationships and health as well as crime, domestic violence, sexual assault, dropout rates, unemployment, and homelessness. It is also a factor in public health problems such as unwanted pregnancy, HIV/AIDS transmission, and the spread of sexually transmitted diseases (STDs).
Drug abuse takes a tremendous national financial toll as well. The Office of National Drug Control Policy estimates that illegal drugs will account for an economic loss of over $160 billion from the U.S. economy for the year 2000. This figure represents an increase of 5.8% annually between 1998 and 2000, and includes $14.8 billion in healthcare costs and $110.4 billion in lost productivity from drug-related illness, incarceration, and death.
When methaqualone first entered the U.S. market in the mid-sixties, it was classified as a Schedule V drug by the U.S. Drug Enforcement Agency (DEA). Schedule V drugs are considered the least dangerous and addictive of prescription medications and require only a doctor's prescription for access.
As the abuse of methaqualone increased, the DEA took action to limit access, changing the drug to a Schedule II substance in 1973. Schedule II drugs are those that are potentially dangerous with a high risk of psychological and physical addiction, but still can be medically beneficial if administered under a physician's care. They require a doctor's written prescription and cannot be refilled without additional prescriptions. Schedule II drugs also have stringent legal standards for manufacturer-to-pharmacy distribution, storage, and record-keeping.
Despite the reclassification of methaqualone to Schedule II, the use and abuse of the drug soared throughout the '70s and early '80s. Legitimate use for the drug rapidly decreased with the new classification. By 1982, Lemmon Company, the only remaining U.S. manufacturer of the drug, reported that prescriptions written for Quaaludes had dropped from a high of four million in 1973 to less than 300,000, a decline of over 90%.
In 1983, Congress began hearing testimony on a proposal to reclassify methaqualone to a Schedule I controlled substance. Schedule I drugs are those that are highly addictive and dangerous and have no recognized medical value. But because the drug was still manufactured and prescribed in the United States, which seemed to meet the Schedule II criteria of providing some therapeutic value, the FDA and DEA were reluctant to move the drug to Schedule I.
In the meantime, parts of the country such as Miami and Atlanta experienced an explosion of methaqualone abuse and began legislating against the drug on a state level. By 1984, nine states with growing methaqualone problems including Florida, Georgia, and Illinois had banned the sale of the drug.
Citing increasing political pressures and negative publicity surrounding Quaaludes, the Lemmon Company halted production and distribution of the drug as of January 31, 1984. With the final remaining obstacle to reclassification removed, Congress changed methaqualone to a Schedule I controlled substance in August of 1984, effectively outlawing the drug in the United States.
Statistically, however, legal sources of methaqua-lone had only been a fraction of the total Quaalude supply in the United States. In 2001, the DEA estimated the illicit, or counterfeit, production of the drug at 150 metric tons annually in the early 1980s, over 20 times the amount of legitimate methaqualone produced worldwide.
In the early 1980s, Colombia was a flourishing center of methaqualone counterfeiting. Operation Swordfish, a DEA investigation targeting organized drug crime in Miami, resulted in the seizure of 250,000 methaqualone pills in addition to large quantities of marijuana, cocaine, and cash and put a major dent into Miami's flourishing drug trade. After methaqualone was moved to Schedule I, the DEA, the Department of State, and U.S. Customs worked with agencies in foreign countries producing the drug to control the export of methaqualone and its precursor chemicals.
Today, South Africa is both the world's largest producer and consumer of methqualone in the form of counterfeit Mandrax. The country also serves as a drug gateway between southern Asia and the United States. A report by the United Nations Office for Drug Control and Crime Prevention (ODCCP) points out that part of the Mandrax problem is that vast quantities of the legal chemicals used to produce methaqualone are produced in southern Asia and are not adequately regulated. Illegal methaqualone production is also starting to spread to surrounding areas of Africa, including Kenya, Mozambique, Swaziland, Tanzania, and Zambia.
In 1999 and 2000, South Africa signed agreements with the United States that provided anti-drug crime assistance. The South African Narcotics Bureau (SANAB) has worked extensively with the United States DEA and the United Nations International Drug Control Program (UNDCP) to stop narcotics production and trafficking in the region. The relationship has meant an increase in methaqualone-related arrests. In November and December of 2001, 5.8 tons of methaqualone and Mandrax powder were seized from drug manufacturing operations in Johannesburg and Port Elizabeth. The December raid alone, which represented 3.3 tons, had a street value of 550 million rand ($49.05 million USD) and was the largest seizure to date by South African authorities. In January 2002, South African police confiscated 1.5 million Mandrax tablets worth an estimated1.5 million rand ($133,779.00 USD).
Federal guidelines, regulations, and penalties
A conviction of methaqualone possession in the United States is a federal offense that can carry serious consequences. If the amount of methaqualone is small, it is classified by DEA as a "personal use amount" under the Controlled Substances Act of 1988. Anyone charged with his or her first offense of possessing a personal use amount faces a civil fine of up to $10,000. The fine amount is based on the offender's income and assets and the circumstances surrounding the case. With first offenses, jail time is typically not involved, and the proceedings are civil rather than criminal. This means that if the offender pays the fine, stays out of trouble for a three-year period, and passes a drug test, the case is dismissed and no criminal or civil record is made.
Anyone convicted of methaqualone trafficking (transporting or dealing the drug) faces significantly harsher penalties. Federal guidelines mandate that a first-time trafficking offender face up to 20 years in prison and a $1 million fine. If death or serious injury is involved with the trafficking charge, the sentence must be at least 20 years with a maximum sentence of life in prison.
Methaqualone was designated a Class B drug in the United Kingdom under the Misuse of Drugs Act of 1971. As such, possession carries a penalty of three months to five years imprisonment, and trafficking carries a sentence of six months to 14 years. A fine may also be imposed.
See also Rohypnol
Johnston, Lloyd D., et al. Monitoring the Future: National Survey Results on Drug Use, 1975-2000. Vols. I and II. Bethesda, MD: National Institute on Drug Abuse, 2001.
Ziemer, Maryann. Quaaludes. Berkeley Heights, NJ: Enslow Publishers, 1997.
South Africa Health Info. <http://www.sahealthinfo.org/admodule/cannabis.htm>. April 17, 2002 (July 8, 2002.]
U.S. Department of Justice. Drug Enforcement Agency. February 2002 (April 1, 2002). <http://www.usdoj.gov/dea/concern/abuse/contents.htm>.
National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected], <http://www.nida.nih.gov/>.
Paula Anne Ford-Martin