Magazine article Addiction Professional

Field Needs More Street Smarts about These Drugs

Magazine article Addiction Professional

Field Needs More Street Smarts about These Drugs

Article excerpt

I was surprised recently when I found out that one form of the SCID (Structured Clinical Interview for DSM) asked whether an individual used "street drugs" and included on the list of drugs to be chosen benzodiazepines (such as Xanax and Valium) and opioid painkillers (such as OxyContin and morphine). As a pharmacologist, I always thought that "street drugs" were those you could buy from a drug dealer, while the drugs listed above were called "prescription drugs."

I do understand that prescription drugs can be sold on the black market and are often illegally sold "out the back door" of physicians' offices and pharmacies. However, to me the term "street drugs" conjures up a picture of illegal drugs that are not available by prescription: heroin (over 100 street names), cocaine, marijuana, Rohypnol (roofies), GHB (Grievous Bodily Harm), Ecstasy (ex), LSD (acid), ketamine (Special K), and methamphetamine (crank, ice). These are true street drugs.

What strikes me about these drugs is that not much is known about the pharmacology of any of them. Much more research is needed, but here are some things we do know:

* Heroin -- a powerful illegal drug that breaks down in the brain to morphine. Advocates who suggest that heroin be legalized to treat the pain of cancer and other diseases are not aware that simply increasing the dose of morphine will produce the same effect. There is thus no need to legalize heroin, a widely abused and dependence-producing drug.

* Cocaine -- a drug that has an approved therapeutic use (local anesthetic for eye surgery). However, one wonders whether another less dependence-producing drug such as lidocaine could not be used in place of cocaine, so that cocaine can be taken off the Food and Drug Administration's (FDA's) prescription-approved drug list.

* Marijuana -- a smokable form of THC that has some approved medicinal effects (though not in the form of a joint), is much less toxic than the legal drugs alcohol and nicotine, but is associated with dependence production. Marijuana is so controversial that one can cite scientific literature (mostly old) on marijuana effects that are both beneficial and harmful. We know a lot about the acute effects of marijuana but not much about its long-term effects. …

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