Buprenorphine
Buprenorphine is an opioid drug used for the treatment of opioid addiction. A derivative of thebaine (chemically similar to morphine and codeine), buprenorphine hydrochloride is a partial opioid agonist that blocks other opioids from attaching to receptors in the brain. It was first marketed in the 1980s by Reckitt & Colman (now Reckitt Benckiser) as an analgesic and today primarily functions as a treatment for opioid addiction. In 2001, the Food and Drug Administration approved the use of two buprenorphine-based formulations—Subutex, which contains pure buprenorphine, and Suboxone, which features a second ingredient, naloxone, to guard against overdose. They are the first drugs available under the Drug Abuse Treatment Act of 2000, which allows qualifying physicians to practice medication-assisted opioid addiction therapy with Schedule III, IV, or V narcotics approved by the FDA.
Carisoprodol
Carisoprodol is a colorless, crystalline powder used as a relaxant used to treat muscle spasms and strains. It works by blocking nerve impulses sent to the brain and eventually metabolizes into meprobamate, an anti-anxiety drug classified as a Schedule IV drug. Carisoprodol is marketed in the United States under the brand name Soma. When taken in multiple doses, Soma can prolong the effects of other drugs, and it’s emerged in recent years due to offshore Internet pharmacies and its status as an unregulated, controlled substance. While its metabolite is a controlled substance, carisoprodol itself has never been scheduled, despite ranking fifteenth among all drugs as a cause of overdose. A 2000 report from the Drug Enforcement Administration listed carisoprodol as the most abused non-controlled substance in the country.
Duloxetine
Duloxetine is a drug that primarily used to treat major depressive and generalized anxiety disorders. Manufactured by the Indiana-based Eli Lilly & Company, duloxetine’s first public mention was made in 1988 by David T. Wong and Frank P. Bymaster, two of the researchers behind Eli Lilly’s fluoxetine (Prozac). In 2002, the drug maker joined forces with the Quintiles Transnational Corporation to commercialize duloxetine in the United States under the trade name Cymbalta. Cymbalta was approved by the F.D.A. for treatment in major depressive disorders and diabetic neuropathy in 2004—the same year in which a college student who had shown no outward signs of depression committed suicide at Eli Lilly’s lab in Indianapolis, where she’d been participating in a company drug trial for duloxetine.
Ethyl Glucuroncide (EtG)
Ethyl Glucuroncide (EtG) is a metabolite of ethanol (the intoxicating agent in fermented and distilled liquors) indicative of ethanol use even after ethanol is no longer measurable. EtG testing is not an appropriate indicator of impairment, but it does provide proof that ethanol was recently ingested. Rolling Rocks and Manhattans aren’t the only sources of ethanol. Regular use of select substances such as mouthwash, cold medicines, disinfectant, and hand sanitizer may also bring on a positive EtG result, inspiring heated debates regarding the test’s credibility. In summer 2006, the Wall Street Journal ran a story about a Pennsylvania nurse whose license had been suspended because of “flunking” such a test, despite her insistence she’d been sober five years prior to testing. Incidental exposure to alcohol can generate EtG levels as high as 15,000 ng/mL.
Ketamine hydrochloride
Ketamine hydrochloride is a general dissociative anesthetic for human and veterinary use. It’s a substance of choice for radiation and burn therapy, treatment of battlefield injuries (primarily in developing countries), and children with adverse reactions to other sedatives. Ketamine was first reported in 1962 as part of an effort to find a safer anesthetic alternative to phencyclidine (PCP), which was more likely to cause intense hallucinations and seizures. The drug was first given to American soldiers during the Vietnam War and emerged as a recreational drug in the 1970s and resurfaced in the nineties rave scene as “Special K.” Today, it’s classified as a Schedule III drug due to the debilitating nature of its side effects which, in cases of overdose, can lead to death.
Methadone
Methadone is a synthetic narcotic similar in effect to morphine. Best known for treating narcotic addiction, it’s often used as a substitute for morphine, as its slower metabolism and higher lipid solubility provide a longer-lasting effect than morphine-based drugs. Methadone was originally synthesized by German scientists Max Bockmühl and Gustav Ehrhart during World War II, when the U.S. and its allies cut off the supply of opium, which was used to prepare morphine. Its original name, Dolophine, comes from the German dolphium, which comes from the Latin dolor (meaning pain). Generally, one will only hear methadone referred to as Dolophine by older addicts who used the product in the 1960’s and 1970’s. Medical professionals who believe that Dolophine is the generic name for methadone, when it’s actually the reverse, may also use the old brand name.
Nitrous Oxide
Nitrous Oxide is a colorless, non-flammable gas used in surgical and dental procedures to reduce pain. Also known as “laughing gas,” nitrous oxide is a chemical compound that, under room conditions, possesses a pleasant, slightly-sweet odor. The gas found scientific use as an anesthetic in clinical dentistry and medicine in 1844 during a nitrous oxide exhibition in Hartford, Connecticut. In the audience was a local dentist named Horace Wells, who watched with interest as one of the volunteers inhaled the gas, then injured his leg when staggering into nearby benches. When he went back to his seat, he appeared unaware of the injury until the effects of the gas wore off. Wells immediately recognized N2O’s potential painkilling abilities—the birth of nitrous oxide as a dental and medical painkiller had arrived.
Oxycodone
Oxycodone is primarily used to treat chronic pain, especially for patients who have adverse reactions to morphine. It was first synthesized in 1916, a few years after the German pharmaceutical company Bayer stopped mass producing of heroin due to addiction and abuse by patients and physicians. One of oxycodone’s most popular trade names, OxyContin (short for Oxycodone Continuous Release), was introduced to the market in the mid-nineties by Purdue Pharma L.P., which made national news in spring 2007 for pleading guilty to misleading the public about the drug’s risk of addiction. The plea agreement came days after the company agreed to pay $19.5 million to twenty-six states and the District of Columbia to settle complaints that it encouraged physicians to over prescribe the drug.
Phentermine
Phentermine is an anorectic agent designed to stimulate weight loss in obese patients when used short-term and in combination with exercise, diet, and lifestyle changes. Classified as a Schedule IV drug in the U.S. by the FDA, phentermine was first approved in 1959 as an appetite-suppressing drug. In the 1990s, it was combined with fenfluramine or dexfenfluramine, other appetite suppressants, and heavily marketed as an anti-obesity medication called Fen-Phen. Fen-Phen was only available for a short time, as it was shown to cause potentially fatal primary pulmonary hypertension (PPH) and heart valve problems. The first PPH wrongful death case to go to trial was that of Mary J. Linnen, who received a prescription for Fen-Phen in April 1996 and experienced heart palpitations and shortness of breath after only eleven days of treatment. The FDA did not ask manufacturers to remove phentermine from the market.
Pregabalin
Pregabalin is an anticonvulsant drug used to treat neuropathic pain and is an adjunct therapy for partial onset seizures in adults. It can also be effective for treating chronic pain in disorders such as fibromyalgia and spinal cord injury and is approved to treat generalized anxiety disorder in Europe. Pregabalin is marketed by Pfizer under the trade name Lyrica, which fell under scrutiny in January 2008 when the FDA issued an alert that it and ten other “antiepileptic” drugs may double the risk of suicidality in patients. Findings from almost 200 placebo-controlled clinical studies showed that 0.43 percent of patients in the drug treatment groups experienced suicidal behavior or thoughts as opposed to 0.22 percent of the patients in placebo groups.
Quetiapine fumarate
Quetiapine fumarate is an oral antipsychotic drug used for treating schizophrenia and bipolar disorder. Deaths due to overdose are rare and typically involve ingestion of multiple other drugs. Anglo-Swedish pharmaceutical company AstraZeneca currently markets quetiapine under the brand name Seroquel, which was approved by the U.S. Food and Drug Administration for treatment of schizophrenia in 1997 and mania-associated bipolar disorder in 2004. It’s sometimes used off-label to treat conditions such as obsessive-compulsive disorder, post-traumatic stress disorder, restless legs syndrome, autism, alcoholism, and Tourette syndrome. It has also been used by physicians as a sedative for those with sleep disorders or anxiety disorders.
Salvia divinorum
Salvia divinorum is a powerful natural hallucinogen with dissociative effects. Also known as “diviner’s sage,” salvia divinorum is commonly used in healing rituals by Mazatec shamans and grown in Oaxaca, Mexico. Though salvia is legal in most countries and the majority of the United States, the drug has garnered much attention from the press and lawmakers regarding its potential for misuse. Perhaps the most well-reported case is that of Brett Chidester, a 17-year-old Delaware student who took his own life in January 2006, leaving behind a note in which he lamented that the meaning of life “is nothing.” He reportedly purchased salvia from a Canadian-based Internet company some four months prior to his suicide, which his parents believe to be the cause of his death. Most proposed bills have not made it into law.
Tetrafluoroethane
Tetrafluoroethane is a haloalkane refrigerant with thermodynamic properties similar to R-12 (dichlorodifluoromethane), but without its ozone depletion potential. Used primarily as a high-temperature refrigerant for domestic refrigeration and automobile air conditioners, it can also be found in cleaning solvents and as a propellant for the delivery of pharmaceuticals (e.g. bronchodilators), gas dusters, and in air driers for removing the moisture from compressed air. These days, tetrafluoroethane is one of several over-the-counter chemicals being abused by teenagers in the United States. In coming years, the practices of “huffing” and “dusting” have gained popularity in adolescents and teens aged 12 to 17. “Huffers” gravitate towards oven cleaners, spray paints, and aerosol deodorants by spraying the contents into a paper bag, placing the bag over their faces, and inhaling the contents. “Dusters” inhale computer-cleaning sprays containing difluroethane or tetrafluoroethane.
Z Drugs
Zaleplon, zolpidem, zopiclone, and eszopiclone (trade names Sonata, Ambien, Imovane, and Lunesta, respectively) are a group of sleep aids often classified as “Z drugs,” drugs with effects similar to benzodiazepines, which are typically used to treat insomnia. While studies have not proven them any more effective than benzodiazepines, benzodiazepines may actually worsen sleep architecture, while Z drugs have little to no disruption of normal sleep cycles. They have also been marketed as having fewer dependency issues and fewer side effects, possibly with less potential for abuse. A recent analysis of FDA data and clinical trial data shows that Z drugs at prescribed doses cause an increased risk of developing cancer in humans, including cancer of the brain, lung, bowel, breast, and bladder, and neoplasms. FDA data has also shown that zolpidem, zaleplon, and eszopiclone are clastogenic and cause cancer in rodents.