ABSTRACT
Introduction
Patterns of drug use
Myths of youthful drug use
New trends
Stimulants
Hallucinogens
Opiates
Combined substances
Future directions
Author: R. K SIEGEL
Pages: 7 to 17
Creation Date: 1985/01/01
New trends in drug use in the United States of America have usually started in populations of young users in California. The use ofhallucinogenic drugs (psychedelics), phencyclidine (PCP) and the smoking ofcocaine free base were all first detected in populations of young Californianusers. Five patterns of youthful drug use are described : experimental,social-recreational, circumstantial-situational, intensified and compulsive.These patterns are supported by several myths whereby users tend to trust theappearance and folklore surrounding specific drugs. New trends in drug usedetected in a sample population of young users in California include increaseduse of cocaine, psilocybin mushrooms, psycho-active phenylisophropylamines,PCP, fentanyl, and codeine combined with glutethimide. Other evidence suggeststhat future trends are likely to include increased use of cathinone, yohimbine,feutanyl analogues and ephedrine.
New patterns of drug use have appeared first among youth in many societies. While some of these novelpatterns have proven to be transient phenomena affecting a few young people,others have been a reflection of widespread behaviour among both youth andadult populations. Thus, a study of new fashions in drug use among youth ishelpful in identifying and predicting incipient drug problems among otherpopulations.
In the United States of America, the new patterns first appear as casual experiments among secondary school andcollege students [ 1] . Youthful experimentation with drugs has been interpreted in various ways, such as : "part of growing up"within an American Socialization and educational process ( [ 1] , p. 102) ; a search for freedom and Sensation [ 2] ; the expression of a biological drive toward altered States of consciousness [ 3] ; a result of a psychological readiness for escape, thrill-seeking, and rebellion [ 4] . These as well as numerous other explanations [ 5] have been given to youthful experimentation with both licit and illicit substances.
The specific substances chosen by youth appear to be a function of availability and need [ 1] . Availability is largely determined by economic and legal factors while need is influenced by psychosocial variables [ 6] . For example, the technological availability of inexpensive lysergic acid diethylamide (LSD) during the l 960s coupled witha youthful search for meaning and individuation led directly to the psychedelicera [ 5] , [ 7] - [ 10] . During the l960s and 1970s Cannabis became increasingly available and gradually replaced LSD as the psychedelic drug ofchoice [ 1l] . Among lower economic classes in urban environments, the low cost of phencyclidine (PCP) and its ease of productionand distribution contributed to its consistent popularity as a hallucinogenicdrug of choice throughout the 1970s [ l2] . Other readily available drugs such as tobacco, alcohol and Cannabis account for muchof the use by contemporary youth in the United States [ 13] . Users claim that these drugs help them to fulfil several psychological needs, including relief from boredom, evidence of adulthood, having fun, making friends, maintaining personal energy, and reducingstress. Contemporary youth of the l980s appear to use d rugs for reasonssimilar to those given by youth in the 1970s [ 14] , [ 15] .
Although many of the drugs used during the l 970s [ l6] are no longerpopular in the l980s, the patterns of use are the same. These patterns aredetermined by the specific drug category and its availability, as well as bythe user's needs. Five patterns of use, defined by the National Commission [ 1] , are discussed below.
Experimental use is defined as short-term, non-patterned trials of drugs with varying intensity and with a maximum frequency of 10 times. Theseusers are primarily motivated by curiosity about the drugs and a desire toexperience the anticipated effects. Experimental use is generally in socialsettings and among close friends.
Social-recreational drug use generally occurs in social settings among friends or acquaintances who wish to share an experienceperceived by them as acceptable and pleasurable. Such use is primarilymotivated by social factors and does not tend to escalate to more individuallyoriented patterns of use. Unlike experimental use which is limited to a fewepisodes, social use tends to be repeated in weekly or biweekly episodes.
This pattern of drug use is defined as a task-specific, self-limited use which is variably patterned, differing in frequency, intensityand duration. It is motivated by a perceived need or desire to achieve a knownand anticipated drug effect deemed desirable to cope with a specific conditionor . situation. Such use may occur in four or five episodes per week.
This is defined as long-term patterned d rug use at least once a day. Such use is motivated Chiefly by a perceived need to achieve relief from apersistent problem or stressful situation or a desire to maintain a certainself-prescribed . level of performance.
The pattern is characterized by high frequency and intensity levels of drug use of relatively long duration,producing some degree of dependence. The compulsive patterns are usuallyassociated with a preoccupation with drug-seeking and drug-taking behaviour tothe relative exclusion of other types of behaviour. The motivation to continuecompulsive d rug use is primarily related to a need to elicit the acute drugeffects in the face of increasing tolerance and incipient withdrawal effects.
A new form of compulsive use that has emerged in the 1980s; called "binge" or "runs" refers to continuous periods of repeated drug-taking,during which users consume substantial do Sages of d rugs. During binges, whichcan interrupt any pattern of drug use, users may assume some of the behaviouralcharacteristics of compulsive users, but they may also adopt other patterns ofuse when they are not binging. This form of drug use appears to be motivated bya desire to maximize pleasurable drug effects and is usually associated withsome degree of toxicity.
A number of beliefs or myths associated with youthful drug use support thepatterns and trends. The mythology of drug use consists of folklore, fact andfiction generated by both the pros and cons of drug use. A number of such mythsdeveloped during the 1970s [ 17] and operated to shape the specific drug trends and patterns seen among young people. The mostpopular and Significant myths affecting youthful drug use are described below.
Young drug users rely heavily on dealers, or other users, for information concerning the identity, purity and properties of drugs. Analysisof street d rug samples throughout the period 1973 - 1983 suggested thatrelatively few d rugs were the same as alleged [ 18] , [ 19] . The percentage of samples found to be the same as their alleged Contents were : cocaine, 32 percent ; amphetamine, 12 per cent ; methamphetamine, 32 per cent ; cannabis(marijuana and hashish), 90 per cent ; LSD, 88 per cent ; 34-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxymethamphetamine (MDMA),27 per cent ; mescaline, 24 per cent ; psilocin and psilocybin, 28 per cent ;heroin or other opiates, 41 per cent ; methaqualone, 37 per cent ; and PCP, 54per cent.
Many legal non-prescription psycho-active drugs are abused Widely yet perceived by youth to be safe becausethey are available over-the-counter. Contemporary trends among youth indicatedangerous abuse of these substances, particularly in view of this myth. Forexample, nasal inhaler abuse, involving the nasal decongestantsl-desoxyephedrine and propylhexedrine has been associated with both dependencyand toxicity among young users [ 20] . Certain forms of herbal cigarettes, teas and capsules are promoted as safe and legalhallucinogens, euphoriants, and cannabis substitutes, although many of themcontain psycho-active drugs that produce adverse toxic reactions [ 21] .
The strength of this myth may account for the relative paucity of botanical drugs (e. g., peyote cactus or psilocybin mushrooms) among streetsamples submitted to laboratories for analysis [ 22] . Yet the wide spread availability of psilocybin mushrooms, San Pedro cactus (Trichocereus pachanot) Containing mescaline,morning glory seeds (Riveacorymbosa and Ipomoea violacea) Containing ergotalkaloids, and Hawaiian wood rose seeds (Argyreia spp.) containing amides oflysergic acid, supports the growing popularity of these naturally occurringhallucinogens among youth.
Many young drug users readily experiment with tablets, capsules and other preparations that resemble legitimatepharmaceutical preparations. For example, counterfeit methaqualone tablets thatare produced illegally resemble "Qualude" but these tablets may containdepressants other than methaqualone. "Look-alikes" are made to look liketablets and capsules of the prescription drugs but do not contain the samedrugs [ 23] . The most common look-alikes are designed to resemble amphetamines but contain caffeine, ephedrinepseudoephedrine or phenylpropanolamine. Look-alike depressants containdoxylamine succinate, acetaminophen and Salicylamide. Counterfeit methaqualoneas well as look-alike tranquillizers have been found to contain methaqualonealong with hydroxyzine, phenobarbital, pyrilamine, diphenhydramine, diazepamand other compounds.
Even when users suspect that drugs are not pure, they usually endorse the myth that the cuts are relativelyinert diluents rather than active adulterants. However, many adulterants anddiluents have pharmacological properties, often resulting in adverse reactions.For example, heroin substitutes have been found to contain quinine, procaineand belladonna alkaloids [ 24] . Cocaine substitutes may include a variety of stimulants and local anaesthetics as well as otherdrugs such as ketamine [ 17] . Amphetamine substitutes have included Strychnine.
The patterns and myths discussed above have contributed to the occurrence of new trends and practices in drug use observed since 1977among young people whose age ranges from 10 to 21 . Sources used in thecompilation of these data includeexaminations and interviews of drug users,Drug Abuse Warning Network reports, laboratory reports on the analysis ofstreet samples of drugs, articles from the alternative or underground press, aswell as reports in the medical-scientific literature. Detailed informationabout these sources has been described by Siegel [ 17] . Drug trends seen in a combined population of youth and adults have been reviewed by Messinger [ l8] , [ 19] .
The sample of young drug users for this study was obtained from the greater Los Angeles area. Thispopulation may differ from other metropolitan areas of the United States, butCalifornia has been traditionally regarded as the origin of new drug fashionsand practices. For example, widespread use of the hallucinogens, non-medicaluse of PCP and the smoking of cocaine free base all originated in California.Thus, the study of new drug practices and trends in this population may provideimportant information on the development of drug use patterns elsewhere.
The supply and demand for cocaine among youth have increased dramatically in recentyears. The average purity of street cocaine during the period 1982 - 1984 was73 per cent and the price dropped to an average of $ 85 per gram. Thesedevelopments have contributed to the increased availability and accessibilityof cocaine to the young and to less affluent people. In Los Angeles, youngcocaine users in the 12 - l7 age group report having purchased Small quantitiesof cocaine at clubs and schools. Single doses sell for as little as $ 5 and $l0. The primary pattern of cocaine use that these young people adopted was thecompulsive binge pattern. The decreased availability of cocaine paraphernaliasuch as cocaine spoons has resulted in less precise control over individualdoses.
Among users in the l8 - 2l age group, there has been an increase in experimental smoking of cocaine hydrochloride in combinationwith tobacco or cannabis and experimental smoking of cocaine free base [ 25] . Small amounts of cocaine free base known as "rock cocaine" are sold in inexpensive individual doses and are increasinglyavailable to lower-income youth. In addition, the experimental smoking ofinexpensive coca paste has started to appear among a small group of Los Angelesyouth.
Young users reported increased use of look-alike stimulants with a concomitant decrease in actual amphetamine and methamphetamine use. Anaverage look-alike stimulant contains a combination of caffeine (250 mg),phenylpropanolamine hydrochloride (50 mg) and ephedrine sulfate (25 mg). Someusers reported ingesting l0 to l5 of these preparations per day, which producedtoxic effects. Even one or two such doses can cause hypertension or heartdamage, and in one case such use caused the death of a l7-year-old male [ 23] . The most common pattern of look-alike use was circumstantial-situational. The low cost of look-alikes makes it possiblefor users to continue consuming these substances for a long time ; l00 Capsulesor tablets sell for $ 20.
Psilocybin mushrooms remained the hallucinogen of choice among the youth studied here. The primary pattern of usewas experimental. This trend has been supported by the proli feration of salesof mushroom spores and growing kits which enable users to cultivate their ownproducts cheaply, reliably, and discreetly. The most common cultivated Specieshas been Psilocybec bensts,Selling for approximately $10 per dosage unit.Analysis of street samples has revealed a high purity of the drug [ 26] .
Since 1977 there has been a decrease in use of LSD Concomitant with anincreased use of substituted amphetamine. compounds. The most popular are MDA(3,4-methylenedioxyamphetamine), MMDA (3-methoxy 4,5-methylenedioxyamphetamine), and MDMA (3,4-methylenedioxy- methamphetamine). Increased expcrimentationwith these and related Substances has been observed since l 982. Thesesubstances have appeared under a variety of street names, such as "love drug" (MDA) and "ecstasy" (MDMA), which seem to have enhanced their appeal. Asingle capsule of these substances sells for $ 6 - l0, and ingestion results inmild hallucinogenic effects [ 27] . The major patterns of use have been experimental and Social. Analyses of street sampleshave revealed a variety of adulterants, including ephedrine,phenylpropanolamine, procaine, and niacinamide. Illicit synthesis of both MDAand MDMA may also produce street samples contaminated with toxic aminobutanehomologues.
The use of PCP has declined Since l977 [ 12] but has still remained a steady drug of choice among certain groups of youth in urban areas. Thelow-dose (35 - 75 mg) cigarettes laced with PCP powder, which were used beforel977, have been replaced by tobacco cigarettes dipped in concentrated liquidPCP. Such treatment increases the dose of PCP to as much as l20 mg percigarette. Combinations of PCP with cannabis cigarettes are also popular.Available for $l0 - 20 per cigarette, PCP is easily synthesized and can keep aperson smoking it intoxicated for most of a day. Intensified use of PCP is themost common pattern followed by users to dissociate themselves from reality.PCP is often contaminated with other psycho-active analogues. I t remains adrug of choice, although it is often associated with confusional delirium andviolent psychotic disorders [ 28] , [ 29] .
Since l980, fentanyl and its various analogues, including the so-called "China White" andother street forms of synthetic opiates [ 30] , havebeen increasingly available and abused in California. These compounds have 50 -2,000 times the strength of heroin. They are manufactured within the countrywithout the need to import opium poppy products, and Can yield profits of up to$ 2,000,000 for an investment of $ 200 in precursors. The use of fentanylcannot be detected by current urine analysis methods. Increasing numbers ofboth social-recreational and compulsive heroin users are turning to fentanyl asan alternative drug with similar effects. Fentanyl is also used in combinationwith heroin or cocaine. While use of such synthetic opiates is still limited toselected heroin dealers and their customers, the number of toxic crisisreactions resulting from their use, including respiratory depression and death,have risen in California and Arizona. The 3-methylfentanyl analogue is thoughtto have been directly responsible for 67 deaths in the California area since1980. A Contaminant of fentanyl, l-methyl-4-phenyl-l,2,3,6-tetrahydropyridine(MPTP), has been linked to cases of Parkinson's disease.
In l965 a mixture of codeine and glutethimide started to be used by individuals seeking a heroin-like euphoria. Since l98l, young usershave reported an increase in experimental and social-recreational patterns ofsuch use. Loccisano reports that the price, availability, legal status andpharmaceutical purity of these substances have contributed to their popularity( [ 3l] , p. 4). A major reason for such popularity is that a dose of the two substances combined Can be obtained for $ l0, whileit would cost approximately $ 50 for a dose of heroin producing similareffects. Physical dependency, toxic crisis reactions and fatal overdoses havebeen described as a result of this form of polydrug use. Despite such effects,the use of these two substances in combination has remained popular among youthassociated with the growing subculture of punk-rock music.
Pentazocine and tripelennamine in combination are injected to produce an initial heroin-like effect followed by a dream-like state ofeuphoria. The abuse of these two substances was associated with toxic and fatalreactions among young users until l983, when pentazocine in the Talwin formulawas changed to include naloxone [ 32] . Since then users have turned to the use of codeine and glutethimide in combination.
Predictions about future drug use among youth seem warranted in the light of this survey. The predictions are based on ananalysis of past use and recent trends, as well as on the predictions made bythe various sources of in formation referred to in this article. If the newtrends since l977 continue along their present lines, certain drug usepractices and patterns will probably be maintained into the near future.
Intranasal cocaine use in the United States increases at an estimated rate of 5,000 new users per day,and this trend will probably continue. Experimental intranasal use of cocainefree base, heroin, and other opiates, already seen in adult populations, islikely to be increasingly used in future by younger people. Preparations andderivatives of khat and cathinone have already been used in commercial cocainesubstitutes and in future may become increasingly popular as d rugs of abuse.
As more cocaine is sold in the free base form, thus saving users the cost and logistics of preparingtheir own supplies from street cocaine hydrochloride, smoking cocaine isbecoming more affordable and attractive to younger people. Since 1980 there hasbeen an increase in the number of illicit laboratories that process coca pastein the United States. This has generated domestic supplies of coca paste whichare sometimes smoked by adults but , because of lower costs than even cocainefree base, may become increasingly more popular among youth [ 33] .
Improved legislative measures and drug law enforcement activities have begun to reduce the availability of look-alikestimulants. The simple inexpensive synthesis of fentanyl and its analoguesalpha-methyl fentanyl (AMF) and para-fluoro fentanyl (PFF) will probablycontinue to make these opiates attractive to young users [ 30] .
The inconvenience of growing and storing psilocybin mushrooms is likely to result in their decreasing use. At the same time, newsynthetic hallucinogens, including substituted amphetamines , are likely to beincreasingly abused. These new hallucinogens, already appearing in California,include escaline (4-ethoxy-3,5-dimethoxyphenethylamine sulfate), CMe(2,5-dimethoxy-4-methyl-phenethylamine hydrochloride), and 2C-B(4-bromo-2,5-dimethoxyphenethylamine). Yohimbine, recently popularized as apowerful aphrodisiac [ 34] , will probably be increasingly used for smoking as well as for oral and intranasal consumption.
The current codeine and glutethimide combinations may continue slowly to disappear while experimentation with newdrug mixtures increases. Recent experimental combinations reported by youngdrug users include the following non-prescription medications : ephedrine andpyrilamine maleate ; ephedrine and phenobarbital ; and epinephrine anddiphenhydramine hydrochloride.
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