There are two principal forms of legal instrumental drug use—over-thecounter and pharmaceutical. (Drinking coffee to stay alert might constitute a third variety—with a somewhat milder effect than the first two.)

Over-the-counter (OTC) drugs are also called proprietary drugs. They may be purchased directly by the public, off the shelf, without a physician's prescription. Examples of OTC drugs include aspirin, No Doz, Sominex, Allerest, and Dexatrim. The retail sales of OTC drugs totaled about $10 billion per year in the late 1980s. OTC drugs are not strongly psychoactive and are rarely used for the purpose of getting high. (At least, not intentionally. Some OTC drugs contain caffeine and are manufactured to look like prescription drugs, mainly amphetamines. They are sold on the street as "lookalikes," and naive customers will purchase and take them as if they were the stronger psychoactive pharmaceutical.)

OTC drugs are fairly safe if used instrumentally, and they do not normally represent a threat to human life. But no chemically active substance can be completely safe, and deaths have been known to occur with these proprietary products. As we'll see shortly, through a program called DAWN (the Drug Awareness Warning Network) the federal government collects information on hospital emergencies and deaths by drug overdose in areas with roughly one-third of the population of the United States. Two OTC drugs, Tylenol and aspirin, caused more than 11,000 nonlethal hospital emergencies and 370 deaths by overdose in these areas, indicating that these drugs are far from entirely harmless. However, in relation to their total use, the toxicity of OTC drugs is extremely low, and they need not be considered in detail in this book.

Prescription drugs are also called ethical drugs because they are advertised only to professionals—pharmacists and physicians—and not to the general public. They are also called legend drugs (from the ancient meaning of the word "legend," denoting an inscription). Prescription drugs are manufactured, bought, sold, and used legally, for legitimate medical purposes. They are prescribed by physicians to patients for the alleviation or cure of physical or psychiatric ailments, and the prescriptions are filled and sold at licensed pharmacies. In the United States, there are 315,000 physicians legally permitted to write prescriptions, and 150,000 pharmacists working at 60,000 locations legally permitted to fill these prescriptions and sell the prescribed drug.

We'll describe the prescription drug situation in the United States a bit later in this chapter. Here, it is enough to know that prescription drugs— those taken legally, via prescription, for medical and psychiatric problems— are a major source of psychoactive drug use. The pharmaceutical drug industry sells about $30 billion worth of drugs each year at the retail level. Some 1.5 billion prescriptions are written in the United States each year; about one in seven of these drugs is psychoactive. (The others work almost exclusively on the body, such as penicillin and antibiotics.)

One reason why presciption drug use is so interesting to us is that, if a .:ug is psychoactive, it rarely remains exclusively within the confines of proved medical usage. Heroin, cocaine, morphine, barbiturates, sedatives, tranquilizers, amphetamines—these widely used street drugs were all riginally extracted or synthesized, then marketed, for medical purposes, and they then eventually escaped into recreational street usage. In fact, many of the psychoactive plants of the world—marijuana, the coca plant, and psychedelic mushrooms and cacti—have been used for both healing and euphoria, often within a religious context.

Thus it is misleading to think that medical and recreational use occupy totally distinct worlds. In fact, many of he drugs used in both worlds are identical, and the major motives for use m each of these two worlds—taking a drug to feel better—are not radically Efferent from one another. In fact, the licit medical and the illicit recreational worlds of drug use overlap.