Aside from alcohol, the most widely used sedatives are the barbiturates and methaqualone. Barbiturates are defined as central nervous system depressants that are derived from barbituric acid. The first barbiturate, Veronal, was marketed commercially in 1903. Since then some 2,500 different derivatives have been synthesized, but only a dozen of these are widely sold and used in the United States. Barbiturates are classified according to the speed of their action. The short-acting barbiturates include Amytal ("ammies," in street parlance), Tuinal ("tooies," or "Christmas trees"), Seconal ("sekkies," "seggies," "reds," or "red devils"), and Nembutal ("yellow jackets," "nimmies," or "nimbies"); they all produce an intoxication or high if taken in sufficient doses, and they are used recreationally on the street. Long-acting barbiturates include phenobarbital and Fiorinal; they do not produce a high. and are rarely used on the street, and need not be discussed here. Methaqualone is marketed under a number of different trade names, including Quaalude ("hides"), Sopor ("soaps"), Parest, and Optimil. At one time. methaqualone was regarded by the medical profession as safe and nonaddicting. Today, it is regarded as capable of producing death by overdose. extreme mental clouding, drowsiness, discoordination, disorientation, and a true physical dependence.

Barbiturates are, in many ways, even more dangerous than heroin. The barbiturate withdrawal is even more severe and life-threatening than withdrawal from heroin—that is, it is much more likely to result in death. The classic withdrawal syndrome appears upon the discontinuation of "chronic" use of barbiturates: nausea, muscular twitching, aches and pains about the head and body, anxiety and nervousness, trembling, profuse sweating, dizziness, cramps, a feeling of feebleness, and finally, in the later stages, convulsions and sometimes coma, occasionally resulting in death. Naturally, the heavier the dependence, the more extreme the reactions. Severe dependence is induced as a result of taking roughly 800 to 1,000 milligrams daih for a month to six weeks. A moderate physical dependence can be induced with half that amount. Tolerance builds, although more slowly than with the opiates. There seems to be a kind of leveling off in tolerance level; the plateau seems to stabilize at between 1 and 2.5 grams a day. As with heroin addiction, babies born of barbiturate-dependent mothers are themselves addicted and must be withdrawn, a painful and sometimes lethal process

Death from an overdose of a barbiturate can occur at ten times the therapeutic dose (one Amytal tablet contains 100 milligrams, for example). Death is typically caused by respiratory failure, an inhibition of the breathing mechanism. Barbiturates demonstrate something of a cross-tolerance with alcohol, the two being remarkably similar in their actions; the effects of the two taken together are synergistic—that is, more toxic than the sum of their separate effects. Since the two are commonly taken in conjunction. this synergistic function is especially problematic.

The prescription use of the short-acting barbiturates, as well as methaqualone, has been dropping throughout the 1970s and 1980s, as we saw in Chapter 4. In the decade and a half from the early 1970s to the late 1980s. the number of prescriptions written for most sedatives and tranquilizers has been cut by 90 percent; this development is probably the most remarkable change that has taken place in patterns of drug use and abuse in America during this period. Has this decline in the legal prescription use of the general depressants translated into less abuse and misuse of these drugs? Are they associated with fewer medical maladies?

The evidence is consistent enough to discern a trend. Judging by the data provided by the Drug Abuse Warning Network (DAWN), the implication of barbiturates in both lethal and nonlethal overdoses diminished significantly from the late 1970s and early 1980s to the mid- to late 1980s. The number of yearly emergency-room episodes associated with barbiturates dropped by 65 percent from October 1979-September 1980 to 1986; the number of deaths by overdose in which the drug was implicated declined by 46 percent. The decline in the number of emergency room episodes and medical examiner's reports in which methaqualone was implicated during the same period was even more precipitous. (Methaqualone was not prescribed by physicians in the United States in 1985 and 1986.) ER episodes and lethal overdoses in which methaqualone was reported present declined by 90 percent between 1979-1980 and 1986. Thus the trend for these two sedatives, barbiturates and methaqualone, is unambiguously down; for the latter, it is down spectacularly. A continuation of this downward trend seems likely, at least for the foreseeable future.

The same cannot be said for PCP (also known as Serinyl, phencyclidine, or "angel dust"). PCP is usually classified as a hallucinogen, but it is in fact a powerful animal tranquilizer, sedative, and anesthetic with often inconsistent and contradictory effects. (The reason why it is mistakenly classified as a hallucinogen by most observers is that some users occasionally experience hallucinations, mainly of a delusional character. These experiences are, of course, totally uncharacteristic of those typical or common with the psychedelics or hallucinogens: There are no colors, for example, no synesthesia, no eidetic imagery, none of the same feelings of timelessness or "oneness" with the universe, no sense of the fluidity of things in the physical world, and so on. In fact, PCP shares next to no typical effects in common with the true hallucinogens. Why it is placed in this category is a mystery to me.) The number of mentions of PCP in emergency-room data fluctuates somewhat from year to year, without apparent temporal pattern, while the medical examiner's reports implicating PCP in deaths by overdose rose from 91 in 1979-1980 to 245 in 1986. Table 9.1 details the trends in overdoses for the three sedatives barbiturates, methaqualone, and PCP.

In the 1960s, barbiturates were heavily overprescribed, and the number of estimated addicts ran in the hundreds of thousands ; the syndrome of the heavy use of prescription drugs was dubbed "the hidden addiction" (Moffett and Chambers, 1970). Such misusers tended to be older, more respectable, better educated and more middleclass than the heroin addict. They began their heavy drug use much later in their lives, almost always (except for alcohol and cigarette consumption) in some sort of medical or quasitherapeutic context—to ease tension, anxiety, or sleeplessness. Few had anything to do with crime in the conventional sense. They were able to secure their "fix" without having to steal or prostitute themselves; they got their drug supply legally. Society did not frown severely on such drug use; addiction was hidden from the public and often from the addicts themselves. With the sharp cutback in prescribing barbiturates, such misuse and overuse have declined, as has the number of patients dependent on the drug.

The barbiturate intoxication would seem to have little to recommend it aside from an obliteration of one's surroundings and the creation of a hazy, dreamlike state. A reporter describes what heavy users of "downs" look like to the outside observer:  . . . look at their eyes. Chances are they'll be heavy, sleepy-looking, blinking in  slow motion stop and go. There won't be much conversation. Most of the kids   in the group you watch will probably have taken some combination of barbitu   rates and amphetamines. If they're lucky, they'll feel balanced on the kind of thin   edge of consciousness you experience just before dropping off to sleep. If not,   they'll be genuinely drowsy, depressed, and in ill temper.

Strangely, despite their   general depression, they'll be jittery, easily excitable, slightly paranoid. If any of   the kids are really strung out on pills . . . they'll look and act like maniacs. They'll   be confused, argumentative, and violent .

The acute effects of barbiturates are not uniformly sedating. In a study of criminal assaults by adolescents in California, it was found that, after alcohol, the drug the assailant most often identified himself as being under the influence of at the time of his offense was Seconal. In addition, a sizable proportion of the assaults were carried out while the offender was under the influence of alcohol and Seconal simultaneously. When asked what drug or drug type was most likely to "enhance assaultiveness," more than threefourths of these violent offenders, 78 percent, chose Seconal; 11 percent chose alcohol. A matched group of nonassaultive juvenile offenders was asked the same question. More than half (56 percent) chose Seconal and 8 percent chose alcohol (Tinklenberg, 1973; Tinklenberg et al., 1974). (The selection of Seconal over the other barbiturates reflects the illicit distribution patterns in the area in which the study was done, California, and not its special effects in contrast with the other barbiturates.) Barbiturates do not literally and directly cause criminal or violent behavior. But they may very well potentiate it or make it more likely.

As we saw in Chapter 4, since the 1970s, the recreational use of barbiturates, like their pharmaceutical use, has been dropping, although considerably more gradually. In the study of high-school seniors that has been cited previously, the proportion who had tried a barbiturate drug dropped from 17 percent in 1975 to 8 percent in 1986; in 1975, 5 percent had used a barbiturate within the past thirty days, but by 1986, this figure had shrunk to 2 percent. (The other study that I have cited, a nationally representative household survey of the entire population, did not ask about barbiturates specifically, but inquired about its sample's "sedative" use generally, so that it is impossible to determine from it separate trends in barbiturate and methaqualone use.)

The decline in the recreational use of methaqualone lagged a few years behind its spectacular decline in prescription use. In 1972, one of the trade names of methaqualone, Quaalude, ranked 112th among the nation's most commonly prescribed drugs (up from 153rd in 1971). In 1973, the federal government reclassified it as a Schedule II drug, and in a few short years, it dropped out of the circle of the top 200 drugs, never to return. As we saw in Chapter 4, more than ten times as many prescriptions for the methaqualone drugs were written in 1971 and 1976 as in 1966; in 1981, only one-third as many were written as in these 1970s peak years. By 1986, no prescriptions were written for methaqualones in the United States at all. Its heyday of popularity on the street as a recreational drug was the early 1980s. Among high-school students, its use in the mid- to late 1980s dropped by half from its peak years, and now, it is at its lowest point ever since the national surveys on high-school students were begun in 1975. Table 9.2 tells the story of methaqualone's rise and fall among America's high-school seniors. However, while methaqualone's decline in prescription use was precipitous, even spectacular, the decline in street recreational use has been much more gradual.

We had heard an awful lot about Quaaludes and, you know, about sex. That it was supposed to be so fabulous in bed and everything. So Ellen had been bugging me for weeks about copping some. I had this really hip shrink at the time, and he said he'd write up a script, you know, for me, for the Ludes. We both figured it would be therapeutic, make my sex life better. So I asked him—  why not, right? Thing is, at that time, we both worked at night, and we'd come   home kind of tired. So Ellen came home one night and she starts groping me,   with a crazed look on her face—"Quaaludes, Quaaludes," she was whispering in   my ear. So we both dropped—I think it was two 300-milligram tablets each.   Which, I know it now, it's a pretty heavy hit. I made Ellen some dinner while she   took a shower. She came out of the shower, wobbling around like she was drunk.  

I figured she was goofing, cuz I didn't feel a thing. She sat down in front of the   food I made—a cheeseburger, beans and a salad. I was watching the tube. I   looked over at her, and she's just lookin' at the food. I say, Ellen, why don't you   eat? I look back at the tube for a few minutes. Then I look back at Ellen. She's   still just staring at the plate of food in front of her. I go over and wrap each hand   around a knife and fork and say, "Eat, eat." I look back at the tube. Couple of   minutes later, I look back at Ellen. She's still staring at the food. I look more Sedatives and Tranquilizers   closely, and her head is slowly falling down. I keep lookin' at her, and her head   dropped right into the plate of food! There's ketchup and beans all over her face.

Then I got scared and got up to take care of her, and I'm feeling like I'm drunk.   I wiped the food off her face, turned off the tube, and we both hit the sack. As   soon as we pulled the covers over us, we were sound asleep. That was our big  sex orgy on Quaaludes!

Along with the stories of Quaalude's effects came medical reports of cases of a literal physical addiction to the drug, as well as cases of deaths from an overdose of methaqualone (Inaba et al., 1973). In 1970, recording artistjimi Hendrix died of an overdose of a British version of methaqualone, Mandrax. (To be more precise, Hendrix took the drug, vomited, passed out, and died of asphyxiation.) Throughout this furor, the most widely used drug reference volume, the Physician's Desk Reference, or PDR, treated methaqualone with astonishing generosity: "psychological dependence has rarely been reported with Quaalude," the PDR declared, and "physical addiction has not been clearly demonstrated." But the PDR's judgment didn't seem to sway either the federal government or physicians.

With barbiturates and methaqualone, we can see a common pattern. A drug is manufactured and distributed for profit. Aggressive advertising campaigns are launched to sell the drug and to drum up new customers for a broader and broader range of maladies and pseudomaladies. Initial claims as to its safety are made—typically with skimpy and insufficient evidence— that are later revealed to be false. The medical establishment underplays its dangers. (Remember, the bulk of revenues earned by medical journals stem from drug advertisements.) Use is initially restricted to the medical arena. Users are not deviants or criminals. As more information is gathered about the drug, increasingly, pathologies are found to be associated even with legitimate, prescription use, "as directed" by the physician. Then news of the drug's psychoactive properties leaks out. Some medical users begin to take the drug to get high. Adolescents may steal a few tablets from the family medicine chest. Eventually, the illicit use of the drug becomes sizable, not uncommonly challenging the magnitude of prescription use. A huge underground market is created; illegal distribution networks are established.

Then the scare stories begin, touching off government investigations. Controls are established on the manufacture and distribution of the drug in question—controls that may or may not stem the tide of recreational use. What began as a legal, conventional activity—medication—is converted into an illegal, deviant one. Often, the effects that are sought for both activities— an alteration of one's ordinary, everyday consciousness—are the same. Often the dangers of the legal and the illegal use of these drugs are not very different. And the original impetus for the creation and growth of illegal recreational drug use is a venerable American tradition: the quest for profit. In this case, as in so many others, crime and deviance are simply converted forms of conventional, legal behavior, with a slightly different twist and a somewhat different cast of characters.

As I've stated earlier, PCP (phencyclidine, or Serinyl) is not a true hallucinogen, and should not be classified as such. Unfortunately, most observers, including the Drug Abuse Warning Network (DAWN), the National Institute on Drug Abuse (NIDA), and the Institute for Social Research do classify it as a hallucinogen. With the exception of hallucinations, the effects of the two drug types share have next to nothing in common. I prefer to see PCP as a sedative with hallucination-like effects at high doses.

At low to moderate doses, PCP's subjective effects have been described as numbness, disorientation, "spaciness," and a kind of floating sensation. The descriptions are much like barbiturate and methaqualone highs described in the 1970s. However, in larger doses, some users experience schizophrenia like psychotic episodes, hallucinations, violence, suicidal impulses, a seeming disregard for safety, violence, convulsions, and coma. (For users' descriptions of the PCP high, see Carlson, 1979.)

PCP conforms to the medical-to-illicit use pattern discussed above, but with at least one important difference. Phencyclidine was originally developed and used as a general anesthetic for humans. However, because of the incidence of psychotic reactions observed, along with hallucinations, the medical fraternity decided that the drug was too dangerous to be used on humans. Its current legal use is entirely confined to veterinary medicine, to immobilize large animals. DAWN's data indicate a sharp increase in PCP abuse indicators between the early and the late 1970s, followed by a decline into the early 1980s, then a resurgence . Most individuals who show up at a hospital emergency room for treatment for a PCP overdose are male (72 percent), Black (54 percent), and in their twenties (62 percent). The public image of PCP users is that they are teenagers or younger; this was true in the 1970s, but is no longer the case. In 1976-1977, users age 6 to 19 made up 51 percent of all individuals presenting themselves to a clinic for a PCP-related emergency in 1983, they comprised only 18 percent. We can surmise from this that PCP users are probably getting older. During this same period, the proportion of Blacks doubled, from 24 to 54 percent, but the proportion of males remained stable throughout.

In two-thirds of all cases of PCP-related deaths, phencyclidine was found in combination with another drug—typically, alcohol or heroin. The majority of these deaths (245 in 1986) were not drug overdoses, but came about as a result of "external" sources—homicides, suicides, or accidents. (More than half of the accidental deaths were drownings.) "The various methods of death . . . are consistent with observed symptoms of disorientation and violent aggressive behavior" . This points to a possible link between PCP use and the commission of violent crime. Certainly, newspaper and magazine articles, and TV news stories, have emphasized the violence-inducing properties of PCP.

However, one study of some 4,800 Manhattan arrestees whose urine was analyzed for the presence of drugs (Wish, 1986) found that PCP's apparent role in violence and crime was not drastically different than that of the other drugs studied. Of the four drugs tested for, cocaine was the one most likely to have been found in the urine (42 percent); opiates were next most common (21 percent), PCP was third (12 percent), and methadone was last (8 percent). Almost exactly half of all the PCP-positive cases also included one of the other drugs. The most common charge for the PCP-positive arrestees was robbery. In short, the PCP-positive arrestee "looks much like other drug-using arrestees. Far from being charged with assaults or bizarre types of offenses," users of phencyclidine tend to be apprehended "for goal-oriented, income-generated crime." The study did not find "a preponderance of the types of offenses one might expect from persons committing the bizarre, irrational acts ascribed to PCP users" .

It is likely that most users, including those engaged in committing crimes, take PCP in fairly small doses; "emotionally stable people under the influence of low doses of PCP probably will not act in a way very different from their normal behavior" . While PCP is one of the most psychologically dangerous of all drugs currently in use, the vast majority of all episodes of phencyclidine use result in no serious untoward effects at all, and are described by users as mainly positive or pleasant. One estimate holds that of the roughly 20 million instances of use experienced in a given year by some 300,000 regular users, only about 5,000 or 6,000 result in such unpleasant or life-threatening effects that they require a trip to an emergency room—approximately one-thirtieth of 1 percent of all such episodes . It is easy to see that the media have sensationalized the drug and its effects, and exaggerated the most violent and bizarre aspects of the PCP experience to the point that what is actually atypical is described as common, even routine. While one does take a certain psychological risk by ingesting PCP, and while that risk is higher than it is for almost any other illicit drug currently in use, at low doses, that risk is also extremely small. Whether that risk is worth it—common sense asks, why on earth should it be?—is not a scientific or even a medical issue, but a matter of personal values.