America's Habit

Drug Abuse, Drug Trafficking, & Organized Crime

President's Commission on Organized Crime, 1986

Chapter II Portrait of Drug Production and Use

Cocaine Scope of the Problem

Once considered a fashionable drug for the wealthy, cocaine and its deleterious effects are now beginning to be better understood. In the past scientists made a clear distinction between physical and psychological drug dependence, but the health and social consequences of cocaine use have demonstrated that the two courses lead to the same end: cocaine, like other addictive drugs, ruins lives and kills. Widely available across the United States, cocaine is now used by individuals of all socioeconomic groups. The cocaine industry generates an estimated $11 billion in illicit income annually, and it is growing. Cocaine production, importation to the United States and consumption have all increased significantly in recent years. The cocaine industry is fueled by the approximately 25 million Americans who have tried cocaine, of which five to six million use it at least once per month. Of the regular users, it is estimated that almost half may be considered addicted. Although the total number of users appears to have leveled off in the last few years, cocaine consumption has increased 12 percent between 1983 and 1984, from 50-68 metric tons to 55-76 metric tons. As cocaine consumption has increased, so too have more dangerous forms of use of the drug and the deleterious effects associated with it. Cocaine-related deaths increased 77 percent from 1983 to 1984 and cocaine-related emergency room visits increased 51 percent. Requests for treatment for cocaine use have increased 600 percent during the past three years. In 18 states, cocaine is reported as the primary drug of abuse for clients in treatment facilities. There is no indication that without a comprehensive effort at reduction of both the supply of and demand for cocaine, the increases in cocaine use or its deleterious medical and social effects will subside in the near future. From a law enforcement perspective, the consequences of this tolerance and addiction are the intense, steady and increasing demand for the product, which generates vast revenues for organized crime. Today's Cocaine User

The cocaine industry is sustained by the appetite of the cocaine user. With the possible exception of marijuana, cocaine is used by a wider demographic cross-section of society than any other controlled substance. Facts demonstrate that the popular belief that cocaine use is restricted to the wealthy is a myth. For example, a study of 6,406 males arrested for serious crimes and processed in New York City's Manhattan Central Booking police office in 1984 reveals that 42 percent tested positively for cocaine in their system, the drug most frequently detected. The use of cocaine in combination with other drugs appears to be increasing. Fifty-nine percent of the cocaine-related deaths in 1984 involved other drugs, particularly alcohol, heroin and PCP. In addition, more dangerous routes of cocaine administration are now being used. Use of "speedballs," injections of heroin and cocaine, which are often lethal, increased 37 percent from 1983 to 1984. Smoking of coca paste and base, forms of consumption with particularly dangerous health consequences, have also increased. Surveys of cocaine users demonstrated there is no "typical" cocaine user. Results of a 1983 survey of callers to the national 800-COCAINE hotline indicate that the average caller was a 31-year old, white, middle class male with at least some college education and a job with an annual salary exceeding $25,000. Results of the 1985 survey of callers to the hotline reveal that more women, minorities and adolescents called than just two years earlier, and 73 percent of callers in 1985 reported an income of less than $25,000 per year. While almost half of the calls to the hotline in 1983 came from the northeast, calls were fairly evenly geographically distributed in 1985. Just as it has spread geographically and to different socioeconomic groups, cocaine use has increased among certain age groups. Most alarmingly, an increase in adolescent use of cocaine has been reported in the 1984 and 1985 surveys of drug use among high school seniors. The surveys found that current use of cocaine among respondents climbed from 4.9 percent in 1983 to 5.8 percent in 1984, and to 6.7 percent 1985. According to the surveys, annual and lifetime use of cocaine also increased. Health Consequences of Cocaine Use One reason that use of cocaine is so widespread is because of the properties of the drug itself. Cocaine is derived from the leaves of the coca plant (Erythroxylon coca) and has been identified by Dr. Donald Ian MacDonald, administrator of the Alcohol, Drug Abuse and Mental Health Administration, as one of the most powerfully addictive substances known to man. Cocaine is a stimulant traditionally used to produce euphoria. Other initial effects, however, typically include excitation, increased alertness, insomnia, loss of appetite, increased heart rate, increased respiration and increased blood pressure after even one use. Death can also result from first time use as discussed below. Repeated use of cocaine can cause chronic fatigue, convulsions, depression, irritability, loss of sex drive, memory problems, nasal bleeding, paranoia, severe headaches, increased body temperature and death. These symptoms are neither theoretical nor infrequent. Chronic cocaine use causes tolerance, withdrawal symptoms and addiction. Tolerance is evidenced by the fact that chronic cocaine users need to increase their dosage of cocaine to achieve the same effects as lower dosages. As dosage increases, the effect of cocaine use become more pronounced. According to cocaine researcher Dr. Reese T. Jones, "The existence of a true withdrawal syndrome following cocaine use seems compelling." This syndrome includes "depression, social withdrawal, craving, tremor, muscle pain, eating disturbance, encephalographic changes and changes in sleep patterns."

The addictive nature of cocaine and its toxicity have been documented in both animal studies and human experience. According to the results of a study reported in the July 5, 1985 issue of the Journal of the American Medical Association, 90 percent of rats self-administering cocaine intravenously died within 30 days, while the mortality rate for rats self-administering heroin was only 36 percent. The study found that rats using cocaine lost up to 47 percent of their body weight, ceased grooming themselves and deteriorated in general health. Several rats experienced seizures, but immediately self-administered more cocaine after the cessation of convulsions. The study concludes that in regard to human cocaine use: As the intake of cocaine increases and the concentration of this compound becomes greater (through the availability of higher-purity drugs, by IV injections or by 'free-basing') the number of fatalities associated with cocaine abuse is likely to increase. Hundreds of fatalities each year are associated with cocaine use. According to Dr. Mark Gold, director of research at Fair Oaks Hospital in New Jersey: "We have no way of predicting who'll die from the drug and who won't. It could be a regular user or it could be a first-time user." Although overdose is the primary cause of cocaine deaths, death can also result after a regular cocaine user takes the same amount of the drug that he usually takes. This phenomenon is known as "kindling" and is not well understood by scientists. According to Miami's Deputy Chief Medical Examiner Dr. Charles Wetli, "What was a safe dose one day becomes a fatal dose the next." The precise cause of cocaine-related deaths, regardless of dosage, include respiratory failure, cerebral hemorrhage, cardiac arrest or seizures. Because cocaine increases blood pressure and heart rate, individuals with cardiovascular problems are at particular risk. Cocaine's tendency to induce convulsions also creates special risks for epileptics. Death by cocaine is often preceded by anxiety, hallucinations, high body temperature and seizures. One common myth about cocaine is that addiction and death cannot result from intranasal use, or "snorting," which is the most common route of administration. While cocaine deaths are usually associated with intravenous use, coroners have documented cases of death from intranasal use of cocaine. One particular danger associated with intravenous use of cocaine, or any drug, is infection. Hepatitis and Acquired Immune Deficiency Syndrome (AIDS) have both been associated with intravenous drug use. Cultivation The cultivation, refinement and trafficking necessary to bring cocaine from the fields of South America to the streets of the United States obviously requires organization. Coca bushes are grown primarily in the South American countries of Peru, Bolivia and Colombia. The plants are first harvested as early as 18 months after planting, and can usually be harvested from three to four times annually for up to 20 years. The cultivation of coca has increased significantly in recent years, primarily as a result of the cultivation of new coca plants and the maturation of previously existing coca plants. Notwithstanding increased law enforcement pressure in Colombia, the tremendous profits associated with cocaine trafficking have encouraged the spread of coca cultivation throughout the region. Processing In a relatively simple chemical process, coca leaves are converted first to cocaine paste, then base, then cocaine hydrochloride (HCl), the form of coca most commonly abused in this country. The conversion of leaf to paste to base usually occurs near the cultivation site. The dried leaves are first moistened in an alkaline solution and then soaked in kerosene. The kerosene is removed leaving a cocaine precipitate. This in turn is filtered, producing a paste. The paste is dissolved in a solution of sulfuric acid and then potassium permanganate. This mixture is then filtered, ammonium hydroxide is added and the precipitate that forms is coca base. Traditionally, base has been smuggled out of Peru and Bolivia by small aircraft or boats to Colombia, where most of the refining from base to HCl takes place. In numerous cocaine laboratories in the jungles of Colombia, coca base is transformed into pure cocaine HCl by adding ether and acetone, and filtering this mixture, which is then dried. To produce one kilo of pure cocaine, approximately 500 kilos of coca leaves are needed. The pattern of processing and transshipment is somewhat different from that of cultivation. In the area of refining and smuggling cocaine, it is estimated that 75 percent of the drug available in the United States comes from Colombia, 15 percent from Bolivia, 5 percent from Peru and 5 percent from Ecuador, Argentina, Brazil, and Chile. However, these figures are subject to frequent changes because of the mobility of drug traffickers. For example, while most of the conversion to HCl takes place in Colombia, and other South American countries, an increasing number of cocaine laboratories are being seized in the United States. Six such laboratories were seized here in 1982, 11 in 1983, 21 in 1984 and 25 during the first half of 1985. Reasons for this trend include increased law enforcement in Colombia and the increasing cost of ether and acetone in Colombia. The cost of these chemicals has increased as a result of controls imposed by the Colombian government on their importation and sale and a concerted effort initiated by the U.S. Drug Enforcement Administration to disrupt the supply of chemicals essential in the cocaine refinement process. A 55-gallon drum of ether now costs approximately $7,000 in South America, while the same amount costs only $500 to $600 in the United States. Further, acetone and ether are widely available for commercial purposes in the United States, making control of their illicit use much more difficult than it has been in South America.

Heroin

Scope of the Problem

Traditionally viewed as the "hardest drug," heroin's reputation is well-earned. Although there are fewer heroin addicts than users of other illicit drugs, more deaths and emergency room visits are associated with heroin than with any other drug. Heroin's "worst drug" status has also developed because of the crime generally associated with heroin use, a stereotype of the heroin addict as an inner-city street dweller who commits crimes as his sole means of support, the fact that heroin is most often used intravenously, the dramatic addiction and withdrawal symptoms associated with use of the drug, and the relatively quick and generally lethal effects of a heroin overdose.

The Drug Enforcement Administration estimates there were 490,000 heroin addicts and users in 1981. It is estimated that thousands more individuals use heroin occasionally, but are not included in this number. While the addict population has remained relatively steady since 1979, indicators of heroin consumption and effects have increased in recent years. Annual heroin-related deaths reached 1,046 in 1984, a 31 percent increase from 1983. Emergency room visits involving heroin use increased 55 percent from 1981 to 1984, with 10,901 such visits in 1984. This represents a decrease from the 11,028 emergency room visits in 1983. Estimated heroin consumption increased 55 percent from 1981 to 1984, with 5.97 metric tons of heroin consumed in 1984. As a result of increased heroin purity and increased use of the drug in combination with other drugs, the number of heroin addicts and the number of deaths and emergency room visits associated with heroin use should be expected to increase.

Heroin is thus an extremely valuable commodity for organized crime: in fact, an ounce of pure heroin is approximately ten times more expensive than an ounce of gold. Heroin users provide organized crime with billions of dollars each year: it is estimated that illegal income from heroin sales in the United States totaled $6.12 billion in 1982.

The Heroin Addict

Historically, data collection and law enforcement experience support the view that heroin use has been an urban phenomenon, confined in large part to minority populations. One recent study of black inner-city heroin users across the country suggests the extent of heroin's grip in those areas:

Because of the regular availability of heroin and the structure of the relationship of intercity residents to society, the heroin lifestyle has become firmly established as an alternative lifestyle for Black youngsters.

Such studies typically reveal a portrait of the heroin addict as an unemployed, minority male with little education who commits crime to support his habit: A 1985 study of heroin users in East and Central Harlem found the following: 75 percent were male; 55 percent were black and 44 percent Hispanic; 36 percent were under 30 years of age; 61 percent had less than 11 years of education; and 81 percent were unemployed. The annualized crime rate for these heroin users was 1,075 crimes per person. Crimes committed by heroin addicts includes property crime, violent crime and drug offenses.

While regular use of heroin is generally addictive, there appears to be a group of users, known as "chippers," who are able to use heroin occasionally over a long period of time without becoming addicts. In his study of heroin, Stanford University professor John Kaplan maintains:

It is now clear that there exists a sizable population of non-addicted but regular heroin users who seem well integrated into society and in many ways indistinguishable from the rest of the population.

Recently a new group of heroin users has emerged that includes both addicts and non-addicts. These are the "middle class" users, who are involved with heroin as a result of their cocaine habits. In order to counteract the effects of heavy cocaine use, many began to use heroin intranasally, and eventually became addicted to the drug. Dr. Forest Tennant, director of a number of drug abuse clinics in the Los Angeles area, observes:

As cocaine use increases, we're seeing more addicts because heroin is the strongest neutralizer around for cocaine toxicity . . . And we're not talking about gang members and derelicts. I'm treating people who pay their union dues, go to the PTA, take their kids to Little League. We've even got a program for executives.

Health Effects of Heroin Use

While narcotics serve an essential medicinal purpose as analgesics, or painkillers, they are often abused. Heroin, the most abused opiate, is derived from the opium poppy (Papaver somniferum). Heroin is generally used intravenously, the most efficient and dangerous route of administration. "Speedballs," injections of heroin mixed with cocaine, are particularly dangerous. Heroin can also be used subcutaneously, called "skin-popping." All of these intravenous forms of use are associated with AIDS and hepatitis, as discussed earlier. In addition, heroin can be smoked or used intranasally.

Heroin is a particularly dangerous drug because of the ease with which a user can overdose, A lethal dose of heroin is only 10 to 15 times a normal dose. According to Dr. Donald C. Thomas III, former director of emergency care at the District of Columbia General Hospital:

Heroin numbs you to pain, gives you a euphoria, takes you away from reality, makes you slower and changes appetites . . . The real problem for an addict is that the threshold between the dose of heroin that gives that effect, as opposed to the dose that will kill him by suppressing respiratory or cardiac centers in his brain, is very narrow.

Multiple overdose deaths sometimes result from one "batch" of heroin. In March 1985, for example, according to local press accounts, 8 people died and 14 were hospitalized in a few days in Washington, D.C., after injecting some particularly potent heroin. Seven months earlier, 10 people died in Washington within 8 days in a similar incident. It is striking evidence of the drug's overpowering influence that this risk of sudden death apparently poses no deterrent to the seasoned user. As expressed by one heroin addict:

A true, full-blown drug addict would follow a morgue wagon to its origin of overdose to obtain that substance.

Cultivation

Heroin entering the United States is produced from opium poppies, which are harvested in Iran, Afghanistan and Pakistan (Southwest Asia, the Golden Crescent); Burma, Thailand and Laos (Southeast Asia, the Golden Triangle); and Mexico. In 1984, an estimated 51 percent of United States heroin came from Southwest Asia, 32 percent from Mexico and 17 percent from Southeast Asia.

From 1983 to 1984 illicit opium production decreased in Southwest Asia. This change resulted from decreased figures for opium production in Afghanistan caused by adverse weather conditions and a change in the methodology used to estimate opium production in Afghanistan. While total opium production for Southwest Asia decreased in 1984, significant production increases were noted in Southeast Asia and Mexico.

Opium poppy cultivation has begun to appear in the United States as well. During a Federal raid in August 1985, more than 4,000 opium plants were discovered in Vermont, Washington, Michigan and California. Although officials of the Drug Enforcement Administration believe this opium was used for smoking, the potential for domestic heroin production exists.

While America's heroin addict population has remained relatively stable, the problem of heroin addiction in Europe has increased significantly in recent years. According to a 1984 United Nations report:

The drug abuse and trafficking situation in Western Europe is grim and deteriorating . . . Western Europe remains seriously affected by heroin abuse which is a major public health problem.

The number of heroin addicts in the opium producing and other countries is also significant.

There is a greater sense of the need for international cooperation on the problem of drugs, in part because drug producing nations are now feeling the effects of drug abuse, with which the industrialized world has dealt for decades. This development is critical if drug control efforts, including crop eradication, interdiction and drug education, are to be successful.

Processing

The production of heroin begins after the petals of the opium poppy flower have fallen. Several incisions are then made in the seed pod from which sap oozes. The sap dries, darkens and becomes gummy, and is scraped from the pod. This dried sap is raw opium. Each pod can be incised up to five different times.

To produce one kilogram of heroin, a precipitating agent is added to 10-12 kilograms of opium. This mixture is pressed, leaving one kilogram of morphine base. This base is treated with acetic anhydride, which yields one kilogram of heroin. In another production method, poppies are allowed to mature and dry. Alkaloids are then extracted from these plants leaving poppy straw concentrate, which is sold in a brownish powder form.

Marijuana

Scope of the Problem

According to the most recent National Survey on Drug Abuse, which was conducted in 1982, 50-60 million Americans, approximately 20-25 percent of the entire population, have tried marijuana; and 20 million people use the drug at least once per month. Marijuana use has been widespread in this country for the last two decades. Both the number of users and the duration of marijuana's popularity indicate that marijuana use is firmly entrenched in American society.

Although some surveys indicate that the number of marijuana users has been declining recently, levels of use remain significantly higher than for any other illicit drug. The National Survey on Drug Abuse indicates a decline in marijuana use for some age groups. Yet the survey shows that in 1982, 11.5 percent of 12-17-year-olds and 27 percent of 18-25 year olds used marijuana at least once per month. The study indicates a slight, but steady, increase in marijuana use among people over age 25. In 1977, 3.3 percent reported monthly marijuana use, compared with 6.0 percent in 1982. According to the survey of high school seniors conducted each year by the University of Michigan Institute for Social Research, marijuana use among high school seniors peaked in 1978, when 37 percent of these students reported monthly use of marijuana and 11 percent reported daily use of the drug. By 1984 these figures had dropped to 25 percent and 5 percent respectively. However, this decline in marijuana use ended in 1985 when 26 percent of the survey respondents reported monthly marijuana use.

Marijuana consumption and the number of marijuana-associated emergency room visits have remained relatively steady in recent years. In 1984 Americans consumed an estimated 7,800-9,200 metric tons of marijuana, as compared with 8,000-9,600 metric tons in 1983. Use of marijuana in conjunction with other drugs, particularly PCP, diazepam and cocaine, increased in 1984.

The Marijuana User

Marijuana is probably used by a wider demographic cross-section of American society than any other drug. This widespread use was recognized by the 1972 National Commission on Marihuana [sic] and Drug Abuse:

The stereotype of the marihuana [sic] user as a marginal citizen has given way to a composite picture of large segments of American youth, children of the dominant majority and very much part of the mainstream of American life.

While it appears that marijuana, like other drugs, is most commonly used by those between the ages of 18 and 25, its use is by no means confined to that age group. One analysis of marijuana use found that:

Marijuana is now found at the Friday afternoon brainstorming sessions of a New York publishing house. In the cabs of long-haul trucks. In the office of a president of a cosmetic firm. Even, it is alleged, among executives of major American banks.

According to the 1982 National Survey on Drug Abuse, 23 percent of 16 and 17 year olds, 8 percent of 14 and 15 year olds, and 2 percent of 12 and 13 year olds used marijuana at least once per month. Surveys have indicated marijuana use in children as young as nine years old.

Health Effects of Marijuana Use

Marijuana includes any part of the plant Canabis sativa. In addition to marijuana, the following forms of cannabis are also abused: hashish, a resin of the plant; hashish oil, a liquid concentrate derived from cannabis; and sinsemilla, from the female cannabis plant.

The effects of marijuana use have been the subject of exaggeration and misunderstanding for decades. In 1936, for example, the film "Reefer Madness" portrayed those effects as instant violence and insanity. In 1972 the National Commission on Marihuana [sic] and Drug Abuse embraced the opposite extreme:

No conclusive evidence exists of any physical damage, disturbances of bodily processes or proven human fatalities attributable solely to even high doses of marijuana . . . [The] few consistently observed transient effects on bodily function seem to suggest that marihuana [sic] is a rather unexciting compound of negligible immediate toxicity at the doses usually consumed in this country.

Both views have been refuted by medical evidence gathered since the early 1970's. Today marijuana is described as "the most chemically complex of all commonly used illegal drugs." Marijuana contains 421 known chemicals, which when smoked are combusted into more than 2,000 chemical compounds. Marijuana is variously classified as a stimulant, depressant and hallucinogen because its effects vary among users.

Those chemicals found only in cannabis are called cannabinoids. The primary intoxicant in marijuana is delta-9-tetrahydrocannabinol (THC). The concentration of The in marijuana has steadily increased over the last decade as a result of improved agricultural techniques. Analysis of marijuana samples indicates that the average percentage of The in marijuana has increased from .7 percent in 1973, to 3.1 percent in 1982, to 5.6 percent in 1983. The potencies have been reported as high as 14 percent in domestically produced sinsemilla.

Since 1967 when the first intensive government research program on marijuana began, over 7,000 scientific papers have been published on the subject. Contrary to the findings of the 1972 National Commission on Marihuana and Drug Abuse, adverse physical and psychological effects associated with marijuana use have been demonstrated. The measurement of long-term effects of marijuana use are at present problematic because marijuana smoking has been prevalent in the United States for only approximately 15 to 20 years, shorter than the latency period for many marijuana-related diseases. In the case of tobacco it was not until after 50 years of heavy use that there was ample evidence to issue warnings about its effects.

Despite the common public perception that marijuana is less harmful than tobacco, scientific evidence indicates that marijuana, in fact, causes substantially more adverse health effects, due in part to the properties of the drug itself and the manner in which it is smoked. Marijuana is not filtered, as are most tobacco cigarettes, and marijuana smoke is generally inhaled more deeply and held in the lungs longer than tobacco smoke. Marijuana smoke has been found to contain many of the same chemicals as tobacco smoke; indeed it has 50 percent more of cancer-causing hydrocarbons than tobacco smoke.

According to the American Lung Association, marijuana smoking harms the lungs and may cause bronchitis, emphysema and lung cancer. Evidence supporting this conclusion has been building for a number of years. For example, a 1976 study reported that examinations of human lung tissue "have found malignant cellular changes after shorter periods of exposure to marijuana smoke than to tobacco smoke." One comprehensive review of marijuana projects that:

Starting in the latter 1980's, we predict an increase in the rate of lung cancer among middle-aged people, representing the marijuana epidemic that began in the mid-sixties. Those smoking both tobacco and marijuana are most at risk.

Marijuana use can also adversely affect both male and female reproduction. Marijuana use by pregnant women is particularly dangerous and has been linked to lowered birth weight, fetal abnormalities and nervous disorders in offspring. These adverse physical effects are magnified because cannabinoids, being fat soluble, collect in the fatty organs of the body, such as the testis or ovaries, brain and liver. This is of particular concern because marijuana is used by a large population of young people whose lungs, reproductive organs, and other parts of their bodies are still maturing and are particularly vulnerable to the adverse effects of drugs.

In addition to these physical effects of marijuana use, several psychological and behavioral effects have also been associated with the drug. These behavioral changes have been called "the amotivational syndrome." Although lack of motivation may often precede marijuana use, many clinicians have concluded that:

Motivational effects are directly related to use and . . . following cessation of marijuana use normal motivation may return.

In addition to the effects of marijuana on motivation, marijuana use has been found to affect short-term memory, concentration, and logical thinking. A 1982 report concerning the impact of marijuana use on education concludes that:

Every element of learning is incompatible with either the acute intoxication or the chronic mental change that marijuana use can bring.

A 1980 study reported that use of marijuana 20 times or more per month is "positively correlated with absenteeism and poor school achievement among high school seniors." These conclusions are particularly disturbing given the fact that tens of thousands, perhaps even hundreds of thousands, of adolescents use marijuana every day.

A final concern in this area, marijuana's role as a "gateway" to subsequent use of more dangerous drugs, cannot be categorized as either physical or psychological. While many beliefs about marijuana have been proven wrong by subsequent research, this concept has been affirmed. This "gateway" theory does not indicate that marijuana use will definitely lead to the use of other drugs; however, according to a review of marijuana studies conducted by the Department of Health and Human Services,

Statistically, there is little question that use, particularly heavier use, is associated with a likelihood of experimentation with other drugs.

Synthetic Drugs

Scope of the Problem

Many illicit drugs do not occur naturally. Unlike cocaine, heroin and marijuana, which are derived from plants, synthetic drugs are produced solely from chemicals. These synthetic drugs include stimulants, depressants and hallucinogens, known as dangerous drugs; synthetic narcotics, such as methadone; and controlled substance analogs, often called "designer drugs." A controlled substance analog has a chemical structure similar to a controlled substance, and is designed to produce a similar effect.

Use of synthetic drugs is widespread in the United States. More than six million Americans used synthetic drugs for non-medical purposes in 1982. Over 2.5 million people abused depressants, approximately 2.8 million abused stimulants, and almost 1 million abused hallucinogens. Consumption of "dangerous drugs" increased 15 percent between 1983 and 1984, from an estimated 2.66 billion dosage units to 3.06 billion dosage units. The greatest increases were associated with methamphetamine and phencyclidine (PCP). Methamphetamine-related emergency room visits increased 20 percent from 1983 to 1984, and deaths associated with both amphetamine and methamphetamine also increased in 1984.

Statistics regarding the use of controlled substance analogs are difficult to compile. This is because the use of these substances is a relatively new phenomenon, and medical examiners have generally failed to identify controlled substance analogs as a cause of death. Despite these difficulties, one synthetic analog has been responsible for the deaths of at least 100 people on the West Coast. While most of these deaths occurred in California, many law enforcement authorities fear that production and use of controlled substance analogs might spread across the country because of the ease of production and large profit margin associated with these drugs. This spread has already occurred in at least one instance: drug treatment program directors in California, Florida, New York, Texas and Virginia have reported cases of use of the controlled substance analog MDMA.

Synthetic Drug Users

While synthetic drugs are used for a wide range of medicinal purposes, they are also widely abused by individuals from all socioeconomic groups. According to a 1978 study of individuals in treatment for stimulant and/or depressant drug abuse, 68 percent were men, 61 percent were white, 20 percent black and 19 percent of another ethnicity, 59 percent were unemployed, 77 percent had previously been treated for drug abuse, 59 percent were 25 years of age or older, and 46 percent had less than a twelfth grade education.

While most people associate heroin use with crime, a 1982 study by the RAND Corporation found violent crime to be committed most often by multi-drug users, particularly those using combinations including dangerous drugs. Certain synthetic drugs are particularly associated with crime. A study of all arrestees in Washington, D.C., from May 1984 to April 1985 found that PCP, an hallucinogen, is the drug most often detected in these arrestees. An average of over 30 percent of all adults arrested in Washington, D.C., during this period tested positive for PCP use. A study of almost 5,000 male arrestees in New York City in 1984 found that 12 percent of those arrested had PCP in their bodies.

Health Effects of Synthetic Drug Use

Tolerance to stimulants develops quickly. Because of the "crash," or depression, followed by stimulant use, users tend to take stimulants more often in order to compensate for or avoid the post-stimulant letdown. Stimulant users are subject to a vicious cycle in which they must take depressants at night to be able to reverse the stimulant's effects. Stimulants can cause physical dependence and death. Withdrawal is characterized by depression, fatigue and excessive sleep, which may last for several days. Other withdrawal symptoms, including anxiety and thoughts of suicide, may last for weeks or months.

Depressants can also cause tolerance and physical dependence. Abuse of depressants is marked by impaired judgment, slurred speech and loss of motor coordination. Depressants are particularly dangerous when used in combination with alcohol or other drugs. Heavy use of depressants can cause a weak, rapid pulse, shallow respiration, coma and death.

Hallucinogens alter mood, and, in large doses, cause delusions and hallucinations. This impaired judgment can lead a user to physically harm himself or others. "Flashbacks," in which the user has a brief recurrence of the psychedelic effects of hallucinogens, sometimes occur long after the drug is used. Tolerance and psychological dependence can also result. PCP, often called "Angel Dust," is one of the most dangerous and widely abused hallucinogens. Reactions to PCP are unpredictable and include euphoria, depression, anxiety or panic. PCP use is associated with extremely violent behavior, including assault, rape, and murder. Feelings of omnipotence sometimes lead a PCP user to suicidal behavior, including walking in front of moving vehicles or jumping out of windows.

Controlled substance analogs are designed to mimic the effects of various drugs and are particularly dangerous because of their toxicity. One synthetic analog, 3-methyl fentanyl, is up to 1,000 times more potent than morphine. According to Dr. Robert J. Roberton of California's Department of Alcohol and Drug Programs, "You could kill 50 people with the amount that fits on the head of a pin."

Fentanyl analogs, the most commonly abused controlled substance analogs, produce a feeling of euphoria similar to that associated with heroin use. These drugs also produce respiratory depression and muscle rigidity. MPTP, which is a synthetic analog of the narcotic meperidine, causes brain damage, Parkinson's disease and death. Although Parkinson's disease usually strikes people in their fifties and sixties, people of various ages, who have used MPTP, have contracted the disease, which causes slowed movement, tremors, rigidity, dementia and death. The neurological damage associated with use of MPTP is irreversible.

Drug Abuse Fuels Drug Trafficking

Drug abuse in the United States is a problem of vast and growing proportions Millions of Americans use cocaine, heroin, marijuana, or synthetic drugs, or combinations of these drugs. Consumption of cocaine and dangerous drugs has increased recently as have the deleterious health effects associated with then. The downward trend in marijuana use which began in 1979 appears to have ended at least temporarily in 1985.

Particularly dangerous forms of drug use have increased during the last few years. Use of "crack," coca base which is smoked and which has been called the most potent, addictive, and cheapest form of cocaine, has become prevalent in the New York City area. Use of "designer drugs," some of which have caused Parkinson's disease, have been blamed for over 100 deaths. There is evidence of a link between intravenous drug use and the contraction of Acquired Immune Deficiency Syndrome (AIDS).

Drug abuse affects much more than the individual drug user; it also impacts on families, communities and entire governments. The taint of drugs has reached into virtually every aspect of American life, from public safety to the integrity of professional sports. These problems and the full range of massive government and private responses discussed in this report, including increased education and enforcement efforts, expanded intelligence and interdiction programs, and diversions of military resources, costing billions of dollars, is the direct result of a single cause: the destructive self-indulgence of individual drug purchasers. Each time a drug user buys cocaine, heroin, or other drugs, he makes a contribution to organized crime. Such contributions are the sole sustenance of the violence, corruption, illness and death that trafficking groups bring to this and other societies.