DEA Briefs & Background, Drugs and Drug Abuse, Drug Descriptions, Anorectic Drugs

Anorectic Drugs

A number of drugs have been developed and marketed to replace amphetamines as appetite suppressants. These anorectic drugs include benzphetamine (Didrex®), diethylproprion (Tenuate®, Tepanil®), mazindol (Sanorex®, Mazanor®), phendimetrazine (Bontril®, Prelu-27®), and phentermine (lonamin®, Fastin®, Adipex®). These substances are in Schedule III or IV of the CSA and produce some amphetamine-like effects. Of these diet pills, phentermine is the most widely prescribed and most frequently encountered on the illicit market. Two Schedule IV anorectics often used in combination with phentermine (phen-fen combo), fenfluramine and dexfenfluramine, were removed from the U.S. market due to heart valve problems.

Buprenorphine

This drug is a semi-synthetic narcotic derived from thebaine and is currently being investigated for the treatment of narcotic addiction. Like methadone and LAAM, buprenorphine is potent (30 to 50 times the analgesic potency of morphine), has a long duration of action, and does not need to be injected. The buprenorphine products under development are sublingual tablets. Unlike the other treatment drugs, buprenorphine produces far less respiratory depression and is thought to be safer in overdose. Buprenorphine is currently available in the United States as an injectable Schedule III narcotic analgesic (Buprenex®) for human and veterinary use.

Butorphanol

While butorphanol can be made from thebaine, it is usually manufactured synthetically. It was initially available in injectable formulations for human (Stadol®) and veterinary (Torbugesic® and Torbutrol®) use. More recently, a nasal spray (Stadol NS®) became available, and significant diversion and abuse of this product led to the 1997 control of butorphanol in Schedule IV of the CSA. Butorphanol is a clear example of a drug gaining favor as a drug of abuse only after it became available in a form that facilitated its mode of administration (nasal spray v. injection).

Chloral Hydrate

The oldest of the hypnotic (sleep inducing) depressants, chloral hydrate was first synthesized in 1832. Marketed as syrups or soft gelatin capsules, chloral hydrate takes effect in a relatively short time (30 minutes) and will induce sleep in about an hour. A solution of chloral hydrate and alcohol constituted the infamous “knockout drops” or “Mickey Finn.” At therapeutic doses, chloral hydrate has little effect on respiration and blood pressure; however; a toxic dose produces severe respiratory depression and very low blood pressure. Chronic use is associated with liver damage and a severe withdrawal syndrome. Although some physicians consider chloral hydrate to be the drug of choice for sedation of children before diagnostic, dental, or medical procedures, its general use as a hypnotic has declined. Chloral hydrate (Noctec® and other) and compounds, preparations, or mixtures containing choral hydrate are in Schedule IV of the CSA.