Marketed medications, abuse control

It is appropriate to recognize that some medications are more susceptible to abuse than others. If two medications are equally effective for a given indication, the one with lower abuse liability would obviously be preferred. Information on abuse liability is necessary for the appropriate regulation of medications and provides a basis for education of physicians, patients, and the public. In this chapter we describe the control of marketed medications, abuse-liability assessment procedures for premarketing testing in laboratory animals and humans, considerations of the formulation properties, and postmarketing surveillance of abuse. Finally, we provide three case studies of marketed medications that have been abused. 

Ketamine became a controlled Schedule III substance in August 1999 based on DEA data documenting the growing abuse of this drug. The marketed forms of ketamine—Ketalar (for human use) and Ketaset, Ketajet, and Vetalar (for veterinary use)—are available only to licensed medical and veterinary personnel. Clandestine manufacture of ketamine has not been encountered because, in contrast to that of PCP, the synthesis of ketamine is a complex and time-consuming process. For this reason, the vast majority of ketamine distributed in the United States is diverted or stolen from legitimate sources, particularly veterinary clinics. 

Despite all the evidence, the political implications of the therapeutic character of Nazism, and of the use of medical metaphors in modern democracies, remain underappreciated or, more often, ignored. It is a touchy subject, not because the story makes psychiatrists in Nazi Germany look bad. That has been accepted and dismissed as an abuse of psychiatry. Rather, it is a touchy subject because it highlights the dramatic similarities between pharmacratic controls in Germany under National Socialism and in the United States under what is euphemistically called the free market. ... 

Chloral hydrate is normally used today as a sleeping pill only if a person cannot take other sleeping pills called benzodiazepines. It is marketed under the brand name Noctec. The drug comes in liquid or capsule form and may be swallowed or inserted into the rectum. Chloral hydrate is listed on Schedule IV of the Controlled Substances Act, which means that it has a legitimate medical use even though it may be abused. 

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