They're synthetic. They're clandestine. They can heal. They can kill.

• Author: Chawla, Sandeep
• Position: Amphetamine-type stimulants

The ancient Greek word pharmakon meant both medicine and poison. It was the quantity, dose and pattern of use which determined the difference between one and the other, between use and abuse, recalls Sandeep Chawla, Senior Research Coordinator, UNDCP, in this contribution to the Chronicle.

Today, astonishing changes, many of them largely unnoticed, are taking place in the grey world of drag trafficking and abuse. The most significant of these is probably the emergence of clandestine synthetic drugs as a global problem. Recognition of this problem has long been delayed by control systems, national and international, which are mesmerized by the three "classical", botanical drugs: cocaine, heroin and cannabis. Present debates about the validity of controlling cannabis under the same strict regime as cocaine and heroin continue to divert attention from tackling the problem of clandestine synthetic drugs.

Another source of difficulty is the sheer complexity of the synthetic drug problem. Psychoactive drugs - drugs whose pharmacological effect is on the central nervous system (CNS) of the body - have been around for millennia: opium, coca leaf, betel nuts, even tea. They have always had a dual nature and switchback quality. They could be used medicinally, or they could be poisonous or toxic. The development of science and technology gradually perpetuated this duality. The effects of the drug, which were sought by the abuser, were precisely those which were treated as unwanted side-effects in medicine. Pharmaceutical research on CNS-active drugs was thus set on the path of finding ever greater benefit-to-risk ratios - effort to separate the desirable (therapeutic) effects from the undesirable (addictive) side-effects.

Starting from the nineteenth century, when the active ingredients of many plants were chemically isolated or extracted - for example morphine, caffeine, ephedrine and cocaine - a more complex category of semi-synthetic drags was created. These were still, however, based on the chemical and pharmacological models of the old natural drugs, which were the essential raw material. Only at the end of the nineteenth and the early twentieth centuries did a class of fully synthetic drugs emerge. These are substances which have no counterpart in nature and can be produced in unlimited amounts from readily available chemicals. Many of these drugs were designed as structural modifications of naturally occurring drugs, with similar though more...