Epidemiologic issues pertinent to international regulation of 28 stimulant-hallucinogen drugs

This paper examines selected epidemiologic issues raised by the consideration of 28 stimulant-hallucinogen drugs for international drug control. New epidemiologic evidence on these drugs is presented, based on laboratory analysis of drug samples obtained from unauthorized channels of distribution in the United States. A proposal is made for experimental evaluation of international drug controls. The proposed approach is to select some of the stimulant-hallucinogen drugs which are not currently responsible for substantial drug-related morbidity and mortality, but which appear suitable for control on the basis of presumed potential for abuse and other characteristics. Then, randomly assign one-half of this group for new drug regulations, leaving the others without new regulation. If proper epidemiologic surveillance were in place, this experimental trial would produce data to help substantiate inferences about drug control efficacy. Difficulties in implementing this proposal are discussed, with emphasis on surveillance measurement problems. Some of these problems are related to the non-medical character of much stimulant-hallucinogen drug use. However, other problems such as response inconsistency may affect research in drug epidemiology generally. Data from a recent panel study of psychotherapeutic medicine use are presented to illustrate this possibility.