When I use a word . . . The languages of medicines—street drugs

Naming medicines

As I have described before,1 a medicine can have up to four different types of names:

● a unique chemical name;

● generic names, such as British Approved Names (BAN), United States Adopted Names (USANs), and International Nonproprietary Names (INNs);

● brand names, often several of them, distinct to different manufacturers;

● slang or colloquial names, generally a whole host of them.

I have previously discussed the first three of these in their various forms.2345678 Now it’s the turn of the slang or colloquial names.

Colloquial names for prescription drugs

Prescription drugs are not often referred to by colloquial names, by either patients or prescribers.

Patients rarely use generic names of medicines, more often preferring brand names or merely referring to their uses, e.g. “water tablets,” “heart tablets.”

Prescribers may use shorthand in referring to some classes of drugs, such as “thiazides” and “statins,” and the latter is also used by the general public.

Doctors have also from time to time adopted pet names for medicines. A consultant I once worked for used to refer to diazepam as “the sweeties,” at a time when the long term adverse effects of the benzodiazepines had not yet been appreciated.

When captopril was first marketed, a few cynics labelled it craptopill, although not in front of their patients. Similarly, amphotericin has been christened amphoterrible. Propofol, formulated as a white solution, has been more benignly called “milk of amnesia.”9

Street names

Drugs that are often sold on the street have accrued colloquial names that have multiplied around them and are generally known as street names.

The term “street name” originally meant simply “the name of a street,” as the Oxford English Dictionary (OED) defines it.10 The term was first recorded in 1830. The OED similarly defines a road name as “the name of a road.”11 These two definitions are reminiscent of the circular definition of a medication error as “any error that occurs at any point in the medication use process.”12 What they mean, I believe, is that a street name (and a road name) is what a thoroughfare is called. The dictionary goes on, “a representation of this on a sign, typically placed at the end of a street.” It does not include entries for such other possible terms as “avenue name,” “boulevard name,” “crescent name,” or “lane name.”

The OED’s usage data suggest that the term “street name” is used about 30 times more often than the term “road name” in modern written English, and I suspect that when people want to know the name of any type of thoroughfare they will generally ask for either the street name or the name of the street. The very first written instance of “road name” recorded in the OED, from 1878, supports this: “Most of the road-names give us little clue to the origin of the trackways which they designate; but the streets are commonly held to be of Roman descent.” My definition of a street name, “what a thoroughfare is called,” reflects the fact that any kind of thoroughfare is likely to be referred to as a street.

By 1904 the term “street name” had come to mean “a name or alias given to or used by a person (now esp. a member of a gang) on the street.” However, it was not until 1967 that the first written instance in which street names were related to drugs appeared. A street name in this context then became “the (slang or colloquial) name under which a drug is known or sold on the street.” The earliest citation quotes Frederick H. Meyers, then professor of pharmacology at the University of California, “STP is the ‘street name’ for the drug and the name means ‘absolutely nothing.’” “STP” actually stood for “Serenity Tranquility Peace,” and the drug so christened was 2,5-dimethoxy-4-methylamphetamine, also known as “DOM.” You can read about it in PiHKAL (“Phenethylamines I Have Known And Loved”) by Alexander and Ann Shulgin, in which the invention of DOM was attributed to Shura Borodin.13 For myself, I prefer to get my “STP” from Sticky Toffee Pudding.

Street drugs

From the idea of a street name for a drug came the term “street drug,” defined in the OED as “a drug sold illegally on the street.”14 This is an unsatisfactory definition, not merely because it is circular, but because it is ambiguous, in failing to characterise the types of drugs that come under this heading. For example, if in a particular jurisdiction only pharmacists can provide prescription-only medicines, whether for payment or not, then any prescription medicine provided other than by a pharmacist could be defined as a street drug.

Furthermore, a drug need not be sold to qualify as a street drug. In her novel Best Laid Plans,15 Kathy Lette’s alter ego, Lucy, found in possession of ecstasy, tries to defend herself: “I’m not a drug user. I was only purchasing them for my son.” The officer tells her that possession is a minor offence. “But now you’re telling me you’re not just using, you’re supplying?”

Finally, the term “on the street” is ill defined. The OED gives “with reference to the sale or acquisition of drugs: by illegal trafficking, when offered or sold on the streets.”16 But “on the street” does not have to be literally on the street. It could be in a park, or in a room in an apartment block, or in some other comparable place, or via the internet, or conceivably even in a pharmacy. This is generally understood, but it is not encompassed by the definition.

Defining a street drug

The definitional problem in this case is highlighted by the results of a systematic search in Google, Medline, and PsycINFO for definitions of a street drug.17 Seven different features emerged to inform a possible definition. In each case the feature was taken to be a unique indicator: recreational use, illicit use, the use of street slang to label a drug, unprofessional manufacture, the presence of impurities or adulterants, use by people “on the street,” and the use of dangerous drugs. All of these are problematic.

A proposed definition

Although all of the features mentioned above are potentially relevant, no single feature completely defines a street drug.

One feature, however, in the list is more important than the others. It is the feature that, for all its circularity, and the implication that money has to change hands, redeems the OED definition—legality.

One might therefore modify the OED’s definition of a street drug thus: “a medicinal product supplied or sold by one who is not legally permitted to do so.”

This definition would not cover all cases, especially those such as cannabis, possession and supply of which is legal in some places and not others. In other words, cannabis would be a street drug here but not there. Furthermore, it is possible for other drugs, legally available from a pharmacy to be illegally supplied in other ways, without making them susceptible of description as street drugs.

Perhaps no single dictionary-style definition is totally satisfactory.

To circumvent the limitations, a definition such as I have suggested could be afforced by an extensional list of the types of products that are likely to be subsumed by the definition. This is the approach suggested by Sussman and Huver, while recommending caution in using the term “street drugs.”17