Supplemental Drug Card

The supplemental drug card follows the format of the drug card developed for the Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM), with a list of drug categories and common drug names. The CIDI-SAM drug card was modified to include additional drug names provided by the Monitoring the Future Survey (Combined Forms – PartB) (indicated by “a”), the National Survey on Drug Use and Health (indicated by “b”), the Working Group member recommendations (indicated by “c”) and the National Epidemiologic Survey on Alcohol and Related Conditions (indicated by “d”)

Marijuana
-Bluntsc
-Dope d
-Grass
-Hashish
-Hasha
-Hash oila
-Joint d
-Mary Janec
-Pot
-Synthetic marijuana (spice, K2, kronic)
-Spliffsc
-THC
-Weeda / Stimulants
-Adderall®a(amphetaminea and dextroamphetamineb)
-Amphetaminesa
-Bennies d
-Benzedrine®a(amphetamine sulphatec)
-Crystal d
-Cranka
-Cylert® (pemoline)a
-Desoxyn®b (methamphetamine, crystal metha, desoxynb, ice, metha, methedrinea)
-Dexedrine®a(dextroamphetamineb)
-Didrex®b (benzphetaminec)
-Eskatrol® (dextroamphetamine and prochlorperazine)c
-Focalin®a(dexmethylphenidatec)
-Ionamin®b (phenterminec)
-Khat
-Mazanor®b, Sanorex®b (mazindolc)
-Methedronec
-Obedrin-LA®b(methamphetamine hydrochloridec)
-Pep pills (or party pillsc, uppers, upsa)
-Plegine®b (phendimetrazinec)
-Preludin®b (phenmetrazinec)
-Provigil®d
-Ritalin®a, Concerta®a, Metadate®a (methylphenidatea)
-Speed
-Tenuate®b (diethylpropionc)
-Other stimulant / Sedativesa and Tranquilizersa
-Ambien®a(zolpidemc)
-Amytal®b(amobarbitalc)
-Aquachloral Supprettes®c, Somnote®c (chloral hydrateb)
-Atarax®b(hydroxyzinec)
-Ativan®a(lorazepamb)
-Barbituratesa
-Benzodiazepines d
-Buspar®b(buspironec)
-Butisol®b(butabarbital sodiumc)
-Dalmane®b(flurazepamc)
-Downers (or downs)a
-Equanil®, Miltown® (meprobamate)b
-Flexeril®b(cyclobenzaprine)
-Halcion®b(triazolamc)
-Klonopin®a(clonazepamb)
-Librium®a(chlordiazepoxidec)
-Limbitrol®b(amitriptyline and chlodiazepoxidec)
-Lunesta®a (eszopiclonec)
-Methaqualoneb (or quaaludesa, soapersa, quadsa, ludesa, soporb)
-Nembutal®a(pentobarbitalc)
-Placidyl®b(ethchlorvynolc)
-Restoril® (temazepam)b
-Seconal®a(secobarbitalc)
-Serax®a(oxazepamc)
-Sleeping pills
-Solfoton®c (phenobarbitala)
-Soma®a(carisoprodolc)
-Sonata®a(zaleplonc)
-Tranks
-Tranxene®b (clorazepatec)
-Tuinal®a(secobarbital sodium and amobarbital sodiumc)
-Valium®a(diazepamb)
-Vistaril®b(hydroxyzinec)
-Xanax®a(alprazolamb)
-Other sedativec
-Other tranquilizerb
Club Drugs
-BZP (benzylpiperazine)c
-Exstasy d
-GHB (gamma-hydroxy-butyratec, Grievous bodily harma)
-Ketalar®c, Ketalar®c (ketamine)
-Liquid Ga
-MDMA d
-Mollyc
-Rohypnol® (flunitrazepamc, roofies, rophies)a
-Special Ka
-Super Ka
-XTC d
-Other club drug / Cocaine
(or blow d, snow d, cokea, crack, rocka) / Heroin
(or smack d, black tar d, poppy d)
Opioids
-Actiq®c, Duragesic®c (fentanyl)c
-Codeinea
-Darvon®, Darvocet®b (propoxypheneb)
-Demerol®a(meperidinec)
-Dilaudid®a(hydromorphonec)
-Dolophine®c, Methadose®c (methadonea)
-Fioricet®b(acetaminophen, butalbital, and caffeinec)
-Fiorinal®b(aspirin, butalbital, and caffeinec)
-Hydrocodoneb
-Morphinea
-Opana®c (oxymorphonec)
-Opium
-OxyContin®a, Roxicodone®c (oxycodoneb)
-Percocet®a, Tylox®b (acetaminophen and oxycodonec)
-Percodan®a(aspirin and oxycodonec)
-Phenaphen with Codeine®b, Tylenol with Codeine®b (acetaminophen and codeinec)
-SK65b
-Stadol®b(butorphanol nasal sprayc)
-Suboxone® (buprenorphine and naloxone)c
-Subutex® (buprenorphine)c
-T’s & blues
-Talacen®b (pentazocine and acetaminophenc)
-Talwin®a, Talwin Nx®b (pentazocine lactatec)
-Ultram®a(tramadolb)
-Vicodin®a, Lortab®b, Lorcet®b (acetaminophen and hydrocodonec)
-Other opioid
-Other pain relieverb / PCP
(or angel dusta, phencyclidineb) / Hallucinogens
-Angel Dust d
-2C-Ec
-2C-Ic
-Cactus d
-Concentrated THCa(∆9-tetrahydrocannabinolc)
-DMT (dimethyltryptaminec)
-Ecstasy (or MDMA, 3,4-Methylenedioxymethampheta-minec)
-Foxy (or Foxy methoxy)c
-LSD (or acid, lysergic acid diethylamidec)
-Mescaline
-Peyote
-Psilocybin (or Mushrooms, shroomsa)
-PCP d
-Salviaa
-Other hallucinogen
Inhalants or Solvents
-Aerosolsa
-Amyl nitrite (or poppers, butyl nitrite, rushb)
-Cleaning fluid d
-Correction fluid (or degreaser)b
-Glue (or shoe polishb, toluene)
-Gasoline (or lighter fluidb)
-Halothane (or ethic, other anesthetic)b
-Laughing gasa
-Lighter gases (or butane, propane)b
-Nitrous oxide (or whippetsb)
-Paint (or spray paintb)
-Paint thinner (or lacquer thinner, other paint solvents)
-Poppers d
-Other aerosol spraysb
-Other inhalantsb / Other Drugs
Designer drugsc
-Bath salts (or Ivory Wave, Bliss, Red Dove, Vanilla Sky)c
-MDPV (methylenedioxypyrovalerone)c
-Mephedrone (or miaow miaow)c
-Woof woofc
Performance-enhancing drugsc
-Androstenedionea
-Anabolic steroids
-Androa
-Creatinea
-Energy drinksa
Over-the-counter medicinesc
-Cough and cold medicinesa
-Diet pillsa
-DXMa (dextromethorphanc)
-Robosa
-Stay-awake pillsa
Others
-Elavil
-Thorazine
-Haldol
-Kratomc
-PStrattera®a (atomoxetinec)
-Tenex®a(guanfacinec)
-Tofranil®a(imipraminec)
-Wellbutrin®a (bupropionc)
-Anything else
______
(specify)