DRUG INTERNET PROJECT

1.  Cocaine:   date _______                       8.  Ketamine:  date _______

          ______________________                       _____________________

          ______________________                       _____________________

          ______________________                       _____________________

2.  Methamphetamine:  date ______                  9.  MDMA (Ecstasy):  date ______

          ______________________                       _____________________

          ______________________                       _____________________

          ______________________                       _____________________

3.  Ritalin:  date ______                                      10.  LSD:  date ______

          ______________________                       _____________________

          ______________________                       _____________________

          ______________________                       _____________________

4.  Steroids:  date ______                          11.  PCP (Phencyclidine)  date _____

          ______________________                       _____________________

          ______________________                       _____________________

          ______________________                       _____________________

5.  Heroin:  date ______                                      12.  Inhalants:  date ______

          ______________________                       _____________________

          ______________________                       _____________________

          ______________________                       _____________________

6.  Rohypnol:  date ______                        13.  Oxycontin:  date________

          ______________________                       _____________________

          ______________________                       _____________________

          ______________________                       _____________________

7.  GHB:    date _______                           14.  DXM (Dextromethorphan)

          _______________________                     _____________________

          _______________________                     _____________________

          _______________________                     _____________________