DRUG USE

use of drugs for psychotropic rather than medical purposes. Among the most common psychotropic drugs are opiates (opium, morphine, heroin), hallucinogens (LSD, mescaline, psilocybin), barbiturates, cocaine, amphetamines, tranquilizers, and cannabis. Alcohol and tobacco are also sometimes classified as drugs. The term drug abuse is normally applied to excessive and addictive use of drugs. Because such drugs can have severe physiological and psychological, as well as social, effects, many governments regulate their use. Additional reading Reference works include Marc A. Schuckit, Drug and Alcohol Abuse: Clinical Guide to Diagnosis and Treatment, 4th ed. (1995), clearly and economically written; and Jerome H. Jaffe (ed.), Encyclopedia of Drugs and Alcohol, 4 vol. (1995), containing more than 500 articles, bibliographic references, and an extensive index. General discussions about drugs, human behaviour, and social issues include Harold Kalant and Oriana Josseau Kalant, Drugs, Society, and Personal Choice (1971), a succinct, scholarly review of drug reactions on the body and the dilemma society faces in developing drug policies; Edward M. Brecher et al., Licit and Illicit Drugs (1972), a classic when written, which combines history, drug actions, and social policy commentary; Madeline H. Engel, The Drug Scene (1974), a brief sociological treatment; Griffith Edwards, Awni Arif, and Jerome H. Jaffe (eds.), Drug Use & Misuse: Cultural Perspectives (1983); Royal College of Psychiatrists, Drug Scenes (1987), a thoughtful and scholarly review of the effects of various drugs on the body; Susanne MacGregor, Drugs and British Society: Responses to a Social Problem in the Eighties (1989); Oakley Ray and Charles Ksir, Drugs, Society, & Human Behavior, 6th ed. (1993); and David M. Grilly, Drugs and Human Behavior, 2nd ed. (1994).Robert O'Brian and Sidney Cohen, The Encyclopedia of Drug Abuse (1984); David Courtwright, Herman Joseph, and Don Des Jarlais, Addicts Who Survived: An Oral History of Narcotic Use in America, 19231965 (1989); and Charles E. Faupel, Shooting Dope: Career Patterns of Hard-Core Heroin Users (1991), all discuss drug abuse. Broader studies include Charles P. O'Brien and Jerome H. Jaffe (eds.), Addictive States (1992); and Malcolm Lader, Griffith Edwards, and D. Colin Drummond (eds.), The Nature of Alcohol and Drug Related Problems (1992). Drug control and rehabilitation studies are presented in Robert W. Ferguson, Drug Abuse Control (1975), on agencies of control and rehabilitation in many countries; David F. Musto, The American Disease: Origins of Narcotic Control, expanded ed. (1987); Dean R. Gerstein and Henrick J. Harwood (eds.), Treating Drug Problems, 2 vol. (199092), describing the evolution, effectiveness, and financing of drug programs in the United States; and John C. Ball and Alan Ross, The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome (1991), studies of six methadone treatment programs. David Solomon (ed.), LSD: The Consciousness-Expanding Drug (1964), provides the reader with some of the history, rationale, subjective accounts, and mystique that launched the drug movement. Alfred R. Lindesmith, The Addict and the Law (1965), offers a broad analysis of the narcotic problem; while United States, Bureau of Justice Statistics, Drugs, Crime, and the Justice System (1992), relates the history and laws of drug use. Mark A.R. Kleiman, Against Excess: Drug Policy for Results (1992), considers social costs and policy options. Griffith Edwards, John Strang, and Jerome H. Jaffe (eds.), Drugs, Alcohol, and Tobacco: Making the Science and Policy Connections (1993), compiles papers on the role of science in forming national drug, alcohol, and tobacco policies. Avram Goldstein, From Biology to Drug Policy (1994), discusses the biological actions and the problem of developing policies for different classes of drugs.More specific works of general interest include Oriana Josseau Kalant, The Amphetamines: Toxicity and Addiction, 2nd ed. (1973), a classic work reviewing amphetamines and their abuse; Brian Wells, Psychedelic Drugs: Psychological, Medical, and Social Issues (1973); Donald R. Wesson and David E. Smith, Barbiturates: Their Use, Misuse, and Abuse (1977); Jonathan Gabe (ed.), Understanding Tranquilliser Use: The Role of the Social Sciences (1991); Mickey C. Smith, A Social History of the Minor Tranquilizers (1991); John Prescott and Grant McCall, Kava: Use and Abuse in Australia and the South Pacific (1988); Gregory R. Bock and Julie Whelan (eds.), CocaineScientific and Social Dimensions (1992), discussing this drug's toxicity, history of use, and treatments; Virginia Berridge and Griffith Edwards, Opium and the People: Opiate Use in Nineteenth-Century England (1981), a very readable yet thoroughly documented history; Charles F. Levinthal, Messengers of Paradise: Opiates and the Brain (1988); Gabriel G. Nahas, Marihuana in Science and Medicine (1984); Mark S. Gold, Marijuana (1989); and Wayne Hall, Nadia Solowij, and Jim Lemmon, The Health and Psychological Consequences of Cannabis Use (1994), a thorough review of the pharmacology, health, behavioral, and psychological effects of cannabis, prepared for the Australian National Task Force on Cannabis. United States, Office on Smoking and Health, The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General (1988), is an exhaustive presentation of the evidence that tobacco use is more than a habit.Technical works covering the same broad scope are Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th ed. by Joel G. Hardman and Lee E. Limbird (1996); Nora D. Valkow and Alan C. Swann (eds.), Cocaine in the Brain (1990); Malcolm Lader (ed.), The Psychopharmacology of Addiction (1988); Sidney Cohen, The Chemical Brain: The Neurochemistry of Addictive Disorders (1988); John C.M. Brust, Neurological Aspects of Substance Abuse (1993); and Andrew Weil and Winifred Rosen, Chocolate to Morphine: Understanding Mind-Active Drugs (1983). Harold I. Kaplan and Benjamin J. Sadock (eds.), Comprehensive Textbook of Psychiatry/VI, 6th ed. (1995), includes a chapter on substance-related disorders. William Glenn Steiner The Editors of the Encyclopdia Britannica The varieties of psychotropic drugs Opium, morphine, heroin, and related synthetics The opiates are unrivalled in their ability to relieve pain. Opium is the dried milky exudate obtained from the unripe seed pods of the poppy plant (Papaver somniferum), which grows naturally throughout most of Asia Minor. Of the 20 or more alkaloids found in opium, only a few are pharmacologically active. The important constituents of opium are morphine (10 percent), papaverine (1 percent), codeine (0.5 percent), and thebaine (0.2 percent). (Papaverine is pharmacologically distinct from the narcotic agents and is essentially devoid of effects on the central nervous system.) In about 1804 a young German apothecary's assistant named F.W.A. Sertrner isolated crystalline morphine as the active analgesic principle of opium. Codeine is considerably less potent (1/6) and is obtained from morphine. Diacetylmorphineor heroinwas developed from morphine by the Bayer Company of Germany in 1898 and is five to 10 times as potent as morphine itself. Opiates are not medically ideal. Tolerance is developed quite rapidly and completely in the more important members of the group, morphine and heroin, and they are highly addictive. In addition, they produce respiratory depression and frequently cause nausea and emesis. As a result, there has been a constant search for synthetic substitutes: meperidine (Demerol), first synthesized in Germany in 1939, is a significant addition to the group of analgesics, being one-tenth as potent as morphine; alphaprodine (Nisentil) is one-fifth as potent as morphine but is rapid-acting; methadone, synthesized in Germany during World War II, is comparable to morphine in potency; levorphanol (Levo-Dromoran) is an important synthetic with five times the potency of morphine. These synthetics exhibit a more favourable tolerance factor than the more potent of the opiates, but in being addictive they fall short of an ideal analgesic. Of this entire series, codeine has the least addiction potential and heroin has the greatest (see also drug: Analgesics and narcotics). History The narcotic and sleep-producing qualities of the poppy have been known to humankind throughout recorded history. Sumerian records from the time of Mesopotamia (5000 to 4000 BC) refer to the poppy, and medicinal reference to opium is contained in Assyrian medical tablets. Homer's writings indicate Greek usage of the substance at least by 900 BC; Hippocrates (c. 400 BC) made extensive use of medicinal herbs including opium. The Romans probably learned of opium during their conquest of the eastern Mediterranean; Galen (AD 130200) was an enthusiastic advocate of the virtues of opium, and his books became the supreme authority on the subject for hundreds of years. The art of medicinals was preserved by the Islamic civilization following the decline of the Roman Empire; opium was introduced by the Arabs to Persia, China, and India. Paracelsus (14931541), professor at the University of Basel, introduced laudanum, the modern tincture of opium. Le Mort, a professor of chemistry at the University of Leyden (170218), discovered paregoric, useful for the control of diarrhea, by combining camphor with tincture of opium. There is no adequate comprehensive history of the addictive aspects of opium use in spite of the fact that it has been known since antiquity. Because there were few alternative therapeutics or painkillers until the 19th century, opium was somewhat of a medical panacea. Thus, although at least one account in 1701, by a London physician named Jones, spoke of an excessive use of opium, there appears to have been no real history of concern until recent times, and opiates were easily available in the West in the 19th century, for instance, in a variety of patent medicines. Physicians prescribed them freely, they were easy to obtain without prescription, and they were used by all social classes. At one time, the extensive use of these medicines for various gynecological difficulties probably accounted for the high addiction rate among women (three times the rate among men). Today, in the United States, only one addict out of six is a woman. The invention of the hypodermic needle in the mid-19th century, and its subsequent use to administer opiates during wartime produced large numbers of addicted soldiers (about 400,000 during the U.S. Civil War alone); it was thought mistakenly that if opiates were administered by vein, no hunger or addiction would develop, since the narcotic did not reach the stomach. Toward the end of the 19th century, various undesirables such as gamblers and prostitutes began to be associated with the use of opiates, and narcotics became identified more with the so-called criminal element than with medical therapy. By the turn of the 20th century, narcotic use had become a worldwide problem, and various national and international regulatory bodies sought to control traffic in opium from the Near and Far East. In the 20th century, until recently, narcotic use was largely associated with metropolitan slums, principally among poor and culturally deprived. Currently, narcotic use has begun to spread to middle class youth, and, interestingly, there is evidence that the middle class is now beginning to look at narcotic addiction as a mental health problem. When it was confined to the slums, it was considered a police problem.