DRUG MEDICINE

DRUG TEST

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Basically four types of drug tests exist.

Urine drug test

This procedure usually involves you going to the bathroom and filling up a cup with your urine. They either use a test card on the spot for immediate results or send it away to a lab for testing by means of a sophisticated gas analyzer.

Hair Follicle drug test

Hair testing is quite accurate and can go back up to 6 months, showing all of the toxins you used in a sort of timeline. Many people try to get around this by just shaving their head. Know that they will go for your underarm, pubic, leg or arm hair if you do not have the required 1/2 inch on your head.

Blood drug test

Blood testing is usually performed for serious employment positions or when you are applying for insurance policies. This is expensive and not very common.

Saliva drug test

This is not common and can only detect toxins used 3-4 days prior. This method is most often used by insurance companies and law enforcement agencies.

MARIJUANA

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Marijuana

Here you will find everything about marijuana, like How to roll a joint, Smoking pipes and bongs and Eating marijuana. Below we describe our opinion of marijuana.

Taking marijuana affects and stimulates thinking and leads to a philosophic, positive attitude towards life. It causes euphoric feelings. You start feeling very happy and it stimulates your mind. Someone who is "high" has a positive view on the world and on life.

Marijuana doesn't cause any mental harm. No cases are known of individuals crippled for life, neither physically, nor mentally. However, marijuana may intensify already existing latent, suppressed fears.

In the Netherlands marijuana is mostly smoked in a joint. The hash or weed is crumbled on some tobacco and sometimes covered with even more tobacco. Then a big joint is rolled, often very ingeniously, and it is shared by a number of smokers. The consequence of mixing tobacco and marijuana is that the smoker does get STONED, but not HIGH. Being stoned is a pleasant form of a light daze. The smoker feels dreamily, his/her world slows down, music becomes more intense and thoughts expand enormously. A stoned person is not very keen. Why should you worry when you're feeling so fine?!

There is a large variety of effects of the different sorts of marijuana. The experienced taker knows the difference between Nepalese, Turkish, Afghan or Moroccan hash. Some sorts make you light-footed and talkative, other sorts prompt to lie down and dream.

In some circles alcohol is taken while smoking marijuana. mostly beer, sometimes wine, but real macho's also drink whisky or another spirit while smoking marijuana. Then smoking marijuana is useless, as alcohol breaks down the effect of the THC.

The reason why marijuana is so popular is very simple: everyone smoking marijuana on a regular basis, knows from personal experience that it's harmless. Innumerable scientific researches have proven again and again that taking marijuana is not addictive. Everyone who smokes pure hashish from a pipe, without tobacco, would like to take again, because he/she appreciates the effect, but he/she doesn't know that uncontrollable need of the nicotine addict to immediately light another cigarette. Smoking pure hashish or marijuana always is a conscious choice. The marijuana smoker decides to get high, for example to get more out of a conversation or to be able to undergo music or a movie in a more intense way, to feel a bond with nature or to reflect thoroughly on an idea. A marijuana smoker smokes because it gives him/her inspiration, not to escape from reality.

Shortly after the smoke of marijuana has been inhaled, the effect is perceptible. The taker starts to feel euphoric, cheerful and relaxed. The beauty, the fun and the bright side of life, usually defeated by the daily grind, become perceptible. Ideas and views crop up and tensions disappear.

THE EFFECTS OF DRUGS & ALCOHOL

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I. OVERVIEW

A. Absorption

Alcohol is primarily absorbed through the stomach and the small intestines. It is considered a food because it has calories, but does not need to be digested and proceeds directly into the body through the digestive system. After ingestion it is carried through the blood stream and crosses the blood–brain barrier, at which time impairment begins. A greater amount of ingestion causes greater impairment to the brain, which, in turn, causes a person to have a greater degree of difficulty in functioning.

B. Metabolism/Elimination

The majority of alcohol in the body is eliminated by the liver. Ninety percent is eliminated through the body, while ten percent is eliminated (unchanged) through sweat and urine. Before the liver can process alcohol, a threshold amount is needed and can occur at the rate of one 12 oz. can of beer, one 5 oz. glass of wine, or 1 1/2 oz. shot of whiskey per hour.

C. Brief Overview

Alcohol is a central nervous system depressant.
Alcohol is among the most abused drugs in our society.
Alcohol can be as potent as many other illegal drugs.
Alcohol can cause severe damage to a developing fetus.
People often do not realize that they are becoming dependent on alcohol.

D. Short-term Effects

Reduces sensitivity to pain.
Affects vision in the following ways: narrows the visual field, reduces resistance to glare, interferes with the ability to differentiate intensities of light, and lessens sensitivity to colors.

E. Long-term Effects

Damage to vital organs; including liver, heart and pancreas.
Linked to several medical conditions; including gastro intestinal problems, malnutrition, high blood pressure, and lower resistance to disease. Also linked to several types of cancer; including esophagus, stomach, liver, pancreas and colon.

F. Special Hazards Involving the Driving Task

Specific elements to the hazards of alcohol use and driving are listed in a separate section of the curriculum. However, alcohol impairs one's ability to drive or operate machinery safely.

G. Effects with Other Drugs

Alcohol produces a synergistic effect when taken with other central nervous system depressants. These include: sedative hypnotics, barbiturates, minor tranquilizers, narcotics, codeine, methadone, and some analgesics.
Alcohol can be additive in nature when taken with antipsychotic medications, antihistamines, solvents or motion sickness preparations. When used on a daily basis, in conjunction with aspirin, it may cause gastro intestinal bleeding. Also, when used with acetaminophen, an increase in liver damage could occur.

II. BLOOD ALCOHOL CONCENTRATIONS

Alcohol begins to affect individuals prior to reaching the legally intoxicated Blood Alcohol Concentration level of .08%. If a 150 lb. person consumes one drink equal to twelve ounces of beer (5 percent alcohol), five ounces of wine (12 percent alcohol) or one-and-a-half ounces of hard liquor (40 percent alcohol), all would contain about the same amount of alcohol and would raise the person's Blood Alcohol Concentration about .02%. It takes the liver approximately one hour to oxidize or metabolize one drink.

A. Factors Influencing Blood Alcohol Concentrations

Weight
Gender
Food in Stomach
Duration of Administration
Dosage

B. Tests for Intoxication

Blood Analysis
The methodology of blood analysis measures the amount or percentage of alcohol per 1,000 drops of blood.
Breath Analysis
Measures the blood alcohol content of air in the lungs.
Urinalysis
Detects marijuana, cocaine, PCP, and heroin; and gives the presence of the drug. It does not provide the level of impairment, since legal levels of impairment have not been established.

I. DRUG ABSORPTION/METABOLISM/ELIMINATION

A. Method of Administration

Drugs are administered to or enter the human body in a number of ways, including injection, inhalation, and ingestion. The method of administration impacts on how the drug affects the person. For example: injection takes the drug directly into the blood stream, providing more immediate effects; while ingestion requires the drug to pass through the digestive system, delaying the effects.

B. Factors Affecting Absorption/Metabolism

Factors that affect absorption/metabolism include physical, emotional and drug-related factors.

Physical Factors
Physical factors that affect the absorption or metabolism of a drug include:

a. Person's weight and age – The amount of physical mass a drug must travel through will have an outcome on the drug's total effect on the body. Also, the aging process affects the manner in which the drug exerts its effects on the body.

b. Individual biomedical/chemical make-up – Each individual tolerates substances differently. For example: a person's physical condition as well as hypersensitivity (allergies) or hyposensitivity (need for larger doses to gain the desired effect) will influence the total effect of the drug on the individual.

c. Rate of metabolism – Each drug metabolizes or processes within the body at a different rate. The drug remains active in the body until metabolism occurs. For example: certain medications require dosages to be taken every four, twelve or twenty-four hours, depending on the duration and rate at which the drug is metabolized.

d. Food – Food in the body slows absorption of the drug into the body by not allowing it to pass directly through the digestive process without first being processed by the digestive system. A slower process occurs, since the body is digesting food in addition to the substance or drug utilized by the person.
Emotional Factors
The emotional factors that may influence drug absorption and metabolism within the body are:

a. Emotional state – A person's specific emotional state or degree of psychological comfort or discomfort will influence how a drug may affect the individual. For example: if a person began using alcohol and was extremely angry or upset, the alcohol could intensify this anger or psychological discomfort. On the other hand, if alcohol was being used as part of a celebration, the psychological state of pleasure could be enhanced by the use of the drug.

b. Anticipation/Expectancy – The degree to which a person believes that a given drug will affect them, may have an effect on their emotional state. If a person truly believes that by using a substance, they will experience a given effect, then their expectations may cause a psychological change in the manner in which the drug affects them.
Drug-Related Factors
The drug-related factors that influence the way drugs are absorbed and metabolized within the body are:

a. Tolerance – Tolerance refers to the amount of a given substance necessary to receive its desired effect.

b. Presence or use of other drugs – The presence or use of other drugs such as prescription, over-the-counter, nicotine, and caffeine also influence the rate of absorption and metabolism of drugs in the body.

c. Method of administration – A drug injected directly into the blood stream will affect an individual at a greater rate, since it will be directly absorbed through the blood stream and presented to various organs. If a drug is snorted or inhaled, the effects may be enhanced, due to the fact that the sinus cavity is located in close proximity to the brain. On the other hand, if a drug is ingested, the effects may be slower due to the fact that they must pass through the digestive system.

d. Physical dependence (addiction) – If a person is physically addicted to a drug, then more of a given substance may be necessary and the effects on the body will differ from those seen in a non-dependent individual.

C. Elimination

Drugs are eliminated from the body primarily through the liver. The liver and kidneys act as a body's filter to filter out and excrete drugs from the body. The liver metabolizes ninety percent of alcohol in the body, while ten percent is excreted through the lungs and sweat. Also, the liver metabolizes drugs in a fairly consistent manner. For example: alcohol is removed at the rate of one 12 oz. can of beer, one 5 oz. glass of wine, or 1 1/2 oz. shot of whiskey per hour.

II. SPECIFIC EFFECTS ON THE CENTRAL NERVOUS SYSTEM

Drugs affect the various areas of the brain and change normal brain activity. It is important to know what specific functions are located in each of the major brain areas, to better understand the effects of drugs and alcohol on behavior and functioning.

A. Hypothalamus

The hypothalamus regulates homeostasis, the body's system for keeping itself balanced. This includes: sleep and wake cycles, hunger, thirst, sexual behavior, blood pressure, and temperature. Also, the hypothalamus determines what parts of the body are affected by analgesics and regulates hormonal impulses and emotions.

B. Medulla

The medulla is responsible for head balance, movement, and assisting the hypothalamus in regulating automatic body functions.

C. Cerebral Cortex

The cerebral cortex contains half of the nervous system's cells, which regulates the speed and vomiting reflexes. It is also responsible for language, abstract thinking, personality, and interpretation of emotion and sensory information, including judgment.

D. Cerebellum

The cerebellum is responsible for coordination of muscles, maintenance of balance, and specific memory and learning system functions that are not to one part of the brain.

III. DRUG CATEGORIES

A. Marijuana

Absorption
Marijuana may be inhaled or ingested.
Metabolism/Elimination
THC (Delta-9-tetrahydrocannabinol) is highly fat-soluble and may take up to three months to be fully eliminated from the body by the liver and kidneys. One joint affects the body for a period of two to four hours.
Brief Overview
Marijuana is the most frequently used illicit drug in America and has been linked to harming a developing fetus. It has the same or similar effects as depressants, stimulants, and hallucinogens. Marijuana cigarettes yield almost four times as much tar as tobacco, creating a higher risk of lung damage.
Short-term Effects
a. Increases in heart rate, body temperature, and appetite.
b. Drowsiness.
c. Dryness of the mouth and throat.
d. Reddening of the eyes and reduction in ocular pressure.
Long-term Effects
a. Can cause the following medical conditions: respiratory problems, lung damage, and cancer.
b. Memory and concentration impairments.
c. Possible motivational syndrome.
Special Hazards Involving the Driving Task
Marijuana has been linked to the impairment of the ability to drive a vehicle. Concentration is affected and there is difficulty in perceiving time and distance, which can lead to the following: bad judgment, impaired reaction time, poor speed control, an inability to accurately read signs, drowsiness, and distraction.
Effects with Other Drugs
When marijuana is combined with alcohol it creates greater impairment in areas such as reaction time and coordination. When combined with sedatives and opiates, it can cause an increase in anxiety and even hallucinations, along with an increase in heart rate and blood pressure when used with amphetamines. On the other hand, effects are somewhat unpredictable when marijuana is combined with stimulants, such as nicotine, caffeine, amphetamines, and cocaine.

B. Cocaine

Absorption
Cocaine enters the body in one of three ways: injection, smoking, or snorting.
Metabolism/Elimination
Cocaine is a strong stimulant to the central nervous system. Its effects can last anywhere from 20 minutes to several hours, depending on the content, purity, administration, and dosage of the drug.
Brief Overview
a. Cocaine users become dependent on the drug.
b. Crack is a form of the drug that is highly addictive.
c. Exposure to the drug can harm a developing fetus.
d. It produces short-lived senses of euphoria, the length depends on how the drug was administered.
Short-term Effects
a. May cause extreme anxiety and restlessness.
b. May experience the following medical conditions: twitches, tremors, spasms, coordination problems, chest pain, nausea, seizures, respiratory arrest, and cardiac arrest.
Long-term Effects
a. May cause extreme alertness, watchfulness, impaired judgment, impulsiveness, and compulsively repeated acts.
b. May cause stuffiness, runny nose, tissue deterioration inside the nose, and perforation of the nasal septum.
Special Hazards Involving the Driving Task
a. Cocaine may successfully mask fatigue, however, high dosages impair judgment and interfere with the ability of the driver to concentrate.
b. Coordination and vision are impaired.
c. There is an increase in impulsive behaviors with tendencies to take more risks and create confusion within the user.
Effects with Other Drugs
a. Additive effects are noted when cocaine is combined with over-the-counter products, such as diet pills or antihistamines.
b. Cocaine taken with psychotropic drugs, especially antidepressants, can be extremely detrimental.
c. A person who has extremely high blood pressure and uses cocaine may suffer from a stroke or heart attack.
d. Some users combine cocaine with alcohol and sedatives to cushion the "crash" or feeling of depression and agitation that sometimes occurs as the effects of cocaine wear off.
e. A person using cocaine maintains the illusion of being alert and stimulated, although physical reactions are impaired.
f. Further research indicates that additive and antagonistic effects can be produced when cocaine is mixed with alcohol.
g. If cocaine is used in high doses, as in the case of overdose, alcohol will probably have an additive effect on the symptoms that eventually contribute to death.
h. When cocaine is injected in combination with heroin, sometimes called "speedballing," there is an increased risk of toxicity, overdose, and death.

C. Sedative Hypnotics (Barbiturates, Benzodiazepines)

Absorption
Sedative Hypnotics are absorbed through ingestion.
Metabolism/Elimination
Sedative Hypnotics are eliminated by the liver and excreted in urine. Their effect can last anywhere from two to ten hours.
Brief Overview
a. Antianxiety tranquilizers are among the most commonly prescribed drugs in the world.
b. Driving under the influence of tranquilizers is dangerous.
c. A person can become dependent on tranquilizers and depressant drugs, which make them feel calmer, more relaxed, and drowsy.
Short-term Effects
a. Short-term effects can occur with low to moderate use.
b. May experience moderate relief of anxiety and a sense of well-being.
c. There may be temporary memory impairment, confusion, and impaired thinking.
d. A person could be in a stupor, and have altered perception and slurred speech.
Long-term Effects
a. May include over-sedation, decreased motivation, apathy, and lack of interest in surroundings.
b. A person may experience headaches, dizziness, sleep disorders, anxiety, depression, and tremors.
c. There may be an increase in appetite and impairment of thinking, memory, and judgment.
Special Hazards Involving the Driving Task
a. The use of tranquilizers produces drowsiness, incoordination, altered perceptions, memory impairment, poor control of speech, and slower reaction time.
b. Effects on driving include: poor tracking, difficulty in maintaining lane position, and neglecting roadside instructions.
c. When combined with alcohol, the effects may be more hazardous.
Effects with Other Drugs
a. Some people in methadone treatment programs use benzodiazepines to enhance the effects of methadone.
b. When tranquilizers are combined with alcohol or other central nervous system depressants, synergistic effects may be produced, which may be fatal.
c. Alcohol increases the absorption of benzodiazepines, slows their break down in the liver and can cause cardio vascular and respiratory depression.
d. People who take stimulants sometimes take tranquilizers to off set agitation and sleepiness.

D. Opiates (Morphine, Heroin, Codeine, Opium)

Absorption
Opiates are normally absorbed though injection.
Metabolism/Elimination

Opiates are metabolized by the liver and may have a lengthy metabolism due to excessive half-lives of the drugs.
Brief Overview
a. Opiates can cause sedation and euphoria.
b. They are often used to relieve pain, suppress coughs, and control physical conditions such as diarrhea.
c. Respiratory depression and death can occur from overdoses of opiates.
d. Opiates may impair a person's ability to drive.
e. A person can become physically and psychologically addicted to opiates.
Short-term Effects
a. Include drowsiness, dizziness, mental confusion, constriction of pupils, and euphoria.
b. Some opiate drugs, such as Codeine, Demerol, and Darvon, also have stimulating effects.
c. Stimulating effects include: central nervous system excitation, increased blood, elevated blood pressure, increased heart rate, tremors, and seizures.
Long-term Effects
a. May include impaired vision, pulmonary complications, and menstrual irregularity.
b. A person may experience nightmares, hallucinations, and mood swings.
Special Hazards Involving the Driving Task
a. Opiates can cause drowsiness, mental confusion, and visual impairment even at lower, moderate doses.
b. A driver may have difficulty keeping the vehicle in the correct lane and may make errors in judgment.
Effects with Other Drugs
a. Alcohol greatly increases the present effects of opiates and can lead to respiratory arrest.
b. A person injecting heroin mixed with cocaine or methamphetamines, known as "speedballing," produces a stimulant effect.
c. The listed drug combinations increase the risk of toxicity, overdose, and death.

E. Amphetamines

Absorption
Amphetamines are absorbed by the body in one of three ways: snorting, swallowing, or injection.
Metabolism/Elimination
Amphetamines are eliminated through the liver.
Brief Overview
a. Amphetamines have a strong central nervous system stimulant which can increase alertness and induce a sense of well-being.
b. If used while driving, amphetamines are dangerous.
c. The use of amphetamines reduces a person's resistance to disease.
Short-term Effects
a. A person may experience a loss of appetite, increased alertness, and a feeling of well-being.
b. A person's physical condition may be altered by an increase in breathing and heart rate, elevation in blood pressure, and dilation of pupils.
Long-term Effects
a. Anxiety and agitation.
b. Sleeplessness.
c. Higher blood pressure and irregular heart beat.
d. Increased susceptibility to disease.
Special Hazards Involving the Driving Task
The use of amphetamines can interfere with concentration, impair vision, and increase the driver's tendencies to take risks.
Effects with Other Drugs
a. Amphetamines should never be taken with a class of antidepressants known as MAO inhibitors, because of potential hypertensive crisis.
b. Amphetamine users sometimes use marijuana and depressant drugs in order to avoid the adverse side effects of the "crash," therefore creating multiple drug dependencies.

F. Poly-drug Use

(Poly-drug use is where the use of more than one substance normally causes one of three reactions: additive, synergistic, or antagonistic.

Additive Effects
Additive effects occur when drug combinations produce an effect that is like simple addition, such as the equation: 1 + 1 = 2.
Synergistic Effects
Synergistic effects occur when drug combinations produce an effect that is greater than the sum of the effects of the two drugs, such as the equation: 1 + 1 = 3.
Antagonistic Effects
Antagonistic effects occur when a drug combination produces an effect that is less than the sum of the effects of the drugs acting alone, such as the equation: 1 + 1 = 1 or 1 + 1 = 0.

I. IMPACT OF DRUG USE ON DRIVING

A. Necessary Driving Skills

Several skills necessary for driving include: vision, reaction time, judgment, hearing, and simultaneous task processing/accomplishment.
Driving skills can be divided into cognitive skills, such as information processing, and psycho motor skills.

B. Drug Impact on Driving Skills

Impairment is related to alcohol, in terms of its concentration in the blood stream.
The brain's control of eye movements is highly vulnerable to alcohol. It only takes low to moderate blood alcohol concentrations (.03 to .05%) to interfere with voluntary eye movements and impair the eyes' ability to rapidly track a moving target.
Steering an automobile is adversely affected by alcohol, as alcohol affects eye-to-hand reaction times, which are superimposed upon the visual effects. Significant impairment and deterioration of steering ability begin at approximately .03 to .04% Blood Alcohol Concentrations and continue to deteriorate as Blood Alcohol Concentration rises.
Almost every aspect of the brain's information-processing ability is impaired by alcohol. Alcohol-impaired drivers require more time to read street signs or respond to traffic signals than unimpaired drivers. Research on the effects of alcohol on the performance of automobile and aircraft operators shows a narrowing of the attention field beginning at .04% blood alcohol concentration.

C. Dividing Attention Among Component Skills

Most sensitive aspect of the driving performance.
Component skills involve maintaining the vehicle in the proper lane and direction (tracking task), while monitoring the environment for vital safety information, i.e. other vehicles, traffic signs, and pedestrians.
Alcohol-impaired drivers who are required to divide their attention between two tasks tend to favor just one task. Often times the favored task is concentrating on steering while becoming less vigilant with respect to other safety information.
Numerous studies indicate that divided attention deficits occur as low as .02% Blood Alcohol Concentration.
Four conclusions can be drawn from results of epidemiologic and experimental studies.
a. The degree of impairment depends on the complexity of the task involved as well as the Blood Alcohol Concentration.
b. The magnitude of alcohol-induced impairment rises as the Blood Alcohol level increases and dissipates as the alcohol is eliminated from the body.
c. At a given time and Blood Alcohol Concentration, some skills are more impaired than others.
d. There is no evidence of an absolute BAC threshold below which there is no impairment of any kind. Therefore, certain skills important to the driving task are impaired at .01 to .02% blood alcohol level the lowest levels that can be reliably measured by the commonly used devices.

II. THE DUI ARREST AS A WARNING SIGN

A. The Court Reporting Network (CRN)

CRN is the Pennsylvania Alcohol Highway Safety Program's Court Reporting Network.
Helps provide a coordinated and integrated systems approach to the alcohol highway safety problem and resultant driving under the influence counter-measures in the Commonwealth of Pennsylvania.
Purpose of CRN is to provide a computer-assisted information system that links the county DUI programs into a comprehensive statewide network and assists local coordinators in planning, implementing, and monitoring their programs.

(See CRN Flow Chart)

B. Three Problem Levels of Alcohol Users - CRN divides alcohol users into one of three problem levels.

Level I - Non-problem, Social Drinker
a. Client has not been identified as having a problem with alcohol, based on all available criteria.
b. Individual will receive a recommendation for Alcohol Highway Safety School.
Level II - Presumptive Problem Drinker
a. Client appears to be experiencing some degree of life problems due to alcohol.
b. Individual will often receive a recommendation for Alcohol Highway Safety School and outpatient counseling.
Level III - Highly Presumptive Problem Drinker
a. Client has been identified as experiencing serious life problems due to their abuse of alcohol, based on available criteria.
b. Individual will often receive a recommendation for Alcohol Highway Safety School and outpatient treatment.
CRN data indicates that 80% of all arrests for driving under the influence of alcohol place the individual in either Level II or Level III; hence, the DUI arrest may be part of a more total inclusive alcohol problem.
The DUI Educational Program should serve as a mechanism by which the person can evaluate his or her problem and hope to identify the need for further counseling.

III. THEORIES ABOUT ADDICTION/DEPENDENCE

A. Definition of Addiction

Physiological and/or psychological dependence on a drug. The overpowering physical or emotional urge to repeatedly do something that is uncontrollable by the individual and is accompanied by a tolerance for the drug, with withdrawal symptoms if the drug is stopped.

B. Causes of Addiction - There are many different approaches to looking at addiction.

Disease concept refers to alcohol and chemical dependency as a disease.
Genetics have been shown to play a predisposition factor. Essentially, in families where chemical dependency appears to be prevalent and multi-generational, some members may be more susceptible to becoming chemically dependent.
Environmental factors and what people are exposed to within their environment play a critical role in addiction.
Cultural influences and the belief systems which evolve around the use and abuse of drugs are factors which contribute to addiction.

C. Stages Of Addiction - Addiction develops in a predictable series of stages.

Early Stage Addiction
a. Characterized by an increase in tolerance and dependence.
b. People who are becoming addicted can use larger and larger quantities without becoming intoxicated or suffering harmful consequences.
c. As the body cells change to tolerate larger quantities of the chemical, even larger quantities are needed to achieve the same effect.
d. Difficult to distinguish addictive use from heavy non-addictive use because there are few outward symptoms.
e. Alcohol or drugs are used so frequently that the person comes to depend on them.
f. Use begins to seem normal; life without use begins to seem abnormal.
Middle Stage Addiction
a. Marked by a progressive loss of control.
b. It takes more alcohol or drugs to get high.
c. Increased quantities damage the liver, alter brain chemistry, and eventually, tolerance begins to decrease.
d. The drug is used to relieve the pain created by not using.
e. Physical, psychological, and social problems develop.
Chronic Stage Addiction
a. Marked by physical, psychological, behavioral, social, and spiritual deterioration.
b. All systems of the body can be affected.
c. Mood swings are common as the person uses the drug to feel better, but cannot maintain the good feelings.
d. There is less and less control over behavior.
e. Relationships are damaged.
f. The person loses touch with a higher power and with a sense of purpose and meaning in life.
g. Life is consumed with the need to use.

D. Addiction Terminology

Tolerance - Physical tolerance is the body's ability to adapt to the usual effects of a drug so that an increased dosage is needed to achieve the same effect as before. Tolerance begins to occur in the early stage of addiction.
Cross-Tolerance - Among certain related drugs (narcotics), tolerance built up to the effects of one drug will carry over to another drug.
Enabling Behavior - In the area of chemical abuse, behaviors of one person which encourage another's chemical abuse are known as enabling behaviors. These behaviors may be conscious or unconscious, intentional or unintentional. An example would be someone who downplays or denies the problems a friend is having with drugs.
Withdrawal - This is the result of discontinuing the intake of a drug after developing physical dependence. With alcohol this may cause such reactions as mild disorientation, hallucinations, shaking, and convulsions.

IV. PATTERNS OF ALCOHOL USE

A. Alcohol Abuse

Refers to patterns of problem drinking that have resulted in detrimental effects on both social and health problems.
Alcohol can have negative effects on the social well-being and physical health of the problem drinker.

B. Alcohol Dependence

Often referred to as Alcoholism.
Refers to a disease characterized by compulsive alcohol-seeking behavior that leads to the inability to control drinking.

C. Differences between Abuse and Dependence

Alcohol dependency and alcohol abusers experience many of the same harmful effects of drinking.
Critical difference is the physical dependence displayed by alcoholics and their lack of ability to regulate their consumption of alcohol.
Alcoholics will continue to drink in spite of severe negative consequences of their drinking.

D. Warning Signs of Problem Drinking

Frequently drinking to state of intoxication.
Using alcohol to seek relief from problems and cope with stress.
Engaging in antisocial behavior during and after drinking.
Going to work intoxicated or decline in job performance.
Experiencing family or economic problems.
Driving a car under the influence of alcohol.
Sustaining injuries as a result of intoxication.
Seeking out places where alcohol is available and avoiding places where it is not.

V. ALCOHOLISM

A. Definition of Alcoholism

The National Council on Alcoholism and Drug Dependence (1990) defines alcoholism as:

ALCOHOLISM is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking–most notably denial.

1) Terms in the Definition of Alcohol Dependency

a. Primary

i. Refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it.
ii. Suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.

b. Disease

i. Means an involuntary disability.
ii. Represents the sum of the abnormal phenomena displayed by a group of individuals.
iii. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.

c. Often Progressive and Fatal

i. Means the disease persists over time and that physical, emotional and social changes are often cumulative and may progress as drinking continues.
ii. Causes premature death through overdose, organic complications involving the brain, liver, heart, and many other organs.
iii. Contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

d. Impaired Control

Means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.

e. Preoccupation

i. Refers to excessive focused attention given to the drug alcohol, its effects, and/or its use.
ii. The relative value thus assigned to alcohol by an individual often leads to a diversion of energies away from important life concerns.

f. Adverse Consequences

i. Refers to alcohol-related problems or impairments.
ii. Physical health problems, i.e. alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders.
iii. Psychological functioning problems, i.e. impairments in cognition, changes in mood and behavior.
iv. Interpersonal functioning problems, i.e. marital problems, child abuse and impaired social relationships.
v. Occupational functioning problems, i.e. scholastic or job problems.
vi. Legal, financial, or spiritual problems.

g. Denial

Refers to a defense mechanism reducing the significance of events, but more broadly includes a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual's problems rather than a solution. It becomes an integral part of the disease and a major obstacle to recovery. Examples of denial:

i. "I only drink on weekends." (minimizing)
ii. "You'd drink too if you had my job." (blaming)
iii. "Everyone drinks and drives." (generalizing)

h. Progression of the Disease

An addiction develops and can be classified into the following three distinct stages:

i. Early Stage - Early problems are not observed or clearly linked to addiction.
ii. Middle Stage - problems are identified or observed but not yet associated with the use of alcohol.
iii. Late or Chronic Stage - the disease makes it difficult, if not impossible,to think or observe in a rational manner.

B. Symptoms Of Addiction

The behavioral symptoms of alcoholism, discussed previously, which manifest themselves within the three (3) stages of addiction will not be present for every individual at the same time period. The following is an overview of the symptoms within each major stage of addiction.

The Disease Concept Chart (See Addiction & Recovery Chart on the following page)

The disease concept chart, on the following page, indicates the progressive nature of the chemical dependency through the early, middle, and late/chronic stages of addiction.
Recovery
a. Refers to a continuous lifelong process.
b. Critical to know where to find resources to help in the identification and treatment of abusive use of alcohol and/or other drugs.
Symptoms of Alcohol Dependency

The following symptoms mark the three stages of alcoholism, but not all are seen in every individual. These stages are intended only as guidelines, since every individual may experience some or all of these symptoms at different times in their alcoholism.

a. Early Stage

i. Sneaking drinks.
ii. Gulping drinks.
iii. Preoccupation with drinking.
iv. Personality changes when drinking.
v. Drinking to the point of drunkenness.
vi. Guilt feelings about drinking.
vii. Missing responsibilities of work and school due to hangovers.
viii. Seeking companions who are heavy drinkers.
ix. Blackouts.
x. Increased tolerance to alcohol.
xi. Changing forms of alcohol (i.e. vodka to beer).
xii. Spouse complaining of drinking.
xiii. Losing interest in activities not directly associated with drinking.

b. Middle Stage

i. Drinking more than intended (loss of control).
ii. Protecting the supply of alcohol.
iii. Drinking to relieve anger, tension, insomnia, fatigue depression, social discomfort.
iv. Increased incidence of infections and colds.
v. Benders.
vi. Morning drinking.
vii. Drinking despite strong social reasons not to, such as marital and family disruptions, arrests for drunk driving, etc.
viii. Repeated attempts at abstinence.
ix. Paranoid attitude.
x. Projection, resentments, and denial become more severe.

c. Late Stage

i. Alcoholic hepatitis.
ii. Cirrhosis (enlargement of the liver).
iii. Lowering of personal standards.
iv. Tremors when sober.
v. Lowering of tolerance to alcohol.
vi. Blatant and indiscriminate use of alcohol.
vii. Choice of work situations which facilitate drinking.
viii. Brain damage.
ix. Alcoholic seizures.
x. Delirium tremens.
xi. Alcoholic hallucinations.
xii. Fears of "going crazy".
xiii. Depression, isolation, and suicidal preoccupation.

MARIJUANA : Facts Parents Need To Know

2009-01-20T19:16:00.000-08:00

A Letter to Parents

Following a troubling increase in marijuana abuse in the 1990s among U.S. teens, recent findings have shown more encouraging trends. For example, past-year use has fallen significantly among students in the 8th, 10th, and 12th grades since 2001: it has dropped by 24 percent among 8th-graders, 23 percent among 10th-graders, and 15 percent among 12th-graders. Perceived risk of harm from smoking marijuana regularly remained stable for all three grades from 2005 to 2006, and perceived availability of marijuana fell significantly among 10th-graders, from 72.6 percent in 2005 to 70.7 percent in 2006.

Even with these encouraging trends, marijuana is still the illegal drug most often abused in the United States. Its continued high prevalence rate, particularly among teens, indicates that we still have a long way to go. In addition, because many parents of present-day teens used marijuana when they were in college, they often find it difficult to talk about marijuana with their children and to set strict ground rules against it. This conversation must begin early, as marijuana use today often starts at a young age—with more potent forms of the drug now available to these children and adolescents. Parents need to recognize that marijuana use is a serious threat, and they need to tell their children not to use it.

We at the National Institute on Drug Abuse (NIDA) are pleased to offer these two short booklets, Marijuana: Facts Parents Need to Know and Marijuana: Facts for Teens, for parents and their children to review the scientific facts about marijuana. Although it is best to talk about drugs when children are young, it is never too late to talk about the dangers of drug use.

Talking to our children about drug abuse is not always easy, but it is very important. I hope these booklets can help.

Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse

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Fact: There are stronger forms of marijuana available
to adolescents today than in the 1970s or 1908s.
Stronger marijuana means stronger effects.

Q: What is marijuana? Are there different kinds?

A: Marijuana is a green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and flowers of the hemp plant (Cannabis sativa). Before the 1960s, many Americans had never heard of marijuana, but today it is the most often used illegal drug in the United States.

Cannabis is a term that refers to marijuana and other drugs made from the same plant. Strong forms of cannabis include sinsemilla (sin-seh-me-yah), hashish (“hash” for short), and hash oil. All forms of cannabis are mind-altering (psychoactive) drugs; they all contain THC (delta-9-tetrahydrocannabinol), the main active chemical in marijuana. They also contain more than 400 other chemicals.

Marijuana’s effect on the user depends on the strength or potency of the THC it contains. THC potency has increased since the 1970s and continues to increase still. The strength of the drug is measured by the average amount of THC in test samples confiscated by law enforcement agencies. For the year 2006, most ordinary marijuana contained, on average, 7 percent THC.

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Q: What are the current slang terms for marijuana?

A: There are many different names for marijuana. Slang terms for drugs change quickly, and they vary from one part of the country to another. They may even differ across sections of a large city.

Terms from years ago, such as pot, herb, grass, weed, Mary Jane, and reefer, are still used. You might also hear the names Aunt Mary, skunk, boom, gangster, kif, or ganja.

There are also street names for different strains or “brands” of marijuana, such as “Texas tea,” “Maui wowie,” and “chronic.” One book of American slang lists more than 200 terms for various kinds of marijuana.

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Q: How is marijuana used?

A: Most users roll loose marijuana into a cigarette (called a joint or a nail) or smoke it in a pipe or a water pipe, sometimes referred to as a bong. Some users mix marijuana into foods or use it to brew a tea. Another method is to slice open a cigar
and replace the tobacco with marijuana, making what’s called a blunt. When the blunt is smoked with a 40-oz. bottle of malt liquor, it is called a “B-40.”

Marijuana cigarettes or blunts sometimes contain other substances as well, including crack cocaine—a combination known by various street names, such as “primos” or “woolies.” Joints and blunts sometimes are dipped in PCP and are called “happy sticks,” “wicky sticks,” “love boat,” “dust,” “wets,” or “tical.”

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Q: How many people smoke marijuana? At what age do children generally start?

A: A recent government survey tells us:

Marijuana is the most frequently used illegal drug in the United States. Nearly 98 million Americans over the age of 12 have tried marijuana at least once.
Over 14 million had used the drug in the month before the survey.

The Monitoring the Future Survey, which is conducted yearly, includes students from 8th, 10th, and 12th grades. In 2006, the survey found that 15.7 percent of 8th-graders have tried marijuana at least once, and among 10th-graders, 14.2 percent were “current” users (that is, have used within the past month). Among 12th-graders, 42.3 percent have tried marijuana at least once, and about 18 percent were current users.

Other researchers have found that use of marijuana and other drugs usually peaks in the late teens and early twenties, then declines in later years.

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Fact: Research shows that more than 40 percent
of teenagers try marijuana before they
graduate from high school.

Q: How can I tell if my child has been using marijuana?

A: There are some signs you might be able to see. If someone is high on marijuana, he or she might:

seem dizzy and have trouble walking;
seem silly and giggly for no reason;
have very red, bloodshot eyes; and
have a hard time remembering things that just happened.

When the early effects fade, the user can become very sleepy.

Parents should be aware of changes in their child’s behavior, although this may be difficult with teens. Parents should look for withdrawal, depression, fatigue, carelessness with grooming, hostility, and deteriorating relationships with family members and friends. In addition, changes in academic performance, increased absenteeism or truancy, lost interest in sports or other favorite activities, and changes in eating or sleeping habits could be related to drug use. However, these signs may also indicate problems other than use of drugs.

In addition, parents should be aware of:

signs of drugs and drug paraphernalia, including pipes
and rolling papers;
odor on clothes and in the bedroom;
use of incense and other deodorizers;
use of eye drops; and
clothing, posters, jewelry, etc., promoting drug use.

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Q: Why do young people use marijuana?

A: Children and young teens start using marijuana for many reasons. Curiosity and the desire to fit into a social group are common reasons. Certainly, youngsters who have already begun to smoke cigarettes and/or use alcohol are at high risk for marijuana use.

Also, our research suggests that the use of alcohol and drugs by other family members plays a strong role in whether children start using drugs. Parents, grandparents, and older brothers and sisters in the home are models for children to follow.

Some young people who take drugs do not get along with their parents. Some have a network of friends who use drugs and urge them to do the same (peer pressure). All aspects of a child’s environment—home, school, neighborhood—help to determine whether the child will try drugs.

Children who become heavily involved with marijuana can become dependent, making it difficult for them to quit. Others mention psychological coping as a reason for their use—to deal with anxiety, anger, depression, boredom, and so forth. But marijuana use is not an effective method for coping with life’s problems, and staying high can be a way of simply not dealing with the problems and challenges of growing up.

Researchers have found that children and teens (both male and female) who are physically and sexually abused are at greater risk than other young people of using marijuana and other drugs and of beginning drug use at an early age.

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Q: Does using marijuana lead to other drugs?

A: Long-term studies of high school students and their patterns of drug use show that very few young people use other drugs without first trying marijuana, alcohol, or tobacco. Though few young people use cocaine, for example, the risk of doing so is much greater for youth who have tried marijuana than for those who have never tried it. Although research has not fully explained this association, growing evidence suggests a combination of biological, social, and psychological factors is involved.

Researchers are examining the possibility that long-term marijuana use may create changes in the brain that make a person more at risk of becoming addicted to other drugs, such as alcohol or cocaine. Although many young people who use marijuana do not go on to use other drugs, further research is needed to determine who will be at greatest risk.

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Q: What are the effects of marijuana?

A: The effects of marijuana on each person depend on the:

type of cannabis and how much THC it contains;
way the drug is taken (by smoking or eating);
experience and expectations of the user;
setting where the drug is used; and
use of other drugs and/or alcohol.

Some people feel nothing at all when they first try marijuana. Others may feel high (intoxicated and/or euphoric).

It is common for marijuana users to become engrossed with ordinary sights, sounds, or tastes, and trivial events may seem extremely interesting or funny. Time seems to pass very slowly, so minutes feel like hours. Sometimes the drug causes users to feel thirsty and very hungry—an effect called “the munchies.”

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Q: What happens after a person smokes marijuana?

A: Within a few minutes of inhaling marijuana smoke, the user will likely feel, along with intoxication, a dry mouth, rapid heartbeat, some loss of coordination and balance, and a slower than normal reaction time. Blood vessels in the eye expand, so the user’s eyes look red.

For some people, marijuana raises blood pressure slightly and can double the normal heart rate. This effect can be greater when other drugs are mixed with marijuana, but users do not always know when that happens.

As the immediate effects fade, usually after 2 to 3 hours, the user may become sleepy.

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Q: How long does marijuana stay in the user's body?

A: THC in marijuana is readily absorbed by fatty tissues in various organs. Generally, traces (metabolites) of THC can be detected by standard urine testing methods several days after a smoking session. In heavy, chronic users, however, traces can sometimes be detected for weeks after they have stopped using marijuana.

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Q: Can a user have a bad reaction?

A: Yes. Some users, especially those who are new to the drug or in a strange setting, may suffer acute anxiety and have paranoid thoughts. This is more likely to happen with high doses of THC. These scary feelings will fade as the drug’s effects wear off.

In rare cases, a user who has taken a very high dose of the drug can have severe psychotic symptoms and need emergency medical treatment.

Other kinds of bad reactions can occur when marijuana is mixed with other drugs, such as PCP or cocaine.

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Fact: Marijuana has adverse effects on many of
the skills required for driving a car. Driving
while high can lead to car accidents.

Q: How is marijuana harmful?

A: Marijuana can be harmful in a number of ways, through immediate effects and through damage to health over time.

Marijuana hinders the user’s short-term memory (memory for recent events), and he or she may have trouble handling complex tasks. With the use of more potent varieties of marijuana, even simple tasks can be difficult.

Because of the drug’s effects on perceptions and reaction time, users could be involved in auto crashes. Drug users also may become involved in risky sexual behaviors, which could lead to the spread of HIV, the virus that causes AIDS.

Under the influence of marijuana, students may find it hard to study and learn. Young athletes could find their performance is off; timing, movements, and coordination are all affected by THC.

Some of the more long-range effects of marijuana use are described later in this document.

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Q: How does marijuana affect driving?

A: Marijuana affects many skills required for safe driving: alertness, concentration, coordination, and reaction time. Marijuana use can make it difficult to judge distances and react to signals and sounds on the road.

There are data showing that marijuana can play a role in motor vehicle crashes. Studies show that approximately 4–14 percent of drivers who sustained injury or died in traffic accidents tested positive for THC. In many of these cases, alcohol was detected as well. When users combine marijuana with alcohol, as they often do, the hazards of driving can be more severe than with either drug alone. In a study conducted by the National Highway Traffic Safety Administration, a moderate dose of marijuana alone was shown to impair driving performance; however, the effects of even a low dose of marijuana combined with alcohol were markedly greater than those of either drug alone.

In one study conducted in Memphis, Tennessee, researchers found that, of 150 reckless drivers who were tested for drugs at the arrest scene, 33 percent tested positive for marijuana, and 12 percent tested positive for both marijuana and cocaine. Data also show that while smoking marijuana, people display the same lack of coordination on standard “drunk driver” tests as do people who have had too much to drink.

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Fact: Marijuana users may have many of the same respiratory
problems that tobacco smokers have, such as chronic
cough and more frequent chest colds.

Q: What are the long-term effects of marijuana?

A: Although all of the long-term effects of marijuana use are not yet known, there are studies showing serious health concerns. For example, a group of scientists in California examined the health status of 450 daily smokers of marijuana, but not tobacco. They found that the marijuana smokers had more sick days and more doctor visits for respiratory problems and other types of illness than did a similar group who did not smoke either substance.

Findings so far show that the regular use of marijuana may play a role in cancer and problems of the immune and respiratory systems.

Cancer
It is hard to find out whether marijuana alone causes cancer, because many people who smoke marijuana also smoke cigarettes and use other drugs. Marijuana smoke contains some of the same cancer-causing compounds as tobacco, sometimes in higher concentrations. Studies show that someone who smokes five joints per day may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.

Tobacco smoke and marijuana smoke may work together to change the tissues lining the respiratory tract. Marijuana smoking could contribute to early development of head and neck cancer in some people.

Immune system
Our immune system protects the body from many agents that cause disease. It is not certain whether marijuana damages the immune system of people. But both animal and human studies have shown that marijuana impairs the ability of T-cells in the lungs’ immune system to fight off some infections.

Lungs and airways
People who smoke marijuana regularly may develop many of the same breathing problems that tobacco smokers have, such as daily cough and phlegm production, more frequent chest colds, a heightened risk of lung infections, and a greater tendency toward obstructed airways. Marijuana smokers usually inhale more deeply and hold their breath longer, which increases the lungs’ exposure to toxic chemicals and irritants.

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Q: What about pregnancy: Will smoking marijuana hurt the baby?

A: Doctors advise pregnant women not to use any drugs because they might harm the growing fetus. Although one animal study has linked marijuana use to loss of the fetus very early in pregnancy, two studies in humans found no association between marijuana use and early pregnancy loss. More research is necessary to fully understand the effects of marijuana use on pregnancy outcomes.

Some scientific studies have found that babies born to women who used marijuana during their pregnancy display altered responses to visual stimulation, increased tremors, and a high-pitched cry, which may indicate problems with nervous system development. During preschool and early school years, marijuana-exposed children have been reported to have more behavioral problems and difficulties with sustained attention and memory than nonexposed children.

Researchers are not certain whether any effects of maternal marijuana use during pregnancy persist as the child grows up; however, because some parts of the brain continue to develop into adolescence, it is also possible that certain kinds of problems will become more evident as the child matures.

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Q: What happens if a nursing mother uses marijuana?

A: When a nursing mother uses marijuana, some of the THC is passed to the baby through breast milk. This is a matter for concern, because the THC in the mother’s milk is much more concentrated than that in the mother’s blood. One study has shown that the use of marijuana by a mother during the first month of breastfeeding can impair the infant’s motor development (control of muscle movement). This work has not been replicated, although similar anecdotal reports exist. Further research is needed to determine whether THC transmitted in breast milk has harmful effects on development.

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Fact: Marijuana smoking affects the brain and leads
to impaired short-term memory, perception,
judgment and motor skills.

Q: How does marijuana affect the brain?

A: THC affects the nerve cells in the part of the brain where memories are formed. This makes it hard for the user to recall recent events (such as what happened a few minutes ago). It is hard to learn while high—a working short-term memory is required for learning and performing tasks that call for more than one or two steps.

Among a group of long-time heavy marijuana users in Costa Rica, researchers found that the people had great trouble when asked to recall a short list of words (a standard test of memory). People in that study group also found it very hard to focus their attention on the tests given to them.

As people age, they normally lose nerve cells in a region of the brain that is important for remembering events. Chronic exposure to THC may hasten the age-related loss of these nerve cells. In one study, researchers found that rats exposed to THC every day for 8 months (about 1/3 of their lifespan) showed a loss of brain cells comparable to rats that were twice their age. It is not known whether a similar effect occurs in humans. Researchers are still learning about the many ways that marijuana could affect the brain.

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Q: Can the drug cause mental illness?

A: Scientists do not yet know whether the use of marijuana causes mental illness. Among the difficulties in this kind of research are determining whether drug use precedes or follows mental health problems; whether one causes the other; and/or whether both are due to other factors such as genetics or environmental conditions. High doses of marijuana can induce psychosis (disturbed perceptions and thoughts), and marijuana use can worsen psychotic symptoms in people who have schizophrenia. There is also evidence of increased rates of depression, anxiety, and suicidal thinking in chronic marijuana users. However, it is not yet clear whether marijuana is being used in an attempt to self-medicate an already present, but otherwise untreated, mental health problem or whether marijuana use leads to mental disorders (or both).

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Q: Do marijuana users lose their motivation?

A: Some frequent, long-term marijuana users show signs of a lack of motivation (sometimes termed “amotivational syndrome”). Their problems include not caring about what happens in their lives, no desire to work regularly, fatigue, and a lack of concern about how they look. As a result of these symptoms, some users tend to perform poorly in school or at work. Scientists are still studying these problems.

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Q: Can a person become addicted to marijuana?

A: Yes. Although not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent on the drug or addicted to it. In 2004, more than 298,317 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they needed help to stop using.

Some heavy users of marijuana show signs of withdrawal when they do not use the drug. They develop symptoms such as restlessness, loss of appetite, trouble sleeping, weight loss, and shaky hands.

According to one study, marijuana use by teens who have prior serious antisocial problems can quickly lead to dependence on the drug. That study also found that, for troubled teens using tobacco, alcohol, and marijuana, progression from their first use of marijuana to regular use was about as rapid as their progression to regular tobacco use and more rapid than the progression to regular use of alcohol.

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Q: What is "tolerance" for marijuana?

A: “Tolerance” means that the user needs increasingly larger doses of the drug to get the same desired results that he or she previously got from smaller amounts. Some frequent, heavy users of marijuana may develop tolerance for it.

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Q: Are there treatments to help marijuana users?

A: Up until a few years ago, it was hard to find treatment programs specifically for marijuana users. Treatments for marijuana dependence were much the same as therapies for other drug abuse problems. These include behavioral therapies, such as cognitivebehavioral therapy; multisystemic therapy; individual and group counseling; and regular attendance at meetings of support groups, such as Narcotics Anonymous.

Recently, researchers have been testing different ways to attract marijuana users to treatment and help them abstain from drug use. There are currently no medications for treating marijuana dependence. Treatment programs focus on counseling and group support systems. From these studies, drug treatment professionals are learning which characteristics of users are predictors of success in treatment and which approaches to treatment can be most helpful.

Further progress in treatment to help marijuana users includes a number of programs set up to help adolescents in particular. Some of these programs are in university research centers, where most of the young patients report marijuana as their drug of choice. Others are in independent adolescent treatment facilities. Family physicians can be a good source for information and help in dealing with adolescents’ marijuana problems.

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Q: Can marijuana be used as medicine?

A: There has been much debate in the media about the possible medical use of marijuana. Under U.S. law since 1970, marijuana has been a Schedule I controlled substance. This means that the drug, at least in its smoked form, has no commonly accepted medical use.

In considering possible medical uses of marijuana, it is important to distinguish between whole marijuana and pure THC or other specific chemicals derived from cannabis. Whole marijuana contains hundreds of chemicals, some of which may be harmful to health.

THC, manufactured into a pill that is taken by mouth, not smoked, can be used for treating the nausea and vomiting that go along with certain cancer treatments and is available by prescription. Another chemical related to THC (nabilone) has also been approved by the Food and Drug Administration for treating cancer patients who suffer nausea. The oral THC is also used to help AIDS patients eat more to keep up their weight.

Scientists are studying whether marijuana, THC, and related chemicals in marijuana (called cannabinoids) may have other medical uses. According to scientists, more research needs to be done on marijuana’s side effects and potential benefits before it can be recommended for medical use. However, because of the adverse effects of smoking marijuana, research on other cannabinoids appears more promising for the development of new medications.

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Q: How can I prevent my child from getting involved with marijuana?

A: There is no magic bullet for preventing teen drug use. But parents can be influential by talking to their children about the dangers of using marijuana and other drugs, and by remaining actively engaged in their children’s lives. Even after teens enter high school, parents can stay involved in schoolwork, recreation, and social activities with their children’s friends. Research shows that appropriate parental monitoring can reduce future drug use, even among those adolescents who may be prone to marijuana use, such as those who are rebellious, cannot control their emotions, and experience internal distress. To address the issue of drug abuse in your area, it is important to get involved in drug abuse prevention programs in your community or your child’s school. Find out what prevention programs you and your children can participate in together.

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Talking to your children about marijuana

As this booklet has shown, marijuana can pose a particular threat to the health and well-being of children and adolescents at a critical point in their lives—when they are growing, learning, maturing, and laying the foundation for their adult years. As a parent, your children look to you for help and guidance in working out problems and in making decisions, including the decision not to use drugs. As a role model, your decision to not use marijuana and other illegal drugs will reinforce your message to your children.

There are numerous resources, many right in your own community, where you can obtain information so that you can talk to your children about drugs. To find these resources, you can consult your local library, school, or community service
organization.

The National Institute on Drug Abuse offers an extensive collection of publications, videotapes, and educational materials to help parents talk to their children about drug use. For more information on marijuana and other drugs, contact:

National Clearinghouse on Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847
1-800-729-6686
(TDD Number 1-800-487-4889)

And/or visit NIDA’s Web sites at:

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Resources

National Institute on Drug Abuse (NIDA)
NIDA’s mission is to lead the Nation in bringing the power of science to bear on drug abuse and addiction. It does so by supporting most of the world's research on drug abuse and ensuring the effective dissemination and use of this research to improve drug abuse and addiction prevention, treatment, and policy.

For general inquiries, contact NIDA’s public information office at 301-443-1124 or visit the NIDA Web site at www.drugabuse.gov and www.marijuana-info.org. NIDA publications are available through the National Clearinghouse for Alcohol and Drug Information.

National Clearinghouse for Alcohol and Drug Information (NCADI)
NCADI has TDD capability and provides access to educational publications from NIDA and other Federal agencies. Staff provide assistance in English and Spanish. Call 1-800-729-6686, or visit the NCADI Web site at www.ncadi.samhsa.gov.

Center for Substance Abuse Prevention (CSAP)
CSAP, a part of the Substance Abuse & Mental Health Services Administration, provides national leadership in the development of policies, programs, and services to prevent the onset of illegal drug, alcohol, and tobacco use. CSAP publications are available through NCADI.

Center for Substance Abuse Treatment (CSAT)
CSAT, a part of the Substance Abuse & Mental Health Services Administration, supports treatment services, promotes research dissemination and adoption, and operates the National Treatment Referral Hotline (1-800-662-HELP). CSAT publications are available through NCADI.

Feel free to reprint this publication in any quantity you wish.

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This page has been accessed 1945849 times since 1/8/1999.

NIH Publication No. 07-4036
Printed 1995, Revised November, 1998, Reprinted April, 2001, Revised November 2002, September 2004, August 2007.

For more information on marijuana and other drugs, contact:
National Clearinghouse on Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847
1-800-729-6686
TDD 1-800-487-4899

Positive - Negative Drug Herb Interactions

2009-01-16T19:46:00.000-08:00

Negative Drug Herb Interactions

1. Pain Medications

Sometimes herbs and acupuncture can neutralize the effect of pain drugs. For example, patients on neurontin or morphine need to be treated differently. Acupuncture in these patients should be of shorter duration with less stimulation and subtler point selections (like eight extra points, e.g.). Moxibustion is a helpful alternative.

2. Chinese Licorice

Gan cao (chinese licorice) is sometimes problematic… it is in many herb formulas, but in low dosages. Higher dosages can lead to fluid retention. Gan cao can also reduce the absorption of oral tetracycline and some other meds, and can offset the pharmacological effect of spironolactone. The rule of separating the dosage times of herbs and drugs solves this problem.

3. Tannins

Tannins are insoluble with antibiotics. A few herbs such as Da Huang (rhubarb), He Zi, and Mo Yao (Myrrh) contain tannins. Tannic acids may inhibit the absorption of iron.

4. Glycosides

Glycosides, which are active ingredients in many herbs, are neutralized by acidic drugs. That means that, for example, Vitamin C (ascorbic acid) and nicotinic acid could prevent your herbs from working.

5. Blood-thinners

Patients on warfarin (coumadin) are most at risk for problems from drug-herb interactions. Warfarin is given to thin the blood, thus preventing the likelihood of clots blocking blood vessels in the heart, lungs, or brain. Warfarin's dosage needs to be quite exact to work, so we don't want any herbs affecting it. Herbs and herbal formulas that contain blood movers must be avoided. This includes, among others, herbs dan shen (salvia), dang gui (angelica), and yan hu suo (corydalis), and herb formulas like xue fu zhu yu tang, di dan tang, and tao he cheng qi tang. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time, and so they also should be avoided by patients on warfarin.

6. Dan Shen (Salvia)

Salvia (see #5) can also reduce the effectiveness of anti-ulcer drugs.

7. Surgery and Herbs

It's a good idea to stop taking herbs 5 days before surgery, and then after surgery take herbs only to rebuild the body.

8. Drugs for the Heart

Ma Huang (ephedra) should not be taken (even in an herbal formula) if your are on digitalis or any other heart drugs. It also reduces the effectiveness of anti-anxiety and sedative drugs, and increases the cardiovascular effects of caffeine. Kyushin, gan cao (licorice), plantain, uzara root, shan zha (hawthorn), and ren shen (ginseng) may interfere with digoxin.

9. St. John's Wort

Studies have shown that patients who take St. John's Wort while on a Selective Serotonin Re-uptake Inhibiting (SSRI) anti-depressant end up with varying blood levels of drugs. This means it interferes with the effectiveness of your anti-depressant. Because its mode of action is not understood, it should be avoided with monoamine oxidase inhibitors and SSRI's.

It also appears to reduce blood levels of cyclosporin, a drug taken to prevent the body's rejection of transplanted organs. And it reduces the effectiveness of the AIDS drug indinavir. It's not yet clear whether it interferes with the metabolism of all drugs, or just some. It may be difficult for your medications to work effectively if you take St. John's Wort.

10. Ginseng

Ginseng plus phenelzine sulfate may cause headache, tremulousness, and manic episodes. Ginseng should not be used with estrogens or corticosteroids.

11. Valerian

Valerian should not be combined with barbituates.

12. Kelp

Kelp as a source of iodine may interfere with thyroid replacement therapies.

13. Echinacea

Echinacea could cause liver toxicity and therefore should not be used with other known liver toxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole

14. Nonsteroidal anti-inflammatory drugs may negate the usefulness of feverfew in the treatment of migraine headaches

15. Kava when used with alprazolam has resulted in coma

16. Evening primrose oil and borage should not be used with anticonvulsants because they may lower the seizure threshold.

17. Both Rhubard and Aloe cause loss of potassium through the stool... this may increase the side effects of cardiac glycosides and antiarrhythmic drugs.

18. Astragalus (huang qi) may oppose immunosupressive drugs, because it tends to improve immune function.

Some of these herbs are not chinese herbs (feverfew, gingko, valerian, kava, echinacea, everning primrose, borage). If you saw a Chinese herbalist, they wouldn't be an issue. Plus, chinese herbalists prescribe more balanced formulas, not single herbs, so potential interactions with the single herbs are reduced.

Positive Drug Herb Interactions

Gan cao increases the effectiveness of prednisone. This benefit can be used to reduce the dosage of prednisone in patients who have to take it long term. This reduces the serious long-term side effects (bone density loss, adrenal insufficiency, etc.).
In typhoid fever, research showed that those given an herbal formula (xue yang mei) plus a sulfa drug did better than those just given the sulfa drug. Both groups had a 100% cure rate, but the combination group experienced few or no side effects.
In mastitis, those given a heat and toxin clearing herbal formula (jin yin hua, pu gong ying, yu jin, chi shao, dan shen, qing pi) plus penicillin/streptomycin injections did much better than those only given the injection.
In adult primary nephrotic syndrome, one group was simply given corticosteroids, while another group was also given an herb formulas (dan shen, di gu pi, gui ban, han lian cao, hong hua, nu zhen zi, gou qi zi, sheng di, zhi mu). The steroid only group had a recovery rate of 56%, while the combined group's recovery rate was 85%. In another study with nephritic patients, patients given predisone, zhi mu (anemarrhena), shu di huang (rehmannia), and gan cao (licorice) experienced less of the corticosteroid side effects.
Late-stage gastric cancer patients were studied. All patients were given a drug chemotherapy combo of either methotrexate, fluoroacil and vinblastine, or methotrexate, MFC, and fluorocil. One of the two groups was also given herbs (huang qi, tai zhi shen, caulis banthalobi, ji xue tang, bai zhu, fu ling, niu zhen zi, gou qi zi, tu su zi). Side effects were cut in half or eliminated in the chemo plus herbs group.

Generic Competition and Drug Prices

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Generic competition is associated with lower drug prices, with the entry of the second generic competitor being associated with the largest price reduction. We base this conclusion on an analysis of IMS retail sales data for single-ingredient brand name and generic drug products sold in the U.S. from 1999 through 2004.¹

We define a product as having the same compound (active ingredient) and dosage form, ignoring differences in strength and package sizes. For every branded product in the database, we computed the price per dose (extended unit) each month. For the generics, we computed, for all manufacturers of a product, the average price per dose each month and the number of manufacturers. We then combined these two datasets, by product and month, and computed the ratios of the average generic price to the corresponding branded product's price. We ignored any products for which we did not have both branded and generic sales of at least 1000 doses in a given month². Finally we grouped the ratios according to the number of generic manufacturers and computed the average of the individual price ratios. Figure 1 shows these results.

Figure 1

On average, the first generic competitor prices its product only slightly lower than the brand-name manufacturer. However, the appearance of a second generic manufacturer reduces the average generic price to nearly half the brand name price. As additional generic manufacturers market the product, the prices continue to fall, but more slowly. For products that attract a large number of generic manufacturers, the average generic price falls to 20% of the branded price and lower.

1 IMS Health, IMS National Sales Perspective (TM), 1999-2004, extracted February 2005

2 The IMS data contains many instances of products with very low sales volume in a given month, but whose prices can be much different than those of higher volume products. Since this analysis averages individual price ratios without regard to sales volume, eliminating products with low sales volume eliminates the impact of these outliers on the averages.

Drug Side Effects

2009-01-14T08:03:00.000-08:00

Drug Side Effects

A side effect is usually regarded as an undesirable secondary effect which occurs in addition to the desired therapeutic effect of a drug or medication. Side effects may vary for each individual depending on the person's disease state, age, weight, gender, ethnicity and general health.

Side effects can occur when commencing, decreasing/increasing dosages, or ending a drug or medication regimen. Side effects may also lead to non-compliance with prescribed treatment. When side effects of a drug or medication are severe, the dosage may be adjusted or a second medication may be prescribed. Lifestyle or dietary changes may also help to minimize side effects.

Medication Exposures During Pregnancy and Breastfeeding

2009-01-14T07:33:00.000-08:00

Many pregnant women or mothers who are breastfeeding worry about whether to take medications - including prescription and over-the-counter drugs, vitamins, and dietary or herbal supplements. They are afraid these could harm their child. However, sometimes taking medication can’t be avoided. Pregnancy and lactation are natural periods in a woman’s life. Women who are pregnant or breastfeeding can have short-term or long-term health problems. Some of these require medication. Examples include asthma, epilepsy, high blood pressure, and depression. Women with conditions such as these may need medication to care for their own health and that of their children.

In addition, women sometimes take medication before they realize they are pregnant. Then they may worry about the effects of these medications on their unborn child. This can lead to stress and anxiety because there is not enough information available about most medications when taken during pregnancy or while breastfeeding..

All prescription medications are tested to see if they are effective before becoming available to the public. For ethical reasons, pregnant and breastfeeding women are usually not included in these studies. As a result, little information is available about the safety of most medications during pregnancy or breastfeeding when they are first marketed. Fortunately, before prescription drugs are marketed, pregnant animals are studied to help identify harmful medications. But animal studies do not always show how medications will work in humans. They might miss some effects that medications have. And, over-the-counter medications, vitamins, and dietary or herbal supplements are not always tested.

The Food and Drug Administration (FDA) keeps track of possible problems people have with medications, including pregnant and breastfeeding women. The FDA makes sure that warning labels are included in the packages for medications. They also send letters to health care providers about possible problems with medications. Universities, drug manufacturers, private professionals, and the government also do research to provide information about the effects of medications on pregnant and breastfeeding women. However, there is a critical need for more information. Women and health care providers need this information to make informed decisions about whether to use medications during pregnancy or while breastfeeding. They also need information so they can decide how best to manage a mother’s health while she is pregnant or breastfeeding.

The National Center on Birth Defects and Developmental Disabilities at CDC is committed to working with its partners and the public to build a comprehensive approach to address these issues. Our goals for this approach are to generate and interpret information about the effects of medications during pregnancy and lactation; to make that information available to women and health care providers; and to translate it into safe and effective health care for pregnant and breastfeeding women.

Date: October 29, 2004
Content source: National Center on Birth Defects and Developmental Disabilities

Herbalism

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Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, and phytotherapy. Sometimes the scope of herbal medicine is extended to include fungi and bee products, as well as minerals, shells and certain animal parts^[1].

Many plants synthesize substances that are useful to the maintenance of health in humans and other animals. These include aromatic substances, most of which are phenols or their oxygen-substituted derivatives such as tannins. Many are secondary metabolites, of which at least 12,000 have been isolated — a number estimated to be less than 10% of the total. In many cases, these substances (particularly the alkaloids) serve as plant defense mechanisms against predation by microorganisms, insects, and herbivores. Many of the herbs and spices used by humans to season food yield useful medicinal compounds

Complementary and alternative medicine: What is it?

2009-01-14T07:14:00.001-08:00

Complementary and alternative medicine: What is it?

Ranging from herbs to acupuncture, alternative medicine is becoming increasingly popular. Learn the basics.

When you were a child and sprained an ankle or came down with the flu, you probably visited a family doctor or a pediatrician to treat your problem. As an adult, you most likely visit your primary care physician for what ails you. But now your friends are suggesting alternative medicine treatments that you've never heard of — things like homeopathy, ayurveda, acupuncture and herbs.

What are these alternative medicine treatments? Are they safe? Will they work? Get the basics yourself before starting any alternative medicine therapy, and always tell your doctor which ones you're trying.

What is alternative medicine? What is complementary medicine?

Alternative medicine generally refers to practices not typically used in conventional medicine. What's considered alternative medicine changes constantly as more and more treatments undergo rigorous study and are proved to be effective or not.

Complementary medicine is thought of as treatments used in addition to the conventional therapies your doctor may prescribe, such as using tai chi or massage in addition to prescription medicine for anxiety.
Alternative medicine is generally thought of as being used instead of conventional methods. For example, this might mean seeing a homeopath or naturopath instead of your regular doctor.

Integrative medicine: Combining complementary treatments with conventional care

Conventional doctors are learning more about complementary and alternative medicine (CAM) because they recognize that more than half of people try some kind of alternative treatment. Many health care institutions have begun integrating therapies that aren't part of mainstream medicine into their treatment programs. A number of medical schools now include education on nontraditional techniques in their curriculum. As complementary and alternative therapies prove effective, they're being combined more often with conventional care. This is known as integrative medicine. You're practicing integrative medicine when you choose to add a complementary treatment to an existing conventional treatment. For instance, you may decide to take an omega-3 fatty acid supplement to help keep your heart healthy in addition to statins your doctor prescribed to reduce your cholesterol. Remember, talk to your doctor before combining complementary and alternative treatments with conventional treatments to avoid possible problems.

What are the principles of complementary and alternative medicine?

Many alternative medicine practitioners base their work around a few common principles. Some of these are similar to what your conventional doctor might do, while others are quite different. Basic philosophies of complementary and alternative medicine include:

Prevention is key to good health. Taking steps to better your health before you get sick is the best way to keep yourself healthy.
Your body has the ability to heal itself. Alternative medicine practitioners see themselves as facilitators. To them, your body does the healing work, and treatment encourages your natural healing processes.
Learning and healing go hand in hand. Alternative medicine practitioners see themselves as teachers and mentors who offer guidance. To the practitioner, you're the one who does the healing.
Holistic care. The focus is on treating you as a whole person — recognizing that physical health, mental well-being, relationships and spiritual needs are interconnected and play a part in your overall health.

What are some examples of complementary and alternative medicine?

To make sense of the many therapies available, it might help to look at them in the broad categories that the National Institutes of Health uses for classification. Keep in mind that while these categories may be useful for understanding types of complementary and alternative medicine, the distinctions between therapies aren't clear-cut. Some treatment systems may use techniques from more than one category. For example, traditional Chinese medicine uses several types of complementary and alternative medicine. Some techniques may fit in more than one category. For example, acupressure could fit either in the category of manipulation and touch or in the category of energy therapies. Here are the broad categories of complementary and alternative medicine.

Healing systems
Healing systems are complete sets of theories and practices. A system isn't just a single practice or remedy — such as massage — but many different practices that all center on a philosophy or lifestyle, such as the power of nature or the presence of energy in your body. Many healing systems developed long before the conventional Western medicine that's commonly used in the United States.

Examples of complementary and alternative medicine healing systems include:

Ayurveda. This form of medicine, which originated in India more than 5,000 years ago, emphasizes a unique cure per individual circumstances. It incorporates treatments including yoga, meditation, massage, diet and herbs.
Homeopathy. This treatment uses minute doses of a substance that causes symptoms to stimulate the body's self-healing response.
Naturopathy. This type of treatment focuses on noninvasive treatments to help your body do its own healing. Naturopaths draw on many forms of complementary and alternative medicine, including massage, acupuncture, herbal remedies, exercise and lifestyle counseling.
Ancient medicines. These complementary and alternative medicine treatments include Chinese, Asian, Pacific Islander, American Indian and Tibetan practices.

Mind-body connections
Mind-body techniques strengthen the communication between your mind and your body. Complementary and alternative medicine practitioners say these two systems must be in harmony for you to stay healthy. Examples of mind-body connection techniques include:

Meditation
Yoga
Biofeedback
Prayer
Hypnosis
Relaxation and art therapies, such as poetry, music and dance

Dietary supplements and herbal remedies
These treatments use ingredients found in nature. Examples of herbs include ginseng, ginkgo and echinacea, while examples of other dietary supplements include selenium, glucosamine sulfate and SAM-e. Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules. Some say that they trust herbal medicine because it's been used for thousands of years. Others say that they like it because it's "natural."

Remember, though, that natural doesn't mean that herbs and supplements are always safe — and added ingredients aren't always natural. Dietary supplements and herbal remedies can cause side effects and interact with medications, so be sure to investigate possible dangers or drug interactions with your doctor. As with other complementary and alternative treatments, always talk to your doctor before taking an herb or supplement to make sure it's safe for you.

Manipulation and touch
These methods use human touch to move or manipulate a specific part of your body. They include:

Chiropractic and spinal manipulation
Massage
Other types of manipulation and touch therapies, such as osteopathy, craniosacral therapy and acupressure

Energy therapies
Some complementary and alternative medicine practitioners believe an invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. Unblocking or re-balancing your energy force is the goal of these therapies, and each claims to accomplish that goal differently. Proponents of acupuncture, for instance, say that the insertion of needles into points along energy pathways in your body restores your natural energy.

Other energy therapies include:

Therapeutic touch
Reiki
Magnet therapy
Polarity therapy
Light therapy

Are conventional doctors opposed to complementary and alternative medicine?

Many doctors aren't opposed to complementary and alternative medicine. But many doctors practicing today did not receive training in CAM therapies, so they may not feel comfortable addressing questions in this area. However, as the evidence for certain therapies increases, doctors in the United States are increasingly referring people to complementary and alternative practitioners. Your doctor may be willing to discuss these options with you.

At the same time, conventional doctors also have good reason to be skeptical when it comes to complementary and alternative medicine. Some complementary and alternative medicine practitioners make exaggerated claims about curing diseases, and some ask you to forgo treatment from your conventional doctor to use their unproven therapies. Some forms of complementary and alternative medicine can even hurt you.

Conventional medicine relies on methods proved to be safe and effective with carefully designed trials and research. But many complementary and alternative treatments lack solid research on which to base sound decisions. The dangers and possible benefits of many complementary and alternative treatments remain unproved.

Why is there a lack of evidence about complementary and alternative treatments?

One reason for the lack of research in complementary and alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional medications or procedures are often directly or indirectly funded by the government or drug companies, giving conventional treatments more resources to do studies. Most complementary and alternative treatment trials are more difficult to fund, so there are fewer trials. Nonetheless, a number of studies are currently under way on complementary and alternative treatments ranging from herbs to yoga that may help identify what works and what doesn't, and what's safe and what isn't. In fact, the U.S. government has established a National Center for Complementary and Alternative Medicine to help guide the public in making wise choices when it comes to complementary and alternative treatments.

Talk to your doctor about possible benefits and dangers

Work with your conventional medical doctor to help you make informed decisions regarding complementary and alternative treatments. Even if your doctor can't recommend a specific complementary and alternative treatment, he or she can help you understand possible risks and benefits before you try a treatment. Though some of these treatments can be helpful, many have side effects and can cause problems with certain medications or health conditions. Keep in mind that CAM treatments aren't a substitute or replacement for conventional medical care — but used wisely and in conjunction with conventional medical treatment, they may help you alleviate stress, pain and anxiety, manage your symptoms, maintain strength and flexibility, and promote a sense of well-being.

Herbal supplements: What to know before you buy ?

2009-01-14T07:09:00.000-08:00

Herbal supplements: What to know before you buy

New government regulations should lead to safer herbal supplements, but they still can present a risk. Here's what you should know before you purchase dietary supplements.

Herbal supplements may become even more popular as new safety regulations are implemented, but are they right for you? That depends on the herb, your current health and your medical history.

Herbal supplements have active ingredients that can affect how your body functions, just as over-the-counter and prescription drugs do. Herbal supplements may be particularly risky for certain individuals, and herbal supplement labels are often vague, confusing and of little help when it comes to making a selection. If you're considering herbal supplements or other dietary supplements, educate yourself about any products you intend to use before purchasing them and talk to your doctor about any supplements you're considering taking.

Are herbal supplements safe?

Until recently, government oversight and consumer protection were very limited for dietary supplements. But new regulations contained within the Federal Food, Drug, and Cosmetic Act give the Food and Drug Administration (FDA), the federal agency responsible for overseeing the safety of U.S. food and drug products, the authority to oversee the manufacture of domestic- and foreign-made dietary supplements, including herbal supplements.

Dietary supplements don't need to go through the rigorous review process that new drugs must undergo before being "approved" by the FDA. But the new regulations aim to improve safety by requiring supplement manufacturers to follow certain manufacturing practices and to ensure that supplements contain what their labels claim and are free of contaminants. The FDA is responsible for monitoring the safety of supplements after they're on the market and enforcing action against unsafe supplements. These new regulations will be phased in over a three-year period so that by June, 2010, all supplement manufacturers should meet these requirements.

How do you know what's in an herbal supplement?

You can expect certain information to be included on the labels of all herbal supplements, which should help you understand what's inside the packaging. This information includes:

The name of the herbal supplement, such as St. John's wort
The net quantity of contents, for example, 60 capsules
In certain cases, a disclaimer: "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease."
A Supplement Facts panel, which includes serving size, amount and active ingredient
Other ingredients, such as herbs and amino acids, for which no daily values have been established
The name and address of manufacturer, packer or distributor

Manufacturers typically refer to herbal products by their common name and the part of the plant used to make the herbal supplement, such as root, stem or leaf. If you don't understand anything on an herbal supplement's label, ask your doctor or pharmacist for clarification.

How do you choose an herbal supplement?

Although new regulations are being implemented, choosing an herbal supplement of the highest quality remains difficult. To choose the best herbal supplement brands:

Look for standardized herbal supplements. The U.S. Pharmacopeia's "USP Dietary Supplement Verified" seal on a supplement indicates the supplement has met certain manufacturing standards. These standards include testing the product for uniformity, cleanliness and freedom from environmental contaminants, such as lead, mercury or drugs. Other groups that certify herbal supplements include ConsumerLab.com, Good Housekeeping and NSF International. Although each group takes a slightly different approach, the goal of each is to certify that herbal supplements meet a certain standard. Don't assume that all herbal products on the market are safe. Even the groups that test herbal supplements aren't obligated to report products that fail to live up to their standards.
Buy only single-herb products. And choose products that clearly show how much of the herb each dose contains. Some products are mixtures of several herbs with unknown proportions of each.
Beware of claims that sound too good to be true. If a claim sounds outrageous to you, trust your instinct. No one herbal supplement can possibly address a wide spectrum of health concerns.
Be extremely cautious about herbal supplements manufactured outside the United States. Many European herbs are highly regulated and standardized. But toxic ingredients and prescription drugs have been found in some herbal supplements manufactured in other countries.

Who shouldn't use herbal supplements?

Avoid using herbal supplements if:

You're taking prescription or over-the-counter (OTC) medications. Some herbs can cause serious side effects when mixed with prescription and OTC drugs such as aspirin, blood thinners or blood pressure medications. Talk to your doctor about possible interactions.
A proven medical treatment is available for your medical condition. A traditional medication with an established record for safety and effectiveness will generally be less likely to result in adverse side effects.
You're pregnant or breast-feeding. As a general rule, don't take any medications — prescription, OTC or herbal — when you're pregnant or breast-feeding unless your doctor approves. Medications that may be safe for you as an adult may be harmful to your fetus or your breast-feeding infant.
You're having surgery. Many herbal supplements can affect the success of surgery. Some may decrease the effectiveness of anesthetics or cause dangerous complications, such as bleeding or high blood pressure. Tell your doctor about any herbs you're taking or considering taking as soon as you know you need surgery.
You're younger than 18 or older than 65. Older adults may metabolize medications differently. And few herbal supplements have been tested on children or have established safe doses for children.

What You Need to Know About Drugs

2009-01-10T21:05:00.000-08:00

Medicines Are Legal Drugs

If you've ever been sick and had to take medicine, you already know about one kind of drugs. Medicines are legal drugs, meaning doctors are allowed to prescribe them for patients, stores can sell them, and people are allowed to buy them. But it's not legal, or safe, for people to use these medicines any way they want or to buy them from people who are selling them illegally.

Cigarettes and Alcohol

Cigarettes and alcohol are two other kinds of legal drugs. (In the United States, adults 18 and over can buy cigarettes and those 21 and over can buy alcohol.) But smoking and excessive drinking are not healthy for adults and off limits for kids.

Illegal Drugs

When people talk about the "drug problem," they usually mean abusing legal drugs or using illegal drugs, such as marijuana, ecstasy, cocaine, LSD, crystal meth and heroin. (Marijuana is generally an illegal drug, but some states allow doctors to prescribe it to adults for certain illnesses.)

Why Are Illegal Drugs Dangerous?

Illegal drugs aren't good for anyone, but they are particularly bad for a kid or teen whose body is still growing. Illegal drugs can damage the brain, heart, and other important organs. Cocaine, for instance, can cause a heart attack - even in a kid or teen.

While using drugs, a person is also less able to do well in school, sports, and other activities. It's often harder to think clearly and make good decisions. People can do dumb or dangerous things that could hurt themselves - or other people - when they use drugs.

Why Do People Use Illegal Drugs?

Sometimes kids and teens try drugs to fit in with a group of friends. Or they might be curious or just bored. A person may use illegal drugs for many reasons, but often because they help the person escape from reality for a while. If a person is sad or upset, a drug can - temporarily - make the person feel better or forget about problems. But this escape lasts only until the drug wears off.

Drugs don't solve problems, of course. And using drugs often causes other problems on top of the problems the person had in the first place. A person who uses drugs can become dependent on them, or addicted. This means that the person's body becomes so accustomed to having this drug that he or she can't function well without it.

Once a person is addicted, it's very hard to stop taking drugs. Stopping can cause withdrawal symptoms, such as vomiting (throwing up), sweating, and tremors (shaking). These sick feelings continue until the person's body gets adjusted to being drug free again.

Can I Tell If Someone Is Using Drugs?

If someone is using drugs, you might notice changes in how the person looks or acts. Here are some of those signs, but it's important to remember that depression or another problem could be causing these changes. A person using drugs may:

lose interest in school
change friends (to hang out with kids who use drugs)
become moody, negative, cranky, or worried all the time
ask to be left alone a lot
have trouble concentrating
sleep a lot (maybe even in class)
get in fights
have red or puffy eyes
lose or gain weight
cough a lot
have a runny nose all of the time

What Can I Do to Help?

If you think someone is using drugs, the best thing to do is to tell an adult that you trust. This could be a parent, other relative, teacher, coach, or school counselor. The person might need professional help to stop using drugs. A grown-up can help the person find the treatment he or she needs to stop using drugs. Another way kids can help kids is by choosing not to try or use drugs. It's a good way for friends to stick together.

Understanding drugs and why they are dangerous is another good step for a kid to take. Below, we've listed some words that may be new to you.

Words to Know

Addiction (say: uh-dik-shun) - A person has an addiction when he or she becomes dependent on or craves a drug all of the time.

Depressant (say: dih-preh-sunt) - A depressant is a drug that slows a person down. Doctors prescribe depressants to help people be less angry, anxious, or tense. Depressants relax muscles and make people feel sleepy, less stressed out, or like their head is stuffed. Some people may use these drugs illegally to slow themselves down and help bring on sleep - especially after using various kinds of stimulants. (See below.)

Hallucinogen (say: huh-loo-sun-uh-jun) - A hallucinogen is a drug, such as LSD, that changes a person's mood and makes him or her see, hear, or think things that aren't really there.

High - A high is the feeling that drug users want to get when they take drugs. There are many types of highs, including a very happy or spacey feeling or a feeling that a person has special powers, such as the ability to fly or to see into the future.

Inhalant (say: in-hay-lunt) - An inhalant, such as glue or gasoline, is sniffed or "huffed" to give the user an immediate rush. Inhalants produce a quick feeling of being drunk - followed by sleepiness, staggering, dizziness, and confusion.

Narcotic (say: nar-kah-tik) - A narcotic dulls the body's senses (leaving a person less aware and alert and feeling carefree) and relieves pain. Narcotics can cause a person to sleep, fall into a stupor, have convulsions, and even slip into a coma. Certain narcotics - such as codeine - are legal if given by doctors to treat pain. Heroin is an illegal narcotic because it is has dangerous side effects and is very addictive.

Stimulant (say: stim-yuh-lunt) - A stimulant speeds up a person's body and brain. Stimulants, such as methamphetamines and cocaine, have the opposite effect of depressants. Usually, stimulants make a person feel high and energized. When the effects of a stimulant wear off, the person will feel tired or sick.

Drugs history

2009-01-10T18:15:00.000-08:00

Drugs are chemical compounds that modify the way the body and mind work. Most people think that these biological activities should help or heal sick people or animals.

There is, however, no known drug that is not harmful or even poisonous at high doses, and much of the scientific work on drugs has attempted to widen the gap between effective and toxic doses.

The word drug has acquired bad connotations in recent years because the widespread abuse of a few chemicals that affect the central nervous system has become a serious sociological problem. Nevertheless, drugs act on many other organs in the body, can benefit as well as harm the nervous system, and have made possible a revolution in the way modern doctors treat disease.

Just as there is no health benefit without potential toxicity, there is no absolute goodness about drugs. However, their enormous health benefits outweigh the drawbacks in individual cases. The history, discovery, manufacture, action, acceptance, and rejection of drugs are the themes of this book.

It used to be said that what distinguishes humans from animals is that people take drugs. This old adage is no longer quite true. Rats and monkeys that have been addicted experimentally to some drugs will inject themselves with those drugs to support their addictions. But otherwise the old saying still holds.

History Of Drugs

The history of drugs is shrouded in the beginnings of the human race. Alcohol was made, drunk, and used to excess as far back as memory and records go. Tobacco (Nicotiana), hemp (Cannabis sativa), opium poppy (Papaver somniferum), and other plants containing drugs have been chewed and smoked almost as long as alcohol, and coffee has been served in the Middle East throughout that area's history.

Tobacco was carried from Virginia to England by Sir Walter Raleigh, whose pipe smoking prompted Elizabeth I to remark, "I don't like this herb." Of course, the queen did not know anything about tar and nicotine, but she became one of the first people to initiate the acrimonious debate about tobacco constituents that we face today. Likewise, the effects of cannabis have given it a bad name.

Coffee was introduced by the Ottomans to the Western world when the Turks made a foray into central Europe in the 16th century. Its active alkaloid, caffeine, is often on the forbidden list for patients suffering from rapid heart beat or angina. Some of the chemicals that flavor coffee, such as esters of caffeic acid, stimulate cardiac hormones and thus add to the danger of disturbing the rhythm of the heartbeat.

Apes and humans are believed to have taken their separate evolutionary ways some 5-10 million years ago. In those times, prehumans, almost humans, and later, nomadic groups of obviously human individuals roamed the landscape in search of food and shelter.

The driving forces behind this foraging behavior were the need to defend themselves against the environment and the need to reproduce their species. The earliest humans were often threatened by malnutrition or even starvation; by predators-both animal and competing or cannibalistic human hunters; and by parasites and degenerative diseases.

The kindling and taming of fire further separated humans from animals. Fire gave primitive nomads some protection from cold and a way to make food more palatable.

The earliest records of their short and deprived years, estimated as no more than a couple of decades, are wall paintings and carvings on rocks that have endured for thousands of years in jungles or deserts.

The pictures give us little insight into any healing arts those forebears may have invented. Probably accidental discovery of the healing powers of roots, barks, leaves, and berries and of nutritional sources of proteins and starch occurred even during those earliest stages.

Planting Seeds

Only recently, 10,000-20,000 years ago, nomadic tribes began to settle down in some parts of the world and formed small agricultural communities. This development was one of the most profound changes in the history of the human race.

Planting seeds, domesticating animals, and erecting permanent shelters for humans and animals improved nutrition, provided more comfortable, though still primitive, living accommodations, and started the societal bonds that developed into villages, towns, and cities, where the first truly historical times began.

At this stage, when people began to live close together, certain rules were established to bring needed order out of unstructured conglomerated living. Strong individuals emerged as the leaders of tribal or village communities.

Ambitious leaders increased their power by shrouding their personalities and decisions in mystery, elevating them to an exalted reputation.

Thus emerged the concept of superhuman beings, of gods with powers over natural phenomena such as fertility, family bonds, lightning, and the awesome power of storms.

When the demands of multiple deities for sacrifices grew excessive, all these powers and supernatural beliefs and superstitions were united in monotheistic religions, often after catastrophic wars and through a longing for peace.

The deities were represented ritualistically by priests and priestesses, and valuable sacrifices offered by the people further enhanced the splendor and power of these leading personalities.

Authority

Part of the influence of these commanding individuals came from the personal help they could give to sick, wounded, and otherwise afflicted members of their groups. The medicine man, witch doctor, or shaman was the first person to turn to in distress.

Sometimes authority lay in an influential woman who functioned as priestess, nurse, and midwife. In most cases, power, enforced by superstition, centered in a dominant male recognized as healer, priest, judge, and leader in peace and war. A knowledge of healing herbs formed part of his power base and prerogative; among his duties was applying such healing products when needed.

Botanical specimens taken from trees, shrubs, and other plants formed the mainstay of most of these early medicines. Sometimes the shaman deepened the mystery of the power of his medication by adding parts of animals, and even human hearts.

Some mind-induced (psychosomatic) illnesses were probably improved by suggestions, just as they are today. Also, some functional disorders responded to the active chemicals in suitably chosen plants. It must have been hard for a medicine man to decide which plant to give a patient. Trial and error was the order of the day.

Even after a healing effect was found in a certain plant, it was probably used for a variety of illnesses, whether identical in symptoms or only vaguely similar. Modern physicians still face complicated choices in diagnosis and drug therapy in spite of help from analytical tests, X-rays, ultrasound, nuclear magnetic resonance visualization, blood cell counts, urinalysis, and other laboratory aids.

We can only imagine the dilemma of an ancient medicine man, who was guided only by vague symptoms such as a generalized pain, nausea, fever, or convulsions.

In such a dilemma, and without any knowledge of anatomy or pathology, some herbal concoction was given in the hope that it would work. The medicine man undoubtedly added prayers or exorcisms to the medication and believed sincerely that his ministrations would aid the afflicted.

Cynical healers also appeared. In Roman times, predictions about world affairs as well as the course of a patient's disease were based on the inspection of the intestines of newly slaughtered chickens. There was a saying that described one of these healer-seers (called a haruspex) encountering another member of the guild: Haruspex, haruspicem videns ridet ("When one haruspex sees another, he laughs").

Early Records Of Natural Drugs

Fortunately, some medicine men and women were careful observers, who had a patient's recovery uppermost in mind. Especially those who had risen to power and influence and had a scientific bent or deep compassion could be relied upon to search for valid explanations of their findings.

China And The Chinese

One of the oldest records of such medicinal recommendations is found in the writings of the Chinese scholar-emperor Shen Nung, who lived in 2735 B.C., or 4730 B.P. (before the present). He compiled a book about herbs, a forerunner of the medieval pharmacopoeias that listed all the then-known medications.

He was able to judge the value of some Chinese herbs. For example, he found that Ch'ang Shan was helpful in treating fevers. Such fevers were, and still are, caused by malaria parasites.

The drug consists of the powdered roots of a plant in the breakstone family (Saxifragaceae, now identified as Dichroa febrifuga, Lour.). Almost 4700 years later, a group of Chinese chemists isolated two compounds (the dichroines) from the plants, one of which later proved to control bird malaria.

The leaves of this plant-called Shun Chi or chuine in present-day China-also contain antimalarial chemicals (the febrifugines), one of which is identical with one of the dichroines. These alkaloids (organic bases) were studied and synthesized during World War II in an effort to protect Americans from malaria in the Pacific and other tropical campaigns.

However, chemists could not separate the nausea the drugs produced from their antimalarial effects.

The emperor Shen Nung also observed the stimulating effect of another ancient Chinese medicinal plant, Ma Huang. This one, now called Ephedra sinica, contains a number of alkaloids, chief of which, ephedrine, was isolated by the Japanese chemist Nagai in 1887, more than 4600 years after the effect of the plant had been recorded.

Ephedrine and some closely related compounds are responsible for the ability of the wiry plant to stimulate blood pressure and breathing. The drug also contracts blood vessels. The Chinese book Pen Tsao (Herbal Medicines) of 5000 B.P. recommends castor oil for purging and the opium poppy for sleep.

Natural Drugs

The 5000-year tradition of natural drugs continues to flourish in China even today. A curious philosophy underlies their reasoning: Diseases are evil occurrences that are counteracted by good influences, they say, and nature is good and therefore healing.

The traditional Chinese physicians overlook the fact that nature is not always kind. Cataclysms such as earthquakes, floods, and hurricanes threaten life.

Medicinal plants are toxic, often deadly poisonous. The widespread toxicity of botanical materials can be seen in the history of assassinations, suicides, and accidental poisoning by swallowing certain plant products, as well as the killing of game and enemies with curare-tipped arrows.

Some Chinese pharmacognosists claim that synthetic compounds with no structural resemblance to harmless natural products are more dangerous than naturally occurring plant constituents, but this claim is unsubstantiated.

Some synthetic compounds are highly toxic, others are not, and the same is true of natural products. In thousands of cases, chemical manipulation of their structure has lessened the toxicity of natural alkaloids, antibiotics, hormones, snake venom's, and other biologically active substances.

Frequently, these semisynthetic chemical cousins or analogues can be used in clinical medicine much more safely than their natural ancestors.

Ancient Drugs

Much knowledge of early drugs has been lost from every civilization. What remains is passed on in sporadically recorded epics and folklore unearthed by archaeologists and linguistic scholars. Tropical and subtropical regions, with their greater variety of plants, have given us most of the descriptions of these medicines.

Although some ancient drugs have survived throughout the ages and are still used in a refined form, they amount to a small percentage of modern medications.

Hindu

Ancient Hindu records mention eating chaulmoogra fruit to treat leprosy. We now know that the fruit contains several oils not very effective against leprosy bacteria. Treating the disfigured areas with these oils has been replaced entirely by swallowing dapsone, a synthetic drug, or by using other medicines.

Ipecacuanha, Cephaelis Species

A treatment still in use in underdeveloped regions for some intestinal problems is ipecac, the powdered roots of ipecacuanha (Cephaelis species). These plants were already being used by Brazilian Indians before the European conquest.

The Indians treated "bloody flux," a form of amoebic diarrhea, with "igpecaya." Samuel Purchas (ca. 1577-1626) in Purchas his Pilgrims published a description of this material in 1615. As often happens in medicine, the successful recovery of a highly placed person made treatment with a new drug popular.

In the case of ipecacuanha, the dauphin, son of Louis XV, was cured of his amoebic infection by the physician Claude-Adrien Helvetius (1715-1771).

However, amoebiasis was not studied intensively until 1875, and another 35 years passed before extraction of ipecac showed that the alkaloids emetine and cephaline were the active ingredients of the plant.

Ipecac had been used for centuries to make poisoned people vomit; unfortunately, this property has limited the use of emetine for curing amoebiasis.

Intestinal Worms

Mediterranean peoples used to pulverize the dried flower heads of species in the ragweed family, especially Artemesia maritima, to get rid of intestinal worms.

This plant is native to south-central Russia. Its active ingredient, santonin, was synthesized by British and Swiss organic chemists, yet studies have not been able to separate clinically effective doses from toxic ones.

However, santonin is still used for roundworm infections in farm animals.

Another plant used to treat worms is goosefoot (Chenopodium anthelminticum). From its flowers comes a volatile oil that contains the active principle ascaridole. The Romans gave it the name Chenopodium; the Hebrews called it Jerusalem Oak; and others dub it Mexican tea.

Likewise, a thick, dark green oil that helps to expel tapeworms can be pressed from the male fern (Dryopteris filix-mas). This plant's use is ancient. Its active ingredient is also ascaridole. In humans it is effective only at almost toxic doses, and it is prescribed mostly in veterinary medicine.

Early medicine men used it because they needed medications regardless of side effects. Many of these antique natural drugs would be unacceptable to today's regulatory agencies such as the U.S. Food and Drug Administration, as well as to the medical profession.

South and Central American Indians

South and Central American Indians made many prehistoric discoveries of drug-bearing plants. Mexican Aztecs even recorded their properties in hieroglyphics on rocks, but our knowledge of their studies comes mainly from manuscripts of Spanish monks and medical men attached to the forces of the conquistador Hernan Cortes (1485-1547).

Pre-Columbian Mexicans used many substances, from tobacco to mind-expanding (hallucinogenic) plants, in their medicinal collections. The most fascinating of these substances are sacred mushrooms, used in religious ceremonies to induce altered states of mind, not just drunkenness.

In the recent past, many of these mushrooms as well as flowers and shrubs have been extracted chemically, and their active ingredients have been identified.

For example, peyote, a small cactus, now named Lophophora williamsii, contains alkaloids, especially mescaline, that cause hallucinations.

The Indians called sacred mushrooms teonacatl (nahuatl means God's flesh). Some of these mushrooms belong to Psilocybe species and contain hallucinogens (psilocine, psilocybin).

These and other plants that produced temporary psychotic reactions were abhorred by the Spanish priests, who saw their use as rites of the devil.

Cocaine

Other South American Indians, especially those in the Peruvian Andes mountains, made several early discoveries of drug-bearing plants. Two of these plants contain alkaloids of worldwide importance that have become modern drugs. They are cocaine and quinine.

Cocaine is extracted from leaves, especially from Erythroxylum coca, a bushy shrub native in South American countries at high altitudes, such as Bolivia, Peru, Ecuador, and Chile. Cocaine is the primary alkaloid in these leaves.

Sigmund Freud, the Austrian psychoanalyst (1856-1939), treated many deeply disturbed cocaine addicts. In the course of his practice, he noted the numbing effect of the drug. He called this effect to the attention of the clinical pharmacologist Carl Koller, who introduced cocaine as a local anesthetic into surgical procedures.

Cocaine's potential for addiction was known and used with sinister intent by South American Indian chiefs hundreds of years ago.

The chiefs maintained a messenger system along the spine of the Andes to control their thinly populated kingdoms, which stretched for thousands of miles along the mountains and were isolated from each other by the rugged terrain. The messengers had to run at high altitudes and needed stimulants for this exhausting task.

Their wealthy employers provided the runners with coca leaves for this purpose and enslaved them further by paying them with more coca leaves, thus maintaining the addiction for which the poor runners were willing to continue their never-ending jobs. When coca leaves reached Europe with the Spanish conquistadores, they led to one of the first European waves of euphoric hallucinogenic drugs.

Quinine

Quinine was isolated from the bark of the cinchona tree by the French chemists Joseph-Biename Caventou and Pierre-Joseph Pelletier in 1820, 200 years after the bark was introduced into Europe for the treatment of malaria. The Peruvian Indians had recognized for years the value of the quinquina tree for treating feverish patients.

Some historians believe that malaria was imported to South America by the conquistadores and their African slaves. A persistent story exists about Dona Francisca Henriquez de Ribera, wife of Count Chinchon, the Spanish viceroy of Peru. She fell ill with malaria (the "tertians" variety with chills and fever that recur every third day) and was cured by an Indian healer who gave her the bark.

In gratitude for the cure, the countess distributed the bark to other patients in Lima and thus alerted Spanish physicians to its clinical potential. The great Swedish botanist Linnaeus (Carl von Linne, 1707-1778) later called the tree cinchona in honor of Countess Chinchon, misspelling her name in the process.

It is improbable that the countess persuaded Spanish doctors to use the bark because she died in Cartagena, Colombia, in 1641, while returning home. Because the antimalarial value of cinchona became more widely recognized while supplies of the bark fell short of demand, the cost of the powder was often matched by its weight in gold.

Cinchona Tree

The cinchona tree grows wild in the sub-Andean jungles, and a number of European powers tried to transplant it to other tropical places. Peruvian officials realized what a gold mine these trees represented and strictly prohibited their export.

A British attempt to smuggle some trees out of Peru failed, but two Dutch adventurers managed to get a few specimens across the border. The stolen trees were taken to Java and became the ancestors of later improved plantation trees that, before 1940, furnished 97% of the world's supply of quinine.

The inaccessibility of Java-and of Sri Lanka, where a few smaller plantations existed-became a source of worry for European drug factories that were the principal sources of pure quinine. This concern was felt acutely by German manufacturers in World War I, when they were unable to supply European colonies in Africa with the drug.

In World War II, British and American suppliers also were cut off from their Oriental sources of quinine when the Japanese occupied Java and Malay.

In both instances, the drug shortage stimulated intensive research to surmount this handicap, and the resulting new compounds are almost the only effective synthetic antimalarials we have today. Nevertheless, quinine has kept a modest but important and inexpensive place in antimalarial treatment.

Synthetic Drugs

As the centuries unrolled and new civilizations appeared, cultural, artistic, and medical developments shifted toward the new centers of power. A reversal of the traditional search for botanical drugs occurred in Greece in the fourth century B.C. (about 2400 B.P.), when Hippocrates (estimated dates, 460-377 B.C.), the "Father of Medicine," became interested in inorganic salts as medications.

Hippocrates' authority lasted throughout the Middle Ages and reminded alchemists and medical experimenters of the potential of inorganic drugs. In fact, a distant descendant of Hippocrates' prescriptions was the use of antimony salts in elixirs (alcoholic solutions) advocated by Basilius Valentius in the middle of the 15th century and by the medical alchemist Phillippus Aureolus Paracelsus (born Theophrastus Bombast von Hohenheim, in Switzerland, 1493-1541).

The ethics of Hippocrates as incorporated in the physicians' Hippocratic oath have survived better than his preference for inorganic salts.

However, we still use magnesium sulfate (named Epsom salts for the British town of Epsom), both internally and externally; aluminum salt astringents; sodium and potassium chlorides and calcium salts for various deficiencies; barium sulfate as an X-ray contrast agent; and - sodium iodide to prevent thyroid disorders, as well as stannous fluoride to prevent tooth decay.

Gold compounds are experiencing a renaissance in the treatment of arthritis, and silver nitrate was used to protect the eyes of newborn infants from gonorrheal blindness before penicillin took its place.

Lithium salts are used in gout and to smooth out the biphasic phase of manic-depression. Many heavy metals are incorporated as traces in diet supplements because they have been recognized as essential parts of important biological catalysts.

The next great-and reactionary-influence on medicinal thought came from a Greek physician from Pergamum, Claudius Galenus, or Galen (129-ca. 199 A.D.), who taught in Rome. Galenic medicine consisted of preparations of plants by soaking (infusion) or boiling (decoction).

As Oliver Wendell Holmes said, "These Galenists were what we should call herb doctors today." Galen claimed that herbal mixtures could provide all the essentials for health and therefore could be applied to all conceivable health defects. He was also a vegetarian.

We know today that a strict vegetarian diet, without milk, cheese, or eggs cannot contain all the protein-building amino acids needed for normal growth and body maintenance. In Galen's storeroom (apotheke), some metallic substances, such as copper and zinc ores, iron sulfate, and cadmium oxide, were still present, probably as a tribute to Hippocrates' drug inventory.

Galen insisted on carefully identifying the type and age of botanical materials and thus foreshadowed the value of controlling the purity of drugs. Among his favorite and potent drugs were hyoscyamus (which contains atropine), opium (the source of morphine), and squill (which contains heart stimulants, cardiac glycosides similar to digitalis).

Medieval Medicines

Galen's teachings made such a profound impact on medieval society and medicine that they were followed for more than 1000 years. In western Europe, where medical knowledge was encased in Catholic monasteries, Galen's prescriptions were embraced by the conservative monks.

Although some teachings of contemporary Islamic scholars filtered into this environment, many centuries passed before herbal medicine could be replaced by newer treatments.

After the fall of the Roman and Byzantine empires and the rise of Islam in the Middle East, the "civilized world" of Europe was in decline. The migration of Eastern peoples, the constant and cruel wars all over the continent, and the absence of cultural and intellectual life-styles made scholarly studies of drugs impossible.

The herb gardens of monasteries were the chief source of healing plants, but infections, heart disease, cancer, and the innumerable battle wounds and disfigurements from torture could not be treated rationally. Plagues swept across the continent and the British isles, chiefly bubonic plague, viral pandemics, and later syphilis.

The victims were laid to rest in mass graves with no medicines to ease their final agonies. Life was hard and, on the average, short; at 50 or 55 a person was an ancient senior citizen; most died in their 40s or earlier.

Bleeding the patient by opening a vein or with leeches was one of the few medical treatments and was used for various ills. Amputation of wounded or badly infected limbs was carried out without benefit of anesthesia or soap-and-water hygiene; cesarean deliveries meant the cruel and certain death of the mother.

These desperate health conditions applied to kings and serfs alike for almost 1500 years. It is no wonder that a better life could be imagined only in the heavens, which represented a hypothesis that had never been proved.

The little that was known about healing plants, minerals, and tissues was called materia medica, a term still used for drug information at the turn of this century. Latin was used throughout the collective accounts of this subject because it was the professional language of the monks and also because it kept the common people in ignorance.

When pamphlets could no longer hold the accumulating knowledge of materia medica, larger, more formal collections were gathered in national pharmacopoeias. The first of these books appeared in Florence in 1498, six years after Christopher Columbus landed in Dominica, followed by others in Nuremberg (1535), Basel (1561), Augsburg (1564), and London (1618).

Standards of purity and methods of preparing various drug products accompanied the descriptions of botanical and mineralogical specimens. One item tells how to make a sort of candy of red rose petals for pale tired people and of white roses for those with too ruddy complexions.

The late Middle Ages coincided with the upsurge of alchemy, a primitive chemistry dealing mostly with inorganic substances. The renewed interest in inorganic materials pushed botanical sources of medicines into second place temporarily. True, quinine (cinchona) appeared during that century, but the next great botanical drug, digitalis, was not introduced until the end of the 1700s.

DRUG MEDICINE

DRUG TEST

MARIJUANA

Marijuana

THE EFFECTS OF DRUGS & ALCOHOL

MARIJUANA : Facts Parents Need To Know

Contents

A Letter to Parents

Fact: There are stronger forms of marijuana available to adolescents today than in the 1970s or 1908s. Stronger marijuana means stronger effects.

Q: What is marijuana? Are there different kinds?

Q: What are the current slang terms for marijuana?

Q: How is marijuana used?

Q: How many people smoke marijuana? At what age do children generally start?

Fact: Research shows that more than 40 percent of teenagers try marijuana before they graduate from high school.

Q: How can I tell if my child has been using marijuana?

Q: Why do young people use marijuana?

Q: Does using marijuana lead to other drugs?

Q: What are the effects of marijuana?

Q: What happens after a person smokes marijuana?

Q: How long does marijuana stay in the user's body?

Q: Can a user have a bad reaction?

Fact: Marijuana has adverse effects on many ofthe skills required for driving a car. Driving while high can lead to car accidents.

Q: How is marijuana harmful?

Q: How does marijuana affect driving?

Fact: Marijuana users may have many of the same respiratory problems that tobacco smokers have, such as chronic cough and more frequent chest colds.

Q: What are the long-term effects of marijuana?

Q: What about pregnancy: Will smoking marijuana hurt the baby?

Q: What happens if a nursing mother uses marijuana?

Fact: Marijuana smoking affects the brain and leadsto impaired short-term memory, perception, judgment and motor skills.

Q: How does marijuana affect the brain?

Q: Can the drug cause mental illness?

Q: Do marijuana users lose their motivation?

Q: Can a person become addicted to marijuana?

Q: What is "tolerance" for marijuana?

Q: Are there treatments to help marijuana users?

Q: Can marijuana be used as medicine?

Q: How can I prevent my child from getting involved with marijuana?

Talking to your children about marijuana

Resources

Positive - Negative Drug Herb Interactions

Negative Drug Herb Interactions

1. Pain Medications

2. Chinese Licorice

3. Tannins

4. Glycosides

5. Blood-thinners

6. Dan Shen (Salvia)

7. Surgery and Herbs

8. Drugs for the Heart

9. St. John's Wort

10. Ginseng

11. Valerian

12. Kelp

Positive Drug Herb Interactions

Generic Competition and Drug Prices

Drug Side Effects

Drug Side Effects

Medication Exposures During Pregnancy and Breastfeeding

Herbalism

Complementary and alternative medicine: What is it?

Complementary and alternative medicine: What is it?

Ranging from herbs to acupuncture, alternative medicine is becoming increasingly popular. Learn the basics.

What is alternative medicine? What is complementary medicine?

Integrative medicine: Combining complementary treatments with conventional care

What are the principles of complementary and alternative medicine?

What are some examples of complementary and alternative medicine?

Are conventional doctors opposed to complementary and alternative medicine?

Why is there a lack of evidence about complementary and alternative treatments?

Talk to your doctor about possible benefits and dangers

Herbal supplements: What to know before you buy ?

Herbal supplements: What to know before you buy

New government regulations should lead to safer herbal supplements, but they still can present a risk. Here's what you should know before you purchase dietary supplements.

Are herbal supplements safe?

How do you know what's in an herbal supplement?

How do you choose an herbal supplement?

What You Need to Know About Drugs

Medicines Are Legal Drugs

Cigarettes and Alcohol

Illegal Drugs

Why Are Illegal Drugs Dangerous?

Fact: There are stronger forms of marijuana available
to adolescents today than in the 1970s or 1908s.
Stronger marijuana means stronger effects.

Fact: Research shows that more than 40 percent
of teenagers try marijuana before they
graduate from high school.

Fact: Marijuana has adverse effects on many of
the skills required for driving a car. Driving
while high can lead to car accidents.

Fact: Marijuana users may have many of the same respiratory
problems that tobacco smokers have, such as chronic
cough and more frequent chest colds.

Fact: Marijuana smoking affects the brain and leads
to impaired short-term memory, perception,
judgment and motor skills.