Drugs, the definition:
Substances used in medicine either externally or internally
for curing, alleviating, or preventing a disease or deficiency.
At the turn of the century only a few medically effective substances
were widely used scientifically, among them ether, morphine, digitalis,
diphtheria antitoxin, smallpox vaccine, iron, quinine, iodine, alcohol,
and mercury. Since then, and particularly since World War II, many
important new drugs have been developed, making chemotherapy an
important part of medical practice. Such drugs include the antibiotics,
which act against bacteria and fungi; quinacrine and other synthetics
that act against malaria and other parasitic infections; cardiovascular
drugs, including beta-blockers and ACE inhibitors; diuretics, which
increase the rate of urine flow; whole blood, plasma, and blood
derivatives; anticoagulants such as heparin and coumarin; various
smooth-muscle relaxants such as papaverine, used in heart and vascular
diseases; smooth-muscle stimulants; immunologic agents, which protect
against many diseases and allergenic substances; hormones such as
thyroxine, insulin, and estrogen and other sex hormones; psychotherapeutics
such as antianxiety drugs and antidepressant drugs; cortisone and
synthetic corticosteroid drugs used in treating inflammatory diseases
such as arthritis; vitamins and dietary minerals; antidotes for
poisons; and various drugs that act as stimulants or depressants
on all or various parts of the nervous system, including analgesics,
narcotics, amphetamines, and barbiturates.
- Advair Diskus
Sources of Drugs
Drugs are obtained from many sources. Many inorganic materials,
such as metals, are chemotherapeutic; hormones, alkaloids, vaccines,
and antibiotics come from living organisms; and other drugs are
synthetic or semisynthetic. Synthetics are often more effective
and less toxic than the naturally obtained substances and are easier
to prepare in standardized units. The techniques of genetic engineering
are being applied to the production of drugs, and genetically engineered
livestock that incorporate human genes are being developed for the
production of scarce human enzymes and other proteins (see pharming).
Pharmacopoeia and Drug Safeguards
Standards for drugs and tests for their identity, quality, and
purity are given in the U.S. pharmacopoeia, first published in 1820
and at first revised every 10 years, later every 5 years. The British
publish a similar pharmacopoeia. The National Formulary published
by the American Pharmaceutical Association gives the composition,
description, method of preparation, and dosage for drugs; the Physician's
Desk Reference is a privately published compilation of information
supplied by drug companies about their drug products, published
yearly. The scientific study of drugs, their actions and effects,
Legislation to safeguard drug purchasers began in the United States
with the Pure Food and Drugs Act of 1906; this was superseded by
the more inclusive and more stringent federal Food, Drug, and Cosmetic
Act of 1938. Such laws are enforced by the Food and Drug Administration.
The 1962 Kefauver-Harris amendments to the Food, Drug, and Cosmetic
Act increased the authority of the Food and Drug Administration
to regulate testing and marketing of new drugs. There are two marketing
classes of drugs: ethical drugs, for which prescriptions are needed,
and proprietary drugs, which are sold over the counter without prescription.
Many of the latter, such as mouthwashes, gargles, and cold preparations,
are only slightly, if at all, effective in curing ailments.
American History of Drugs
Drugs have never been absent from American life, but the type and
level of use have varied over time. Legal responses to drugs were
profoundly influenced by the evolving interpretation of the U.S.
Constitution, which, until the twentieth century, reserved to the
states the police powers to regulate the health professions and
drug availability. The result was a generally free economy in drugs
until late in the nineteenth century when an ineffective patchwork
of state antidrug laws were enacted.
Excluding alcohol and tobacco, opium was the major mood-altering
substance available to Americans in the eighteenth and nineteenth
centuries. Crude opium, the dried juice of the poppy, has been available
for millennia, and from it various medicines have been concocted.
Alcoholic extracts of opium include laudanum and paragoric; extraction
with acetic acid was known as black drop or Quaker's opium. Opium
prepared for smoking was closely linked in popular thought with
About 10 percent of crude opium is the alkaloid morphine, its most
powerful mood-altering ingredient. Morphine was isolated from opium
in 1805 by the German pharmacist F. W. A. Sertuerner, although commercial
production did not begin for about two decades. It was first produced
in the United States in Philadelphia during the 1830s. The impact
of the purified active ingredient was enormous. Morphine could be
taken by mouth, as were crude opium compounds, but it could also
be dusted into wounds, sprinkled on blistered skin, and after the
development of the hypodermic syringe and needle, injected into
the body's tissues with a powerful effect. Heroin, a derivative
of morphine, was commercially introduced by the Bayer Company in
The extraction of purified active ingredients and their direct
injection into the body marked a fundamental change in the relationship
of drugs to society. After popularization of the hypodermic syringe
in the 1860s, the use of opiates rose by the 1890s to a per capita
level rivaled only by that of the early 1970s. Initially, physicians
thought morphine by injection was a protection against addiction
because the amount required for a given level of pain relief was
less than when the drug was taken by mouth. That this erroneous
belief persisted for about two decades illustrates the difficulty
even trained observers have when evaluating new procedures. By the
beginning of the twentieth century physicians were being widely
blamed for having created addicts through careless prescribing.
Both public and professional pressure thereafter led to extreme
caution in the provision of pain relief to patients.
Another drug in use for centuries was contained in the coca leaf,
which people living in the growing regions of the high Andes chewed
as a way to obtain more energy and endurance. Cocaine was isolated
from coca leaves in 1860 by A. Niemann of Vienna. An alcoholic extract
was introduced shortly thereafter by Angelo Mariani as Vin Mariani,
a tonic that proved popular until about the turn of the century.
Testimonials from such celebrities as Thomas Edison, as well as
a gold medal from Pope Leo XIII, came to Mariani for his coca extracts.
Coca-Cola was modeled after Vin Mariani except that the alcohol
was removed to make it a temperance beverage. Cocaine was removed
from the soft drink about 1900.
Cocaine became available commercially in the 1880s and rapidly
found favor with the public. The drug was taken in many forms, including
hypodermic injection. Initially, there were no restrictions on its
sale or distribution. And as in the case of morphine, many physicians
be- lieved that cocaine was harmless and so advised the public.
Over a decade passed before concern about cocaine began to outweigh
the assurances of safety. Due to cocaine's ability to stimulate
violence and paranoia, the reaction against the drug was dramatic
and changed the acclaimed tonic into an extremely feared substance
by 1900. Americans, too, along with their other social concerns
of the Progressive Era, were growing increasingly worried about
narcotics being surreptitiously included in patent medicines (easily
available through mail-order houses) and about their being wrongly
prescribed or overprescribed by physicians.
Some were also uneasy about opium smuggling into the newly acquired
Philippine Islands. Partly because of this concern, but also to
curry favor with the Chinese government, the United States convened
the Shanghai Opium Commission in 1909. The thirteen nations assembled
considered ways to help China with its opium problem, and although
the conclusions were vague and not binding, the commission paved
the way for an international conference, also called by the United
States, which met two years later at The Hague. In January 1912,
The Hague Opium Treaty, which also proposed to regulate cocaine,
was completed by the dozen nations represented and submitted to
all the world's powers for ratification.
The Harrison Narcotic Act of 1914 was the United States' implementation
of The Hague treaty. The act's restriction took the form of a tax,
and its purpose was to stop careless prescribing and easy availability
of opiates and cocaine. This attempt to establish a national antinarcotic
law controlling the health professions encountered serious constitutional
impediments, however, and was not upheld by the Supreme Court as
a legal prohibition of simple addiction maintenance until 1919.
The laws against narcotics at the local, state, and national levels
early in the twentieth century reflected a strong antagonism to
drug use. By 1937 intolerance and fear of drugs had reached such
dimensions that the Marijuana Tax Act was passed with little debate.
As use of drugs decreased, punishment increased until by 1955 the
death penalty for providing heroin to anyone under eighteen was
added to federal statutes. Narcotic use retreated to the margins
of American society.
But, beginning in the 1960s, drugs became increasingly popular
for recreational use, particularly among young people. The favored
drug was marijuana, but hallucinatory substances such as lsd and
peyote, depressants such as barbiturates, and opiates, particularly
heroin, were also widely used. The clash between the extremely punitive
laws that had evolved since the Harrison Act and the large number
of new drug users led to softened penalties and a coalescence of
federal drug laws under the Comprehensive Drug Abuse Act of 1970.
Toleration of drug use continued to rise until it reached a peak
about 1978. Popular music and such entertainments as rock concerts
and movies often glorified and sanctioned drug use. Campaigns to
legalize drugs argued that they were harmless and that legalization
would end black markets and reduce crime. They achieved a de facto
decriminalization of marijuana for the user, but eradication and
interdiction campaigns persisted.
After the late 1970s fear of drug use rose while toleration of
drugs decreased, partly as a result of observation of the effects
of drug use. Extensive antidrug campaigns were conducted in the
media and by activist groups collectively termed "the parents'
movement." The Reagan administration strongly supported the
antidrug mood and First Lady Nancy Reagan introduced the motto of
the antidrug movement, "Just say no."
During the 1980s the use of cocaine, especially a conveniently
inhalable form called crack, reached alarming levels, and by 1989
public opinion polls were reporting that Americans believed that
drugs were the most serious problem facing the nation. Increased
homicides, violence, and damage to fetuses of crack-using pregnant
women were common allegations. The fear of lifelong damage to children
of drug-using mothers created a new concern in the war on drugs.
In 1986 and 1988 increasingly severe federal antidrug laws were
enacted as Republicans and Democrats vied over who was the more
opposed to drug use. Between the 1960s and the 1980s attitudes had
once again shifted: toleration turned into intolerance and a hope
that some drug use might be beneficial gave way to a growing conviction
that any drug use was damaging.
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