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Drugs, the definition:

Substances used in medicine either externally or internally for curing, alleviating, or preventing a disease or deficiency.

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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.

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, is pharmacology.

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 Chinese immigrants.

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 1898.

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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