Intoxicants in society

Rachel Hajar, M.D.
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar

1. Intoxicants in Society

Rachel Hajar. M.D.
Department of Crdolgy, Her Hosp Hamad Mecca! Corporation, Dora, Car

‘ow we perceive the work is alin the mind and
therefore Me is what we make it However, we
need tobe liberated from the restrictions of

‘mundane existence thus we dream, signing that we

{are predisposed to an altered state of consciousness,

People seek tered consciousnessin variety of ways

‘suchas prayer or meditation; others may pursue such

State of mind through art, music, sexual passion or

Intosicating substances.

‘Since prehistory, humans have experimented with
naturally occuring substances for their psychoactive
‘effects. Some anthropologists go so far asto claim that
psychoactive substances shaped citons! Take for
‘example Stone Age a There has been speculation
‘about the use of hallucinogenic plants and opium by
Stone Age cavemen while painting the cave walls and
celings. mainly of wild animals and hunting scenes.

Intocants orpsychoactve substances have been
used in religious ceremonies: for medicinal purposes.
and for recreation,

What are these intoxicating substances? There
are four groups: hallucinogens (substances causing
Visual, audtory and other hallucinations) inebriants
(substances ike alcohol, chloroform, ether, benzene,
and ether solvents and veta chemicals) hypnoties
(Substances causing states of sleep, stupor or

onda pwr On gen
ESE adi

‘Example of à cave painting, France. Cave paintings ao of
Prohioneorkn The exact purpose ofthese cave pairings
‘re intro, However à though ta eave paintings may
fave been a way of emanating wth cars or may Pave
ada regis or ceremonial moaning

‘calm, such as the mandrake, kava, tranquilizers
and narcotics, including opium and its derivatives)
Stimulants (substances causing an increase in mental
‘andlor physical stimulation not usually impairing
the user's performance of daly tasks: tea, coffee,
cocoa, coca-cola, gat, betel, tobacco, cocaine and
amphetamines.

“Tea and coffee are mild stimulants. In some cases,
the effec of particular itoxicant overiaps the four
groups. A substance classified as a stimulant may, at

Houle aga cot Hast

2. the end othe atered state of consciousness tinduces,
‘cause sleep, whilst a solvent such as glue classed
as an nobriat, may have halucinogenic properties

“ENCHANTING PLANTS”

Users sometimes refer to psychoactive drugs
as “enchanting plants," “isorietation plants,” and
*istonary plante Patterns of use vary according to
‘epochs and places, depending on how much a society
‘accep the use ofthat drug

Nature's additve plants ae: cannabis, coca, and
Poppy.

1.1 Opium

The Sumerians in 2400 EC cultivated the opium
‘poppy and referred to it as Hul Gi, the Joy pant. It
as passed onto the Assyrians who in úm passed it
‘onto te Egyptians, The Ebers papyrus c.1600 BC),
‘one of mankinds oldest medical documents, describes
‘remedy to prevent excessive crying in chldren using
grains ofthe poppy plant, strained to a pul, passed
{trough seve, and administered on 4 successive days.

‘Opt Poppy plat

Opium was known to ancient Greek and Roman
physicians as a powerful pain relever In the English
translation of Homer's Odyssey by Rober Fagles it
is mentioned that Helen used a psychoactive drug
‘on Menelaus men but he name of he drug was not
mentioned

“Then een, Zeus daughter, thought of semathing
oe
‘She quickly dropped into the wine they wore

Deption ota scene om Homers The Odyssey parted oto
ase or ming boot

ug which eased men's país and rations,
making hem forge har oubles A ik ofthis
Once media vi wine would garantie no man
ot ater fal oni cheakor oe whale day.
Ink oon fis matron father doe
ris 00m presence, men amet swords
‘eckeddownhisbaerorhis wn asholochaden,
"SEN 22028, Oajesey Homer
(Trans by Rober Fags)

‘Translators ofthe original Greek say thatthe drug
that was mentioned was Neperthe, which figuratively
means “that which chases away sorrow’ (ne = not,
and ponthos = rief, srrou, or mouming). So, Real,
A means "notsomow er anl-somew. In todays wel
Neperthes would be an anziyticoran antidepressant. It
‘thought thats substance vas prepared rom opium,

This belleved that neperthes maybe similar to
laudarum an opum incre atrbutedto Paracelsusinthe
‘ath century. inthe century laudarum was extensively
Lsedinadutsand chicren, ernumerous indications such
as insomria, cardiac and nfectious seases. Laudarum
as nettaxed and hence,chezper han gin or wine, and
52e working dass largely consumed audanum. nthe
aly 20th century encycopediasin Wester cours il
Stated that persons in good mental and physical health
Could use opium without ik of dependence, Oplum was.
sito used to teat melanchota,

By the 15th century, the trading and production of
opium spread from the Medterraneanto China. Opium
has many derivatives, including morphine, codeine,
oxycodone, and heroin, Physicians use such drugs as.
pain mediation

3. The tropcalcamvevousptche part fhe genus Nepertr,
named atora medein for sr a ng offrgetnass”
Imontaned in ancert Greek erature and Grok mythobogy
and aepctes es orgineing in Eoypt The magico ug or
baton appears in Homer's Odyssey, (Bok IV. neporihe"
(now nat porthes= gril som) Helen ace the wine of
or guests (Monelnusmon) wth nopenthe 1 make ther
gal har sore

Unfortunately, many patients abuse such
‘medicines. Many countries began to grow and process.
‘plum to expand ite availabilty and to decrease lt
st. 5 cultivation spread along the Sik Road, from
the Mediterranean through Asia and al to China
here it was the catalyst for the Opium Wars ofthe
‘mid-1800s. Opium dens were estabished as stesto
buy and sell opium. Dens were commonly found in
‘China, Southeast Asia the United States, and part of
Europe. Chinese immigrants othe United Satesin the
‘mig-1800e worked for railroads and brought the hab
‘of opium smoking wth them, Opium dens sprang up
in San Francisco's Chinatown and spread eastward to
New York,

1.2 Coca

Coca (Erythroxyion coca) has been used as a
medicine and stimulant for over 3000 years. is grown
Inthe Andes mountains of Sah America in Colombia,
Peru, and Bola, Cocaine is extracted from its leaves
‘andinhabitants in South America would chew he leaves
‘they belevedttoelevatemood, help wth digestions,
and suppress appetite

Nearly 10 years ago, cocaine was touted as a
wonder drug = a cure for everything from morphine
addiction tuberculosis todepressionto dyspepsia. To
meet he demand, American drug companies beganto
‘explore South America for new medicines.

jar VIEW:

Cocaine has an anesthetic effect and Western
‘medicine used t as such especial in nasal surgery,
Cocaine sill has limited use in medicine today as a
local anesthetic is stil occasionally used in medical
procedures as a topical anesthetic for skin aceratins,
Rose or throat surgeries, and dental procedures.
Incidentally at one time there was cocaine in
¡Coca-cola (ate 18005). At that time & was common to
use cocaine in patent medcines. Coca-cola drastically
reduced its cocaine content toa mere trace" when it
‘becameknown tha cocaine could beharmul wasnt
‘unt 1829 that Coca-Cola snk became cocaine fre.

(Coca sol drink used to contain cosine: vas ergmaly
Intended as a paar medicine when as inverted ato.
{9theanton: To name refrsto tw oe erga nore

Inthe 19708, cocaine evolved as a recreational
drug but it was expensive and widely lieved to have
no sericus consequences, was perceived as "safe
drug The price dropped steady, and by the mid-
19805, was used on a regular basis, especially by
the Americans. The reaizaton at cocaine was highly
‘addictive and dangerous was slow and brought home
bythe Hgh-profie deaths of celebrities

Cocaine processed as powder and crack: crack
is considered the more dangerous form of cocaine.
Powder coeaineisthe hydrochloride sal form (cocaine
HCL) Asa sal. tis slubein water sable asa powder,
and usualy sorted through the nose and absorbed
through nasal mucosa membranes. It can also be
dissaedin water ar melted and injected. Crack an the
‘other handis powder cocaine that hasbeen processed
ita base, such as baking soda, to remove the HCL,
hence, has a sighty modified chemical structure, which
allows to reach he brain more quickly, producing a
more intense “high” and thus allowing crack to have
greater potential for addiction. The name “crack is
‘derived from the cracking sound this form of eoraine
makes when bumed

— 08

4. Exyroxylum coca part from wich cocaine exacted)

1.3 Cannabis (Marijuana or hashish)

Alcohol, nictine, and caffeine are stimulants and
hhavepermeatedour culture. They are integral or social
Interaction and studies claiming health benefits have
proliferated. The use ofthese commodities is 2 way to
(escape the drudgery of everyday le.

Each culture has methods to deal with the
harshness of realty. Among the Suis, a Muslm sec,
hhashsh (cannabis or marjuana) was eaten or smoked
toreacha state ofeuphori, Hashish (sometimescaled
“wine of Haydar) was known to the Arabs long before
lts aleged dscovery in mia- 12h century by the ace
‘monk Haydar founder fthereligcusorderofthe Sus.

There are many myths and legends in Arab
¡tera abouttheuse ohashish, Hashish fguresin he
famous À Thousand and One Nigfts. Oneofthe sores
‘Scheherazade amusedthe Sultan wth was caled "The
Tale ofthe Hashish Eater nit she recounted the story
‘ofahashish user whohad been reducedto poverty asa
‘esl of wasting his savings on his drug and on women.
‘Yet by means of his cherished drug, he was able to
‘escape into a dream world where he was no longer

a beggar but a handsome and prosperous lover. One
‘day this pauper tock some hashish n a publi bath and
‘dropped of no dream in which he was transported
into an enchanting room fled with beautul flowers and
the smell of exci perfumes. All is time, however he
sensedthatthis was only a dream andthatit would not
belong beforehis presenceinthepublicbath weuldbe
elle and he would be besten and town out Even
£5, he continued to enjoy the dream. As he fell deeper
into reverie, he saw hímsel being cried to another
luxurious room filed wth sof, lush cushions where e
was sexual aroused bya sensuous slave gi. ust as
he was about to embrace the gl, he was awakened
‘tom his dream by the laughter of the patrons in the
bathuho had become highly amusedatthe sight ofthis
‘beggar under the in uence of hashish, And ust as he
{eresaw, he was beaten and evicted fom the premises.

“Those who read the above story can appreciate
the state of double consciousness” the beggar found
úhimselfin as a result oftaking hashish - the hashish
{user hallucnates, but he is also aware that he 16
hallucinating = he does not lose complete touch wi
really Hasish causes him to dream, ut it enables
him to remain conscious of his dream so that he
can appreciate the images and themes his mind is
producing. I was this aspect of hashish use that so
fascinated and intigued Western authorsin the later
par ofthe 1th century. Later on, hashish came tobe
denied with a group of brigands called “assassins”
‘andhashish gained for Relfa reputation asa drug that
‘Sowed contusion and chaos.

1.28 Medical marjuana

|Medicalmarjuana or medical cannabisreterstothe
use ofcannabis and ls cannabinastoreat disease:
‘orimprove symptoms.

Debate has swirled around legalizing marjuana,
‘especialy using marjuanain medicine. In June 2015,
JAMA published an article on medical marijuana
{or the treatment of chronic pain and reviewing the
‘pharmacology, dications, and laws related to medical
‘marijuana use. recommended tt physicians should
{understand bat the scientific raionale and the practical
Implications of medical marjuana laws since they
are required to issue certification a patient needs
‘marijuana

‘The use of marijuana and cannabinoids is now
‘common in einical practice. The JAMA article stated
that marjuana has many potential medical Benes,
it also has significant heath risks. Many studies on
‘marijuana are poor qualty; however, marjuana use to
‘control nausea and vomiting related to chemotherapy,
‘chronic pain, neuropathic pain, spasticity associated
‘uth multiple sclerosis are supported by high quality
research. indicated, the physician corts that the

5. = —

“Marjane praphoralia

patient can take marijuana to contra his symptoms,
Neediess to say there were ediorials accompanying
the article, cling fr better qualty research onthe opie
and concern that medical mariana is merely aveled
‘step toward allowing accesso rereational marjuana
‘The potential harm in the chronic use of marjuana
‘such as addiction and psychosis are highighted. The
‘editorial cautioned that since medical marijuana is net
a life-saving intervention, t may be prudent o wait for
high-quality evidence before widely adopting ts use,

Inthe USA, medical marijuana laws differ widely
tom stateto state, As of March 2015, 23 states andthe
Distnetof Columbia had medealmariuanalawsinplace,
‘Marijuana is not approved by the US Food and Drug
Administration (FOA) to teat any medica condition. The
‘American Medical Association (AMA), he Minnesota
Medical Association. he American Society Addiction
Medeine, and eher medica organizations have issued
‘statements opposing ts use for medicinal purposes,
But scientific study ofthe medical uses of marijuana is
‘ongoing, Sofa, evidence suggests that marjuana may
be an effective treatment fr chronic pain, neurepathe
(ner) pain. and muscle spasms due omuliple sclerosis
‘orparapegia. In most US states wih medical maruana
laws, marjuana can be used to treat severe or chronic
pain and severe or persistent muscle spasms. Some
‘Sates alowmarjuanatobeusedoteat cher condns,
Such as glaucoma, selzures, and postraumatc stress.
disorder Every state in the USA with medical marjuana,
laws has ls own is of approved conditions,

Inthe Netherlands marjuana s legal but the pole
donot arrestor prosecute anyone in possession ofless
{han fe grams of marjuana for personal use, hence
the proliferation of coffee shops where adults could
smoke “pot” or marjuana freely, Recently however,
the government started to crack down. Australia has
‘decrminalzed mariana and Spain and Canada have
legalized. Barcelona, Spain's developing areputation
32 he new Amsterdam

“are vun

1.4 Fly-agaric or Amanita muscaria mushroom

Priests or shamans have consumed plants for
úmilemniatonduce states ftrance The shamans were
‘guardians of the traditions oftheir culture, and their
knowledge of myths. songs, medicines and religious

‘The mushroom Amanita muscaria, commonly
Anoum as y-agaic, has been al the center of religious
ritual in Siberia and Central Asia fr at least 3000
years. The ly agarie isa hallucinogen. The Siberian
Shaman performed religous uals usually under the
infuence of fy-agarie (mushroom intoxication). The
first known account of the phenomenon is found in
a journal writen in 1658 by a Polish prisoner of war,
‘who describes its use among he peoples of Western
Siberia, The myths of many Siberian peoples conta
‘y-agariethemes. In many Siberian languages, words
meaning "ecstasy", ‘intoxication’ and “drunkenness
aretracesbleto words meaning ragare, Siberian if
‘drawings depicting armless, one legged figures bear a
femarkable resemblance to the descriptions of fgures
by men under the infuence ofAmanta Muscara

‘The Fly-agaric had a central and revered rol in
shamanie practices. was an ingredient of Soma, a
Sacred beverage in ancient india. and of Haoma, also
3 sacred beverage Inthe religion of ancient Pers
(Zoroastrianism, one of the words oldest regions).

‘Among the cultures and societies that used i
{he consumption was restricted to sacred occasions.
I Was abused on per of death I was believed that
‘consumption of the fy-agare by those who were not
shamans could be fatal

Consumption efhalicinageric mushrooms continues.
tobe popular today in some settings, Motives or their
Use include simple experimentation a desire to enhance
routine experiences, emotions, or social Interactions:
Lo disconnect from realty; to induce visions; as a
sycetherapeutictoo: or fr mystcal rspitualreasons

Itwas net unt the 1950s that the involved species
of fungi were identified and the chemical nature

RS re

6. of the active substances was determined. The
psychoactive ingredient is attributed to ibotenic acid
‘and musciel(saxascles) or psilocybin, whichis similar
in chemical structure to Iysergle acid diethylamide
(LSD) Since both are structural analogues of seretonin
{S-hydroxytyptamine), the hallucinogen effects are
probably mediated through effects on serotonergic
receptors. Some Siberian tribes report that three
(3) fesh A muscaria mushrooms can belethal, whereas
‘others claim that eating as many as twenty-one (21) of
these mushrooms i ste,

Various hallucinogenic mushrooms containing
boten acid and muscimo cr psileybin ae feundinthe
New Word, In Central Ameria, pslocybe mushrooms
ere used forts halucinogenic properties. As already
mentioned, mushrooms of nis genus contain the
psychoactive compounds psibein and psilocybin.

Reports of toxicity associated with this group of
mmustrooms have increased as a consequence oftheir
‘growing popular as hallucnogens, Circumstances
that could lead to hallucinogenic mushroom toxicty
are: Adults and adolescents seeking to achieve 3
State of ntoseation (his is the most common reason
{or ingesting these mushrooms): Incorrect mushroom
identification by a naive forager: Intentional ingestion
by a suicidal person; Unintentional ingestion by a
child who found mushrooms growing in yards or
Outdoor play areas; Foul play, in which an individual

¡lustre the cuts ind in dug abuse and ach. AY lose ain regions must be considered

in doreepingsratgís1o efectiva) rat ation

is polsoned by someone else; Inadvertent poisoning
‘rom dried mushrooms purchased on the Internet
of from other sources where Ihe composition ofthe
mushroom Is unrelabie or where the mushroom might
be contaminated wäh unknown taxis compounds.

Incidental, mushrooms have been traditionally
used as insecticide. In some European countries caps
of Amanita muscara are crumbled up and placed in
saucers ofmikto attract house fes, The fies arinkthe
mil, which contains toxins (hey are soluble in water)
and the fies soon become drowsy, collapse and die
{or they simply drown in thee spiked mik drink). The
specifi epihet muscaria comes fom the Latin word
musea, meaning “af

ADDICTION: A COMPLEX ILLNESS

A real danger of psychoactive substances is
their highly adaietve nature, Human beings have
always had a desire to eat or drink substances that
make them fee! relaxed, stimulated, or euphoric.
Psychoactive drugs induce such feelings but they
can also cause addiction aniness win far-reaching
consequences. Even mild psychoactive substances
‘such as alcohol, nicotine, and cañeine can become
‘compulsive habit.

‘Abnormal pattems of use of these substances
have been observed since antiquity. Alexander the

7. Great was a heavy drinker. Closer to our times,
Adolf Hitler reportedly consumed a cocktal of some
7%substances.indudingmerphine, methamphetamines
and barbiturates, according toa 2014 TV documentary
Mariyn Monroe overdosed on barbiturates. Benjamin
Franklin abused laudanum (an opiate and alcohol
‘mixture for pain and alment) but ved to the ripe od
‘age of 84 Inthose days laudanumvasnat a problem
Freud became addicted to cocaine while studying the
eflecis of cocaine and unsuccessuly used ito treat
his best iend'smerphine addition

In ne pas, the term “addiction” was not used but
rather the condition was refered to as toxicity and
“inebriety” Nowadays, addition ints current medical
‘meanings a compulsion and need to continue taking a
‘dug asa resutoftakingtinthe past. Acommon feature
‘of addictive substances the “dopamine surge” which
Induces feelings of pleasure and euphoria by activating
@mesolmbie dopaminergic reward system in he brain,

‘Addition iv a leamed" behavior we actively seek
adcicive drugs. Our relationship with substances is
‘shaped by mulipl factors, including culture, society
religion, and individual psychology. There are social
‘Srucures that ve peopletotake addiive substances.
‘such as widespread poverty racism, limited options,
nd lack of access to education lack of access to
healthcare, lack of access to safe housing and good
food, Any oe al ofthose factors would drive anybody
to feel desperate, there is medicine available that
makes one feel good, naturally such medicine willbe
consumes,

But addiction is not merely about the substance
‘abused. The personality of the person abusing
the drug matters a lot also. Some people think
that legalizing psychoactive drugs will eradicate
‘addiction. Debate on the issue is ongoing. Some
Believe that legalizing it will make the substance
more accessible and that it would increase the
number of casual users which, in turn, would
increase the number of drug abusers, The War
‘on Drugs, initiated by the USA in the 1970s has
ot made a difference. ("The War on Drugs” is an

American term commonly applied to a campaign
‘of prohibition of drugs, military aid, and mil
intervention, with the stated aim being to reduce
the ilegal drug trade.) If anything, the problem of
drug addiction has increased, The campaign aims
topunish the offender rather than treat the problem,

‘Addiction isa disease, History has shown that
‘addiction has been around since antiquity, Public
‘education andinformation and avallabity ofresources
about he elects of psychoactive drugs shouldbe cur
geal. Once people understand he underyingpathology
‘of addition, people with addition should nt have to
feel shame or feel inferior. They should receive the
help they need and obtain evidence-based treatments
like dabetes heat disease or cancer Education about
‘addiction wil also help other people understand that
‘diets are suffering from a disease that should be
treated tke any other

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Conflicts of interest
‘There are no confits ofinterest

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