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il.-Hs putting users into pleasant, dreamy states while numbing their bodies. Drinks made from the dried root are more relaxing than intoxicating. Kava ceremonies take place at night and often bring large groups of people together for the main social event of island life. Only dried kava is available outside the South Pacific. Herb stores sell it as a coarse powder or larger chips of root. When chewed, dried kava makes the mouth numb and may be relaxing. Some people brew it into a tea, which they like as a mild downer.

One of the most famous of the plant drugs is ginseng, obtained from the roots of several species of woodland plants, one from China and Korea and another from the northeastern United States. People in the Orient have used ginseng for centuries, pay-

ing high prices tor the best quality roots and valuing them as general tonics. They believe ginseng increases vitality, resistance to disease, and longevity. It is especially used by men, and those who use it often say it increases sexual power, particularly as they grow older.

Ginseng has only recently become popular in the West, and Western scientists still do not understand it very well. They are convinced that ginseng has effects, but they don't yet know what all of them are. One source of confusion is that commercial products vary tremendously in potency, some having no activity at all. For some people ginseng is a strong stimulant. It may raise blood pressure and should be used with caution by people with high blood pressure. Other users claim it tones their muscles and skin and increases physical endurance. "Siberian ginseng" is not true ginseng but comes from a related plant; it may be less of a stimulant.

Effects of ginseng are cumulative, often not becoming apparent unless the drug is used regularly for weeks or months. The chemistry of the root is very complex. Some compounds in it may affect the production of steroid hormones, which could explain the results users report. In any case, ginseng is a drug, not just a dietary supplement or new-age hoax, even though it now appears in everything from toothpaste to soda. If you want to try ginseng, avoid these senseless preparations and be prepared to spend a lot of money for whole roots, capsules, or extracts of reliable potency.

Smart Drugs

Since many people in our society turn to drugs for solutions to everything from heartburn to boredom, it is not surprising that they would get excited about drugs that are supposed to boost intelligence, memory, and concentration. Students are always looking for ways to increase brain power. Users of alcohol, pot, and cocaine worry about adverse effects of those substances on their minds. Some people approaching middle age become obsessed with extending their lives, enhancing their declining sexuality, and fortifying their brains against the ravages of old age. For all of these concerns there is a new answer: smart drugs.

Smart drugs are a diverse group of compounds. Some are prescription drugs marketed openly in this country. Others are prescription drugs from other countries not generally available here that can be obtained! by mail order or from Mexico. Still others can be had in health food stores and from other sources selling nutritional supplements.

Ginseng roots.

Piracetam keeps me alert when I am driving. It also helps me formu late new and different ideas when I am taking essay tests in school.

— twenty-one-year-old woman, student

Two kinds of smart drugs are nootropics and cognitive enhancers. The word nootropic (meaning "mind-turning") was coined to describe substances believed to improve learning and memory without affecting the brain in other ways and without causing toxicity, even at high doses. "Cognitive enhancer" is a vaguer term for substances that might improve general mental functioning.

Many of the smart drugs have been around for years, but information on them only became widely available in the 1990s. The media first began paying attention to them at this time, probably because of the appearance of "Smart Bars" in San Francisco and other cities. Smart Bars are clubs that serve nonalcoholic drinks spiked with smart drugs. Who goes to Smart Bars? Students studying for exams are frequent patrons, but all sorts of people wander in to try the concoctions.

Here is a selection of some of the more popular smart drugs.

Piracetam and Relatives (Oxiracetam, Aniracetam, Pramiracetam, and Pyroglutamate)

These drugs, known collectively as pyrrolidone derivatives, are the most important family of nootropics. Smart drug enthusiasts say they cause remarkable enhancement of memory. No one knows how they work, but they may affect nerve pathways in the brain that use acetylcholine as a neurotransmitter. Acetylcholine declines with age, possibly accounting for slowed mental function in the elderly. Users say piracetam is a central nervous system stimulant that wakes up the brain. They claim that it has no toxicity or addictive properties. Piracetam is not sold in the U.S. but can be ordered by mail or purchased over-the-counter at Mexican pharmacies.

DHEA (Dehydroepiandrosterone)

DHEA is an endogenous steroid hormone made in the adrenal gland. It is related to male sex hormones and has weak androgenic activity. Smart drug enthusiasts say it combats obesity, aging, and cancer, extends life, and keeps you looking youthful. They also think it can protect brain cells from the degenerative changes of old age. Research to back up these claims is lacking. The drug is available from "buying clubs" that supply unapproved drugs to AIDS patients. (DHEA is also supposed to boost immunity.)

DMAE (Dimethylaminoethanol)

This endogenous substance, present in small amounts in the brain, also occurs in some fish (anchovies and sardines). It is described as a nutrient that has mild stimulant properties and can also elevate mood, increase intelligence, and counteract fatigue. Like piracetam, it may work on acetylcholine pathways in the brain. Health food stores sell DMAE as a nutritional supplement.


Hydergine is a pharmaceutical drug, derived from ergot, available on prescription in the U.S. as a cognitive enhancer for people suffering from mental impairment as a result of age or brain injury, ft has little toxicity, and its mechanism of action is unknown. Although many doctors question its efficacy, the drug has a large following among smart drug fans, who believe that it improves memory and learning and protects the brain from weakening with age. Hydergine is quite expensive.

Selegiline (Eldepryl, Deprenyl)

A newer prescription drug, recently introduced for the treatment of Parkinson's disease, Eldepryl has gained a strong reputation as another smart drug, one that wakes up the brain, increasing alertness and energy and enhancing all mental functions. Eldepryl is metabolized to amphetamine and methamphetamine in the body, which probably accounts for these effects.

Vasopressin (Diapid)

Vasopressin is an endogenous hormone produced by the pituitary gland. Also known as antidiuretic hormone or ADH, it causes the body to retain urine. Doctors prescribe it in the form of a nasal spray to treat patients with a rare disease called diabetes insipidus, marked by frequent urination. Smart drug enthusiasts say that vasopressin spray also affects the mind, improving attention, concentration, and memory. In addition, they say, it instantly counteracts the crash that follows use of stimulant drugs and the grogginess caused by high doses of marijuana and alcohol. Vasopressin nasal spray can give you a number of uncomfortable side effects, including nasal irritation, runny nose, headache, and abdominal cramps.

It is difficult to assess the benefits and risks of smart drugs, because not enough research exists on them. Although doctors question their safety, especially when used in the combinations that their fans prefer, safety may be less of a concern than efficacy. It is not at all clear that these substances really have the beneficial effects claimed by their promoters, and we do not have enough information to know just what are the effects of long-term use.

Suggested Reading

There are a number of guides to medical drugs written for patients. Three useful ones are: The Doctors and Patients Handbook of Medicines and Drugs by Peter Parish (second edition, revised; New York: Knopf, 1980); The Essential Guide to Prescription Drugs by James W. Long (revised edition; New York: Harper & Row, 1980); and Pills That Don't Work: A Consumer's and Doctor's Cuide to Over 600 Prescription Drugs That Lack Evidence of Effectiveness by Sidney M. Wolfe, Christopher M. Coley, and the Health Research Group founded by Ralph Nader (New York: Farrar, Straus & Giroux, 1981). All these books are written by medical doctors.

Is There No Place on Earth for Mel by Susan Sheehan (Boston: Houghton Mifflin, 1982) is a vivid case history of a young schizophrenic woman who, during repeated hospitalizations, is "treated" with ever-increasing doses of virtually all the major tranquilizers currently in use.

An excellent all-around guide to herbal medicine is: The New Age Herbalist: How to Use Herbs for Healing, Nutrition, Body Care, and Relaxation by Richard Mabey and Michael Melntyre (New York: Macmillan [hardcover], Collier [softcover], 1988). See also the periodical publication HerbalGram from the American Botanical Council (P.O. Box 201660, Austin, Texas 78720).

The best reference on smart drugs is the book Smart Drugs &) Nutrients by Ward Dean, M.D. and John Morgenthaler (B&J Publications, P.O. Box 483, Santa Cruz, California 95061-0483).

Problems with


In the preceding chapters we have discussed the risks and problems associated with using specific drugs. Here we will comment on some more general problems drug users are apt to encounter.

Uncertainty of Dose and Quality

When drugs come from legal sources they are likely to be pure, of standard dosage, and correctly labeled. Yet even medical drugs can be outdated and mislabeled, and they sometimes contain fillers and colorings that can be harmful to some people. These problems are insignificant compared to those of black-market drugs, which are regularly cut with impurities, are of uncertain dosage, and are often completely misrepresented to the buyer.

Buying pills and powders on the street is a risky business at best. Not only do you have to deal with unsavory characters and participate in illegal transactions, you have no assurance of getting what you pay for. If you are lucky, what you buy will contain some of what it's supposed to contain and be cut with nothing more dangerous than starch or sugar. If you are less lucky, the pills and powders will be inactive, and if you aren't lucky at all, they will contain something actively harmful. Not only are you likely to get ripped off on the black market, you can also wind up in a hospital emergency room. People who inject street drugs are in greatest danger, because putting impurities directly into the bloodstream gives the body no chance to deal with them.


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Laboratories) Even natural drugs are suspect on the black market. Marijuana may be laced with PCP or contaminated with paraquat. "Magic mushrooms" may be very ordinary mushrooms sprayed with LSD or PCP, and even if they are the genuine article, it is impossible to know how potent they are.

Some help with these uncertainties is offered by private testing labs that will analyze samples of drugs for a reasonable fee while protecting the customer's anonymity. Drug enforcement authorities will not allow these labs to give quantitative results, however, so that although you may find out what is in your material, you still won't know how potent it is. About the only way to be sure that you are getting what you want in the way of nonmedical drugs is to grow your own drug plants or collect them in the wild. Otherwise, you must know your sources; remember that the black market encourages deception and misrepresentation, and be extremely cautious about consuming any substance obtained on the street.

Mixing Drugs

In a few instances, the results of mixing psychoactive drugs are clear. For example, we have noted the additive effects of combining alcohol and downers or tranquilizers. In many more cases the effects of drug combinations are unpredictable, depending more on the individual and on set and setting than on pharmacology. Mixing drugs can increase the problems associated with individual drugs and may create some new ones.

At the very least, drug combinations take getting used to. Many marijuana smokers use alcohol while smoking, but there is no predictable result of this combination. Some people find themselves more stoned, others less stoned, others sleepy or headachy. Until you know the effects of a given combination on you, you should proceed cautiously. People who get into bad relationships with drugs often use many drugs together, and some combinations may promote dependency and abuse. People who ingest alcohol and cocaine together often wind up taking more of both than they would if they used either by itself. Coffee and cigarettes together form a very stubborn habit — it is almost as if one triggers a desire for the other.

These days it is not unusual to see groups of people drinking alcohol, snorting coke, and smoking pot, as well as using tobacco, drinking coffee, and eating chocolate — all at the same time and in large doses. Such polydrug consumption tends to promote immoderation and lack of awareness about the nature of the substances being consumed.

Drug combining is a problem in medicine as well. Medical patients often receive many prescription drugs simultaneously, and doctors are often ignorant about how they interact. Interactions of medical drugs and recreational drugs are also largely unknown. If you are taking medical drugs, keep in mind that they might change your reaction to recreational drugs. If you use recreational drugs, consider that they might combine unfavorably with prescribed medication.

Medical Problems

Acute Problems

Overdosing and allergic reactions are the most important acute medical problems that can arise from taking psychoactive drugs. Mild overdoses of drugs may produce nausea and vomiting, which usually require no treatment but can be very unpleasant. Large overdoses can cause convulsions, coma, and death; they are medical emergencies requiring immediate treatment in hospitals. Anyone who suddenly loses consciousness or stops breathing after taking a drug should be seen immediately by a doctor. If you are around someone who develops an overdose (OD) reaction, put all legal considerations aside and summon medical help. Never administer more drugs — of any type — to a person suffering from overdose.

Intravenous users of drugs are in the greatest danger of dramatic overdose reactions, but people who smoke or snort stimulants and depressants can have them too, as can people who take very large doses by mouth. Remember that ODs can quickly result in death if hospital treatment is not obtained immediately.

Allergic reactions to drugs take many forms, ranging from itching and swelling of parts of the body to death from asphyxiation owing to the swelling of tissues in the windpipe. Serious allergic reactions are very unpredictable and may occur to contaminants of street drugs as well as to the drugs themselves. They may also develop suddenly in people with no prior history of allergy. The symptoms of serious allergic shock are itching in the throat and difficulty in breathing. Again, this is a medical emergency requiring prompt treatment. Anyone who develops such a reaction should be taken to a hospital at once.

Chronic Medical Problems

Any drug used in excess over time can produce illness. Different drugs irritate different systems of the body. In some cases the association between a drug and a disease is very clear, as it is with alcohol and cirrhosis of the liver or tobacco in the form of cigarettes and lung cancer. We have reviewed these specific physical consequences in previous chapters.

People who use any drug intravenously expose themselves to other risks that are consequences of that method of administration. Putting crude and unsterilized needles into veins carries a grave danger of introducing serious infections. Hepatitis is probably the most common disease transmitted in this way; it can make people sick for months and cause permanent liver damage. Of much greater concern is AIDS (Acquired Immune Deficiency Syndrome), a fatal, incurable viral infection that destroys the immune system. Intravenous drug users are at risk for this new and devastating disease if they share needles. A needle used by an infected person can easily transmit the virus to the bloodstream of the next user. Another possible calamity is bacterial endocarditis— an infection of the heart valves. In addition, needle users frequently suffer from abscesses and inflamed and damaged veins. Intramuscular and subcutaneous injections are less dangerous but not without risk. They transmit hepatitis and AIDS equally well.

Smoking anything irritates the throat, bronchial tubes, and lungs. In susceptible individuals regular smoking of any drug, whether it is tobacco, marijuana, or crack cocaine, can result in respiratory infections, decreased breathing capacity, coughing, bronchitis, and, probably, a greater risk of emphysema and lung cancer. It is also important to keep in mind that smoking puts drugs into the bloodstream and brain very directly, even faster than intravenous injection, making the drugs more toxic and

165 Problems with thugs more addicting. Snorting drugs is less direct than intravenous injection, but not nearly as safe as oral use; it can lead to chronic irritation and erosion of the nasal membranes. Even taken by mouth, some drugs in excess are very irritating. Heavy drinking can cause chronic inflammation of the esophagus and stomach, and too much coffee often gives rise to chronic indigestion.

Heavy users of drugs often have erratic lifestyles that interfere with regular sleep, good nutrition, and healthful habits of hygiene and exercise. In addition, the drugs they take may suppress appetite, rob the body of vitamins, and upset normal metabolism. All of these effects can lead to such chronic problems as malnutrition, anemia, and decreased resistance to infection. For example, dietary deficiencies in the alcoholic greatly increase the liver's susceptibility to the toxicity of alcohol and contribute to the development of cirrhosis.

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