Pharmacology and Drugs

“Smoking, alcohol and drugs destroy the family, raise the cost of health care, overwhelm the educational, criminal procedure and social systems of the nation and contribute to the emergence of an unprecedented wave of violence and homelessness.”

People have been using drugs for thousands of years, but science has taken them up quite recently. The study of drugs involved in pharmacology, its subject – everything related to the action of chemicals on a living organism.
Pharmacology is a part of biology, closely related to physiology and biochemistry. Pharmacology section psychopharmacology – focuses on the effects of drugs on behavior. Although the name of science is a combination of psychology and pharmacology, to understand the effects of drugs on human behavior, environmental factors must also be taken into account, i.e. social. This book is devoted to human psychopharmacology.

People talk a lot about drugs, but it’s not easy to give a precise definition of drugs. With great difficulty, the experts nevertheless developed an acceptable definition. The World Health Organization (WHO) in its report in 1981 defined drugs in a broad sense as “a chemical substance or mixture of substances different from those necessary for normal life activity (like food), the intake of which entails a change in the functioning of the body and, possibly, its structures “.
This basic definition raises the question of what is drug use and abuse. Later in this chapter we will examine in detail the distinction between them, but now it is important for you to understand the general idea. The concept of “drug abuse” is used differently by different people who write on this subject and there is no universally accepted definition. Therefore, the only way to define this concept is to reach agreement between experts. Scientists have reached such an agreement regarding the terms used in scientific studies on alcohol and drugs, as well as in clinical practice. The definition of drug abuse can be given as follows: “drug use is detrimental to the physical and mental state,” legal capacity “and the social status of the person and people experiencing the impact of the person.”

As you can see, the main role in the definition is played by the consequences of the behavior of the addict for himself and the people of his social group. This classification of drugs and their use details this definition. There are some problems with him. The main thing is that the behavior that leads to disastrous consequences within one social or cultural group may not lead to them within another community, or their power of action will be different. Thus, it is impossible to give a definition that works everywhere. But, nevertheless, the term “abuse” in relation to alcohol and other drugs is used very, very often, and therefore it is not necessary to abandon attempts to reach a definition applicable to the absolute majority of situations. For now, the original notion of drug abuse is sufficient.

Medicine and drugs

Before finishing the historical consideration of the subject, one should pay attention to the interesting and long-standing relationship between the use of psychoactive substances as drugs (this is discussed in detail in Chapter 5) and their use for other purposes. Many of these drugs were once used for medicinal purposes. Medicine did not immediately become such a science as we know it now. Even in our century, various folk remedies and so-called “patented drugs” were widespread. Perhaps the best example is the opiates (opium and morphine), which throughout the 19th century were used in the treatment of various diseases – rheumatism, pain, fever, delirium tremens, colds, etc. Opiates served as anesthesia during surgical operations. Doctors widely used opiates and often prescribed them to patients, while very poorly imagining how they affect the body. They only knew that opiates relieve pain and other, mostly incomprehensible, symptoms. Unfortunately, such widespread use led to a significant increase in the number of people falling into physical dependence on these substances. The fact that drugs are addictive was clearly realized only in the 1870s.

There are many more examples. Chloroform and ether were developed as anesthetic drugs, but they also did not pass use for inappropriate purposes: it was in the middle of the last century. In the history of cocaine, there was a period when it was used to treat depression and relieve pain. He was even used as a cure for opium addiction! In the second half of the 19th century, doctors found many uses for marijuana, including the treatment of insomnia and nervous disorders. However, their list was smaller than for opiates. In the twentieth century, we witnessed the emergence of synthetic amphetamine stimulants, and some of them were available for a long time without a prescription.

It is important to understand that in medicine (whether popular or modern), the use of psychoactive substances as medicines and their use for non-medical purposes will always be closely related. In the past, such substances often came into medicine from religious ceremonies and traditional medicine practices. Nowadays, a situation where a substance developed as a drug replenishes the ranks of drugs is common. In any case, it will not be possible to separate medicine and drugs.

Drugs and society

Drugs are familiar to people for several thousand years. They were consumed by people of different cultures, for different purposes: during religious ceremonies, to recuperate, to change consciousness, to relieve pain and unpleasant sensations.
Already in the pre-writing period, we have evidence that people knew and used psychoactive chemicals: alcohol and plants, the consumption of which affects consciousness. Archaeological research has shown that as early as 6400 BC people knew beer and some other alcoholic beverages. Obviously, the fermentation processes were discovered by chance (grape wine, by the way, appeared only in 4-3 centuries BC). The first written evidence of intoxicant use is the story of Noah’s drunkenness from the Book of Genesis. Various plants have been used that cause physiological and psychological changes, usually in religious ceremonies or during medical procedures. An example is the use in the Middle East of 5 thousand BC. “grass of joy” (apparently, opium poppy). Around 2700 BC China has already used hemp (as an infusion, as tea): Emperor Shen Nung ordered his subjects to take it as a medicine for gout and absent-mindedness. Stone Age people knew opium, hashish, and cocaine and used these drugs to alter consciousness (during religious rites) and in preparation for the battle. On the walls of the burial complexes of the Indians of Central and South America there are images of people chewing coca leaves (one of the ways to take cocaine), dating from the middle of 3 thousand BC. It should be borne in mind that the fact of using a drug in one culture does not give us the right to assume that in other cultures at the same time people knew this drug and used it. As now, there are similarities and differences in the use of drugs by people of different cultures.

Throughout history, contacts between distant cultures have occurred through trade and war. For example, as a result of the crusades and journeys of Marco Polo, the Europeans recognized opium and hashish, which were widespread in the East. Later travels of Europeans (mainly Englishmen, French, Portuguese and Spaniards) to America brought new discoveries. The main psychoactive substances brought to Europe from America are cocaine (from South America), various hallucinogens (from Central America) and tobacco (from North America). Studies have shown that a two-way exchange took place between cultures. The birthplace of the coffee tree is Ethiopia. The Europeans became acquainted with the coffee drink in the 17th century, the sailors brought coffee beans to South America, which is now the world’s leading coffee producer. We add that from Europe came to America alcohol, obtained by distillation, and in Chile in 1545 hemp appeared.

Until the beginning of the 20th century, there were practically no restrictions on the production and use of drugs. Sometimes attempts were made to reduce or even prohibit the use of certain substances, but they were short-lived and, as a rule, unsuccessful. For example, tobacco, coffee and tea were initially greeted by Europe with hostility. The first European to smoke tobacco – Columbus’ satellite Rodrigo de Jerez – was imprisoned upon his arrival in Spain, as the authorities decided that the devil had settled in him. There have been several attempts to outlaw coffee and tea.

There are also cases when the state did not prohibit drugs, but rather promoted the flourishing of their trade. The best example is armed conflicts between Britain and China in the mid-19th century. They are called the Opium Wars, because English traders imported opium into China. By the mid-19th century, several million Chinese were addicted to opium. At this time, China, of course, came in first place in the world in the consumption of opium, most of which was grown in India and shipped to the country by the British. The Chinese government has passed many opium import control laws, but not one of them (including a total ban) has the desired effect. The British did not want to reduce the opium trade: first, it gave great profits, and secondly, in England itself there was no such surge of drug addiction, although opium was widely used in medicine. In 1839, a conflict broke out: the Chinese government destroyed a large cargo of opium belonging to British and American traders. The first opium war began. Britain won and, by the Nanking Treaty of 1842, received, among other things, the right to use the ports of Hong Kong as compensation for the destruction of opium. Trade continued and in 1856 led to the second war. This second opium war ended in 1858, and according to the terms of the Treaty of Tiensa, China continued to import opium, but could impose large customs duties. The opium trade declined and eventually stopped only at the beginning of the twentieth century, when a campaign began all over the world for allowing the use of drugs for medical purposes only (as painkillers).

In the twentieth century, almost the same drugs were used in Europe and America. Interestingly, many new or well-forgotten old drugs were first used in the United States, and then they spread to other countries, so that America set the tone for international drug use,
Description of the process by an amphetamine user

“Coming from amphetamines can not be compared with anything. You sleep powder, dissolve in water, put into a button accordion. Then you drag your hand with a belt. At this time you are very excited, your heart is pounding because you know that in a couple of minutes you will be happy. And here you go in. “

The effects of prolonged use

If stimulants are taken for a long time and regularly, new problems arise. One of them is the development of tolerance to the drug, and in the case of stimulants its character is rather complicated. First, there is a strong tolerance to cocaine. This means that the effect of the first dose taken can be repeated a second time only if the dose increases.

This is how a person using crack describes it:

“You can take so much crack that it will kill you, and you will not notice it, because the lungs are numb and you can be delayed again and again. After the first time, you try to feel the same coming all night. You think that it will happen again with the next dose, and you put another crack in the phone and drag it deeper. But it will be no longer, it will never be like that. Nothing compares to the first puff. ”

Strong tolerance to the physiological effects of cocaine (rapid heartbeat) was studied in humans in the laboratory. This tolerance quickly disappears, usually within a day. Studies of long-term tolerance to cocaine and amphetamines have not yet yielded significant results. In some cases, the development of tolerance to the various actions of stimulants on the body is clearly observed. For example, tolerance to hyperthermia (increase in body temperature) is constantly growing. However, other studies provide results that can be called reverse tolerance or increased sensitivity as a result of prolonged drug use. In these cases, small doses are sufficient for a particular effect. This is absolutely true for the property of cocaine to cause convulsions: the convulsive effect of the drug increases with prolonged use. This phenomenon is called kindling. The effect can also be achieved by electrostimulation. Such a phenomenon can play a role in cases when death from overdose occurs when taking relatively small doses of cocaine. In any case, the presence of normal or inverse tolerance depends on a variety of complex processes occurring during a certain impact on the body.
Addiction

Although the abstinence syndrome caused by cocaine or methamphetamines is not life threatening, it is still strong. The main symptoms include depression, falling out of society, severe anxiety, sleep disorders and, finally, a sense of urgent need for a drug. Many people who have gone through this say that the temptation to resume taking the drug is impossible to resist. From one to five days after the end of the reception, “breaking” lasts: a person is experiencing a deep depression, a complete breakdown and can only think about the drug. Sometimes during the break-up period, a person is so exhausted that he cannot even want to take another dose, but when he recovers a little, desire will flood with a new force. The second phase is abstinence: from 1 to 10 weeks, the person continues to feel a strong desire to take cocaine, he is still in a state of depression of severe or moderate severity, and he cannot feel pleasure. Finally, in the third phase there is a noticeable improvement, but for months or even years, the person sometimes experiences craving for the drug. This is a phase of extinction: the desire to take a dose again is caused by the “prompts” of the environment, which make a person suffer until finally he learns to extinguish these “hints”, possibly through special training.

Not all people who have experimented with cocaine or crack have an addiction, and not everyone who has taken drugs regularly for more than a year has such strong withdrawal symptoms. But if they appear, life becomes a nightmare. The risk of death in overdose, stimulatory psychosis and severe depression – this is not all. Many people who smoke crack often have chest pains associated with heart or lung damage. People who take cocaine through their nose suffer from insomnia, constant fatigue, severe headache, cramps and various infections that enter the body through the nose. Many coca women cannot stop using drugs during pregnancy, and the baby is in grave danger. Withdrawal symptoms last for a very long time, and therefore many people again firmly “sit on the needle” even after a few months of complete abstinence from cocaine.

Cocaine and other drugs.

Cocaine and other stimulants are often taken along with other drugs, especially with alcohol and opiates. As shown by the latest research, when mixing alcohol with cocaine, a new substance is formed in the body – cocaethylene. By its pharmacological properties, it is similar to cocaine, but may be more toxic. Many of the deaths from cocaine overdose are actually linked to cocaethylene poisoning. The combination of cocaine (or amphetamine) with heroin, a speedball, is especially popular among heroin addicts. A mixture of cocaine and heroin is sometimes called the cause of death from overdose (as was the case with John Belushi and Phoenix River), but experiments with a mixture of cocaine and opiates did not record the appearance of additional effects or synergism.

Acute effects of high doses

At high doses of stimulants, a characteristic psychosis is observed. Laboratory studies, when volunteers take amphetamines, cocaine, phenmethrazine (Preludin) or methylphenidates (Ritalin), confirm this. Such reactions with large doses of crack create a serious problem.
Paranoid disorder is the most common symptom of stimulatory psychosis. Another frequent symptom is an impulsive, stereotypical behavior; a person shakes, tears his hair, smokes cigarettes one by one, turns some thing in his hands. Sometimes there are hallucinations and goosebumps. Stimulatory psychosis is successfully treated with chlorpromazine (Thorazine) or other substances used in the treatment of schizophrenia.

Of course, large doses of cocaine or amphetamines are always accompanied by the risk of death from overdose. It is difficult to accurately determine the dose at which this risk begins. For cocaine, a small or moderate dose means 15-60 mg. (Usually, the “lane” contains 16–20 mg.) But there have been deaths from cocaine overdose, when people were given only 20 mg as a local anesthetic. Apparently they suffered a rare case of enzyme deficiency, which destroy cocaine in the blood and liver. These cases are exceptions, usually stimulatory psychosis or death occurs at much higher doses. In 1985, more than 500 people died from cocaine overdose in the US, but for many the compelling argument that cocaine kills were the deaths of athletes Len Bias, Don Rogers and film actor John Belushi. Stimulants can kill in different ways:
Cocaine can cause convulsions or a seizure that ends in suffocation.
Cocaine directly affects the nerve cells of the heart, which can cause a change in the rhythm of the heartbeat (arrhythmia). In severe cases, this can lead to fibrillation — a condition where the heart vibrates but does not pump blood.

Cocaine can cause a spasm of the coronary artery and the termination of blood access to the heart muscle. This leads to myocardial infarction and heart failure if the person remains alive.
Cocaine can cause a rupture of the cerebral artery due to high blood pressure, which can cause an attack. These are the most likely causes of death from cocaine overdose. Which factor causes death in a particular case is rarely established. Often the case is further complicated by the fact that other drugs are mixed with cocaine in order to bring about new sensations, and the result of such mixing is often unpredictable.

Acute effects of small and moderate doses

Stimulants produce many different effects beyond the brain. We discuss the effects of cocaine and amphetamines together, because in practice their measurable effects are identical. Although people taking these drugs claim that there are considerable differences between stimulants, in the laboratory, even experienced drug users cannot distinguish between cocaine and amphetamines or methylphenidates.
Stimulants are a classic example of sympathomomic drugs. This means that they stimulate the activity of the sympathetic branch of the autonomic nervous system, or imitate such activity. So, they produce the same physiological effects that accompany the usual emotional uplift: heartbeat, breathing increase, blood pressure rises, sweating increases. Meanwhile, the blood drains from the viscera and flows to large groups of muscles and the brain. Finally, the body temperature rises and the pupils dilate.

Cocaine and amphetamines also have an anorexic action (that is, they suppress appetite). After taking these drugs, people simply do not want to eat. Because of these properties, amphetamines and phenmetrazine (Preludin) have been prescribed to people on a diet. Patients actually ate noticeably less and lost weight, but in order to maintain this achievement, they had to increase the doses, and when people stopped using the drug, they, as a rule, became stout again. Thus, the benefits of these drugs were outweighed by the risk of drug dependence and side effects, which called into question their use for the treatment of obesity.

Moderate doses of cocaine and amphetamines cause mood elevation. People become more sociable and talkative. Emotional rise and vigor lead to a state of insomnia. These drugs improve physical endurance and strength. For example, a person shows the best results when running or swimming. The results do not increase much, but the athlete gets a significant advantage. Figure 6-2 shows the effects of methamphetamine on cycling. A control injection has little effect on fatigue and a decrease in driving speed, but an injection of methamphetamine (Methedrine), administered three hours after the start of the test, gives a significant improvement in the result, lasting several hours. Although there is no such data on the action of cocaine, it is safe to assume that it has the same effect, but it is less durable. Improving physical characteristics is one of the reasons that cocaine has recently been so common among athletes. When former coach of the Maryland basketball team Lefty Drizel noted this at a conference in June 1987 devoted to drugs, condemnations rained down on him from all sides. He actually advocated testing athletes for drugs, because if they give even the slightest advantage, the athlete will be tempted to take them.
Since stimulants increase the body’s resistance to fatigue, they are often used in the learning process. A person can learn during the whole night. This use of stimulants poses several problems. Information learned under the influence of a drug is easier to remember after taking the same drug. This is the phenomenon of dependence of learning outcomes on the state of the body, which is also observed in cases with other drugs. Recovering information in a sober form is difficult, so do not resort to this method of learning material. In addition, research data suggests that stimulants gradually deteriorate the ability to memorize. Figure 6-3 shows the increase in memorization errors after taking cocaine. Notice that the effect depends on the dose of the drug and the time it is taken, and that a 32 mg injection is much stronger than 96 mg given through the nose. Separate evidence suggests that stimulants reduce the ability to solve complex problems. Here is the case of William Halstead. Halstead’s discoveries at the beginning of our century make it possible to call him the father of modern surgery. But when he studied the anesthetic properties of cocaine, he was probably the first American to become addicted to this drug.

At this time, he published an article in the New York Medical Journal that began:

“Despite the fact that it can be explained in different ways, although at a loss on the possible misunderstanding of why modern hospitals, and, moreover, many, with a certain distrust expressed almost no interest in such a thing as local anesthesia, and with complete confidence Under these circumstances, I do not think that it is worth trying to defend the reputation of surgery instead of trying to win over others, and this prompted me a few months ago to write on this subject most of something like a scrapping article that poor health prevented me from finishing. ”

Cocaine undoubtedly influenced Halstead’s style, and it’s terrible to think about how this surgeon even operated! Thus, the statement that About cocaine improves mental ability – a myth. Another largely misguided notion of cocaine and amphetamines is their ability to increase sexual potential. This question is far from complete. But according to the available data, it is clear that although some people talk about sexual arousal and increased potency when taking stimulants, the majority do not experience anything like this. Many men who take stimulants, on the contrary, develop impotence, and women have a lack of interest in sex, but stimulants do not have such an effect on most people.
“He is necessary for me, he is simply necessary for me. You can’t even imagine this close to yourself.”
Actor John Belushi about cocaine.

Stimulant Pharmacokinetics

Stimulating drugs can be introduced into the body and absorbed in different ways, and accordingly have different strength and duration of action. Cocaine, amphetamines and similar stimulants (methylphenidates, phenthrazine) are well absorbed through the stomach, but the result is slower and it is noticeably weaker than if taken in other ways. Both cocaine and amphetamines are usually inhaled through the nose, and they are absorbed almost as quickly as they are ingested. In this case, the action begins after 5-15 minutes, while with intravenous injection, stimulants give a strong effect after 30 seconds. When smoking cocaine in the form of crack, the result comes even faster.

An important difference between cocaine and amphetamines is the duration of action. Cocaine metabolism occurs quickly: after 20-80 minutes, all its effects disappear. Cocaine metabolites can be detected in the urine within 2-3 days of administration. Amphetamines act from 4 to 12 hours, although their metabolites disappear from the urine after 2-3 days.

The mechanism of stimulating action

As mentioned in Chapter 3, stimulants such as cocaine and amphetamines act on the brain mainly through the interaction with the monoamine neurotransmitters dopamine, norepinephrine and serotonin. Both cocaine and amphetamines block the reuptake of norepinephrine and dopamine. In addition, they appear to increase the release of norepinephrine and dopamine into the synapse. Cocaine also inhibits serotonin reuptake. Thus, initially, stimulants cause a storm in the transmission channels of nerve impulses sensitive to monoamine mediators. As a result of increased neuronal activity and, in particular, due to blocking reverse absorption, the long-term effects of stimulant intake include depletion of monoamine reserves. If we recall that a low level of monoamine content in the brain is associated with clinical cases of depression, it becomes clear why among the consequences of consuming large doses of cocaine are depression. To substantiate this hypothesis, we turn to the data of animal experiments.

It has long been known that animals love cocaine. Rats and monkeys will prefer cocaine to any other drug and, under certain circumstances, even food. Obviously, the strong invigorating effect of cocaine and amphetamines comes from the fact that they interact with the dopamine-containing neurons of the nerve channels that make up the central node of the anterior brain. As you remember from Chapter 3, this part of the brain is responsible for the feeling of pleasure, and cocaine can be called the catalyst of processes in the pleasure system. Since the long-term use of the drug depletes the reserves of dopamine (and other mediators important for depression), then a person’s ability to experience normal pleasure decreases. This is associated with depression, which so often accompanies cocaine abstinence and is known as “cocaine sadness.” Figure 6-1 shows the relationship between cocaine and mood with moderate and heavy use. The left peak of the curve corresponds to a rise in mood after taking cocaine, a fall on the right side of the graph means a subsequent depression. After a large dose, depression is stronger. This is true as with one dose, and with prolonged use. The longer a person has taken a drug, the stronger and longer his depressive withdrawal syndrome will be.

Second cocaine epidemic

It is said that those who do not learn from mistakes are doomed to repeat them. In the case of cocaine, this is true. Why of all stimulants, the choice fell again on cocaine? In the early 70s, cocaine was quite difficult to get, and it cost a lot of money. He was known as a drug of movie stars and athletes (the few who could afford to spend such money), and had a reputation as “champagne among stimulants.” At this time, cocaine was mostly smelled in small doses, and rarely encountered problems with intravenous injections. There were, of course, trouble. For example, the former Dallas Cowboys defender, football player

Hollywood Henderson, admitted that he had acquired a habit that costs him $ 1,000 a day, but there were relatively few such victims of cocaine. Cocaine was considered quite a harmless drug. There were books in which it was written that cocaine “is not addictive, as dangerous drugs”, many advocated its legalization.
Nowadays, there is not the slightest doubt that cocaine is a very dangerous drug. Words like the ones above seem terribly naive, because we see how many people died from cocaine overdose, we have names of celebrities trying to recover from cocaine addiction. What has changed? One of the reasons was the appearance of cheap cocaine. Now it began to be consumed by more people and in large doses. Another important factor was the spread of crack. Crack knew in the late 70s, and in 1986 it just broke into the life of American society.

Yet cocaine is usually consumed in a cleaner form. Regular cocaine, which can be bought on the street, is a white powder. A paste is made from coca leaves, into which hydrochloric acid is poured, and cocaine hydrochloride is obtained. Since street cocaine is salt, it is readily soluble in water and can be injected with a syringe into a vein. Cocaine can be sniffed, and in this way it produces a rather strong effect, but since the drug constricts the blood vessels in the nose, it is slowly absorbed. By the way, this narrowing of the blood vessels can cause inflammation and damage to the nasal mucosa. With the introduction of cocaine through the nose, psychosis also occurs, deaths in overdose, etc., but less often than if administered intravenously. Therefore, until the end of the 80s, while the main method of cocaine use was the way through the nose, the danger of this drug was underestimated.

In the process of smoking cocaine, it is absorbed through the lungs completely and very quickly and causes very pleasant and very short sensations, followed by a strong breaking. But at the high temperature required for smoking, cocaine in the composition of the salts is destroyed. In order for cocaine to be smoked, it is necessary to separate the cocaine base from the hydrochloride (get “free cocaine”). One way is to mix the salt of cocaine with the flammable substance ether. Many people who could not handle him were badly burned. However, crack can be obtained in a simpler and safer way – by dissolving the salt of cocaine in an alkaline solution, for example in baking soda. After evaporation, you get a crack. It has a low melting point, and therefore it can be heated and inhaled smoke containing intact cocaine. (The name “crack” comes from the English “crack” – “crackling”, as when the mixture is heated, a crackling sound is produced by soda remaining in the compound.) When smoking crack cocaine quickly gets into the brain, causing such a quick rise and such pleasant sensations, that many addicts prefer it to comparable doses of cocaine, which must be administered intravenously. This euphoria is short-lived, and after 10-20 minutes, the person is eager to introduce another dose. Researchers note that the desire to take the next dose in people who smoke crack is higher than that of intravenous cocaine.

Crack is cheaper and less dangerous in production than other types of “free” cocaine, so drug dealers distribute it. In addition, it is so potent that it can be sold in small portions for 10-20 dollars, which means that it is relatively affordable. Crack is very addictive, and it does so quickly, so in one instant a large market of this drug formed. Crack came to the attention of the media at the end of 1985, and at the beginning of 1986 Time, Newsweek and television spoke of it as a national disaster. In the late 1980s, millions of Americans consumed crack. When two well-known athletes, Len Bias and Don Rogers, were killed in one week from an overdose of cocaine, it became clear again that cocaine must be fought. Cocaine is lethal, especially in the form of crack. At this time, other consequences of overdose, in particular the development of paranoia, became very frequent. In 1990, there were more than 80,000 ambulance calls related to cocaine use (compared to 10,000 in 1985 and almost absent in 1970). With the spread of crack Cain addiction has become a major health problem.

Crack and cocaine still have a strong influence on society. One of the sides of the problem is the incredible increase in the activity of the underworld associated with cocaine. Cocaine sales are controlled by large and well-organized criminal groups, known as cartels. The largest of these, the Cali cartel, is in Colombia. He supplies most of the cocaine to the United States. When the governments of the United States and Colombia declared war on drug smuggling, this resulted in a series of armed clashes. In the first half of 1989, more than two thousand people were killed in Medellín (Colombia). Hundreds of judges and members of the judiciary were the victims of attempts, hundreds of others resigned. Although the head of the Medellín cartel, Pablo Escobar, was killed in a shootout with the police in 1993, the cartels continue to expand, covering Eastern European and Asian countries, and are becoming global. Newsweek wrote in 1993: “The annual income of organized crime is estimated at $ 1 trillion, which is almost equal to the annual federal budget of the United States. The Cali cartel tried to launch its own satellite into space to avoid tapping the CIA’s telephone conversations.”

In the United States itself, cocaine goes hand in hand with crime and violence. The famous Los Angeles gangs “Blades” and “Crips” have absorbed groups from other cities and are fighting with other groups (from Jamaica and other Latin American countries) for control of the crack market. These well-organized groups represent a great danger to citizens and a headache for the police. Unlike the former small drug dealers, gang members have well-armed and sophisticated systems for transporting their goods. Many cases of shootings on the roads and other urban violence are related to crack.

Crack has an exceptional effect on people of its destructiveness. Dependence on him brings people to extreme despair and self-destruction. “Crack houses” – the places where crack is sold and smoked – became in the 90s the den of lawlessness. When a drug addict runs out of money, sexual services of a different kind become a means of paying for crack, and an additional risk factor appears – AIDS. In special studies of the life of “crack houses”, one can find indications of numerous cases of murder, rape, child prostitution, etc., the usual things for these places.

A good idea of ​​them will give the words of one addict:

In the houses of crack I have seen things that I have not seen anywhere else. Worse places can not be imagined. No one cares about anyone, do what you want. What did I not see! I saw a girl that ______ fifty times, until she was already covered in blood and could not even get up, and this is for a small piece of crack. I saw one guy splashed acid on her face, just because she didn’t want to sleep with him anymore. I saw a single shot of an egg shotgun for trying to steal some crack. Hey, man, these are bad places … ”
In recent years, an extensive campaign against crack has been launched, a description of all the dangers cannot be ignored. Why do people still smoke crack?

The following seductive and ominous description belongs to the person who smokes crack:

“Imagine that you are on the island, and about ten meters from the coast there is a sort of orange-pink mist, sparkling and alluring. You enter the cold, dark water and float to this blazing cloud, and here you are near, and you already feel the heat, and you well, but the fog is a little distant. You dive and you are almost in its very center, and it’s so beautiful. But now the fog drifts into the sea faster, and you need to swim faster and faster to catch up with it, and you are further and further from coast. That’s the way it is with crack. After the first puffs you feel good, you draw deep – and you are in the middle e, and you have fun, but then you let go and you need more. Very soon you find yourself the devil knows where, in the cold dark ocean, and you have to quickly swim to this warm, wonderful, sparkling fog, which you can never reach, or turn back and swim for miles in this dark cold water. “

Amphetamines

After Harrison’s law, cocaine consumption in America began to decline, but a new stimulant, amphetamine, soon appeared on the scene. This is a class of drugs that includes amphetamine, dextroamphetamine and methamphetamine. They were first synthesized in the late 19th century, and, although they were immediately available for research, their medical use began only in the 1920s. It was believed that they are useful in the treatment of colds, obesity, narcolepsy (a disease in which a person falls asleep uncontrollably). They, oddly enough, were also used to treat hyperactive children. Amphetamines are now rarely used in medicine, mainly because they are very easy to abuse. These drugs were used as stimulants during World War II on both sides of the front. After the war, amphetamine abuse reached epidemic proportions in Japan, Sweden and some European countries, but in America until the 1960s they were not considered dangerous drugs. Ironically, they became America’s headache when doctors began to prescribe them as a cure for heroin addiction. As with the cocaine treatment of morphineism, undertaken by Freud, this innovation turned into a surge in the abuse of amphetamines, especially on the west coast.
Injection of amphetamines leads to addiction, similar to cocaine problems at the beginning of the century (and which we see now). Immediately after the injection, a person experiences a short but strong rise or “arrival”. The very pleasant sensations that occur after the injection of cocaine or amphetamine are often described as orgasmic in nature. But since they do not last longer than a few minutes, the person soon wants to return to the heights of bliss again, although the level of the drug in the blood is still quite high. Several injections follow one after another, the person becomes more and more excited, but it becomes more difficult to achieve the same pleasant recovery as the first time. Both cocaine and amphetamines suppress appetite and interfere with sleep, and therefore a person can not sleep for days, eat very little, and at the same time inject himself dose by dose. In the 1960s, such people were called “speed freaks” (speed freak). With their appearance, it became clear that amphetamine has almost all the properties of cocaine. For example, after taking a large dose of amphetamine, a person also feels goosebumps, as well as overdose of cocaine, and paranoid hallucinations appear, that is, amphetamines can cause a psychosis almost identical to cocaine.
Here is a description of a typical fast eccentric from San Francisco: “He’s a very nice man and very generous. However, when he smacks … he starts having problems. Because he has a shotgun very quickly in his hands … I saw him he drove the hitchhikers from the highway exit: they cause him paranoia. At four o’clock in the afternoon, he yells with a huge shotgun in his hand “come on, come on, get out of here, you can’t stand here.”
This paranoid psychosis caused by an overdose of cocaine and amphetamines can be called stimulatory psychosis.
In the late 60s they wrote “Speed ​​is killing!” The slogan does not imply that death comes from an overdose. Deaths from amphetamine overdose have occurred, but comparatively rarely. The paranoid state, which often leads to the commission of an act of violence, develops much more often. In addition, after taking large doses of amphetamines, a person “breaks down” (falls asleep for a long time), and when he wakes up, he finds himself in a state of severe depression. It can last several days and is an abstinence syndrome after heavy use of amphetamine or cocaine. To overcome depression, a person often takes a drug again, and everything repeats from the beginning. Ultimately, the physical and mental state of a person is seriously deteriorating, and the person is no longer able to break this circle.
When the risk to which a person is exposed when using amphetamines became apparent, other, less dangerous stimulants were sought. In the 1970s, amphetamines-related phenmetrazine became popular. Soon, however, it turned out that it causes all the same side effects. By the mid-1970s, another tendency was revealed: a “new” stimulant, an “organic”, a “natural” or a “natural” drug appeared on the scene – of course, because there can be nothing wrong with … cocaine?

Early use of cocaine

The further history of cocaine is very curious. It was attended by one young Viennese doctor who needed some kind of discovery to gain recognition.
Although now Sigmund Freud is better known as a researcher of another problem, his first work was devoted to cocaine. Freud tried cocaine in 1884 and soon realized that he had discovered an amazing substance. In his first major publication, O Coke, he promoted cocaine as a local anesthetic and a cure for depression, indigestion, asthma, various neuroses, syphilis, drug addiction and alcoholism. He also believed that cocaine increased sexual arousal.

Of this list of possible medical indications of cocaine, only one was valuable – for local anesthesia. When cocaine molecules interact with neurons of the peripheral nervous system, the latter cannot be excited, which causes numbness in some part of the body. Cocaine acts on the central nervous system quite differently. Cocaine became the first local anesthetic, and this revolutionized surgery. Nowadays, of course, cocaine derivatives are more widely used, such as procaine or novocaine. But cocaine itself is still used in surgery, especially in face surgery, as it constricts blood vessels, reduces bleeding and reduces pain.
Freud’s early thoughts about cocaine were erroneous and led to a wave of abuse of this drug. It’s funny, but the first to demonstrate what people expect in the future was Freud’s friend Ernst von Fleischel. He suffered from chronic pain, and because of this he became a morphine. Freud undertook to cure him and prescribed cocaine. Fleischel began to consume it in more and more large quantities and, indeed, got rid of the addiction to morphine. But his daily dose of cocaine soon amounted to one gram. Fleishel became the first cocaine in Europe. He had strange symptoms, which, as we now know, are the result of cocaine overdose. Among them were paranoid hallucinations, which are often observed in paranoid schizophrenia, and itching of the skin, so-called “goosebumps”, in which a person feels as if insects or snakes crawl on his skin. These symptoms are the result of a cocaine overdose, and the first of many who experienced these sensations was Fleischel.

Freud was amazed at the devastating effect that cocaine had on Fleischel, and in the following articles he diminished his enthusiasm for cocaine. But the harm was already irreparable. It was a cocaine epidemic of the 80s, yes, yes, it was the 80s of the XIX century! Doctors prescribed cocaine; in pharmacies without someone’s prescription, patented drugs containing it were sold (for example, Mariani coca wine, a record holder in sales in Europe). And, of course, cocoa. Older advertisements say that this drink “contains tonic and stimulating substances from coca plants.” Cocaine took a place in music and literature: he gave Sherlock Holmes vivacity and improved deductive abilities; Stephenson apparently wrote a story about Dr. Jackel and Mr. Heide during his cocaine treatment for tuberculosis. Good recommendations cocaine gave Thomas Edison, Jules Bern, Emile Zola, Heinrich Ibsen and President Grant.

The Cocaine Metcalfe wine ad shows how cocaine became so popular: Speakers, singers and actors found that coca wine strengthened the vocal cords well. Athletes, runners and baseball players on their own experience were convinced that prolonged use of coca, both before and after the competition, gives strength and energy and reduces fatigue. Older people have learned that this is a reliable aphrodisiac, the best of all known.

With such an advertisement, cocaine was not difficult to become popular. With the increase in the number of people who use drugs, danger has become noticeable. Many discovered these dangers on themselves, and after cocaine psychosis, deaths from overdoses, and heavy drug addiction, public opinion came out against cocaine. One of the works that most impressed the public and changed the perception of cocaine was an article that dealt with the case of Annie Meyer, who was a successful business woman and a “balanced Christian” until she became a “friend of cocaine.” Meyer described well all the power of cocaine addiction. It was a period when she ran out of money. “I took the scissors and loosened my golden tooth. Then I pulled it out, flattened it and rushed to the nearest pawnshop (blood flowed down my face, the dress was wet with blood), where I sold the tooth for 80 cents.” After that, attitudes toward cocaine began to change. Reports of rape committed under the influence of cocaine were added to the dramatic descriptions of drug addiction, and public opinion exploded. The culmination of indignation was the adoption in 1914 of Garrison’s cocaine control law. Initially, the law was intended to control the spread of opiates,like morphine and heroin, but the inclusion of cocaine in the list of dangerous drugs was by no means accidental.