Just The Facts

Smokers and non-smokers alike often do not fully appreciate the health risks of tobacco use, particularly cigarette smoking.  The latest epidemiologic studies indicate that death rates for smokers are two to three times higher than for non-smokers at all ages.  This means that half of all smokers will eventually die as a result of their smoking.  If current smoking trends persist, about 500 million people currently alive, nearly 9% of the world’s population, will eventually die as a result of tobacco.

People who die from tobacco use do not die only in old age.  About half of all smokers who are killed by tobacco die in middle age.  On average, these smokers who die in middle age lose about 20-25 years of life expectancy.

About half of all tobacco-related deaths occur at ages 35-69 years, making tobacco the most prevalent cause of premature death in developed countries.

Smokers in their thirties and forties have five times as many heart attacks as non-smokers.  Heart attacks are the main way in which smoking kills young tobacco users.  In industrialized countries, tobacco is responsible for 75-80% of all heart attack deaths in young smokers under the age of 50.

Lower tar cigarettes do not substantially reduce the risk of heart attack in smokers.

In the 1990s, smoking is estimated to be the cause of one in five male deaths from cardiovascular diseases in developed countries (and about 6% of female CVD deaths).

Smoking causes about 30% of all cancer deaths in developed countries (40-45% of male cancer deaths, and 10-15% of female cancer deaths).  On average, about 90-95% of male lung cancer deaths in developed countries, and 70-75% of female lung cancer deaths, are due to smoking.

By the end of the 20th century, cigarette smoking will have killed about 62 million people in developed countries: 52 million men, 10 million women.

Passive smoke

Passive smoking is a cause of additional episodes and increased severity of symptoms in asthmatic children.  Asthmatic children are up to 2.5 times more likely to have their condition worsened by passive smoking.  In the United States alone it is estimated that 200,000 to one million asthmatic children have their condition worsened by passive smoking.

The risk of lower respiratory tract diseases (such as croup, bronchitis, and pneumonia) is estimated to be about 50-60% higher in children exposed to environmental tobacco smoke (ETS) during the first 1-2 years of life, compared with unexposed children.  About 10-15% of lower respiratory tract disease in young children under 18 months of age is attributable to passive smoking.

In children, exposure to environmental tobacco smoke is causally associated with increased prevalence of fluid in the middle ear, symptoms of upper respiratory tract irritation, and a small but significant reduction in lung function.

Environmental tobacco smoke is a cause of lung cancer in lifelong non-smokers exposed to ETS.  Epidemiological studies carried out in several countries suggest that the lung cancer risk is about 20-30% higher than for people who have never smoked and haven’t been exposed to ETS.

No matter what the tobacco industry says, or those funded by the tobacco industry, second-hand smoke is dangerous – even deadly – to our health.  The world’s most reputable scientists, medical organizations and government health agencies all agree on this issue.  They state bluntly that second-hand smoke – also known as “environmental tobacco smoke” (ETS) or “passive smoking” – causes a whole slate of serious health problems.  For adults, the dangers include heart disease, lung cancer, nasal sinus cancer, and respiratory ailments.  For infants and children, harmful health effects include sudden infant death syndrome, lower birth weight, various respiratory illnesses including bronchitis and pneumonia, and middle ear disease.

And the scientific evidence continues to mount.  Newer studies are showing links between second-hand smoke and cervical and breast cancer, stroke, and miscarriages in adults.  Children exposed to second-hand smoke are at higher risk for asthma, decreased lung function, cystic fibrosis, and cognitive and behavioral problems.

The hazards of alcohol abuse

Alcohol occupies a unique place in many human societies.  It is a widely used drug, tolerated physiologically and socially, with a place in religious ceremony, in ritual, in spontaneous celebration, and in everyday social transactions.  However, it also a drug that contributes extensively to illness, to violence, to social disorder, and to mortality.

Humans have consumed alcohol on a regular basis over the past 10,000 to 15,000 years.  Like fat and sugar, alcohol is rare in nature, and as with fat and sugar, we have few biologic curbs on excess consumption.  The joys of abstinence, moderation, and drunkenness have produced a welter of maxims throughout human history.  Some of them have been in support of the healthful consequences of alcohol: “Use a little wine for thy stomach’s sake” (Saint Paul); “There are more old drunkards than old doctors” (French proverb).  Yet only recently have we had sufficient data to consider the full impact of alcohol on public health.

Recent evidence uncovered by university researchers proves that a moderate amount of alcohol, approximately 4 ounces daily, may reduce the risk of high blood pressure and heart disease.  Using a very controlled narrow scientific view that evaluates humans primarily as machines and data, it is very possible to show that drinking a mild amount of alcohol will reduce the risk of heart disease.  At best, however, this is misleading research because it does not view the person within in the context of living life in an environment that is low in oxygen, high in toxins and high in stressors.

The benefits derived from alcohol are largely due to the toxic side effects that the chemical produces in the blood stream.  Ethanol, the official chemical name for this drug, actually causes the blood vessels to dilate by inhibiting nerve control.  This effect may relieve the symptomatic representation of high blood pressure and arteriosclerosis (narrowing of the blood vessel in the heart), but it is certainly is not a long-term solution for the problem.  In addition, it may even exacerbate other health concerns that may be masked by the inhibition of normal body functions.

Alcohol use is widespread, although the per capita consumption has varied from decade to decade.  While U.S. consumption of alcoholic beverages increased after World II, since 1981 it has declined slightly.  But even with declines in alcohol use, two of three American adults drink alcoholic beverages.  About half of all alcohol consumed in this country is ingested by heavy drinkers, estimated to be between 6.5 and 10 percent of the total population.  The extent and frequency with which these individuals drink cause serious health and behavioral problems – disrupting their own lives and that of their family, friends, and employers – and also extracts a heavy societal toll.

Alcohol use is involved in:

• One-half of all murders, accidental deaths, and suicides
• One-third of all drowning, boating, and aviation deaths
• One-half of all crimes
• Almost half of all fatal automobile accidents

The health problems associated with alcohol abuse include brain damage, cancer, heart disease, and cirrhosis of the liver.

How alcohol effects the human body

Alcohol is a potent nonprescription drug sold to anyone over the national legal drinking age.  This drug is a tranquilizer and a member of the family of sedative-hypnotic drugs.  When consumed in substantial amounts, alcohol seems to act as a foreign substance in the human body, which causes a toxic reaction in the body’s metabolic functions.  The short-term expression of this toxicity is felt as a hangover.  Toxicity resulting from long-term overexposure may develop into alcoholism and alcohol-related diseases such as cirrhosis.

Unlike carbohydrates, fats, and proteins, which can be manufactured by the body, alcohol is an introduced substance that is not synthesized within the body.  It is a food because it supplies a concentrated number of calories, but it is not nourishing and does not supply a significant amount of needed nutrients, vitamins, or minerals – these are empty calories.  Alcohol may be considered to have triple the calories found in fat!

Most foods are prepared for digestion by the stomach so that their nutrients can be absorbed by the large intestine, but 95 percent of alcohol is absorbed directly through the stomach wall or the walls of the duodenum and the small intestine.  Various factors affect the speed of alcohol’s absorption into the body.

Alcohol moves from the bloodstream into every part of the body that contains water, including major organs like the brain, lungs, kidneys, and heart, and distributes itself equally both inside and outside the body’s cells.  Only 5 percent of consumed alcohol is eliminated from the body through the breath, urine, or sweat; the rest is oxidized or broken down in the liver.

Physical effects of alcohol abuse

Since alcohol so easily permeates every cell and organ of the body, the physical effects of chronic alcohol abuse are wide-ranging and complex.  Large doses of alcohol invade the body’s fluids and interfere with metabolism in every cell.  Alcohol damages the liver, the central nervous system, the gastrointestinal tract, and the heart.  Alcoholics who do not quit drinking decrease life expectancy by 10 to 15 years.  Alcohol also can impair vision, impair sexual function, slow circulation, cause malnutrition, cause water retention (resulting in weight gain and bloating), lead to pancreatitis and skin disorders (such as middle-age acne), dilate blood vessels near the skin causing “brandy nose,” weaken the bones and muscles, and decrease immunity.

The liver breaks down alcohol in the body and is therefore the chief site of alcohol damage.  Liver damage may occur in three irreversible stages.

Fatty liver: Liver cells are infiltrated with abnormal fatty tissue, enlarging the liver.

Alcoholic hepatitis: Liver cells swell, become inflamed, and die, causing blockage.  (Causes between 10 and 30 percent mortality rate.)

Cirrhosis: Fibrous scar tissue forms in place of healthy cells, obstructing the flow of blood through the liver.  Various functions of the liver deteriorate with often fatal results.  (Found in 10 percent of alcoholics.)

A diseased liver:

• Cannot convert stored glycogen into glucose.  This lowers blood sugar and produces hypoglycemia.

• Inefficiently detoxifies the bloodstream and inadequately eliminates drugs, alcohol, and dead red blood cells.

• Cannot manufacture bile (for fat digestion), prothrombin (for blood clotting and bruise prevention), and albumin (for maintaining healthy cells).

• Alcohol in the liver also alters the production of digestive enzymes, preventing the absorption of fats and proteins and decreasing the absorption of the vitamins A, D, E, and K.  The decreased production of enzymes also causes diarrhea.

The brain and central nervous system

Alcohol profoundly disturbs the structure and function of the central nervous system, disrupting the ability to retrieve and consolidate information.  Even moderate alcohol consumption affects cognitive abilities, while larger amounts interfere with the oxygen supply to the brain, a possible cause of blackout or temporary amnesia during drunkenness.  Alcohol abuse destroys brain cells, producing brain deterioration and atrophy, and whether the organic brain damage and neuropsychological impairment linked to alcohol can be reversed is unknown.  Alcohol also alters the brain’s production of RNA (a genetic “messenger”), and serotonin, endorphins, and natural opiates whose function may be linked to the addictive process.

A neurological disorder called Wernicke-Korsakoff’s syndrome results from vitamin B deficiencies produced by alcoholism and the direct action of alcohol on the brain.  Symptoms of this condition include amnesia, loss of short-term memory, disorientation, hallucinations, emotional disturbances, double vision, and loss of muscle control.  Other effects include mental disorders such as increased aggression, antisocial behavior, depression, and anxiety.

The digestive system

Large amounts of alcohol may inflame the mouth, esophagus, and stomach, possibly causing cancer in these locations, especially in drinkers who smoke.  Alcohol increases the stomach’s digestive enzymes, which can irritate the stomach wall, producing heartburn, nausea, gastritis, and ulcers.  The stomach of a chronic drinker loses the ability to adequately move food and expel it into the duodenum, leaving some food always in the stomach, causing sluggish digestion and vomiting.  Alcohol may also inflame the small and large intestines.

The heart

Moderate daily drinking may be good for the heart, but for many the risks outweigh the benefits.  Even one binge may produce irregular heartbeats, and alcohol abusers experience increased risk of high blood pressure, heart attacks, heart arrhythmia, and heart disease.  Alcohol may cause cardiomyopathy (a disease of the heart muscle). Cessation of drinking aids recovery from this condition.

Withdrawal symptoms

Three to 6 days after a heavy drinker (drinking a fifth of liquor a day) completely stops drinking, alcohol is finally gone from the body, and acute and life-threatening effects may occur.  Withdrawal phenomena include sleep disorders such as insomnia, visual and auditory hallucinations, disorientation, alcoholic convulsions, epileptic seizures of the grand mal type, and delirium tremens accompanied by acute anxiety and fear, agitation, fast pulse, fever, and extreme perspiration.  Consequently, alcoholics who decide to quit drinking should do so under competent medical supervision.

A quick Look at alcoholism

Evidence indicates there may be genetic factors that help determine whether a person will become an alcoholic.  A child of an alcoholic has four times the risk of becoming an alcoholic compared with a child of nonalcoholic parents.  However, alcoholism is an equal opportunity disease, striking persons of every economic class and race, both genders, and many ages.  Being successful and happy at home or in business is no protection against alcoholism.

For many years, alcoholics were objects of scorn and pity and were viewed as morally defective persons rather than sufferers of a life-threatening disease.  While acceptance of this condition as a disease clears the way for understanding, treatment, and recovery, alcoholics can and must take responsibility for their own recovery.  And since alcoholism, like diabetes, is treatable but not curable, recovery from alcoholism takes a lifetime.

Living sober

Learning to live without alcohol requires many adjustments in attitudes, values, and lifestyles.  If serious psychological disturbances have developed because of drinking, psychiatric counseling designed for alcohol abusers may be required.  Occupational rehabilitation or vocational guidance also may be necessary.

Abstinence is the absence of alcohol or drugs; sobriety is a way of life.  Recovery begins where formal treatment leaves off, and this lifelong process never ends.  In developing a new way of life, many factors play a part.  Recovering alcoholics should avoid people, places, and objects associated with their drinking.  After being sober for some time, alcoholics should make new friends and engage in new activities by going to school, returning to work, learning a new hobby, doing volunteer work, or renewing a lost association with their churches or religious groups.

Positive addictions should be substituted for alcohol addiction: Walking, jogging, sports, or a regular schedule of exercise promotes well being and self-esteem and provides a healthy outlet for energy.  Research indicates that exercise releases brain chemicals that stimulate a natural high.  Even a walk after dinner can act as a tranquilizer that helps alleviate the urge for alcohol.

Caffeine is probably the most abused drug in our society.  Six out of ten adults drink coffee every day and almost all children regularly eat chocolate and drink cola, both of which are laden sources of caffeine.  With a single cup of regular coffee providing 100-150 mg. of caffeine, the average intake per person each day is 200 mg. Caffeine has an immediate and powerful effect on the body and its use rapidly becomes habitual.  90% of caffeine is metabolized and only 10% is excreted from the body.

The effects of caffeine on the body are many and varied, though most are mediated by the nervous system.  In terms of its biochemistry, caffeine is closely related to nicotine, cocaine and heroin, and in many ways its effects are similar to these narcotic drugs.

Caffeine and the nervous system

Caffeine is initially a powerful stimulant to the nervous system, giving that familiar ‘coffee high’.  After a variable length of time there will be a ‘let down’ effect as the caffeine wears off and the person feels exhausted and depressed.  This encourages repeated use of caffeine to maintain the high.

Regular use of caffeine causes nervous irritability, anxiety, muscle tension, shakiness, and headaches.  The use of caffeine is a major cause of insomnia.  In children the intake of cola and chocolate can lead to hyperactivity, lack of concentration, and learning and behavioral disorders.

Vitamin B1 (Thiamin) is destroyed by caffeine.  This vitamin regulates many aspects of brain function and a deficiency will lead to nervous exhaustion, depression, poor memory, drowsiness, inability to concentrate, and loss of appetite.  Caffeine has been implicated in causing epileptic seizures, psychosis, and respiratory failure.

Caffeine and the circulation

Caffeine increases plasma triglycerides and cholesterol.  Caffeine stimulates heart muscle and can cause rapid or irregular heartbeats and palpitations.  There is a 60% increase in heart attacks associated with the daily consumption of 1 – 5 cups of coffee, and a 120% increase with more than 5 cups per day.

Caffeine and the digestive system

Caffeine increases the production of hydrochloric acid in the stomach and thus aggravates peptic ulcers.  There is a 72% greater chance of developing stomach ulcers if you are a coffee drinker.  Two cups of coffee per day doubles your chances of developing pancreatic cancer.  Caffeine inhibits the absorption of iron.  The liver metabolizes caffeine and a high caffeine intake stresses the liver and impairs its blood cleansing abilities.

Caffeine and the urinary system

Coffee and cola drinkers have an increased chance of developing cancer of the bladder.  Caffeine is an irritant to the kidneys and acts as a diuretic.

Caffeine and birth defects

Three or more cups of coffee per day during pregnancy can lead to major defects of the central nervous system such as cleft palate, joint & bone abnormalities, neural tube defects, blood tumors and irregular development of the jaw.  Large doses of caffeine may stimulate contractions and cause miscarriage.

Miscellaneous effects of caffeine

Caffeine is a stimulant of the thyroid gland.

Caffeine is an immunosuppressant and thus impairs the body’s ability to fight disease.

Caffeine predisposes women to develop fibrocystic breast disease and increases the chances of developing breast cancer.

Breaking the caffeine habit

The following symptoms frequently occur when a regular caffeine intake is stopped:

Headaches, frequently severe and lasting up to 4 weeks

Drowsiness, lethargy and malaise

Runny nose and ‘cotton mouth’

Nervousness and irritability

Trembling and chills

Insomnia and nightmares

Depression and loss of concentration

Cravings for coffee, tea, cola, chocolate or nicotine

Many people feel so rough when quitting caffeine that they give up, or they stop drinking coffee, but replace it with tea or chocolate.  If you can hang in there for at least a couple of weeks then eventually the withdrawal effects will diminish and you will begin to feel much better then you have, perhaps in years.  Make sure if you are cutting out coffee that you replace it with other, healthier, fluids such as spring water, herbal teas and fruit juice.

How Can I Quit Or Reduce My Caffeine Consumption?

Cut back gradually.  Eliminate a cup or glassful a day rather than going “cold turkey.”

• Keep a log to see how much caffeine you consume.  Remember to count medications and supplements.  Experiment with your intake to see how you feel, both physically and psychologically.

• Substitute herbal tea, hot cider, or decaf coffee for caffeinated drinks.

• Be active or be still – run, walk, bike ride, swim, do yoga or meditate.

• Eat regular meals

• Stop smoking – caffeine and cigarettes often go together.
• Ask others in your house or office to decrease their caffeine with you.  There is strength in numbers.

Note: coffee does NOT help you to sober up after drinking alcohol.

Moderation is the key to caffeine intake.  When your caffeine intake is not moderate, be prepared to experience rattled nerves and poor sleep patterns.  Caffeine’s effects vary according to the individual – some people feel very little effect and some people feel frazzled by the smell of a coffee bean.

The amount of caffeine in some common foods and beverages is as follows:

Coffee, brewed – 40 to 180 mg. per cup

Coffee, instant – 30 to 120 mg. per cup

Coffee, decaffeinated – 3 to 5 mg. per cup

Tea, brewed American – 20 to 90 mg. per cup

Tea, brewed imported – 25 to 110 mg. per cup

Tea, instant – 28 mg. per cup

Cocoa – 4 mg. per cup

Chocolate, milk – 3 to 6 mg. per ounce

Chocolate – bittersweet – 25 mg. per ounce

Cola and other soft drinks, containing caffeine – 36 to 90 mg. per 12 ounces

Cola and other soft drinks, decaffeinated – 0 mg. per 12 ounces

Some common brands of medications that contain caffeine are:

Caffedrine Caplets

Enerjets

NoDoz Maximum Strength Caplets

Vivarin

What about decaffeinated products?

The National Cancer Institute has warned that Trichloroethylene (TCE), the chemical most commonly used to remove caffeine, has been shown to cause liver cancer.  They also warn that 3 common TCE substitutes are also possible carcinogens.  Water decaffeination is safer but it still leaves behind many other chemicals that have known adverse effects on the body.  Until there are safer decaffeination methods, it is best to avoid all products that have, or once had, caffeine.

Health Issues associated with Coffee and Caffeine

There are four main health issues associated with coffee and the over-consumption of caffeine:

1) Exhausted adrenal glands: Caffeine is a central nervous system stimulant.  It causes the adrenal glands secrete adrenaline, the hormone your body depends on in emergencies to elevate your heart rate and increase your respiration and blood pressure for a rapid fight-or-flight response.  When you overuse stimulants, the adrenals become exhausted.  If your caffeine sensitivity has diminished or you’re one of those who claims you can drink 3 shots of espresso and go right to sleep, guess what? Your adrenals have given up responding.  This means you have less resistance to stress, which leaves you vulnerable to health hazards such as environmental pollutants and disease pathogens.

As we age, the adrenals become more and more important to us as the production center of the essential youth and sex hormones including DHEA, pregnenolone, progesterone, testosterone and estrogen.  Many people in their forties find they can no longer tolerate the same level of caffeine consumption as they could in their twenties and thirties.  The multiple effects of aging become apparent in the forties and the body frequently shows an increased variety of reactions to the toxicity of coffee and caffeine.

The adrenals can be considered the storage center for the vital force, your inherited reservoir of energy.  They need nourishing to keep them in optimal health.  Think of your adrenals as a bank account.  If you continue to make withdrawals without any deposits, you will hit bottom with a looming overdraft in the form of depleted energy and health.

2) Severe blood sugar swings: Caffeine forces the liver to release glycogen into the blood stream.  The pancreas responds to the sudden rise in blood sugar by releasing insulin, the hormone which causes excess carbohydrates to be stored as fat.  Within the span of an hour or two, the result is a sharp blood sugar drop resulting in a state of hypoglycemia (low blood sugar).  That’s when you think it’s time for another cup of coffee and the whole cycle starts up again.

As Barry Sears advises in his book, The Zone, achieving a hormonal balance and blood sugar stability allows you to maintain your natural weight and optimal energy level.  He counsels that the breakdown of caffeine causes the pancreas to release too much insulin, thus creating a climate in which excess carbohydrates are stored as fat and are unavailable for use as energy by your brain.  Although caffeine is a metabolic stimulant, the ultimate effect is to increase your appetite and contribute to weight gain and thus caffeine should be avoided by anyone working to reduce body fat.

3) Acid imbalance: Over 208 acids in coffee can contribute to indigestion and a wide variety of health problems. Over-acidity can cause arthritic, rheumatic, and skin irritations.  Many people experience a burning sensation in their stomach after drinking coffee because coffee increases the secretion of acid in the stomach.  Optimal health calls for an alkaline pH balance in the body.

Caffeine breaks down into uric acid, which the body excretes through the kidneys.  An excess of uric acid taxes the kidneys and can cause kidney stones and gout.  Additionally, men have to be concerned about prostate conditions that may be aggravated by coffee consumption.

4) Essential mineral depletion: Coffee inhibits the absorption of some nutrients and causes the urinary excretion of calcium, magnesium, potassium, iron, and trace minerals, all of which are necessary for good health.  Women need to be concerned about osteoporosis as menopause sets in.  Studies show that women who drink coffee have an increased incidence of osteoporosis compared to non-coffee drinkers.  Men are not immune to osteoporosis either.

There are a number of health conditions for which doctors advise their patients to eliminate coffee and all caffeine from their diet:

Acid indigestion

Anxiety, irritability and nervousness

Candida or yeast problems

Colitis, diverticulitis, diarrhea and other irritable bowel symptoms

Chronic Fatigue Syndrome and other auto-immune disorders

Diabetes or hypoglycemia (low blood sugar)

Dizziness, Meniere’s syndrome or tinnitus (ringing in the ears)

Gout (Elevated Uric Acid levels)

Heart disease or heart palpitations

High blood pressure

High cholesterol

Insomnia and interrupted or poor quality sleep

Liver disease and gallbladder problems such as gallstones

Kidney or bladder problems including kidney stones

Migraines or other vascular headaches

Osteoporosis

Skin irritations, rashes and dryness

Ulcers, heartburn, and stomach problems such as hiatal hernias

Urinary tract irritation

Female health issues

Women in particular need to be concerned about their caffeine intake during pregnancy because caffeine crosses the placental barrier to the fetus and studies show higher incidence of miscarriage, infertility, and low birth weight in those women who ingest much caffeine.  PMS symptoms and fibrocystic breast disease are both aggravated by caffeine.  Hot flashes and other symptoms caused by hormonal fluctuations during menopause also are aggravated by caffeine.  Coffee causes the body to excrete calcium and other minerals.  Women at risk for osteoporosis need to eliminate their intake of caffeine and coffee.

Male health issues

Coffee is an irritant to the urinary tract and bladder.  It is also a diuretic that aggravates conditions associated with frequent urination.  Eliminating coffee and caffeine often relieves symptoms associated with frequent urination due to enlarged prostate glands.

Caffeine, like sugar, over stimulates the adrenals and then weakens them with persistent or chronic use.  First, sugar stimulates and weakens the adrenals, which creates fatigue.  Then we use caffeine to keep us aware and awake, further depleting our adrenals, to which many respond by drinking more caffeine with sugar.  In addition, people who overuse caffeine tend to need more tranquilizers and sleeping pills to help them relax or sleep.

Caffeine can be a lifetime drug for many.  We begin with hot chocolate or chocolate bars, which contain some caffeine, move into colas or other soft drinks with caffeine, and then add coffee and tea.  Many adults use caffeine daily, but this is slowly changing with education and experience revealing the long-range problems resulting from caffeine abuse.

What is Cocaine?

Cocaine hydrochloride is a central nervous system stimulant derived from the coca plant.  Abused for the intoxicating effects, cocaine interferes with the reabsorption process of dopamine, a chemical messenger in the brain responsible for controlling pleasure, alertness, and movement.

How long has cocaine been used?

The Incas were probably the first to use cocaine 5,000 years ago, but the cocaine that we are familiar with today was first refined by a German chemist in 1858.  In its concentrated, purified form, cocaine was used in various medications and led to the first major epidemic of cocaine abuse around 1900.  Soon after, restrictions were placed on the drug because of adverse side effects and addictive properties.

How pure is cocaine?

Cocaine is processed with many volatile solvents, such as kerosene, benzene, and gasoline, and these poisons may remain in the powder.  In addition, dealers may “cut” or combine the cocaine with other substances like talcum powder, amphetamines, anesthetics, and other substances that may reduce the purity and cause unwanted side effects.

What are cocaine’s short-term effects?

Depending on the means of administration, users may begin to feel an intense “high” characterized by a surge of energy, intense pleasure, and increased feelings of confidence.  Cocaine intoxication is rather short, lasting only 15-30 minutes for powder cocaine and 5-10 minutes for crack.  Crack fumes can reach the brain in as little as 10 seconds.  These short periods of intoxication can lead to cocaine “binges” where cocaine is used over and over to prolong the “high.”  When drug supplies are depleted and/or the user becomes tolerant to cocaine’s intoxicating effects, the binge abruptly ceases.  After the pleasurable effects wear off, the user will experience a “coke crash,” which is characterized by depression, irritability, fatigue, paranoia, anxiety, and intense craving for more of the drug.

What are cocaine’s physical effects?

Cocaine use can cause dilated pupils, nausea, headaches, sweating, increased heart rate, elevated blood pressure, insomnia, loss of appetite, and seizures.  Cocaine speeds up the heart by stimulating the same nerves that cause fear, thereby causing the heart to beat erratically or stop.  Cocaine also shrinks the peripheral blood vessels and places extra pressure on the heart and circulatory system.  These effects can lead to heart attacks, strokes, brain seizures, cardiac arrest, and respiratory failure in otherwise healthy people.  New and chronic users can die suddenly.  In Texas, 300-400 cocaine overdose deaths due to cocaine use have been reported each year.

What are cocaine’s long-term effects?

Chronic use of cocaine can cause heart problems, permanent liver damage, nutritional deficiencies, and long-term changes in the brain, triggering intense craving for cocaine.  In addition, research has shown that long-term cocaine use can compromise the immune system.  Other effects are related to how cocaine is administered.

Snorting: Snorting cocaine may cause a loss of the sense of smell, nose bleeds, sores around the nose and upper lip, swallowing problems, hoarseness, and sinus problems.  Stuffy or runny noses are common and chronic use may damage the structures on the inside of the nose.  Because of cocaine’s anesthetic effects, users may not be aware of the extent of damage to their nose and mouth.

Smoking: Smoking crack can cause severe chest pain, wheezing, chronic cough, parched lips, tongue, and throat, extreme hoarseness, singed eyebrows and lashes, and burns on fingers.  In the extreme, crack can cause bleeding in the lungs and “crack lung,” a condition characterized by pneumonia-like symptoms.

Injecting: Users may have collapsed and scarred veins, bacterial infections, infections of the heart lining and valves, abscesses or boils, pneumonia and tuberculosis, and other infectious diseases.  Injecting users are at risk for contracting HIV, the virus that causes AIDS, and hepatitis B and C, liver diseases that can lead to cancer.  These diseases are spread by sharing needles and using unsterilized drug paraphernalia.

What are cocaine’s effects on the mind?

Cocaine causes severe behavior changes including violent, erratic behavior in some and suicidal feelings in others.  Users under the influence may experience tactile hallucinations, where they feel “coke bugs” crawling on their body.  After using cocaine, they may be confused, anxious, and depressed.  They may even lose interest in food or sex, have trouble feeling pleasure, and act paranoid after long term use.  In severe cases, users may exhibit cocaine-induced psychosis where users lose touch with reality and exhibit paranoid behavior.  Because of its effects on behavior, cocaine intoxication is often listed as a contributing factor in drownings, car crashes, burns, and suicides.

Is cocaine really addictive and what does that mean?

Yes.  The onset of addiction is rapid and severe, and not even “recreational users” who limit their use to weekends are immune from the threat of addiction.  Once more, all methods of cocaine use cause addiction.  Clinicians estimate that 10 percent of recreational users will go on to serious, heavy use of cocaine.  Users who become addicted will “crave” more of the drug as soon as the intoxicating effects wear off, if they do not get their regular dose of cocaine or crack.  Cocaine abusers may have a hard time limiting their use, may build a tolerance to the drug requiring larger amounts to get the same effect, and may develop problems with schools, jobs, and personal relationships.  Cocaine addicts have to support expensive habits, which can cause them to quickly turn to lives of shoplifting, theft, drug dealing, and prostitution.

Does treatment for cocaine addiction work?

Yes.  Cocaine addiction is a chronic relapsing “brain disease” characterized by compulsive drug seeking and use that results from chemical imbalances in the brain.  Long-term use of cocaine can alter the brain’s chemistry to the point that the individual may have very long-term and possibly permanent cravings for cocaine.  A national study has found that treatment for cocaine or crack dependency is effective, reducing cocaine or crack use by over 50 percent.

How long does cocaine remain in the body?

Benzoylecognine, a metabolite unique to cocaine, can be detected in the urine 2-4 days after cocaine ingestion.  The disruption to brain chemistry can remain for much longer.  Individuals who have become dependent on cocaine will feel intense cravings for cocaine long after use has ceased making recovery difficult.

Does cocaine affect pregnancy?

Yes.  Pregnant cocaine users risk miscarriages, severe hemorrhaging, premature births, and stillbirths.  Infants who do survive are not only born premature with smaller than average heads, but also they are smaller in size than their peers and may exhibit withdrawal symptoms.  Crack babies may have developmental difficulties as they grow older.

Are adolescents at-risk?

Yes.  Teens and young adults may not be aware of the dangers of using cocaine, especially the threat of addiction and overdose.  Any use of cocaine or crack is particularly dangerous because the physical effects can be severe, causing unexpected death in some.  In addition, cocaine use can cause violent behavior and suicidal tendencies.  As memory, perception, and judgment are clouded under the influence, users are at risk of severe injuries, overdoses, entanglement in violence and crime as they support their habits, and HIV/AIDS from sharing needles and trading sex for drugs.

Who should I contact if someone close to me has a problem with cocaine?

Contact the Alcohol and Drug Abuse’s toll-free hot line at (800) 832-9623 or your local Council on Alcohol and Drug Abuse for referral assistance.  You may also contact your family physician, hospital, or yellow pages for other intervention and treatment options.

MDMA, called “Adam,” “ecstasy,” or “XTC” on the street, is a synthetic, psychoactive (mind-altering) drug with amphetamine-like and hallucinogenic properties.  Its chemical structure (3-4 methylenedioxymethamphetamine) is similar to two other synthetic drugs, MDA and methamphetamine, which are known to cause brain damage.

Health hazards

Beliefs about MDMA are reminiscent of the claims made about LSD in the 1950s and 1960s, which proved to be untrue.  According to its proponents, MDMA can make people trust each other and can break down barriers between therapists and patients, lovers, and family members.  Many of the risks users face with MDMA use are similar to those found with the use of amphetamines and cocaine.

Risks include:

Psychological difficulties, including confusion, depression, sleep problems, drug cravings, severe anxiety, and paranoia – during and sometimes weeks after taking MDMA.  Even psychotic episodes have been reported.

Physical symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating.

Increases in heart rate and blood pressure, which are a special risk for people with circulatory or heart disease.

Recent research findings also link long-term MDMA use to damage to those parts of the brain critical to thought and memory.  It is thought that the drug causes damage to the neurons that use the chemical serotonin to communicate with other neurons.  In monkeys, exposure to MDMA for 4 days caused brain damage that was evident 6 to 7 years later. This study provides further evidence that people who take MDMA may be risking permanent brain damage.

Also, there is evidence that people who develop a rash that looks like acne after using MDMA may be risking severe side effects, including liver damage, if they continue to use the drug.

MDA, the parent drug of MDMA, is an amphetamine-like drug that has also been abused and is similar in chemical structure to MDMA.  Research shows that MDA destroys serotonin-producing neurons in the brain, which play a direct role in regulating aggression, mood, sexual activity, sleep, and sensitivity to pain.  It is probably this action on the serotonin system that gives MDA its purported properties of heightened sexual experience, tranquility, and conviviality.

MDMA is also related in its structure and effects to methamphetamine, which has been shown to cause degeneration of neurons containing the neurotransmitter dopamine.  Damage to these neurons is the underlying cause of the motor disturbances seen in Parkinson’s disease.  Symptoms of this disease begin with lack of coordination and tremors and can eventually result in a form of paralysis.

The book Brave New World, written in 1932 by Aldous Huxley, provided readers a shocking portrayal of a future in which all babies come from test tubes, free love prevails, and citizens are bred according to letter-graded castes.  Though it is now 70 years old, the book seems startlingly familiar, in certain respects.

The government in Brave New World kept the population artificially happy and complacent by the use of soma, a mind-altering drug.  Soma was given to people as a reward for excellent service to the government.  It allowed them to go on a “soma holiday.”  As someone told the protagonist of Brave New World, Bernard Marx, “Glum, Marx, glum – what you need is a gram of soma.  Take a holiday from reality whenever you like, and come back without so much as a headache or a mythology.”

The government hypnotized citizens from birth into believing such sayings as “One cubic centimeter cures ten gloomy sentiments,” and “A gram is better than a damn.” Little tablets of soma provided a pleasant, mindless escape from the real world, and kept society complacent and docile.  At any sign of unhappiness, people instinctively took a little soma, and escaped their troubles.

Frightening, isn’t it?  The use of a government-sanctioned, mood-altering drug keeps an entire population of people artificially, chemically happy.  People are urged to never feel unhappy, and to quickly remedy the situation by the use of artificial substances.

Modern psychiatric medicine prescribes drugs such as Prozac to those people who feel down or depressed due to chemical imbalances in their brain.  Prozac is an example of a selective serotonin reuptake inhibitor (SSRI), meaning it works by blocking the reuptake of serotonin in the synaptic clefts after it has been released.  This allows serotonin to remain present longer after the firing of neurons, producing an effectively greater concentration of serotonin.  For people with naturally low levels of serotonin, which often results in depression or feelings of despair, drugs like Prozac prove to be a solution that allows them to lead more normal, happier lives.  Available by prescription only, Prozac should only be used in those cases where it is medically necessary.

But what about the rest of us, who have normal levels of serotonin but still aren’t satisfied with the ups and downs of daily life?  For us, the latest craze is St. John’s Wort, touted as a natural, herbal way to lift our mood.  The pretty little yellow flowers on the St. John’s Wort plant seem innocent enough.  In reality, however, St. John’s Wort acts as a mild SSRI, like a gentler form of Prozac.

You’d think that the government, to prevent excessive and potentially unsafe usage, would heavily regulate a mild form of Prozac.  However, exactly the opposite holds true.  No regulation of St. John’s Wort exists.  The Food and Drug Administration cannot regulate what it deems “herbal supplements.”  Therefore, no safe dosage has been established, the claims for St. John’s Wort have not been officially tested, and manufacturers and distributors of St. John’s Wort are free to do as they please, make outrageous claims, and sell dosages as large as they wish.

Since when does being labeled “herbal” make something safe?  Once the drug Ecstasy was banned, another commercially available drug called “Herbal Ecstacy” [sic] was heralded as its substitute.  The “natural” ingredients in Herbal Ecstacy and its wide availability lead many to believe in the safety of the drug.  However, nothing could be farther from the truth.  The drug, while containing plant-derived substances, is far more dangerous than your garden-variety mint sprigs.  It has been cited in the death of at least one person, and is responsible for adverse effects in hundreds of other people.  Yet the FDA cannot regulate it, because it still qualifies as an “herbal supplement.”

We need to stop believing that anything “natural” is completely safe to use casually, and we need to use a bit more caution before consuming herbal products.  Otherwise, the social repercussions can be downright scary.

In contrast to studies of illicit users, the few controlled clinical trials with MDMA in healthy volunteers have reportedly not found evidence of cognitive changes, despite cerebral blood flow alterations in one study.  The possible risks of neurotoxicity must be considered when assessing the potential administration of MDMA to humans.

There is little doubt for the majority of those that have experienced this drug that they have shifted or changed at some emotional level.  That is not surprising, considering that ecstasy was specifically designed for this purpose.  However, the question that begs to be asked is, “Are these changes positive and do they really have an effect throughout the life of the user?”  Again, taking a mind altering substance and weighing the risk against the benefits is always an area best left to individual judgment.

A recent World Health Organization (WHO) report recognized, but did not condemn marijuana’s health hazards since there is insufficient research available to prove its effectiveness as a medicine.  The WHO came to the conclusion that, “Weighed in the balance with other legal drugs, there is no compelling public reason to prohibit marijuana.”

The report also contains the following summarizing statement:

“Frequently, the risks of cannabis use are compared with those of other drugs such as alcohol and tobacco.  However, the science to evaluate health risks of cannabis is much less extensive and much less conclusive than the voluminous research that has been conducted on these psychoactive substances.  In addition, there is insufficient research on cannabis-related mortality from accidents and other causes to permit proper comparison.”

Having identified what it could not say, the WHO then included the following conclusions in its’ summary:

“The chronic use of cannabis produces additional health hazards including: a selective impairment of cognitive functioning; prolonged use may lead to greater impairment, which may not recover with cessation of use, and which could affect daily life functions.”

“Cannabis use can exacerbate schizophrenia in affected individuals.”

“Airway injury, lung inflammation, and impaired pulmonary defense against infection (results) from persistent cannabis consumption over long periods of time.”

“Cannabis use during pregnancy is associated with impairment of fetal development leading to a reduction in birth weight.”

“Cannabis use during pregnancy may lead to postnatal risk of rare forms of cancer although more research is needed in this area.”

Any substance that is used in large enough quantities can easily transform itself from a medicine into a toxic compound.  Health concerns regarding the long-term use of marijuana boil down to whether or not the cognitive impairment resulting from using this herb prevents a user from making a healthy and reasonable judgment as to when the substance has lost its medicinal value.

Maybe the smoke is about to clear in the debate over medical marijuana.  Few ideas, it seems, are so firmly held by the public and so doubted by the medical profession as the healing powers of pot.  But at last, researchers are tiptoeing into this field, hoping to prove once and for all whether marijuana really is good medicine.

To believers, marijuana’s benefits are already beyond discussion: Pot eases pain, settles the stomach, builds weight, and steadies spastic muscles.  And that’s just the beginning.  They speak of relief from PMS, glaucoma, itching, insomnia, arthritis, depression, childbirth, attention deficit disorder and ringing in the ears.  Marijuana is a powerful and needed medicine, they say, tragically withheld by misplaced phobia about drug addiction.

However, the drive to legalize medical marijuana is based almost entirely on the testimonials of sick people who swear it makes them feel better.  Those stories are not the kind of dispassionate experimentation that drives medical thinking.  “We lack evidence that there is something unique about marijuana, other than an impressive number of anecdotal reports,” says Dr. Billy Martin, chief of pharmacology at the Medical College of Virginia.

In the medical establishment’s view, the buzz about marijuana is little more than that.  Pot has many effects on the body, including some that are probably worthwhile.  But does it substantially relieve human suffering, they ask? And if so, is it any better than medicines already in drugstores?

Series of Studies Planned

For the first time in at least two decades, marijuana the medicine is being put to the test.  Scientists say they will try to hold marijuana to the same standards as any other drug, to settle whether its benefits match its mystique.

Given marijuana’s recreational uses and abuses, people in this new field are understandably eager to come across as serious scientists experimenting with a serious medicine.  (Even marijuana’s usual reason to be – the high – is dismissed as a mere side effect, and probably an unwanted one at that.)

One way to buff up a pharmaceutical’s raffish image – especially one that’s a drug in more than one sense of the word – is to call it something else.  When the University of California at San Diego started the country’s first institute to study the medical uses of marijuana this year, they named it the Center for Medicinal Cannabis Research.  Cannabis is the botanical term for pot.

“We talked about it a lot,” says Dr. Igor Grant, the psychiatrist who heads the new center.  “Marijuana is such a polarizing name.  We don’t want this institute to be caught in the crossfire between proponents and antagonists.  Ultimately, if cannabis drugs become medicine, they will almost certainly be known by that name, not marijuana.”

The center will give out $9 million over the next three years to California researchers – enough to underwrite six or seven marijuana studies a year each involving between 20 and 50 patients.  At least four other studies of the medical effects of marijuana are planned.  Three are sponsored by the National Institute of Health, the other by California’s San Mateo County.

The medical marijuana movement began in earnest in 1996 when California passed a statewide referendum intended to make it legal.  Alaska, Arizona, Hawaii, Maine, Oregon, and Washington adopted similar laws and Colorado and Nevada joined them in the November election.  “I was just so surprised at these policy decisions being made with so little scientific information,” says Margaret Haney of Columbia University.  “I’m not against the use of medical marijuana.  There’s just no data about its efficacy.”

Most of the new research will probably focus on four main uses of marijuana that seem to hold the greatest promise:

Relieving severe nausea and vomiting caused by cancer chemotherapy.  This is probably marijuana’s best-known medical use.  While the drug almost certainly helps ease nausea, there is no research showing how it stacks up against highly effective anti-nausea drugs developed over the past 15 years.

Stopping weight loss

Marijuana clearly improves appetite.  However, the drug has not been adequately tested in people who are unintentionally losing weight, such as those with AIDS or cancer.

Treating muscle spasticity conditions, including multiple sclerosis

Many victims say it helps, and some animal research backs up the idea.  But is it better than standard medicines?

Easing pain

Researchers especially want to test it on AIDS patients with peripheral neuropathy, numbness and pain in the feet that afflicts between 20 percent and 30 percent with the disease.  Animal studies suggest marijuana may be a mild to moderate painkiller, and many with AIDS are already using it, since there is no other good treatment.

One of the first questions to answer is whether objectively testing marijuana as a medicine is even practical.  At the San Mateo County Health Center, Dr. Dennis Israelski will tackle this by enrolling 60 AIDS patients who already use marijuana for painful neuropathy.  They will be randomly assigned to smoke marijuana – or forgo it – for six weeks.  Will people go along with this if it means giving up something they already believe helps them?  If not, it may be hard to complete larger and more elaborate studies of marijuana.

Other studies will compare marijuana to THC – delta-9-tetrahydrocannabinol, the most active ingredient in pot.  THC has been available since the 1980s in a synthetic pill form called Marinol.  Theoretically, THC and smoked marijuana should do pretty much the same things, although some argue that the other chemicals in pot are essential for its effects.  But many prefer smoking marijuana because the dose is much easier to control.

Marinol takes a couple of hours to kick in.  By then it’s impossible to fine-tune the level in the bloodstream, which sometimes is too high, producing an unpleasantly intense and uncontrollable high.  The joint is an efficient drug delivery system.  When smoked, marijuana’s chemicals reach the bloodstream in seconds and hit the brain soon thereafter.  Users can regulate the effect puff by puff.

In one of the new studies, Haney will compare marijuana with Marinol in AIDS patients experiencing unwanted weight loss.  Volunteers won’t be told whether they are getting genuine marijuana or dummy joints, Marinol or sugar pills.  Then she’ll see who eats the most.

Issues of approval

But even if Haney and others show marijuana is a uniquely useful medicine, many doubt that packs of marijuana cigarettes will ever become standard items at the pharmacy.  The job of making marijuana an official prescription medicine would be daunting.  Because the stuff cannot be patented, no drug company will pay hundreds of millions for the encyclopedic testing necessary to convince regulators.

And then there is that drug delivery system.  Nonsmokers often have trouble inhaling marijuana smoke, which they find harsh.  And it is, after all, a form of smoking, one of the ultimate health taboos.  “It’s not going to be easy to sell marijuana cigarettes as a medicine, even if it could be shown there are particular benefits,” says Grant.  “It seems that if these things are indeed useful, we would have to find a way to deliver them in a manner that is prescribable.”

To many, that means marijuana’s real future is its ingredients: THC and the other 60 or so unique compounds called cannabinoids.  These are chemicals that pharmaceutical firms can isolate, improve and call their own.  These products could offer the health benefits of marijuana, only better – refashioned to avoid pot’s unwanted effects and delivered, of course, without smoke.

“Marijuana does too many things to be a really good drug by itself,” says John Huffman of Clemson University, a chemist who works with cannabinoids full time.  Some of the effects it has are obvious to the 70 million or so Americans who admit trying marijuana: a sense of well being, a ravenous appetite, an altered perception of time and distance, talkativeness, and so forth.  Other impacts may be less obvious.  For example, marijuana also appears to disrupt short-term memory and suppress immune defenses.

Among the companies searching for better ways to harness marijuana are Unimed Pharmaceuticals of Deerfield, Illinois, which makes Marinol.  The company is working on a THC aerosol spray, intended to offer the quick, easily controllable wallop of marijuana smoking.  Unimed President Robert E. Dudley says that in testing so far, the spray seems to work pretty much like a joint, reaching peak blood levels of THC within minutes.  “It mirrors what you would expect to see with inhaled marijuana smoke,” he says, including the high.

The high, in fact, is one thing that some pharmaceutical designers would like to get rid of.  Atlantic Technology Ventures of New York City is testing a synthetic form of THC intended to be a painkiller.  By tweaking the molecule, says CEO Joseph Rudnick, “we kept most of the benefits of THC but got rid of the psychogenic effects.” In safety testing in France, no one got high.

All of the research done on genuine marijuana will use pot supplied by the nation’s only legal supplier, the federal government’s National Institute on Drug Abuse.  Every year or two, it pays the University of Mississippi to plant an acre and a half of marijuana for experiments.  Until recently, all of it went to experiments intended to document marijuana’s hazards, not its benefits.  Some complain that the government provided pot only for government-financed research and made that funding almost impossibly difficult to get.

However, Dr. Steven Gust of the institute says the real issue was lack of interest.  “The fact of the matter is, there were very, very few applications to conduct research on medical applications of marijuana,” he says.

Now, the government will supply marijuana for scientifically rigorous studies backed by nongovernmental organizations.  It is even shipping some north for experiments sponsored by Health Canada, the Canadian government agency.  To the believers, however, all of this is simply an attempt to prove the obvious and they question whether the studies are necessary at all.

Dr. Lester Grinspoon, a retired Harvard psychiatrist, became a believer in the 1960s.  His son suffered terrible nausea during treatment for leukemia and tried marijuana against his father’s advice.  It seemed to work.  Instead of vomiting for eight hours after chemotherapy, he’d ask to stop for a sandwich on his way home.  Now Grinspoon is chairman of the NORML Foundation, whose purpose is to legalize marijuana.

“We’re going to have to go through this business of doing these studies,” he concedes.  “But they won’t prove anything that clinicians who have paid attention to this don’t already know.”

In essence, the jury is still out regarding the medicinal benefits of marijuana.  Consequently, if one is interested in using this drug for medical purposes, it may be useful to use the “moderation” rule in order to limit the possible toxic side effects of this herb.

In the end, learning to have a relationship with one of the oldest medicinal herbs known to human kind may be the ultimate key to unraveling the issues around healthy cannabis use.  This document neither opposes nor endorses the use of marijuana as medicine.  The purpose of this section is to urge that we take the proper precautions when embarking on any healing journey that makes any substance a panacea.