Drug

• 1. Introduction

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  A drug is any chemical substance other than a nutrient or essential dietary ingredient that produces a biological effect when given to a living organism. That single definition stretches across an enormous range of substances. It covers a tablet swallowed for a headache and a brew sipped by an Amazonian shaman to reach religious ecstasy. The same word names caffeine, nicotine, and alcohol, the three most widely used drugs in the world. It also names cocaine and heroin, the substances most people picture first.

  How does one word carry so much weight? The story runs from medicinal plants once preserved as dry matter in barrels to molecules built in laboratories through organic synthesis. It moves through cancer wards, religious initiations, student dorm rooms, and international treaty rooms. The questions ahead are these. How are drugs sorted and named? Why does a single drug help one person and fail another? Why have entire religions been built around them? And why did the world spend decades writing treaties to control them?

• 2. Classifying The Pharmacy

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  A pharmaceutical drug, also called a medication or medicine, is a chemical substance used to treat, cure, prevent, or diagnose a disease or to promote well-being. To bring order to thousands of such substances, scientists sort them into drug classes. Each class groups related drugs that share a similar chemical structure, bind to the same biological target, follow a related mode of action, and treat the same disease.

  The Anatomical Therapeutic Chemical Classification System, known as the ATC, is the most widely used drug classification system. It assigns every drug a unique ATC code, an alphanumeric string that files the substance into specific classes. A second major scheme, the Biopharmaceutics Classification System, takes a different angle. It sorts drugs by their solubility and by their permeability or absorption properties.

  Psychoactive drugs form a category defined by where they act rather than by structure. These substances affect the central nervous system, altering perception, mood, or consciousness. They divide into groups such as stimulants, depressants, antidepressants, anxiolytics, antipsychotics, and hallucinogens. Such drugs have proven useful in treating a wide range of medical conditions, including mental disorders, around the world. Yet every drug can carry side effects, and abuse of several psychoactive drugs can cause addiction or physical dependence. Excessive use of stimulants can even promote stimulant psychosis, a sign that the line between medicine and harm runs straight through the same molecule.

• 3. The Genetics Of Efficacy

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  The 10 highest-grossing drugs in the United States may help only 4 to 25 percent of the people who take them. Drug action is highly specific, and its effects may surface only in certain individuals. Often the deciding factor is the genotype of the patient, written into their genes long before any prescription.

  Erbitux, known by the name cetuximab, makes this vivid. It increases the survival rate of colorectal cancer patients, but only those who carry a particular mutation in the EGFR gene. Some drugs are approved specifically for certain genotypes. Vemurafenib is one such case, used for melanoma patients who carry a mutation in the BRAF gene. The drug and the gene must match.

  The number of people a drug can help decides whether testing it is worth the cost. Phase III trials may run between 100 million and 700 million dollars per drug. That arithmetic drives personalized medicine, the effort to develop drugs adapted to individual patients rather than to an average that may not exist.

• 4. Over The Counter And Behind It

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  Dispensing of medication is often regulated by governments into three categories. Over-the-counter medications are available in pharmacies and supermarkets without special restrictions. Behind-the-counter medicines are dispensed by a pharmacist without a doctor's prescription. Prescription-only medicines must be prescribed by a licensed medical professional, usually a physician.

  In the United Kingdom, behind-the-counter medicines are called pharmacy medicines. They can only be sold in registered pharmacies, by or under the supervision of a pharmacist, and they are marked by the letter P on the label. The range of medicines available without a prescription varies from country to country, so the same substance may sit on an open shelf in one place and behind a counter in another.

  Medications are typically produced by pharmaceutical companies and are often patented, giving the developer exclusive rights to produce them. When a drug is not patented, or its patent has expired, it becomes a generic drug. Other companies may then produce it without restrictions or licenses from the patent holder, which is the moment a once-exclusive medicine opens to the wider market.

• 5. Generating The Divine Within

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  Some religions, particularly ethnic religions, are built completely around certain drugs called entheogens, a word meaning generating the divine within. Most entheogens are hallucinogens, falling into the categories of psychedelics, dissociatives, or deliriants. Shamans across different cultures use them to achieve religious ecstasy.

  Kava shows how versatile a single entheogen can be, acting as a stimulant, a sedative, a euphoriant, and an anesthetic. The roots of the kava plant are made into a drink consumed throughout the cultures of the Pacific Ocean. Far away, Amazonian shamans use ayahuasca, also called yagé, a hallucinogenic brew, for the same spiritual purpose. Mazatec shamans hold a long and continuous tradition of religious use of Salvia divinorum, a psychoactive plant that helps bring on visionary states during spiritual healing sessions.

  The Xhosa people regard Silene undulata as a sacred plant. Its roots are traditionally used to induce vivid lucid dreams during the initiation of shamans, dreams the Xhosa consider prophetic. This makes it a naturally occurring oneirogen, similar to the dream herb Calea ternifolia. Peyote, a small spineless cactus, has probably been used by Native Americans for at least five thousand years as a source of psychedelic mescaline. Today most mescaline comes not from the vulnerable peyote but from a few columnar cacti, in particular San Pedro. The entheogenic use of cannabis has also been practiced for centuries, and Rastafari use marijuana, which they call ganja, as a sacrament in their religious ceremonies.

• 6. Smart Drugs And Designer Drugs

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  Nootropics, commonly called smart drugs, are claimed to improve human cognitive abilities such as memory, concentration, thought, mood, and learning. Among students, one nootropic has become a study drug: methylphenidate, branded commonly as Ritalin and used to treat attention deficit hyperactivity disorder and narcolepsy.

  Methylphenidate carries a sharp warning behind its reputation. At high doses it can become highly addictive, and serious addiction can lead to psychosis, anxiety, and heart problems. Its use is linked to a rise in suicides and overdoses. Injecting it intravenously can cause emphysematous damage to the lungs, a condition known as Ritalin lung. Evidence for use outside student settings is limited but suggests it is commonplace.

  Designer drugs follow a different logic, built or altered to produce a desired effect. An early example of what would now be called a designer drug was LSD, which was synthesized from ergot. Others include analogs of performance-enhancing drugs, such as designer steroids taken to improve physical capabilities, sometimes used by professional athletes. Since the late 1990s, many such synthesized drugs have been identified. In Japan and the United Kingdom, this prompted a newer class of controlled substances known as a temporary class drug, and synthetic cannabinoids continue to power the designer drug synthetic cannabis.

• 7. Drugs For Pleasure

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  Recreational drug use means taking a drug, whether legal, controlled, or illegal, mainly to alter consciousness and create positive emotions and feelings by acting on the central nervous system. The hallucinogen LSD is one psychoactive drug commonly used this way. Ketamine, a drug used for anesthesia, doubles as a recreational drug in both powder and liquid form, valued for its hallucinogenic and dissociative effects.

  Cannabis is the most commonly consumed controlled recreational drug in the world. Its use is illegal in many countries, yet several countries permit it legally, usually only for personal use. It appears in the leaf form of marijuana, also called grass, or in the resin form of hashish, with marijuana being the milder of the two. Many medicinal drugs that have potential for recreational use are heavily regulated as a result.

  Not every recreational drug is forbidden. Some that are legal and accepted in many places include alcohol, tobacco, betel nut, and caffeine products, and in some areas the legal use of khat is common. A separate group, the legal intoxicants commonly called legal highs, are used recreationally, and the most widely used of these is alcohol, often subject to an age restriction on its consumption and purchase.

• 8. Writing The Drug Laws

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  In 1961, the Single Convention on Narcotic Drugs became an international treaty meant to prohibit the use of narcotics, except those used in medical research and treatment. It could not keep pace alone. In 1971, a second treaty, the Convention on Psychotropic Substances, was introduced to deal with newer recreational psychoactive and psychedelic drugs that the first had not anticipated.

  Numerous governmental offices in many countries handle the control and supervision of drug manufacture and use, and the enforcement of various drug laws. The legal status of a single substance can fracture across borders. Salvia divinorum is legal in some countries and banned in others, and even within the United States its status varies from state to state, with the degree of prohibition shifting wherever it is legislated against.

  National agencies carry this work forward. The Food and Drug Administration in the United States is a federal agency responsible for protecting and promoting public health, regulating food safety, tobacco products, dietary supplements, prescription and over-the-counter medications, vaccines, biopharmaceuticals, blood transfusions, medical devices, cosmetics, animal foods, and veterinary drugs. In India, the Narcotics Control Bureau, a federal law enforcement and intelligence agency under the Ministry of Home Affairs, combats drug trafficking under the Narcotic Drugs and Psychotropic Substances Act. The same molecule that heals in a clinic can be hunted by an intelligence agency in another room, which is why the word drug never sits still.