Psychoactive drug

A psychoactive drug or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior. These drugs may be used recreationally to purposefully alter one's consciousness, as entheogens for ritual or spiritual purposes, as a tool for studying or augmenting the mind, or therapeutically as medication.

Because psychoactive substances bring about subjective changes in consciousness and mood that the user may find pleasant (e.g. euphoria) or advantageous (e.g. increased alertness), many psychoactive substances are abused, that is, used outside of the guidance of a medical professional and for reasons other than their original purpose. With sustained use, physical dependence may develop, making the cycle of abuse even more difficult to interrupt. Drug rehabilitation can involve a combination of psychotherapy, support groups and even other psychoactive substances to break the cycle of dependency.

In part because of this potential for abuse and dependency, the ethics of drug use are the subject of a continuing philosophical debate. Many governments worldwide have placed restrictions on drug production and sales in an attempt to control drug abuse.

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History

Drug use is a practice that dates to prehistoric times. There is archaeological evidence of the use of psychoactive substances dating back at least 10,000 years, and historical evidence of cultural use over the past 5,000 years.^[1] While medicinal use seems to have played a very large role, it has been suggested that the urge to alter one's consciousness is as primary as the drive to satiate thirst, hunger or sexual desire.^[2] Others suggest that marketing, availability or the pressures of modern life are why humans use so many psychoactives in their daily lives. However, the long history of drug use and even children's desire for spinning, swinging, or sliding indicates that the drive to alter one's state of mind is universal.^[3]

This relationship is not limited to humans. A number of animals consume different psychoactive plants, animals, berries and even fermented fruit, becoming intoxicated, such as cats after consuming catnip. Traditional legends of sacred plants often contain references to animals that introduced humankind to their use.^[4] Biology suggests an evolutionary connection between psychoactive plants and animals, as to why these chemicals and their receptors exist within the nervous system.^[5]

The 20th century has seen governments initially responding to many drugs by banning them and making their use, supply or trade a criminal offense. A notable example of this is the Prohibition era in the United States, where alcohol was made illegal for 13 years. However, many governments have concluded that illicit drug use cannot be sufficiently stopped through criminalization. In some countries, there has been a move toward harm reduction by health services, where the use of illicit drugs is neither condoned nor promoted, but services and support are provided to ensure users have the negative effects of their illicit drug use minimized. This can go hand-in-hand with supply reduction strategies by law-enforcement agencies.

Uses of psychoactive substances

Psychoactive substances are used by humans for a number of different purposes, both legal and illicit.

Anesthesia

Main article: Anesthesia

General anesthetics are a class of psychoactive drug used on patients to block pain and other sensations. Most anesthetics induce unconsciousness, which allows patients to undergo medical procedures like surgery without physical pain or emotional trauma.^[6] To induce unconsciousness, anesthetics affect the GABA and NMDA systems. For example, halothane is a GABA agonist,^[7] and ketamine is an NMDA receptor antagonist.^[8]

Painkillers

Main article: Analgesics

  Psychoactive drugs are often prescribed to manage pain. As the subjective experience of pain is regulated by endorphins, neurochemicals that are endogenous opioids, pain can be managed using psychoactives that operate on this neurotransmitter system. This class of drugs includes narcotics, like morphine and codeine,^[9] and also NSAIDs such as aspirin and ibuprofen.

Psychiatric medications

Main article: Psychiatric medications

  Psychiatric medications are prescribed for the management of mental and emotional disorders. There are 6 major classes of psychiatric medications:

• Antidepressants, which are used to treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.^[10]
• Stimulants, which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.
• Antipsychotics, which are used to treat psychoses such as schizophrenia and mania.
• Mood stabilizers, which are used to treat bipolar disorder and schizoaffective disorder.
• Anxiolytics, which are used to treat anxiety disorders.
• Depressants, which are used as hypnotics, sedatives, and anesthetics.

Recreational drugs

Main article: Recreational drug use

Many psychoactive substances are used for their mood and perception altering effects, including those with accepted uses in medicine and psychiatry. Classes of drugs frequently used recreationally include:

• Stimulants, which elevate the central nervous system. These are used recreationally for their euphoric and performance-enhancing effects.
• Hallucinogens, which induce perceptual and cognitive distortions.
• Hypnotics, which are used recreationally to because they induce inebriation.
• Analgesics, which are used recreationally because of their euphoric effects.

Examples include caffeine, alcohol, cocaine, LSD, and cannabis.^[11]

In many cultures, possessing or having used recreational drugs is seen as a status symbol. Recreational drugs, especially those known as club drugs, are seen as status symbols at social events such as at nightclubs and parties.^[12] This is true of many cultures throughout history; drugs have been viewed as status symbols since ancient times. For example, in ancient Egypt, gods were commonly pictured holding hallucinogenic plants.^[13]

Ritual and spiritual use

Main article: Entheogens

Certain psychoactives, particularly hallucinogens, have been used for religious purposes since prehistoric times. Native Americans have used mescaline-containing peyote cacti for religious ceremonies for as long as 5700 years.^[14] The muscimol-containing amanita mushroom was used for ritual purposes throughout prehistoric Europe.^[15] Various other hallucinogens, including jimsonweed, psilocybin mushrooms, and cannabis have been used in religious ceremonies for centuries.^[16] There is speculation that hallucinogenic mushrooms and cacti greatly influenced the major religions of India, North and South America, the Middle East, and Europe, including Christianity.^[16]

The use of entheogens for religious purposes resurfaced in the West during the counterculture movements of the 1960s and 70s. Under the leadership of Timothy Leary, new religious movements began to use LSD and other hallucinogens as sacraments.^[17] In the United States, the use of peyote for ritual purposes is protected only for members of the Native American Church, which is allowed to cultivate and distribute peyote. However, the bona fide religious use of Peyote, regardless of ancestry, is protected in Colorado, Arizona, New Mexico, Nevada, and Oregon.^[18]

Administration

For a substance to be psychoactive, it must cross the blood-brain barrier so it can affect neurochemical function. Psychoactive drugs are administered in several different ways. In medicine, most psychiatric drugs, such as fluoxetine and oxycodone, are ingested orally in tablet or capsule form. However, certain medical psychoactives are administered via inhalation, injection, or rectal suppository/enema. Recreational drugs can be administered in several additional ways that are not common in medicine. Certain drugs, such as alcohol and caffeine, are ingested in beverage form; nicotine and cannabis are often smoked; peyote and psilocybin mushrooms are ingested in botanical form or dried; and certain crystalline drugs such as cocaine and MDMA (ecstasy) are often insufflated. The efficiency of each method of administration varies from drug to drug.^[19]

Effects

Main article: Neuropsychopharmacology

Psychoactive drugs operate by temporarily affecting a person's neurochemistry, which in turn causes changes in a person's mood, cognition, perception and behavior. There are many ways in which psychoactive drugs can affect the brain. Each drug has a specific action on one or more neurotransmitter or neuroreceptor in the brain.

Drugs that increase activity in particular neurotransmitter systems are called agonists. They act by increasing the synthesis of one or more neurotransmitters or reducing its reuptake from the synapses. Drugs that reduce neurotransmitter activity are called antagonists, and operate by interfering with synthesis or blocking postsynaptic receptors so that neurotransmitters cannot bind to them.^[20]

Exposure to a psychoactive substance can cause changes in the structure and functioning of neurons, as the nervous system tries to re-establish the homeostasis disrupted by the presence of the drug. Exposure to antagonists for a particular neurotransmitter increases the number of receptors for that neurotransmitter, and the receptors themselves become more sensitive. This is called sensitization. Conversely, overstimulation of receptors for a particular neurotransmitter causes a decrease in both number and sensitivity of these receptors, a process called desensitization or tolerance. Sensitization and desensitization are more likely to occur with long-term exposure, although they may occur after only a single exposure. These processes are thought to underlie addiction.^[21]

Affected neurotransmitter systems

The following is a classification of notable drugs by their primary effects on their respective neurotransmitters or receptors. However, it should be noted that most drugs act on more than one transmitter or receptor in the brain.^[22]

Addiction

Main article: Addiction

Psychoactive drugs are often associated with addiction. Addiction can be divided into two types: psychological addiction, by which a user feels compelled to use a drug despite negative physical or societal consequence, and physical dependence, by which a user must use a drug to avoid medically harmful withdrawal.^[24] Not all drugs are physically addictive, but any activity that stimulates the brain's dopaminergic reward system — typically, any pleasurable activity^[25] — can lead to psychological addiction.^[24] Drugs that are most likely to cause addiction are drugs that directly stimulate the dopaminergic system, like cocaine and amphetamines. Drugs that only indirectly stimulate the dopaminergic system, such as psychedelics, are not as likely to be addictive.

Because so many consumers want to reduce or eliminate their own use of psychoactive drugs,^[26] many professionals, self-help groups, and businesses specialize in drug rehabilitation, with varying degrees of success. Many parents attempt to influence the actions and choices of their children regarding psychoactives.^[27]

Common forms of rehabilitation include psychotherapy, support groups and pharmacotherapy, which uses psychoactive substances to reduce cravings and physiological withdrawal symptoms while a user is going through detox. Methadone, itself an opioid and a psychoactive substance, is a common treatment for heroin addiction. Recent research on addiction has shown some promise in using psychedelics to treat and even cure addictions, although this has yet to become a widely accepted practice.^[28][29]

Legality and ethics

The legality of psychoactive drugs has been controversial through most of history; the Opium Wars and Prohibition are two historical examples of legal controversy surrounding psychoactive drugs. However, in recent years, the most influential document regarding the legality of psychoactive drugs is the Single Convention on Narcotic Drugs, an international treaty signed in 1961 as an Act of the United Nations. Signed by 73 nations including the United States, the USSR, India, and the United Kingdom, the Single Convention on Narcotic Drugs established Schedules for the legality of each drug and laid out an international agreement to fight addiction to recreational drugs by combatting the sale, trafficking, and use of scheduled drugs.^[30] All countries that signed the treaty passed laws to implement these rules within their borders. However, some countries that signed the Single Convention on Narcotic Drugs, such as the Netherlands, are more lenient with their enforcement of these laws.^[31]

In the United States, the Food and Drug Administration (FDA) has authority over all drugs, including psychoactive drugs. The FDA regulates which psychoactive drugs are over the counter and which are only available with a prescription.^[32] However, certain psychoactive drugs, like alcohol, tobacco, and drugs listed in the Single Convention on Narcotic Drugs are subject to criminal laws. The Controlled Substances Act of 1970 regulates the recreational drugs outlined in the Single Convention on Narcotic Drugs.^[33] Alcohol is regulated by state governments, but the federal National Minimum Drinking Age Act penalizes states for not following a national drinking age.^[34] Tobacco is also regulated by all fifty state governments.^[35] Most people accept such restrictions and prohibitions of certain drugs, especially the "hard" drugs, which are illegal in most countries.^[36][37][38]

In the medical context, psychoactive drugs as a treatment for illness is widespread and generally accepted. Little controversy exists concerning over the counter psychoactive medications in antiemetics and antitussives. Psychoactive drugs are commonly prescribed to patients with psychiatric disorders. However, certain critics believe that certain prescription psychoactives, such as antidepressants and stimulants, are overprescribed and threaten patients' judgement and autonomy.^[39][40]

Recreational drugs are heavily regulated, an indication of widespread moral objection to recreational psychoactive drug use. However, critics believe that regulation of recreational drug use is a violation of personal autonomy and freedom.^[41] In the United States, critics have noted that prohibition or regulation of recreational and spiritual drug use might be unconstitutional.^[42] Because there is controversy about regulation of recreational drugs, there is an ongoing debate about drug prohibition.

At the beginning of the 21st century, legally prescribed psychoactive drugs used for legitimate purposes have been targeted by the US Justice System.^{[citation needed]}

See also

References