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Nicotine (Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco)

Pronunciation: NIK-uh-teen (also pronounced NIK-uh-tin)
Chemical Abstracts Service Registry Number: 54-11-5
Formal Names: Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco
Informal Names: Chip (cigarette mixed with PCP), Fry Daddy (cigarette mixed with crack cocaine)
Type: Stimulant (pyridine alkaloids class).
Federal Schedule Listing: Unlisted
USA Availability: Generally available to adults as a component of tobacco products; nonprescription and prescription in pharmaceutical format
Pregnancy Category: C or D (depending on pharmaceutical format) drugsencyclopedia.net/nicotine/nicotine-habitrol-nicoderm-niconil-nicorette-nicotiana-rustica-nicotiana-tabacum-nicotrol-prostrop-tobacco/#more-28″ class=”more-link”>Read more

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PHARMACOLOGICAL AND OPIOID RECEPTORS

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Opium (Papaver album, Papaver somniferum, Poppy)

Pronunciation: OH-pi-uhm
Chemical Abstracts Service Registry Number: 8008-60-4
Formal Names: Papaver album, Papaver somniferum, Poppy
Informal Names: Ah-pen-yen, Aunti, Aunti Emma, Big O, Black, Blackjack, Black Pill, Black Stuff, Chandoo, Chandu, Chinese, Chinese Molasses, Chinese Tobacco, Chocolate, Cruz, Dopium, Dover, Dover’s Deck, Dover’s Powder, Dreamer, Dream Gun, Dreams, Dream Stick, Easing Powder, Emma, Fi-Do-Nie, Garden-Poppy, Gee, God’s Medicine, Goma, Gondola, Gong, Goric, Great Tobacco, Gum, Guma, Hard Stuff, Hocus, Hop, Indonesian Bud, Joy, Joy Plant, Mawseed, Midnight Oil, Mira, Mud, O, Oil, OJ, OP, Ope, Pen Yan, Pen Yen, PG, Pin Gon, Pin Yen, Plant, PO, Pox, Skee, Tar, Tongs, Tox, Toxy, Toys, When- Shee, Winshee, Yen Shee Suey, Ze, Zero
Type: Depressant (opiate class).
Federal Schedule Listing: Schedule II (DEA no. 9600)
USA Availability: Prescription
Pregnancy Category: C

Uses.
Many opium products are discussed elsewhere in this book, but here we are dealing with the substance from which all those products originate. Opium has long been used to relieve pain, fight coughs, cure diarrhea, and control spasms. Traditionally, opium is dried sap harvested from the seedproducing portion of opium poppy plants. At harvest time fields of poppies can have a strong smell, and children in the fields can be overcome by those airborne chemicals. A modern opium variety is “poppy straw,” composed of dry or liquid extracts from the plant. The natural product can be used by itself or can be refined to produce various drugs known as “opiates,” valued for their medicinal effects.

Archaeologists have found evidence of opium poppy cultivation dating from 15,000 years ago, but examination of historical records has not proven that ancient peoples understood opium’s medicinal benefits; the product may have been used traditionally but without understanding how or even whether it worked. Opium may have been used in Roman Empire religious ceremonies, perhaps exploiting the drug’s effects to symbolize a process of death and reincarnation, and even older records imply that ancients may have believed that opium could produce happiness, although evidence of ancient recreational use is nonexistent.

The Opium War from 1840 to 1842 was the first drug war, followed by the second Opium War of 1856 to 1860. These military conflicts were fought against China by England and other European powers in order to force the Chinese government to legalize the opium trade (certainly a goal different from that of the “drug war” familiar to Americans as the twenty-first century
began).

Opium and its morphine component were widely used to treat wounded soldiers in the American Civil War, and later historians have routinely said that addiction became so common that it was called “the soldier’s disease.” Such illness may have existed, but an investigator who diligently examined medical writings from that time found none that attributed postwar addictions to war-related medical use. In that era the opium trade was legal, and someone who analyzed opium import statistics found no evidence that consumption rose due to Civil War addictions; a distinguished authority has noted that people of that era called dysentery “the soldier’s disease.”

Just before World War I an article in the Journal of the American Medical Association declared, “If the entire materia medica at our disposal were limited to the choice and use of only one drug, I am sure that a great many, if not the majority, of us would choose opium; and I am convinced that if we were to select, say half a dozen of the most important drugs in the Pharmacopeia,
we should all place opium in the first rank.”1 Although many useful drugs have been discovered since then, opium is still the basis for many standard medications. Because opium is a natural product, its morphine content can vary greatly from batch to batch. Opium commercially processed for medical use is adjusted so that 10% of any given amount of medical opium is composed of morphine.

Although medical opinion about opium has changed little, public opinion has changed a lot. Reasons for that shift go beyond the scope of this book, but in the nineteenth century, use of opium and its derivatives had wide social approval in America. Alcohol was considered more hazardous to health and home. One of the most telling measures of approval came from the life insurance industry in India, which freely granted policies to known opium users, as mortality statistics showed opium having no effect on life span. A life insurance official reported similar experience in China, although older users in China had higher mortality than older nonusers (probably many users took the drug for diseases that nonusers did not have, with the death rate
related more to those diseases than to opium). Some of those statistics would change as the twentieth century progressed because drug laws would change the kinds of people who used opium, thereby associating opium with populations having higher mortality for reasons unrelated to opium’s drug properties.

Although identified with China, opium has been grown in the United States. In the late eighteenth century Benjamin Franklin used laudanum (typically wine laced with opium) to treat himself for kidney stones. During the nineteenth century Americans used opium mainly as an ingredient in laudanum and paregoric. Paregoric is a liquid including anise, camphor, and opium. Paregoric was first produced in the eighteenth century as an asthma medicine.

The compound is no longer used for that purpose but can reduce lung congestion by helping people to cough up mucus. Paregoric is a standard diarrhea remedy and is used to help infants suffering from drug withdrawal syndromes. In the 1960s the compound had a flurry of popularity among opiate addicts who would process the product in hopes of isolating the opium, then inject the substance they produced. The outcomes were typical of what happens when oral medications are injected, resulting in lung damage and disfiguring injuries to injection sites.

Less familiar modern opium preparations include home remedy mixtures of the substance with caffeine, aspirin, and acetaminophen (Tylenol or other brands). In America opium preparations were once a standard method of quieting noisy infants and children, and that practice is still followed in some parts of the world. One hazard in that custom is the possibility of fatal overdose,
as people administering such concoctions do not always understand pediatric dosage.

Drawbacks.
Although some opium users have generally unhealthy lifestyles, few ailments have been attributed solely to the drug. Those ailments tend to be in the gastrointestinal tract, such as problems with the small intestine’s bile duct. “Cauliflower ear,” in which an ear thickens and becomes misshapen, was once associated with opium smoking. The affliction, however,
apparently came not from the drug but rather from the habit of lying down for hours in a comatose condition with an ear pressing against a hard surface.

Abuse factors.
Recreational use of opium is harder to define than we might think, because even if persons take the drug in a social setting, they can be seeking to reduce mental anxiety or physical pain, which is not the same as using a drug for fun. Some people swallow dry opium or drink tea made with
seed or with dried heads of poppy flowers. In the nineteenth century poppy tea was a common medicinal drink, but in the early twenty-first century the habit tends to be limited to opiate addicts. The traditional recreational way to use opium is to inhale its smoke. Heating opium enough to make it smoke can reduce the drug content, and opium is already far weaker than substances refined from it (such as morphine and heroin). One authority estimates that
the amount of active drug inhaled by someone who smokes a given weight of opium will typically be 300 to 400 times less than the drug content in the same weight of injected heroin. Moreover, while an entire dose of heroin might be ingested in a few seconds, a pipeful of opium is smoked over a much longer period to slowly savor its effects, further reducing the opium’s impact. The English poet Samuel Taylor Coleridge started out using opium for medical purposes, as did Thomas De Quincey, and both men produced classic accounts of hallucinations and creative inspiration occurring under opium’s influence. Those accounts and later ones may well be true, but for such results people need to be particularly sensitive to the drug and also be prone to such experiences regardless of pharmaceutical encouragement. Arsenic is sometimes added to opium to increase smokers’ interest in sexual activity, a practice generating reports of arsenic poisoning among users. Drug interactions. Not enough scientific information to report about the natural product, although many studies have examined drug interactions with opiates and opioids.

Cancer.
Laboratory tests find that opium smoke may cause cancer, as may opium dross (waste products, such as scrapings from the inside of an opium pipe, which some persons chew or suck). Opium is suspected of causing esophageal and bladder cancer.

Pregnancy.
A pregnant woman using paregoric can give birth to an infant having dependence with opium.

Additional information.
Seed from opium poppies is a food product commonly used in breads, cakes, and candies. Consumption of amounts found in a normal meal can cause a false opiate positive in drug screens; controversy exists about whether further analysis of results from such testing can show
that poppy seed was the cause. Poppy seed oil is a comparatively unfamiliar product, but animal tests indicate it has good potential for human nutrition. In some parts of the world iodized poppy seed oil has been used instead of iodized salt to treat goiter and has been suggested as a means of preventing nervous endemic cretinism caused by iodine deficiency in the diet of pregnant
women. Iodized poppy seed oil is taken up by cancerous portions of a liver, giving the substance clinical usefulness if anticancer drugs are blended into it, as the drugs then concentrate exactly where they are needed in the liver. Results from animal research have led investigators to speculate that consuming normal poppy seed oil may help prevent cancer.

Opium lettuce is not related to opium but can produce mild sensations similar to opium. Sedative and pain relief qualities of opium lettuce have been used for centuries. Lung and urinary tract afflictions have been treated with it. Opium lettuce is smoked for recreational purposes, but results have not caused the practice to gain popularity. A case report tells of individuals who
received medical care after injecting a preparation made from the plant. It has other names including Acrid Lettuce, Bitter Lettuce, Compass Plant, Great Lettuce, Green Endive, Lactucarium, Lactuca virosa, Poison Lettuce, Prickly Lettuce, Strong-Scented Lettuce, and Wild Lettuce.

Additional scientific information may be found in:
Aurin, M. “Chasing the Dragon: The Cultural Metamorphosis of Opium in the United
States, 1825–1935.” Medical Anthropology Quarterly 14 (2000): 414–41.

Gharagozlou, H., and M.T. Behin. “Frequency of Psychiatric Symptoms among 150
Opium Addicts in Shiraz, Iran.” International Journal of the Addictions 14 (1979):
1145–49.

Goodhand, J. “From Holy War to Opium War? A Case Study of the Opium Economy
in North-Eastern Afghanistan.” Disasters 24 (2000): 87–102.

Haller, J.S. “Opium Usage in Nineteenth Century Therapeutics.” Bulletin of the New
York Academy of Medicine 65 (1989): 591–607.

Kalant, H. “Opium Revisited: A Brief Review of Its Nature, Composition, Non-Medical
Use and Relative Risks.” Addiction 92 (1997): 267–77.

Lerner, A.M., and F.J. Oerther. “Characteristics and Sequelae of Paregoric Abuse.” Annals
of Internal Medicine 65 (1966): 1019–30.

Quinones, M.A. “Drug Abuse during the Civil War (1861–1865).” International Journal
of the Addictions 10 (1975): 1007–20.

Strang, J. “Lessons from an English Opium Eater: Thomas De Quincey Reconsidered.”
International Journal of the Addictions 25 (1990): 1455–65.
Note
1. 64 (February 6, 1915): 477.

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Nicotine (Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco)

Pronunciation: NIK-uh-teen (also pronounced NIK-uh-tin)
Chemical Abstracts Service Registry Number: 54-11-5
Formal Names: Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco
Informal Names: Chip (cigarette mixed with PCP), Fry Daddy (cigarette mixed with crack cocaine)
Type: Stimulant (pyridine alkaloids class).
Federal Schedule Listing: Unlisted
USA Availability: Generally available to adults as a component of tobacco products;
nonprescription and prescription in pharmaceutical format
Pregnancy Category: C or D (depending on pharmaceutical format)

Uses.
Tobacco’s history is mentioned on page 18. Nicotine is the addictive drug component of tobacco and is found in other plants as well. Nicotine is one of the more hazardous drugs, and dosage via tobacco smoke adds still more peril. Although nicotine has medical uses, characteristics of the natural product tobacco fall within the criteria of a Schedule I controlled substance. Nonetheless, federal law explicitly excludes tobacco from such control, making the tobacco industry legal. At the time this book was written debate was under way about limiting adult access to nicotine products, a restrictive effort requiring changes in law.

Traditional medical uses of the drug include treatment of insect bites, skin and intestinal parasites, vomiting, earache, toothache, runny nose, hernia, and heart pain. Although tobacco smoking worsens a gastrointestinal inflammation called Crohn’s disease, medical practice uses nicotine skin patches, oral capsules, or suppositories to treat inflammation of the colon and rectum caused by ulcerative colitis. Nicotine chewing gum has been used successfully to treat finger or toe sores deriving from Buerger’s disease, an affliction in which blood vessels get blocked off (and which, despite the usefulness of pharmaceutical nicotine, seems to be worsened by smoking). Pharmaceutical nicotine helps some persons suffering from the tics of Tourette’s syndrome.

Researchers have found cigarette smoking to reduce the likelihood of getting preeclampsia, a potentially serious disease of late pregnancy in which women suffer fluid retention, high blood pressure, and too-high urine protein levels.

Cigarette smoking is also associated with a lower probability of getting Parkinson’s or Alzheimer’s disease. Even though “association” does not demonstrate cause and effect, some experiments using pharmaceutical nicotine to treat those afflictions show positive results. Such results, however, have not yet given nicotine a generally accepted role in treating those diseases. Nicotine reduces hunger pains and raises blood sugar, effects that help users eat less (Native Americans have traditionally chewed tobacco to better endure circumstances involving little food, water, or rest). Nicotine initially raises blood pressure, but continued dosage will lower it.

Drawbacks.
Tobacco smoking can lead to lung cancer and heart disease. Many other afflictions are attributed to tobacco smoking: bronchitis, emphysema, cataracts, mouth cancer, pancreas cancer, bone density loss (making broken bones more likely), abdominal aortic aneurysm (a sac ballooning out from the blood vessel wall), brain aneurysm, and gastroesophageal reflux (recurrent backward flow of acid and partially digested food from the stomach to the esophagus, making esophageal cancer more likely). One study noted that smoking tends to produce changes causing women to go through menopause at a younger age than nonsmokers. Laboratory tests imply that smokeless tobacco promotes tooth decay. Still more unwanted actions are known, partly because tobacco has simply been studied so intensively that more is known about it than is known about many other substances. Whether nicotine itself causes afflictions produced by tobacco is uncertain. For example, some investigators suspect that heart disease in smokers comes from carbon monoxide and tar constituents of smoke rather than the nicotine.

In adults 40 mg to 100 mg of pharmaceutical nicotine can produce fatal poisoning; an equivalent dose through cigarettes would require a person to quickly smoke several packs. Smaller dosages can be dangerous for children who play with nicotine patches or gum or who consume tobacco.

Abuse factors.
As with many drugs, persons often find nicotine unpleasant at first but learn to ignore bad sensations and focus upon effects that are enjoyed. Experiments examining differences that users perceive in various drugs find that some sensations from nicotine, amphetamine, and cocaine are similar, so similar that in one experiment persons receiving injections of nicotine typically identified it as cocaine. A user can establish a physical dependence
with nicotine, causing withdrawal symptoms if dosage stops:
nervousness, tenseness, crankiness, lightheadedness, broken sleep, weariness, distractedness, tremors. These symptoms often last a few days, sometimes longer, and can relate to a person’s expectations (a psychosomatic component).

Debate exists about how addictive nicotine is. A study published in 1994 noted that about 33% of tobacco smokers become addicted. A study published in 2000 found that 20% to 60% of adolescent smokers are addicted. Many smokers with no interest in quitting can nonetheless substantially reduce their cigarette consumption with little difficulty. In contrast, many smokers wanting to stop find themselves unable to cease, and for them even pharmaceutical
nicotine can be an insufficient replacement for tobacco. Among such persons the persistence of a smoking habit suggests that something more than the drug nicotine is involved. Tobacco smoke contains thousands of chemical ingredients besides nicotine; perhaps some of the less-studied ones are important. In addition, the paraphernalia and mechanics of cigarette smoking provide a psychological buffer to users, allowing continual brief respites in interactions with other persons (such as breaking eye contact during a puff). Nicotine itself is a mild stimulant able to release adrenaline and increase pulse rate and blood pressure, with the physiological arousal produced by the drug masking physical arousal provoked by life’s tensions, thereby making smokers feel less nervous despite the stimulant effects. Smokers tend to have lower levels of body chemicals that are supplemented by antianxiety and antidepressant drugs.

Such pharmaceuticals, unfortunately, seemingly have little ability to help smokers quit their tobacco addiction.

As with any addiction, the power of nicotine and tobacco depends upon needs met by those substances. People do not smoke simply to avoid temporary withdrawal symptoms. If a person’s life is filled with situations that smoking eases like nothing else can, breaking the addiction is hard. If a person finds other ways of dealing adequately with those situations, desire for cigarettes can go away and never be bothersome again. Contrary to expectations of researchers, a laboratory test found nicotine to be no more appealing to exsmokers than to persons who have never smoked—a finding implying that life circumstances, and not just chemistry, determine this drug’s appeal.

Alcohol and illicit drug abusers reliably tend to be tobacco cigarette smokers, so reliably that the amount of tobacco use can be used to estimate the amount of cocaine and opiate usage by persons in drug abuse treatment programs.

An experiment found that persons smoked less tobacco when they had access to marijuana, suggesting that those persons used the two substances for similar purposes. Nonsmokers tend to avoid drug abuse, implying that smokers and nonsmokers use different strategies to cope with life’s challenges.

Cigarette smoking is more prevalent among schizophrenics, seriously depressed persons, and persons with low-grade psychiatric disturbance that may lack outward symptoms. Almost two thirds of smokers in one research project turned out to have a history of present or past psychiatric abnormality.

Among such individuals smoking may be a strategy of self-medication. One study found that withdrawal symptoms can depend on the extent to which the drug is used for self-medication.

Improvement has been measured in alertness, energy, and happiness as cigarette smokers start their day’s consumption in the morning. Conversely, cutting off a smoker’s supply of cigarettes produces measurable increases in fatigue, irritation, sadness, stress, and disorientation. New users do not get favorable effects sought by experienced users but instead have measurable nausea and general uneasiness. Among new users nicotine reduces job performance skills such as physical coordination and accuracy in memory tasks the opposite of what happens with experienced users.

Although pharmaceutical nicotine has various medical applications, its main use is for treatment of addiction to tobacco smoking. One authority aptly described nicotine chewing gum as the methadone of cigarettes, meaning that such a treatment strategy is intended to switch addicts from tobacco to pharmaceutical nicotine, just as treatment personnel seek to switch heroin addicts to methadone. Although such programs may have an official goal of eliminating a person’s addiction, in practice simply switching a person from a more harmful drug to a less harmful drug is often considered a success.Drug interactions. Nicotine interacts with commonly used medical drugs.

Antipsychotic drugs and the anti–blood clot medicine heparin flush from the body faster if a person uses nicotine. Nicotine also reduces the sedative effect of benzodiazepines and reduces pain relief from various opioids. Cigarette smoke acts as a monoamine oxidase inhibitor (MAOI), a type of chemical found in some antidepressants and that can have serious adverse effects when
used simultaneously with some medicines (though acute danger from cigarette interactions may be small). Caffeine seems to make nicotine more pleasurable.

Rat studies show that nicotine increases alcohol’s appeal and worsens pancreas inflammation caused by both drugs. Birth control pills increase the boost that nicotine gives to pulse rate, and some researchers speculate that such increase is related to the elevated risk of heart disease found among smokers who use birth control pills.

Cancer.
Tests indicate that pure nicotine (as opposed to smoke containing nicotine) does not cause cancer.

Pregnancy.
Smoking reduces female fertility according to most studies of the topic, and studies of Canadian farm couples and of men in the Netherlands found an apparent reduction in male fertility as well. Pregnant women who smoke tobacco increase the chance of miscarriage, premature birth, smaller full-term infants, and sudden infant death syndrome (SIDS or “crib death”).

The children are more likely to have muscle tone abnormalities. Smoking harms male and female gametes, damages chromosomes, and can change DNA in ways linked with childhood cancer. Nicotine usage by a pregnant woman changes movements and heart action of a fetus. One researcher warns that nicotine patches or chewing gum may deliver even more nicotine to a
fetus than smoking would. Nicotine enters the milk of nursing mothers. Rat experiments indicate that fetal exposure to nicotine combined with newborn exposure to nicotine in milk increases the risk of offspring developing lung trouble similar to emphysema. Human birth defects have been attributed to tobacco smoking. Although a study of teenage tobacco smokers did not see
any increased incidence of birth defects in their infants, research based on animal experimentation and published in 1998 declared that nicotine causes defects in fetal brain development leading to problems in thinking and learning that may not become apparent until years after birth. The children tend to have lower scores on psychological measurements, somewhat reminiscent of “cocaine babies,” deficits that continue for years. Some investigators see a link between pregnant smokers and offspring with psychological problems.

Investigators tracking mothers and daughters for three decades found that daughters were more likely to take up smoking if their mothers smoked during pregnancy.

Additional information.
Scientific studies find that “passive smoking” threatens health of bystanders who inhale smoke from tobacco products and exhalations of smokers. A study of spontaneous abortions found them more likely in pregnant nonsmoking women who inhale environmental smoke and use a lot of caffeine or a moderate amount of alcohol. Infants from nonsmoker women who were exposed to tobacco smoke during pregnancy are more likely to have lower birth weight and persistent pulmonary hypertension. Offspring also exhibit the same kinds of lower psychological test scores that are seen in children of active smokers. Inhalation of smoke by infants is suspected of
contributing to SIDS. For sure, compared to children in nonsmoking households, infants of smokers are hospitalized more often for pneumonia and bronchitis. The level of environmental smoke necessary for ill effects is often unclear in scientific studies; a person working in a poorly ventilated smokey bar for eight hours a day will have a considerably different exposure than
someone in a nonsmoking household who sits outside once a week with a friend who smokes a couple of cigarettes.

Additional scientific information may be found in:
Brown, C. “The Association between Depressive Symptoms and Cigarette Smoking in an Urban Primary Care Sample.” International Journal of Psychiatry in Medicine 30 (2000): 15–26.

Brown, K.G. “Lung Cancer and Environmental Tobacco Smoke: Occupational Risk to Nonsmokers.” Environmental Health Perspectives 107 (1999, Suppl. 6): 885–90.

Colby, S.M., et al. “Are Adolescent Smokers Dependent on Nicotine? A Review of the
Evidence.” Drug and Alcohol Dependence 59 (2000, Suppl. 1): S83–S95.

Dursun, S.M., and S. Kutcher. “Smoking, Nicotine and Psychiatric Disorders: Evidence
for Therapeutic Role, Controversies and Implications for Future Research.” Medical
Hypotheses 52 (1999): 101–9.

Haustein, K.O. “Cigarette Smoking, Nicotine and Pregnancy.” International Journal of
Clinical Pharmacology and Therapeutics 37 (1999): 417–27.

Parrott, A.C., and F.J. Kaye. “Daily Uplifts, Hassles, Stresses and Cognitive Failures:
In Cigarette Smokers, Abstaining Smokers, and Non-smokers.” Behavioural Pharmacology
10 (1999): 639–46.

Robinson, J.H., and W.S. Pritchard. “The Role of Nicotine in Tobacco Use.” Psychopharmacology
108 (1992): 397–407.

Stolerman, I.P., and M.J. Jarvis. “The Scientific Case That Nicotine Is Addictive.” Psychopharmacology 117 (1995): 2–10.

Van Gilder, T.J., P.L. Remington, and M.C. Fiore. “The Direct Effects of Nicotine Use
on Human Health.” Wisconsin Medical Journal 96 (1997): 43–48.

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