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For centuries, Peruvian elites used booze and drugs to cement their empire

The elites of the ancient Wari empire in Peru, which ruled the highlands of the country from 600 to 1,000 AD, used communal drugs and beer to maintain their political control for thousands of years, according to a new study. Archaeologists believe that hallucinogenic from a native tree were added to beer during their massive feasts. 

Image credit: The researchers

Previous studies have highlighted the role that chicha, a beer-like drink still consumed today in many Andean countries, played a key role in the culture of the Wari — a civilization that flourished in the south-central Andes and coastal area of modern-day Peru, whse used to host big parties for their neighbors. Now, the discovery of a psychotropic tree in a Wari brewery suggests they combined the two intoxicants for a bigger punch. 

Archaeologists from the Royal Ontario Museum made the discovery at Quilcapampa, a former Wari village in Peru, where the remains of what the residents drank and ate were preserved thanks to the arid environment. They found traces of potatoes, quinoa, and molle tree (Schinus mole), used to make chicha with a 5% alcohol content. 

So far, nothing spectacular. But among the leftovers, the researchers found hallucinogenic vilca seeds from the Anadenanthera colubrina tree. Previous studies suggest the seeds were used extensively across South America. The earliest evidence, a pipe with the seeds, is from a site in Northern Argentina that dates back 4,000 years.

The Quilcapampa settlement

The Wari arrived in Quilcapampa late in the ninth century. A group of migrant families from the heartlands farther north settled in the area and likely introduced the practice of combining chicha with vilca seeds to strengthen alliances with non-Wari communities. It was a strategy to make friends and also to consolidate political power.

“Our excavations at Quilcapampa have recovered vilca seeds, which were probably imported, in direct association with large quantities of molle used to create the beer for a feast that was held just before the site was abandoned,” researchers wrote. “This was one of many such events hosted by Quilcapampa’s Wari-associated families.”

Image credit: The researchers.

Similar to the drug ayahuasca, used by Amazonian communities, vilca results in an out-of-body experience. The seeds, bark, and other parts of the tree have tryptamine alkaloids, including the psychedelic substance DMT. Since the effects are weakened if ingested, the Wari usually smoked or grounded the seeds into snuff, the team said. 

The molle tree used to make chicha grew near the settlement. But this wasn’t the case of the vilca seeds, which had to be imported from the eastern borders of the Andes and transported over the mountains. Archaeologists found in Quilcapampa painted drinking vessels from the Wari that portray the vilca tree with distinctive seed pods

Vilca was incorporated in communal feasts hosted by the elites, the researchers argue. This helped to cement social relationships and highlight the Wari hospitality. They offered their visitors an experience that wasn’t available elsewhere and couldn’t be easily replicated, as it was too dry in the region near Quilcapampa to grow vilca. 

“We argue that the addition of vilca to molle chicha was an effective method for the hosts of Wari feasts to channel its psychotropic effects into a more collective experience,” the researchers wrote. “A host who provides alcohol and food to guests reinforces patron-client relationships, forging an indebtedness that confirms heightened position.”

The study was published in the journal Antiquity

Pill for your thoughts: what are nootropics?

Nootropics are drugs that have a stimulating effect on our minds and brains. They’re meant to improve our cognitive abilities in various ways. On the face of it, that sounds awesome; who doesn’t want to get smarter by taking a pill? But many drugs touted with having a nootropic effect have no evidence to show for it. Some are complete swindles.

Image credits Lucio Alfonsi.

All of this doesn’t help give nootropics, which are a genuine category of drugs, a good name. Despite the undeniable appeal of being referred to as ‘cognitive enhancers’.

Today, we’re going to take a look at what nootropics are, talk about a few that we know are genuine, their effects, and some of the controversy around this subject.

So what are they?

The term was coined in 1972 by Romanian-born chemist and psychologist Corneliu Giurgea. At the time, he stated that to qualify as a nootropic, a compound should do the following:

  • Improve learning and memory.
  • Make learned behaviors or memories more resilient in the face of factors or conditions that disrupt them, such as hypoxia.Protect the brain against chemical or physical injuries.
  • Increase the efficacy of the tonic cortical/subcortical control mechanisms.
  • Have extremely low levels of toxicity, produce few (ideally no) side-effects, and to not induce the same effects of other psychotropic drugs (i.e. not get you high).

All of these are very useful pointers. However, I’ve found that the best way to explain what a certain family of drugs is to someone is to point at the examples people have direct experience with. We’re lucky, then, since virtually every one of us uses nootropics. Caffeine, nicotine, or L-theanine in various types of tea are some of the most-used nootropics in the world. Caffeine is the single most widely-used one. Besides coffee, caffeine is also naturally present in chocolate and tea. Many processed items such as food supplements, energy drinks, or sodas also contain caffeine.

All of these compounds influence our cognitive abilities in one form or another. Caffeine is notorious for helping pick us up when we’re feeling sleepy. But it also has a direct influence on the levels of various neurotransmitters in the brain. Past research has noted this leads to improved short-term memory performance and learning ability. These effects were not related to the stimulating effects of caffeine but occurred alongside it. According to Stephanie M. Sherman et al., 2016:

“Participants who drank caffeinated coffee were significantly more awake by the end of the experiment, while participants who drank decaffeinated coffee did not experience the same increase in perceived wakefulness”, it notes, adding that caffeine also “increased explicit memory performance for college-aged adults during early morning hours. Young adults who drank caffeinated coffee showed a 30% benefit in cued recall performance compared to the decaffeinated coffee drinkers, and this effect was independent of the perceived positive effect of the caffeine.”

Nicotine, an active ingredient in tobacco plants, also seems to have nootropic potential. D M Warburton, 1992, reports on a range of effects nicotine has on the (healthy) brain, including improvements in attention “in a wide variety of tasks” and improvements in short- and long-term memory. It further explains that nicotine can help improve attention in “patients with probable Alzheimer’s Disease”. Some of these effects were attributed to the direct effect nicotine has on attention, while others “seem to be the result of improved consolidation as shown by post-trial dosing” — meaning the compound likely also helps strengthen memories after they are formed.

Please do keep in mind here that I do not, in any way, condone that you pick up smoking. There isn’t any scenario under which I’d estimate that the potential nootropic effect of nicotine outweighs the harm posed by smoking. There are other ways to introduce nicotine into your system if you’re really keen on it.

L-theanine is very similar in structure to the neurotransmitter glutamate — which has the distinction of being the most abundant neurotransmitter in the human brain. Glutamate is our main excitatory neurotransmitter, and a chemical precursor for our main inhibitory neurotransmitter, as well. To keep things short, glutamate is an important player in our brains.

Because of how similar they are chemically, L-theanine can bind to the same sites as glutamate, although to a much lower extent. We’re not very sure what effects L-theanine has on the brain exactly, there is some evidence that it can work to reduce acute stress and anxiety in stressful situations by dampening activation in the sympathetic nervous system (Kenta Kimura et al., 2006).

How they work

Coffee and tea are some of the world’s most popular sources of natural nootropics. Image via Pixabay.

A wide range of chemically distinct substances can have nootropic effects. As such, it’s perhaps impossible to establish a single, clear mechanism through which they act. But in very broad lines, their end effect is that of boosting one or several mental functions such as memory, creativity, motivation, and attention.

The nootropic effects of caffeine come from it interacting with and boosting activity in brain areas involved in the processing and formation of short-term memories. It does this, as we’ve seen, by tweaking neurotransmitter levels in the brain. Others, like nicotine and L-theanine, also influence neurotransmitter levels, or bind to receptor sites themselves, thus influencing how our minds and brains function. Others still influence our mental capacity through more mechanical means. As noted by Noor Azuin Suliman et al., 2016:

“Nootropics act as a vasodilator against the small arteries and veins in the brain. Introduction of natural nootropics in the system will increase the blood circulation to the brain and at the same time provide the important nutrient and increase energy and oxygen flow to the brain”. Furthermore, “the effect of natural nootropics is also shown to reduce the inflammation occurrence in the brain […] will protect the brain from toxins and [minimize] the effects of brain aging. Effects of natural nootropics in improving brain function are also contributed through the stimulation of the new neuron cell. [Through this] the activity of the brain is increased, enhancing the thinking and memory abilities, thus increasing neuroplasticity”.

The brain is a very complicated mechanism, one whose inner workings we’re only beginning to truly understand. Since there are so many moving parts involved in its functions, there are many different ways to tweak its abilities. Way too many to go through them all in a single sitting. One thing to keep in mind here is that nootropics can be both natural and synthetic in nature. In general — and this is a hard ‘in general’ — we understand the working mechanisms of natural nootropics a bit more than those of synthetic nootropics.

Still, even with caffeine, we start seeing one of the main drawbacks — most of which remain poorly understood — of nootropics. The word ‘nootropic’ is a compound of two Ancient Greek root words and roughly translates to “mind growers”. But, just as tuning a guitar’s strings alters what chords it can play overall, nootropics affect our minds and brains in their entirety. They often act on multiple systems in the body at the same time to produce these effects.

We separate nootropics by their effects in three classes. These are eugeroics, which promote wakefulness and alertness. One prominent eugeroic is Modafinil, currently used to treat narcolepsy, obstructive sleep apnea, and shift work sleep disorder. It’s also being investigated as a possible avenue for the treatment of stimulant drug withdrawal.

The second class is part of the ADHD medication family, which includes Methylphenidate, Lisdexamphetamine, Dexamfetamine. Ritalin is a drug in this category. It was originally used to treat chronic fatigue, depression, and depression-associated psychosis. Today, Ritalin is the most commonly prescribed medication for ADHD as it addresses the restlessness, impulsive behaviour, and inattentiveness associated with the disorder.

Finally, we have nootropic supplements. These include certain B vitamins, fish oil, and herbal supplements such as extracts of Gingko biloba and Bacopa monnieri. Supplements tend to be the more contested than the rest, with the plant extracts themselves being the most contested overall. One thing to keep in mind here is that the FDA doesn’t regulate nootropic supplements the same way it does for prescription drugs, so buyer beware. Another is that there is little reliable evidence that these supplements actually help boost memory or cognitive performance beyond a placebo effect. A review of literature on the efficacy of supplements (Scott C. Forbes et al., 2015) concludes that:

“Omega-3 fatty acids, B vitamins, and vitamin E supplementation did not affect cognition in non-demented middle-aged and older adults. Other nutritional interventions require further evaluation before their use can be advocated for the prevention of age-associated cognitive decline and dementia”.

One final point here is that the nutrients these supplements provide — if they work — shouldn’t produce meaningful effects unless you’ve been taking them for a while. Dr. David Hogan, co-author of that review and a professor of medicine at the University of Calgary in Canada, told Time.com that age also plays a factor, and that such nutrients may not be of much help if taken “beyond the crucial period” of brain development.

No side effects?

“Caffeine has been consumed since ancient times due to its beneficial effects on attention, psychomotor function, and memory,” notes Florian Koppelstaetter et al., 2010. “Caffeine exerts its action mainly through an antagonism of cerebral adenosine receptors, although there are important secondary effects on other neurotransmitter systems”.

Adenosine receptors in the brain play a part in a number of different processes, but a few that are important to our discussion right now are: regulating myocardial (heart) activity, controlling inflammation responses in the body, and keeping tabs on important neurotransmitters in the brain such as dopamine.

Caffeine helps make us be more alert by impairing the function of these receptors; one of the things that happen when adenosine binds to these sites is that we start feeling drowsy, even sleepy. But our brains come equipped with these receptors for a very important reason — they keep us alive and healthy. Messing with their activity can lead us to some very dangerous situations. Caffeine intake, for example, increases blood pressure and heart rate, at least in part by interfering with these adenosine receptors. Heavy caffeine intake has been linked to tachycardia (rapid heart contractions) in certain cases.

The risk posed by nootropics comes down to their very nature. By design, these are drugs meant to tweak the way our brains work. But our brains are so essential to keeping our bodies alive that any wrong tweak can lead to a lot of problems. There is some evidence that the use of certain nootropics comes at “a neuronal, as well as ethical, cost”. Revving our brains ever harder could mean they wear out more quickly.

“Altering glutamate function via the use of psychostimulants may impair behavioral flexibility, leading to the development and/or potentiation of addictive behaviors”, Kimberly R. Urban, Wen-Jun Gao, 2014, reports. “Healthy individuals run the risk of pushing themselves beyond optimal levels into hyperdopaminergic and hypernoradrenergic states, thus vitiating the very behaviors they are striving to improve. Finally, recent studies have begun to highlight potential damaging effects of stimulant exposure in healthy juveniles.”

“This review explains how the main classes of cognitive enhancing drugs affect the learning and memory circuits, and highlights the potential risks and concerns in healthy individuals, particularly juveniles and adolescents. We emphasize the performance enhancement at the potential cost of brain plasticity that is associated with the neural ramifications of nootropic drugs in the healthy developing brain”.

This leads us neatly to:

The controversy

The ethical implications of using nootropics in school

Although nootropics are still poorly understood, they have an undeniable allure. And there’s no shortage of people willing to capitalize on that demand.

There are valid uses for nootropics, and there is research to support these uses. ADHD medication being a prime example of that. But there is also a lot of false advertising, inflated claims, false labeling, and general snake-oilery going on in the field of nootropics.

We live in a world where cognitive ability and academic achievement have a large impact on our livelihoods, and the quality of our lives. As such, there is a lot of incentive for us to boost these abilities, and nootropics seem to offer an easy way to achieve them. So, naturally, there’s a lot of incentive for people to try and sell them to you. There is a growing trend of use of nootropics by students trying to make it through the curriculum — or to get an edge over their peers — in universities around the world. Factor in the fact that we still have a poor understanding of nootropics, and a poorer understanding still of their side- and long-term effects on our brains, and it becomes worrying.

The Federal Drug Administration and Federal Trade Committee have sent multiple warnings to manufacturers and distributors of nootropic drugs and supplements over the years over charges of misleading marketing, the manufacture and distribution of unapproved drugs or no proven safety or efficiency at the marketed doses, even over the use of illegal substances.

In closing, nootropics are a valid and real class of drugs. While there is still much we don’t yet understand about them, we know that they exist and they can work in the way we envision them, as long as we do so responsibly. In many ways, however, they suffer from their fame. Everybody wants a pill that would make them smarter, sharper, more focused. That in itself isn’t damnable. The trouble starts when we’re willing to overlook potential risks or even willingly ignore known side-effects in chasing that goal.

Demystifying nootropics – Is cognitive enhancement even a thing?

Whether you’re a college student hoping to improve your grades, a professional wanting to achieve more at work, or an older adult hoping to stave off dementia, the idea of popping a magic pill that boosts your brainpower can be tempting. So it’s no surprise that the use of nootropics or smart drugs is on the rise globally. But do they work? And more importantly, are they safe? In a sea of supplements and marketing blurb, what’s the real story behind these supposed cognitive enhancers? Let’s have a look at some of these questions.

Nootropics are prescription drugs, supplements, or natural substances that claim to boost cognitive functions such as memory, creativity, or motivation. Similarly, cognitive enhancement refers to the use or abuse of said smart drugs by healthy people exhibiting no neurological-based deficiency. Meaning, more often than not, ‘smart drugs’ are an off-label prescription medication used for non-medical purposes. Despite this unsettling fact, the use of off-label prescription nootropics is on the rise globally.

Developed in 1964 by Romanian chemist Corneliu E. Giurgea, the concept of nootropics involves a list of criteria which is as follows:

1. Nootropics should aid with improvement in working memory and learning

2. Supports brain function under hypoxic conditions or after electroconvulsive therapy.

3. Protects the brain from physical or chemical toxicity.

4. Natural cognitive functions are enhanced.

5. Nootropics should be non-toxic to humans without causing depression or stimulation of the brain.

The criterion above may suggest that cognitive enhancers are purely lab-made; however, they’re also present in everyday foodstuffs and beverages. As an example, caffeine is a natural nootropic and the most widely consumed psychoactive substance worldwide. Found in coffee, cocoa, tea, and certain nuts, an intake of one or two cups of coffee a day has been shown in clinical trials to increase alertness and decrease reaction time, albeit very gently. And while caffeine was once considered risky, many experts now agree that natural caffeine present in foodstuffs is more beneficial than harmful when consumed in moderation.  

Due to the sheer volume of false advertising surrounding nootropics, the first thing to check is whether a cognitive enhancer is backed by science — the best thing to do this is to see if it has gone through clinical or human trials. A prime example here is caffeine, whose cognitive benefits have been thoroughly tested in humans by various academic institutions. To date, it has been shown that caffeine consumption increases intracellular messengers, prolongs adrenaline activity, and circulates calcium into cells. Collectively, these mechanisms provide neuroprotection, increases heart rate, vascular tone, blood pressure, and bronchodilation. Human trials have also indicated that caffeine improves vigilance and attention without affecting memory or mood.

Eggs are another proven brain food that has been through clinical trials; shown to be rich in choline, a substance key to the production of acetylcholine, instrumental in many bodily functions, from achieving deep sleep to retaining new memories. Frequent egg consumption is associated with higher cognitive performance as well, particularly among the elderly. However, as with synthetic nootropics, too much of these foods also has adverse consequences, with higher doses of caffeine causing jittery, anxious feelings. Nevertheless, you’ll be pleased to hear there is no official daily limit on the number of eggs a person can eat just as long as they don’t add saturated fat or too much salt to them.

Another well-trialed natural nootropic is an ancient herb called Ginkgo biloba – both human and animal models have elucidated the herb’s neuroprotective effects. As a result, Gingko has been studied repeatedly in treating Alzheimer’s disease due to its antioxidant and antiapoptotic properties. Numerous studies have also cited its safety in humans with cognitive impairment, where the nootropic induced inhibition against caspase-3 activation and amyloid-β-aggregation in Alzheimer’s disease. The list of human studies proving the benefits of Ginkgo Biloba in healthy volunteers is extensive, with no safety issues noted. However, as with other cognitive enhancers, contrasting studies contradict these positive findings suggesting that all trials should employ neuroimaging.

The most salient factor to note here is that all of the above nootropics are proven in human or clinical studies – severely lacking with the majority of cognitive enhancers currently on the market today. A simple search on the PubMed database will tell you which nootropics have been trialed in humans and list any safety issues. Another excellent way to navigate the minefield of false advertising by some nootropics manufacturers is to use established brands.

Similarly, it’s also crucial to check whether mixing nootropics with alcohol or other drugs are safe. Firstly, always approach a medical professional before mixing drugs or alcohol with prescription medicine. Secondly, over-the-counter (OTC) medication bought in pharmacies should come with safety leaflets advising whether it is safe to take with medications, other supplements, or alcohol. Unfortunately, not all OTC remedies contain safety information as they are mostly unregulated. And while there are many papers on the use of caffeine with alcohol, most OTC nootropics haven’t been tested with other drugs. Experts advise: if you begin to mix or stack OTC medicines and start to feel ill, you should stop your drug regime and see a medical professional right away – this includes the stacking of nootropics.

I’m confused. Just how many types of nootropics are there?!

With a tsunami of potions and powders on the market, it can be challenging to take brain boosters responsibly. The first thing to know is that nootropics can either be synthetic or natural where they’re manufactured like prescription drugs or occur in plants and food. Likewise, dietary supplements or OTC drugs can contain natural and synthesized products – with prescription drugs being purely synthetic in structure.

Synthetic nootropics are composed of artificial chemicals rather than natural ingredients – being heavily laden with synthesized chemicals designed to mimic natural neurotransmitters. For instance, caffeine is found naturally in coffee beans and synthesized for bulk manufacturing. The synthetic version, found in many energy drinks, possesses a higher absorption rate into the body than its natural counterpart, causing significantly more side effects. Meaning, the raw version of caffeine is far less severe on the human body than its synthetic counterpart.

Notably, the only proven nootropics to make an immediate, marked difference in cognition are prescription drugs prescribed by your doctor. Specifically, drugs designed for Attention Deficit Hyperactivity Disorder (ADHD) such as Adderall and Ritalin, as well as the anti-narcoleptic modafinil, show demonstrable effects on healthy people’s concentration, attention, and alertness. And even though their impact on cognitive enhancement is questionable in healthy people, their off-label use is still on the rise despite numerous health risks, including dependence, tolerance, and cardiovascular, neurologic, and psychological disorders.

Prescription nootropics primarily consist of stimulants comprising methylphenidate, amphetamine, and dextroamphetamine- designed to counteract ADHD. And although these work well for many people with this condition, these pharmaceuticals aren’t proven safe for healthy people who want to improve their focus and attention. Many college students acquire this medication nefariously, and while they appear to help in the short term, there are dangerous risks.

Yet, modafinil, a novel stimulant FDA-approved to treat narcolepsy, sleep apnea, and shift work disorder, has several remarkable features distinguishing it from other medications. Unlike amphetamines, for example, modafinil is reported to have minimal side effects at the correct therapeutic doses. It also appears to have low abuse potential, with some studies suggesting that it may help with learning and memory in healthy people. 

Carrying on in the vein of synthetic nootropics, the biggest OTC nootropic in this class is the racetam family. An alleged cognitive enhancer designed to improve memory and suppress anxiety and based on a native brain-derived neurotrophic factor modulator. Racetam products are mainly derivative of Pyrrolidinone, a colorless, organic compound that supposedly enhances the learning process, diminishes impaired cognition, and protects against brain damage. Several pyrrolidine derivatives are commercially available, including piracetam, oxiracetam, aniracetam, noopept, and pramiracetam. However, in reality, research on their effectiveness in healthy adults is non-existent.

In contrast, human studies categorically link naturally occurring nootropics with healthy brain function. Explicitly, past studies have shown that food-derived nutrients such as unsaturated fat, vitamins, caffeine, minerals, various proteins, glucosinolates, and antioxidants can boost brain function. Despite this, the evidence backing the psychological benefits of their diet supplementary doppelgangers is weak. A fact that will shock many whose morning ritual involves the intake of supplements bought over-the-counter or online.

To compound this, a 2015 review of various dietary supplements found no convincing evidence of improvements in cognitive performance, even in unhealthy participants. Dr. David Hogan, the lead author of the review, feels nutritional supplements don’t provide the same benefits as food. “While plausible mechanisms link food-sourced nutrients to better brain function. Data showed that supplements cannot replicate the complexity of natural food and provide all its potential benefits.” However, he concedes that: “None of this rules out the potential for some OTC nootropics to improve cognition. Still, there isn’t much compelling evidence to support these claims.” Suggesting there is still much conjecture when it comes to dietary supplements as an aid to cognitive enhancement.

These findings make complete sense as all nutrients and fuel for our bodies come from our diet – proven to act as vasodilators against the small arteries and veins in the brain. When introduced into our system, these healthy foods increase blood circulation, vital nutrients, energy, and oxygen flow towards the brain. They also counteract inflammatory responses in the brain, modulating neurotransmitter concentration. For this reason, experts will always state that a healthy balanced diet is their preferred mode of treatment for healthy cognitive function – at least for now.

How do nootropics work?

Coffee — one of the most popular nootropics.

A recurring critical theme in many whitepapers covering the subject is that unless you’re deficient in a nootropic chemical, it’s unlikely taking more of it will help to enhance your brain processes. Officially, cognitive enhancement works by strengthening the components of the memory/learning circuits — dopamine, glutamate, or norepinephrine to improve brain function in healthy individuals beyond their baseline functioning.

Most experts state that nearly all OTC and dietary supplements lose their potency and thus stop working over time. Moreover, scores of non-prescription drug effects (if present at all) seem to be temporary, lasting until their metabolism and elimination. Meaning you may have to take more for any noticeable benefit if there is one. The author’s general advice is to ensure that the brand is well-established and trusted, avoiding prescription drugs for non-medical purposes. 

In an interview with InsiderDavid A. Merrill, MD, director of the Pacific Brain Health Center, states that nootropics likely won’t benefit you much if you’re not already experiencing symptoms such as trouble focusing or poor memory.

Indeed, as nootropic intake is also rising amongst gamers, Dr. Migliore adds in her interview with PC Gamer, ingesting these compounds is unlikely to help you if your body isn’t deficient in any of them. Adding “If you spend 10-15 minutes outside every day and eat a balanced diet, your vitamin D levels are most likely normal”. She then goes on to ask: “Will taking a supplement of vitamin D do anything for you? Probably not. On the other hand, if you avoid the sunlight and don’t eat meat, your vitamin D levels may be low. For those people, a vitamin D supplement might lead to increased energy.”  

Is Dr. Migliore, licensed clinician, and world-famous gamer, hinting that sun-deprived gamers may benefit from smart drugs? Also, how will I know when I’m deficient in a specific nutrient? I can only glean my ‘deficient behavior.’ Would it not, therefore, make sense to take cognitive enhancers where a nutritional inadequacy is suspected? 

Despite how logical this sounds, all experts agree that a sensible diet, social interaction, and regular exercise help boost cognition, with many naturally occurring nootropics found in food shown to improve mental faculties.  

So should we use nootropics then?

There are numerous ethical arguments concerning the ongoing nootropics debate, with a slew of countries hurriedly adapting their laws to this ever-expanding field. Side effects and false advertising aside, there is no doubt that nootropics exist that work. And if there are nootropics that work, more smart drugs will soon be developed that work even better with increased functionality. And this is where ethical problems arise concerning the point at which treating disorders becomes a form of enhancement, where patients become super-humans. Should resources be spent trying to turn ordinary people into more brilliant and better performing versions of themselves in the first place?

I mean, how should we classify, condone or condemn a drug that improves human performance in the absence of pre-existing cognitive impairment once proven efficacious? Are we in danger of producing ‘synthetic’ geniuses? And even worse, will they be better than the real thing? Approximately 95% of elite athletes have used performance-enhancing drugs to compare doping in competitive sports here. If brain doping becomes acceptable in working life and education, will the same go for sports? Will we see separate competitions for these synthetic geniuses to level the playing field? Governmental bodies must address these urgent issues. 

And even though the use of nootropics has risen over the past years with such drugs broadly perceived as improving academic and professional performances – not enough empirical evidence supports the assumption that these brain boosters give rise to cognitive enhancement in healthy users. Married with a deluge of reports on the unwanted, and sometimes dangerous, side effects of these drugs, the case for their use is fragile.

For example, the non-medical use of prescription stimulants such as methylphenidates for cognitive enhancement has recently increased among teens and young adults in schools and college campuses. Accordingly, memory enhancement dominated the market with more than 30% share in 2018. However, this enhancement likely comes with a neuronal, as well as ethical, cost. 

In that respect, a 2017 study involving 898 undergraduates, who were not diagnosed with ADHD, reported that off-label prescription nootropics did not increase the grade point average or advantage of any healthy volunteers. Further confirmation that research on nootropics still appears to be inconclusive in terms of clarifying and defining how such drugs act as mind stimulants even where proven medication is involved. 

Just how safe are these nootropic ‘supplements’?

The problems relating to the safety of nootropics are linked directly to the adverse events reporting systems. Concentrating on the United States, even the FDA, usually a benchmark for drug regulation globally, is uncharacteristically vague about smart drugs. Most nootropics are sold as OTC supplements, meaning there are no figures for side effects associated with OTC nootropics in the USA. For this reason, only adverse events linked to indistinct dietary supplements are compiled in unprocessed data sets – meaning there is no analytics available. Historically, adverse events associated with dietary supplements are difficult to monitor in the USA because the manufacturer doesn’t register such products before a sale. Thus, little information about their content and safety is available, with no way to know if a supplement contains what producers claim or to glean the long-term effects. Compounding the reason to use only well-known, trusted brands found at reputable pharmacies.

To enumerate, the official FDA system that records adverse events for dietary supplements, the CFSAN Adverse Event Reporting System (CAERS), covers foods, nutritional supplements, and cosmetics and only provides raw data. The reported adverse events document serious events, including death and hospitalization, and minor events, including taste, coloring, or packaging. Unbelievably, even though CAERS includes severe medical incidents, the names of up to 35% of all side effects in this database are redacted under Exemption 4. A regulation that exempts manufacturers from disclosing information that constitutes “trade secrets and commercial information obtained from a person which is confidential.” Companies whose products have caused death are also allowed to purge their brand name and products from the FDA database using this privilege.

Hence, it’s challenging to gain statistics for the number of adverse events related to dietary supplements, making tracking dangerous supplements that have used the Exemption 4 clause unfeasible. Accordingly, most studies covering adverse events attributed to OTC supplements explore predictive statistics, signs, or signals that could roughly approximate the number of hospitalizations, doctor’s visits, or deaths that may happen that year. Many studies rely on multiple sources to assess the number of adverse events related to dietary supplements. Even then, it can prove impossible to track one brand. In general, knowledge regarding the safety of OTC supplements is limited, with many studies finding that CAERS underrepresent adverse events associated with OTC drugs. To give readers an idea of the enormity of the problem, among the 1,300 supplements labeled Exemption 4 in the CAERS database, more than one-third involved deaths or hospitalizations.  

Another emerging safety issue, OTC drugs can also cause hospitalization even where prescription drug regimes have ended – particularly with patients with a history of psychiatric illness. Posing the question, does this show a loss of plasticity as these psychopharmaceuticals permanently reroute and lay down brain circuitry and tracts. Thus, we have a false opposition in terms here – how can these prescription stimulants be viewed as nootropics, which are temporary by their very nature?

In short, this suggests that healthcare providers, specifically those in the mental health and substance abuse fields, should keep in mind that nootropic use is an under-recognized and evolving problem that can cause severe episodes, particularly amongst those with pre-existing mental disorders or illnesses. 

 Have other nootropics been elucidated in human trials?

Yes, numerous nootropics have been through human trials, with significantly more natural cognitive enhancers trialed instead of synthetic drugs. Making sense as foodstuffs are part of our everyday diets, needed to fuel our whole body.

First on the list is Bacopa monnieri, a herb found throughout the Indian subcontinent in marshy areas, used for centuries in ayurvedic medicine to improve brain function.  Human studies reveal consistent cognitive enhancement resulting from Bacopa monnieri administration across young, old and impaired adult populations. The most robust effects of Bacopa monnieri are memory performance, including positive effects on learning and consolidation of target stimuli, delayed recall, visual retention of information, and working memory. 

In adults aged 55 and over, Bacopa monnieri has shown improvements in executive functioning and mental control. Clinical studies have also revealed that it may boost brain function and alleviate anxiety and stress, possessing numerous antioxidant properties – a class of potent compounds called bacosides present in the herb thought to be responsible for this. 

Surprisingly, despite its addiction liability and undesired adverse effects, preclinical and clinical studies have demonstrated that nicotine has cognitive-enhancing effects. Functions like attention, working memory, fine motor skills, and episodic memory are all susceptible to nicotine’s effects. There may also be a link between dementia and this nootropic with nicotinic receptor activity observed in Alzheimer’s disease patients. Despite this, experts agree that nicotine use is only justified to quit smoking and is, therefore, avoided as a smart drug.

One of the most popular drugs for cognitive enhancement is methylphenidate, otherwise known as Ritalin – a commonly prescribed medication for treating ADHD. Users should note that a large proportion of literature on the safety and efficacy of this drug comes from studies performed on normal, healthy adult animals, as there is currently no sufficiently reliable animal model for ADHD.

Methylphenidate is a stimulant closely related to amphetamine and cocaine that works by increasing levels of dopamine and norepinephrine in the brain. For healthy users, most studies on its cognitive effects involved adult animals or humans. In studies on healthy volunteers, higher doses increased movement and impaired attention and performance in prefrontal cortex-dependent cognitive tasks – lower doses improved mental performance and reduced locomotor activity. Nevertheless, long-term use of stimulants like Ritalin can lead to attention-based side effects, hyperactivity, being distracted easily, and poor impulse control – also seen in patients who use the medication for ADHD.

Many reports discuss the role of Panax ginseng, a herb used in Chinese medicine, in improving the cognition function of Alzheimer’s disease patients due to its antioxidant properties, claimed to suppress Alzheimer’s disease pathology. Over the last decade, several studies have revealed that single doses of Panax ginseng can modulate aspects of brain activity measured by electroencephalography and peripheral blood glucose concentrations in healthy young volunteers. The same studies have also indicated that the herb enhances aspects of working memory, improves mental arithmetic performance, and speeds attentional processes.

Another natural nootropic, Rhodiola rosea, known as golden root, is a flowering plant that improves cognitive function. It’s mainly known for its ability to counteract physical and mental fatigue, with numerous human studies hosted on the subject. Sharing the same property with Bacopa monnieri and Panax ginseng, it is considered an “adaptogen,” a substance that enhances endurance, resistance and protects against stressful situations. Human studies show that Rhodiola rosea may also protect the nervous system against oxidative damage, thus lowering the risk of Alzheimer’s disease.  

Research on nootropics indicates that the big hope appears to be modafinil. This prescription drug is considered first-line therapy for excessive daytime sleepiness associated with narcolepsy in adults. However, clinicians need to be cautious with younger users because of reports of side effects involving tachycardia, insomnia, agitation, dizziness, and anxiety. Nevertheless, modafinil is FDA-approved for use in children over age 16 years. 

The efficacy of the drug modafinil in improving alertness and consciousness in non-sleep-deprived, healthy individuals has led to the military trialing the drug as a cognitive enhancer. Pointedly, a 2017 study found evidence that modafinil may enhance some aspects of brain connectivity, including alertness, energy, focus, and decision-making. In non-sleep-deprived adults, this also includes improvements in pattern recognition accuracy and the reaction-based stop-signal trial. 

Furthermore, modafinil improved the accuracy of an executive planning task and faster reaction times, with one study even listing increased digit span. Side effects are also dampened, with numerous cognitive functions remaining unaffected by modafinil. These include trail making, mathematical processing, spatial working memory, logical memory, associative learning, and verbal fluency.

As can be seen, cognitive enhancement is genuine, with human studies available to verify this exciting field’s mode of action and mechanisms.

Recommendations for smart drug usage

Nootropics and smart drugs are on the rise in today’s society, but more research involving neuroimaging is needed to understand their benefits better. However, there is no doubt that nootropics fulfilling Giurgea’s original criteria exist, particularly in their natural form.

In addition to these considerations, it’s always important to highlight that an active lifestyle with regular mental and physical activity, social interaction, and high-quality nutrition shows protective-preventive effects on various diseases and positively impacts brain health. Many experts are only willing to recommend these factors for cognitive enhancement. In particular, exercise increases dendrite length and the density of dendrite thorns and promotes the expression of synaptic proteins. An increase in the availability of growth factors and increased neurogenesis in the hippocampus also occurs, conversely decreasing beta-amyloid levels. No other nootropic currently has been so extensively studied or proven.

But the medical community can not ignore the many contrasting views of natural and synthetic nootropics; there’s growing evidence that some of these pills and powders can boost cognitive function, albeit temporarily. To date, Ginkgo biloba is the most studied and established herb for cognitive enhancement. In contrast, despite the vast number of studies on the subject, no prescription drug is officially recommended for non-medical use, despite evidence that they may provide cognitive enhancement for healthy people.

As we have seen, smart drugs exist; the main point to cover is safety. Experts recommend you only use trusted brands, checking the CAERS database for every new supplement or drug you use. They also state that if you become ill when using any prescription, OTC drugs, or dietary supplements, stop using them immediately and see a medical professional. Don’t forget to check the PubMed database for human trials and safety data regarding any cognitive enhancers you’re taking. It’s also an excellent place to double-check the credibility of any brands you may want to try. If they’re not involved in any studies, the chances are their products may be unsuitable for academic trials.

Finally, an underground movement is happening in the nootropics field, a faction demanding to be better, demanding their forced evolution, desperate to be good as the next person, terrified of being left behind. The next generation of smart drugs (and they are coming) will either advance humanity as a whole or divide us irrevocably. Will these synthetic geniuses, who feel so inferior they’ll risk their health to win the race, show us the same kindness afforded them? The answer awaits us all.

Europe’s biggest ever drug drone was just seized by Spanish cops

A French smuggling gang was using the drone to traffic drugs from Morocco to southern Spain, taking advantage of its capacity to carry up to 150 kilograms of cargo. The drone has a wingspan of nearly five meters and a flight range of seven hours. It can reach a maximum speed of over 100 miles per hour and is worth up to $7.700. 

Image credit: Spanish police

The gang trafficked the drugs from Morocco to the small town of Almachar in Spain, with only 1,811 inhabitants. Pedro Luis Bardón, from the National Police’s airborne resources unit, told El País newspaper that they had never seen a drone that big used for this purpose. It’s the biggest one ever found in Spain and very possibly in Europe. 

The five-motor drone, made in China, was discovered in a warehouse in the city of Malaga, following a joint investigation by Spanish and French cops. They also found 85 kilos of weed and hashish and arrested four people in the operation, three in France and one in Spain – who will now face prosecution because of drug trafficking. 

The gang flew the drone using an electronic system that relayed the exact takeoff and landing points. It could also be flown using a remote control. The police said the criminals didn’t have much knowledge related to its use, which posed a danger to other air traffic, even for passenger flights, considering the massive size of the seized drone. 

The inside of the drone is hollow, and would normally be used for cameras or other electrical equipment. In the case of the drug gang, it was being used for packages of narcotics, particularly cocaine. “Technology makes our lives easier, but it also ends up in the hands of the bad guys,” said the Málaga police chief, Roberto Rodríguez Velasco. 

A trafficking hotspot

It’s not random that the gang chose to move the drugs in the stretch of sea between southern Spain and Morocco. This is known as one of Europe’s busiest trafficking zones, with large amounts of weed and cocaine being smuggled. The stretch could be easily covered by the seized drone thanks to its average seven hours flight autonomy. 

The discovery of the drone follows similar busts by the Spanish police. In July this year, they found a network of drug traffickers that used a fleet of small drones to move cocaine from Morocco to Ceuta, an autonomous Spanish city near the coast of Africa. The police found seven drones, each capable of carrying between four and 25 kilograms. 

Image credit: Mugin.

Drones are also frequently used to move drugs from Mexico to the United States. The first reported seizure was in Calexico, on California's border with Mexico, in April 2015. It had been used to carry a total of 28 pounds of heroin over the border in four trips. Over the next five years, 170 similar incidents were officially reported. 

Still, drones aren’t the only method used by gangs to traffic drugs, at least in Europe. In March this year, Spanish police found a 30 feet long fiberglass narco-submarine, capable of carrying two tons of drugs. Since 2019, when the first submarine was discovered in Spain, the police have found several of these vessels being used to traffic drugs across Europe.

What is MDMA: party drug or therapeutic agent?

MDMA in pill form (ecstasy) and powder (molly). Credit: Flickr, Kripos_NCIS.

MDMA, short for 3,4 methylenedioxymethamphetamine, is a psychoactive drug whose effects can resemble those of both stimulants and psychedelics. The drug is known to produce distortions in time and perception, enhance the enjoyment of sensory experiences, and make people feel more energized. Its defining feature is that it increases self-awareness and empathy, which together enable a feeling of connectedness that many users report.

In its tablet or capsule form, MDMA is known as Ecstasy, whereas Molly — slang for ‘molecule’ or ‘molecular’ — refers to the crystalline powder form of MDMA. However, both versions may contain a number of other drugs that can be harmful and even life-threatening. In fact, sometimes drugs sold as Ecstasy or Molly do not even contain MDMA, which is replaced by other stimulants such as methylone or ethylone. Ecstasy tablets purchased on the street are often adulterated with methamphetamine, ketamine, caffeine, ephedrine, cocaine, phencyclidine (PCP), or over-the-counter cough suppressants such as dextromethorphan.

MDMA is one of the most popular recreational drugs in the world. The drug is often associated with raves and the party scene, although recently many people in their late 30s and 40s have started using MDMA at home due to its anxiety-relieving effects. In fact, the role of MDMA in clinical practice is going through a revival thanks to recent research showing it can treat post-traumatic stress disorder (PTSD), anxiety, and addiction. In 2017, the Food and Drug Administration (FDA) granted breakthrough therapy status to MDMA-assisted psychotherapy.

MDMA was first developed by the German pharmaceutical giant Merck in 1912. Initially, MDMA was known as “Methylsafrylaminc,” a precursor compound that the company used to synthesize medications designed to control bleeding.

For decades the drug was little known until it started gaining a small following among psychiatrists in the 1970s and early 1980s who recognized its therapeutic value by making patients more communicative and open about their problems. It’s worth noting that Alexander Shulgin, an American chemist and pharmacologist affiliated with the University of San Francisco, was the linchpin of MDMA research during these early days.

Shulgin was first introduced to MDMA in 1976 by one of his students at a course he was teaching at the time at San Francisco State University. The American chemist went on to develop a new synthesis method that made it much easier to make MDMA. He then went on to introduce the chemical to psychologists in California, which then spread to hundreds of psychologists and lay therapists around the nation who found small doses of MDMA greatly aided talk therapy. Some therapists called the drug ‘Adam’ since they believed MDMA helped patients return to a more innocent, primordial state.

The CIA took note as well and experimented with MDMA, along with other hallucinogenic drugs like LSD, as part of its MK-Ultra project that sought to assess whether psychedelics could be used for ‘mind control’. Although this secret project is notorious for testing psychedelic drugs on unwitting subjects, classified reports suggest that the CIA only used MDMA on non-human subjects. These experiments produced the first known toxicology studies on MDMA — given the codename EA-1475.

It was also around this time that MDMA started becoming widely available on the street. Eventually, the DEA banned MDMA in 1985 under its ‘War on Drugs’ policy, placing it on the list of Schedule I substances — along with LSD, heroin, and marijuana — that supposedly have no currently accepted medical use and a high potential for abuse. To this day, MDMA is still classed as a Schedule I drug. Most of the MDMA in the U.S. is synthesized in clandestine labs in Canada and the Netherlands.

What are the effects of MDMA

Credit: Positivechoices.org.au.

It takes around 15 minutes for MDMA to circulate through the bloodstream and reach the brain, where it leads to psychoactive effects similar to both a stimulant and hallucinogen. These effects typically last three to six hours.

MDMA is classed as an empathogen, meaning it increases a user’s feeling of empathy and compassion towards others. The main action of MDMA in the brain is that it increases serotonin, the neurotransmitter that, among other things, is responsible for regulating prosocial behavior, empathy, and optimism.

However, too much serotonin in the brain can trigger “serotonin syndrome”, which especially happens when MDMA is taken together with other drugs such as alcohol, amphetamines, or cocaine.

Some of the most common side effects of MDMA include euphoria, feeling energetic, dilated pupils, jaw clenching and teeth grinding, excessive sweating and skin tingles, muscle aches and pains, reduced appetite, accelerated heartbeat, high blood pressure, dehydration, and heatstroke.

Overdosing on MDMA or simply taking repeated doses of the drug over a long time can cause visual and auditory hallucinations, irrational behavior, anxiety, irritability, paranoia, vomiting, high body temperature, racing heartbeat, convulsions.

After the MDMA high wears off, most users will experience a 24- to 48-hour period during which they may feel lethargic, have a low appetite, or experience a state of unease or generalized dissatisfaction with life (dysphoria, or the opposite of euphoria). Colloquially, this unpleasant period is known as “suicide Tuesday”, a reference to the fact that the crash happens after a heavy weekend of partying.

Tolerance of MDMA sets in rapidly, making users chase the euphoric effects with repeated doses. But rather than reaping the desirable effects, users who abuse MDMA and have high tolerance typically wind up experiencing more of the sympathomimetic effects, placing them at risk for cardiovascular instability, arrhythmias, and hyperthermia. Long-term abuse of MDMA can result in depression, memory and concentration problems, and liver problems.

Long-term use of MDMA can also cause dependence, although it is exceedingly rare compared with other highly addictive drugs such as cocaine or alcohol. Less than 1% of patients seeking drug treatment at clinics in Australia are for ongoing problems related to MDMA. MDMA is described as a “self-limiting” drug as the intensity of the positive effects decreases with increased use, while negative effects increase.

The spikes in blood pressure and heart rate can be dangerous for people with underlying cardiovascular problems. But perhaps the greatest risk of MDMA is that it raises body temperature, especially since its use is often accompanied by strenuous physical activity (such as dancing) in a hot environment such as a crowded venue or in the summer heat. This combination exacerbates fluid loss, which further interferes with the body’s ability to cool itself properly.

In the early 2000s, some public officials went on a crusade against ecstasy, which they nicknamed “agony”. Some warnings included that MDMA use can lead to Parkinson’s disease, a lifetime of depression, and even “holes in your brain”. Dr. John Halpern, a psychiatrist at Harvard University, thoroughly debunked these claims finding no evidence that ecstasy users have decreased cognitive performance.

The effects of MDMA can also vary because ecstasy and molly are often tainted with other substances, which have their own psychoactive effects when used alone or in combination with MDMA. Purchasing illegal substances off the street or in nightclubs is always a gamble because you can never be sure what’s inside. In 2018, a pill testing trial at a major music festival in Australia found that nearly half the pills tested were of low purity. Some 84% of people who had their pills tested thought they had bought MDMA but only 51% actually contained any MDMA. On the other end of the spectrum, pill tests in the UK and New Zealand have sometimes found up to three doses of MDMA in a single pill.

People have died as a result of taking MDMA, although the number of deaths is relatively low compared to other drugs such as heroin, alcohol, and pharmaceuticals. Most of the deaths are not directly from the drug itself but as a result of other complications or contaminants. There were 92 MDMA-related deaths in England and Wales in 2018, up from 56 the year before, and 10,000 hospitalizations for MDMA-related illness/injury in 2011 in the US.

Water intoxication and MDMA

People taking on MDMA should drink around 500ml of water an hour if they’re active and half of this amount if inactive in order to combat the dehydration effects of the drug. However, it’s easy to go overboard especially due to overheating from the venue and the effects of MDMA itself.

Unlike alcohol, MDMA is an antidiuretic, meaning it makes you retain water. When you have too much water in your body, the ratio of salts and water can be thrown off balance. Cells can start swelling with water, and the body can suffer from water intoxication, a condition called hyponatremia. Symptoms include headache, vomiting, and confusion or seizures. In some cases, water intoxication can lead to death.

MDMA-assisted therapy

Ecstasy has long been associated with rave culture, particularly electronic dance music (EDM) events. Raves refer to all-night dance parties characterized by loud music and a psychedelic atmosphere.

But more recently, MDMA is seeing a resurgence as a therapeutic drug, particularly for PTSD. There hasn’t been a new, effective drug meant to treat PTSD in nearly 20 years, but promising clinical trials performed since the previous decade have shown that MDMA might greatly enhance therapy.

The treatment protocol involves pure MDMA ingested in pill form that is not adulterated with any other substances. Moreover, the drug is always taken under the supervision of a specially-trained therapist over the course of a 12-week program. During this time, the patient will experience 2-3 daylong sessions, each lasting roughly 8 hours.

Therapists say that MDMA heightens feelings of safety and social connections, allowing patients to revisit traumatic memories and process all the terrible things they went through without triggering the same panic.

Speaking to NPR, Saj Razvi, a Colorado-based psychotherapist who was a clinical investigator in the Phase 2 trials of an MDMA study for PTSD, said that these sessions can look almost like a “bad trip”. But although they may seem nerve-wracking, MDMA-assisted therapies lead to emotional breakthroughs that otherwise “may take months or years to accomplish”.

After this phase 2 trial of MDMA-assisted therapy concluded in 2017, researchers found that 54% of the patients who took the drug improved their symptoms to the point that they no longer fit the diagnosis for PTSD, compared to 23% for the control group. What was particularly staggering was that the positive effects appeared to increase, rather than wane, over time. One year after their therapy, 68% of the participants who took MDMA no longer had PTSD.

Although MDMA is still a schedule I substance in the United States, researchers are able to perform clinical trials with the drug thanks to private sponsors such as the Multidisciplinary Association for Psychedelic Studies (MAPS). The non-profit is now working to get the FDA on board in order to include MDMA in its expanded access program, which will allow patients to use MDMA.

Besides PTSD, research has found MDMA-assisted psychotherapy considerably reduces anxiety in autistic adults and terminally-ill cancer patients, as well as prevents alcoholism relapse.

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Young Americans are drinking less, but they’re using weed and prescription drugs more than ever before

College-age Americans are staying away from booze compared to their peers 20 years ago, according to a new study. However, the use of marijuana and mixed use of alcohol and marijuana is more common among them today, as is polysubstance abuse.

Image via Pixabay.

While we all know that alcohol isn’t good for you, it has been the recreational drug of choice for many around the world since antiquity. But younger people in the USA were moving away from alcohol between 2002 and 2018, a new study reports, even among those not enrolled in college.

But it seems that to be human is to fall to vice, for the same study found that the use of marijuana and alcohol and marijuana together has increased.

High hopes, low drinking

“We’re encouraged by the significant decreases in alcohol use disorder–for both college and noncollege participants,” said lead author Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan School of Nursing. “Alcohol-related consequences are one of the leading causes of mortality and morbidity for young adults.”

“The prevalence of alcohol use disorder in both groups in 2018 was roughly half of what it was in 2002. We are excited to learn about these drops in disordered drinking.”

The percentage of college-enrolled young US adults (aged 18-22) from the US that abstained from drinking alcohol increased from 20% in 2002 to 28% in 2018, while in those not in school this figure rose from 24% to 30%. More excitingly, alcohol abuse — problematic behaviors ranging from binge-drinking to straight-up alcohol addictions — decreased roughly by half in both groups. All in all, very good news from both a public health perspective as well as in regard to these groups’ quality of life.

But that hole in our hearts (and glasses) demanded to be filled — as such, more people are turning to marijuana, to both marijuana and alcohol, or to prescription drugs. While there seems to be less misuse regarding these two than what we’ve seen regarding alcohol in the past, the team cautions that we still need to keep a close eye on the situation and nip any potential issues in the bud.

The study used data from a nationally-representative survey of 182,722 young adults. For the 2015-2018 interval, the team also looked at the link between prescription drug misuse and trends in alcohol and marijuana consumption. However, they say they were particularly surprised by the drop in alcohol consumption and misuse. The findings give us cause for hope “even with increases in marijuana use disorder and co-use of alcohol and marijuana”, according to Ty Schepis, professor of psychology at Texas State, co-author of the study.

“Points of concern that deserve more attention are the rise in co-use of alcohol and marijuana, as we know that polysubstance use can have more negative consequences and be more difficult to treat,” he adds.

Roughly three-quarters of those who reported “disordered use” of both substances during the previous year had also used prescription drugs, some illicitly. The majority of these participants admitted to misusing their prescription drugs.

So on the one hand, people seem to be getting better at managing their alcohol intake, perhaps by employing marijuana as a crutch. On the other hand, more young people seem to be using or misusing several substances at once (not just marijuana or alcohol), which obviously isn’t very healthy or a very good sign that all is well in society.

“For example, from 2015 to 2018, only 2.5% of young adults who abstained from both alcohol and marijuana reported misusing prescription drugs, while 25.1% of co-users misused prescription drugs,” Schepis said. “That is a tenfold difference with potentially dangerous consequences.”

The findings, however, can help inform better strategies aimed at helping people overcome such issues in the future. Current interventions tend to focus on a single substance at a time and are “less effective” at tackling polysubstance abuse, according to McCabe.

“The finding that abstinence is increasing among college students and young adults not in college is very important for U.S. colleges and universities to take into account moving forward,” he said. “These findings reinforce the importance of the need to support those young adults in recovery and abstinence for other reasons. There are over 1 million U.S. young adults in recovery and a wide variety of resources are needed to support these individuals.”

“Brain supplements” found to contain several unapproved drugs, false labeling

New research gives us cause to be wary of supplements that claim to improve mental focus and memory. These products can contain unapproved pharmaceutical compounds in doses and combinations that can be dangerous to users, according to a new paper.

Image credits Raman Oza.

An analysis performed by a team at the Harvard Medical School in Boston, Massachusetts, found five drugs that have not been deemed safe or approved for human use in over-the-counter supplements known as “nootropics”,”smart drugs”, or “cognitive enhancers”. The findings highlight the need for tighter regulation of such products, the team argues.

Brainboosters, brainbusters

“Over-the-counter cognitive supplements are popular because they promise a sharper mind, but they are not as closely regulated as pharmaceutical drugs,” said study author Pieter A. Cohen, M.D., of Harvard Medical School in Boston, Mass.

“Use of these supplements poses potentially serious health risks. Not only did we detect five unapproved drugs in these products, we also detected several drugs that were not mentioned on the labels, and we found doses of unapproved drugs that were as much as four times higher than what would be considered a typical dose.”

Current laws in the U.S. do not require dietary supplements to be tested for safety or effectiveness by the Food and Drug Administration (FDA) before hitting the shelves, unlike pharmaceutical drugs. The FDA only intervenes if such supplements reach the market with misleading or incomplete labels, or if they contain unapproved substances.

The team searched the National Institutes of Health Dietary Supplement Label Database and the Natural Medicines Database looking for supplements that contain piracetam analogues. Piracetam is a drug that is not approved in the U.S. but has previously been included in supplements. An analogue is a substance with a chemical structure that is similar to but slightly different from another compound, and they are often used as loopholes around safety laws (since they tend to have the same effect but aren’t, strictly speaking, the same substance).

They identified a total of 10 supplements from the list. Eight of them promised to increase mental ability, one was sold as “workout explosives”, and the last is described as having the words “outlast, endure, overcome” printed on the label. In total, these products contained five unapproved drugs, they explain. Two of these were piracetam analogues (omberacetam and aniracetam), and the other three were vinpocetine, phenibut, and picamilon.

Known side-effects of these compounds can include increased and decreased blood pressure, agitation, or sedation, and the FDA has warned that vinpocetine should not be consumed by women of childbearing age as it “may cause a miscarriage or harm fetal development”. All the supplements contained oberacetam, which is prescribed as a medicine for traumatic brain injury and mood disorders in Russia but at a typical dose of 10 milligrams (mg); the recommended dosage of these supplements contained 40 mg each, or four times that dosage.

The team also warns that some supplements contained more than one unapproved substance, with one of them combining four unapproved drugs. Furthermore, most of the quantities listed on the labels were inaccurate.

Researchers also found that for those products with drug quantities provided on the labels, a majority of the declared quantities were inaccurate.

“With as many as four unapproved drugs in individual products, and in combinations never tested in humans, people who use these cognitive enhancement supplements could be exposing themselves to potentially serious health risks,” said Cohen. “The effects of consuming untested combinations of unapproved drugs at unpredictable dosages are simply unknown and people taking these supplements should be warned.”

“The fact that these supplements are listed in official databases does not mean the labeling is accurate or the dosage levels of ingredients in these supplements are safe,” he adds. “Our study also raises concerns regarding the quality and legality of supplements listed in supplement databases.”

These supplements could be particularly harmful in combination with prescription drugs, the team adds, as the compounds can interact in unknown ways. One particularly troubling possibility is that consumers of such supplements may experience side-effects and treat those side-effects with prescription medicine, placing themselves at risk.

The study didn’t look at all unapproved substances marketed in cognitive supplements, but their results don’t paint an encouraging picture.

The findings have been presented at the 2021 American Academy of Neurology Annual Meeting.

Humans aren’t the only animals that get drunk (or worse): here are a few others

Drinking isn’t good for you, but watching parrots get drunk is both healthy and entertaining. Not for the parrots, though.

There’s no day like a weekend day — cause that’s when we get to party. But humans aren’t the only animals that like to abuse their systems with various chemicals. In fact, a lot of animals do it; and get into trouble afterward. We’ve seen the shenanigans that animals go through in love (and lust), some of which are amusingly similar to those we humans cause or experience. So let’s see whether our furry and feathered friends also mirror us in the bad choices we make on a night out on the town (spoiler: they do).

The Darwin Drinking Awards

Northern Australia is the only place on Earth that I know of which has three seasons: a wet season, a dry season, and a drunken parrot season.

Red-collared Lorikeet.
Image via Wikimedia.

Just before the wet season, roughly in mid-to-late December, the local Weeping Boer-bean trees (Schotia brachypetala) are flowering. This brings swarms of red-collared lorikeets to the area to feed on the nectar of the trees’ flowers. However, after a while, some of the birds start to sway a little bit — and then fall out of trees. Darwin locals report that the birds lack coordination and that they seemingly lose their ability to fly and sometimes even to walk. Vets say the birds act similar to drunken people. They also seem to experience disorientation, energy loss, and perhaps headaches, all very familiar hangover symptoms.

While the possibility of a virus affecting these birds hasn’t yet been ruled out, the event may have more to do with the trees — which are also known as the Drunken Parrot Tree, I’ll let you judge for yourself. So far, local animal caretakers and vets provide safe, quiet places for the parrots to recover — which can take months in some rare cases according to National Geographic — while providing sweetened porridge and fresh fruit. The prevailing theory is that the parrots get drunk off their tails on nectar and fruit fermented in the baking Australian heat.

Tripping Reindeers

Reindeer live in Siberia (in North America too, but they’re called caribou there). The hallucinogenic mushroom Amanita muscaria also lives in Siberia, among other places. And the reindeer like to get really, really high on the ‘shrooms during those long and dreary winter months.

Image credits Bernard Spragg. NZ / Flickr.

Reindeer that partake of the mushrooms have been documented to act almost as if drunk, running around aimlessly, making strange noises, and twitching their heads.

“They have a desire to experience altered states of consciousness,” Huffington Post cites researcher Andrew Haynes, who studied the behavior in the wild. “For humans a common side-effect of mushrooms is the feeling of flying, so it’s interesting the legend about Santa’s reindeer is they can fly.”

He also adds that herdsmen drink the reindeer’s urine to get high themselves.

“Fly agaric is found across the northern hemisphere and has long been used by mankind for its psychotropic properties, but its use can be dangerous because it also contains toxic substances,” he explains for the Pharmaceutical Journal.

“Reindeer seem to metabolise these toxic elements without harm, while the main psychoactive constituents remain unmetabolised and are excreted in the urine. Reindeer herders in Europe and Asia long ago learnt to collect the reindeer urine for use as a comparatively safe source of the hallucinogen.”

Sharing, it seems, really is caring.

Popped-up Wallabies

Wallabies are adorable, diminutive kangaroos native to Australia and New Guinea.

They look like this.
Image via Pxfuel.

Opium poppy farmers on Tasmania (an island off the south Australian coast) have reported that wallabies will sometimes break into their fields to dine on the flowers, which are the raw material for prescription painkillers.

Although exactly which species of wallabies are responsible is still unknown, the animals have been seen eating poppies before running around in circles and eventually passing out, according to a BBC report. Lara Giddings, the attorney general for the island state of Tasmania even described the animals as being “high as a kite” and creating crop circles.

“The one interesting bit that I found recently in one of my briefs on the poppy industry was that we have a problem with wallabies entering poppy fields, getting as high as a kite and going around in circles,” Lara Giddings told a parliamentary hearing on security for poppy crops. “Then they crash.”

“We see crop circles in the poppy industry from wallabies that are high.”

Rick Rockliff, a spokesman for poppy producer Tasmanian Alkaloids, told the BBC that these wallaby incursions aren’t very common, although other animals have been spotted “acting unusually” in the poppies.

Australia is a major producer of raw materials for the painkiller industry, supplying around half of the world’s (legally-grown) opium. And, it seems, the main supplier for wallabies as well.

Bees on a binge

Bees keep the world turning, but that doesn’t seem to stop them from functional alcoholism.

https://www.youtube.com/watch?v=ZhUKLsSjUZs

The bee nervous system is similar enough to that of humans for alcohol to have similar effects on them. In fact, researchers sometimes use bee colonies as models to test out the effects of alcohol intoxication in humans and other vertebrates. For example, a team of researchers at Ohio State University routinely gives bees ethanol — drinking alcohol — to see how it affects them. Unsurprisingly, they found that it affected their flying, walking, and grooming.

“Alcohol affects bees and humans in similar ways — it impairs motor functioning along with learning and memory processing,” Dr Julie Mustard, an entomology researcher at the university, explained to the BBC.

But bees seem in no way content to limit their day-drinking to the lab. Just last year, Australian Parliament’s head beekeeper Cormac Farrell explained that the bees, which could be seen sometimes dropping on the ground around the Australian House of Parliament in Canberra, are just really blitzed. Sadly for the bees, they can sometimes drink themselves to death, and the queens aren’t very understanding of them — they will post guards at the entrance of their hives to keep any ‘merry’ bees from getting in.

“As the weather heats up, the nectar in some Australian flowers will ferment, making the foragers drunk,” Farrell told The Canberra Times last year. “Usually this makes them a bit wobbly, and if they come back to the beehive drunk the guards will turn them away until they sober up.”

“The drunk bees are kept out of the hive to stop the honey from fermenting inside, which could hurt the whole colony,” he added.

Only introduced and exotic honeybees seem affected, with Farrell noting that he had not seen any drunk native bees, of which Australia can boast 2000 species.

So, are bees just the victims of excellent work ethic and fermenting sugar? It doesn’t appear that way — bees just seem to enjoy getting smashed hard. Charles Abramson of Ohio State University told Newscientist that while most animals need to be coaxed into drinking alcohol, “we can get [bees] to drink pure ethanol, and I know of no organism that drinks pure ethanol – not even a college student.”

A bee, he adds, will drink the equivalent of a human downing 10 liters of wine in a single sitting. Flawless work ethic indeed!

Puff puff porpoise

Dolphins… like to pass toxic pufferfish around to get high.

The behavior was first reported on by marine biologist Lisa Steiner in 1995. She was studying a group of rough-toothed dolphins roughly in the region of the Azores when she noticed that some of them were pushing an inflated pufferfish around and rubbing their faces against it. Which was an odd sight, as that pufferfish uses one of the most lethal substances on Earth, tetrodotoxin, to protect itself from, among others, dolphins. Later on, Steiner would hypothesize that the dolphins were only exposed to tiny amounts of tetrodotoxin, and this resulted in a high, not death. Which is an ideal outcome in my book.

It’s still unclear whether the dolphins are actually getting a chemical kick out of the pufferfish or if they’re just harassing the poor animal for sport. The main points of contention are that tetrodotoxin isn’t known to cross the brain-blood barrier, and that it’s extremely deadly — one pufferfish contains enough to kill 30 full-grown people. However, in episode two of the BBC One documentary film, “Dolphins: Spy in the Pod,” a group of dolphins was filmed hunting pufferfish and biting into it but not eating it, then sharing the fish with their mates.

So this one is still a bit up in the air. But no matter whether the fish is used as a drug or a simple toy, given how toxic it is, it’s definitely dangerous.

These are a few of the more unusual stories of animals binging, but they’re certainly not the only ones. Jaguars like to chew on the roots of yagé vines — a main component of the hallucinogenic brew ayahuasca — and their diminutive cousins love catnip. And, well, humans are animals too. While it’s definitely a lot of fun reading about their shenanigans, hangovers aren’t, so enjoy your own real-life shenanigans in moderation.

AI-designed drug will be used on humans for the first time

Credit: Pixabay.

A novel drug meant to treat obsessive-compulsive disorder (OCD) has been designed by an artificial intelligence (AI). Researchers explain that it took the AI only 12 months to find the right molecule, a process that typically takes five years for human researchers. The medicine will soon begin clinical trials, marking the first time a drug discovered by an AI will be used on humans.

The molecule, known as DSP-1181, was among billions of possible chemical combinations that the AI went through while respecting countless parameters. It’s a delicate process that typically involves a lot of trial and error, but which has been vastly accelerated by machine learning algorithms.

British startup Exscientia and Japanese pharmaceutical company Sumitomo Dainippon Pharma worked together to make this kind of AI a reality. Speaking to the BBC, Exscienta chief executive Prof Andrew Hopkins said:

“We have seen AI for diagnosing patients and for analysing patient data and scans, but this is a direct use of AI in the creation of a new medicine.”

“There are billions of decisions needed to find the right molecules and it is a huge decision to precisely engineer a drug,” said Prof Hopkins.

“But the beauty of the algorithm is that they are agnostic, so can be applied to any disease,” he added.

Researchers plan on conducting phase one trials in Japan with subsequent global tests to follow if these initial results are promising.

DSP-1181 is a long-acting serotonin 5-HT1A receptor agonist meant to treat OCD. In Japan, one million people have this condition, while the disorder is present in around 3 million people in the United States.

The British firm plans on using this AI-aided approach to discover novel treatments for other medical conditions. Researchers are currently working on drugs for cancer and cardiovascular disease.

The average cost of research and development for a new drug is $2 billion. Raising the efficiency of drug discovery is paramount in the future and, as this news story shows, AI will play a critical role.

For now, DSP-1181 is the first AI-designed drug meant to treat human diseases. However, by the end of the decade, most new drugs could be discovered by an AI, Hopkins believes.

Malaria eradication by 2050 is ambitious but achievable

Every two minutes, a kid under age 5 dies of malaria, one of the oldest and deadliest diseases known to mankind. But malaria could be eradicated within a generation, a landmark report says.

According to 41 malariologists, biomedical scientists, economists, and public health policy experts, a future free of malaria — one of the world’s oldest and deadliest diseases — can be achieved as early as 2050. This statement contradicted last month’s WHO-led malaria review that concluded eradication cannot be achieved any time soon and urged the WHO not to shy away from this “goal of epic proportions”. The Lancet Commission analyzed new epidemiological and financial data and concluded that eradication is possible.

Malaria is a life-threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. 

Malaria infected about 219 million people in 2017 and killed around 435,000 of them — the vast majority babies and children in the poorest parts of Africa. Due to ongoing transmission, half the world’s population is still at risk of contracting malaria. These figures are little changed from 2016, but global case numbers had previously fallen steadily from 239 million in 2010 to 214 million in 2015, and deaths from 607,000 to around 500,000 from 2010 to 2013.

Since 2000, the number of countries with malaria has fallen from 106 to 86, cases have fallen by 36%, and the death rate has fallen by 60%. This is mainly due to the widespread use of bed nets treated with insecticide and better drugs for treating people who are infected.

Martin Edlund, head of Malaria No More, said the world should do everything possible to eradicate the disease: “If we double down on ending malaria now, the world will reap massive social, humanitarian and economic benefits and save millions of people from needlessly dying from mosquito bites.”

“For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, one of the report authors. “This report shows that eradication is possible within a generation.”

So, what will it take? The report estimates that based on current trends, the world will be “largely free of malaria” by 2050. To reach eradication by 2050, current technologies need to be used more effectively and new ways of tackling the disease needs to be developed. This could include the “game-changing” gene-drive technologies that could make mosquitoes infertile or make them resistant to the parasite.

King Mswati III of Eswatini (formerly Swaziland) and chair of the African Leaders Malaria Alliance said: “Malaria eradication within a generation is ambitious, achievable and necessary. The struggle has been constant to keep up with the malaria mosquito and the parasite, both of which are evolving to evade the effect of malaria interventions. We must make sure that innovation is prioritized.”

How much is this going to cost? The report estimates that around $4.3bn is spent on malaria annually. With $2 billion more in annual funding and strong partnerships to develop and deploy the correct tools, including new vaccines, we would be able to rid the world of malaria by 2050. Business as usual would mean many lives lost and the constant struggle against the malaria parasite and the evolving resistance to drugs.

“Eradicating malaria has been one of the ultimate public health goals for a century, it is also proving to be one the greatest challenges,” said Dr Tedros Ghebreyesus, the director general of the World Health Organization. “But we will not achieve eradication within this time frame with the currently available tools and approaches – most of which were developed in the past century or even earlier.”

Americans spend $150 billion a year on illicit drugs

The amount of money spent by Americans on cannabis, cocaine, and heroin in 2016 reached $150 billion, according to a RAND Corporation report. The study showed that most of the spending came from a small share of people who use drugs on a daily or near-daily basis.

Credit: Flickr

The amount spent on these four drugs fluctuated between $120 and $145 billion per year between 2006 and 2016, according to the research. This is comparable with the $158 billion spent by Americans on alcohol in 2017, according to a different analysis.

“To better understand changes in drug use outcomes and the effects of policies, policymakers need to know what is happening in markets for these substances,” said Greg Midgette, the study’s lead author, an assistant professor at University of Maryland and an adjunct policy researcher at RAND, a nonprofit research organization

Apart from estimating expenditures on drugs such as cannabis, cocaine, heroin, and methamphetamine, researchers from RAND used a variety of sources of information about drug use and drug prices to also estimate the number of people who use these substances and how much they consume, and how much they spend on consumption.

Looking specifically at cannabis, from illegal and state-licensed sources, the report showed its spending increased by 50% from 2006 to 2016, going from $34 to $52 billion. The market for cannabis is roughly the size of the cocaine and methamphetamine markets combined.

From 2010 to 2016, the number of individuals who used cannabis in the past month increased by nearly 30 percent, from 25 million to 32 million, according to the report.

At the same time however, the consumption of cocaine dropped from 2006 to 2015 and then picked up in 2016, the report showed. There were 2.4 million individuals who used cocaine on four more or days in the past month in 2015 and 2016, the results show.

The consumption of heroin increased by approximately 10 percent per year between 2010 and 2016, according to the analysis. Whereas most heroin consumed in the United States comes from poppies grown in Mexico, the introduction of synthetic opioids like fentanyl into heroin markets has increased the risk of using heroin.

There was a steady increase in the amount of heroin seized within the United States and at the southwest border from 2007 through 2016. Changes in the composition of heroin users, potentially involving increased use among individuals without criminal histories, have increased the uncertainty underlying these estimates.

Estimates about methamphetamine use are subject to the greatest uncertainty, largely because national data sets do a particularly poor job of capturing its use, the researchers explain. The federal government discontinued a critical data collection effort in 2003, the Arrestee Drug Abuse Monitoring, or ADAM.

“While there is considerable uncertainty surrounding national methamphetamine estimates, multiple indicators suggest methamphetamine use has exceeded its previous peak around 2005,” concludes Beau Kilmer, co-author of the report and director of the RAND Drug Policy Research Center.

Drug overdoses in the U.S. on the decline for the first time since 1990

The drug overdose epidemic in the United States is such a huge problem that it has effectively reduced life expectancy in the country. In 2018, more than 68,000 were killed by prescription opioid painkillers and other drugs, particularly heroin, fentanyl, and methamphetamine. That’s a kill rate higher than the peak annual deaths from car crashes, AIDS, or guns.

On the upside, at least there are fewer overdose fatalities than in 2017, a 5% decline that marks the first drop in three decades.

The reduction was reported by the Centers for Disease Control and Prevention — one of the rare good news in a string of depressing updates on drug abuse in the country.

Experts in addiction and law enforcement say that the overall drop in deaths to overdoses can be pinned to tighter regulations of opioid prescriptions. In 2016, Massachusetts became the first state in the nation to pass a law that limits opioid prescriptions to 7 days. Since then, over half of all states have enacted laws that restrict the prescribing or dispensing of opioids for acute pain. More cautious prescribing of opioid drugs has thus hit the supply and, consequently, the risk of overdose.

However, prescription painkillers are no longer the leading cause of overdose deaths. In the past decade, heroin — which now kills four times as many people than in 2000 — and then fentanyl, surpassed prescription opioid drugs as the main cause of overdose death. These factors are much harder to control and regulate by the federal government. To make things even more challenging, the CDC reports a 21% rise in deaths provoked by methamphetamine, 12,987 fatalities in 2018 from 10,749 in 2017. Deaths provoked by cocaine also spiked this year by nearly 5%.

The pattern of death by overdose is not uniform across the country. The hardest-hit states include Ohio, New Jersey, Delaware, and Maryland.

In order to further stave off drug overdose fatalities, local authorities and treatment facilities plan to improve access to local drug rehab and treatments. For instance, naloxone is a life-saving drug that reverses overdoses, sparing thousands thus far. Growing awareness about the dangers of opioids, particularly the synthetic variety, is also paramount. Fentanyl — the deadliest drug in America —  is a very powerful synthetic opioid that’s 50 to 100 times more concentrated than morphine. For a user with little tolerance to the drug, even less than a milligram of fentanyl can trigger an overdose. And if fentanyl wasn’t scary enough, carfentanil — a fentanyl analog that’s 10,000 times more powerful than morphine — is becoming a growing presence across the country.

There is already some good progress in treating America’s opioid epidemic. Today, it is easier than ever to gain access to methadone, buprenorphine, and naltrexone — three F.D.A.-approved medications that suppress craving and withdrawal symptoms related to opioid consumption.
Credit: Pixabay.

The dangers of mixing alcohol and drugs

Credit: Pixabay.

Credit: Pixabay.

Alcohol is commonly used at the same time with over-the-counter medications, prescription drugs, and illicit drugs. However, doing so can have unpredictable and unwanted consequences — and some of these are extremely dangerous. Here’s a brief description of the general effects that can occur by combining alcohol and various classes of drugs.

Alcohol and antidepressants

Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, as well as other conditions. An increasing number of people are turning to such drugs. According to the Centers for Disease Control and Prevention (CDC), the percentage of people aged 12 years and over using antidepressant in the United States rose from 7.7 percent in 1999-2002 to 12.7 percent in 2011-2014.

There are many classes of antidepressants and the effects of the use of alcohol, also known as ethanol (ETOH), in conjunction with these drugs will depend on their class.

Generally, the symptoms of using alcohol in conjunction with most antidepressant drugs include:

  • Inhibiting the medicinal effect of the antidepressant drug (Zoloft, Prozac, Lithium, etc.);
  • Drowsiness, dizziness, and even an increase in depression; alcohol itself is a depressant and can exacerbate the symptoms of the condition.
  • Amplification of alcohol’s effects, particularly on motor function, coordination, and reduced reaction time.
  • Increase potential for damage to organs, such as the liver.

Alcohol and medication for diabetes

There are various prescription medication designed to control diabetes, such as insulin for type I diabetes and metformin for type II diabetes. Drinking alcohol in such a situation can lead to all sorts of serious consequences due to the high sugar content of many alcoholic beverages. When combined with diabetes medication, alcohol can lead to effects such as:

  • Rapid heartbeat and increased blood pressure;
  • Fatigue, weakness, dizziness, headache, nausea, and/or vomiting;
  • Potentially dangerous alterations in blood sugar levels;

Alcohol and opiates

The most dangerous combination of alcohol and drugs is with opiates, such as heroin or painkillers.

Opiate painkillers like OxyContin, Hydrocodone and Vicodin depress the central nervous system to dampen pain, as well as inhibit breathing. When mixed with alcohol, the risk of overdose spikes. About 22% of prescription painkiller fatalities involve alcohol.

Alcohol and stimulants

While alcohol suppresses the functions of the central nervous system (CNS), there are numerous drugs that stimulate CNS functions. Some examples of such stimulants include:

  • Amphetamines;
  • Prescription medications for the treatment of ADHD (attention deficit hyperactivity disorder), such as Ritalin and Concerta (methylphenidate) or Adderall (amphetamine and dextroamphetamine);
  • Caffeine and several drugs classified as antihistamines or decongestants;
  • Illicit drugs, particularly cocaine and methamphetamine (crystal meth).

People mix alcohol with stimulants in order to ‘take the edge off’ of the stimulant. This practice is particularly common among college students who abuse ADHD medication to help with studying and people who use cocaine at parties. The main problem is that stimulants conceal the effects of alcohol, which means people can no longer gauge their level of intoxication, leading to overconsumption. Some common problems associated with mixing stimulants and alcohol include:

  • The effects of stimulants are negated by alcohol.
  • Taking stimulants and alcohol in combination leads to a significant reduction in the overall effects of both drugs. This makes it easier to overdose on one or both drugs.
  • Higher risk of developing seizures, psychotic behavior, hallucinations, or delusions.
  • Emotional problems, such as increased symptoms for depression, anxiety, loss of motivation, etc.
  • Damage to organs such as the liver, gastrointestinal system, and cardiovascular system if alcohol and stimulants are mixed chronically.

Alcohol and over-the-counter medication

Just because some medication doesn’t require a prescription, that doesn’t make it harmless. Tylenol, for instance, contains acetaminophen which can cause liver damage if a user takes too much or combines it with alcohol. Other medications, such as cough syrup and laxatives, already contain as much as 10% alcohol, which can interact with just a drink or two.

In conclusion, the safest thing is to avoid combining drugs and alcohol. Always contact your doctor or local pharmacist before you mix any kind of drugs, legal or not, with alcohol.

Anonymous drug testing at festivals can save lives. Study finds 1 in 5 drugs were not as sold

Secret Garden Party, 2014. Credit: Flickr, Angel Ganev.

Drug-related fatalities at festivals are on the rise, particularly in the United Kingdom. In such situations, there’s not much law enforcement can do, despite their best efforts, as some festivals gather tens of thousands of people. In fact, the police can make matters worse. A UK non-profit organization called The Loop, which focuses on harm reduction, has a different strategy for keeping festival-goers safe. Instead of controlling supply with a wide net which is bound to let dubious substances through the cracks, Loop performed free, anonymous drug testing at the grounds of a festival.

The results were striking. One in five drugs were not as sold, containing cutting agents or dangerous psychoactive substances. When people saw the results, they were far more likely to discard the rest of their drugs and share warnings on social media, thus alerting other festival-goers of the dangers of tainted drugs or frauds.

Looks can be deceiving

Chemists at The Loop, which included researchers at Durham University, set up temporary laboratories at the Secret Garden Party, a four-day festival in Cambridgeshire in July 2016. The researchers tested approximately 247 substances and offered harm reduction advice to the anonymous festival-goers who submitted the samples.

Test results revealed that one in five substances was not as sold or acquired. For instance, meth and ketamine were sold instead of cocaine, while in many cases what was supposed to be MDMA (the psychoactive ingredient in ‘ecstasy’ pills) turned out to be n-ethylpentylone, a designer drug that looks exactly as MDMA but which causes anxiety, paranoia, insomnia, and psychosis.

“The mis-selling of pentylone and its analogues is particularly insidious because the effects are initially quite similar to MDMA itself, but the empathogenic effects are not so pronounced and the euphoria fades more quickly. This leads people to redose, but redosing seems to disproportionately extend the time to clear the body and this makes sleep very difficult or impossible for up to 72 hours without further medication. This stimulated sleep deprivation is horrible at best, and multiple cases of temporary psychosis have been recorded,” according to a blog post.

Other dubious substances found in the samples include anti-malaria drugs, brown sugar, or plaster of paris.

According to the study, two-thirds of the people who were informed they had been missold subsequently discarded the substances. According to The Loop, drugs sold at festivals were twice as likely to be something other than advertising compared to offsite purchases. This highlights the significant risks festival-goers expose themselves when they decide to acquire drugs on site.  Women were more likely to be using the drug for the first time and more likely to use the disposal service, the authors added in their study published in the International Journal of Drug Policy. 

While a couple hundred people might not seem like much for a festival like Secret Garden Party which regularly sees 30,000 cross its gates, many broadcasted the fact that drugs sold at the premises are highly questionable. This may have helped advert some fatalities. In 2016, there was just one drug-related hospital admission, against 19 in the previous year, marking a 95% reduction.

“The service not only identifies and informs service users about the contents of their submitted sample and provides them with direct harm reduction advice but this pilot tells us they spread the information to their friends,” Fiona Measham from Durham University’s Department of Sociology, and director of The Loop, told The Guardian.

Asian heroin. Credit: DEA, Wikimedia Commons.

What are the most addictive drugs on Earth?

Asian heroin. Credit: DEA, Wikimedia Commons.

Asian heroin. Credit: DEA, Wikimedia Commons.

What are the most addictive drugs? This question seems simple, but the answer depends on whom you ask. From the points of view of different researchers, the potential for a drug to be addictive can be judged in terms of the harm it causes, the street value of the drug, the extent to which the drug activates the brain’s dopamine system, how pleasurable people report the drug to be, the degree to which the drug causes withdrawal symptoms, and how easily a person trying the drug will become hooked.

There are other facets to measuring the addictive potential of a drug, too, and there are even researchers who argue that no drug is always addictive. Given the varied view of researchers, then, one way of ranking addictive drugs is to ask expert panels. In 2007, David Nutt and his colleagues asked addiction experts to do exactly that – with some interesting findings.

1. Heroin

Nutt et al.’s experts ranked heroin as the most addictive drug, giving it a score of 3 out of a maximum score of 3. Heroin is an opiate that causes the level of dopamine in the brain’s reward system to increase by up to 200% in experimental animals. In addition to being arguably the most addictive drug, heroin is dangerous, too, because the dose that can cause death is only five times greater than the dose required for a high.

Heroin also has been rated as the second most harmful drug in terms of damage to both users and to society. The market for illegal opiates, including heroin, was estimated to be $68 billion worldwide in 2009.

2. Cocaine

Cocaine directly interferes with the brain’s use of dopamine to convey messages from one neuron to another. In essence, cocaine prevents neurons from turning the dopamine signal off, resulting in an abnormal activation of the brain’s reward pathways. In experiments on animals, cocaine caused dopamine levels to rise more than three times the normal level. It is estimated that between 14-20m people worldwide use cocaine and that in 2009 the cocaine market was worth about $75 billion.

Crack cocaine has been ranked by experts as being the third most damaging drug and powdered cocaine, which causes a milder high, as the fifth most damaging. About 21% of people who try cocaine will become dependent on it at sometime in their life. Cocaine is similar to other addictive stimulants, such as methamphetamine – which is becoming more of a problem as it becomes more widely available – and amphetamine.

3. Nicotine

Nicotine is the main addictive ingredient of tobacco. When somebody smokes a cigarette, nicotine is rapidly absorbed by the lungs and delivered to the brain. Nutt et al’s expert panels rated nicotine (tobacco) as the third most addictive substance.

I

More than two-thirds of Americans who tried smoking reported becoming dependent during their life. In 2002 the WHO estimated there were more than 1 billion smokers and it has been estimated that tobacco will kill more than 8m people annually by 2030. Laboratory animals have the good sense not to smoke. However, rats will press a button to receive nicotine directly into their bloodstream – and this causes dopamine levels in the brain’s reward system to rise by about 25-40%.

4. Barbiturates (‘downers’)

Barbiturates – also known as blue bullets, gorillas, nembies, barbs and pink ladies – are a class of drugs that were initially used to treat anxiety and to induce sleep. They interfere with chemical signalling in the brain, the effect of which is to shut down various brain regions. At low doses, barbiturates cause euphoria, but at higher doses they can be lethal because they suppress breathing. Barbiturate dependence was common when the drugs were easily available by prescription, but this has declined dramatically as other drugs have replaced them. This highlights the role that the context plays in addiction: if an addictive drug is not widely available, it can do little harm. Nutt et al’s expert panels rated barbiturates as the fourth most addictive substance.

5. Alcohol

Although legal in the US and UK, alcohol was scored by Nutt et al.‘s experts 1.9 out of a maximum of 3. Alcohol has many effects on the brain, but in laboratory experiments on animals it increased dopamine levels in the brain’s reward system by 40-360% – and the more the animals drank the more dopamine levels increased.

Some 22% of people who have taken a drink will develop dependence on alcohol at some point during their life. The WHO has estimated that 2 billion people used alcohol in 2002 and more than 3m people died in 2012 due to damage to the body caused by drinking. Alcohol has been ranked as the most damaging drug by other experts, too.

Eric Bowman, Lecturer in Psychology and Neuroscience, University of St Andrews

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Being empathetic might put you at risk of relapsing as a coping mechanism

Empathy might be the original gateway drug, new research suggests.

Smoke.

Image via Pixabay.

Empathy smooths your way through social situations, but it might also smooth the path to drug addictions, a new paper suggests. The research, carried out at the University of Minnesota (UoM), was carried out using mice models but may carry over to humans as well.

Blue empathy

A research group led by  Dr. Jonathan Gewirtz at the UoM set out to analyze the links between empathy, stress, and drug use. The team’s hypothesis was that empathy (the awareness of another’s feelings and emotions), while very useful in social situations, can also expose one to more stress (as revealed by previous research). This stress, the team explains, can push former drug users into relapsing.

The team started by training a group of male mice to mimic drug-seeking behavior. The animals were placed in a two-sided compartment. Mice going to one side would receive a shot of saline (water and salt) solution, while those going to the other side would get a shot of morphine. Repeated over several days, the mice started associating one side with the drug.

Next, the researchers switched things up: over two weeks, mice going into either compartment would receive only saline injections. This was meant to mimic a period of sobriety. With the mice properly sobered, the team was ready to test the role of empathy in relapse. During this step, one of the sober mice witnessed another mouse in a fearful state, the team reports. This sober mouse was then immediately placed in the dual-sided compartment, and the team tracked their fear response and preference for either compartment.

These mice consistently preferred the compartment they associated with morphine. This, the team reports, suggests they were expressing drug-seeking behavior in response to witnessing another mouse going through a traumatic event. Some mice were afterward treated with oxytocin, a hormone which has been linked with social bonding among other effects. The oxytocin heightened the mice’s fear response, the team adds.

All in all, the team concludes that mice (and people too, potentially) are negatively affected by witnessing a stressful or traumatic event. This negative emotional impact is strong enough to push them to seek drugs, even after a period of sobriety. Oxytocin treatment exacerbates this response, suggesting that social bonding (and empathy, by extension) is a driving force in this behavior.

The researchers say these findings are the first to demonstrate the direct link between empathy and drug relapse, and the first to suggest that oxytocin may play a role in enhancing this response.

The findings have been presented at the 57th Annual Meeting of the American College of Neuropsychopharmacology (ACNP), held December 9-13, 2018, in Hollywood, Florida.

Credit: Pixabay.

Hundreds of dietary supplements are tainted with unlisted drugs

A new review of dietary supplements revealed that 746 of them were contaminated with unknown drugs. The vast majority of the supplements are meant for sexual enhancements, weight loss, and bodybuilding.

Credit: Pixabay.

Credit: Pixabay.

Researchers at the California Department of Public Health combed through a Food and Drug Administration database of contaminated supplements for 2007 to 2016.

The findings suggest that about 80% of the dietary supplements were contaminated by one drug that should not have been in the product and 20% contained at least two such drugs. In the case of two particular supplements, researchers found six unapproved drugs.

The most common contaminants in supplements were sildenafil (Viagra) for sexual enhancement products; sibutramine and phenolphthalein in weight-loss products (both are banned by the FDA); and steroids in muscle-building supplements.

According to the study, more than half of the time, the FDA fails to enforce the recalls of supplements it has identified as containing unapproved drug ingredients.

Dietary supplements represent a $35 billion market, with more than 50% of the United States’ population consuming them.

Most supplement consumers wrongly believe that the products they are purchasing are regulated or vetted in some way. However, due to a 1994 law known as the Dietary Supplement Health and Education Act, such products are regulated as food. Therefore, they do not have to adhere to the strict rules or be subject to regulatory oversight like pharmaceuticals.

But — as this new study shows — many supplements contain pharmaceuticals. Worst of all, some products contain unlabeled pharmaceuticals. In light of this reality, the 1994 act ought to be overhauled. Many dietary supplements, such as vitamins, are risk-free, but the same can’t be said about the vast majority of sex, weight loss, and bodybuilding supplements — it is these categories that should be targeted for regulation.

“There’s many problems with the law [regulating supplements], so the ideal situation would be to revise the law so the FDA could do this much more efficiently,” Pieter Cohen, an assistant professor at Harvard Medical School who has studied the dangers of supplements, told Gizmodo. “One common-sense situation would be that individual brands need to be registered with the FDA prior to sale. And if they were found to be adulterated, the FDA would withdraw the registration and make them illegal to sell.”

Meanwhile, the FDA said that it is aware of the study’s findings and is in the process of analyzing them.

“The FDA is committed to doing everything within its resources and authorities to identify and remove unsafe products from the market, and we continue to work collaboratively with all of our stakeholders to help ensure that products marketed as dietary supplements are safe, well-manufactured, and accurately labeled,” reads their public statement.

When the FDA finds a supplement product that contains potentially hazardous ingredients, such as undeclared active pharmaceuticals, the agency said it works to remove it from the market. The challenge lies in the fact that even after a recall, other distributors may continue to sell the adulterated or misbranded product. The FDA has also found that distributors often re-label products to evade detection.

“Despite these challenges, the FDA recognizes the seriousness of this problem and continues to act within its resources and authorities to address this problem as best it can,” a FDA spokesman said.

The new findings were reported in the journal JAMA Network Open.

Credit: Pixabay.

Regular cannabis use may impair the ability to envision one’s personal future

Credit: Pixabay.

Credit: Pixabay.

A new study has found an association between regular cannabis use and an impaired ability to mentally travel back and forth in time. Those who use cannabis infrequently or who have never used the drug show no impairment in episodic foresight.

Episodic foresight is defined as the ability to project oneself into the future and mentally simulate situations and outcomes. Kimberly Mercuri, a researcher at the Australian Catholic University, and colleagues conducted a study involving 57 cannabis users and 57 control subjects.

In order to measure episodic foresight, the participants had to complete the Autobiographical Interview task, which involves responding to a cue word by either describing an event that occurred in the past or imagining a novel future event.

Regular cannabis users, defined here as those who smoked at least three times per week, showed difficulties imagining future scenarios, compared to the participants who had never used cannabis or use it less than once a week.

“The findings indicate that with regular cannabis use the ability to mentally time travel is negatively impacted; relative to people who have never used the drug and those who use it infrequently,” Mercuri told PsyPost.

“I guess the take home message is that there is growing evidence for possible cognitive deterioration with regular use which in turn can hinder the simplest of day-to-day tasks as the capacity to recall and imagine the self plays important roles other cognitive process (e.g decision making, goal setting).”

“Also, this deficit is not isolated to cannabis users, with another paper of ours indicating a significant impairment in future thinking observed in long-term opiate users,” the researcher said.

Mercuri notes that the findings do not imply that recreational cannabis use does not have consequences on episodic foresight. More research is required to understand the neurological underpinnings of the effect identified by the study. One important line of inquiry is whether the same effect is present in other drug-dependent groups.

The findings appeared in the Journal of Psychopharmacology.

Updated for grammar and spelling.

Credit: Pixabay.

More than 200 common prescription drugs might cause depression

A new study suggests that over one-third of American adults take at least one drug with depression as a side effect. Those who use such drugs are more likely to suffer from depression than those who don’t.

Credit: Pixabay.

Credit: Pixabay.

Researchers at the University of Illinois at Chicago analyzed data from the National Health and Nutrition Examination Survey, a large and nationally representative dataset, which contains information on the medications used by 26,00 American adults between 2005 and 2014. Among the medication used by the survey’s participants, the researchers found over 200 common prescription drugs that depression or suicidal symptoms listed as potential side effects. Some of these drugs include certain types of proton pump inhibitors (PPIs), beta blockers, anxiety drugs, painkillers including ibuprofen, ACE inhibitors (used to treat high blood pressure), and anticonvulsant drugs.

More and more Americans are using such prescription drugs, according to the study published this week in the journal JAMA. In the year 2005-2006, 35 percent of the participants had been taking a prescription drug with depression listed as a potential side effect, but less decade a later, in 2013-2014, this figure jumped to 38.4 percent. What’s more, the fraction of American adults taking three or more prescription drugs with these side effects jumped from 6.9 percent in 2005-2006 to 9.5 percent in 2013-2014.

Some of the medication on the list are well known for their depression-like side effects, such as beta-blockers and interferon. However, the sheer number of drugs with similar effects was surprising even to the researchers. What’s more, some of the drugs singled out by the study are sold over-the-counter in pharmacies.

Does this mean that these drugs are responsible for the surge in depression and suicide rates seen in the United States? Maybe, but that’s not what this study set out to do. The researchers have not established any causal relationship between the drugs they identified in the study and depression — they merely pointed out a correlation. So, just because these medications could potentially trigger depression in patients, that doesn’t mean they will in every situation.

On the other hand, there’s a worrisome dose-response pattern: the more of these drugs patients took concurrently, the higher their risk of depression. 

As such, the findings do warrant serious consideration and further research. Meanwhile, the authors recommend that physicians pay close attention to these side effects when prescribing medications.

8 New Tools and Emerging Technologies For Tuberculosis

Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB. Credit: NIAID, Flickr.

Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB. Credit: NIAID, Flickr.

 

World TB Day is celebrated every year on March 24 to raise public awareness about the devastating health, social and economic consequences of tuberculosis (TB). World TB Day 2018 is exceptionally noteworthy because never in the history of TB has there been more attention and commitment to ending the infectious disease that kills 1.7 million people each year.

The animation below shows how TB spreads in the body and how the immune system fights it. It also illustrates the different ways the TB bacterium can develop into the disease; either through overwhelming the immune system (common in children) or by latent TB waking up and becoming active (typical for those with weak immune systems such as older people, those who are HIV positive, or have had organ transplants or chemotherapy).

Global progress depends on advances in TB diagnosis, prevention, and care in countries with high TB burden. In celebration of World TB day, here are eight new developments about tuberculosis drugs, vaccines, and diagnostics.

  1. TB is diagnosed using a skin test, or by culturing bacteria from a person’s sputum. Both methods can only be performed by trained microbiologists and may take several days to give results. Good news! Professor Alessandra Luchini, of George Mason University in Virginia, and her team developed a urine test that detects a specific sugar that coats the surface of TB bacteria and gives results in half a day.
  2. A team of chemists working in collaboration with doctors and public health researchers in South Africa has developed a new test that makes it easier to diagnose TB. The test developed by Professor Carolyn Bertozzi and the team at Stanford ChEM-H is called DMN-Tre and takes just a few steps and produces results in under an hour. They attached the sugar trehalose to a fluorescent dye that, once ingested, glows about 700 times brighter than before. When you see a very bright cell, it means live tuberculosis is present.
  3. The only licensed TB vaccine, BCG (Bacillus Calmette Guerin), was developed by Albert Calmette, a French physician and bacteriologist, and Camille Guérin, a veterinarian more than a century ago. However, a new study suggests that when given to adolescents who had been vaccinated as infants, a single dose of BCG could prevent a sustained TB infection by 45 percent.
  4. A newer live attenuated TB-vaccine ‘MTBVAC’ developed by Biofabri, Professor Carlos Martin and his team at the University of Zaragoza has finished Phase 1b trials carried out in healthy HIV unexposed newborn infants in South Africa, a country highly endemic for tuberculosis. MTBVAC was found to be well tolerated and induced a dose-dependent immune response that was distinct from the response induced by BCG. A subsequent Phase 2 trial in newborns to confirm its safety and to determine the final dose will go ahead in the next months.
  5. To create a better TB vaccine, a better understanding of the pathogenesis of TB is essential. A granuloma is an aggregate of cells and is the pathological hallmark of TB. To study how granulomas form, Professor Joanne Flynn and colleagues from the University of Pittsburgh use animal models, mainly using different macaques to watch how infection spreads in real-time. Flynn and her team developed an imaging modality called PET/CT, which uses fluorodeoxyglucose (FDG) as a probe, just like in cancer studies where they measure the level of inflammation or metabolic activity for each granuloma.
  6. The World Health Organization (WHO) has requested drug makers to submit an Expression of Interest (EoI) for Bedaquiline and Delaminid, two new-generation drugs, recommended for drug resistant-TB. Drugs passing the standards (or pre-qualified) will then be included in a list for procurement by the UN and other organisations.  This will ensure more manufacturers to supply quality medicines, which will make the market more competitive and prices more affordable.
  7. XDR-TB refers to strains of TB that are resistant to rifampicin and isoniazid and a fluoroquinolone and at least one of the three injectable TB drugs, capreomycin, kanamycin, and amikacin. The Nix-TB trial is the first TB clinical trial to test a new drug combination which has the possibility of being a shorter, all oral, and affordable treatment for XDR-TB. This combination does not require injections and has far fewer pills.
  8. Research conducted by Rockefeller scientists offers hope for a new and potent weapon against tuberculosis. Their work focuses on an antibiotic that kills MTB in the laboratory but is not suitable for clinical use. Fidaxomicin is uncommonly adept at killing tuberculosis cultivated in the lab. However, when taken orally, an antibiotic must be absorbed by the gut and eventually reach the lungs – but fidaxomicin is unable to do so. By understanding how fidaxomicin operates, the research by Rockefeller scientists could allow others to design new antibiotics that could be used to treat tuberculosis patients and might even work on other bugs.