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Abbreviations
Δ9-THC: Δ-9-tetrahydrocannabinol
ADHD: attention-deficit/hyperactivity disorder
AIDS: acquired immune deficiency syndrome
AUD: alcohol use disorder
CBD: cannabidiol
CDC: U.S. Centers for Disease Control and Prevention
CRF: corticotropin-releasing factor
CSA: Controlled Substances Act
DA: dopamine
DAT: dopamine transporter
DEA: U.S. Drug Enforcement Administration
DMT: dimethyltryptamine
DSM-5: Diagnostic and Statistical Manual of Mental Disorders (fifth edition)
GABA: γ-aminobutyric acid
GPCR: G protein-coupled receptor
5HT: serotonin (5-hydroxytryptamine)
KOR: κ (kappa) opioid receptor
LSD: d-lysergic acid diethylamide
MDA: methylenedioxy-amphetamine
MDMA: 3,4-methylenedioxy-methamphetamine
MOR: µ (mu) opioid receptor
MPH: methylphenidate
NDEWS: National Drug Early Warning System
NDTA: National Drug Threat Assessment
NE: norepinephrine
NIAAA: National Institute on Alcohol Abuse and Alcoholism
NIDA: National Institute on Drug Abuse
NMDA: N-methyl-D-aspartate
OUD: opioid use disorder
PCP: phencyclidine
psilocybin: 4-phosphoryloxy-N,N-dimethyltryptamine
PTSD: posttraumatic stress disorder
SAMSA: Substance Use and Mental Health Services Administration
SUD: substance use disorder
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A BRIEF HISTORY OF THE USE OF PSYCHOACTIVE AND ADDICTIVE SUBSTANCES
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Addictive and hallucinogenic substances have been used throughout mankind’s cultural history. Traditionally, these substances have been used by healers for medicinal purposes and by priests in religious ceremonies. Hallucinogenic plants and mushrooms were used in pre-Columbian Mesoamerican cultures, opium has been known to man since prehistoric times, and alcoholic substances have been widely socially accepted for thousands of years. The advent of chemistry and pharmaceutical companies in the 19th century allowed for the analysis of psychoactive substances in coca leaves and poppy seeds, leading to the extraction and identification of the active ingredients and the synthesis of new compounds that were modeled after the botanical material. The hope was to find substances that could cure medical conditions and relieve pain without some of the addictive or adverse properties of the botanical extracts. Cocaine, morphine, and heroin were synthesized, and, although it seems absurd from today’s vantage point, were marketed as less addictive and more beneficial for addiction treatment. Morphine was a blessing during the American Civil War, as it was 100 years later during the U.S. involvement in Vietnam, and in both wars, many soldiers developed dependencies.
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Regulatory Responses in the U.S. to Issues of Purity, Use, and Misuse of Drugs
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Initial steps to regulate pharmaceuticals were introduced with the Pure Food and Drugs Act in 1906. That act stipulated that active ingredients be listed on the label of a drug’s packaging and that drugs could not fall below purity levels established by the U.S. Pharmacopeia (National Formulary). However, addictive drugs continued to be legally available without prescriptions as long as they were properly labeled. In 1908, with opium dens in most major cities, the first Opium Commissioner was appointed, and in 1914, the Harrison Narcotics Act was enacted. It regulated and taxed the production, importation, and distribution of heroin and cocaine. For the first time, doctors and pharmacists had to keep records of prescriptions.
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The temperance movement and Prohibition, solidified ...