Cocaine is derived from the coca plant and its use by natives of South America goes back many centuries. It was used for ritual and religious purposes as well as to promote energy and to allay hunger. South Americans chewed the leaves of the plant, which delivered a far less potent form of the drug than the methods of delivery in use today.

In this country, we have used cocaine both for medicinal and recreational purposes. An ingredient in patent medicines and tonics sold in the late 19th century and even in early Coca-Cola, cocaine was used for its uplifting and energizing effects. Doctors prescribed it for depression and fatigue. In all its forms, it has been a well-publicized problem in the United States. There was an epidemic of cocaine use in the 1980’s.

Since the development of smokable forms of cocaine, such as “freebase” and “crack,” cocaine use has been increasingly associated with violent crime. Cocaine does have legitimate medical uses, including topical anesthesia, but most use of this highly addictive drug in the 20th century has been related to illegal activity. It is snorted, smoked and sometimes injected.

Amphetamines are synthetic stimulants, including prescription drugs and a variety of illegal drugs, including methamphetamine (often called “speed” or “crank.”) Drugs such as Dexedrine, Dexamyl and Benzedrine were widely prescribed for weight loss in the 1950’s and 60’s and have been used medically to treat narcolepsy and depression. The clear dangers of addiction and the diversion of these drugs for illegal purposes were recognized in the late 60’s and early 70’s. Doctors curtailed much use of amphetamines. The federal government also took action against the prescription use of these drugs.

Various forms of illegal “speed,” often snorted, smoked or injected, have been very popular. When asked about the difference between cocaine and amphetamine, one addict explained that, “Speed’s a better buy!” (His answer referred to the comparatively lower cost and longer action for amphetamines.) The negative effects, including paranoia, tend to hang on longer than with cocaine.

Other diet pills have been developed with the intention of creating a safer alternative, but, despite the modified effects, there continue to be problems similar to those experienced with amphetamines. One very popular combination, referred to as Fen-Phen (Fenflyueramine and phentermin lonamin, has recently been associated with heart problems and deaths, so its use has been discontinued. Ritalin (Methylphenidate) is another amphetamine-like drug, which has been used to treat attention deficit hyperactivity disorder and narcolepsy.

Nicotine is the currently the deadliest drug of all. Quickly and thoroughly addicting, this legal, highly available drug is responsible for more deaths in the United States and worldwide than any other drug. The World Health Organization estimates that there are currently 3.5 million death a year from tobacco, a figure expected to rise to about 10 million by 2030 (WHO, 1999). Nicotine use is declining in this country, but there are disturbing trends worldwide. “Long, relentless public health awareness campaigns in the U.S., Britain and other western countries have finally shown some results, with the number of smokers dropping steadily at about 1% per year. To make up for this, and to pay the enormous costs of the recent settlements, tobacco companies have had to turn elsewhere for sales. They seem to be successful, sales worldwide are up 2%!” (The Web of Addictions, 1996).

Caffeine, widely used as a stimulant, is a natural substance that is present in the leaves, seeds or fruits of more than 60 plant species. It is readily available in coffee, tea, soft drinks and over-the-counter pills such as No Doz and Excedrine Migraine. Americans use caffeine regularly with little consideration of the drug effect. While a mild and relatively safe stimulant, when compared to amphetamines or cocaine, there are still problems associated with excessive caffeine intake. “Excessive intake” is considered to be more than five or six cups per day. Sleep disturbances, withdrawal syndrome (headache, depression, fatigue) and panic attacks are the problems most clearly related to excessive use. While research has been done in efforts to understand the health risks of caffeine, results have not been conclusive in finding links between caffeine use and serious illness.