Observations on Consciousness Alteration
By Andrew T. Weil, M.D. Journal of Psychedelic Drugs 9(1), Jan-Mar 1977: 75-78.
By Andrew T. Weil, M.D. Journal of Psychedelic Drugs 9(1), Jan-Mar 1977: 75-78.
With marijuana decriminalization well underway, pressure is now mounting for reform of laws against the private, recreational use of cocaine, and there is even growing support from respectable persons and institutions for the legalization of heroin. It is no longer fanciful to envision an end to the entire structure of control of drugs by means of the criminal law.
Of course, the folly of this system has long been evident to those who would see it. Laws against the possession and use of psychoactive drugs have never worked; in fact, they are always counterproductive, worsening the very situations they aim to improve. Society's attempts to control cocaine provide an illuminating model of this counter productivity.
Coca leaf was a sacred and revered substance in the ancient Incan empire, and its use was an integral element of the fabric of society. Use of the leaf was restricted to certain classes and purposes and was regulated by a system of social controls accepted by all (Mortimer 1974; Grinspoon & Bakalar 1976). The Spanish destroyed this system when they conquered Peru. As a result , coca use spread throughout the native population and lost its sacred character.
After a brief attempt to eradicate coca chewing as a satanic vice, the new Spanish authorities decided to allow it as a means of getting more work out of Indians. Most of the conquerers had low opinions of the Indians and did not believe their tales of wonderful effects of the divine leaf. Those Europeans who condescended to try coca often did not feel anything from it, possibly because they did not bother to learn the art of chewing it in the Indian manner and possibly because they approached it with a negative set (Mortimer 1974; Grinspoon & Bakalar 1976).
By the late 1800's, when Europeans finally did wake up to the real virtues of coca, they tried to incorporate it into their medicine, mostly in the form of alcoholic tonics and wines containing extracts of the leaf. The most famous of these tonics was Vin Mariani a la Coca du Perou (Mariani 1896; Andrews & Solomon 1975; Mortimer 1974; Groff 1975). But by this time, a German chemist, Albert Niemann, had isolated cocaine from coca and pharmacologists represented this pure alkaloid to be the sole substance of interest in the leaf, embodying all of the therapeutic properties of coca in a more concentrated and easily administered form. This idea persists today even though it is sadly mistaken. Average coca leaves contain only 0.5% cocaine, and as the Indians chew them, this low dose enters the body very slowly (Martin 1970; Weil 1975). Moreover, cocaine is but one of a number of compounds that act synergistically to produce the characteristic effects of coca; its separation from all the flavors and nutrients of the whole leaf as well as from the other alkaloids that modify its stimulating action is major meddling with the chemistry of coca (Martin 1970; Weil 1975).
In 1884, Carl Koller "discovered" the local anesthetic effect of cocaine when he watched a colleague lick the drug from the point of a knife and heard him comment on the numbness of his tongue (Becker 1963). Doctors on both sides of the Atlantic hailed the drug as a new panacea and began prescribing it quite indiscriminately and in high doses for all sorts of conditions, including dependence on alcohol and opiates (Grinspoon & Bakalar 1976; Ashley 1975). This kind of use soon produced cases of acute toxic reactions, some of them fatal, as well as cases of chronic dependence, mostly in persons already addicted to opiates. Sensational publicity about these untoward results quickly gave cocaine a bad reputation and led to Its rejection by the medical profession as dangerous (Grinspoon & Bakalar 1976; Ashley 1975); it also engendered the attitude that coca leaf was the source of all the trouble. After all, if coca had not come to Europe and America, the cocaine problem would never have developed.
It is most significant that the "terrible effects" of cocaine, which justified passage of anti-cocaine laws at the turn of the century, were consequences of unwise medical use of the drug by physicians. To this day, the vast majority of deaths from cocaine have occurred in medical circumstances rather than recreational ones (Woods & Downs 1973; Ashley 1975; Grinspoon & ,Bakalar 1976).
In the United States, we have tried to solve the cocaine problem through criminal legislation for almost three-quarters of a century. What has that accomplished?
Consumption of cocaine, mostly in adulterated form by the intra nasal route, has vastly increased, and its grossly inflated price has diverted huge sums of money to groups that probably do not have the best interests of society at heart. Coca leaf, the safe, natural form of the drug, has disappeared from the country; it is unknown to medical doctors and cannot be obtained even for legitimate therapeutic use. Scientific research on cocaine has been minimal and on coca nonexistent.
The recreational use of cocaine in the U.S. is now so widespread and is growing so rapidly, especially in affluent sectors of society, that the chances of making the drug disappear or significantly curtailing its availability are vanishingly small. Cocaine is here to stay, thanks to the activities of pharmacologists and doctors of the last century and the direct effects of laws designed to prohibit its use.
I believe' we can still do something to save the situation and that is to make coca leaf available as a recreational stimulant.
For a number of years I have been investigating the uses of coca among Indians in South America, mostly in the Colombian Amazon and the Peruvian Andes. In the course of meeting and living with many hundreds of coqueros, I have never seen an instance of coca toxicity nor a single case of coca dependence, either physiological or psychological. There is no development of tolerance to the effect of coca, even in regular, daily use over many years, and, certainly, no appearance of any withdrawal syndrome on sudden discontinuance of it. Nor have I seen any signs of physical deterioration attributable to coca (Weil 1975).
Of course, I am familiar with propaganda against coca that comes from non-Indian officials of South American governments and international narcotics agencies. (For an example of this kind of writing, see Granier-Doyeux .) The thrust of this propaganda is that coqueros are undernourished and unproductive. My observations, like those of others with first-hand experience of Indian life, are that excessive use of coca, when it occurs, is a result of social and economic deprivation rather than a cause of it.
Aside from its regular use as a mild stimulant, coca enjoys a great reputation as a remedy in the folk medicine of South America. It is considered the best treatment for the symptoms of altitude sickness and a useful remedy for all painful and spasmodic conditions of the gastro-intestinal tract. Indians also use it as general tonic and restorative, especially to combat fatigue during physical exertion. They, believe it invigorates and tones the body, prolongs life, increases the digestion and assimilation of food, promotes dental hygiene, and confers resistance to disease (Martin 1970, Mortimer 1974).
In South America I had a chance to prescribe coca as a treatment for various ailments and was able to confirm some of its folk medicinal applications' I found it particularly useful in relieving gastro-intestinal symptoms and as an adjunct in programs of weight reduction and physical fitness. In giving coca as a remedy, I taught patients how to chew the leaves as learned from Indian coqueros. Most people liked the flavor of the leaves and the novel sensation of topic oral anesthesia. I saw no adverse reactions. I believe that coca in whole leaf form is less toxic than many drugs now in common use and may be effective in a number of common diseases. I would like to see North American physicians take interest in coca and experiment with it because I think it would make a safe and useful addition to the modern pharmacopeia (Weil in press).
I hope also that coca will eventually be available here as a recreational drug, particularly to persons who now use cocaine, amphetamines, and other stimulants, that are more toxic and more encouraging of abuse.
Coca leaf has several characteristics that recommended it as a recreational stimulant. It tastes good, produces immediately perceptible sensations in the mouth, and it easily becomes a stimulus for high states of consciousness that can be used productively. I have contend that high states experienced after taking psychoactive drugs are latent in the human nervous system and are not direct effects of the drugs (Weil 1972). People learn to associate them with physical cues that are direct effects of drugs, and this association is shaped more by expectation than by pharmacology. Highs can be had without drugs (and might be preferable that way), but drugs can be useful as long as they remain effective over time and do not compromise health or productivity.
The topical anesthesia of coca is a striking physical change that lets you know something is happening to you. It can become a strong cue for good moods and feelings of physical energy, especially since the historical and cultural aura of coca encourages expectation of these results. Aside from the oral anesthesia, the actual pharmacological effects of coca are quite subtle. Persons who approach the leaf with no expectation may feet nothing outside of the mouth. This is all to coca's credit because it is healthier to learn to get high on subtle drugs rather than strong ones.
The abuse potential of coca is low relative to cocaine and many other common drugs. This is so, first, because the concentration of active compounds in the leaf is small and, second, because the best way of using coca -holding a quid of leaves in the mouth in an alkaline solution and sucking the juices out of them over the better part of an hour - ensures a gradual rise of cocaine in the bloodstream. In leaf form, coca provides some essential vitamins and minerals (Duke, Aulik & Plowman 1975). Moreover, chewing coca is work much more work than snorting a powder or swallowing a pill. Having to work to get the reinforcing effect of a stimulant is a safeguard against overusing it.
Although outsiders who visit Indian communities in the Andes may come to like chewing coca in the traditional way, many North Americans might be unwilling to masticate a large handful of dry leaves into a manageable quid and keep it in the mouth in the required manner. To be a useful recreational drug in our society, coca would have to be available in a culturally acceptable form that left the chemical composition of the leaf intact as well as those physical characteristics that discourage overuse.
The coca wines and tonics of the last century failed on three counts. They changed the route of administration for the worse: coca that is simply swallowed does not have as good an effect as coca retained in the mouth in alkaline solution. They made the drug too easy and attractive to take, eliminating the requirement for work Imposed by the whole leaf. And they combined coca with alcohol, a much stronger and more dangerous drug. am not in favor of reviving those preparations.
The best solution to the problem of how to use coca in our society is a chewing gum. An extract of whole coca, containing all the alkaloids in standardized doses, as well as the natural flavors, vitamins, and minerals, can be incorporated into a sugarless gum base together with an appropriate alkali. Coca in chewing gum form would closely reproduce the traditional method of use, including the necessity of working for a reinforcing effect; 'it should also be acceptable to people of modern, industrialized cultures. Several colleagues and I are currently working on such a product.
As a natural stimulant of low abuse potential that provides some nutritional factors and may have some beneficial effects on the body, whole coca can be useful to some people. It can serve as a stimulus to physical activity, such as hiking, running, and athletics, and may motivate individuals who are so inclined to develop better habits of exercise. It can be an aid to concentration and mental activity, as coffee can be, although coca does not produce the jitteriness of caffeine and is much better for the digestive system. It can provide a useful break from routine work and, especially in the company of friends, an occasion for pleasant social interaction. Using the effect for such purposes rather than simply feeling it is one way of building good relationships with coca.
For too long we have tried to control drugs by means of legal prohibitions. These laws have not only failed, they have made things worse. In the case of coca, they have driven out of circulation the natural substance that easily lends itself to the formation of good relationships while steadily encouraging the growth of a black market in cocaine, which is less useful, more dangerous, and much easier to abuse.
Perhaps it is time to try a positive action instead of a negative one. Making coca leaf available, first as a therapeutic agent on medical prescription, and later as a recreational drug for those who wanted it, would be a positive step. It would help shift the burden of control from the legal process to the social process. Only social controls are effective in modifying patterns of drug use, and they depend on right education and experience (Jacobson & Zinberg 1975). Socially controlled drug use, in which abusive patterns of consumption simply do not develop because people recognize their inutility, will not come about overnight, especially after so many years of misinformation and repressive legislation. But it will never begin to come about until we provide those who want to use drugs with forms of them that can be used constructively.
The story of Western civilization's interaction with coca, from the Spanish conquest of Peru to the explosion of cocaine use in contemporary America, makes fascinating study. It shows clearly how we have gone wrong in our relationships with Nature's pharmacological gifts and reminds us again and again that drug abuse is not inherent in substances but rather in the ways we think of them and what we do with them. If we had set out deliberately to get ourselves in a colossal mess with coca we could not have done it better. The process has been one of unremitting folly and almost willful failure to see the error of our ways. If we are to reverse it, after all this time, we must go back to the very beginning and try to understand the natural substance, the coca leaf itself, that the Incans said was sent from heaven to improve our lives.
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