ASIA, DRUG USE IN
By Dr.fourkan Ali
Asia is the world's largest continent; India
and China are its most populous countries. More than half the world's
population lives in Asia. Thus we find considerable variation in drug use and
drug problems there, not only among the various countries but also within them.
Unfortunately, the available information about drug use in Asia is sketchy and
fragmentary; few good studies have been published. Epidemiological data are
almost completely absent. The rapid social, economic, cultural, and political
transformations are adding to the complexity of drug-use patterns and
associated drug-related problems in Asia and worldwide. This article provides a
broad overview of the historical, cultural, political and economic forces that
have shaped drug use in Asia. It should be kept in mind that current drug use
in many parts of Asia is tied to drug-production. Myanmar and Afghanistan
produce most of the world's illegal opium, while the Golden Triangle of
Southeast Asia (Myanmar, Thailand, and Laos) find users contracting HIV
infections from contaminated needles.
TEA
Most people know the tea plant Camellia
sinensis in the brewed form of TEA. Tea has been part of Asian culture
for thousands of years. Its use seems to have originated in southeastern China.
It is mentioned in the very early Chinese medical literature. To a large
extent, the medical benefits of tea can be ascribed to the chemical
theophylline, which depending on its use can have eithermildly calming or
stimulating effects. The use of tea as a popular beverage and its production in
large quantities has only been documented since the sixth century. The history
of tea is also a history of international trade. Japan was one of the first
countries to import tea from China, and tea became part of the Japanese
culture. Chanoyu (the way of the tea) is a meditation ritual
introduced in Japan by Zen Buddhist monks several hundred years ago, and
elaborate tea ceremonies developed there. This tea ceremony is still taught and
practiced in modern Japan.
Tea became the primary stimulant beverage not
only in China and Japan but also in India, Malaysia, the Russian empire, and
other Asian countries.
In the 1700s, tea was imported directly to
Great Britain and to the British colonies by the East India Company. Even
today, there are tea-preferring countries like Britain and coffee-preferring
countries like Spain. The difference in preference goes back to the time of
colonial trading: Those countries with tea-producing colonies drank tea, because
it was cheaper than coffee; countries with coffee-producing colonies drank
coffee, because for them it was cheaper than tea.
OPIUM
After tea, the drug most often associated with
Asia is Opium. Opium is prepared from the opium poppy (Papaver somniferum ),
which grows well in the alkaline limestone soil of Turkey and Iran, east
through Afghanistan and Pakistan to the northern mountainous areas of Myanmar
(formerly Burma), Thailand, and Laos. The area forms a crescent, thus the name
Golden Crescent. The mountainous areas of Myanmar, Thailand, and Laos are known
as the Golden Triangle.
Medical historians have been able to document
that Arabian physicians of Asia Minor extracted raw opium from the seed pods of
the poppy and used it to treat pain and diarrhea before a.d. 1000. Arabian
traders began exporting opium to India and China about that time, and it also
appeared in trade shipments to Europe. Although accurate documentation is
scarce, some observers claim that opium use spread faster in precolonial and colonial
India, than in China. A British royal commission investigated Indian opium use
in 1895 and claimed that the people of India had not suffered detrimental
effects from the taking of opium. The situation was different in China. The
British traded Indian-grown opium for Chinese tea and porcelain. This led to an
increasing supply of opium in China, associated with an increasing use of opium
for recreational purposes. During the nineteenth century a raging epidemic of
opium smoking in China led to a situation of great concern to the Chinese
government. In an attempt to cut the supply of opium, the Chinese government
tried to close its ports to British trade. This resulted in the Opium wars
(1839-1842), but Britain won the war and the right to continue trading opium to
China.
The different responses of India and China to
the availability of opium might be explained, to some degree, by the way this
drug was introduced to the population. In India, opium was introduced as a
medicinal plant, to be taken by mouth and swallowed. In contrast, in China
during the 1500s, Portuguese sailors had just introduced New World tobacco
smoking as a form of a recreational drug use. Many Chinese, who had just picked
up tobacco smoking, substituted opium for tobacco. Thus opium was not only
introduced as a nonmedicinal recreational drug, but it was also introduced in a
different route of administration. Drugs inhaled through the lungs seem to
produce faster and more severe dependence than those ingested through the
gastrointestinal tract.
Effective government control of opium smoking
in China did not become possible until late in the nineteenth and early
twentieth centuries when Britain, the United States, and other world powers
signed international agreements to help curb worldwide supply and distribution
networks. They cooperated because opium abuse spread and started to affect
these countries directly. In 1930, the League of Nations Commission of Inquiry
into the Control of Opium Smoking in the Far East reported that opium use had not
been prohibited in any Asian country except the Philippines. By 1950, this
situation had changed dramatically. Many Asian countries placed high priority
on narcotic-control policies. Harsh penalties, including the death penalty, had
been reinstated for drug trafficking and possession of opium and derivatives,
like Morphine and Heroin.
Despite these government actions, opium and
its derivatives are still used widely in regions where they are grown. In 1990,
Myanmar, Thailand, and Laos supplied about 56 percent of the heroin consumed in
the United States. By 1999, Latin America supplied most of the heroin to the
United States, accounting for 82 percent of the heroin seized in the U.S. The
Southeast Asian opium crop, which was on the rise in the early 1990s, suffered
a sharp decline due to adverse weather in the later 1990s. China has moved to
contain opium trafficking. In 1998, China began a "Drug Free
Communities" program to eliminate drug trafficking and abuse as well as
drug-related crime.
CANNABIS
Known in the United States mainly as the
Mari-Juana plant, Cannabis sativa may first have been
cultivated in Asia in a region just north of Afghanistan. From there it seems
to have spread to China and India. It is mentioned in the early medical
literature of China (e.g., in the Shenmong bencao ) as well as
in India (e.g., in the Sushruta samhita ). Early nonmedical
use has also been documented.
Cannabis use seems to have become popular especially in India and
the Islamic countries. The many social rules associated with its use are
evidence of its long-standing integration into Indian culture. Traditional
Indian society was divided into hereditary classes or castes. The highest caste
was to use white-flowered cannabis; the Kshatriya, the warriors, used the red-flowered
plants; the farmers and traders, the Vaishya caste, were to use the
yellow-flowered plant; and the Shudra, servant caste, used plants with dark
flowers.
The earliest Indian medical text, Sushruta
samhita, apparently dating from pre-Christian times, differentiated three
major ways of preparing and administering Cannabis —BHANG,
GANJA, andcharas. Bhang was a sweet drink prepared from the leaves
and flower shoots, which also might be brewed as a tea. Ganja was
the dried flowers, which was smoked. Charas was a cake
compound from the most resinous parts of the plant; this seems to have been the
upper-class favorite. While bhang, ganja, and charas are still used
in India today, the form of preparation may not be quite the same as the
recipes in the Sushruta samhita.
BETEL NUT
In southern parts of Asia, mainly in India,
Indonesia, Malaysia, southern China, and also in East Africa, many people chew
Betel Nut (Areca catechu ). The nut is prepared by wrapping it in a
betel pepper leaf (Piper belle ) with a compound of lime (calcium
hydroxide or calcium carbonate) and spices. Chewing this preparation produces
mild stimulating effects. At the same time, the saliva becomes red and the
mouth and teeth are stained red. Mouth cancer may result.
The ancient Greek traveler and historian
Herodotus wrote about betel-nut chewing in 340 b.c. Although its use seems to
be declining, an estimated 400 million persons are still dependent on this
substance.
OTHER NATIVE DRUGS
Students interested in Ethnopharmacology and
cultural practices associated with drug use will find many fascinating accounts
in Asian history. One modern example involves the consumption of a drink called
Kava, which is prepared from the roots of Piper methysticum. In
Polynesia, Micronesia, and Melanesia this drink is taken for recreational
purposes, to calm and sedate the user.
There are ancient drug-taking practices
connected to Fly Agaric, a sometimes deadly mushroom (Amanita mascaria )
found in several countries. One way to reduce the toxicity of this mushroom is
to feed it to a reindeer and drink the reindeer urine, which contains
intoxicating metabolites of the chemicals found in the mushroom.
STIMULANTS
Some Asian countries have suffered epidemics
of drug use in connection with legally produced drug products. An especially
widespread epidemic of Amphetamine use started in Japan during World War II and
continued into the 1950s. A second wave of amphetamine use was reported in the
late 1970s. Recently an epidemic of Methampheta-Mine "(ice)" smoking
spread across the Pacific into Hawaii and other American states after earlier
micro-epidemics in Asia.
ALCOHOL
The account of drug use in Asia would be
incomplete without mention of alcoholic beverages. At present, Asia is the
continent with the lowest overall per-capita consumption of Alcohol. In many
Asian countries, alcohol consumption is prohibited on religious grounds—because
of the prohibitions of Islam: the Koran forbids its use. Nonetheless, even in
the most conservative Islamic countries, there is some alcohol dependence.
Saudi Arabia for example, has an Alcoholics Anonymous (AA) organization and a
modern hospital for drug and alcohol treatment.
In addition to religious and social restrictions
on alcohol consumption, there are some important biological factors known to be
related to genetic variation within the Asian population. For example, many
Asian people have the "flushing syndrome" in response to alcohol that
is associated with their particular configuration of aldehyde dehydrogenase, an
alcohol-metabolizing enzyme. One prominent sign is that their facial skin
becomes flushed. Although this response might work to discourage alcohol use,
and thus protect against alcohol dependence, many Asian people—especially
men—are known to "drink through" the flushing response to become
intoxicated. In fact, South Korean males suffer from the highest recorded
prevalence rates of alcohol abuse and dependence: An estimated 44 percent of
adult men have a history of currently active or former alcohol abuse and/or
dependence. The reasons for this very high rate are a matter of speculation and
should be a topic of intense study. As evidence of the considerable variation
in alcohol problems in Asia, Taiwan has one of the lowest rates of alcohol
abuse and dependence in the world for both adult men and women. This variation
cannot be explained by differences in research methods, because the same
methods have been used in surveys of Taiwan and South Korea. The difference
must involve fundamental social and cultural differences, or fundamental
biological differences in vulnerability to alcohol-related problems, or a
combination.
Alcohol use is not a new phenomenon in Asia.
The drinking of fermented beverages has been part of Asian cultures since
antiquity, as documented in the early classical literature of China (in
the Shujing and the Liji ), India (in
the Susruta samhita ), and other countries. The Susruta
samhita describes various stages of intoxication. In China, the fall
of the Shang Dynasty in the eleventh century b.c. was attributed to excessive
use of alcohol by the emperor and his followers. The same explanation was given
for the fall of later dynasties. In China, different forms of alcohol have been
fermented from various kinds of grain. In other parts of Asia, alcoholic
beverages were based on a large variety of different substances, including rice
in the case of Japanese sake; horse milk in the case of Kumys, an alcoholic
beverage prepared by northern and central Asian nomads; and toddy-palm sap in
the case of arrack prepared in southern India and Indonesia.
An early epidemic of drug use combining
alcohol with a drug called hanshi can be traced in the ancient
writings of the time of the fall and overthrow of the Chinese Han Dynasty—a
time of rapid changes in society (second and third century a.d.). The use
of hanshi was associated with an unconventional
"bohemian" lifestyle, disregard of social norms, "disheveled
hair," and "incorrect clothing." The hanshi users
were reported to claim that the drug helped open their minds and clarify their
thinking. Although reports of this early epidemic are sketchy, hanshi is
mentioned in several later medieval texts, mainly in relation to remedies that
can be used to help treat its detrimental side effects. At present it is not
clear which chemical compound was present in hanshi.
TOBACCO
Probably the most widespread twentieth-century
epidemic in Asia is Tobacco smoking. Today, in most Asian countries, local,
international, and especially American tobacco manufacturers are marketing
their products aggressively—in part because of declining demand in North
America and in part because of the increasing economic strength of the Asian
countries. One result has been an increase in the consumption of tobacco
products since the 1960s, especially the smoking of cigarettes.
Tobacco became a part of Asian culture from
the time it was imported by Europeans from their colonies in the Americas
during the 1600s. The "hubbly-bubbly," or hookahs, of the Middle East
and India were used for smoking tobacco. This was centuries before modern
advertisement techniques were applied by the tobacco industry. But recently,
tobacco-related diseases and deaths are becoming more prominent in the health
statistics of Asia. This toll is connected directly to an increasing
consumption of tobacco products. Part of the tobacco is imported from the
United States and other international suppliers. Some observers noticed
similarities to the situation in the nineteenth-century, when British traders
aggressively fought to keep the lucrative opium trade from being interrupted.
Some thus call for international agreements concerning tobacco trade, similar
to those which helped curb the opium problem at the beginning of the twentieth
century. International support seems to be needed to help these countries
reduce tobacco-related problems.
THE FUTURE
As commerce between countries has increased,
so has the traffic in drugs. For centuries Asia has had trading partners for
its tea, opium, and Cannabis. In return it has received shipments
of other goods, including pharmaceuticals. Sometimes these exchanges have been
within Asia, as in the early introduction of opium into China by Arabian
traders, and the later commerce in opium between colonial India and China. Now
trading is done on a worldwide scale, whether it is the legal trade with tea or
the illegal traffic of opium. Recently some countries in Asia have reported an
increase in Polydrug use among their younger population.
Since the 1950s, a number of Asian countries
have also experienced a growth of what might best be called "drug
tourism." Travelers, mainly from the Western Hemisphere, have come to Asia
to purchase and consume such drugs as opium, Cannabis, heroin, and magic
mushrooms. For many, it has come as a surprise that Asian countries respond
with harsh penalties, as did Singapore in 1994, when a man from the Netherlands
was hanged for possessing a large amount of heroin. It must be kept in mind
that a long history of harsh penalties and social sanctions against those who
violate social conventions, including local drug regulations, are part of Asian
heritage—as well as the seemingly exotic custom of drug use.
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