Cannabis, cocaine and heroin have interesting life stories and long rap sheets. We might know them today as illicit drugs, but each was once legal.

Then things changed. Racism and politics played a part in how we viewed them. We also learned more about their impact on health. Over time, they were declared illegal.

But decades later, these drugs and their derivatives are being used legally, for medical purposes.

Here’s how we ended up outlawing cannabis, cocaine and heroin, and what happened next.

Cannabis, religion and racism

Cannabis plants originated in central Asia, spread to North Africa, and then to the Americas. People grew cannabis for its hemp fibre, used to make ropes and sacks. But it also had other properties. Like many other ancient medical discoveries, it all started with religion.

Cannabis is mentioned in the Hindu texts known as the Vedas (1700-1100 BCE) as a sacred, feel-good plant. Cannabis or bhang is still used ritually in India today during festivals such as Shivratri and Holi.

From the late 1700s, the British in India started taxing cannabis products. They also noticed a high rate of “Indian hemp insanity” – including what we’d now recognise as psychosis – in the colony. By the late 1800s, a British government investigation found only heavy cannabis use seemed to affect people’s mental health.

In the 1880s, cannabis was used therapeutically in the United States to treat tetanus, migraine and “insane delirium”. But not everyone agreed on (or even knew) the best dose. Local producers simply mixed up what they had into a tincture – soaking cannabis leaves and buds in alcohol to extract essential oils – and hoped for the best.

So how did cannabis go from a slightly useless legal drug to a social menace?

Some of it was from genuine health concerns about what was added to people’s food, drink and medicine.

In 1908 in Australia, New South Wales listed cannabis as an ingredient that could “adulterate” food and drink (along with opium, cocaine and chloroform). To sell the product legally, you had to tell the customers it contained cannabis.

Some of it was international politics. Moves to control cannabis use began in 1912 with the world’s first treaty against drug trafficking. The US and Italy both wanted cannabis included, but this didn’t happen until until 1925.

Some of it was racism. The word marihuana is Spanish for cannabis (later Anglicised to marijuana) and the drug became associated with poor migrants. In 1915, El Paso, Texas, on the Mexican border, was the first US municipality to ban the non-medical cannabis trade.

By the late 1930s, cannabis was firmly entrenched as a public menace and drug laws had been introduced across much of the US, Europe and (less quickly) Australia to prohibit its use. Cannabis was now a “poison” regulated alongside cocaine and opiates.

The 1936 movie Reefer Madness was a high point of cannabis paranoia. Cannabis smoking was also part of other “suspect” new subcultures such as Black jazz, the 1950s Beatnik movement and US service personnel returning from Vietnam.

Today recreational cannabis use is associated with physical and mental harm. In the short term, it impairs your functioning, including your ability to learn, drive and pay attention. In the long term, harms include increasing the risk of psychosis.

But what about cannabis as a medicine? Since the 1980s there has been a change in mood towards experimenting with cannabis as a therapeutic drug. Medicinal cannabis products are those that contain cannabidiol (CBD) or tetrahydrocannabinol (THC). Today in Australia and some other countries, these can be prescribed by certain doctors to treat conditions when other medicines do not work.

Medicinal cannabis has been touted as a treatment for some chronic conditions such as cancer pain and multiple sclerosis. But it’s not clear yet whether it’s effective for the range of chronic diseases it’s prescribed for. However, it does seem to improve the quality of life for people with some serious or terminal illnesses who are using other prescription drugs.

Cocaine, tonics and addiction

Several different species of the coca plant grow across Bolivia, Peru and Colombia. For centuries, local people chewed coca leaves or made them into a mildly stimulant tea. Coca and ayahuasca (a plant-based psychedelic) were also possibly used to sedate people before Inca human sacrifice.

In 1860, German scientist Albert Niemann (1834-1861) isolated the alkaloid we now call “cocaine” from coca leaves. Niemann noticed that applying it to the tongue made it feel numb.

But because effective anaesthetics such as ether and nitrous oxide had already been discovered, cocaine was mostly used instead in tonics and patent medicines.

Perhaps the most famous example was Coca-Cola, which contained cocaine when it was launched in 1886. But cocaine was used earlier, in 1860s Italy, in a drink called Vin Mariani – Pope Leo XIII was a fan.

With cocaine-based products easily available, it quickly became a drug of addiction.

Cocaine remained popular in the entertainment industry. Fictional detective Sherlock Holmes injected it, American actor Tallulah Bankhead swore by it, and novelist Agatha Christie used cocaine to kill off some of her characters.

In 1914, cocaine possession was made illegal in the US. After the hippy era of the 1960s and 1970s, cocaine became the “it” drug of the yuppie 1980s. “Crack” cocaine also destroyed mostly Black American urban communities.

Cocaine use is now associated with physical and mental harms. In the short and long term, it can cause problems with your heart and blood pressure and cause organ damage. At its worst, it can kill you. Right now, illegal cocaine production and use is also surging across the globe.

But cocaine was always legal for medical and surgical use, most commonly in the form of cocaine hydrochloride. As well as acting as a painkiller, it’s a vasoconstrictor – it tightens blood vessels and reduces bleeding. So it’s still used in some types of surgery.

Heroin, coughing and overdoses

Opium has been used for pain relief ever since people worked out how to harvest the sap of the opium poppy. By the 19th century, addictive and potentially lethal opium-based products such as laudanum were widely available across the United Kingdom, Europe and the US. Opium addiction was also a real problem.

Because of this, scientists were looking for safe and effective alternatives for pain relief and to help people cure their addictions.

In 1874, English chemist Charles Romley Alder Wright (1844-1894) created diacetylmorphine (also known as diamorphine). Drug firm Bayer thought it might be useful in cough medicines, gave it the brand name Heroin and put it on the market in 1898. It made chest infections worse.

Although diamorphine was created with good intentions, this opiate was highly addictive. Shortly after it came on the market, it became clear that it was every bit as addictive as other opiates. This coincided with international moves to shut down the trade in non-medical opiates due to their devastating effect on China and other Asian countries.

Like cannabis, heroin quickly developed radical chic. The mafia trafficked into the US and it became popular in the Harlem jazz scene, beatniks embraced it and US servicemen came back from Vietnam addicted to it. Heroin also helped kill US singers Janis Joplin and Jim Morrison.

Today, we know heroin use and addiction contributes to a range of physical and mental health problems, as well as death from overdose.

However, heroin-related harm is now being outpaced by powerful synthetic opioids such as oxycodone, fentanyl, and the nitazene group of drugs. In Australia, there were more deaths and hospital admissions from prescription opiate overdoses than from heroin overdoses.

In a nutshell

Not all medicines have a squeaky-clean history. And not all illicit drugs have always been illegal.

Drugs’ legal status and how they’re used are shaped by factors such as politics, racism and social norms of the day, as well as their impact on health.

Philippa Martyr, Lecturer, Pharmacology, Women’s Health, School of Biomedical Sciences, The University of Western Australia

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

As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.

Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.

Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.

But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.

Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.

Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.

Using two defibrillators

During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.

Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.

DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.

A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.

The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.

Evidence of success

New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.

Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.

The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.

Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.

From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.

The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.

The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.

Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.

Training and implementation

Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.

There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.

Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.

Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.

Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.

Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology

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