ASIA, DRUG USE IN

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, and charas. 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.

(See also: Source Countries for Illicit Drugs )

BIBLIOGRAPHY

Bureau of International Narcotics and Law, U.S. De-Partment of State. (1999). International narcotics control strategy report (INCSR). Washington, DC.

Helzer, J. E., and Canino, G. J. (1992). Alcoholism in North America, Europe and Asia. New York: Oxford University Press.

Hobhouse, H. (1987). Seeds of change: Five plants that transformed mankind. New York: Harper & Row.

Smart, R. G., and Murray, G. F. (1985). Narcotic drug abuse in 152 countries: Social and economic conditions as predictors. The International Journal of the Addictions, 20 (5), 737-749.

Spencer, C. P., and Navaratnam, V. (1981). Drug abuse in East Asia. Kuala Lumpur: Oxford University Press.

Westenmeyer, J. (1982). Poppies, pipes and people: Opium and its use in Laos. Berkeley: University of California Press.

White House Office of National Drug Control Pol-Icy. (2000). National Drug Control Strategy: 2000 Annual Report. Washington, D.C.

Christian G. Schutz

Revised by Frederick K. Grittner