Dräger Review 107 special Dräger Review Dräger Drägerheft 107 special Technology for Life Drugs and Alcohol

Risky Beauty: White Zinfandel grape seen through a microscope

Drugs and Alcohol Effects, Dangers, Protection

Draeger_EN_001 1 08.04.13 16:32 CONTENTS

is the economic damage 60 billioncaused by drunk workers eacheuros year in the EU – more beginning on page 32.

CHEW BLOW CARLOS CARLOS VILLALON REDUX/LAIF / & CO. KGAA AG DRÄGERWERK

COVER PHOTO: BEVSHOTS-EUROPE.COM / ACTION PRESS ACTION / BEVSHOTS-EUROPE.COM PHOTO: COVER 12 14

4 INTOXICANTS 14 PIONEER 28 RISK FACTOR Prevalence: Some substances Dräger-Alcotest: Breath testing for Humans: High at work? This often change the way you feel. This alcohol has been practiced since 1953, leads to devastating accidents was discovered long ago – some and not only on German streets. 32 WORLD OF WORK milestones. 20 MEASURING ALCOHOL Addiction: When employees 6 DRUGS New Methods: Ankle bracelets allow come to work with the smell History: Intoxicants affect not monitoring and freedom of movement. of alcohol, or under the influence only the body and mind, but also of drugs, it becomes dicey. 22 EFFECTS society and the economy. Ethanol: How and where alcohol 38 ADDICTION 10 ALCOHOL affects people. Help: Drug and alcohol addiction History: Ethanol has been providing is a disease which afflicts users 23 LEGAL HIGHS a rush since the Stone Age. and others alike. There are various Bath Salts: A growing player approaches for rehabilitation. 12 CONSUMPTION in the drug market. Behavior: Is it possible to imagine 42 ON THE ROADS 24 DRUG TESTING mankind without drugs and alcohol? Alcohol Limits: How they have Saliva Sample: In Belgium they evolved to protect motorists. sift woozy drivers from traffic using modern saliva tests.

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Draeger_EN_002 2 08.04.13 16:33 Cover image: White Zinfandel, a type of grape, reveals its hidden beauty beneath the microscope. Michael W. Davidson of Florida State University in the USA has photographed different intoxicants using this technology since 1992, including (from left to right): Beer, Tequila Sunrise, and meth- cathinone, a psychoactive stimulant

SWALLOW SMOKE 58 KGAA & CO. AG DRÄGERWERK 62 PICTURE ALLIANCE / AP PHOTO

46 ROAD SAFETY 58 SOCIETY Alcohol-Interlocks: Breath as an Brain Doping: Increasing personal ‘ignition key’ – only sober drivers can achievement targeted by using drugs is start their vehicles. usually not without consequences 50 HEALTH 61 RANKING Myths and Legends: Does alcohol Drugs: The 20 most dangerous evaporate when cooked? Sorry: Barely, substances. and there are some other surprises. 62 DRUGS 52 AUTHORS Policy: The U.S. states of Washington Inebriate: Many works of world and Colorado have legalized the literature have been thanks to ‘Drugs cultivation and ownership of marijuana. and Inebriation’ (Ernst Jünger, 1970). 66 L AW 56 FINAL DESTINATION Society: Is there a ‘right’ to be Emergency Room: Last station in the state of intoxication? for many partygoers – especially on 68 MINI LEXICON the weekend. Intoxicants: Substances, consumption, risks.

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Draeger_EN_003 3 08.04.13 16:33 Global Drug Consumption Some substances change the way you feel. This was discovered long ago, and ever since then people have been growing and producing these substances, initially as a doorway to the world of the gods, then as a product consumed for recreation. A glass of wine can do you good, a bottle can be hazardous – to both you and others. Here are some MILESTONES in the world of inebriation.

Kincardine O’Neil, Atlanta, Georgia, USA: Akron, Ohio, USA: Dry (1935) Scotland: Ice Bock (2012) Coca-Cola (1887) On Mother’s Day, William Griffith The world’s strongest beer Physician and Druggist John Wilson and Robert Holbrook has an alcohol content of 65 Stith Pemberton developed Smith founded the self-help group percent: ‘Armageddon’ by ‘Coca-Cola’, which Alcoholics Anonymous, which Brewmeister (type: ‘ice bock’). originally con- now has around two million mem- tained “Peruvian bers in more than 180 countries. coca leaves, wine, and cola nuts”.

Vienna, Austria: Drug Report (2012) Bethel,B New York, USA: According to the ‘World Drug MMy Generation (1969) Report’ (www.unodc.org), 230 million WWithout drugs in front of, people – around three percent of the onon, and behind the stage, world’s population – have consumed ttheh legendary and rainy illegal drugs in their lives. Heroin, WWoodstock Festival would cocaine, and others cause 200,000 susurelyr have been a washout. drug-related deaths – annually.

Mixeteco Mountains, Mexico: Ouagadougou, Burkina Magic Mushrooms (1955) Faso, West Africa: American banker R. Gordon Humanization of the Ape South Wasson became the (approx. 2000 BC) Pacific: Kava first outsider ever to par- The original inhabitants Here, a take in the ceremonial of the sub-Sahara grew euphoriant consumption of psycho- millet and brewed beer

ES / ALAMY, / ALAMY, ES WME, / FRIEDRICH IMAGO STARK, ARCHIV, drink is active mushrooms. His pu- from it. Legend has it that made from blication in LIFE triggered it was this which made kava (Piper a boom in 1957. them true humans – they methysticum). lost their fur and tails.

Lima, Peru: Souvenir (1859) The Austrian expedition ship „Novara“ stashes a 60-pound bale Tierra del Fuego and Patagonia: Minimalism of coca leaves. A year later Albert Plants that can be fermented do not grow Niemann isolated ‘cocaine’ from here, which is why people have been unable to

SHUTTERSTOCK, IRYNA / DDP RASKO IMAGES, / WOLF-FEIX, / MCPHOTO IMAGO ACTION / BRAUN, PRESS MATTHIAS V PHOTOS: PICTURE ALLIANCE, ACTION PRESS, MAURITIUS IMAG PICTURE PRESS, ALLIANCE, ACTION PHOTOS: this stash in Göttingen, Germany. manufacture alcoholic beverages.

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Draeger_EN_004 4 08.04.13 16:33 PREVALENCE INTOXICANTS

Novaya Zemlya, Russia:a: Half a Spirit (1924) Darmstadt, To the shamans, every flyy agaric Germany: Partyrty mushroom embodies a mmush-ush- Drug (1912) room spirit. They eat two and a half of The pharmaceuticalti l them so that the half-mushroom-spirit company Merck keeps turning around to look for its other synthesized MDMA, half so the shaman can keep up with it. which later became famous as ‘ecstasy’.

Canton, China: First Opium War (1839–42) Çatal Höyük, Turkey: Ancient The English smuggled opium from India into Vintage (approx. 5500 BC) China. When the Manchus forbade this the In 1961 James Mellaart found a Opium War ensued, and China lost. One of the vessel in an excavation contain- consequences was the cession of Hong Kong. ing remnants of wine, the earliest evidence of the drink. New Delhi, India: Betel The leaves of this palm are part of the “betel bite”. They have a euphoriant effect and are mentioned in early Sanskrit texts, making them one Alamut, Iran: Hashish of the oldest known drugs. (approx. 1000 AD) The secret society of the Assassins (‘hashish Vietnam: Apocalypse Now (1971) smokers’) threatened In the “Golden Triangle” (Laos, Thailand, Myanmar) Heroin No. 4 is produced. nearby rulers with Saigon, Vietnam: American army doctors estimate that 10 assassination. What Courier (1970) to 15 percent of all American soldiers in is not clear is whether A pilot working Vietnam consume heroin. the fighters received for the American hashish as an incitement Ambassador is or a reward. arrested carrying heroin worth eight million U.S. dollars.

Java, Indonesia: Monopoly Ethiopian Highlands, East (19th century) Africa: Origin of Khat The Netherlands generated An everyday drug in this as much as 15 percent region. The cathinone contain- of their income from their ed in the leaves of the khat colony by selling opium. bush is a psycho-stimulant.

DRÄGER REVIEW 107 | SPECIAL 5

Draeger_EN_005 5 08.04.13 16:33 DRUGS HISTORY

Between Dream and Nightmare People, with their eternal desire for transcendence, for the state of intoxication and liberation, desire from the limitations of existence itself, will let themselves instigate wars, change societies, and build business empires – LEGAL AND ILLEGAL.

t all started with plants defending themselves from herbivores. In the Icourse of e volution, many plants developed chemical shields so as not to be eaten: ingredients which were either poisonous or distasteful to animals. In the depths of prehis tory the first humans discovered that these plants were also poisonous to them. But they discovered something else too: many of these leaves, roots, mushrooms, and cacti, when administered in the right doses, produced astounding effects on the eater. They alleviated pain, healed illness, and facilitated contact with the spirits, gods, and ancestors. There- for healers and shamans were needed because only they knew the fine line between trance and poisoning. Intoxication Since Antiquity Consciousness-altering plants have been part of human hist ory since the very beginning. The Old T estament men- tions hallucinatory acting mandragora (mandrake) as well as m yrrh, a tropi- cal resin which in high doses is analge- sic rather like opium. For thousands of years people have made pr oducts from hemp and hashish to intoxicate them- selves. Herodotus writes of the Scythi- ans, a nation of horsemen who inhabit- ed the steppes of Eastern Europe in the 8th and 7th centuries BC, and who, in their steam-baths, cast hemp seeds onto red-hot stones and became “so ecstatic that they cried out with joy.” With the spread of Islam and its mandatory rules of life, social changes What can be learned from nature, and how can nature be reconstituted came to the Orient from the 8th cen- for the benefit of mankind? Even alchemists of old sought to answer this

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Draeger_EN_006 6 08.04.13 16:34 Road to cigarettes: the USA in 1916, child labor for the harvesting and processing of tobacco leaves

tury AD onwards. Outlawing alcohol amounting to more than fourteen bil- made drugs like opium, hashish, loco- lion euros (2011 in Germany alone) weed, and khat more significant. The “significantly contribute to maintain exotic stories of Scheherazade in the the social and medical pr oblems asso- 1001 Nights seem to originate in a col- ciated”, Dr. Henrik Jungaberle, Addic- orful plume of hashish smoke. Yet hash- tion Prevention and Drug Researcher at ish was more of a poor-man’s herb in the University of Heidelberg. old Islamic societies; the more afflu- Genie from the Bottle ent reached for opium. Hashish has also been known since the Neolithic Age in The cultural history of tobacco, still China and India. In India its use w as used today by some people of t he Ama- subject to strict rituals – as it still is t o zon as a healing and religious plant, rep- a degree today in the cult surrounding resents an example of how many plant- the Vedic god of fertility, Shiva. derived psychoactive substances have In the modern era, following a dark undergone a change of meaning over period of witchcraft and witch-hunts the course of time, evolving from ritu- involving hallucinogenic drugs like hen- ally consumed sacraments, into a large- bane and belladonna, a phase of geo- ly individualized means of enjoyment. graphical and intellectual expansion This is easy to follow using opium occurred which had a direct impact on as an example, just as we can trace a the use of drugs. Christopher Colum- line from the plant itself to the isolated, bus discovered America in 1492. The intoxicating substance. The physician tobacco plants arrived back in Europe and naturalist Paracelsus (1493–1541) with the Spanish Conquistadors, and used laudanum (which means ‘praise- explorers and traders carried tobacco worthy’), a tincture of opium containing from there all over the world. Used at alcohol, to make opium into an everyday first as a healing and medicinal plant medicine for the treatment of common in courtly circles and by medics as well complaints in broad sections of society, as bio logists on account of its stimulat- rather like aspirin today. For 400 years it ing effect, at the end of the 16th Cen- was probably the most widely used medi- tury people began to smoke its leaves cament in the Western world, which following the Indian model. This ne w may also be why it was the first drug to fashion spread quickly, and the author- be analyzed scientifically. ities – and clergy – wer e soon trying to In 1804 the pharmacist F. W. work out ways to forbid the new cus- Sertürner succeeded in isolating t he tom. Having had little success in t heir ‘sleep-inducing substance’ in opium, many attempts to restrict the consump- known as morphine. This was the first tion of tobacco, rulers decided at least time that the active ingredient in a

PHOTOS: AKG-IMAGES (2), THINKSTOCK AKG-IMAGES PHOTOS: Beautiful but terrible: the opium to earn something from it. So tobacco plant-based product had been sepa- poppy is the source of the drug was taxed – even today: tax revenues rated from the inactive. As ear ly on >

DRÄGER REVIEW 107 | SPECIAL 7

Draeger_EN_007 7 08.04.13 16:34 DRUGS HISTORY

Every ban on drugs and alcohol releases enormous criminal energies

> as 1827 the Darmstadt-based compa- every hour from an overdose of opioids Over the course of the 20th century ny Merck began to mass-produce mor- over the past ten years in the EU. Most there were a growing number of inter- phine. The invention of the hollow nee- of these deaths involved heroin. national treaties aimed at restricting dle for injections came in 1841, paving the worldwide production of morphine War on Drugs the way, from a medical point of view, and cocaine. The International Opium for the military hospitals to treat the Modern chemistry and the onset of the Convention of 1912 aimed for the first wounded in the Franco-German War of Industrial Revolution were the motiva- time to monitor global production of 1870/71. Morphine became the ‘medi- tional forces behind another fundamen- the two drugs. Substances which until cine of the soldiers’. Countless combat- tal transformation: ritually used trance then had been widespr ead and used ants returned home addicted. inducers became, with the isolation of the among other things as medicines were In order to retain the pain- relieving individual substances in them, pharmaco- declared illegal. Se veral other trea- effect while excluding the risk of addic- logical consumer goods used according to ties followed, until in 1961 the Single tion, ‘heroin’, named in remembrance one’s state of mind: either to lift up, or to Convention on Narcotic Drugs bound of the wounded war-heroes, was pro- forget. Albert Niemann succeeded in 1860 more than 180 nations under inter - duced in 1898 using mor phine and in isolating cocaine from the coca plant. national law, and subjected poppy , acetic acid, and mass-marketed. Hero- From there it did not take long to arrive coca, and cannabis plants – as well in remains one of the most dangerous at the ‘Roaring Twenties’ when bohemian as substances produced from them, addictive drugs up to this day. According society and the demimonde in Berlin and and certain derivatives – to strict con- to the European Union Annual Report Paris plunged into the hysterical night- trols, while prohibiting all non-medic- 2012, an average of one person has died time consumption of ‘snow’. inal uses.

White gold: a drug dealer in Columbia Little effort, great return: Farmers mix baking soda under the coca leaves, prepares cocaine for sale on the streets which can sweat the cocaine out better under the sun

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Draeger_EN_008 8 08.04.13 16:34 However, the classification into legal and illegal drugs is controversial. As in the previous prohibition efforts (Alco- hol: United States, 1919-1933; Opium: China, 19th century) enormous eco- nomic and cr iminal energies wer e released to circumvent the bans. Much money can be made from the smuggling of drugs, as the British East-India Com- pany found out in India and China in the 19th century. By smuggling opium into sealed-off China, that trading enti- ty attempted to offset British foreign trade deficits originating with China in the tea trade. China, whic h could not defend itself against this flood of drugs was forced to open up its mar kets and Ceremony: Hindus in Rajasthan in Northern India prepare themselves to tolerate the opium trade. for a virtual journey. Everything is done for the ride on their “opium-vehicle” To this day, many people earn a lot of money with illegal drug production and trafficking. The policy of global drug prohibition, launched by former Ameri- substances sold as finished products. ation, because they give rise to a mar- can President Richard Nixon as the ‘War They contain synthetic cannabinoids ket which is fast- changing, volatile, and on Drugs’, has failed. This was admit- and cathinones (derivatives of canna- difficult to monitor.” ted by the Global Commission on Drug bis and khat substances). They man- To this can be added the long-known Policy in its 2011 report. Drug cartels age to circumvent the Narcotics Act stimulants and hallucinogens: ecst a- AM / PHOTONICA AM / PHOTONICA / GETTY WORLD IMAGES, are EYE / GLOW / HUTCHINSON UBIQUITOUS IMAGES a component of globally organized because they are not explicitly for- sy, LSD, GHB (date-rape-drugs), crack criminality alongside money launder- bidden. As soon as t hey are incorpo- cocaine, crystal meth, desomorphine ing, trade in weapons, and human rated after a delay into the Narcotics (‘krokodil’) – a hydra whic h grows two trafficking. And it is mor e successful Act, and thereby forbidden, new vari- new heads for every one cut of f. That than ever before. ant forms arise to which the Act does is why mor e and mor e drug experts not yet apply. Among these substances are realizing that the situation cannot Hare and Tortoise found in “bath salts” (see page 23) are be confronted by penal means alone. The wheel of drugs turns ever faster. amphetamine-like substances such as Besides education about ef fects and Every week a new drug is brought on mephedrone and bupropion, but also active involvement with the groups the market in the EU, says the EU drug the cathinones in herbal blends lik e most at risk of drug abuse endanger- observation agency in their 2011 annu- Spice and K2. Cecilia Malmstr öm, ment; many groups now see a w ay out al report. There is a hare-and-tortoise Member of the EU Commission, says: of the misery and crime in a relaxation game in play, the stakes being mainly “Stimulants and synthetic drugs play a of the strict prohibitions – for drugs such

PHOTOS: ALVARO YBARRA ZAVALA / EDIT BY GETTYEDIT BY TIM GRAH IMAGES, / YBARRA ZAVALA ALVARO PHOTOS: ‘legal drugs’ – psycho active designer central role in the European drug situ- as cannabis. Regina Naumann

DRÄGER REVIEW 107 | SPECIAL 9

Draeger_EN_009 9 08.04.13 16:34 ALCOHOL HISTORY

Working in the vineyard, Strasbourg, France (1519): from the grape to the barrel – wine-making was made by hand the entire way

eolithic Chinese menus may have included a cocktail of wine, Nmead, and rice beer. The people who settled on the banks of the Yellow River around 7000 BC f ermented the juices of grapes and hawthorn berries together with honey and rice. This brew, which contained ten percent alcohol, is currently the oldest known man-made alcoholic beverage. The Neolithic Chinese cocktail was reconstructed by American Molecular Archaeologist Patrick McGovern. He examined traces left behind in ceram- ic drinking vessels found during exca- vations in Jiahu, a Stone Age site in the Chinese province of Henan. By a com- plex process of proofs he decrypted the composition of this prehistoric drink: ‘Uncorking The Past’, as he calls it, which is also the title of his book. Refining Raw Materials In order to prepare for the fermenta- tion process, people used to break down the starches in grains by chewing them. The amylase in their saliva converted long-chain polysaccharides into short- chain sugars – a rather uncouth pro- cedure by today’s standards perhaps, From Biblical Vine yet very important in the history of alcoholic beverages. It w as not the consumption of ethanol which was an to Gin Lane issue 9000 years ago, but the very art of its production. Alcohol as a natural- Since prehistoric times people have crafted drinks containing ly occurring intoxicant is older than the the potable alcohol, ETHANOL. As a result of that there history of modern man. Many animals enjoy the intoxi cating effects of over- have always been interactions between the social, economic, ripe fermented fruit whose sugar has and technological developments. been transformed by wild yeasts.

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Draeger_EN_010 10 08.04.13 16:35 The art of producing alcoholic beverag- Solid Residues: American Molecular Archaeologist Patrick McGovern es coincided with the development of discovered substances in Stone Age ceramic flagons in China, agriculture during the Neolithic Revolu- and used them to reconstruct the making of alcoholic beverages tion. In particular the early civilizations improved the methods of agriculture, fruit growing and viticulture steadily, more feed stock was available for pro- ducing alcoholic beverages. Wine-grow- ers and brewers refined the selection al phenomenon. The British wine expert opment with his Lubeca v alve which of raw materials, fermenting process- Oz Clarke writes that, in the third mil- allowed beer to be tapped safely from a es, and subsequent procedures such as lennium before Christ the viticulture in high-pressure carbon dioxide system. distillation and storage. The alcoholic Egypt had expanded so far, that experts The industrialization of the manu- GY OF HENAN GY fermentation was probably discovered made similar differences in the quali- facture, storage, and distr ibution of by accident and through observation. ties, as it is the case today. The imagery alcoholic beverages has brought with it Beer’s ancestor was a fermented cereal of wine in biblical texts not least testifies consistent quality and low prices. Cheap brew, while fermenting fruits produced to the early importance of viticulture. spirits (made from potatoes) have how- wine-like drinks, allowing the physiolog- ever been blamed for the kind of alco- Alcohol in the Tank ical and psychological effects of alcohol holism depicted in t he famous print to be enjoyed at any time. In order to obtain more concentrated ‘Gin Lane’. This ter m describes the One of the roots of beer production alcoholic beverages, ethanol has to be abuse of alcohol, in par ticular by low- lies in Mesopotamia, where by the sec- distil led from the initial product. This er groups of the population, during the ond millennium BC a wide range of was made possible around the year 1000 Industrial Revolution. beers had been established. In much by means of what was known as the ‘alem- Nowadays ethanol made on an indus- of Central Europe, beer was one of the bic’, a vessel used to separate sub stances trial scale, from agricultural products, most important food-stuffs all the way and it is according to this principle mod- is becoming an increasingly important up to the 17th century. Cultural scien- ern stills pr oduce their high-quality source of energy, used in products such tist Wolfgang Schivelbusch even claims spirits. Aside from mashes made from as the vehicle fuels E10 (ten percent that the corpulent bodies depicted in grains and fruits, more recent times have ethanol) and E85 (85 percent ethanol). northern European art in t he 17th seen the introduction of potatoes (vodka) The second-generation of biofuels will century had much to do with the cui- and sugar-cane (rum). then no longer be derived from the same sine of the day, which contained a lot The alembic was the first in a series sources as drinking alcohol, but mainly of beer and beer soups. The Bav arian of technical innovations concern- from cellulose fibers. Peter Thomas State regulations of 1516 which allowed ing alcoholic dr inks. They included Read up: only water, malt, yeast, and hops as raw the bottle-fermentation of champagne Uncorking the Past – materials for the production of beer (17th century), wine corks (18th centu- The Quest for Wine, was conceived at that time. This pro- ry), re frigeration machines for the brew- Beer, and Other Alcoholic Beverages / vision is known as t he “Purity Law”. ing of beer (19th century), and the con- University of California (see Dräger Review 106; pages 18–21). tinuous distillation of spirits (also 19th Press, 348 pages The production of wine fr om grapes century). In 1889, Johann Heinr ich

PHOTOS: ACTION PRESS / ULLSTEIN, AKG / SCIENCE PHOTO LIBRARY, J. ZHANG UND Z. ZHANG, INSTITUTE RELICS LIBRARY, AND ARCHAEOLO OF CULTURAL SCIENCE PHOTO / ULLSTEIN, AKG / PRESS ACTION PHOTOS: developed rapidly into a complex cultur- Dräger contributed to this line of devel-

DRÄGER REVIEW 107 | SPECIAL 11

Draeger_EN_011 11 08.04.13 16:35 CONSUMPTION BEHAVIOR

Wings of the Spirit Is mankind even conceivable without drugs? Almost always accompany him at all times and in every country SUBSTANCES that alter his thinking, feeling and acting.

s teenagers in Los Angeles come a visible role and thus to communicate Drinking kava is a ritual used to promote home from a night of popping one’s identity and social status,” knows friendly relations, and coca leaves help A ecstasy, a new day begins in Dr. Henrik Jungaberle, Addiction Pre- the coqueros – or coco-chewers – through China with drinks containing caf- vention and Drug Researcher at the Uni- their day. This type of drug consumption feine. Millions of cups of coffee, tea, versity of Heidelberg. is deeply rooted in such cultures. and cola, as well as cigarettes and Stimulating drugs such as cof fee, Rituals Give Structure amphetamine pills, accompany peo- tea, and tobacco – together with canna- to Drug Consumption ple through their everyday lives all over bis and khat leaves – are ritual accompa- the world. In West Africa men discuss Highly ritualized, religious forms of niments to socializing, relaxation, and the day’s events amid clouds of hash- drug use are to be found primarily in hospitality. They play an important role ish smoke, and in Europe millions of Central and South America, South Asia, in social interaction, especially in Islam- bottles of beer are opened at the end and Oceania. Plants containing psycho- ic countries because of the widespread of each working day. active substances are given much impor- ab stinence from alcohol t here. But Few cultures get by without the tance by shamans and spiritual healers rituals can also change, especially in the intoxicating, mind-altering, or stimu- (see pages 6–9). Psilocybin mushrooms, industrialized nations. “In our pluralis- lating experiences of drugs: “Like food, peyote cactus, and locoweed ar e just tic society new rituals are forever aris- drinks, and sex, intoxication is one of some wings of the spirit and which the ing – rituals that protect and rituals that the fundamental needs of the human Indians of Central and Sout h America encourage people to consume. Often they being.” Wolfgang Nešković, a former have long used to penetrate the king- are given publicity in the media,” says German Federal High Cour t Judge, dom of the gods, spirits, and ancestors Drug Researcher Jungaberle. As the sun- said that while campaigning for the lib- in their spiritual séances. sets on the beach it will be enjoyed with eral treatment of cannabis (see pages Many drugs are part of everyday life, certain alcoholic drinks, or heavily ritu- 66–67). “A human phenomenon is also such as the drinking of kava in the cul- alized techno parties in industrial tem- CARLOS CARLOS VILLALON / REDUX LAIF, / LAIF, CHINAFOTOPRESS ULLSTEIN BILD-IMAGEBROKER.NET / to ritualize the consumption of intoxi- tures of the South Pacific and the chew- ples with its own jargon, its own music

ULRICH DOERING, PICTURE ALLIANCE, SCOTT HOUSTON / SYGMA / CORBIS / SYGMA / DOERING,ULRICH PICTURE SCOTT ALLIANCE, HOUSTON cating beverages and tobacco, to give it ing of coca leaves in countries like Bolivia. and drug use. New rituals of fasting and PHOTOS:

New York City: for Lara, ecstasy is the Lake Eyasi, Tanzania, Africa: young men Nuku‘alofa, Tonga Islands: women prepare substance of choice pass around the hashish pipe the euphoriant kava from roots

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Draeger_EN_012 12 08.04.13 16:35 BEHAVIOR CONSUMPTION El Alto, Bolivia: an old man fortifies himself with the leaves of the coca bush – as his fore fathers did

drug abstinence are also emerging, and such as the American prohibition from the conquerors of America and Oceania

not only in Christian circles. 1919 to 1933 did not last, and in f act had an easy time of destroying indigenous Alcohol has spr ead triumphantly became a major factor in the develop- cultures using fire-water. across the whole world over the past ment of organized drug- related crime. As an ancient intoxicant and stimu- 9,000 years, and abstinent cultures have lant alcohol is in most cultur es a cen- From Forbidden to Permissive – found it difficult to hold it off in the face tral element of ceremonies with which Both Have their Justification of globalization. Any culture where alco- large and small transitions ar e cele- hol manages to get a foothold, then finds A prohibition of alcohol der ived from brated in life. These range from ‘ happy it difficult to abolish it. Excessive bans the Koran is true in much of the Islamic hour’ at the end of the working day, up world. The verses concerned do not actu- to the end of school with drinking among ally use the word “haram” (forbidden) – high school seniors. Among the mesti- a minority of Muslim clergy t ake the zos in Peru, maize beer is a const ant position that only an excess of wine is for- com panion to a range of events such as bidden – but this interpretation has not baptism, a boy’s first haircut, and ear- prevailed with in the institution. piercing for girls. In other cultures, Because of genetic predispositions in alcohol strengthens people in their dai- East-Asians, Aborigines, and the indige- ly work: in Normandy you might pop into nous people of America their tolerance the bar for a Calvados, while in Peru, for alcohol is worse than most Europe- alcohol is consumed before heavy phys- ans. They commonly have only a small ical work. amount of the enzyme alcohol dehydroge- With one point all cultures are cer- nase, which is used to break down alcohol tainly in agreement: drinking alcohol Linhuan, China: Bangbangcha tea is one of in the liver, and for this reason they feel alone at home is suspicious and there- the most popular everyday drugs in Asia the effects more quickly. That is also why fore frowned upon. Regina Naumann

DRÄGER REVIEW 107 | SPECIAL 13

Draeger_EN_013 13 08.04.13 16:35 Multiple decades of tech nical progress: The first Dräger Alcotest with test tube came onto the market in 1953. Today, fast, precise measuring units incorporating electrochemical sensors are state of the art

Blow, Who Should Drinking and driving is dangerous. For decades there was no measuring process available to determine a driver’s LEVEL OF INTOXICATION quickly and reliably. In 1953 Dräger broke new ground with its first ‘Alcotest’. Today, breath-alcohol measurements are even admissible in court.

low, read, finish: When Dräger to prove an offense pursuant to Para- fic control to see whether somebody is brought its Alcotest device onto graph 24a of the German Road Traffic intoxicated. The tubes contain sulfuric Bthe market in 1953, it was the Act. “The Dräger Alcotest 7110 Eviden- acid and yellow po tassium dichro- first time that a single breath-test could tial MK III is cur rently the only device mate. These basic substances react to be used to find out whether or not a with a design cer tification from the form acetaldehyde and trivalent green driver was under the influence of alco- Physikalisch- Technische Bundesanstalt,” chromium, during testing, when t he hol. Through continuous r esearch says Dr. Jürgen Sohège, Product Manager ethyl alcohol known as e thanol pass- into breath alcohol measurement, the at Dräger. es through the tube together with the Lübeck based company has since then On the other hand there is the first exhaled air. The intensity and extent developed a range of o ther methods Alcotest with Dräger tubes (and a plas- of the coloration indicates the concen- based on electronic sensor systems – up tic bag to check volume), which still tration of ethanol. If this pretest indi- to court usable measurement results, serves primarily as a pretest in road traf- cates a minor offense, or even a crimi-

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Draeger_EN_014 14 08.04.13 16:35 DRÄGER-ALCOTEST PIONEER

PHOTOS: DRÄGERWERK AG & CO. KGAA & CO. AG DRÄGERWERK PHOTOS:

nal act (an absolute inability to drive), defined as the limit for absolute inability motor-wagon was invented by Daimler then further analysis is performed for to drive. Similar limits were established and Benz in 1 886, but the first such confirmation. elsewhere. The problem of driving under vehicle to reach England’s shores did The development of t he tube is a the influence of alcohol is a global one – not arrive until 1894. In spite of t his, classic example of farsighted knowledge as is the market for Dräger’s Alcotest. In however, the traffic in industrialized transference from another application. many countries the name is synonymous Britain was already heavy enough in The know-how comes from the gas detec- with alcohol testing. 1870 to elicit a ban on being “dr unk tion systems in which Dräger has se t while in charge of any carriage, horse, From Intoxication and global standards since the 1930s, says the cattle, or steam engine on any highway Steam Engines doctorate in electrochemistry Sohège. or other public place.” Yet the Licensing Dräger’s engineers came up wit h the The phenomenon of alcohol of fend- Act of 1872 was not much of a success. idea for the new measuring process the ers on the roads was however not new The problem has accompanied the his- morning after a company party. The mea- in mid-20th Century, nor did it or igi- tory of mobility ever since, and is coun- surement process was timely, because nate at the onset of automotive traffic. tered all over the world by means of pro- of the mass mo torization after the The automobile was not even invented hibitions, monitoring, and prevention. Second World War, the number of traffic when the British Parliament first made But what exactly constitutes ‘drunk’? accidents caused by alcohol increased it an offense to drive under the influ- Until the middle of the 20th Century, dramatically. This is reflected in the case ence of alcohol. In 1872 a Licensing Act the authorities lacked a quick and reli- law. Thus, also in 1953 for the Federal was passed by Westminster in the hope able method of determining a driver’s Republic of Ger many, a blood alco- of reducing the danger to the public level of intoxication at road-side control hol concentration of 1.5 per mille was caused by drunken vehicle drivers. The points. It is difficult to measure exactly >

DRÄGER REVIEW 107 | SPECIAL 15

Draeger_EN_015 15 08.04.13 16:35 1938 1953 1953 1978 The American ‘Drunkometer’ worked using The classic: Borkenstein (left) and The ‘Alcytron’ prototype: the first a wet-chemical measuring process Dräger’s Alcotest tubes his ‘Breathalyzer’ to feature an infrared sensor

Since the 1920s and the link between exhaled air and blood liter of blood (‘per mille’), while BrAC is alcohol concentration. They also assumed given in milligrams of ethanol per liter 1930s, the relationship that the reason for this lay exclusively in of exhaled air. between blood and the exchange of gas between the air and The first ever attempt to utilize the the blood in the lungs. Later however, the discovery of the link between BAC and breath alcohol content diffusion of alcohol in the entire respira- BrAC to monitor road-users was the has been proven tory track was recognized as the basis of ‘Drunkometer’ which was developed the link between BAC and breath alcohol in the USA in 1938 by Rolla N. Harger content (BrAC). and which works on the basis of a we t- chemical process. “It w as more of a Dräger Tubes Offer the transportable chemistry lab than a tru- First Quick Test ly mobile test device,” says Dr. Sohège. The Swedish scientists concluded t hat When Dräger launched its Alcotest tube “two liters of exhaled air (at 34 degrees onto the market in 1953, it was followed Celsius) contain around as much alcohol in North America by the ‘Breathalyz- as one cubic centime ter of blood.” In er’ developed by Robert F. Borkenstein, most countries a factor of 2,100 is used as which measured the BrAC using a chem- an average ratio between the measured ical reaction which was evaluated electri- values of blood and br eath alcohol con- cally. Dräger later took over the manufac- centration (Blood Breath Ratio, BBR). ture and distribution of the Breathalyzer. > how much somebody’s reactions are lim- Because the statistical spread of BBR is But the Dräger tubes are the first alco- ited by the effect of alcohol, so instead related to a range of per ipheral condi- hol test, which was regularly used oper- the blood alcohol content (B AC) or the tions and extends from 2,000 to 2,300, ationally on the road to get an objective amount of alcohol in t he urine is mea- it is not normal practice to convert one assessment of the BrAC. “Since the 1950s sured. These time-consuming pr oce- measured value directly into the other police and road traffic authorities have dures, however, are not really possible unit in tests that are to be used as e vi- known that measuring the influence of to perform on a large scale in e veryday dence in court. Instead, independent alcohol on the spot as quickly as possible traffic monitoring. limits have established themselves for is a necessar y part of reliable preven- “Then in the 1920s and 1930s it was both breath and blood alcohol tests, each tion,” says Dr. Sohège. The testing tubes scientifically proven that blood alcohol with its own validity. In Germany’s Road spread quickly as a r esult. They were content could be determined by means Traffic Act, Paragraph 24a states: “It is accepted not only by the legal authorities, of the breath,” explains Dr. Sohège. an offense to drive a motor vehicle on but also because they were so easy to read The American doctor Emil Bogen sug- the road with 0.25 mg/l or more alcohol and understand by the drivers who were gested using exhaled br eath to prove in the exhaled breath, or 0.5 per mille being monitored. Early markets alongside BAC as far back as 1927. Decisive in this or more alcohol in the blood, or a quan- Germany included the United Kingdom, respect were the studies done by Swedish tity of alcohol in the body which leads to Sweden, and Australia. pharmacologists Göran Liljestrand and the aforementioned breath or blood alco- The experts knew that the demands Paul Linde, which they published in 1930 hol concentrations.” BAC is denoted in for alcohol analysis would be continually On the Expulsion of Alcohol in Exhaled most coun tries in terms of milligrams rising. “There was soon a demand for fast- Air. Liljestrand and Linde demonstrated of ethanol per kilogram of blood or per er, more accurate – and therefore judicial-

16 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_016 16 08.04.13 16:35 DRÄGER-ALCOTEST PIONEER

1980 Dräger took over the production of the ‘Breathalyzer’ from Smith & Wesson

INFRARED OPTICAL SENSOR ly useful results,” says Dr. Sohège. He adds that from a criminological point of view, Schematic Measurement Principle breath testing is the more direct of the two procedures, since the breath alcohol content which is related to the diffusion of alcohol from arterial blood provides a more direct reflection of the concentra- tion of alcohol acting on t he arteries in the brain than the blood alcohol level, which is measur ed in venous whole- blood, or its ser um, using pr ocesses such as gas chromatography or alcohol dehydrogenase. Measuring Equipment of the Future Will Be Based on Electronics Lamp Window Window Interference Detector Infrared spectrum The new devices for testing br eath filter Spectral Gas alcohol which Dräger developed in the Lines 1970s and 1980s utilize electrical and electronic systems. “When we developed ELECTROCHEMICAL SENSOR this new technology we made good use of the possibilities offered by miniaturized Measurement System sensors as each new generation of them came out,” says Dr. Sohège. Technical Electric Pump Motor Piston input came once again fr om the field of gas detection systems. Already by 1978, Dräger was show- ing the way things were going to go with its ‘Alcytron’, a prototype incorporating an infrared optical sensor. In this pro- cess a light source emits infrared radi- ation of a specific wavelength, which is guided through a measuring cham- Sampling Chamber ber and then measured by a photocell. Electrochemical Sensor When the gas being measured is in the

PHOTOS: DRÄGERWERK AG & CO. KGAA, & CO. AG CORBIS (1), INDIANA UNIVERSITY DRÄGERWERK (1) PHOTOS: chamber, it ab sorbs part of the radia- Infrared or electrochemical sensor: the two common measuring processes for tion, reducing the strength of the sig- determining breath alcohol concentration levels are based on different principles. nal coming from the photocell. This While the infrared optical sensor measures the absorption of light by ethanol, the signal generated by an electrochemical sensor is produced by the oxidation allows you to deduce the concentration of molecules on a catalytic layer of gas. Four years later the Alcotest 7010 >

DRÄGER REVIEW 107 | SPECIAL 17

Draeger_EN_017 17 08.04.13 16:35 1982 1988 1998 2003 Alcotest 7010 with an Electrochemical sensor: Measurements for use in court Breath alcohol based infrared optical sensor Alcotest 7410 with the Alcotest 7110 Evidential immobilizer: Interlock XT

Modern electrical serves as a signal b y which to produce for a breath alcohol monitoring method a reading. This electrochemical sensor which could be used as evidence in court. engineering is responds very specifically to alcohol, “This was an absolute milestone, since the key to breath alcohol meaning that ketones, such as acetone, the device’s redundant design guarantees which may also be present in exhaled air particular ly reliable results on a par with measurements cannot distort the result. The sensor was blood samples when used as e vidence,” premiered in 1988 in the Alcotest 7410. says Dr. Sohège. This technology’s capa- With its electr ochemical sensor bility was confirmed by the Physikalisch- and infrared technology, Dräger had Technische Bundesanstalt (PTB), which by 1990 established the two processes approved the Alcotest 7110 Evidential which would, over the coming years, MK III as t he first ever breath alcohol lay the foundation for a series of innova- measuring device whose readings could tions. The first Alcotest 7410 was used to be admissible as e vidence in court. A develop a whole family of devices all the similar dual- sensor system is used in the way to the 7410 Plus with its digital full- Alcotest 9510 evidential device which was text display and electronic data transfer launched in 2007 and which can be used features. “The readings are generated as a stationary or mobile system. in the local language of the country, this Paradigm Shift in Measurement made measurements intuitively easy to Strategies follow for everyone involved,” explains > arrived on the market, but was only Dr. Jürgen Sohège. Measuring devices Since 1953, when t he first Dräger- used for stationary purposes. incorporating electrochemical sensors Alcotest tubes appeared, engineers are In parallel with its infrared tech- have long since been standard issue for now working on systems with further nology, Dräger introduced a semicon- pretesting. In Germany today, virtually improved response times to facilitate ductor sensor based on tin o xide. This every police cruiser has an electronic comprehensive, high- frequency traffic measuring cell was used to equip the alcohol measuring unit on board. The testing. “This is a worldwide trend for mobile Alcotest 7310 which came onto very latest Dräger pr etest devices are the near future,” predicts Dräger’s Prod- the market in 1980. From then on, mea- the Alcotest 6510 introduced in 2004, uct Manager Sohège. Optical filter tech- sured values could be read on the dig- the Alcotest 6810 (from the year 2005), nology is also being improved in order to ital display just seconds af ter a sample and the Alcotest 7510 (2008). produce even more accurate infrared had been taken at a check-point. Soon, But infrared technology is also pro- sensors. Transdermal measurements electrochemical sensors were setting gressing nicely: the Dräger Alcotest 7110 could represent a completely new option new standards in fast and accurate BrAC appeared in 1985 with an infrared sensor in the future, where alcohol concentra- monitoring. In these devices the measur- which responded especially selectively tion in the blood is measured through ing chamber is charged with a precisely to alcohol. The t hird generation of the skin (see pages 20–2 1). Unlike defined volume of air. In the chamber, this device (1994) can, as an op tion, breath testing and blood samples, this the ethanol contained in the air oxidiz- be combined with an electrochemical technology offers the advantage of com- es electrochemically on the outside layer sensor. This dual-sensor system became plete cooperation-free measurement. It of a measuring electrode, which acts as standard issue four years later in t he would benefit alcohol testing equipment a catalyzer, producing a current which Alcotest 7110 Evidential, forming the basis which is used outside of the road traffic

18 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_018 18 08.04.13 16:36 DRÄGER-ALCOTEST PIONEER

2007 With touchscreen: Alcotest 9510 Evidential measuring device

HOW ALCOHOL IS MEASURED IN THE BODY field, in areas such as emergency medi- cine where patients could be examined Alcohol in the gastro- for the influence of alcohol. intestinal system But the experts for alcohol measure- ment think beyond the improvement of Blood/heart existing solutions. It is about a paradigm shift – distancing itself from the subse- Capillary blood in quent control associated with preven- the lung alveoli tive measure, to preventing the opera- tion of vehicles or critical systems under the influence of alcohol. The purpose of Heart Lung air the Dräger Interlock XT. (Henry’s Law) It is installed in passenger transport vehicles such as buses, taxis, and loco- motives so as to make travel safer for passengers. But Alcohol-Interlocks are Arteries 2 x sample of breath also being used in automobiles belong- Arteries in the arm in the brain containing lung air ing to drivers who have attracted atten- tion by drinking and driving so that they Veins in the arms Direct alcohol can return to the roads, but under strict concentration measure- ment (mg/l) on each stipulations (see also pages 46–49). The 1 x sample of venous sample of lung air first Dräger Interlock, which activates whole-blood (gas concentration) the ignition only after a negative breath Transport test, came onto the market in 1994. Whether traffic control, Alcohol- Separating off solid components Interlock, or long ter m monitoring, whether electrochemical sensors or Blood serum Compare directly against infrared technology – each new gen- limit value eration of the breath alcohol testing 4 x alcohol concentration measurement (‰) equipment from Dräger sets new stan- in blood serum (liquid dards in the market, which brings more concentration) security in life. The Dräger Alcotest has Blood serum back-calculated been doing this since 1953 – ever since to whole-blood (‰) using the first automobile drivers blew into mean devisor 1.2 When you drink, alcohol finds its way the Dräger tube and bag t o test their into various parts of your body – such breath. Peter Thomas as blood, air you breathe, urine, and sweat. This diagram shows the way the Information: Compare against relevant alcohol level is measured limit value Precise breath alcohol testing from the blood (left) and in exhaled air using Dräger devices

PHOTOS: DRÄGERWERK AG & CO. KGAA & CO. AG DRÄGERWERK PHOTOS: www.draeger.com/107/diagnostic

DRÄGER REVIEW 107 | SPECIAL 19

Draeger_EN_019 19 08.04.13 16:36 MEASURING ALCOHOL NEW METHODS

Through the Skin In the USA, where there is a high alcohol-related crime rate, law enforcement authorities are keen to monitor the parole behavior of ALCOHOL OFFENDERS more effectively. They have even resorted to instruments like electronic shackles – or, to use a more delicate term, ankle bracelets.

hen the alcohol content is sent via a transmitter to a central office for also arise in the area of prevention. to be monitored continu- analysis. The delinquent has little chance: This can be in traffic, for general safe- W ously and without interrup- every violation is followed by immediate ty reasons drinking and driving should tion, random testing is ruled out (blood, reprimand. The inside of this ‘bracelet’ is be prevented, but also in the profession- breath, or urine tests). These are expen- technically complex. “ Measuring alcohol al environments, if certain machines sive, they sometimes need medical per- through the skin works by the same prin- require complete sobriety. In all these sonnel, and do no t cause behavioral ciple as breatha lyzing: using an electro- cases, you can’t stigmatize and restrict change among the delinquents. But chemical fuel cell,” explains Dr. Jürgen innocent people by having them wear measuring alcohol in sweat and alco- Sohège, Pro duct Manager at Dräger. “The an alcohol detector. hol evaporated from the skin is another device takes half-hourly samples from the For this purpose, the breath test- matter. A small proportion of the alco- ‘air cushion’ next to the skin. Inside an ing before starting a vehicle equipped hol you drink – around five to ten per- electrochemi cal sensor, the alcohol is with the interlock system is already a cent – is not broken down in t he liv- converted into an electrical signal which reality (see also pp. 46–49). But op ti- er. But instead excreted in the breath, can be evaluated.” Tens of thousands of cal methods of measurement are also through the skin, or in t he urine or these devices are now in use in Amer i- conceivable which measure the alcohol sweat. Excretion through the skin is ca, and the feedback has been positive, content in the body through the skin – very low at just one percent, but it has with three out of four offenders sticking on your finger for instance. In the USA a distinct advantage, which is that the to the terms of their paroles. But there there is a broad-based research alliance

quantity of alcohol which passes out of is an even tougher approach whereby known as the Driver Alcohol Detection BAUER-GRIFFIN, / S BARTEE SCRAM / PHOTOGRAPHY (2) the body by that route gives a clear pic- delinquents are subject to stricter terms System for Safety (DADSS) in which opti- ture of the alcohol concentration in the such as house arrest, which is enforced cal methods employing near infrared body, with a delay between half an hour using the GPS transmitter in the device. light (NIR) are employed in measuring and two hours. This makes it an eas- As many as 90 per cent of the these peo- devices used in cars. The electromag- ily accessible marker for alcohol con- ple monitored adhere to the rules of their netic waves, which range in frequency sumption. paroles. from 0.7 to 2.5 µm, penetrate up to five With a small tamper-proof device, the millimeters into the skin when a finger With Light in the Skin SCRAM ® by Alcohol Monitoring Systems is placed on the sensor. The light waves which is attached to the ankle, the mea- Measuring alcohol is not always a case are reflected by the tissue and analyzed, surements can be performed automati- of tracking and penalizing alcohol- producing a figure of tissue alcohol con-

cally around the clock, and the results are related offences. A large demand could centration – and if necessary, preventing PRES ACTION COLOURPRESS.COM, / JFX IMAGES PHOTOS:

20 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_020 20 08.04.13 16:36 Di debitem autem ipsam harciis alicip- sus exeruptaqui nestrum as- sedic tem eos eic tem id mo diandebisque sit quam que volupta illist isitibus

“Captive” U.S. actress Lindsay Lohan was caught drunk at the wheel – and had to wear an ankle bracelet. Right: Andy Dick at a film premiere in Los Angeles (2009)

The SCRAM ankle bracelet continuously An Arresting Idea monitors the alcohol Who sins, will be punished. But still it can be level of a delinquent milder: an adjudication that relies on under- standing and behavioral changes. One means to this is continuous (24/7) monitoring of compliant behavior using an ankle bracelet, such as this SCRAM (Secure Continuous Remote Alcohol Monitor). Every 30 minutes the device measures the alcohol secreted through the skin, sending the figures – together with temperature readings – to a central server, either directly via an inte grated mobile chip, or via a base station.

the car from starting. There is already says Dr. Sohège. One company in Ham- when it comes to using this method in a table-top device based on t his tech- burg, Germany (Dermalog Identification practice, such as light dispersion in the nology, the TruTouch® 2500 made b y Systems GmbH), is also busy developing tissue, the spectral overlap of alcohol TruTouch Technologies, which is used transdermal alcohol measurement on with those of proteins and fats, as well preventa tively in high-risk working areas the basis of near infrar ed technology. as an unsatisfactory calibration – it’s still to ensure that every employee is com- In her initial experiments, the physicist very expensive. “We have come a long pletely sober before starting work. Clarissa Hengfoss has demonstrated that way, but it will take some time before we “Even when the near-infrared tech- it is possible to measure tissue alcohol in have a device which can be used in every- nology is not fully developed, it shows the finger using spectroscopic means. day situations,” says Managing Director interesting possibilities for the future,” There are however technical difficulties Günther Mull. Regina Naumann

DRÄGER REVIEW 107 | SPECIAL 21

Draeger_EN_021 21 08.04.13 16:36 EFFECTS ETHANOL

Brain: Skin: reduced because brain cells die pasty, puffy off: memory, concentration, judgment, intelligence; can end in Nose: complete mental degradation bulbous swelling Oral Cavity, Throat, Esophagus: cancer Heart: high blood pressure, Liver: fatty degeneration, cardiac arrhythmia, swelling, liver cirrhosis myocardial inflammation (shrunken liver), cancer

Waist: Pancreas: overweight dysfunction, inflammation (pancreatitis) Nerves: yourself, aggression, and a reduction in disorders, cramps, shaking, tingling Reproductive Organs: your capacity to think, speak, and see. reduced libido, impotence Finally dizziness and unconsciousness occur. The threshold at which coordi- Stomach and Intestines: mucositis (gastritis), nation and reactions are impaired may dysfunction, cancer be relatively low in some people. In the words of the Institute for Occupational Personality: Safety and Health of the German Social unreliability, irritability, The Harm Alcohol Does restlessness, excessive jealousy, Accident Insurance, in its GESTIS sub- Potential effects of excessive consumption multiple anxieties, depression, stances database: “The performance of suicidal thoughts the CNS can be impaired by blood eth- anol concentrations of 200 to 300 mg/l (0.2 to 0.3 per mille), and fr om 0.6 to 0.7 ‰ upwards, the majority of people are significantly affected. Carousel of Senses Some effects consist of variously com- bined symptoms. The dizziness which Pure Nerves comes with intoxication is caused on Minor cause, big effect: even small quantities of alcohol can one hand by a neurologically disturbed reconciliation of those senses required limit your COORDINATION AND REACTIONS. to maintain a feeling of balance. The positional dizziness of drunkenness, on or many people, alcohol is sim- lus transmission routes are amplified, the other hand, is caused b y the diffu- ply part of life. A g lass of wine but most are suppressed. The brain, for sion of ethanol into what is known as F frees up the thoughts, a round of instance, loses its ability to recognize and the ampullary cupula belonging to the beer makes merry. Yet the mildly dis- assess dangerous situations properly. A organ that senses r otation. Normal- inhibiting effect of an alcoholic dr ink study by the National Institute on Alcohol ly speaking, the cupula and the lymph (one interna tional ‘Standard Drink’ con- Abuse and Alcoholism in Maryland, USA, surrounding it have the same specific tains ten grams of ethanol) is nothing revealed this effect on the brain using weight. At alcohol levels of 0.3 ‰ and other than the first stage in a complex magnetic resonance tomography. upwards, the specific weight of t he process affecting the central nervous sys- The effect begins about two minutes cupula decreases so markedly in com- tem (CNS): ethanol molecules build up after the first drink is consumed and parison with the lymph that it begins in the proteins of nerve cells and alter increases in pr oportion to the alco- to respond not only to rotational move- their function. Ethanol has a par ticu- hol concentration in your blood as you ments, but to changes in the head’s posi- larly strong effect on the ion channels, drink – leading eventually to serious dis- tion. This is what pr oduces a sense of which are responsible for transmitting orders. Subjectively, ethanol is at first dizziness, which can also occur under signals along the body’s system of neu- stimu lating, numbing, and warming. reversed conditions as t he ethanol is

rons and muscle cells. Cer tain stimu- Higher doses can lead to overestimating broken down. Peter Thomas GRAPHIC: PICFOUR

22 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_022 22 08.04.13 16:36 BATH SALTS LEGAL HIGHS

Rise of the Synthetics The narcotics scene is always changing – new substances appear continually on the market, especially SYNTHETIC DRUGS, sold as ‘bath salts’ are spreading fast. Their effects have even shocked experienced physicians.

ath salts, spice, plant nutr i- psycho active substances. A quick look physical risks are much higher than ents: they may all sound har m- at the new syn thetics reveals a ver y the known effects of established drugs, Bless, but in essence they are life- heterogeneous picture, because even sometimes exponentially higher – as threatening. Alongside conventional if their effects are often similar to those when products available on the market narcotics, ‘legal highs’ sold under fan- of known narcotics, most of them are are combined with one another. cy names are playing an incr easing- fundamentally chemical. This is true A good few horror stories have been ly important role in the drug market. for the synthetic cannabinoids, which circulating around the effects of sub- This group of synthetic substances is dock at the cannabis receptors in the stances like mephedrone and methylene- only legal for the reason that they have brain and are primarily in herbal smoke dioxypyrovalerone (MDPV) con tained not yet been banned, and in many coun- blends. Synthetic cathinones on the oth- in ‘bath salts’. In the USA, reports the tries much is being done to make them er hand are sold in products referred to New York Times, a man climbed up a just that. Yet chasing synthetic drugs is as bath salts. The toxicity and intensi- pole at the side of a r oad and jumped rather like the race between the hare ty of these ‘legal highs’ are often many down into traffic, another entered a and the tortoise, since producers are times those of conventional drugs, for monastery in his state of intoxication and putting new things onto the market fast- which reason their psycho logical and stabbed a priest to death. Peter Thomas er than existing mixtures are being pro- hibited. In Germany the sale and con- sumption of a drug cannot be banned until the substance involved is listed under the Betäubungsmittelgesetz, or Narcotics Act. What is more, substanc- es branded as bat h salts and smok - ing blends are sold explicitly for non- human consumption – which makes quick prohibition difficult, including in the USA. Regional Trends The problem is becoming e ver more pressing: 57 new variants of synthetic drugs were discovered in 2012 alone, according to the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) in its annual report. Three years previously it had been just 2 4

new substances. EMCDDA President PICTURE ALLIANCE, STAR-MEDIA PHOTOS: Wolfgang Götz is therefore warning of Under false pretenses: Drug producers are attempting to get around state bans a boom in products. An international with an increasing number of new substances. This includes also this herbal mixture with drugs which is intended neither to spice your meal nor to make camomile tea. register, he says, is urgently needed to They are all about getting high – which is why these samples landed in the Chemistry prevent more effectively the spread of Department of the Office of Criminal Investigation in Frankfurt a. M., Germany

DRÄGER REVIEW 107 | SPECIAL 23

Draeger_EN_023 23 08.04.13 16:36 The Trail of Saliva Conventional blood and urine tests are time-consuming and sometimes misleading when it comes to rooting out drug offenders on the roads. In Belgium the police have been sifting woozy drivers out of traffic for some years using MODERN SALIVA TESTING – and in Australia you may well be subjected to on-the-spot screening at work.

oss Rebagliati wrote sporting equivalent of one in every 25 people on history twice over. The Canadi- earth. Hard drugs like heroin, cocaine, Ran snowboarder won the giant and ecstasy are taken by far fewer peo- slalom at the 1998 Winter Olympics ple (see Table 1). in Nagano, Japan, becoming the first The highways are another are- Olympic gold medalist is t his sport. na where, with the exception of alco- He also became the first Olympic ath- hol, no other drug is as widespread as lete to be found guilty of cannabis con- cannabis. This was shown by a study sumption. He got lucky, since at the published in 2011 by the German Fed- time of the competition smoking dope eral Highway Research Institute and had not yet become punishable. Reba- entitled DRUID (Driving Under Influ- gliati remains on the eternal list of ence of Dr ugs, Alcohol, and Medi- winners. cines). During the study almost 50,000 Today the hemp plant called can- automobile drivers in Europe were nabis is f irmly on t he banned sub- stopped on the open road and tested stance blacklist, whether in the form for alcohol, illegal drugs, and medica- of pressed resin (hashish) or dried buds ments. The authors recommended in (marijuana). This is not because it mas- the study to introduce limits for the sively enhances the performance of the drug-related driving impairments. As human body, but because its active sub- there is with alcohol. stance, tetra hydrocannabinol (THC), But that is easier said t han done. makes athletes more willing to take As for alcohol, there are not only estab- risks. This can be dangerous, especial- lished limits, but also portable and easy- ly on steep slopes. “Anyone who smokes to-use breath alcohol tests that allow pot, skates with more risk!” warned the legally actionable analysis directly on- Swiss Department for Alcohol and oth- site (see also pages 14-19). On the oth- er Drug Problems back in the year 2002 er hand, for example drug testing by in reference to the little intoxicating German Police Officers – in cases of pipes. Anyhow, fans tease that one of the suspected drivers – extravagant blood most attractive snowboard disciplines tests are arranged. In contrast, urine may still be called the “half-pipe”. samples have only “limited relevance”. Meanwhile the call for new test proce- Limits for Drugs dures has become louder in t he USA. Cannabis is the most widely consumed “While drugged driving arrests are ‘illegal’ drug in the world. According to on the rise, our police force needs a Fresh from the blisterpack: estimates by the United Nations Office breathalyzer-like technology that works a porous on Drugs and Crime (UNODC), up to to identify drug-impaired drivers, on- sampler ready for drug testing five percent of all people be tween the the-spot, before they cause irrepara- ages of 15 and 64 smok ed a joint at ble harm,” urged U.S. Senator Charles

least once in the year 2010. That is the Schumer in January 2012. KGAA & CO. AG DRÄGERWERK PHOTOS:

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Draeger_EN_024 24 08.04.13 16:37 SALIVA SAMPLE DRUG TESTING

Hygienic in the laboratory: the DCD 5000 with sampler below and holder above

Although drugs and medicaments leave quick results since it absorbs addic- behind clear traces in the human body, tive substances immediately after most bodily substances are not suitable they have been taken, and distributes for quick mobile testing. In t he hair them around the whole body. Because and nails, for example, intoxicating every human’s blood is very much the substances can still be proven months same in its c hemical composition, afterwards. But they say as little about and because it cannot be manipulated the exact time at which a substance while it is being sampled, blood analy- was swallowed, inhaled, or injected as sis is a very reliable technique. Finally, the sweat plasters that have to be left the concentration of a substance in the for days on the skin to take effect. blood provides a direct statement about Human blood, howe ver, is a dif- the intoxicating effect of the drug in the ferent matter altogether: it supplies central nervous system. And yet there is one major drawback when it comes to spontaneous traffic checks: blood sam- pling is invasive and can only be done Table 1: by qualified medical personnel. Global consumption of illegal drugs Efficient Saliva Testing Drug Consumption [In Percent: 1.), 2.)] Urine sampling, which is often used Cannabis 2.5 – 5.0 as a pretest before blood sampling, is Opioids (e.g. 0.6 – 0.8 only of limited use when it comes t o heroin) reliable and quick drug screening. It Opiates 0.3 – 0.5 must be done out of sight in or der to Cocaine 0.3 – 0.4 protect the person’s privacy, so it is Amphetamine- 0.3 – 1.2 easy to manipulate. Another problem like stimulants is that it produces a lot of false-positive Ecstasy 0.2 – 0.4 results which then cause unnecessary It’s enough: Other drugs 3.4 – 6.6 blood tests. The r eason for this is A color indicates that the metabolic byproduct of the there is enough saliva for analysis Source: UNODC 2012 active ingredient in cannabis (THC) 1.) = key question: what proportion of people produces a positive result in a urine between the ages of 15 and 64 consumed this drug during the past 12 months? test for much longer than the active 2.) = minimum and maximum estimates substance itself. This means a greater risk that the subsequent blood test Cannabis is the most widely consumed ‘illegal’ drug in the world. According will have no legal validity, since courts to estimates, as many as five percent only recognize direct evidence of THC of all adults worldwide have smoked as proof of somebody’s inability t o at least one joint in their lives. Hard drugs like heroin, cocaine, and ecstasy drive. Demonstrating the metabolic are taken much less widely byproduct alone is legally irrelevant. >

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Draeger_EN_025 25 08.04.13 16:37 1. 2. 3. 4. 5.

Handling the DrugTest Take sample using pre- Color display indicates Insert cassette and Analysis and results 5000 hygienically: prepared test cassette sampling is finished cartridge into analyzer in a few minutes

> In Belgium, t he false-positive rate caused by urine testing rose at a certain point to 15 percent. This meant, strictly speaking, that traffic police wer e taking one in seven blood samples for nothing – a troublesome fact for drivers and officers alike. For many years there wasn’t an alternative to this practice. But the country is now pioneer ing a new approach, having established saliva testing legall y in 2010. Since then, traffic checks on suspected drug consumers in Belgium have followed a strict procedure: if a driver attracts attention then a saliva test is performed on the spot. If the concentration of a particular substance exceeds a certain threshold (see Table 2) then a second saliva sample is taken and sent t o a laboratory for confirmative analysis. If the driver refuses to cooperate or is unable to perform the test, then a blood sample is taken at the nearest hospital. 0.28 milliliter of saliva will suffice to prove the presence of various drugs, with the Dräger DrugTest 5000 (see below), in a short time – such as here in Australia Studies show that the number of drivers proven to be incapable of dr iving has risen since t he introduction of t he saliva test. Also in F rance, the saliva test has now been established into law. Likewise in Spain, wher e there are currently no mandatory limits. To the Point Saliva is similar to blood in its suitability for drug testing. It consists of ar ound 99 percent water, which comes out of the blood vessels int o the saliva glands, bringing with it many soluble substances into the mouth and throat – PHOTOS: DRÄGERWERK AG & CO. KGAA & CO. AG DRÄGERWERK PHOTOS: including the active subst ances in The device is designed for simple and hygienic to use, and operates drugs. As with blood, clear indications independently – even under harsh conditions

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Draeger_EN_026 26 08.04.13 16:37 SALIVA SAMPLE DRUG TESTING

THC can be detected in the saliva for as long as the effects remain

about the time of dr ug use, as well joint in Australia and N ew Zealand in Table 2: Drug Testing in as the intoxicating effect can be 2012. No other region ranks so high as Belgium: detection limits (known understood. On top of that, samples are this. Checks in Australia start with the as ‘cutoffs’) in ng/ml easy, quick, and reliable to take. Even highways. Unlike in Belgium, the police Substance Pretest Confirmation for the drug THC, which passes only a do not test on suspicion, but instead Saliva Saliva Blood very small amount out of the blood into systematically as a deterrent. Between (Plasma) the saliva; this method is suitable as the 2004 and 2009 in t he state of Victoria THC 25 10 1 active traces of THC accumulate during alone, more than 100,000 drivers were (Cannabis) smoking in the mucus. The proof can it tested for drugs. On-the-spot saliva Amphetamines, 50 25 25 be detected as long as the effect of the testing at the roadside is done almost Ecstasy drug continues in the body. like an assembly line basis (see also Opiates 10 5 10 Dräger Review 104; page 16 ff.). Cocaine, ben- 20 10 25 Almost like an Assembly Line Random sampling is also on the rise zoylecgonine Furthermore, the latest saliva testing at work, as Michael Wheeldon explains. Source: DRUID – Oral fluid and blood confirmation compared equipment, such as the Dräger DrugTest He is Managing Director of the drug in Belgium. Van der Linden T, Legrand SA, Silverans P, Verstraete AG. J Anal Toxicol. 2012 Jul;36(6):418-21 5000 introduced in 2008, pr oduces test service provider Integrity Sampling very reliable results. This device can Pty Ltd. The company was founded in Traffic checks of suspected drug detect very small quantities of active 2001 with the aim of testing employees consumers in Belgium follow a strict substances (THC: five nanograms per on behalf of t heir employers. The procedure: if a driver attracts attention then a saliva sample is taken. If milliliter), and it pinpoints the time proportion of people testing positive is substance concentration exceeds a of drug consumption within a time around two percent, much like on the certain threshold then a second, stricter window of up to eight hours, while only roads. “The number of tests has r isen saliva test is performed. If the driver refuses to cooperate then a blood sample requiring a saliva sample volume of just steadily over the past ten years,” says is taken at the nearest hospital 0.28 milliliters. “This makes it ver y Wheeldon. “In 2012 we used Dräger easy to determine whether a person equipment to per form around 35,000 Table 3: has taken one or more drugs recently alcohol and drug tests.” In the beginning Cannabis consumption by region and is still inf luenced by them,” says it was primarily mine operators who Region Consumption (%) Dr. Stefan Steinmeyer, responsible for commissioned the company. Nowadays the subject matter of “Dr ug Testing” requests come from all kinds of safety- Oceania 9.1–14.6 at Dräger. relevant industries. North America 10.8 As well as the technology, the legal The manager does not fear a drop West / Central Africa 5.2–13.5 basis has to be r ight. Saliva testing in demand. “Australian employers are Western / Central Europe 7.0 has so far only been carried out on a legally bound to ensure the safety of Asia 2.2 mass scale in Australia. Ther e, since their employees in the workplace.” This Source: UNODC 2012 2004, drug testing has been pushed includes seeing that everyone in the Key question: how many people between the ages of 15 and harder by the law than in any o ther team really is sober. Frank Grünberg 64 have consumed this drug during the past twelve months? country. But t hen again, nowher e else is cannabis consumption so high. The EU DRUID program: In Australia and New Zealand, at least On-the-spot drug testing every one in nine adults smoked at According to the UNODC, at least one equipment for safer roads least one joint in 2012. No other region in nine adults smok ed at least one www.draeger.com/107/ddt5000 has such a high figure

DRÄGER REVIEW 107 | SPECIAL 27

Draeger_EN_027 27 08.04.13 16:37 RISK FACTOR HUMANS

Risks and Side Effects A chain is only as strong as its weakest link, and SAFETY PRECAUTIONS are only as effective as the people who take them. If those people numb their senses they endanger not only their own safety.

f you had drunk a bottle of wine, would tating oil-spill off the coast of Alaska, on you trust yourself to distinguish with the other hand, can hardly be blamed I certainty between a r unway and a on the captain of the tanker Exxon Val- country road? Or would you still sit your- dez, which ran onto a reef in 1989. He self behind the wheel of your car? Any was lying drunk in his cabin while his sensible person would present “no” as crew was busy causing one of t he big- the answer. But in 1968, the German gest environmental catastrophes in weekly Die Zeit reacted with horror to a maritime history. Two years previously draft act proposed by the Federal Coun- an Amtrak train travelling at 110 mph cil which looked to reduce the blood crashed into a line of Conrail locomo- alcohol limit for drivers from 1.3 to 0.8 tives in Maryland, USA. Sixteen people per mille (see pages 42–45). “A pattern of died and 170 were injured. Eighteen futility” wrote the newspaper, grumbling minutes beforehand the crew of the that citizens were to be denied the free- Conrail convoy had smoked a joint and dom to judge their own ability to drive, overlooked a signal. An alcoholic and and bemoaning blanket punishment for drug-addicted engineer was later held everyone with a quantity of alcohol in principally responsible for the accident. their blood, even those who could still Every possible technical safety risk is drive properly. The subjective assess- considered today. Machines are designed ment of the danger at that time was a lot. for optimal interaction with people who have played through situations and vari- Hashish in the ants and scenarios designed to make Driver’s Seat the incalculable as predictable as pos- Today we know that assessing one’s own sible: humans. The blood alcohol lim- ability to drive after drinking still resem- it is now down to 0.5 ‰ in Germany as bles a game of dice. Sometimes you win, well as other countries. In many Slavic sometimes you lose. While one pilot may and Baltic nations, auto- drivers have to be able to land his aircraft after several abstain entirely – and rightly so, believes glasses of vodka and lines of cocaine as the doctor of psychology and addiction Denzel Washington did in “Flight”, ano- researcher Michael Klein of the German ther will miss the runway even with a Institute for Addiction and Prevention hangover. Autopilots cannot replace an Research at the Catholic University of attentive pilot, and automobiles cram- North Rhine-Westphalia. “The problem med full of airbags canno t prevent a with alcohol is that you don’t notice its head-on collision. effects until after it has begun to change In 2008 a R ussian passenger air- your perception.” This, he explains, craft crashed just short of its destina- takes place well before the obvious rush, tion onto the tracks of the Trans-Sibe- and sometimes from 0.3 ‰ onwards. rian Railway. The pilot’s inebriation The problem that makes people on

cost 88 people their lives. The devas- the road and in all relevant safety areas > AL GRILLO / PICTURES – STILL BILD ULLSTEIN PHOTO:

28 DRÄGERDRÄGDRÄRÄRRÄGÄGÄGERERRR RREVIEWEVIEEEVEVIVVIEVIIEW 10110707 | SSPSPESPECSPECIALPECPEPEECCIAIALIALAL

Draeger_EN_028 28 08.04.13 16:37 Facts and Figures u Alcohol is involved in more than one in ten road deaths in Germany u Medicaments and drugs play a part in between 14 and 17 percent of all worldwide traffic accidents causing death and injury u In North America, the number of drivers under the influence of illegal drugs exceeds the number of drunk drivers u The combination of drugs or medicaments and alcohol significantly increases the risk of being injured or killed

Oily consequences: the drunken captain of the Exxon Valdez caused one of the greatest eco-disasters of all time

Draeger_EN_029 29 08.04.13 16:37 Nervous Contestants The sympathetic and parasympathetic nervous systems are part of the autonomic nervous system, acting in opposition to control important bodily functions.

> a risk is the disinhibiting effect. Things the consumption of alcohol and o th- Using magnetic resonance tomo graphy, which are inhibited in a normal setting er drugs. This in turn allows the initia- researchers examined the way emotions would be released due to drugs. Take tion of other actions, enabling certain are processed. One group of participants for example somebody’s unwillingness types of behavior which would other- was given alcohol by infusion, another to perform a risky overtaking maneu- wise not occur.” group saline solution. Both groups were ver, which falls away because the fear is then shown a series of facial expressions, Emotions blocked. “Human behavior is a balance and while their brains were scanned con- Unrecognized between initiating things and feeling tinuously. In certain areas of the brain, inhibited,” says Michael Klein. “Social- A study by the National Institute on Alco- clear differences could be seen in the way ly well-adjusted people have acquired a hol Abuse and Alcoholism (NIAAA) in the sober subject group reacted to neu- high degree of control over their aggres- Maryland, USA, illustrates the way in tral and frightening expressions. These sion. But this control is restricted by which alcohol can manipulate the brain. differences could not be detected in the drunken group. Intoxicated people fail to recognize threats coming from other people – and are unable to develop stra- Central Nervous tegies to avoid conflict. System: Drive Similar results were produced by Eyes: Attentiveness a study at t he University of Granada in Pupil dilation Bronchia: Spain, showing that people under t he Expansion Saliva: influence of drugs have difficulty under- Limited, viscous standing the emotions expressed in the Heart: face of the person opposite. The mor e Frequency  Strength  intensive consumption in the past, the Blood pressure  more difficult it became t o recognize Liver: rage, anger, and fear. A further Spanish Gastrointestinal Break down glycogen study revealed neuropsychological impair- Release glucose System: ments of memory, the processing of feel- Peristalsis  Sphincter tone  Bladder: ings, and the ability to make decisions in Circulation  Sphincter tone  70 percent of the drug addicts – regard- Wall muscle tone  less of whether they had consumed alco- hol, cannabis, amphetamines, or cocaine. Skeletal Muscles: The consequences are foreseeable Sphincter tone  Wall muscle tone  not only for high-risk occupations. The danger of misreading certain situations makes people who have consumed drugs or alcohol a risk at football matches, at Sympathetic demonstrations, and in t heir general Nervous System daily interactions. On top of that there Fight/Flight is a change in character and the ten-

dency to violence which alcohol brings SHUTTERSTOCK, ISTOCKPHOTO PHOTOS:

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Draeger_EN_030 30 08.04.13 16:37 HUMANS RISK FACTOR

Eyes: Close focus Pupil contraction Saliva: Bronchia: Lots, thin Constricted Secretion  Heart: Frequency  Blood pressure 

Gastrointestinal system: Secretion  Peristalsis  about. “The question of whether some- Sphincter tone  one is violent or not is a matter of prob- ability. The problem is that many peo- Bladder: Sphincter tone  ple basically concede the right to be Wall muscle tone  aggressive under the influence of alco- hol,” says Addiction Researcher Klein. Not that this is the case everywhere. In Parasympathetic Islam, and in Chinese socie ty, offences Nervous System committed under the influence of alco- Rest/Relaxation hol are excused less readily than they are in a country like Germany. “The Amer- icans call this “German discount” – if you’re very drunk you’re considered only partially sane – and t herefore not fully the pilot on the seat next door slur s or rial vehicles and people who transport accountable.” smells of alcohol. Already with strange passengers, as well as t he police, fire- In many ar eas, the security risks decisions, without further suspicion, you fighters, and rescue workers. Most high- posed by people under the influence of begin to wonder.” Part of pilot training is security professions are governed by psychotropic substances, are now met to recognize such things, bring them up, nation- specific regulations, but rarely with strict prohibitions, as well as alco- and not sweep them under the carpet out by international standards. Under pres- hol and dr ug testing. In aviation f or of some mis guided sense of embarrass- sure from Germany, the Inter national instance, there is a worldwide ban on ment. Young pilots also have to be able Maritime Organization (IMO) did impose alcohol for ground and flight crews, and to broach the subject with more expe- in 2010 a limit of 0.5 per mille f or all attempts to enforce this international- rienced colleagues and t ake action – persons who bear r esponsibility on a ly include unannounced tests. Depend- “Regardless of the con sequences – even ship. Many other areas are less clear ing on the country and the contract of if the flight is cancelled!” and governed only by individual working employment, pilots may be obliged no t arrangements. These may include dr ug Many Regulations, to consume any alcohol a cer tain num- screening and alcohol tests as contractual Few Standards ber of hours before they begin work. Yet duties, but they fail to make people more testing rarely happens, and e ven the The law is inconsistent – in Germany, but predictable. Isabell Spilker annual medical examinations that take also internationally. From the potential place provide only limited insight into threat posed by the operation of a chem- Links u potential addiction. ical plant, for example, to the activi- Project DRUID (Driving under the Influence of Drugs, Alcohol and Medicines): Seems even more crucial because the ty carried out by an excavator opera- www.druid-project.eu general understanding of the risk, as con- tor, or outright of occupational health u Study: “Why we like to drink”, NIAA, firmed by Markus Wahl of the German and safety regulations, resulting in a Maryland, USA, published in the Journal of Neuroscience: http://www.jneurosci.org/ pilots’ union, Cockpit: “We all have the diffuse ban to consume drugs or alco- content/28/18/4583.short claim to operate safely. This is the highest hol during work hours. Then there are u Study: “Alcohol and fear-potentiated startle: priority.” He considers the interperson- simple occupational safety and accident the role of competing cognitive demands in the stress-reducing effects of intoxication”, published al realm more important than irregular prevention regulations. These apply to in the Journal of Abnormal Psychology: testing. “It is obviously irritating when people like drivers of hazardous mate- http://psycnet.apa.org/journals/abn/107/4/

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Draeger_EN_031 31 08.04.13 16:37 Draeger_EN_032 32 Strung Strung out at at out work that makes you lonely can be like a prison – a prison like be can as the loss of reality, reality, of loss the as Alcohol dependency Alcohol 08.04.13 16:37 FOTO: BLIND ADDICTION WORLD OF WORK

Whether hard liquor before work, a glass of prosecco at lunch, the joint added to the “crime scene” or the daily line of coke in the company‘s restroom: work, alcohol, and drugs do not work well together – especially when SAFETY AND EXPERTISE suffer. Workplace intoxication can present difficult situations for superiors, colleagues, and the addicts themselves.

n Mondays the dyers skipped for Addiction Issues (DHS), a non-profit Ludwig Eickemeyer never stood out. work. Clothing colored with indi- organization dealing with addictions, Among friends he was the buddy who Ogo hung on the lines, waiting for at least five percent of all employees in liked a drink or two. He did his job in a the sun to turn the dye into a brilliant Germany are alcoholics. The Interna- way that meant no one was bothered by blue. A little way away the wage workers tional Labor Organization (ILO) sus- his addiction – neither his colleagues lay around in the grass chewing the fat. pects that up to 25 percent of workers nor his superiors. “At a certain level I Since the chemical process by which indi- worldwide drink enough alcohol to be could do all of my work so that everyone go becomes blue required a lot of urine, considered at risk. was satisfied,” says Eickemeyer. “But they downed large quantities of alcohol. For businesses, the economic con- I may have never been below 1.2 per Four hundred years later, Ludwig sequences are considerable. German mille during this time. I needed it t o Eickemeyer* had a blood alcohol le v- employer associations calculate that function.” Up to this small, harmless el of 1.8 per mille when he crashed his damage to the economy caused b y accident after work, where the police motor-vehicle. He was coming home the consumption of alcohol at w ork took away his driver’s licence – and from a night shif t. He was not a dyer, amounts to 15 billion eur os, while gave him a new life. nor had he drunk anything that morn- more pessimistic estimates cite 30 bil- Co-Alcoholism Encourages ing; but his blood w as carrying enough lion. Each year 92,000 Ger mans are the Disease residual alcohol to knock most people declared unfit to work on account of out. It was the normal state of things for alcohol- related addictions or psycho- “Sometimes I feel shocked and sad the mining electrician, and not just on ses. As consumption increases, employ- when I reflect on how I could have Mondays. This went on for 18 years. ees miss work up to 16 times more fre- done everything differently in my life quently and forfeit 25 percent of their if my alcohol addiction had been dis- Driver’s License Traded working capacity. There are no com- covered,” says Eickemeyer, today Chair- for a New Life parable, statistically backed figures man of a support group in the German That there was no accident caused by describing the effects of cannabis, Ruhr area. him during this period, borders on a cocaine, heroine, or other intoxicat- Recognizing people’s dependency miracle. Up to 30 percent of all mis- ing substances taken at the workplace. on alcohol or other drugs, and helping haps at work take place under the influ- It is estimated that between 5 and 7 them, is therefore one of the main the- ence of alcohol or other drugs. Accord- percent of employees take drugs with mes of global campaigns and projects

PHOTO: HENRIK SORENSEN / GETTY IMAGES / HENRIK SORENSEN PHOTO: ing to estimates by the German Center some degree of regularity. around addiction at work. When col- >

DRÄGER REVIEW 107 | SPECIAL * Name changed 33

Draeger_EN_033 33 08.04.13 16:38 Clear guidelines aimed at helping addicts out of their dependency

> leagues and superiors tolerate addic- of increased unreliability, frequent ed to heroine. In the evening he stole tions, this is known as co-alcoholism, absences, and mood-swings. “Addicts materials from the company and on the and it can extend to ignoring addiction- are masters of camouflage,” explains weekend he smuggled drugs across the related absence or even covering it up, Sabine Morati*. For 20 years she went border. He was in the German Armed burdening business operations and to work every day – sober, but suffer- Forces, and later as a fitter, regularly on encouraging the illness itself. Mana- ing from withdrawal symptoms which drugs, never facing the consequences. gerial staff are legally bound to protect she made up for by overzealousness. Maybe he was noticed, maybe not, but the safety and health of people w or- “Never look negative!” Her colleagues nobody ever offered him help or com- king under them, which means relie- at the bank appreciated her, although mitted him to a treatment program. ving addicts of their work and reques- she was considered ill-tempered. That Increase the Pressure But Don’t ting that they seek help. was a smokescreen. Fritz Lehmann* Forget Your Social Obligations For colleagues and more especially succeeded in completing his appren- for superiors, it is crucial to take note ticeship as a roofer even while addict- Germany’s statutory social accident insurance body, the DGUV, recom- mends a clear action plan, for the per- son in the first steps of consultation and omission to move through to the advanced stage of addiction therapy. Prevention and Help While these actions begin with a u Change drinking customs: To what extent is the consumption of alcohol focus on resolution (in the hope that taken for granted inside the company? Are corporate celebrations always boozy, the odd slip will be no ticed by col- and is a forthcoming vacation or a business milestone jointly achieved reason leagues who recognize the danger of enough to crack open a bottle? A general ban on alcohol could make sense, but addiction and the associated risks), if is not always the solution, since often it merely postpones the problem. the lapses continue then they advise u Check what drinks are on offer: Is the bubbly always at hand in the colleagues to up the pressure in con- canteen? That case of beer on the office floor or in the foreman’s office at the versations. At the end the DGUV rec- construction site could be replaced with water. ommends getting addiction experts, u Teach your staff when and how addiction arises: The risks of employee organizations, manage- the occasional slip-up, and how a weekend of heavy partying can affect your ment, and people fr om the addict’s performance and your willingness to take risks. private sphere involved to help them u Promote health awareness: Addiction prevention is part of see reality – and take action. If their preventative healthcare, which management and factory bosses should behavior does not change, then official encourage among their workforce. warnings and dismissal ar e the last u Set up works advisory centers: It is not possible for every company resort, and even they should include to have a full-time addiction help, but voluntary helpers trained in seminars and a reinstatement clause which allows by self-help groups can assist. employees to return to their old jobs u Tell people about the therapy which is available: Contact with addiction if they abstain. counselors, self-help groups and specific therapists can open doors for addicts This is because t he loss of a job which by themselves they may not have seen. Nobody can be forced into therapy. can be t he worst possible punish- But if the pressure is great enough, they will often consent. ment for an addict, usually even

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Draeger_EN_034 34 08.04.13 16:38 ADDICTION WORLD OF WORK

worse than breaking with their fami- lies and friends. It was a social obliga- tion to take into account, the option In the European Union, of returning as motivation, according to the DGUV. drunken employees Fear of losing one’s job is often the reason why addicts and other employ- cause around 60 billion ees who notice their behavior do not act earlier. Even colleagues with cour- age often lack knowledge of how t o euros of economic handle such situations. Is their cowork- er really an addict, or does he just like damage – every year to have a good time? How do you speak to somebody if you think they can’t do their work properly in the state they are in today – and probably tomorrow? People often worry about the conse- quences their colleagues will have t o face. Social abuse perhaps, widespread discrediting – or even getting fired on the spot? Few will know that it is not so much the person’s job which is at risk, but rather the insurance provid- ed by professional associations to cover the eventuality of an accident at work, which is forfeited if the employee has alcohol in his or her blood (e ven a residual amount) or is under the influ- ence of drugs. Dismissal really is the ultima ratio, since addiction is consid- ered an illness and does not represent a reason in itself to get fired. Universal Approaches, Cultural Differences Around the world there are countless associations, groups, clinics, and uni- versities working on strategies aimed at teaching employers and employees

PHOTO: ISTOCKPHOTO PHOTO: how to handle the dangers of addiction, >

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Draeger_EN_035 35 08.04.13 16:38 Only very few companies have the working conditions, the stress, and the cultural environment in mind

> how to prevent it, and how to deal with alcohol and drug abuse. The approach- es are basically universal, although they do display cultural and legislative As many as 30 percent differences. “The thing is that there is a trian- of all accidents at gle of action – three points that encom- pass and influence the whole affair,” work occur under the explains Steve Allsop, PhD Exper t at the Australian National Drug Research Institute. “You have t he individual, influence of alcohol the drug, and the circum stances.” To achieve meaningful pr evention you or other drugs have to assess on t he one hand t he availability of substances – for instance, whether alcohol can be pur chased inside the company. “A person has to be treated in terms of education or therapy,” adds Allsop, remarking, “It is on these two areas that most companies focus worldwide. Only a very few look at working conditions, the stress, and the cultural environment.” But think of this: it is essential t o con- sider the fact that construction workers in assembly or mining jobs, often locat- ed far from civilization, have ver y few opportunities to spend their evenings in a meaningful way. Strict Bans on Alcohol are Rare Foremost among pr eventative mea- sures is education inside com panies about the health aspects of alcohol and drug consumption, as well as t he far reaching legal, safety-related, and social consequences. In countries such as New Zealand, Australia, and the USA,

tight alcohol and dr ug monitoring GETTY IMAGES / CHRIS JACKSON PHOTO:

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Draeger_EN_036 36 08.04.13 16:38 ADDICTION WORLD OF WORK

“Germany is doing well in comparison” among employees is common practice in certain professions. In Germany on Are corporate strategies for preventing addiction at work sensible the other hand, this is legally impossi- and effective? The German Center for Addiction Issues (DHS) ble: drug and alcohol tests may only be investigated this question as a national partner of the European project insisted upon before employment com- European Workplace and Alcohol (EWA) running until mid-2013. mences, but not afterwards. CHRISTINA RUMMEL of DHS speaks about the first interim results. Many companies now r ely on employment agreements incorpo rat- The EWA project examines corporate addiction prevention ing addiction prevention measures. in Europe. How does Germany shape up? These include guidelines for anybody Germany does well in comparison with other European countries. There confronted with alcohol or drug abuse, are numerous established activities aimed at recognizing the risks of and create a clear legal situation. addiction at work and preventing it. Germany also has one of the best Fritz Lehmann, Ludwig Eickemeyer, addiction help systems: a well-developed network of counselors, and Sabine Morati can no longer imagine a good rehabilitation network, and plenty of research into addictions. how they managed to work at all: strung Preventing addiction at work has been a live topic here for 30 years, out, brought up to the bearable limit, cold while other countries are only now discovering it. But it still is not the and sweaty, because their bodies lacked end of the story for us. substances. Following their treatment What do you think still needs to be done? they were different people, but they were Small and medium sized businesses have a lot to do. Addiction prevention allowed to stay in their jobs. None of them now takes place in all large companies, where there are works councils, have relapsed. “The realization of who I occupational physicians, and established structures. The owners of small am and what I am r eally doing here is businesses and management level workers in medium sized companies too great,” says Eickemeyer. So too was are usually plagued with very different worries. There they have hardly any the shock of contem plating the circum- capacity for addiction help programs available. stances in which he had worked all those How can the EWA project help companies? years. Shock enough indeed to say no to At the moment we are trying to learn from one another and evaluate our a beer at the next office party – and the national activities. After we conducted surveys in Germany, several things one after that – and to earn the admira- are going: from flyers to trainings. We will then conduct further surveys tion of his colleagues. Isabell Spilker to see how much perception has changed. At the end, the results of all the European partners will be brought together and a “tool kit” will be created, Links even small companies will be able to work with it. u “Management of alcohol- and drug-related issues in the workplace”, International Labor Are national differences taken into consideration? Organization, www.ilo.org Yes, the tool kit will be adapted to the particular conditions in each u “Alcohol, Work and Productivity”, European country, since there are of course cultural differences in the way people Commission, http://ec.europa.eu/health/alcohol/ docs/science_02_en.pdf deal with drugs and alcohol. But we are making sure that we learn u European Workplace and Alcohol: from one another. The United Kingdom, for instance, is very progressive www.eurocare.org/eu_projects/ewa when it comes to the use of new media. Self-testing using apps and u Maximising employees performance by minimising the impact of substance in the visiting advice centers are things which occur much more naturally there. workplace (Mepmis): These are good suggestions. http://www.alcoholdrugsandwork.eu/

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Draeger_EN_037 37 08.04.13 16:38 ADDICTION HELP

How Therapy Can Help One of the key mottos among RECOVERING ADDICTS goes: “There is no shame to be sick. It is a shame, to do nothing about it.” To recognize and understand the dependency is the purpose of addiction treatment – even 20 years after the last beer or the last joint. This is a complex theme approached from many sides in our expert interview, patient report, and stages of therapy.

Addiction is like a cage. It prevents personalities from unfolding. Proven concepts help find a way out of the prison

FOTO: BLIND FOTO:

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Draeger_EN_038 38 08.04.13 16:38 Therapy’s goal is that the person understands why he is sick “Only those who understand their addiction, have a chance at a life of abstinence. This is the experience of Heinz-Peter Roehr. The addiction therapist who has worked for over 30 years in the German Speciality Hospital Fredeburg – and Mr Röhr, what kind of people come to you? has already helped hundreds of people The image of the addict is changing. At the moment we have many patients who use multiple drugs. Straightforward alco- holics are becoming rarer. Many take cannabis, cocaine, am phetamines, and designer-drugs as well as dr inking. The therapy: that is for the patient to become grandeur. Borderline patients prefer sed- classic heroin addict is also less and less aware of his or her illness, t o become ative substances: alcohol, heroin, tran- commonplace, although that does not motivated to abstain, and to begin to quillizers. But addiction is a ver y indi- make the addiction any less danger ous. understand the background to why he or vidual problem. So-called ‘soft drugs’ such as cannabis she has become an addiction suf ferer in How do you prepare your should not be seen that way. People suffer the first place. patients against not relapsing immensely under the personality-chang- Do you research the causes then? again afterwards? es that these drugs cause. We do try to recognize and understand We take the different situations of con- But a drug like heroin is much backgrounds. Sufferers have t o real- sumption under the magnifying glass. The more destructive to people ize that they are actually dependent on patients get shown how to react in those than a combination of alcohol something else, perhaps on an unr e- moments with different behavior pat- and cannabis, isn’t it? solved parental relationship or on other terns. Most have left the clinic with a new This may seem so, in r eality, the curve people – and that they suffer from a lack sense of self and a certain understanding spirals straight down. What seems harm- of self-esteem. of their disease. Statistically most relapses less at the outset brings people to a low- How long does it take to happen in the first three months. That is point. When the pressure builds up, they come to this realization? why we nearly always add aftercare, which come to us. That can vary a lot and depends on how takes place in forums such as group dis- The pressure from outside? they take to therapy and how quickly they cussions or other thera peutic activities. Admittedly, almost nobody comes t o us begin to process their problems. Literature voluntarily. It is mor e likely to be their What might a reason be for u Katherine van Wormer, employers no longer putting up wit h it, giving up therapy? Diane Rae Davis: Addiction Treatment: their families going on strike, or their bod- A relapse for example, although that in A Strengths Perspective (Substance Abuse Counseling), Brooks Cole ies giving up. When phy sical impairment itself does not have to mean immediate sets in, patients realize that if they don’t discharge; rather it can be pointed out, Heinz-Peter do something now, the end may be near. understood, and processed within therapy. Röhr is That doesn’t sound like realizing Do different types of narcotic a member you’re addicted. Are those promising dependencies give you conclusions of a multi- professional reasons to be entering therapy? about the people or give you therapist Realization and the motivation to live in instructions for their therapy? team who treat abstinence often develop only once in the Yes, for sure. People with narcissistic dis- addicts therapeutic community. In fact it does orders tend towards cocaine, because it not matter whether or not a patient real- has precisely the effect they are look-

PHOTOS: PHOTOS: EIKO OJALA / IKON / CORBIS; IMAGES ly PRIVAT wants to go at first. This is the goal of ing for: it accentuates their delusions of

DRÄGER REVIEW 107 | SPECIAL 39

Draeger_EN_039 39 08.04.13 16:38 saw that I had br oken off therapy and did not allow me to work. I now “My excessiveness had nothing else to do with my time. saved my life” I drank almost dail y to the point of uncon sciousness. It was this excessive- Maren S. drank half of her life, but did not want to ness which in the end saved my life. admit how big her problem was. Not even in therapy. I reached an absolute low-point and In her account of her personal struggle against wanted to put an end to my life. I had already chosen the tree. I just w ant- addiction she reveals what finally opened her eyes. ed to attend one more session with my therapist. She immediately saw that something was wrong with me and did something she had never done before with any of her clients: she admitted to being a recovering alcoholic herself, and told me she knew exactly how bad it was going for me. or thirty years I drank, and during chiatric clinic for ten days. Afterwards “I Wanted to Do that time I almost bur ned down I felt so great that on the way home I Something for Myself” F my apartment three times. While bought myself a bottle of liquor. At the drunk I drove my automobile head-on hospital, a social worker from the Alco- That for me was the turning-point. Here into a wall, fell down a staircase head- hol and Drug Counseling had contact- was somebody who understood me, who over-heels, fell off a high ladder in a ed me. She advised me to take up outpa- explained to me that alcoholism was an bathroom – tearing the washbasin from tient therapy and one-on-one therapy. I illness – an illness which does not heal, its anchors on the way down. But woe did both – and kept on drinking. but which can be brought to a standstill betide anyone who addressed the sub- – but only by me. At last I was able to Flabbergasted Boss ject of my drinking problem: I didn’t admit that I was an alcoholic. Because I have a problem. The social worker set up inpatient ther- was now committed to doing something At work, nobody ever noticed any- apy for me for a period of 16 weeks. I had for myself, I was able to do the remain- thing wrong. I was a personnel officer to tell my employer, who was absolutely ing six weeks of inpatient therapy. at a large com pany, and never drank flabbergasted. I entered therapy. The Then I attended another outpatient before work. During the day, I often problem was that I was doing it only for therapy, and since t hen I have been felt bad, I was shaking, and had sweats. my boss, my therapist, my family, and attending Alcoholics Anonymous every But I had diabetes anyway, so I was able my friends – but not for me. After ten week, a self-help group, without whom to blame everything on that. Eventual- weeks I left: during a weekend at home I would certainly not keep my sobriety. I ly, I was approached by my doctor. He I had gotten drunk – which meant the can’t say for sure that I won’t be drinking wanted to send me to the hospital for end of the therapy. again next week or next year . But I can alcohol detoxification, so that I would Once I had washed down my frus- speak for today: and today I am not going be clean again. I ag reed grudgingly, tration back home, I got back in touch to drink. I have been saying that now for took a few days off, and went to the psy- with my employer two days later, who 14 years.” Report: Isabell Spilker

40 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_040 40 08.04.13 16:38 HELP ADDICTION Therapy: four steps

to success different addiction types and patient The goal of addiction therapy is for a patient to categories. One-on-one and group remain abstinent permanently. Achieving discussions investigate the causes of addiction, so that certain patterns can be this state – which is always vulnerable – requires recognized and treated specifically. Over insight, professional help, and discipline. the course of the remaining thera peutic treatment (relaxation techniques, creativity training, activities for leisure planning, and so on) an attempt is made to make it easier for patients to start a life free of intoxication and substances. Contact with family and friends is usually limited at first, Step 1: attending therapeutic group and individual but increased towards the end of therapy, Recognize the problem counseling, once or twice a week. This at which point attention is paid to the and seek help demands that the relationship with the patient’s working and social environment. The family physician is usually the first therapist is good and based on mutual point of contact, or an outpatient clinic. trust, otherwise treatment is unlikely to be Step 4: What is important at the beginning is to successful. The advantage of outpatient Aftercare recognize the problem of dependency therapy is that sufferers can remain in their Conversational Therapy: The basis as such, otherwise all of the subsequent accustomed environments and with their for a life of abstinence has been created, steps may prove fruitless. Patients families, and even go to work. However, but the risk of relapse still remains. must recognize the extent of their addic- there can be drawbacks since the daily Regular conversational sessions with a tion, and personal circumstances must routine will usually be the same as before physician, at an advisory center, or be clarified, before treatment can begin. detoxification, and some people tend to with an outpatient psychotherapist can relapse in familiar surroundings. help a patient to stay on track. Step 2: Inpatient: Specialty hospitals offer Self-Help Groups: Whether it’s Physical Withdrawal inpatient treatments away from everyday Alcoholics Anonymous, or workers’ Outpatient: Patient’s withdrawal is usually environments for between 6 and 16 welfare associations, self-help groups done under the supervision of a family weeks, usually divided up into groups of have over time become one of the physician. During the first week the doctor strongest pillars in the battle against will perform daily medical checks on addiction. This is where recovering the health of the patient, assisting where addicts and their relatives can meet people necessary helping with medication to who have lived through similar things elevate withdrawal symptoms such as shak- and come out on the other side. ing, sweating, and circulatory problems. In the second week the patient visits the doctor every two days. During this period the addiction sufferer is given an incapacity to work certificate. Inpatient: In particular for cases of severe physical dependency, inpatient treatment is indicated for physical withdrawal. Detoxification is offered at internistic hospital stations or at spe- cialty hospitals where specially trained staff supervise withdrawal and offer accompanying discussion therapy. Links u National Institute of Drug Abuse: Principles of Drug Addiction Treatment: A Research-Based Step 3: Guide, www.drugabuse.gov (USA) Rehabilitation – The Actual Therapy u An overview of self-help groups in the US: www.mentalhelp.net Outpatient: The ambulatory care takes u An overview of Australian self-help groups:

PHOTOS: PHOTOS: EIKO OJALA / IKON / CORBIS IMAGES between 12 and 18 months and involves www.coshg.org.au/grouplinks.html

DRÄGER REVIEW 107 | SPECIAL 41

Draeger_EN_041 41 08.04.13 16:38 Glass by Glass The acute effects of alcohol are varied and depend on many 0.2 ‰ factors – but for the sake of Talkativeness rises, simplicity they can be grouped into inhi bitions leave, the response different blood alcohol levels. time is increased.

How Little is Enough? Ever since they existed they have been controversial: ALCOHOL LIMITS FOR DRIVERS. Complete sobriety is the ideal state when it comes to performance at the wheel. In reality more liberal, graduated limits have proven effective. But what is the thinking behind limits like 0.3, 0.5, and 0.8 per mille?

Alcohol blurs reality – especially 42 DRÄGER REVIEW 107at | highSPECIAL speed

Draeger_EN_042 42 08.04.13 16:38 ALCOHOL LIMITS ON THE ROADS

0.5 ‰ 0.8 ‰ The sensation of pain is damped, First balance problems occur, also the visual performance and hearing de creased. sense of sight is impaired, the response Miscalculation of speeds. time is extended from 30 to 50 times.

he two visitors epitomize the cli- The thing to do, says Michael Wenzien, ing for, an umbrella organization repre- ché of the veteran couple: mar- is to help people see t he danger they senting more than 200 entities including T ried for decades, they have been are suppressing. He is a police of ficer, all of the German Transportation Min- through everything together. They are at Station 620 in Hamburg, responsible istries, accident insurance companies, accustom ed to noticing each other’s for prevention. The simulator stops as automotive manufacturers, and driving weaknesses and idiosyncrasies. He, many as 200 times a year in vocation- clubs. “Zero Limit“, which in the history focused and self-assured, is at the wheel al colleges, trade fairs, and shopping of German driving was a strategy adopt- of the Alcohol Dr iving Simulator, at malls. As in real life it sorts people into ed solely by the former GDR, was abol- the Hamburg Police. She watches the categories which the officer knows all ished there on January 1, 1993, where- increasingly unsteady journey with good- too well from the highways: “For those after a limit of 0.8 ‰ applied until April natured mockery. who over- estimate themselves, we get 1, 2001 when the general German limit The problem is t hat the artificial them to drive on a country road where of 0.5 was brought in. The exception is automobile is making things more and 70 km/h is allowed. By t he time they for new drivers in their probation peri- more difficult for the driver as his com- exit the third corner they’re clocking ods, and drivers under 21: since August puter-simulated level of drunkenness ris- 90. Similarly conspicuous are the over- 1, 2007 they have been obliged to remain es. It narrows down his field of vision and cautious who know they should not be completely sober, as are bus and taxi driv- makes the steering spongy and imprecise. driving, but do it anyway. Those are the ers and operators of hazardous materi- It extends braking distances and increas- ones we see at night, cr eeping along a al vehicles. An all-out ban is very unlike- es reaction times. Deer jump out of the multi-lane road at 40 km/h.” Both driv- ly. In the end, the philosophy of Western bushes, vehicles cr oss his pat h with- ers know they are doing something for- societies puts trust in the reason and out warning, children stumble onto the bidden – it ex cites one of t hem and judgment of the individual. The balance road. And then, after three or four virtual frightens the other. But neither has the between the wishes of the driver’s free- drinks, the man is unable to stop in time. sense not to drive. dom and the rights of others. Underlying “You see?” blurts out the woman. “How That is why, to add to preventative argu- this is the “Recht” conception of Konigs- many times have I told you already?” ments, checkpoints are set up as deter- berg’s Enlightenment Philosopher , rents. And if somebody ex ceeds alcohol Immanuel Kant: “Recht (legal justice) Making Dangers Clear limits they are punished. This is necessary, is the embodiment of all those conditions For police officers this is the moment to since it is also the state’s responsibility to under which one person’s arbitrary judg- raise his eyebrows knowingly. They know protect the rights of others. A typical case: ment can be reconciled with another’s it from the street, the mixture of self- Kirchweyhe near Bremen, Germany, in according to a general law of freedom.” assurance and false confi dence. This type April 2010. A car crashes, af ter midnight That is why there are limits – or in other of driver often draws attention at check- in a Tempo-30-Zone, against a tree. The words, ‘compromises in numbers’. points: the one who is sur e he has every- speedometer hangs at 130 km/h, impact Deterrence as a Goal thing under control. But at just 0.5 t o speed is later ascertained as 107 km/h. 0.9 ‰ Blood Alcohol Content (B AC), the The rescue services find six young people The German rule is 0.5 per mille and was risk of dying in an accident is between 11 inside, three of them dead; the driver dies created in 1973 and reinforced 2001 with and 13 times greater, even if only one vehi- later in intensive care. His blood alcohol § 24a of the Road Traffic Act. The thinking cle is involved. This rises to a factor of 50 level is measured at 1.4 ‰. behind this is general deterrence. Does it between 1.0 and 1.4 ‰. Above 1.5 ‰, the “Zero alcohol at the wheel“ is what work? “The number of accidents under

PHOTO: THINKSTOCK PHOTO: danger is almost 400 times greater. the German Road Safety Council is call- the influence of alcohol and other intox- >

DRÄGER REVIEW 107 | SPECIAL 43

Draeger_EN_043 43 08.04.13 16:38 1.0 ‰ 2.0 ‰ A bidding frenzy begins. Alcohol acts partially as a strong sleeping pills, speech Emotions and behavior are is clearly slurring. Memory problems occur, as well clearly altered. as blurred vision. Muscles go limp, the pupils are small.

> icants fell by almost 40 percent between drunk driver attracts attention by mak- Those are left to the judges, and the high- 2001 and 2011. And that, although there ing mistakes, or causing an accident. est courts of the land have continuously had neither been a tightening of the law This is clearly not every driver. This is adjusted them in line with new research nor a significant increase in the traf- when § 316 of the German Criminal findings. The philosophy behind t hese fic control since 2001,” stated Dr. Beate Code comes in. Established in 1953, it limits differentiates between an “abso- Merk, Bavaria’s Justice Minister, after is 20 years older than the general blood lute” and a “relative” inability to drive. after a good decade of “Zero comma five”. alcohol limit. Anybody who “dr ives a An absolute inability to drive means vehicle despite being unable t o control the point beyond which scientists have Blood Alcohol Levels Crumble it safely on account of having consumed shown that nobody is able to drive safe- The actual application of t he law and alcoholic beverages or other intoxicat- ly. In 1953 the Federal Supreme Court of its limits becomes more complex, and ing substances” faces up to 12 months in Germany interpreted current research is justified very differently, whenever a jail. But § 316 does not name any figures. to mean that this was at 1.5 ‰. In 1966,

Blood Alcohol Levels 0.0 ‰ 0.1 ‰ 0.2 ‰

0.3 ‰

0.4 ‰ -

0.5 ‰

0.7 ‰ - 0.8 ‰ 1.0 ‰ * International Comparison: No figures Although the physiological effects of alcohol are the same all over the world, No limit different countries allow different blood alcohol levels on their highways – from (no BAC figure defined) 0.0 to 1.0 ‰. This map is a snapshot from the beginning of 2013.

44 * USA: varies from state to state – up to 1 ‰ DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_044 44 08.04.13 16:38 ALCOHOL LIMITS ON THE ROADS

now fall unconscious suddenly and go into shock. If he continues to drink then 2.5 ‰ coma and death threaten – by circula- The effect now crosses over into a form of tory failure, suppression of the breathing anesthesia: pupils dilate, all aforementioned reflex, or hypothermia because the body’s disorders are amplified. The drinker may temperature has been sinking steadily.

following a report issued by what was then the German Federal Health Office, this figure was cut to 1.3 ‰. Physicians had stated that not one test person was able to fulfill the demands of driving at a BAC of 1.1 ‰ or above. To give defen- dants the benefit of the doubt the Court added a safety margin of 0.2 ‰. Then in 1990, the “absolute zone” was defined as 1.1 ‰ and upwards: anyone accused under § 316 of the German Criminal Code is not permitted to present person- al counterevidence if a reading of 1.1 ‰

or above has been pr oven. Even if the GMBH FOERST PHOTO: person was able to drive perfectly, it is Sobering: using a driving simulator you can get an idea of how the roads can appear at different levels of intoxication immaterial. They are sentenced. Relative inability to drive, in which drunkenness appears together with alcohol-related malfunctions, is anoth- on for levels 1.1 ‰ and upward. When criminal wrong doing will be punished. er matter. An example of this is a driv- it comes to taking samples it is crucial If you connect with this view, the question er who is unable t o drive a straight to adhere fastidiously to procedure. For remains: Is it “criminal injustice“ when line. The r equirements of e vidence instance: samples have to be taken by a a driver is at 0.1 ‰ on the road and safely are strict, but the flipside is that it doctor, and if the doctor wants to hand arrives at their destination? Specifically, if matters not whether somebody’s prov- over that responsibility – to a nurse for they do not harm anyone, but the law says en blood alcohol level is below 0.5 ‰: example – then this can only be done “yes”, the danger presented to them from after an accident, severe penalties can with the suspect’s consent. Procedur- this is as equal as if someone improperly be imposed, even at levels of 0.3 ‰ and al mistakes are therefore a risk, and a handle explosives in a pedestrian zone. above. All of these limits serve only one resourceful attorney may well use them A survey conducted for Dekra in 2012 purpose – to decide for or against con- to fight for acquittal. showed that Germans think an absolute viction – they are known as “evidence zero limit would not be a bad t hing; 78 Changing Mentalities limits”. And because they are of criti- percent of those asked are in favor. Many cal significance, there are strict regu- The Koblenz Administrative Appeals Court experts also believe it would be sensible, lations around how they are measured. issued a verdict in 2010 which illustrated well justified, and one day absolutely possi- The “blow” on the roadside is the clearly the different approaches taken in ble to realize – thanks to a general change clarification of the first suspicion. A different areas of law. A license suspen- in mentality. It used to seem fine to brag decisive role is the court of law breath sion during the administrative pr oce- that you had not been caught: ‘Imagine it sample with extremely reliable analy- dure serves as a pr ecautionary protec- – dead drunk, but they didn’t even catch sis - in Germany they are only permit- tion avoiding dangers to other road users me!’ Say that today and almost everyone ted with the Dräger Alcotest 7110 Eviden- demonstrated by inappropriate drivers. will shake their head: ‘What kind of a per-

GRAPHIC: PICFOUR tial - or a blood sample, which is insisted In criminal proceedings, however, later son are you?’” Silke Umbach

DRÄGER REVIEW 107 | SPECIAL 45

Draeger_EN_045 45 08.04.13 16:38 ROAD SAFETY ALCOHOL-INTERLOCKS

Simple Yet Convincing The principle behind the BREATH ALCOHOL IGNITION INTERLOCK is remarkably simple. It does not release a vehicle’s starter motor until it has accepted a breath test.

Preventing drunk driving: the Interlock XT is an intelligent ignition key which prevents people from driving under the influence of alcohol

FOTO: BLIND FOTO:

46 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_046 46 08.04.13 16:39 Incorruptible: the Dräger Interlock XT is pro tected against tampering; the measuring system inside accurately detects alcohol

Interlock XT: First blow, then drive. The principle behind the breath alcohol controlled immobilizer www.draeger.com/107/interlock

aking a breath test to start your 2011). Positive results obtained in field mechanisms to ensure that breath alco- automobile? To many this may tests have encouraged lawmak ers in hol content is analyzed accurately, and T sound strange, but in some plac- various European countries to push tamper attempts are detected reliably. es it is already a reality: the driver blows forward the introduction of alcohol Once a breath sample has been provid- hard into the mouthpiece of a discreet interlocks. By the year 2015 for exam- ed and accepted, it passes through the hand-held device which analyses the ple, every new school bus in F rance sampling bellows onto an electrochemi- alcohol content in the exhaled air. If will have to be equipped with an alco- cal sensor. If the result is negative then the result is negative, then – a few sec- hol interlock. In Sweden this is already the device sends a signal to the vehicle’s onds later – the interlock releases the mandatory for any transport commis- electronics to release the starter motor. starter motor. This form of immobiliz- sion put out for tender by the state. More Safety er, known as an “alcohol inter lock”, The principle of the alcohol interlock is not there to protect against theft, is as simple as it is convincing: if you are When these devices are installed in pas- but to reduce the risk of people driv- drunk, then you cannot start your vehi- senger and freight vehicles it is referred ing under the influence of alcohol. The cle. Although it may seem like a good to as ‘primary prevention’. The driver is latest devices feature electrochemical idea to equip every single vehicle with not under any actual suspicion. “Using sensors – including Interlock XT, which such an immobilizer right away, blanket an alcohol interlock meets the need measures specific amounts of alcohol. installation would be almost impossible for safety of passengers and the envi- Alcohol interlocks represent a par- from a legal and economic point of view. ronment,” says Bettina Velten, Product adigm-change in the way road safety is Nevertheless there are enough examples Manager at Dräger. “This builds trust monitored, since the tests they perform showing that the system works well and and highlights the responsibility taken are done preventatively – before you is accepted. These include passenger by drivers and operators.” start your engine. Conventional r oad- transport (buses, taxis) as well as goods But installing the devices in vehi- side checks are done at random and transport (e.g. hazardous materials). In cles belonging to drivers with previ- aim to identify alcohol offenders who both cases, drivers carry a heavy respon- ous records is a different matter. This are driving on the highway, and pun- sibility towards passengers, the gener- ‘ secondary prevention’ serves to pre- ish their behavior as a pe tty or crimi- al public, and the environment. Then vent any more drunken road use, and nal offense. there is the use of such immobilizers is prescribed instead of, or af ter a ban to encourage people who have alr eady on driving. The direct effectiveness of USA: Pioneering Introduction been found drunk-driving to learn strict alcohol interlocks has been confirmed The USA (where there are now more separation between drinking and driv- in scientific publications such as the than 200,000 such devices in use) and ing. In the Netherlands, a law having Meta-Study published in 2011 by the US- Canada pioneered the introduction of been passed to that effect at the end of American Guide to Community Preven- breath alcohol controlled immobilizers 2011, states more than 1,000 auto mobile tive Services, and the Cochrane Study in in the 1980s. They are also widely used drivers now have such devices fitted in 2009. A study entitled “Alcolock Imple- in Australia, and in Eur ope: the first their vehicles (see also Dräger R eview mentation in the European Union” pre- European schemes were in Sweden 106; pages 44–47). sented in 2006 and sponsor ed by the (regionally at first, beginning in 1999, But the technology can onl y be European Commission under scores nationwide since 2004), France (ini- effective if it w orks reliably and can the suitability of this technology for a tial study in 2004), and Finland (since withstand manipulation. The Dräger range of purposes. Bus and truck driv-

PHOTOS: MIQUEL GONZALEZ, KGAA & CO. AG PHOTOS: DRÄGERWERK 2008, program established as law in Interlock XT incor porates various ers were involved in the project as test >

DRÄGER REVIEW 107 | SPECIAL 47

Draeger_EN_047 47 08.04.13 16:39 Alcohol-Interlock Dräger DrugTest 5000 in freight transport used for industrial safety

Alcohol interlocks are a major element in primary prevention in the

> groups for primary prevention. Drivers Dräger Interlock XT, comply with the in order to extract the full potential of an with existing records of driving while European standard EN 50436, fulfill all interlock program, the device should be drunk formed further test groups for of the conditions governing testing pro- combined with accompanying activities. the secondary prevention area. cedures and operating behavior. Rapid Detection Methods Events – such as measured results Putting a Stop from breath alcohol tests and jour - The first technical interlock concepts Alcohol interlocks have pr oven an ney durations – ar e all stored in the came about in the 1960s. Dr. Robert B. effective method of preventing con- device together with dates and times, Voas of the National Highway Traffic victed alcohol of fenders from driv- and can be r etrieved by trained and Safety Administration (NHTSA) in the ing while drunk again – this especial- access- authorized personnel using the USA is consider ed a pioneer of t he ly when compared against taking away appropriate hardware and sof tware. idea, having anticipated the function driver’s licenses, since people’s will- This is usually done every few weeks. of modern interlock technology in ingness to get behind the wheel when The user ’s details are encrypted so his essay entitled “Cars that Drunks they shouldn’t obviously grow under that others cannot see them from the Can’t Drive”. Voas was involved in the influence of alcohol, even if their outside. When used as par t of thera- the technical ignition interlock speci- driving permit has been withdrawn. A py, the results allow conclusions to be fications that now apply in America breath alcohol controlled immobiliz- drawn about things like whether the and which were published for the first er puts a tec hnical stop to this kind user’s drinking behavior has changed. time in 1992 (Model Specifications of drunk driving. But it leads some Studies have shown that some drivers for Breath Alcohol Ignition Interlock of those involved to try to circumvent who have committed multiple of fen- Devices). Initially, experiments were the devices. That is why r eliability ses return to the road drunk as soon done in North America using systems and protection against tampering are as their devices have been uninstalled that attempted to ascertain the ability so important. Devices which, like the at the end of the program. That is why, to drive by means of reaction-testing.

48 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_048 48 08.04.13 16:39 ALCOHOL-INTERLOCKS ROAD SAFETY

Checking breath alcohol levels underground

PHOTOS: DRÄGERWERK AG & CO. KGAA & CO. AG DRÄGERWERK PHOTOS:

workplace

1. When you 2. … the Interlock XT 3. The alcohol 4. … and if you pass 5. Now you switch on asks you to give content in your breath the test, the system can start the the ignition … a breath sample. is analyzed … releases the starter. engine

But in the end, testing breath alcohol demands on the devices and on data are the drivers, who can submit breath before the commencement of driving management have risen. “With our samples under unambiguous and proved the quickest and most dir ect experience we are ready to assist those reproducible conditions. Meanwhile, method of proof. This basic principle who are working to introduce drunk everybody else benefits too from the has not changed much since. With the driving programs,” points out Bettina extra safety brought about by the use of proliferation of alcohol interlocks, the Velten. The winners in these schemes alcohol interlocks. Peter Thomas

DRÄGER REVIEW 107 | SPECIAL 49

Draeger_EN_049 49 08.04.13 16:39 HEALTH MYTHS AND LEGENDS

The Fairy-Tale of the Healthy Drug Numerous stories surround the EFFECTS OF ALCOHOL AND DRUGS. They will downplay the dangers, or even re-interpret intoxicants as healthy. But upon closer inspection, most of them prove to be nothing more than bizarre fairy-tales.

o question: A glass of wine in burg-Eppendorf University Hospital. “In tea-drinkers. Alcohol relaxes the stom- good company can be good, the case of red wine, flavonoids and poly- ach muscles, making you feel subjective- N even a cigarette. Carrying on phenols like resveratrol appear to play a ly that your fullness has been alleviated; a conversation is easier, the mood is part, helping among other things to pre- but actual digestion is slowed down. relaxed. It’s fun, and you’re reluctant vent blood platelets from sticking togeth- Nor does alcohol deliver what it prom- to spoil it – for example by the warn- er, something that makes a heart attack ises as an aid to sleep. It does make you ings concerning the dangers of alcohol more likely.” In this respect a glass of tired and might help you t o fall asleep and other drugs. It is much more com- wine or beer can still be healt hy, but more easily, but the sleep you then get fortable there, yet the idea that alco- higher quantities of alcohol damage may not be any more re juvenating. Dur- hol in moderation is actually benefi- the heart instead. “The name ‘Holiday ing the first half of t he night, alcohol cial to your health – or that you can Heart Syndrome’ is given to the cardi- prevents deep sleep, making you t oss keep the effects of drugs in check with ac arrhythmia and atrial fibrillation that and turn without dreaming and awak- little tricks. But is that true? often occurs following vacations involv- en frequently; your muscles slacken, and ing a lot of drinking,” says the doctor. anybody else in bed with you will suffer Healthier Alcohol That is all ver y well and good, but from your snoring. More dangerous still Red wine drinking received the highest of surely schnapps aids the digestion after are the brief interruptions in breathing scientific honors when epidemiolo gical a heavy meal? Not so, say researchers in known as sleep apnea, which alcohol can studies revealed that moderate alcohol Switzerland of late. They gave 20 people intensify. What is so unfortunate about consumption correlated with a low inci- cheese fondue containing 200 grams of it all is that regular drinkers will not be dence of cardiovascular illness. But there cheese, accompanied by bread and fol- able to escape these sleeping difficulties are limits to this. Only moderate alcohol lowed by either wine, a glass of schnapps, simply by ceasing to drink suddenly. That consumption appears to have a positive or just tea. The results were surprising: leads instead to a distinct sleeplessness, effect on the blood vessels”, explains Dr. those who drank alcohol digested t he which, sadly, many people deal wit h by Renate Schnabel, cardiologist at Ham- food significantly more slowly than the drinking again.

zzZZZ Is red wine good Z zzzzZZZZ for your heart? zzZZZzzZZ

Does alcohol help you sleep better?

50 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_050 50 08.04.13 16:40 Does alcohol evaporate when cooked?

Just a few drops of wine int o the fish Intoxicated from a champagne bath? stew? No problem, it’ll evaporate as it cooks. Un fortunately that too is a falla- Decadent, but scientifically studied: Bathing in champagne really can increase cy dispelled at every Christmas Market, your breath-alcohol level to over 1.5 per mille – but only up to 15 minutes after you where mulled wine heated for hours still leave the bathtub. Your blood-alcohol concentration will remain at 0.1 per mille. has ‘plenty of punch’. Alcohol does boil at Alcohol does not reach the blood through the skin, and you will remain as sober as 78 degrees Celsius, and evaporates when a judge even after such an extravagant bath. mixed with water, but only down to a con- centration of five percent. At that ratio the mixture forms what is known as an ‘azeo- trope’, which has a constant boiling point. blood are much higher after smoking ing alcohol at a constant 0.1 to 0.2 per That is why in exper iments done on red a hookah than they are after cigarettes. mille per hour. And if you happen to be wine sauce, it still contained five percent During one sitting, consumers inhale driving home and encounter the police alcohol even after 2.5 hours of boiling. about the same amount of smoke as they after an inebriated night, garlic on your Waterpipes are fashionable because would from 100 unfiltered cigarettes – a breath or peppermint sweets in your people believe they offer a mor e thought-provoking fact from the World mouth will be met with indifference beneficial way of smoking. After all, the Health Organization. by the officers. Measuring devices like smoke passes through water before you the Dräger Alcotest 9510 cannot be Tricks for the Breathalyzer inhale it, and is t herefore cleaned. duped. Foreign aromas do not affect This too is erroneous, say experts. The A strong coffee, a short nap, a good the reading, and even if a lower breath- health dangers are underestimated on jog to break a sweat – that should ban- alcohol content is indicated at lower account of the sweet aroma of the smoke ish the hangover. Unfortunately this temperatures, the device adjusts that and its lack of bitter ness and harsh- thought-process leaves out the liver. The reading back up to the normal temper-

PHOTO: SHUTTERSTOCK;PHOTO: GRAPHICS: PICFOUR ness. Nicotine concentrations in t he liver is unimpressed by it all, process- ature. Regina Naumann

Waterpipes: healthier than cigarettes?

Is schnapps good for your digestion?

DRÄGER REVIEW 107 | SPECIAL 51

Draeger_EN_051 51 08.04.13 16:40 Loaded Literati A ramble through LITERATURE REVEALS DRINKING in all its facets: the pleasures and pains of intoxication, the allure and destructiveness of excess – all this can be found in the literary works and biographies of recent centuries. But the emphasis has shifted.

Here’s to poetry: Charles Bukowski downs some inspiration at a reading in Paris (1978)

FOTO: BLIND FOTO:

52 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_052 52 08.04.13 16:40 INEBRIATE AUTHORS

enjamin von S tuckrad-Barre “Hardly a crime drank his last beer on the way to Brehab. One last sip. One of t he novel can be consumed most famous German writers who is without alcohol” recovering alcoholic – for some years now, he says. After years of being perma- MICHAEL KRÜGER is a German publisher and nently plastered, he took the train to the author. With the scientific satire “Literature & Alco- clinic – a train whic h would have had hol”, he wrote a not entirely seriously intended space for Johann Wolfgang von Goethe, directory real existing and possible drunken literature. E. T. A. Hoffmann, and Charles Baude- laire, as well as Edgar Allan Poe, Ernest Mr. Krüger, as an author and publisher you can surely answer this: Hemingway, and Char les Bukowski, Does alcohol produce better writing? Oscar Wilde, Jean Paul, and Jack Lon- Better no, but it may be easier. Historically there have been authors who have don. only been able to write under the influence of alcohol. This was already heard of in ancient times, when they believed the gods would moisten the tongue and Hair Turned Green speak through the author. In our society today things have changed now that It certainly would have been an illus- alcohol is considered a drug and an intoxicant. trious compartment of talks and ther- As a publisher, do you notice by a manuscript whether or not apy. Goethe recounting his two or three an author has been drinking? bottles of wine daily and how his wife No. Alcohol may moisten the tongue, but I can’t see that in a manuscript. Maybe it would C hristiane perished of alcohol while not have reached me without alcohol, but as a reader I cannot possibly know that. he himself drank on, undeterred in his Literati and alcohol somehow belong together. Could it be that drinking garden-house in Weimar. Drug-crosser is simply noticed more among authors? Baudelaire, who admitted having dyed For sure. I would not say that there is any more drinking in literary circles his hair green under the influence of than in other professions. Young people especially drink enormous amounts his favorite everyday tipple absinthe nowadays, and they certainly are no poets. (combined with opium). But there must be something to explain this connection Hoffmann, who stoked his imagina- between alcoholism and creativity? tion by night with wine and punch. All There is no doubt that alcohol is a theme among authors, since it is one of the of them would have sat cozily together ways of assuaging fear of failure. A freelance author’s profession is not an and promised to say no next time any - easy one, and it is beset by fears. You keep asking yourself: is what I have written body offered them a glass of something good enough? Alcohol can free you of this fear. strong; and each one of t hem would To many, a glass of red wine goes with a book. Does wine free up your have probably lived for twenty or thirty imagination and allow you to immerse yourself in a story? more years – apart from Goethe, who, The question is, why do you read? If you read in the evening to relax, then it incredibly, survived to the ripe old age may not be a bad thing. Almost every crime novel – to take that genre as of 82 despite more than 60 years of alco- an example – is so bad you can only digest it with alcohol. The next day you will hol abuse. Hoffmann would not have have forgotten what you read anyway, which is not such a terrible thing. As a died of cirrhosis of the liver at the age publisher there is no way I could drink while reading, since it would obscure my

PHOTOS: PHOTOS: SOPHIE BASSOULS / SYGMA/CORBIS; PETER-ANDREASof HASSIEPEN / HANSER 46, and Wilde would not have had to > view of things. For me, reading is work, and that can only be done while sober.

DRÄGER REVIEW 107 | SPECIAL 53

Draeger_EN_053 53 08.04.13 16:40 “I hate to advocate drugs, alcohol, violence, or insanity to anyone, but they’ve always worked for me.” Hunter S. Thompson

> say to his final visitor, just before dying ancient times their vices in letters or Years ago they made booze their trade- at the same age: “My wallpaper and I anecdotes, poems – without it at once mark, accompanied by wild, alcoholic are fighting a duel to the death. One or to be described as such, or the necessi- excesses and pop literature in the same the other of us has to go!” Jack London ty to feel. On top of that, the picture of breath – and doing it now as their trade- would probably not have taken his own the tippling author, seen in retrospect, mark, to have overcome that. life at the age of 40, while Hemingway is never really a bad one. Alcohol and The American Augusten Burroughs might have under gone therapy for his drug abuse adhere somehow less nega- chronicled his own rehabilitation in a depression and not shot himself in his tively to dead poets than to those alive book, while Joachim Lottmann uses late sixties (see also pages 22–23). But today, who are generally considered alcohol as a title to lure readers, while would their writings in their years of dissolute, immoderate, and not to be in the book he assures us constantly that abstinence have delighted us like those taken seriously. he himself has never enjoyed drinking of the time of drinking? it. The image of t he modern drinker Title Allure One thinks of the great writers, the has changed, for readers and authors image of the drinker is not far away. It is not difficult to accept Günter Grass alike. People seem to have grown tired Whether one, tw o, three glasses to with a glass of wine in his hand. N or of feeling that every book has t o be relax the pen, or smoking-experiments Michel Houellebecq either, even if he drawn from the bottom of some bar - to expand t he consciousness: alco- never seems to tire of claiming that sex rel. Whether the consumption of alco- hol, drugs, and literature seem curi- is the better drug. Authors like Christian hol is now hidden better or abstinence ously inter twined. Not only because Kracht and Benjamin von S tuckrad- is actually lived, remains the secret of many authors have positioned since Barre realized what alcohol did to them. the authors. Isabell Spilker

PHOTOS: ONLINE USA, INC. / ACTION PRESS, MAURITIUS IMAGES / UNITED PR(9) ARCHIVES, / MAURITIUS IMAGES PRESS, ACTION / ONLINE USA, INC. PHOTOS: The Old Man And The Sea (of Booze!): Ernest Hemingway in Pamplona (1959). Right: Hunter S. Thompson who while drunk invented a new kind of reporting, then went on to baptize his dissolute writings as ‘Gonzo Journalism’ using drugs of all kinds

54 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_054 54 08.04.13 16:40 INEBRIATE AUTHORS

Top Works of Intoxication Despite or because of alcohol: these works would not have existed as we know them had it not been for intoxication before, during, or afterwards – and it is a short list which would be easy to expand, and with more than just Ringelnatz’s Kuttel Daddeldu.

Johann Wolfgang von Goethe (1749–1832): Gottfried Benn (1886–1956): Bierode A homage to the Dr. Faustus Where else would Mephistopheles brown brew, the Benn had fallen in every respect. Not have led Faustus to show him the ‘easy life’ without irony, the poet and doctor Gottfried Benn dedicated other than in Auerbach’s Cellar, where wine flowed here once more his great vice. unabated? Goethe hung out and enjoyed his first glasses of wine there as a student. Ernest Hemingway (1899–1961): The Old Man and the Sea The Pulitzer Jean Paul (1763–1825): Siebenkäs, and Nobel prize-winning work was setand Hesperus Jean Paul, a contemporary of Goethe, written in Hemingway’s adoptive home used to enjoy his wine, liquor, and beer, nor did of Cuba, where he daily drank several dark-green work stop him doing so. Would his writing have daiquiris, mojítos, and downed wine, whiskey, been better without? Maybe it would not have and tequila by the bottle. existed at all, since “drunkenness increases two things: courage and love,” he claimed. Malcolm Lowry (1909–1957): Under the Volcano Lowry’s most successful work, to a Edgar Allan Poe (1809–1849): The Raven degree autobiographical, which revolves around the Although he would get legless on just a glass of fate of a drinker: in the final stages of alcoholism wine, the tormented author Poe never escaped the the protagonist finds himself on a journey through clutches of alcohol. Countless later writers based Hell, which at the same time is Paradise. themselves on Poe – without him we would not have had many of the great works we enjoy today. Charles Bukowski (1920–1994): Post Office None of his works would be the way we know Charles Baudelaire (1821–1867): and love them today without alcohol. Only someone The Flowers of Evil Baudelaire’s familiar with the highs and lows of drunkenness magnum opus is due to absinthe. It made and who has experienced the destruction of his own him France’s greatest lyricist; they say body, like binge drinker Bukowski, can describe that only the madness of absinthe could such things so convincingly. elicit such genius. Hunter S. Thompson (1937–2005): Jack London (1876–1916): John Barleycorn: The Rum Diary This book is Alcoholic Memoirs Classic of hard liquor: what about alcohol and it was written in alcohol. his autobiographical novel about alcohol addiction The enfant terrible of the ‘Gonzo naturally cannot tell us is that in the end the author Journalism’, Thompson erected a monument committed suicide under the influence of drugs. to himself with this eccentric work.

DRÄGER REVIEW 107 | SPECIAL 55

Draeger_EN_055 55 08.04.13 16:40 FINAL DESTINATION EMERGENCY ROOM

The Drunk Shift Especially on weekends, it is for some PARTY-GOERS their final destination: the Emergency Room. Those who end up here have ingested so much alcohol or other drugs that they are no longer in control of themselves. Underlying this: more and more young people are being treated for alcohol poisoning.

beeping sound – like a digital Between 150 and 300 patients are cared here with three or more per mille, then alarm clock that nobody turns for every day. Many of these patients are they could easily have downed 2 bottles A off. To outsiders it may be irri- stranded drinkers, especially in winter. of vodka.” For heavy drinkers there is tating, but it is t he sound which the “It is not without reason that these peo- also the risk of life-threatening delir- nurse Judith Szücs has been listening ple keep finding their way back to us. ium tremens (see box). “Those cases to for the past five years. She is 26 years They feel more comfortable here than end up in intensive care.” of age and works at the Central Emer- they would in a mak eshift shelter,” An increasing number of young peo- gency Room at Ger man Hamburg- says Dr. Mayer. As if on cue, a R oma- ple populate the Emergency Room on Eppendorf University Hospital (EUH). nian staggers past along t he bright weekends after binge dr inking. Too The incessant noise of t he monitor corridor. “He has discharged himself, many people are pushing alcohol to the stands for the pulse of people l ying in which often happens,” explains Sister limit. They drink hard liquor in record- the beds in their unit. On the screens, Judith. It occurs when withdrawal sets time, then video their exploits for the different colored waves dance jagged- in, which is when habitual dr inkers Internet. ly up and down in time with the tones. need to get their blood alcohol back up In Germany in t he year 2005, Usually they indicate that everything is to its normal level. “If someone arrives 19,423 children and teenagers between all right with the patient. 10 and 19 years of age r eceived inpa- If you end up with Judith Szücs and tient treatment for alcohol poisoning; her colleagues then you may well be six years later this figure had risen to under the influence of alcohol, drugs, 26,349. In addition t o alcohol t here or both. Take 47-year old Christa for are always drugs, a common r eason instance. She is lying dazed in Room for treatment. “Especially marijuana, U18 following suspected medication cocaine, methadone, and mushrooms. abuse. “When she arrived all she could We don’t really get synthetic drugs like tell us was that she had taken too many crystal meth here,” says Dr. Mayer. sleeping pills,” says the nurse. But only And that goes for tonight, on which the result of the blood test brings cer- a father brings his daughter t o the tainty which substances are actually Emergency Room. The delicate little circulating in the body. 15-year-old shakes her head back and forth. “I feel so sick!” whimpers the 150 to 300 Patients – Daily girl. Sister Judith and Nurse Christo- So far this Saturday night has been pher come running. After a few words quiet at EUH. “Between two and five with her they know that she has drunk patients with drug or alcohol problems too much vodka. Her father found his are admitted every day. That depends daughter in the streets. Once her blood also of any major events in Hamburg”, samples have been taken the 15-year-old says Dr. Ulrich Mayer, Director of the is allowed to lie down on a mattress in Emergency Room at EUH. He and his the corridor. There, under the glaring colleagues have been administer ing neon lights of reception, she is watched Dr. Ulrich Mayer, Director of the first aid and treating heart attacks, lac- Emergency Room at the University constantly by staff. The girl could equal-

erations, and broken bones since 2007. Hospital Hamburg-Eppendorf ly have slept off her state of drunken- OHLIGSCHLÄGER PATRICK PHOTOS:

56 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_056 56 08.04.13 16:40 What is delirium tremens? Delirium tremens (literally: ‘trembling insanity’) or alcoholic delirium is a life-threatening complication arising from existing alcoholism and requires medical treatment. It occurs among five to 15 percent of alcoholics, either hours or days after their last drink. The mortality rate if untreated is around 20 percent, but if treated is about two per- cent. Withdrawal symptoms and their duration depend on the constitution of the alcoholic and his or her drinking habits. Anxiety, disturbed sleep, and autonomic disorders can however persist for up to six months and can cause patients, as they attempt to escape the symptoms in a kind of misguided ‘self-therapy’, to relapse.

ness at home, but her f ather prefers to leave her her e, “as a disciplinar y measure,” he says. He has barely dis- appeared into the night when the next emergency rolls in. Dangerous ‘Water’ Manuela lies on a str etcher accompa- nied by doctors and two police officers. This 15-year-old can no longer speak . She is asleep. Her friend has to explain why she is here, and excessive vodka is once again the reason. The Slavic word ‘ vodka’ is a diminutive of ‘voda’, which in English means water. This girl had been drinking the high- percentage liquor straight out of t he bottle with her friends – and it w asn’t the first time, her underage companion adds. While Manuela sleeps off the effects in the corridor, the police officers try to notify her parents. Only when the offi- cers get through to her parents does it became apparent that they had believed their daughter was in her bedroom the whole time. Her parents arrive at EUH 30 minutes later. They don’t seem to compassionate. Her father pulls out his mobile phone and snaps a pic. “ We’ll put that in a place of honor t o remind Manuela of this evening.” As her parents leave the building at around 3 a.m. t he beeping moni- tors and the dancing lines on t he dis- plays, signaling that everything is still Naive: After half all right. Thomas Soltau a bottle of vodka this 15-year-old sleeps Interview: Prof. Dr. Rainer Thomasius off her drunkenness on delirium tremens and the drinking games young people play. www.draeger.com/107/er

DRÄGER REVIEW 107 | SPECIAL 57

Draeger_EN_057 57 08.04.13 16:41 SOCIETY BRAIN DOPING

Moral Dilemma It certainly sounds appealing: take a pill – and get cleverer. Supporters of COGNITIVE ENHANCEMENT believe this to be possible. But is it really, and how high is the price for this?

Can the muscle of the mind be enhanced just like the muscles of the body? Not quite, but something like that. Yet this is not only unfair, but can be dangerous

58 DRÄGER REVIEW 1107 | SPECIAL

Draeger_EN_058 58 08.04.13 16:41 If there’s nothing there to start with, then performance enhancing drugs can’t cook anything up, even if they do make existing knowledge available more quickly

magine Who Wants To Be A Million- ly understood. Scientists don’t like that The Candidates aire, and imagine a player who ge ts term, branding it a popular slogan. Sub- Ievery question right – no matter what stantive mental performance enhanc- Which groups of substances subject. He picks up on every subtle hint er called “cognitive enhancer s” or claim to tune the mind? the host drops, and wins the hearts of “neuro-enhancement supplements”. u The classic mental performance the audience with his quick witted way. And they are looking for them urgent- enhancers are psychostimulants such as He wins, and it is celebrated throughout ly. “Dementia” is one of t he keywords amphetamines. These have not only the land – until he owns up: “I doped.” when it comes t o research funding. been used illegally, but also semi-officially Hero-worship turns to angry disap- Were pharmacology needs to succeed to keep pilots and soldiers awake and pointment, just as it did for Lance Arm- in halting the mental degradation of alert. In medicine they have been replaced strong, the former professional cyclist Alzheimer’s long-term, that would be a to a large extent by amphetamine-like now banned for life from competing. feat on a par with the invention of anti- substances such as ritalin. They boost Because doping is unfair and doping is biotics. But just like those anti-bacterial attentiveness, but can cause people to cheating, right? weapons, you can be sure that cognitive overestimate their own capabilities. Hard The effect a performance-enhancing enhancers will spread beyond the people illegal stimulants include cocaine and substance has on a t op athlete is easy to who really need them. This is the moral even more dangerous derivatives. explain: more oxygen in the blood gives dilemma of brain doping. u Tiredness can be alleviated using you more long distance endurance, and modafinil, which is prescribed to treat Does Doping Help Society? suppressing pain means extending t he cases of narcolepsy. limits of what you can st and. But what Using antibiotics without needing them u Brain-dopers have also experimented is the mental equivalent of physical and you could be har ming everybody. using medicaments that are prescribed for enhancement? Why has t ournament Bacteria can become resistant. But what dementia such as acetylcholine esterase chess long been subject to a substance ban of somebody who tweaks their memo- inhibitors and memantine. monitored by the World Anti-Do ping Agen- ry or boosts their attentiveness – how u Anti-depressants are used with cy? Which substances are aspiring super- could that harm anybody else? Come the intention of boosting performance minds suspected of misusing? to think of it, could no t that person’s by improving mood. increased productivity benefit society? These are the drugs most often Working Through the Night Researchers from the United Kingdom mentioned in studies. Then there are A whole series of mechanisms can be and the USA advocated this view point in countless vitamins which are used involved. Tenacious learning of facts 2008 in the scientific journal “Nature”, to enhance performance together with the requires maximum concentration. Rit- among them Brain Researcher Michael aforementioned substances, as well as alin, the popular “fidget” drug could Gazzaniga, Stanford Law School Pro- permitted substances such as coffee and help. But if tiredness is damping your fessor Henry Greely, and Neuroethi- nicotine. More exotic approaches range zeal, then the stimulant modafinil can cist Martha Farah. Their prescription: from hormones like oxytocin (which is sup- get you working through the night. And “Cognitive enhancement has muc h posed to boost social intelligence) all the to decrypt the emotional responses of a to offer for individuals and society as way to cannabis derivatives used to erase game-show host better than your rivals, a whole, and an appropriate social aspects of the memory which inhibit you can take the human social-hormone response to it will be to make enhance- learning. So far the limited benefits of oxytocin. It is available as a nasal spray. ments available and control the risks.” stronger substances have been eclipsed

PHOTOS: IMAGE SOURCE / CORBIS; ISTOCKPHOTO / SOURCE IMAGE PHOTOS: This is how brain doping is common- The experts wrote this in the knowledge > by a long list of serious side-effects.

DRÄGER REVIEW 107 | SPECIAL 59

Draeger_EN_059 59 08.04.13 16:41

PHOTOS: FRANK BOXLER, PICTURE-ALLIANCE / ZB / PICTURE-ALLIANCE FRANK BOXLER, PHOTOS: Start them early – ritalin tablets in the hand of a child (left). On the right, 450 students take a statistics test – some of them perhaps using ritalin. Brain doping at universities is much more widespread than previously thought

Dreams of Wakefulness what we certainly can expect are side- effects. The least of these among doping To enhance mental abilities - this desire is old. Millennia-old practices can substances is dependency. And then, for help to achieve that. Meditation especially is one of them. Its techniques any substance which affects the metab- allow people to change their ability to concentrate, as well as the structure olism of the brain in a significant way, and chemistry of their gray matter. there are the issues of lasting changes to The quick and convenient way, to greater alertness (for warriors on guard), the personality, the regulation of emo- endurance (for carriers or hunters), and sought mental abilities (visions of tions, and memory loss after long-term the shamans, the wise counsels), has lead through the ‚Garden of Nature‘ since use, none of which have been adequate- prehistoric times: Khat , the everyday drug of North Africa acts like an ly researched. amphetamine. Coffee and tea inhibit the fatigue signal in the brain. The leaves As soon after the “Nature” authors of the coca bush are a classic stamina-enhancer, that allow long concentrated published their piece, seven leading work, even in thin Andean air. German experts produced a mani- It was not until the triumph of chemistry in the 19th century that high-strength festo entitled “The Optimized Brain” pure substances came into play: amphetamines were synthesized in 1887, while their in which they argued as follows: “No stronger sister ‘meth’ was produced in 1893. Ritalin has been around since 1944, one can wish that the already present the modern anti-depressant version since 1984. Our modern understanding of neuro- high social competitive pressure result- chemistry and the structure of the brain allows us to design substances specifically ing from the proliferation of neuro- for brain doping; hence the pharmacology used in fields such as modern anti-dementia enhancement to further be increased. drugs is still in its infant stages, and much progress may still be made in the future. A continuous focus on performance and efficiency of life would be inhu- mane and isolating.” They did howev- er claim that great opportunities lie in improving our understanding of the > that it is illegal for healthy people to use month in the process – a genuine com- mental processes of learning and emo- such drugs, practically all of which are petitive advantage in today’s perfor- tional regulation. These experts advo- only available on prescription (ritalin mance-boosted society. cate research, but not a rush to the even falls under some narcotics acts). Internet drugstore: many future uses Don’t just Look at The hope is that con trolled release will of enhancers are imaginable which Performance be better than letting things run wild. could bring genuinely beneficial prog- The prospects for professional brain- But the truth is that the actual bene- ress to people. What is important, they workers, already far beyond the exam fits that can be obtained from today’s said, is to identify rules: “Above all it room, are attractive believes, Mainz brain doping are rather meager. If used would seem sensible to establish high- based Neuro Philosopher, Thomas Metz- incorrectly, stimulants like ritalin can er safety and effectiveness standards inger: a stimulant-consumer can write, even be detrimental to exam results. for cognitive enhancer s than those calculate, or invent for 12 to 14 hours The stimulants reduced their self-crit- prevalent in therapeutic pharmaceu- through the night from Friday to Sat- icism in the subjects and made t hem ticals research; since they aim only at urday then spend the rest of the week- check carelessly wrong answers as true. improving performance and mental end resting and staying healthy, gain- So it is unlikely that we can expect a dra- state, not saving lives, healing, or alle- ing a whole week’s worth of work every matic improvement in intellect, but viating illnesses.” Silke Umbach

60 DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_060 60 08.04.13 16:41 DRUGS RANKING

The 20 Most Dangerous Substances Dangerous drugs consume another: the junkies in front of the train station and the party kids who dope themselves with ecstasy and speed. The two or three beers in the evening are something else, right?

hen it comes t o how dan- family and in t he wider surroundings, dings and to society in general, alco- gerous a drug is, the first crime, misery, environmental damage, hol is the uncontested winner, part- W question is its potential for damage to society and economic costs, ly of course because it is consumed b y physical and psychological dependen- such as by medical care. so many more people than heroin or cy, and the seriousness of withdraw- crack/cocaine. Trailing behind in the Alcohol and Heroin al s ymptoms – but also bodil y damage. list are LSD, magic mushrooms, and are at the Top However, in order to be able t o mea- the opioid buprenorphine. Although sure the “danger” by which we mean Heroin, crack/cocaine and metham- only small quantities of these drugs the overall damage caused by drug con- phetamine are, according to this sur- suffice for a trip to high places, t he sumption, much more has to be taken vey, the most dangerous drugs when it overall damage to the user is muc h into account. comes to addiction, mental damage, less, and to society almost zero. “Yet That is exactly what David J. N utt and mor tality. But alcohol is close a low rating does no t mean t hat a did at Imperial College London. Nutt is behind in fourth place on account of its drug is harmless,” warns Nutt. “Every a Neuro-Pharmacologist and was – mem- potential for addiction. When it comes drug can be dangerous under certain ber and Chair of the Advisory Committee to damage in a consumer ’s surroun- circumstances.” Regina Naumann on the Misuse of Drugs (ACMD) – Gov- ernment Drug Representative Gordon Brown, until he was dismissed in 2009, because he publicly began for an objec- tive assessment of the dangers of illegal and legal drugs. After that he founded High-risk – for others too the Independent Scientific Committee This graph depicts various drugs according to the total damage on Drugs, which helped to produce a they incur upon consumers and other people. The figures are study in 2010 in which Nutt subjected normalized (0 to 100), and then weighted: 46 percent towards the 20 most-used legal and illegal drugs 80 consumers, 54 percent towards other people. CWD = cumulative in the United Kingdom to a thorough weighted distribution. GHB = gamma-hydroxybutyric acid. analysis. Nutt and his team laid down 70 LSD = lysergic acid diethylamide.

a range of criteria by which to evaluate 60 these drugs in a 100-point system. More than half of the criteria relate to damage 50 to the individual: physical damage such Damage to consumers: CWD 46 40 as bodily destruction and death, psycho- Damage to other people: CWD 54

logical damage such as dependency and 30 impairment of mental and interpersonal abilities, and social damage such as loss 20 Total damage in each category each in damage Total of personal assets and the breakdown of 10 human relationships. With the other criteria they assessed 0

the damage of drug use by third parties: GHB Khat LSD Heroin Butane Alcohol CocaineTobacco Ecstasy

SOURCE (GRAPHIC): WWW.THELANCET.COM, VOL 376, NOVEMBER 6, 2010; ILLUSTRATION: PICFOUR (GRAPHIC):SOURCE WWW.THELANCET.COM, 6, 2010; ILLUSTRATION: 376, NOVEMBER VOL Cannabis Ketamine the physical and mental injuries in the Methadone Mephedrone Buprenorphine Amphetamines Benzodiazepine Crack (Cocaine) Anabolic steroids Methamphetamine Magic Mushrooms

DRÄGER REVIEW 107 | SPECIAL 61

Draeger_EN_061 61 08.04.13 16:41 A Bit of a Downer In the states of WASHINGTON AND COLORADO marijuana is now allowed, but the euphoria disappeared with the smoke of the first joints. Strict rules limit the new freedom: municipalities prohibit stoner clubs, and U.S. laws still prohibit trade in and consumption of marijuana.

Rules must be followed – also in a drug paradise: a cannabis plant in Denver, Colorado, with a tracking62 ability DRÄGER REVIEW 107 | SPECIAL

Draeger_EN_062 62 08.04.13 16:41 POLICY DRUGS

Medicine: Michael Dare of Seattle hoped for relief from his pain with mariju- ana and consumed the drug here demonstratively in public

hivering, but clearly in a good over the age of 21 to own an ounce of tracts. It will be har d to punish them mood, more than a hundred marijuana; people of legal age may in states with legalized marijuana drug Speople gathered on the night of also grow up to six cannabis plants in use in the home, even if it inter feres December 6, 2012, under the space enclosed areas. It is forbidden to sell the with job performance. needle, the symbol of Seattle. The harvest – but not to give it to others for “It will be fascinating to watch how moment the clock reached midnight free. As in Washington State, you are not the state governments handle the new the celebrating started to begin. ‘Ini- allowed to smoke weed in public or be regulations, and how Washington D.C. tiative 502’ came into effect – the first under the influence of marijuana while and the industry will react – and of time that marijuana had ever been driving a vehicle. Marijuana shops are course, what consumers will do,” says legalized in an American state. not allowed within a 300 meter radius Professor Mark Kleiman. Kleiman is an Giggling, joints and pipes wer e of schools, playgrounds, kindergartens, expert in criminal law and drug policy passed around. Police observed the spec- and public parks. at the Luskin School of Public Affairs, tacle, without interfering. They were which is part of the University of Cali- State Versus Federal responding to the blog notice on the fornia in Los Angeles, and for years has website of their Police Commissioner: The situation is a com plicated. So the been advo cating more research on the “Until further notice, police officers will U.S. federal law classifies cannabis as legaliza tion of mari juana. He accus- not undertake actions in the face of vio- an intoxicant of the highest class with- es opponents and supporters alike lations of I 502 – apart from verbal warn- out medical benef its with high r isk of debating the issue with much too ings. We will give all of you a gener ous of dependency – like heroin, LSD and much propaganda and too little objec- grace period to adjust to the brave new ecstasy. Possession, acquisition, sales tivity. “There is no way to study legal and kind of stoned world.” and production are punishable by harsh marijuana when marijuana is illegal. Ever since then, anybody over the penalties. Even now t he authorized That is one of the reasons why I would age of 21 may own an ounce of mar i- use of cannabis, in 18 U.S. states and like for Washington and Colorado to go juana (just under 30 grams) for person- the District of Columbia, for medical ahead with the experiment. We should al use and consume it in private in the purposes is still illegal under U .S. law. find out. Now we might.“ north-western American state of Wash- These contradictions engender g ray- Film-maker Eugene Jar ecki is a ington. Smoking in public remains pro- zones in the workplace. State employees vehement proponent of the legalization hibited, as does driving a vehicle while are still subordinates of federal regula- of marijuana. In The House I Live In he stoned, and the production and sale of tions – from police officers to teach- documents the fatal consequences of the drug except for medicinal purposes. ers, from foresters to bus- drivers. But the ‘War on Drugs’. The American anti- The state of Washington has one year to things are different in private compa- drug campaign was launched in 1971, develop rules governing the cultivation nies. There, drug-testing is often part of and according to Jarecki has so far cost of and trade in cannabis. job interviews; random sampling is also more than one trillion dollars, while A month after the euphoria in Seat- common practice. Up until now, mari- the only real losers have been the poor tle similar scenes played out in Col- juana in the bloodstream represented and minorities, contributing to the orado. There, on Januar y 5, 20 13, a reason to turn down your application overcrowding of US pr isons. Around Amendment 64 on the legalization of or even fire you. Boeing does not intend half a million people are doing time in marijuana came into force. The amend- to change this practice for now, while the USA for drug offences, around ten ment, which had been supported by 55 other companies have stated that they percent of them having broken laws

PHOTOS: PHOTOS: PICTURE ALLIANCE / AP percent PHOTO; UPI / LAIF of voters, again allows anybody will be reviewing their employment con- connected to marijuana. >

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Draeger_EN_063 63 08.04.13 16:41 DRUGS POLICY

As long as a the Federal Government threatens crackdowns, marijuana won‘t be a business

> Opponents and suppor ters alike are But it is not just criticism of US federal ized marijuana industry at between 45 waiting anxiously to see whe ther drug policy that is shifting the mood and 100 billion dollars per year. Washington will change its drug policy. towards legalization. High debt and Professor Kleiman, however, is wor- President Obama stated at the end of empty coffers have helped local munici- ried at the prospects of a profit-making 2012 that it was not one of the prio ri ties palities, state governments, and the marijuana business. “Cannabis traders of his government to assert federal law federal government in Washington to are not just interested in occasional in this area. “It would not make sense recognize untapped potential of tax smokers,” he says, pointing out simi- for us to see a top priority as going after revenue in the billions. A group of 300 larities with the tobacco and alcohol recreational users in states that have economists – including Nobel Prize- industry, which generates 80 percent of determined that it’s legal.” Democrat winners – have urged a sym pathet- its business through heavy smokers and Patrick Leahy, who is Chairman of the ic reassessment of the legalization of drinkers. “In my opinion there should US Senate Judiciary Committee, hinted marijuana. be no commercial trading of marijua- at a possible compromise: “We could act na. But of course, this approach will not Taxes and Profits complement so, that in states with rel- bring lush profits or a big tax injection.” evant case-law, it is legal t o possess an They cite a study b y Harvard Econo- Ever since the legalization of mari- ounce of marijuana.” Yet liberaliza tion mist Jeffrey Miron which claims that juana, Colorado and Washington State has its opponents too, and some of their the USA could earn an additional six bil- have been working towards regulating support comes from the United Nations. lion dollars annually if it were to tax the production and the drug trade. In Col- The UN has declared that the decisions drug in the same way that it taxes alco- orado, politicians, secur ity experts, of the voters in Washington and Colo- hol and tobacco. At the same time, the marijuana activists, and business rado violate international agreements state could save a considerable sum by associations have been de veloping a and threaten agreements and threaten not prosecuting criminal cases relating legal framework. From October 2013 the health of society as a whole and of to marijuana. Other studies have esti- onwards, the authorities will be able to young people in particular. mated the potential benefit of a legal- issue business licenses. In Washington the authority responsible for alcohol retailing licenses is also responsible for developing the equivalent legal frame- work for marijuana. This unse ttles “Legalization Prevents the Drug War” drug policy expert Kleiman, in whose Since 1989 the world-famous magazine The Economist has been pushing the view the development of alcohol licens- idea that “Prohibition has failed; legalization is the least bad solution.” The es following Prohibition in the United liberal Londoners field various justifications. In the USA alone, 40 billion dollars States is the best possible example of are spent trying to prevent drug smuggling, and more than 6,000 police how drug legalization should no t be officers and soldiers die each year in the drug war. The chasm between low regulated: “Alcohol causes more dam- production costs and high retail prices is what finances criminal structures. age in the USA than all other illicit Legalization would dry up this source and drug consumption would become drugs combined.” more a healthcare issue than a criminal one. As with tobacco, if drugs were legalized, education about the health risks could limit consumption. “Our Targeting Young People suggestion is a messy one,” writes the magazine, “but a century of manifest If marijuana becomes legal, f ears failures argues for trying it.” Kleiman, then the industry will be

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Draeger_EN_064 64 08.04.13 16:41 Grass-green: Jake Dimmock, co-owner of the Northwest Patient Resource Center in Seattle, tends his mari- juana crop, which is destined for medicinal use

able to advertise its pr oduct open- ly and design its mar keting strategies specifically for young people. Inves- tors and entrepreneurs are waiting in the wings to occupy the new market. Yale gra duates Brendan Kennedy and Michael Blue have founded Privateer Holdings, the first ever venture capital company investing exclusively in mar- ijuana-related business ideas. F rom marijuana vending machines called ‘Medbox’, to rating services for mari- juana shops, to upmarket head-clubs Nancy Jo Arm- strong (left) and like ‘Diego Pellicer’ which is managed Nancy King by former Microsoft Manager Jamen count the ballots Shively in Seattle, there seems to be no from the mari- juana petition in limits. If only there would not be the Washington state: unclear legal situation between the fed- 341,000 voters eral government and the states still. As voted “Yes” long as marijuana trade is still t hreat- ened by federal police raids, as long as US drug authorities keep closing businesses, and the US tax authorities keep confiscating earnings and pros- ecuting businesspeople on account of illegal activities, bankers will not give the new industry a chance. Entrepre- neurs will be unable t o obtain credit cards and bank accounts. Transactions between producers, retailers, and cus- tomers, as well as be tween business- owners and employees, are therefore all done in cash for the time being. Even landlords have been hesit ant about providing marijuana companies with

premises and storage space. THE NEWS TRIBUNE (1) / (2), PETER HALLEY AP PHOTO / PICTURE ALLIANCE PHOTOS: In Seattle, marijuana is weighed and packed – quite legally. It will take years before scientifical- If you are over 21, your are allowed to buy state-controlled and ly, economically, and medically rele- taxed grass in one of the governmental retail stores vant results can be garnered from legal- ization. Kerstin Zilm

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Draeger_EN_065 65 08.04.13 16:41 LAW SOCIETY

No, No, and Again No! Is there a “RIGHT TO GET HIGH”? The state claims to forbid citizens all sorts of things – certain drugs for example. This done for their own good, they say. Yet it overlooks utter drunkenness in many areas. Is this inconsistent?

o”, says the German Feder- So which of these things is a drug con- • That the policy of punitive drug preven- al Constitu tional Court in Karl- sumer doing? It is a q uestion which tion did not work. Nsruhe, Germany. “No”, “No”, and has caused many judges headac hes. The Constitutional Court respond- again “No”. The Court issued its ‘Can- There was a mushrooming of lawsuits ed, however, that “the prohibition of nabis Decision on March 9, 1994. The under the German Narcotics Act (BtMG) in canna bis products does not force any- judges examined whether citizens should the 1970s and 1980s. Faced with a wave of one to fall back on other intoxicants that have the right to intoxicate themselves hashish and tragic heroin cases as depicted are not subject to the German Narcotics at will – with substances that the legis- in the cult classic We Children from Act, such as alcohol.” For reasons of legal lature had prohibited. Part of the argu- Bahnhof Zoo, the state felt forced to con- certainty, the legislature decided to cre- ment was that tolerating alcohol was front a situa tion it perceived as extreme- ate a definitive list of banned substances. done under a false pretext. The first “No” ly threatening. The road to the highest Nobody would be prosecuted, they said, is the most far-reaching: “The consump- authority was inevitable. for intoxication in itself. And how could tion of drugs falls under the restrictions Wolfgang Nešković, currently a Mem- they be? If they were, lawmakers would of Article 2, Section 1 of t he Basic Law ber of German Parliament, but then a be obliged to ban nail-polish-remover, of Germany. There is no such thing as a judge at the District Court of Lübeck, adhesive, and gasoline when they learned ‘right to intoxication’ which would, were set the ball rolling in 1992. Nešković’s that “sniffer” used these substances to it to exist, escape these limitations.” criminal chamber considered itself intoxicate themselves. un able to con vict a defendant under the Intoxication is Hard to Prosecute The Addiction Fight terms of the German Narcotics Act. Its Article 2 of Ger many’s Basic Law gua- main arguments were as follows: The second “No” from the Constitu- rantees the right to “free development • That legislators were treating alcohol tional Court is clearly thus: not all poi- of the personality”. Each individual may consumers tolerantly, thus violating the sons have to be treated equally. It is not do what he or she pleases. Y et this com- basic principle of equality established in necessary to legalize drugs, even if they prehensive promise soon f inds itself Article 3 of the Basic Law; are not causing problems at home in limited: you may do anyt hing, “ provided • That intoxication was and had long Germany, since Germany has long been it does not infringe on the rights of oth- been a cultural nor m, and t herefore bound under interna tional treaties to ers or violate the constitutional order or part of the development of personality forbid a whole catalogue of substances.

moral customs.” pro tected by Article 2; Cannabis is one of them, as are amphet- SHUTTERSTOCKPHOTO:

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Draeger_EN_066 66 08.04.13 16:42 amines, LSD, heroin, and co caine. In vational force when it comes t o future the end it comes down to legal practice. prevention policy. Protecting passive Is the government fighting what it actu- smokers has already worked: the dam- ally wants to fight? It’s not the intoxica- age caused even to the smokers them- tion – it is addiction. selves is on the decline. Dr. Clemens Veltrup, as Psychothera- Proportionality is Important pist who directs the Freudenholm Ruhle- ben specialty hospital in Schleswig-Hol- The German Constitutional Court cer- stein, believes there is a contradiction tainly permitted legislators to place between the legal treatment of the var- bans asymmetrically in 1994. But the ious addictive substan ces, and the actu- judges then went on to set limits on the al dangers in herent to them. Few of the prosecuting zeal of the courts with their 1.3 million pill-addicts in Germany are third “No”: not everybody caught carry- seen at inpatient addiction therapy. ing a small amount of hashish should be “Only 700 of them attended clinics in brought before the court. The key state- What should the State prohibit 2012,” he says. In the field of illegal sub- its citizens to do concerning ment ran like this: “The imposition of stance treatment, on the other hand, their best interests? What criminal penalties against experimen- lawyers argue about, has real large infrastructures have developed tal and occasional users of small quan- implications in practice over the decades. Laws also have risks tities of cannabis products can lead in and side effects. their effects on the individual perpetra- Pragmatists know ideal laws will nev- tors to inappropriate and special pre- er happen. But there are specific fields ventive measures that may cause rath- in which conditions can be improved. er adverse results.” On the roads, for example, completely Nobody, therefore, has a right to be in legal medicines represent a significant the state of intoxication. But in the fight danger; tranquilizers are being exam- against addiction, it is important to pre- ined par ti cu larly closely in this respect. serve proportionality - the law does not Danger to others is the strongest moti- allow an iron fist policy. Silke Umbach

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Draeger_EN_067 67 08.04.13 16:42 MINI LEXICON INTOXICANTS

Drugs – ABCs Here is a brief, factual tour of COMMONLY USED DRUGS – their active ingredients as well as methods of use, risks, prevalence (frequency of use), origin, and history. A stroll.

Alcohol Active ingredient: ethyl alcohol (ethanol) Form of consumption: drunk in various forms and mixtures with very diverse alcohol contents between 2 percent (fer- mented mare’s milk, ‘kumis’) and 95 percent (corn schnapps, ‘Everclear’). Effect: see page 22. Prevalence: in the countries of the European Union, consumption among people over 15 is 12.5 liters of pure alcohol annually – which is twice as high as the global average. Risks: the EU and WHO list more than 40 recognized alcohol related diseases, alcohol also “plays a role in numerous other health problems, such as injuries and fatalities on the roads.” In the countries of the EU, 10.8 percent of all deaths in 2004 in the age group between 15 and 64 were a result of alcohol consumption. Another 3.3 percent of this age group died as the result of other people’s alcohol consumption. Origins and history: see pages 10–11. Synonyms: booze, hooch, firewater. A drug’s effect Fortification: around 3100 BC, workers and risk cannot be seen from on the pyramids were given five liters the outside of beer daily as a supplement to their diet and to keep their mood up. Benzodiazepines Active ingredient: a group of com- pounds whose basic constituents are 1,4- or 1,5-benzodiazepines. They were developed as tranquilizers for calming and sleep-in ducing purposes; their international non-proprietary names

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Draeger_EN_068 68 08.04.13 16:42 often end in -azepam: Diazepam, group have consumed it within the for a good 5,000 years. Its leaves may Lorazepam and Oxazepam. Trade names past twelve months – or one out of three only have been used for ritual activities include Valium, Librium, Rohypnol, people have experimented with cannabis. initially. When impoverishment set in with Tavor, and Praxiten. Risks: restricted physical and mental the Spanish conquest, large sections Form of consumption: as tablets capacity, coupled with self-overestimation; of the population used the plant to stave or injected intraveneously. inability to drive. If consumed heavily off hunger and cold, and to increase Effect: anxiolytic, relaxing, soothing. and regularly: psychological dependency, their productivity. The active ingredient Risks: memory disorders, impaired passivity. was isolated around 1860 and used reactions, and perception – consequently: Origins and history: its home is initially as a local anesthetic and anti- driving impairment; addictive if taken probably the Middle East and Central depressant. Cocaine epidemic long-term without medical supervision. Asia. Used in folk medicine (to among artists and intellectuals in Origins and history: traces of benzodia- reduce the pain of neuralgia, migraine, the 1920s; renaissance in the zepines occur in human and animal and seizure disorders), but also in 1970s and since the early 1990s as blood as well as certain plants. They were all cultural circles as an intoxicant. First a ‘performance drug’. discovered more or less by accident mentioned in 2700 BC in a Chinese Synonyms: coke, snow, blow; crack in the USA in 1957. The first medicine book of medicines. Its was used as a and rocks (for crack). in this group came onto the market in remedy with euphorizing effect that Descent: “If you wanna get down, down 1960 under the name Librium, and Valium began in 19th century Europe. on the ground, Cocaine” – JJ Cale (1976). followed in 1963. It was not until the Synonyms: dope, ganja, bud, grass, 1980s that their addictive potential was weed, hash, pot, piece, shit, spliff. Crack cocaine hydrochloride recognized; a study of this group of Queen of Pot: physicians prescribed mixed with alkalis Ò Cocaine substances in 2008 nevertheless foretold cannabis for Queen Victoria (1819–1901) is smoked. First appeared in 1983/84 that “they will still be prescribed for to treat period pains. on the West Coast of the USA. many years to come.” Synonyms: tranks, benzos, vals; rosh Cocaine crystal-like ‘Designer Drugs’ and roofies for rohypnol. powder made from the leaves of Amphetamines (‘speed’) and Sleepless: “My wife doesn’t let me take the coca bush Methamphetamine (‘ecstasy’) Valium,” said benzodiazepine’s inventor Leo Active ingredient: Cocaine Active ingredients: these structurally Sternbach to The New Yorker. Form of consumption: sniffed, similar and synthetically produced intra veneously injected, and smoked designer drugs belong to the substance Cannabis genus of (crack). category of beta-phenylalkylamines the hemp plant Effect: stimulates the central nervous (beta- phenethylamines). Active ingredient: system strongly by suppressing the Form of consumption: usually Tetrahydrocannabinol (THC) re-uptake of noradrenaline, dopamine, and swallowed, more seldom sniffed, taken Form of consumption: usually serotonin in synaptic vesicles. Immedi- intraveneously, or even smoked smoked, mixed with tobacco in cigarettes, ately effective, euphorigenic, stress-redu- ( methamphetamine). as blunts (larger) or joints (smaller), cing. Loss of inhibition coupled with Effect: as an analeptic it provides a lift or with special hashish pipes. The effect increased energy and creativity. and produces wakefulness, vitality, and occurs here almost immediately, Prevalence: around 4.6 percent of all self-confidence; methamphetamines often delayed when cannabis drinks, yogurt, Europeans aged between 15 and 64 have a much stronger effect than and baked cookies are consumed. have consumed cocaine at least once amphetamines (see also page 23). Effect: accentuates existing positive in their lives. 1.2 percent of the same Prevalence, amphetamines: or negative moods; makes consumers age group have consumed cocaine during around 3.8 percent of all Europeans considerably more upbeat. Feelings the past twelve months – or one out aged between 15 and 64 have consumed of relaxation, inner peace and equilibrium; of four people have experimented with amphetamines at least once in their often reduced drive. Cheerfulness cocaine. lives. 0.6 percent of the same age group and heightened social communicative - Risks: rapid psychological dependency, con sumed amphetamines in the last ness are also observed. all the way to ‘cocaine psychosis’; twelve months – or one out of six people Prevalence: almost 25 percent of all impurities in filler substances increase have experimented with amphetamines. Europeans aged between 15 and 64 have the risk of side-effects. Prevalence, ecstasy: around GETTY IMAGES consumed cannabis at least once in Origins and history: the coca bush 3.4 percent of all Europeans aged

PHOTO: their lives. 6.8 percent of the same age has been cultivated in South America between 15 and 64 have consumed

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ecstasy at least once in their lives. Yours, Hein,” telegraphed Nobel Prize for Risks: collapse if overdosed, psychoses 0.6 percent of the same age group Literature winner (in 1972) Heinrich if consumed regularly, lasting state of fear consumed ecstasy in the last twelve Böll from Poland on November 9, 1939 even after small doses – given genetic months – or one out of six people have to his parents in Cologne. disposition. experimented with ecstasy. Origins and history: developed as Risks: overdose and side-effects, Diazepam Ò Benzodiazepines a fast-acting anesthetic from 1962 in the especially in the case of impure and Indispensable: the WHO includes it in USA, where it was approved in 1970 intraveneously administered drugs; its list of ‘Essential Medicines’ that belong then used immediately, including in the hallucinations, psychological dependency, to the minimum equipment for basic Vietnam War; non-medical consump- collapse, dehydration. medical care. tion initially among ‘psychonauts’, today Origins and history: the colloquial as a ‘club drug’ at raves, etc. expressions ‘designer drug’ and, in Ecstasy Ò 'Designer Drugs' Synonyms: Special K, Vitamin K, jet, Germany, ‘Weckamine’ (which means super acid, Kit Kat, bump. ‘wake-amines’) describe on the one hand Hashish resin from the Paradise: “If captains of industry, the intentional synthesis of these sub- blossoms of the female hemp plant leaders of nations could partake stances in the laboratory, and on the other Active ingredient: tetrahydrocanna- of this love medicine the whole planet hand their effect. In 1887 the Romanian binol (THC), levels between five and might be converted into the Garden chemist Lazâr Edeleanu synthesized 20 percent depending on origin. Of Eden.” Psychonaut Marcia Moore in amphetamine in Berlin, which was used Ò Cannabis Journeys Into the Bright World (1978). from 1933 onwards as Benzedrine to Pothead in Berlin: treat colds. But its stimulant side-effects “From now on a joint must always Marijuana dried, shredded soon came to the fore – in environments be burning on German soil!” declared pieces of the female hemp plant such as the military, which since World actor and cabaret artist Wolfgang Active ingredient: tetrahydrocannabinol War II used amphetamines to increase per- Neuss (1983). (THC), levels between 1 and 7 percent for mance, and also in sport. A new depending on origin; Dutch greenhouse dimension of misuse began in the 1960s Heroin Ò Opioids strains (skunk, sinsemilla, Nederwiet) with injected amphetamines, which Synonyms: H, stuff, junk, mud, tar, up to 22 percent. con tinues to this day; the ‘party drug’ skag, brown sugar, smack, China white, Ò Cannabis is now con sumed in various forms. chiva, dragon. Beat poetry: “I could do these things The development of methamphetamines À la mode: in 1986 The Sunday Times endlessly on grass,” wrote Jack Kerouac occurred in parallel: synthesized for coined the term ‘Heroin Chic’ to describe to his friend Allen Ginsberg. the first time in 1893 in Japan, they became heroin consumer culture, especially commonplace in almost every army very thin, pale models. Methadone in the Second World War thanks to their Active ingredient: synthetic Ò Opioids stimulant effects – in Germany under Ketamines Form of consumption: in powder or the name Pervitin, which was patented in Active ingredient: a so-called tablet form, as drops or syrup; taken orally 1937. As with MDMA (ecstasy), which ‘dissociative anesthetic’ closely related to when used legally as part of substitution was first synthesized in 1912, these uses hallucinogens (phencyclidine derivative). therapy for heroin addicts; illegal usage both eclipsed potential medical applications Form of consumption: drunk in oral and intravenous. in the treatment of colds and the stimula- a watery solution or sniffed as a Effect: similar to other opioids, but tion of appetite. Used for doping, powder (Ketanest, Ketaset, Ketalar); weaker and more delayed. ecstasy in particular has become the more rarely intraveneously injected. Prevalence: lifetime prevalence unhappy star of the music scene Effect: produces a kind of cataleptic estimated at 0.2 percent. since the mid-1960s. state in which the consumer sees himself Risks: dependency, death following Synonyms, amphetamines: speed, as disconnected from his surroundings and massive overdose. pep, white, crank, uppers. body (‘K Land’), and from time (‘K Hole’). Origins and history: first synthesized Synonyms, methamphetamines: Bizarre, sometimes terrifying dreams, in 1939 by I.G. Farben as ‘Va 10820’, and ice, meth, crystal, glass, Tina; visual and auditive hallucinations. produced initially in small quantities for ecstasy: E, Adam, XTC, beans, X, Prevalence: incomplete, inconsistently from 1942 onwards as a painkiller under MDMA, love drug. collected data estimates usage at around the name ‘Amidon’, before being re- Nobel plea: “The service is tight … today 2 to 4 percent among young adults named ‘methadone’ in the USA in 1947. I am writing primarily about Pervitin. … (15–34 years) in selected EU countries. Used in the USA from the late 1940s

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Draeger_EN_070 70 08.04.13 16:42 onwards to compensate for the withdrawal in the 17th century. In Europe, opium symp toms suffered by patients addicted was used as an analgesic mainly from the to heroin; in Germany from 1950 onwards 18th century onwards. Morphine, the (as ‘Polamidon’). First experimental most important main alkaloid, was isolated methadone program in Germany between from opium in 1804; heroin, which has 1973 and 1975 in Hanover. Substitution an even greater potential for addiction, was programs using methadone were esta- synthesized in 1898. During the early blished in Germany from around 1990 decades of the 20th century the medicinal onwards following positive research work use of opioids, especially heroin, shifted there. to misuse as an illegal drug (pre)produced Synonyms: dolly, doll, red rock. mainly in the ‘Golden Triangle’ of Thai- Curative: the idea that methadone land, Laos, and Myanmar, as well as (Amidon) entered the market as Afghanistan. In Germany opioids are the IMPRINT ‘Adol phine’ prior to 1945 proved to be primary drug involved in half of all drug Publisher: Drägerwerk AG & Co. KGaA, an urban legend spread in New York in therapy inquiries. Corporate Communications Editorial Address: Moislinger Allee 53–55, the 1970s to discredit methadone Piercing damage: “I’ve seen the 23558 Lübeck, Germany / substitution therapy by associating it needle / And the damage done” – [email protected], www.draeger.com Editor in Chief: Björn Wölke, with the Nazi regime. Neil Young sing ing about the demise of Tel. +49 451 882 20 09, Fax +49 451 882 39 44 a heroin-addicted guitarist on the Editorial Consultant: Nils Schiffhauer (responsible according to press law) Opioids (active in drugs album Harvest (1972). Art Direction, Design, Picture Editing and such as morphine, opium, heroin, Coordination: Redaktion 4 GmbH, Hamburg Translation: Lektornet.de codeine, etc.) Opium Printing: Lehmann Offsetdruck GmbH Active ingredients: naturally Active ingredient: morphine Ò Opioids ISSN 1869-7275 Code number: 90 70 329 occurring or synthesized substances By the book: “Whoever wishes to which stimulate what are known as smoke opium must purchase a permit the opioid or μ-receptors in the brain personally from the responsible Opium and spinal chord. Officer. The fee for this permit shall be

Form of consumption: smoked, one dollar a month, and must be paid The articles in Dräger Review eaten, sniffed, or intraveneously injected. quarterly in advance” – Paragraph 5 of provide information on products and their possible applications Effect: induces states ranging from the ‘Ordinance on Opium’ issued in general. They do not constitute exuberant happiness (heroin) to fantasies by Imperial Governor Meyer-Waldeck any guarantee that a product has specific properties or is suitable for and (erotic) hallucinations. in Tsingtao, 1912. any specific purpose. All specialist Prevalence: the number of ‘problematic personnel are required to make use exclusively of the skills they have opioid consumers’ in Europe is estimated Speedball blend of cocaine acquired through their education and training and through practical experience. The views, opinions, and state- at 1.4 million. Three percent of all drug- with morphine or heroin ments expressed by the persons named in the texts as induced deaths among Europeans aged Pushing the deadline: the physician well as by the external authors of the articles do not necessarily correspond to those of Drägerwerk AG & between 15 and 30 are connected Lord Dawson of Penn injected a Co. KGaA. Such views, opinions, and statements are to opioids. fatally ill British King George V with a solely the opinions of the respective person. Not all of the products named in this magazine are available Risks: heavy dependency, death if deadly mixture of cocaine and mor- worldwide. Equipment packages can vary from country to country. We reserve the right to make changes to overdosed, severe withdrawal symptoms phine on January 20, 1936 at around products. The current information is available from your (‘turkey’) – especially after heroin. five minutes to midnight, “so that Dräger representative. © Drägerwerk AG & Co. KGaA, 2013. All rights Origins and history: opioids emerged in the announce ment of the King’s death reserved. This publication may not be reproduced, what is now Turkey more than 8,000 years could be published in the morning stored in a data system, or transmitted in any form or using any method whether electronic or mechanical, ago as opium, which was garnered edition of the newspapers…” by means of photocopying, recording, or any other technique in whole or in part without the prior permis- from the opium poppy. Juice obtained from sion of Drägerwerk AG & Co. KGaA. Ò Benzodiazepines scored, unripe poppy seed capsules was Valium Dräger Safety AG & Co. KGaA, Lübeck, Germany, made into pills and used as a medicine to Kids on your nerves: “And though is the manufacturer of the following products: Dräger-Alcotest devices (pp. 14–19), Dräger-tubes alleviate pain. Opium has only been she’s not really ill / There’s a little yellow (pp. 14–19), Dräger Interlock XT (pp. 19, 46–49), smoked since the discovery of America by pill” (Mother’s Little Helper, The Dräger DrugTest 5000 (pp. 24–27, 46–48), Dräger Alcotest 7110 Evidential (pp. 42–45) the Europeans, who brought tobacco and Rolling Stones, 1965). as well as Dräger Alcotest 9510 (pp. 50–51). pipes back home with them. It found its way to China via contemporary Indonesia www.draeger.com

DRÄGER REVIEW 107 | SPECIAL 71

Draeger_EN_071 71 08.04.13 16:42 Beer Belly Fire-water Parasympathetic Nervous System Nervous Parasympathetic Happy Pill DrugTest 5000 Gin Lane Skipping Work Law Cheerful Intoxication LSD Skin Sensor Alcohol Interlock Life

Joint War on Drugs Sweat MDMA Ecstasy Poison Dependency Morphine Liquor Breath Heroin Witches Purity Law Purity Evidential DRUID Speedball Ban Alcohol Cocaine Emotions Sober Legalization BAC Roadside Checkpoint Opioids Drunk Ritalin Amphetamines Crack F.W. Sertürner

Spice Profit EthanolInebriated Corn Schnapps Industrial Safety Sympathetic Nervous System Opium Sampling Unable toUnable Drive Blood Drugs Limits Prohibition Labrador Tea Catalyzer Traffic Locoweed Prevention Reactions Soul Pretest Bootlegger Rights Urine Shamans Injection IntoxicantRoad Deaths High-risk Professions Sober Alcohol Saliva

Illegal Tube Aconite Henbane CultureSynthetic Khat Offender Driver’s License Driver’s Scythians Pervitin Vodka Wine Paracelsus Author PPT

Shisha Beer Marijuana Electrochemical Bath Salts Approval Opium Poppy Alcotest Betel Enzyme Benzedrine KavaWoodstock Ankle Bracelet Addiction

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