Peter R. Martin: Historical Vocabulary of Addiction, Vol. II

Drug

According to the electronic version of the Oxford English Dictionary (OED) the noun drug is a borrowing from the French word drogue.  There are various historical meanings in Middle French and French for drogue which was considered to be an “ingredient used in chemistry or pharmacy” and historically the word was also used to refer to “a thing which is of poor quality, person whom one does not value and in regional use… in the senses ‘poor merchandise’, ‘worthless thing’” and “also in Middle French the adjectival use of drogue in the sense of being ‘badly dressed’.”

An example of the first use in the English language in about 1400 of the noun drug was in a quotation by William Langland (c. 1330 – c. 1386), the presumed author of this work of alliterative verse in Middle English, an allegory with a complex variety of religious themes known as The vision and creed of Piers Ploughman (Langland and Wright 1856): “Lyf leeved that lechecraft Lette sholde elde, And dryven awey deeth With dyas and drogges.”  The meaning of drug referred to in this quotation is defined in OED as: “Originally: any substance, of animal, vegetable, or mineral origin, used as an ingredient in pharmacy, chemistry, dyeing, or various manufacturing processes… In later use: specifically, a natural or synthetic substance used in the prevention or treatment of disease, a medicine; (also) a substance that has a physiological effect on a living organism.”  This later use of drug is exemplified by a quotation from the Scottish pioneer of political economy Adam Smith (1723 – 1790) in his treatise The wealth of nations (Smith and Skinner 1970): “Tea… was a drug very little used in Europe before the middle of the last century.”  This quotation suggests the evolving and overlapping uses of this beverage for pleasure and for ceremonial and medicinal purposes (Weisburger 1997).

Understanding which specific drug should be employed for treatment of a given medical condition — for the first time based on detailed pathophysiological understanding of the given disorder rather than previously-employed traditional methods incorporating herbal remedies with divination and rituals — has evolved progressively since the 18th century.  

The concepts of William Cullen (1710 – 1790), a British physician, chemist and agriculturalist who also served as a professor at the Edinburgh Medical School and a central figure in the Scottish Enlightenment (Cullen 1789), have been considered the foundation of subsequent advances published in notable volumes written in the major European languages on the subject of Materia medica (“The branch of medicine that deals with the origins, preparation, and use of the Materia medica, or substances and preparations used in the practice of medicine) as reviewed in the Edinburgh Medical and Surgical Journal (Anonymous 1834). 

This editorial entitled Histoire Abrégée des Drogues Simples essentially examined the early transformation of Materia medica into the medical use of drugs as employed in the modern field of pharmacology (“The branch of medical science that deals with drugs and their uses.”):

“Great as were the improvements introduced into medical science, and the revolutions effected in medical theory and practice by the writings of Cullen, we doubt whether they were in any department more remarkable, more valuable, or more beneficial, than in that of Materia Medica and the general principles of Therapeutics.  Previous to his time, indeed, there seemed to be scarcely any necessary connection between Pathology and Therapeutics; and while the former was but a collection of fanciful conjectures, and unfounded or gratuitous hypotheses, the latter seldom aimed at anything else than the repetition of a series of random and empirical rules, irrational or inert applications, and not unfrequently, superstitious observances. 

“From these degrading marks of an ignorant and illiberal taste the doctrines of Cullen suddenly and immediately rescued the department of Materia Medica; and so great and effectual was the change, that, while it is almost superfluous to ascend higher than the era of the publication of even the surreptitious copy of the Lectures of this Physician, for correct views on Materia Medica and Medical Therapeutics, it is certain that the complete system published by that author in 1789 forms the basis of the most important improvements which these sciences have undergone. By shunning the errors of his predecessors, and many of his foreign contemporaries, and by exercising a judicious spirit of selection, scepticism, and sound criticism, Cullen was enabled to present a treatise on the Materia Medica, not only more complete and systematic than had been hitherto given, but of infinitely greater practical utility. It accordingly continued long to occupy a prominent place in the library of the physician, and still possesses so great value that no one who wishes to understand the connection between Pathology and Therapeutics, can dispense with the diligent perusal of that work...

“A still more serious objection was the disregard avowed and expressed by Cullen, of the aids of chemical analysis in illustrating either the physiological or the therapeutic powers of medicinal agents.  Though this disregard might be excusable at a period when general chemistry was almost in its infancy, and when the analysis of organic bodies was not only imperfect but positively erroneous, and Cullen perhaps acted wisely in this particular instance in not burdening his work with information of questionable merit, it is impossible to doubt, that, as a general principle, such disregard of the chemical constitution of medicines and drugs is not justified either upon rational principles, or by the subsequent history of Materia Medica and Pharmacy.”

The word drug eventually developed another, more specific meaning than that describing a pharmacological agent provided for medicinal uses — the word came to represent agents that can be self-administered for their rewarding psychoactive effects (Marin 2020, 2023).   Rather than prescription by a physician of a drug to treat disease, self-administration opens the possibility of the agent being used repeatedly in an out-of-control and self-destructive manner resulting in a drug use disorder (Martin 2016, 2019).  

An early example of this use is characterized by a quotation of Sir Paul Rycaut (1629 – 1700), an English diplomat, historian and authority on the Ottoman Empire (Rycaut 1687): “They have many times license from their Superiour, to be drunk or intoxicate themselves with Aqua vitae, Opium, or any stupifying Drugs, to be better able to perform with more spirit and vehemency their mad Dance.”  This meaning of the word drug is defined in OED as: “A substance with intoxicating, stimulant, or narcotic effects used for cultural, recreational, or other non-medicinal purposes.  In later use frequently: specifically, a controlled substance used illegally and often habitually.” 

In the following quotation from his novel Yolande, William Black (1841 – 1898), the Glaswegian novelist and contemporary of Anthony Trollope, emphasized the loss of control over use and the destructive outcomes associated with self-administration of harmful drugs (Black 1883): “One of the results of using… those poisonous drugs, is that the will entirely goes.”

By the early 20th century, drug addiction had become recognized to be a serious public health problem quite comparable in nature to the challenges presented by infectious diseases, which have profoundly shaped the history of medicine and of therapeutics.  The toll of contagious diseases first came to be documented using epidemiologic principles and were managed initially within the population by preventive strategies providing an example for a promising first approach to addiction (Martin 2020) before pathophysiologic principles were not yet understood (Terry 1914):

“I believe that few of those confronting us affect more seriously the public health than this of drug addictions.  It directly and indirectly increases the death rate and lowers the birth rate of every civilized community.  It closely resembles, in its dissemination, contact infection of disease; in one neighborhood nearly all the users will be addicted to one drug while in another section some other drug will be the favorite.  Knowing the address of the applicant, I could prescribe correctly for over fifty per cent of the users in my city.

“We concern ourselves, quite rightly, with other preventable conditions, quarantine our scarlet fever and diphtheria, trace with zeal our typhoid cooks, and tabulate with regret each death from these causes, feeling even some measure of responsibility in their occurrence; yet contributory to how many such records, to our deaths from pneumonia, tuberculosis, our still-births and suicides might be stated, were the truth known, ‘drug addiction.’ The social misery, the inefficiency and communal depletion resulting from this civic malady, may not be properly realized by one who has not seen for himself this pitiful array of wrecks waiting, as in a breadline, for the free dope prescription, wives fearful lest their husbands discover their condition; fathers and mothers hiding by every artifice, a stimulated cunning may devise, their habit from their own children; young men  and women asking in a whisper for a fifty-cent prescription for “coke,’ a vicious circle of carelessness, ignorance and cupidity involving a responsibility that has been shifted from shoulder to shoulder until no one seems willing to admit it, yet intimately associated with the public welfare, and health conservation and deserving of most careful investigation and expert treatment.”

As specified in OED the word drug is: “Frequently [used] with [a] distinguishing word, typically denoting the relative strength or potential harm of drugs, as soft (“Of the highest standard, quality, or rank; outstanding, matchless”) or hard (“Very powerful or potent”), or their origins, uses or effects, as “designer, gateway, lifestyle, love, recreational, street drug.”    Consequently, the word drug can be used in various ways in combination with qualifying or distinguishing terms — many of these concepts have contributed to the current understanding of addiction as will be discussed next. 

A designer drug is defined in OED as: “A synthetic analogue of a controlled recreational drug, developed to circumvent drug laws.” An example of one of the earliest uses of this distinguishing term for the word drug is found in a quotation from an Associated Press (Nexis) article (Noffsinger 1983): “Thirty-four people have died in the last four years after using ‘designer drugs’, heroin look-alikes concocted in underground laboratories and hitting the streets one step ahead of government regulations, officials say.”  This quotation indicates that a designer drug prepared illicitly in the laboratory to bypass legal prohibitions can potentially be very dangerous.

Whereas the substance that the designer drug is intended to mimic is legally controlled by governmental regulation because of the potential for abuse and/or its impact on public health, the designer drug is disseminated by unlawful means to any willing buyer.  The synthesis in a clandestine laboratory of the designer drug 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine (MPTP), a meperidine congener intended for self-administration in a potentially harmful manner, resulted in significant neurotoxicity (Davis, Williams, Markey et al. 1979).  However, it is of considerable interest that by serendipity, MPTP has also led to important advances in pathophysiologic understanding of medically important human conditions related to Parkinson’s disease (Burns, LeWitt, Ebert et al. 1985).

A gateway drug is defined in OED as: “A drug (such as cannabis or alcohol) perhaps regarded as relatively harmless or non-addictive in itself but perceived as leading to the use of hard drugs such as heroin and cocaine.”  The designation of what constitutes a gateway drug is not necessarily determined by pharmacology, but rather by the ease of availability of specific agents to young people within a population and individual susceptibilities of some members of the population for various reasons to these drugs (Reich, Dietrich and Martin 2011). 

An explanation of the gateway concept embodied by this now very widely employed qualifying term for the word drug is found in the following quotation from the person who coined the word (Kandel and Kandel 2014):

“The gateway hypothesis was developed by Denise Kandel, who observed that young people become involved in drugs in stages and sequences (Kandel 1975).  She found that in the general population of the United States and other Western societies, a well-defined developmental sequence of drug use occurs that starts with a legal drug and proceeds to illegal drugs.  Specifically, the use of tobacco or alcohol precedes the use of marijuana, which in turn precedes the use of cocaine and other illicit drugs.  Thus, in 2012, among U.S. adults 18 to 34 years of age who had ever used cocaine, 87.9% had smoked cigarettes before using cocaine, 5.7% began using cigarettes and cocaine at the same time, 3.5% used cocaine first, and 2.9% had never smoked cigarettes.

“An alternative to the gateway hypothesis has been proposed on the basis of the idea that the use of multiple drugs reflects a common liability for drug use and that addiction, rather than the use of a particular drug, increases the risk of progressing to the use of another drug.  Population studies have shown both generalized risk across substances and substance-specific risk — in particular, risk attributable to tobacco use.

“Although epidemiologic studies can establish the sequence in which different substances are used and can specify their associations, such studies cannot determine what causes the progression from one drug to the next, nor can they identify on a molecular level the mechanisms underlying the progression.”

A lifestyle drug is defined in OED as: “A drug prescribed to treat a condition that is not necessarily serious or life-threatening but that has a significant impact on the quality of life.”  The earliest known use of the noun lifestyle drug was in the 1980s.  The following quotation by the British historian Roy Porter (1946 – 2002) in his book Blood and guts: a short history of medicine succinctly describes use of the distinguishing term lifestyle when combined with the word drug (Porter 2002): “Launched in 1959, the Pill was the first ever fully effective contraceptive, and it pointed to a new era of lifestyle drugs: ones designed not to counter sickness but to improve living itself.  Viagra (1998) for treating male impotence is another.”

Accordingly, some pharmaceutical agents may alter and thereby presumably improve lifestyle — either by protecting from consequences of sexual activity (oral contraceptive) or enhancing performance of sexual functions to enhance the (perceived) quality of life.  At first, it may seem difficult to appreciate if or how these agents might be related to addictive disorders, which is the focus of this discussion.  However, the lifestyle drugs just mentioned may allow promiscuous sexual behavior in both women and men — with little possibility of an unwanted pregnancy in the former and significant enhancement of the ability to repeatedly achieve sexual arousal in the latter.  Therefore, these pharmaceuticals may facilitate a high frequency of indiscriminate engagement in sexual activity (Alpert 2005) — in a susceptible individual, such lifestyle drugs may facilitate progression to out-of-control and self-destructive sexual activity which has been considered a behavioral addiction (Martin 2022).

The earliest known use in English of the noun love drug was in the early 1600s in the Jacobean tragedy The Insatiate Countesse: a tragedie attributed to John Marston (1576 – 1634), an English playwright, poet and satirist — though some scholars suggest contributions by William Barksted (fl. 1611), the English actor and poet (Marston and Barksted 1616): “Let him that hath drunke loue drugs trust a woman.” 

The term love drug is defined in OED as: “Any drug that (supposedly) provokes or increases sexual desire or enhances sexual performance; an aphrodisiac.”  Although love drug may be considered a specific variant of a lifestyle drug, it is an ancient term that refers exclusively to the arousal of sexual appetites, whereas the latter is a modern concept having a wider, more general meaning including functions beyond the sexual.  The recent confounding of the meanings of love and lifestyledrug is indicated in an article from the Courier-Mail (Brisbane) by the following quotation (Anonymous 2002): “A love drug that claims to trigger erections more quickly and safely than Viagra is expected to reach the Australian market next year.”

The adjective recreational (“Of, relating to, or concerned with recreation; used for, or as a form of, recreation”) has been in use since the 17th century, as exemplified by a quotation of Edward Reyner (1600–1660), an English clergyman and writer, in Rules for the governing of the tongue: together with directions in six particular cases (Reyner 1658): “We may use Recreational speeches sometimes, to instruct, reprove or comfort others, in a pleasant way.”

However, as a distinguishing word recreationalwas recently combined with drug to form recreational drug which is defined in OED as: “Designating or relating to the use of a (usually illegal) drug for pleasure, especially as an occasional social activity; designating a drug so taken, frequently in recreational drug.”  This combination word was first used in the English language by the American physician and psychologist Paul Ausubel (1918 – 2008) in his book Drug addiction: physiological, psychological, and sociological aspects  in which he compares the etiology and effects of addiction to marihuana, barbiturates and other non-opiate drugs to the opiates and concludes about their patterns of use that (Ausubel 1958): “Recreational users are found in all three categories.”

A street drug is defined in OED as: “A drug sold illegally on the streets.”  In essence, this means that the drug in question is readily available and can be purchased by anyone who has the asking price, or is willing to offer other services in return to be able to get intoxicated — by definition, all designer drugs are street drugs, but not vice versa and lifestyle, love and recreational drugs can all be obtained by both a prescription from a physician or illicitly on the street. 

The earliest known use of the expression street drug was in the 1960s as expressed in a quotation from the Report of the Institute on New Developments in the Rehabilitation of the Narcotic Addict (1967): “No one became re-addicted... presumably because the street drug failed to have much effect.”  This signifies that drugs sold illicitly “on the street” without governmental oversight may not be what the purchaser wants or bargained for.  Any agent can qualify as a street drug and different drugs might be so named based on geographic location as suggested by a quotation from an editorial in the British Medical Journal: “Phencyclidine is now a class 2 controlled substance in the United States — and after marijuana has become the most widely abused ‘street drug’ in North America.” 

Two levels of governmental oversight are side-stepped in the marketplace with respect to the distribution of street drugs.  First, there is a lack of quality monitoring of substances by the Food and Drug Administration (FDA), the federal agency of the Department of Health and Human Services (DHHS) responsible for protecting and promoting public health through the control and supervision of pharmaceutical safety, among many other related responsibilities.  Second, as street drugs are illegal, they circumvent the regulations of the Drug Enforcement Administration (DEA), the United States federal law enforcement agency under the U.S. Department of Justice tasked with combating illicit drug trafficking and distribution within the U.S. — the lead agency for domestic enforcement of the Controlled Substances Act, sharing concurrent jurisdiction with the Federal Bureau of Investigation (FBI) and U.S. Customs and Border Protection.  The regulations of these agencies rather than any specific pharmacologic characteristic ultimately determine the appropriate distinguishing words applied to any drug.

In summary, the meaning of the noun drug has evolved from its original sense as a general term for any substance of animal, vegetable or mineral origin, used as an ingredient in pharmacy, chemistry, dyeing or various manufacturing processes.  Over the last 600 years, the word came to be viewed as a natural or synthetic substance used in the prevention or treatment of disease, a medicine and also a substance that has a physiological effect on a living organism.  Most important in regard to the field of addiction, the meaning of drug has become transformed to a term often associated with illicit substances that are widely distributed without governmental regulation and for recreational purposes, while still retaining its original meaning of a substance used for medicinal purposes.  The major factor that determines if a drug is considered relevant to the field of addiction is whether it is self-administered in an out-of-control and self-destructive manner or is prescribed by a practitioner for medical indications.

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July 3 , 2025