234 Ma Huang
a means of improving sexual performance, and also as a legal substitute for
MDMA. How well the product lives up to such advertising is debatable.
In the 1990s retail gross sales of ma huang products was estimated at over
a half billion dollars a year. In the year 2000 surveys from 755 persons un-
dergoing outpatient surgery were reported, saying that 18% were using ma
huang.
Drawbacks.Purity of ma huang products is uncertain. Examination of 20
ma huang dietary supplements found them to vary widely in content of
ephedrine and pseudoephedrine, and 4 even had inconsistency among various
batches of the same product. One examined product lacked any ephedrine or
pseudoephedrine at all. Many contained cathine, a Schedule IV prescription
drug found inkhat. Perhaps the most alarming finding was that actual con-
tents of half the products did not match the label description. Another study
of 9 ma huang products had similar results. In a separate instance, undeclared
contents of a ma huang product was a factor causing an athlete to flunk when
tested for drugs banned from competitive sports.
The herb is known to cause paranoia, delusions, combativeness, mania, and
hallucinations similar to what amphetamine abuse can do. Someone with such
behavior was diagnosed and medicated for mental illness because no one sus-
pected ma huang use. Case studies offer vivid accounts of overdose causing
users to direct violence against themselves and others. Psychiatric problems
can persist for quite some time after drug use stops.
A study found that ephedrine did not account for all of ma huang’s adverse
effects and that unwanted actions increased if the herb was ground up. Herb-
alists commonly prescribe 5 or 6 grams of ma huang for steeping as one dose
of tea, yielding (depending on potency) perhaps 38 to 75 mg of ephedrine.
The U.S. Food and Drug Administration (FDA) has found many examples of
hazard in an ephedrine dose exceeding 10 mg. Two studies found the sub-
stance to be safe in that amount, although one of those studies and a third
one noted heartbeat irregularity, reduced salivation, and difficulty with sleep.
Headache, dizziness, nausea, vomiting, skin rash, urinary retention, kidney
stones, and heart inflammation have been associated with using ma huang.
Persons with glaucoma should avoid the substance. Ma huang is suspected of
causing liver disease, but investigators are uncertain. Stroke, heart attack, and
death have been attributed to the substance, but those claims are disputed.
An experiment measuring heart rate and blood pressure yielded unclear re-
sults about ma huang’s influence. The herb may cause adverse reaction with
monoamine oxidase inhibitors (MAOIs, commonly found in antidepressants).
Persons with diabetes or thyroid disease should consult with a physician be-
fore using ma huang. Aircraft pilots have been advised to avoid the natural
product.
Abuse factors.Stopping the usage of ma huang can cause a person to be
tired, sleep a lot, be sad, and have trouble concentrating. Those are opposite
of typical effects that the substance has, suggesting that a user’s body has
developed a dependence on ma huang (because withdrawal from dependence
often produces effects opposite to what a drug does). Dependence is a tradi-
tional sign that a substance is addictive.
Drug interactions.The FDA considers combining ma huang with cola nut