Drugs in context
July 6, 2013 11:00 PM   Subscribe

Dr. Carl Hart, psychopharmacologist at Columbia, bust pernicious drug myths and talks provocatively about race and the "War on Drugs."
posted by klangklangston (114 comments total) 62 users marked this as a favorite

 
studies have repeatedly found that the diferences between them ['crack babies'] and babies who were not exposed cannot be isolated from the health effects of growing up poor, without a stable, safe environment or access to healthcare.

Good lord. This is really something.
posted by George_Spiggott at 11:05 PM on July 6, 2013 [18 favorites]


He's doing some fantastic work.
posted by rtha at 11:17 PM on July 6, 2013 [3 favorites]


The first thing is we decriminalize all drugs. [...] When you decriminalize, now you have that huge number of people—we're talking 1.5 million people arrested every year—that no longer have that blemish on their record. That increases the likelihood that they can get jobs

And that, right there, is why I don't expect decriminalization to happen anytime soon. 1.5 million people, potentially dropped straight into the job market?

Crack babies and cokeheads may not be a threat, but a million and a half more people suddenly competing for jobs that are already too few on the ground ... that's a threat.

The economy is the elephant in the room. Notice that the "crack epidemic" (and PCP before that), and the law enforcement attention dedicated to it, started to ramp up at about the same time that manufacturing in the US was collapsing. It's almost as if we didn't have enough jobs to go around anymore, so we decided to invent a few out of thin air: some people get to be prisoners, other people get to work as guards, administrators, parole officers, police officers, judges, lawyers, clerks, bail bondsmen... the list goes on.

It may not be particularly effective in terms of Keynesian economic stimulus, keeping a substantial fraction of your working-age population incarcerated and sitting on their hands by paying another substantial fraction of your working-age population to keep them there, but it does help to keep everyone from paying too much attention to the fact that the real, productive jobs have mysteriously vanished.

This situation is particularly egregious and offensive because the roles of 'prisoners' and 'participants in the law enforcement-prison-industrial complex' seem frequently to be assigned based on skin color, but it would still be the symptom of an economy and perhaps a country rotting from within if the assignments were done by lottery. It would just be more obvious.
posted by Kadin2048 at 11:28 PM on July 6, 2013 [60 favorites]


I was puzzled by the use of "cosmetological" when he was discussing cocaine consumption. Might that have been a typo?
posted by clockzero at 11:30 PM on July 6, 2013


There are a couple of typos in the article, so I think that's likely the case.
posted by Kadin2048 at 11:31 PM on July 6, 2013


From the interview:

We find that 85% of the people, for example, who use cocaine are not addicted, [...] there is far more evidence to support the view that there are other things going in the lives of people who are predisposed to addiction, that can predict their addiction as well as other problems.

same percentage holds true for heroin, I believe (or so I heard about twenty years ago from a friend in Narcotics Anonymous). Of everybody that tries it once, 15 percent end up addicted. Which makes the problem not the drug so much as what that 15 percent are bringing to the drug.
posted by philip-random at 11:35 PM on July 6, 2013 [8 favorites]


Misinformation is a hellava drug.
posted by XhaustedProphet at 11:39 PM on July 6, 2013 [13 favorites]


Wait, what? Start treating drugs as if they were merely pharmacological substances and start treating problems associated with drug use as though they stem from sociological and economic problems rather than springing from the drug use?

Sheer madness, I tell you!
posted by hippybear at 11:42 PM on July 6, 2013 [12 favorites]


To be fair, this appears to have been an interview, but he undercuts his argument that risks of drug use have been exaggerated when he uses language ike this:

"Nobody really cares about black communities, and that's why this irresponsible behavior has been allowed to continue."


Really? Nobody?

I saw heroin make a poor community (South Boston's projects) much worse off than it had been. And the economy was amidst a bubble at the time that made jobs more plentiful up and down the class structure. So, maybe his research is talking about average experience? Or maybe he is just universalizing from his own experience.
posted by Cassford at 11:45 PM on July 6, 2013 [3 favorites]


I vividly recall discussing the results of comprehensive study in regard to drugs on Australian forum, and the majority being so utterly outraged by the numerous and completely contrary assertions to that which they had absorbed through the media and via social conditioning - quite frankly, the reaction was extremely aggressive...on the trembling edge of becoming personally threatening. I can't imagine any politician being willing to completely sacrifice his reputation and career by running on a platform of decriminalisation and education in respect to the responsible use of drugs.
posted by Nibiru at 11:46 PM on July 6, 2013


KG:What kinds of environmental factors matter?

CH: Well, let's think about drug use. Drug effects are predictable, and some drugs are really good at increasing euphoria and feelings of positive reinforcement. Now, if you don't have anything competing with drugs for pleasure and happiness, all you have is deprivation. Why wouldn't you get high?

If you have competing reinforcers or alternatives, like the ability to earn income, learn a skill, or receive some respect based on your performance in some sort of way, those things compete with potentially destructive behavior. And so as a psychologist, you just want to make sure people have a variety of potential reinforcers. If you don't have that, you increase the likelihood of people engaging in behaviors that society does not condone.


Quoted for fucking TRUTH.

>Nobody really cares about black communities, and that's why this irresponsible behavior has been allowed to continue."
Really? Nobody?


He's using a rhetorical device. Obviously someone cares -- he does, for one. He means no one in a position to change things cares.

You're right, he's generalizing from his personal experience. But there's a flip side to that statement -- he has personal experience. And he also has research that backs him up, and all of our memories of how the drug war has been waged, and the kinds of people who waged it, and what the result of all of that has been.
posted by JHarris at 11:53 PM on July 6, 2013 [39 favorites]


I saw heroin make a poor community (South Boston's projects) much worse off than it had been.

Had Heroin been legally and safely available at an affordable price...of a (standard) formulation/potency which removed the possibility of excessive dosage and the, "pot luck" factor in regard to additives, would that community still have been, "worse off"?
posted by Nibiru at 11:53 PM on July 6, 2013 [5 favorites]


The problem is at least partly political. No politician who hopes for funds from the prescription drug people will run on a platform of easy availability of drugs. The 'war on drugs' is so ineffective that the experiment of access to marijuana in Washington (state) and Colorado is inspiring some hope.
Maybe the way to a more realistic approach is to point out that pot can be taxed like alcohol. What politician is not looking for another source of revenue?
posted by Cranberry at 11:56 PM on July 6, 2013


Also, and I'm sorry to be only critical so far, but I found the following assertion odd, and doubly so when coming from someone who is supposed to understand chemicals on a professional level:

Well, I should say so few people actually know that they use methamphetamine. All those people who use Adderall and those kinds of drugs, they are using methamphetamine, basically. It is the amphetamine, not the "D" [like Adderall] or "meth" in front of it, that creates the effects.

Even small differences between closely-related chemicals can render them utterly different in pharmacological terms, can't they? This just seems kind of strangely hand-wavey, unless of course the principle I articulated doesn't hold in the case of amphetamines. I'm certainly not a chemist.

I think he's making a number of interesting points, despite my nit-picking. Among these, one of the best (to me) is that the question-articulating process in scientific investigation is among the most crucial to get right in order to arrive at meaningful answers.
posted by clockzero at 11:57 PM on July 6, 2013 [3 favorites]


It rather reminds me of the Rat Park experiments (Previously on Metafilter).

My limited experiences with drugs makes me lean to this theory. I used to work graveyard shift in a call centre. It was a horrifying existence. You didn't sleep, poor pay, and pretty much everyone you talked to hated you. Everyone there drank, smoked pot, or played MMORPGS, about a third each for the various drugs of choice. This was the only time in my life I smoked pot regularly. People self-medicate in response to bad situations.
posted by Grimgrin at 11:58 PM on July 6, 2013 [16 favorites]


Cassford: There's some hyperbole there, but as you point out, this seems to be an interview, and it is possible that Hart is not particularly adept at giving interviews, i.e., making sure that you make you point forcefully in language that is bulletproof from criticism or misunderstanding. The basic point stands, I think: speaking broadly of American society, I don't think we take poverty in black communities seriously enough, particularly as an origina of a myriad of other problems: violent crime, drug abuse and so forth.

I have from time to time conducted interviews on a good deal less volatile topics (i.e., personality interviews with performing artists) and sometimes by mutual agreement, I offer a draft to the interviewee and/or the publicist who set the meeting up so they can make corrections to details of fact and so forth. Almost invariably, I find they also want to tone down a few of the more sweeping statements as well, e.g, for "tenors are lazy and hate to rehearse," they want instead to go on record saying, "I have found that some tenors I've worked with can be lazy at times"

My guess is that if the interviewer had challenged Hart on this statement, he might have qualified is a bit or at least specified in more concrete terms what "nobody really cares" is supposed to mean in this context.

posted by La Cieca at 12:03 AM on July 7, 2013 [2 favorites]


And that, right there, is why I don't expect decriminalization to happen anytime soon. 1.5 million people, potentially dropped straight into the job market?

Crack babies and cokeheads may not be a threat, but a million and a half more people suddenly competing for jobs that are already too few on the ground ... that's a threat.
First of all, that's a completely ridiculous read on politics. The same thing is true with immigration reform, but it's politically popular.

Second of all, removing drug laws won't remove prior convictions, all of those people will still have the same criminal records.

On the other hand, state government will no longer need to spend massive amounts of money on prisons, incarcerating people and so on - which is a huge net win for the balanced budgets/ low taxes side of things.
The economy is the elephant in the room. Notice that the "crack epidemic" (and PCP before that), and the law enforcement attention dedicated to it, started to ramp up at about the same time that manufacturing in the US was collapsing. It's almost as if we didn't have enough jobs to go around anymore, so we decided to invent a few out of thin air: some people get to be prisoners, other people get to work as guards, administrators, parole officers, police officers, judges, lawyers, clerks, bail bondsmen... the list goes on.
This is the bigger economic "problem" with drug reform, if drugs are legal, then all these people lose their jobs. In fact in California, for example the Prison Guards union actually donates to laws that will increase incarceration rates.
I saw heroin make a poor community (South Boston's projects) much worse off than it had been. And the economy was amidst a bubble at the time that made jobs more plentiful up and down the class structure. So, maybe his research is talking about average experience? Or maybe he is just universalizing from his own experience.
What exactly did you see happen that wasn't caused by Heroin's illegality? If Heroin were legal, would the same things have happened?

I mean what exactly could have happened due to legal heroin? People spending more time sleeping in bed instead of working? Maybe it wouldn't have been pretty, but it's hard to imagine it would be worse then stuff like gang violence and bloodshed and millions of people in prison.
Even small differences between closely-related chemicals can render them utterly different in pharmacological terms, can't they? This just seems kind of strangely hand-wavey, unless of course the principle I articulated doesn't hold in the case of amphetamines. I'm certainly not a chemist.
Well, methamphetamine can be used to treat ADD just like adderal, if the dosing is right. I think with methamphetamine the stuff gets absorbed more quickly into the brain, and of course the dosing will be way larger if it's taken "recreationally"

I think the thing about Meth is that it's so easy to make - in a way it's like alcohol. Alcohol is actually a really harmful drug compared to stuff like marijuana, but it's so easy to produce it's impossible to control. After booze (easy to grow biologicals like marijuana and mushrooms), Methamphetamine is probably the easiest drug to make, I would guess. I would bet that if 'better' drugs were available like MDMA people wouldn't really take meth nearly as much.
posted by delmoi at 12:51 AM on July 7, 2013 [2 favorites]


I'd disagree a bit here, delmoi; MDMA is just as easy to synthesize, if not easier, but it's less attractive to produce and sell for a number of reasons. It's far less potent per milligram, it suffers from much greater diminishing returns, and it's much less chemically addictive. Thus, MDMA is not subject to the same demand from addicts, and isn't produced in the same quantities as methamphetamine. I'm sure you can definitely make a killing selling "molly" at a concert, but you definitely won't have people calling you up 24/7 like a meth dealer will.

Meth isn't the universally soul-destroying terror it's made out to be, but 12 to 24 hours of re-dosing for a single session is absolutely the norm, and benders of over a week are not unheard of. It's such an effective stimulant you can literally run on the stuff for days without sleep, until your body finally gives out. It's exceptionally popular with the working poor for this reason (just take more meth as needed to power through work shifts, collapse after, repeat). MDMA isn't even comparable, and indeed you'll just stop getting much of an effect after 8+ hours of use. This is why meth, coke, crack, and heroin are the meat and potatoes of the drug trade while MDMA, LSD, mushrooms, etc are side orders. Some drugs taste like more.

And while alcohol is certainly easy to make I'd argue that weed is even easier to make, and the reason why one is more illegal than the other has to do with a history of racism, religion, and class conflict more than anything to do with the logistics of production.

All that said, addicts are predisposed to addiction, and the drug they end up addicted to is almost irrelevant, more likely a product of coincidence and geography than anything else. A predisposition to addiction, as Gabor Mate and many others have repeatedly observed, is almost always due to serious past psychological trauma.

Drug addicts are chasing the same dopamine reward response we all are, in every aspect of all of our lives; they have simply been denied natural access to those receptors, due to neurological damage, which certain drugs can bypass.
posted by mek at 1:31 AM on July 7, 2013 [36 favorites]


same percentage holds true for heroin, I believe (or so I heard about twenty years ago from a friend in Narcotics Anonymous). Of everybody that tries it once, 15 percent end up addicted.

Wait...that actually sounds really bad to me. Fifteen percent of those who try it once are getting addicted? If this is the sort of thing that Dr. Hart is talking about, then I believe that he is drawing the wrong conclusions from this data. That's the sort of statistic that seems to argue in favor of criminalization.

I think that he's quite right about how much of the effect of a drug comes from its context. Personally, I have argued for years that marijuana is a gateway drug, but the reason for that is because it's illegal. First of all, when young people realize that marijuana is not very harmful, they are apt to become cynical about all anti-drug propaganda. Second of all, those who go on to smoke weed are going to be more comfortable breaking similar kinds of laws in the future. My solution would be full legalization.

Also, I think that Hart has an excellent point that addiction is simply more likely for someone who is unhappy and hopeless. But I'm still not convinced that this legalization is the best approach to all drugs. I have two objections to his line of reasoning. First of all, while context may well be an critical element of addiction, it's a little early to assign it complete blame.

Secondly, even if addiction is completely predicated on certain pre-existing psychological factors, that alone might be a good reason for heavily restricting certain drugs. Certainly, some drugs are more habit forming than others, and when some seem to strongly facilitate addiction, perhaps that's enough of a reason to control them. Why should the FDA be more permissive about recreational drugs than medical drugs?

Blanket decriminalization has always seemed like a naive approach to me, especially when we reasonably restrict sales of so many other kinds of products that we consider to be hazardous. If someone decides to sell asbestos speedballs, how do we treat that? Bad for building but fine for partying? I'm not suggesting that the medical profession is equipped to start handing out prescriptions for Ecstasy and LSD, and it's probably clear that I think that the current laws are draconian and unreasonable. Not that I'm saying I have any answers...
posted by Edgewise at 1:57 AM on July 7, 2013 [7 favorites]


And that, right there, is why I don't expect decriminalization to happen anytime soon. 1.5 million people, potentially dropped straight into the job market?

In today's political environment the political class doesn't care about about unemployment or privileging non-elite demographics beyond where they are already through inertia. In this case the people who would be bothered by 1.5 million black people coming onto the job market - working class white people - are not politically important.

Your other point though - cops versus robbers as make-work in post-industrial America - is a very real thing and acts against decriminalization.
posted by MillMan at 2:08 AM on July 7, 2013 [1 favorite]


Everything he says about drug use being a symptom of poverty and not the other way around rings very true; all you need to do is take a peek into the hollers of Appalachia (and the creeping stain spreading westward into central and western Kentucky/Tennessee) to see how the crushing poverty and lack of access to education and jobs as the coal mining industry chokes the life out of the mountains is fueling the rush for meth and pills.

(Just from a quick perusal of my Kentucky city's JailTracker and the JailTrackers of surrounding rural counties shows that it's split about 25% toward pills, 25% toward meth, and 50% toward both at once.)

The other thing, though, is a lot of drug users in my state aren't in monetary poverty; they're in social poverty. A lot of coal miners make a pretty good living -- $60K/yr [on the low end] is an absolute boatload of money in a county like Harlan or Pike, where the median income is $18,665 and $23,930, respectively -- without needing a college degree or even a high school diploma. And these young men work 60+ hours a week and have no upward social mobility or transferable skills or anywhere to spend their money other than on their house, their car, and their recreation ... and what is there to do for recreation in some of the most rural, inaccessible parts of the Eastern US? Drugs.

Eastern Kentucky is reeeeally white, though. And rural white poor is distinct from urban black poor in a lot of ways that I didn't touch on. (And the sentencing alternatives he discusses in Montana don't exist here, really; people get locked up for 15 years on possession charges every day.)
posted by none of these will bring disaster at 2:20 AM on July 7, 2013 [4 favorites]


Edgewise: Fifteen percent of those who try it once are getting addicted?

Leaving aside the accuracy of that statement, usually the metric is proportion of 'ever used' population, which is to say, the 15% didn't get addicted after the first use and before the second use.
posted by daksya at 2:27 AM on July 7, 2013 [3 favorites]



Blanket decriminalization has always seemed like a naive approach to me, especially when we reasonably restrict sales of so many other kinds of products that we consider to be hazardous. If someone decides to sell asbestos speedballs, how do we treat that?

Obviously decriminalisation must include highly regulated production and distribution. If safe and affordable drugs were available to consumers from legal and reputable sources, entrepreneurial amateurs (and, not to mention, wealthy criminal cartels) would no longer have a viable business model. How often does one hear of someone creating and selling an alcoholic mixture which is toxic? In other words, your point is moot.
posted by Nibiru at 2:37 AM on July 7, 2013 [3 favorites]


Had Heroin been legally and safely available at an affordable price...of a (standard) formulation/potency which removed the possibility of excessive dosage and the, "pot luck" factor in regard to additives, would that community still have been, "worse off"?

Read Gerry Stimson and Edna Oppenheimer's book, Heroin Addiction in Britain -- which is a longitudinal study of heroin use in the UK during the period when the majority of heroin consumed here was pharmaceutical heroin, provided by the NHS. That population were dying at approximately the same rate that people die when using street heroin.

There's a reason why *all* of the modern Heroin Assisted Treatment programmes insist that the drug be used under supervised conditions with absolutely no take-homes. Even here in the UK, where the tiny numbers of people left over from the old British system can still have heroin takehomes. New programmes don't allow it because of the terrible mortality rates.

same percentage holds true for heroin, I believe (or so I heard about twenty years ago from a friend in Narcotics Anonymous). Of everybody that tries it once, 15 percent end up addicted.


That's probably true of people who try it once. However, a few years ago, I was involved in trying to recruit people who had been regular recreational heroin users (people who used a few times a year, over a couple of years.) This group are actually rarer than hen's teeth. Which isn't to say that they don't exist -- I know a couple myself. But the reality is, most people either develop an enthusiasm for the drug, or they stop using it. This is a guess, but it's a guess informed by being around heroin users for nearly forty years and working in the field for the last twenty-five or so, but my experience is that to all intents and purposes, the vast majority of people who use heroin more than, say, ten times tend to go on to develop a serious problem with it. Not everybody -- but such an overwhelming majority, that you're doing people a horrendous disservice by pretending ongoing recreational use of heroin is likely.
posted by PeterMcDermott at 2:39 AM on July 7, 2013 [24 favorites]


The above said, I fully support Hart's arguments in favour of full decriminalization, and that environmental factors are a bigger pressure towards negative consequences of drug use than pharmacological.
posted by PeterMcDermott at 2:53 AM on July 7, 2013 [2 favorites]


daksya:

Leaving aside the accuracy of that statement, usually the metric is proportion of 'ever used' population, which is to say, the 15% didn't get addicted after the first use and before the second use.

That was my assumption, and it still seems high. I'm not taking the number on face value, either...I'm just saying that, if that's what Hart meant, then I don't consider that to be a compelling argument in his favor.

Nibiru:

How often does one hear of someone creating and selling an alcoholic mixture which is toxic? In other words, your point is moot.

The question is whether there could even exist a form of salable heroin that one may consider "safe" in any sense of the word. I guess things seem simple if we're assuming that the answer is yes, but my point is that I think that would be jumping to conclusions.
posted by Edgewise at 2:55 AM on July 7, 2013


Heroin is given to women in labour. It's simply a very effective painkiller.
posted by Grangousier at 2:58 AM on July 7, 2013 [1 favorite]


Heroin is given to women in labour. It's simply a very effective painkiller.

I'm not sure what your precise point is. The US is currently experiencing an epidemic of painkiller abuse, so if that's an argument in favor of full legalization/decriminalization of heroin, I'm not sure that I'm on board.
posted by Edgewise at 3:11 AM on July 7, 2013


The question is whether there could even exist a form of salable heroin that one may consider "safe" in any sense of the word. I guess things seem simple if we're assuming that the answer is yes, but my point is that I think that would be jumping to conclusions.

I understand your position and agree the term, "safe" is quite subjective when used in this context, however, if we, as a society, can significantly reduce the inherent risk of using illicit substances and increase the possibility of positive outcomes insofar as employment, education, and social inclusion for drug users and addicts, it's absolutely our responsibility to do so. Ultimately, "The War on Drugs" has been a monumental failure from both economical and societal perspectives, so, other than continue to bury our collective heads in the sand, we have no alternative than decriminalise drugs and create a safe and responsible as possible avenue of production and distribution.
posted by Nibiru at 3:17 AM on July 7, 2013


If you can get your hands on a copy, the 1991 book, The War on Drugs II by James Inciardi is a real eye-opener on the subject. It's amazing how wrong our long-held narratives are.
posted by sonascope at 3:17 AM on July 7, 2013 [2 favorites]


What I mean is that it's not a mystical, evil substance that steals people's souls. It's a painkiller. People take painkillers because they're in pain. If they're self-prescribing painkillers in such large numbers, the problem is not with the drugs, it's with the fact that their lives are fucked up. The creation of the mythology of Evil Drugs gives the authorities a scapegoat to take the blame for their own failings.

On the other hand, if such large numbers of people are self-prescribing like that, then it's incumbent on us that it be done in such a way to cause the minimum of harm. Which means decriminalisation and regulation of manufacture and distribution.
posted by Grangousier at 3:22 AM on July 7, 2013 [5 favorites]


This isn't directly connected to the sale of drugs but is germane to the question about harm reduction both physically and socially. The experience of Insite in Vancouver's downtown east side is interesting. It's North America's first safe injection site that has been run by BC's health department since 2003. Their website has info about research done since it's opening which appears to be quite positive.

I find the political and legal battles that have gone on since it's inception fascinating. It's like the attitudes and viewpoints of the 'Drug War' summed up in one issue as not only Canadian but American groups are involved. It even got a comment from George Bush at the time of it's opening which to me speaks of the level of 'threat' such an idea has to the current status quo. The wiki article does a great job of summing it up with links.

The latest news is that Toronto's public heath unit, based on Vancouver's experience is interested in the same sort of program. Montreal all as well apparently. Politics and science clash as seems to be usual with this issue.
posted by Jalliah at 4:05 AM on July 7, 2013 [1 favorite]


The question is whether there could even exist a form of salable heroin that one may consider "safe" in any sense of the word. I guess things seem simple if we're assuming that the answer is yes, but my point is that I think that would be jumping to conclusions.

The safe dose of paracetamol is 4 grams.
10 grams will quite possibly kill you. And not in a nice way - invisible, irreparable damage leading to liver failure, painful and slow. And that is sold in supermarkets in packs of 100.
posted by Sebmojo at 4:07 AM on July 7, 2013 [13 favorites]


Wait...that actually sounds really bad to me. Fifteen percent of those who try it once are getting addicted? If this is the sort of thing that Dr. Hart is talking about, then I believe that he is drawing the wrong conclusions from this data. That's the sort of statistic that seems to argue in favor of criminalization.

I kind of agree with this, despite being (philosophically at least) in favor of decriminalization. A 15% *instant* addiction rate is appalling.

The question is whether there could even exist a form of salable heroin that one may consider "safe" in any sense of the word. I guess things seem simple if we're assuming that the answer is yes, but my point is that I think that would be jumping to conclusions.

The safe dose of paracetamol is 4 grams. 10 grams will quite possibly kill you. And not in a nice way - invisible, irreparable damage leading to liver failure, painful and slow. And that is sold in supermarkets in packs of 100.


What does 4000 mg of heroin do to you? 10,000 mg?
posted by gjc at 4:30 AM on July 7, 2013


What I mean is that it's not a mystical, evil substance that steals people's souls. It's a painkiller. People take painkillers because they're in pain. If they're self-prescribing painkillers in such large numbers, the problem is not with the drugs, it's with the fact that their lives are fucked up. The creation of the mythology of Evil Drugs gives the authorities a scapegoat to take the blame for their own failings.

People are not taking heroin to cure pain. They are taking it because it gets them high.
posted by gjc at 4:34 AM on July 7, 2013 [1 favorite]


The safe dose of paracetamol is 4 grams. 10 grams will quite possibly kill you.

That's kind of meaningless data though. The usual metric we use to determine safety is how many deaths there are, per thousand or per million doses.

With paracetamol, those numbers are pretty low. With heroin -- particularly with self-administered, pure pharmaceutical heroin, or with shitty street heroin used in combination with other depressants like alcohol or benzodiazapnes, the numbers are extremely high.

What does 4000 mg of heroin do to you? 10,000 mg?

Depends on your tolerance levels. I've known people who were receiving 1000 mg a day of pure pharmaceutical heroin. You wouldn't have been able to tell they were on any drug because of their tolerance to it.

But with no tolerance at all, 5mg is a standard dose, 30mg could kill you.
posted by PeterMcDermott at 4:34 AM on July 7, 2013 [2 favorites]


People are not taking heroin to cure pain. They are taking it because it gets them high.

Among people who go on to develop dependence, high levels of physical and/or emotional pain are the norm. The high really isn't *that* great, so it doesn't appeal to most people. People who aren't in some kind of pain, by and large, don't put their lives and liberty at risk and render themselves unemployable, just to get high. There's no shortage of ways to do that that are legally and socially acceptable.
posted by PeterMcDermott at 4:39 AM on July 7, 2013 [10 favorites]


PeterMcDermott: With heroin -- particularly with self-administered, pure pharmaceutical heroin, or with shitty street heroin used in combination with other depressants like alcohol or benzodiazapnes, the numbers are extremely high.

Can you cite a source for the pure heroin part, and also for the deaths per million doses part?
posted by daksya at 4:54 AM on July 7, 2013


People are not taking heroin to cure pain. They are taking it because it gets them high.

Is that observation based on your own experience? Or hearsay?
posted by Mister Bijou at 5:02 AM on July 7, 2013 [2 favorites]


The high really isn't *that* great, so it doesn't appeal to most people.

Does this at least partly explain the lack of recreational heroin users? Those not apt to become addicted take something more exciting after trying heroin a few times?
posted by hoyland at 5:05 AM on July 7, 2013


my quasi-rural area is experiencing a surge of heroin use among younger people and a corresponding wave of petty crime and OD deaths. but "oxy" abuse was rampant before that and when it comes down to it, everybody stuck living here is fucked: no jobs, no future, and just to put the icing on the cake spiralling rent from students and the very liberal middle-aged people who quasi-retire here for the natural beauty. heroin's problems come from the way it's taken. pill based opiates are much easier to abuse and correspondingly are. heroin deaths and petty (and often completely idiotic) property crime get everyone's attention.

the "problems" with the (post-60's Nixon derived) US drug war have been obvious for over 30 years. but then, the politics: hippies and black people, were transparent from the start. the policies of the drug war never had anything to do with the dangers of recreational drug use to begin with.

also, no one gives a fuck about black people.
posted by ennui.bz at 5:16 AM on July 7, 2013 [3 favorites]


He was recently interviewed on BookTV.
posted by phoque at 6:02 AM on July 7, 2013


Among people who go on to develop dependence, high levels of physical and/or emotional pain are the norm. The high really isn't *that* great, so it doesn't appeal to most people. People who aren't in some kind of pain, by and large, don't put their lives and liberty at risk and render themselves unemployable, just to get high. There's no shortage of ways to do that that are legally and socially acceptable.

It seems like you have much more direct experience with addicts then I do but I did spend a good number of years in a party town (ski resort) where all sorts of drugs were the norm. From that anecdotal experience, my own and just being around groups of people who did a lot of different drugs for different reasons this matches what I saw.

Pot was super common. I smoked a lot myself. When people wanted to 'get high' for good time it was LSD, mushrooms, things like ecstasy and to some extent various upper and downer pills. Cocaine was done quite a bit in the restaurant crowd. Heroin was easily available. Of my closer social group the majority had no interest in heroin and cocaine at all whether they had tried it or not. It was almost like those were the 'bad' drugs.

I did have two friends that eventually fell into that scene directly after going through a horrible emotional event. It was tough to deal with on our end because that it was connected with medicating emotional pain was really obvious to us who cared. Thankfully both managed to get out of it. It was the psychological that had to be dealt with. It was hard though because the drugs so easily mask whats going on and then create a vicious cycle as things go down hill of not just desiring them physically but mentally to mask the problems the drugs themselves lead too.

I never did heroin but I tried cocaine once. I hated it. Yeah I felt good but it felt so damn fake. It felt like the 'good feeling' was plopped on top of everything else. It felt like I didn't need it but I could easily see why the high would be really appealing if things in life wasn't what people think it should be.

I did do LSD, mushrooms and ecstacy a few times, usually when there was some big party and I found the 'highs' from them quite different then the cocaine. It's hard to describe exactly why.

A few years after that I spent some time in a First Nations community. The connection with things are crappy and drug use with a lot of people was really obvious even to the lay person. It was obvious with many of the people themselves that were struggling with different drugs. They readily acknowledge the 'escape' that the highs gave them and it was the escape from the crap going one that they said was the main thing that kept rearing itself and drawing them back. I had one friend who talked quite openlly to me about his issue with Oxy in particular as an emotional demon.
posted by Jalliah at 6:41 AM on July 7, 2013 [3 favorites]


I know a guy who nearly died of paracetamol (Tylenol) overmedication. This crap is far more dangerous than most illegal drugs or alcohol, and not only do most people have no idea neither do a lot of doctors -- the first doctor my coworker went to because he was tired all the time waved off the fact that he was taking 12 to 15 Tylenol a day for his arthritis as unimportant. After thousands of dollars in unhelpful tests a second doctor said STOP DOING THAT RIGHT NOW and his health returned to normal within a few weeks.
posted by localroger at 6:52 AM on July 7, 2013 [3 favorites]


I'm a fan of harm reduction- but I think it's misleading to pretend drug use necessarily better. I think there are pluses and minuses of drug use and the war on drugs is the wrong war.

Fight a war on poverty, unemployment, underemployment, harmful/excessive working conditions just to subsist, lack of quality physical and mental skill building tools for people to build their health and capacity to perform in school or work (minus the disability labels required for people to need help with specific areas). Access to physical and mental health promoting activities for the general public including pools and gyms, gardens, recreational activities and hobby supplies.

Fight the war against too little resources for poor people to make their own businesses. What are they supposed to build or sell? How are they supposed to get trained to perform a quality service when their busy easting ramen noodles and living with chronic panic of preventing getting shot by the neighbors while their cognitive and executive abilities decline? People are suffering all over the place.

Drugs can sometimes make it worse and I'm not really a fan of drug use- especially because people who promote drug use often seem comfortable throwing those who wind up addicted in the garbage in the plight to make drug use easier for people who don't have problems with it. I'm not ok with it.

I've watched family members lived destroyed from drug use, chatting with my dying cousin while he says, "My liver finally exploded"... what do say?

The consequences for those who suffer are so horrific that it's not something I think we should risk happening to people because sometimes the drug use really does cloud the ability to recover from trauma or social stigma or other valid reasons to want to escape the pain.

There's a battle we should be fighting alright. And we need every person who can to join this battle for human welfare, human friendly jobs, an ALL INCLUSIVE education system that seeks to train people within their skill sets instead of labelling some people failures and destroying their self esteem and worth for life permitting their communities to watch them starve and feel justified watching them rot fromthe inside out in horrific poverty and abusive work environments. We need to both educate people about health and ensure the resources and support to make healthy decisions are accessible to people of all incomes.
posted by xarnop at 7:00 AM on July 7, 2013 [4 favorites]


There are people who are supposed to, as in it's the job for which they are paid, care about black people -- the elected representatives of black-majority districts and municipalities, the executives of black-rights non-profits. Where are they on this? And not as rhetoric, but as a real prioritized political agenda. The Congressional Black Caucus is poised by way of immigation reform to add 10mm plus Latino competitors to their low skill constituents for jobs with real I9 processes; why aren't they making their support conditioned upon repeal of drug prohibition?

Gay marriage went from unimaginable by anyone to unopposable in polite society in less than 20 years, and a lot more bien-pensant white people would like their law enforcement-driven taxes go down and to see a pot aisle at ther local wine store than want to get gay-married.
posted by MattD at 7:24 AM on July 7, 2013 [1 favorite]


People are not taking heroin to cure pain. They are taking it because it gets them high.

Is that observation based on your own experience? Or hearsay?


I have never, ever heard an addict of heroin say they started using because they were in pain. The exact same number of people I've heard of who started using cocaine because it was an anesthetic. If there is some subculture of people hooked on these drugs because they were self medicating for pain, I've never heard any of them speak out.

I've heard lots of people get hooked on Oxy or Vicodin because they had some kind of pain, but never heroin.
posted by gjc at 7:42 AM on July 7, 2013 [2 favorites]


I have never, ever heard an addict of heroin say they started using because they were in pain.

Your definition of "pain" might be a little too narrow, here.
posted by downing street memo at 7:48 AM on July 7, 2013 [18 favorites]


localranger "I know a guy....." . these are the kind of statements and anecdotes that undermine the reasoned discussion on drug use. I really have to ask what were you thinking. Millions of doses of paracetamol/acetaminophen are taken daily--yes it can be toxic but to even equate it with the dangers of alcohol and most illicit drugs is just talking. And what is with your friend. Can he not read a label. What do you think would happen if he drank 4-8 times the daily safe "dose" of alcohol every day.
There are almost exactly the same number of deaths per year due to acute alcohol and acetaminophen poisoning (370 +/-). BUT, there happens to be over 43,000 additional yearly deaths directly attributable to alcohol--road deaths, falls, asphyxiation, water craft, accidental shootings, etc. This does not even count indirect deaths due to pancreatitis, cirrohsis, heart disease other cancers, eyc.. Almost as many people die each year of alcohol related hypothermia as acetaminophen poisoning. Finally, I am assuming the linked article was necessarily brief and partially quoted and written to stimulate sales. (Nothing wrong with that). But it sure left a lot to be desired if one wanted to really learn anything about the pros/cons of legalizing drugs.
posted by rmhsinc at 7:59 AM on July 7, 2013 [1 favorite]


I'd disagree a bit here, delmoi; MDMA is just as easy to synthesize, if not easier, but it's less attractive to produce and sell for a number of reasons. It's far less potent per milligram, it suffers from much greater diminishing returns, and it's much less chemically addictive. Thus, MDMA is not subject to the same demand from addicts, and isn't produced in the same quantities as methamphetamine. I'm sure you can definitely make a killing selling "molly" at a concert, but you definitely won't have people calling you up 24/7 like a meth dealer will.

On the other hand, you aren't dealing with tweakers that call you up 24/7. There is a boatload of money to be made selling MDMA, you're dealing with a much higher-income clientele who aren't as likely to give you a bunch of hassle and/or rob you, and the cops are much less interested in breaking up MDMA rings, just because they aren't associated with the crime and lower-status people.
posted by empath at 8:11 AM on July 7, 2013 [1 favorite]


What scares me is that none of this is new. When I was an undergrad at Columbia we got students for sensible drug policy off the ground there (which is still growing strong!) and this knowledge has been out there. The utter ignorance on the part of law enforcers has been nearly on par with that of the climate change deniers. Luckily we've seen so much push back from the populous that year after year we've seen medical marijuana, drug courts, harm reduction and now marijuana legalization become part of the dialog.

I will never forget a brief tour done by 3 women coca farmers from Peru, Colombia and Bolivia. These women, a dozen years ago, were getting hit with that big wave of military support done by the Clinton administration. Plan Colombia. Ostensibly it was targeting the anti-government leftist rebels, but the people it hurt were innocent farmers getting hit with herbicides on their coca crops. Utter insanity, as the entire distillation of coca into powder cocaine was driven by the illegality of more dilute preparations that had thrived throughout the 19th and early 20th centuries.

When I talk about it I come off as just this side of stark raving mad, but honestly the complacency of the left and right on this issue is ruining so many futures, yet the rich and powerful (most people on this site) are so divorced from the punishment that we don't feel the harm in our guts. It's too abstract due to segregation in our cities and in our law enforcement patterns.
posted by nutate at 8:15 AM on July 7, 2013 [2 favorites]


Jalliah: [Insight's] website has info about research done since it's opening which appears to be quite positive.

From what I've read, Insight appears to have been a roaring success in terms of objective harm reduction. It deals with a number of issues without coming down on the side of legalization, but specifically the one where society gets to treat addicted people as criminals first and citizens second.

It's great that Ontario is interested in sponsoring safe injection sites, but our federal government is against it:

On June 6, Health Minister Leona Aglukkaq introduced Bill C-65, the Respect for Communities Act. The bill requires any organization applying to operate a safe–injection site to produce a suite of information that advocates say will make it nearly impossible to get a new site under way.
posted by sneebler at 8:23 AM on July 7, 2013


but my experience is that to all intents and purposes, the vast majority of people who use heroin more than, say, ten times tend to go on to develop a serious problem with it.

Assuming this is true (and, as you say, the date here are skimpy), there's still the question of cause and effect: do people who use heroin X number of times or more become addicted because there is something special and unusual about heroin, or because there is something special and unusual about the very small subset of the population who choose to use heroin multiple times?

What Hart seems to suggest is that it's the latter, i.e., that there are some people walking around out there who have a hole in their soul that heroin happens to fill neatly. The solution here would seem obviously to be "let's find a different way to fill that hole," but what we've been doing is making hole-filling immoral, illegal and dangerous.

It's possible that one reason it's difficult to find "recreational" heroin users is that the hole this drug fills is rather specific and rare, or, in other words, for most people in most circumstances, heroin doesn't offer much bang for the buck. It just makes them sleepy. People may try it once or twice out of curiosity and then just shrug their shoulders: "I threw up for a a while and then I sort of napped, and then later I was constipated. Oh, yeah, I remember that my knee wasn't bothering me, that was kind of nice." This kind of "meh" experience is unlikely to motivate your average joe to start poking himself in the arm looking for a vein.
posted by La Cieca at 8:49 AM on July 7, 2013 [4 favorites]


Considering the ability we have now to measure biological responses to social pain, verbal insults, rejection, emotional abuse, trauma, neglect and more- there is literally a physiological process that is related to emotional pain and can become ongoing in the body. The fact that physical painkillers alleviate emotional pain is unsurprising. The fact that chronic health problems can cause emotional or mental problems is unsurprising. That doesn't mean that drugs/painkillers are some GREAT long term solution to this.

The better thing would get better at educating families about their and their children's emotional needs (including specific individuals needs for skill development, recreational activities, nutrition, social interaction) and that these needs are very real developmental needs for physical and mental health.

A campaign to better educate families about the specific aspects of developing health and skill (along with free/low cost resources so that families are able to make different choices)-- and to better educate families about what emotional neglect and abuse looks like in families along with resources they can use to address their harmful parenting values or personal issues that impede being aware of their children's needs and being able to serve them... There are subcultures that entrench emotional or physical abuse and neglect- and often this is because they have adapted to abusive working and living environment and quite literally may be trying to build their kids up for a terrifyingly horrific world. (Though there are many different reasons for abusive and neglectful behaviors, address the systemic nature of such practices in cultural values and the environmental variables that might bring these behaviors out in parents is important.)

Also, the importance of supporting mothers and parents during pregnancy and while caring for small children is a HUGE health factor for child well being. Helping parents create a secure bond with their children IS important- and many children need much more nurturing than a day care can provide. It's worth considering whether we could just pay parents who want to parent their children to parent them. If we're considering subsidizing daycare, why wouldn't we subsidize parenting? When teens are out getting into trouble, what if we could pay their single parent to work part time and get to actually parent them in the afternoons instead of working 2 jobs and never being there to ensure kids eat good food, sleep some, stay out of trouble, have some recreational activities to do... and actually get to see their parent? We have a huge a huge portion of mothers who are socially sanctioned stay at home or part time working moms (or dads) and I think many do good by their children... and then welfare moms get hated for using drugs or other coping mechanisms they learned while being poor and dysenfranchised, but can welfare moms go get a massage when stressed? Afford replenishing veggies? Have the energy to cook while dealing with PTSD and fibromyalgia from all the childhood abuse they went through? Is there a place that would take care of both the parent AND the child if they stop using the drugs and face the trauma issues and can barely function? Do the drug rehabilition programs available to poor people have the kind of services that address trauma and developmental problems or are they just using AA and meds? Which often doesn't really help the person get to full recovery?

These kinds of solutions would go far in preventing the creation of people in pain. This also includes addressing jobs that are harmful to the human psyche or physical well being and don't pay enough for restorative activities/services to mitigate that harm.
posted by xarnop at 9:01 AM on July 7, 2013 [4 favorites]


For a longer read, I strongly recommend his book, which just came out: High Price. (Co-written with Mefi's Own maias). Carl's been doing a lot of media for his book. Here are a few of his recent appearances:
HuffPo
Salon
Melissa Harris Perry
Ebony.

And, while I'm at it, here's a recent excellent article by maias, touching on some of the issues raised in the comments here:

What is the most dangerous activity you can engage in? If you guessed doing illegal drugs, you would be wrong. Extreme sports like big wave surfing, heli-skiing, cave diving, white-water rafting and mountain climbing all have a higher rate of risk to life and limb. Yet the question of a ban on these behaviors beloved by "adrenaline addicts" is viewed as ludicrous, even when the risk of death, say, in climbing Mount Everest once (until recently, about 1 in 3) is greater than the annual risk of dying from heroin addiction (around 1% to 4%).

Or consider mundane activities like driving: Car accidents are responsible for 1% of annual deaths nationwide. Cigarettes and alcohol do at least as much, if not more, harm to each user than heroin or cocaine. Alcohol, cocaine and heroin have a 3% to 15% rate of addiction, depending on how it is measured—and tobacco's rate is higher. Yet the risks don't align well with their legal and social status, especially when you consider that marijuana is safer than any of the legal drugs.

posted by gingerbeer at 9:13 AM on July 7, 2013 [7 favorites]


Wait...that actually sounds really bad to me. Fifteen percent of those who try it once are getting addicted?

That doesn't mean they got addicted the first time. It's of people who ever try it.
posted by spaltavian at 9:21 AM on July 7, 2013 [1 favorite]


Still, what if many could be spared, dealing with recovering from addiction- and just be recommended that there are better solutions? I'm just saying, promoting heroin use is safe seems extremely irresponsible. Promoting use of heroin to fill holes as an understandable coping mechanism that might have side effects-- is good. Again, harm reduction doesn't have to mean pretending there is no harm involved. Like I have plenty of pain, would heroin be a good idea for me to do? I know where to get some.

A lot of us with pain that heroin might fill choose not to because we don't want the harm that comes with it's use. If you're trying to break down the idea there is harm and addictive properties of it's use- you're breaking down that barrier that keeps some people off it (and happy to be off it). I'm just not sure why it's necessary to promote it as safe for recreational use- that's a totally different thing than saying it's understandable people in pain want an escape and might not be able to stop themselves once they've found one.
posted by xarnop at 9:30 AM on July 7, 2013 [1 favorite]


The Fix article by Maia Szavalitz that gingerbeer linked is helpful (emphases added).
For instance, when we talk about the “epidemics” of Oxycontin, methamphetamine or heroin, we rarely acknowledge that the majority of users never become addicted: Over the course of a lifetime, only about 10% to 15% ever get hooked. That risk is not insignificant: Few people would fly on a plane that crashed every tenth flight. But focusing on use as the main factor in addiction obscures what is actually at stake.

There are, decade after decade, headlines about the fall of one drug and the rise of another. Yet the overall rate of people with addictions remains fairly constant. Although population differences and other variables make the numbers hard to compare exactly, a large national survey in 1990 found a 3.6% rate of illegal drug problems (DSM-defined “abuse” or “dependence”) in people ages 15 to 54 during the previous 12 months. The most recent National Survey on Drug Use and Health, which includes people from age 12 to those in their 80s or older, found a 2.5% rate of abuse or dependence in 2011. While that rate may seem much lower, the difference is probably due to the later survey’s inclusion of people over 55, who are numerous and had a 2011 addiction or drug misuse rate of a mere 0.8% or less. It is worth noting that 1990 was the peak of fears about a non-ending crack epidemic; by contrast, today, while there are concerns about growing prescription opioid addiction, the actual rates have been steady since 2006.
posted by spamandkimchi at 10:12 AM on July 7, 2013 [2 favorites]


Your definition of "pain" might be a little too narrow, here.

It is an analgesic, so whatever kind of pain analgesics are normally used to treat would be the definition I am using.

I'm not ignoring what I presume is your point: Of course addicts are in some kind of pain, but it's not the kind of pain a painkiller can treat. They are just leveraging a side effect of the drug to check out for a while. And yes, once someone is addicted, the pain of withdrawal probably is indistinguishable from actual physical pain. But that's *caused* by the drug. It's like saying that people drink to self-medicate their DTs, when they wouldn't have the DTs if they weren't already abusing alcohol.
posted by gjc at 10:19 AM on July 7, 2013


gjc: but it's not the kind of pain a painkiller can treat. They are just leveraging a side effect of the drug to check out for a while.

A painkiller isn't intended to go after the cause of the pain, only diminish the pain itself. And the categorization of the activity of a drug into effects and side effects is a social act, not some intrinsic taxonomy.
posted by daksya at 10:37 AM on July 7, 2013 [8 favorites]


I also liked the phrasing "choice and chance" that Dr. Hart uses for his self-narrative. It's a useful frame in thinking about drug use and drug addiction as well.

A lot of kids in my Chicagoland public high school drank and smoked pot, even more kids in my fancypants New England prep school drank and smoked pot simply because they had more money to spend and less parental supervision. And while getting caught would get you kicked out of prep school, no one was pathologizing a bunch of overachieving kids in J. Crew and L.L. Bean as hopeless drug addicts and alcoholic losers.*

I mean, the trajectory of George W. Bush and his substance use/abuse is a familiar prep schooler-to-Ivy Leaguer story that I have seen umpteen times. Underage drinking followed up by coke (you know, the cool drug, not scary like crack) followed by a 40th birthday realization that the raucous partying with your banker friends that seemed hilarious and fun in your 20s and 30s now seems a little sad and definitely makes you look more like "problem drinker" than "life of the party".

* [Now I'm visualizing what the War on Drugs would have looked like at prep schools in the early to mid-1990s, with SWAT teams coming in through dorm rooms to find Snapple bottles full of dip spit strewn amongst the pseudo-grunge flannels and ripped jeans.]
posted by spamandkimchi at 10:37 AM on July 7, 2013 [1 favorite]


It's almost as if we didn't have enough jobs to go around anymore, so we decided to invent a few out of thin air: some people get to be prisoners, other people get to work as guards, administrators, parole officers, police officers, judges, lawyers, clerks, bail bondsmen... the list goes on.

That's some Brave New World shit right there. Consumption for its own sake. Society decides that some people should be brain damaged gammas ahead of time to make sure a certain role is fulfilled, nevermind how useless and a big waste of human potential it is. It's actually considered a good because it provides a need for more work, i.e. the legal and prison industries.

It's not quite as explicit as in the book, but for people that can't break the cycle of poverty, drug use and crime, where aspects of society like it that way, it seems awfully close. It's disgusting.

How do we reason with the entrenched interests that actually want to make it worse so they can have more jobs to provide for their own families?
posted by Foolhardy at 10:51 AM on July 7, 2013 [1 favorite]


Fifteen percent of those who try it once are getting addicted? If this is the sort of thing that Dr. Hart is talking about, then I believe that he is drawing the wrong conclusions from this data. That's the sort of statistic that seems to argue in favor of criminalization.

despite being (philosophically at least) in favor of decriminalization. A 15% *instant* addiction rate is appalling.

Heroin's a mutherf***er -- no question. It kills the deepest pain (which is usually emotional) and only demands your soul in return (or perhaps your life). And the stats seem to indicate that 15-percent of the culture is sufficiently hurting that they're willing to go ahead with such a deal, regardless of what the law/society etc thinks.

Or as La Cieca just put it ...

What Hart seems to suggest is that [...] there are some people walking around out there who have a hole in their soul that heroin happens to fill neatly. The solution here would seem obviously to be "let's find a different way to fill that hole," but what we've been doing is making hole-filling immoral, illegal and dangerous.

What are the figures on people who try alcohol once eventually developing serious drinking problems? I wouldn't be surprised to find they're much different. But alcohol is legal and accepted and easily attained pretty much everywhere in the cultural, so there's all manner of baggage it just doesn't carry.

Also, because alcohol is legal, it's regulated for dosage, purity etc ... but not heroin. Which gets us to one of the most horrific aspects of the drug's criminalization -- the number of people who aren't addicts (not yet anyway), who are just dabblers, who overdose (and sometimes die) because they simply screwed up on the dosage. I don't have any figures on how many this may be, but I do know from personal experience that it happens a lot. I can immediately think of a half dozen people I know (or know of) who died in just such a manner. Not known to be addicted, found dead, turned blue. And then the next day, you get a warning in the news that there's a particularly strong batch of heroin in town (Vancouver).

The most tragic case was two teenage guys who were apparently trying it for only the second or third time. Someone had told them it was perfectly safe to snort. It wasn't.
posted by philip-random at 10:57 AM on July 7, 2013 [4 favorites]


localranger "I know a guy....." . these are the kind of statements and anecdotes that undermine the reasoned discussion on drug use. I really have to ask what were you thinking.

I am thinking that your comment makes me angry enough to spit molten lava, so I will try with some difficulty to keep this response civil.

I am thinking that I am tired of wading through a mile-wide river of bullshit to find out what is true about anything because of all the vested interests peddling lies and distortions.

I am thinking that the number of people who actually read the directions is approximately zero. I am thinking that if you were to go out and buttonhole 100 people at random and ask them if Tylenol was a dangerous drug you would be doing very good to get five positive responses. I am thinking that my friend and coworker who did I mention nearly died from taking what he thought was a reasonably safe product was not a stupid or unusual guy at all, and there are obviously a lot of people out there like him. At least 340 per year, to take your statistic.

I am thinking that if any other drug was this dangerous it would not be OTC or if it were it would be festooned with skulls and crossbones and Surgeon General's warnings and not sold in packets of more than 10 pills to minimize the risk of abuse.

I am trying to think of another product that can kill you so easily and with so little warning before the damage is irreversible which is sold with so little warning. Alcohol will make you pretty damn sick before it kills you. Smoking we all know about. Where are the ad campaigns warning you about Tylenol? Why is this dangerous drug marketed in easily chewable candy flavored form and marketed as an alternative to the much safer aspirin because, oh dear, aspirin is acidic and might upset your stomach?

I am thinking that I was completely unaware of how dangerous Tylenol is, like most people, until S told me that not his first doctor, who was a GODDAMN DOCTOR, but his SECOND doctor realized he might have a problem. You know that thread we had about terror vs. horror vs. fear? What I felt when I read about Tylenol toxicity was horror. And nobody is doing a goddamn thing about it.

Once when I was poor and had a sprain I took about 8 grams of aspirin. Not a good idea I know and I could have had a problem if I'd cut myself that evening, but it did what I expected and got me over the pass. If I had done that with Tylenol I would be dead.

Lots of people will do stupid shit like that. Where is the fucking skull and crossbones on the Tylenol bottle? Where is the ad campaign? Where are the gross pictures of people dying of liver failure because they OD'ed on Tylenol? Where are the laws regulating how much can be sold how often to limit the danger? WHERE THE FUCK ARE THEY?

Before I got my blood sugar under control I was having regular attacks of gout, and nothing seemed to help. One day I was IRC'ing with a doctor in England and told him Ibuprofen didn't work either, and he asked me how much I was taking, and I said well the max the bottle advises is 800 mg a day. He LOL'd and said you need to do three doses of 4 200 mg pills, that's the MINIMUM dose for gout. He advised me of the side effect warnings and when I did as he'd advised, the swelling subsided and I was able to cope with the attacks much better.

If I'd done that with Tylenol I would be DEAD. There is no sickness and no warning that you're doing anything bad to yourself until the damage is irreversible. Where are the warnings? Where is the skull and crossbones? Where's the ad campaign? Where are the laws limiting the size of the containers?

What I'm thinking is WHERE THE FUCK ARE THE LAWS advising us and protecting us from this dangerous drug that makes billions of dollars for big pharmaceutical... oh never mind, I think I have an idea.

So in answer to your question, that's what I'm thinking. And have a nice day.
posted by localroger at 11:02 AM on July 7, 2013 [12 favorites]


my liver enzymes were high a couple years back. The two things my doctor told me lay off were Tylenol and alcohol ... because (as he put it) both are poisons, the most commonly accepted poisons in the culture, but still poisons.

And, of course, Tylenol is just a brand name, the active ingredient being acetaminophen (aka paracetamol)
posted by philip-random at 11:14 AM on July 7, 2013


And the stats seem to indicate that 15-percent of the culture is sufficiently hurting that they're willing to go ahead with such a deal, regardless of what the law/society etc thinks.

15% of the people who try heroin. I've known a bunch of drug users in my life. People who were completely out of control on prescription drugs, psychedelics, uppers, downers. I knew a guy who got high on robotussin almost daily. Out of a population of maybe 100 drug users I've known and/or partied with, I know a single person who has used heroin, or at least told me about it. I know more people that have smoked crack. Heroin is the drug that every drug user I knew was afraid to touch. I would hazard a guess that if you're going to ride that horse even once, you're halfway dead anyway.
posted by empath at 11:25 AM on July 7, 2013 [3 favorites]


Drugs can sometimes make it worse and I'm not really a fan of drug use- especially because people who promote drug use often seem comfortable throwing those who wind up addicted in the garbage in the plight to make drug use easier for people who don't have problems with it. I'm not ok with it.

I'm not going to say people like that don't exist -- because assholes are everywhere -- but certainly nobody here is doing that, and I think that's a gross misrepresentation of the decriminalization side of the argument. With the exception of a few outlying Ron Paul supporters, nearly all decrim advocates I've been exposed to care deeply about addicts, some of them having been addicts themselves. They're very much in-tune with the social justice goals you mentioned.

I look at it this way : drug addiction brings with it a whole host of negative outcomes. How does adding another one -- like jail time -- make things any better? It doesn't function as a deterrent; that's what the Drug War was supposed to do, and it failed.

Besides, try applying your argument to alcohol. "I don't think alcohol should be legal, because alcohol users just want to get high and don't care about people who get addicted." You won't get very far with that, because we all agree that we're not going back to Prohibition. So why are "drugs" any different?

Alcohol, by any measure, is a "hard drug". Yet, we've found a way to integrate it into our society such that people don't get thrown in jail for possessing it. Why is it so hard to imagine treating other drugs the same way?
posted by evil otto at 11:28 AM on July 7, 2013 [2 favorites]


Where are the ad campaigns warning you about Tylenol?

And hey, don't forget Vicodin, which has a sizable dose of tylenol in it, which makes it more dangerous than hydrocodone by itself, for no real analgesic benefit (and which a lot of people mix with alcohol for recreational purposes).
posted by empath at 11:28 AM on July 7, 2013 [1 favorite]


And hey, don't forget Vicodin

I had to delete the paragraph I started to write about Vicodin, the existence of which I can only ascribe to pure hatred and sadism.
posted by localroger at 11:30 AM on July 7, 2013 [5 favorites]


I'm in favor of decriminalization-- just not with making statements ignoring the potential harms of their use, or acting like the people who get harmed by it were already damaged anyway so they're necessary collateral damage in the quest for making partying easier.

My experience with party people is that they do have impaired ability to have empathy for people harmed by that lifestyle, and sometimes put down "real addicts" to make their personal use look more responsible. But that's just based on things I've seen and how I've been treated and crowds vary.

I know so many drug users who have given so many lectures about how I need "heal" from my issues so that I can smoke pot like they do, or how their drug use is find because they hold their job and an unemployed addict is a terrible person who needs to stop using drugs--- when they're both people who are addicted and simply have different side effects.

The person lucky enough to not have side effects just hasn't been given that challenge of having to quit so they don't really know what they're made of. I've been given so much bullshit lectures about how I need to take MDMA to heal or I need to take methadone for my stress or I need to take acid if I ever want to expand my mind-- and these drugs really fucked me up.

I think the speeches about how safe this stuff is are misleading so yeah to me I see it as a real danger because it harmed me and I think people like myself who can be harmed by this stuff are not so unimportant to be erased or not warned we could be harmed by this stuff? I just dislike the attitude "well it doesn't harm most people so who cares?"

I care. I don't like when people who get harmed are written off as just people were going to be fucked up no matter what so who cares. That's NOT TRUE. That said I respect individual choices to escape if they are in hell. And unless you know what it's like to grow up being tortured in a fucking basement by a child molester/priest I think you can refrain from judging whether there are some people who are better off on emotional painkillers as long as they want them. I don't have an answer as to what's better-- though I do think the drugs are harmful. I respect individual choices if they want to take the risks. I just believe in accurate education about the risks. I also think TONS of things in our society are damaging to human health that we ignore and culturally promote and that matters to me too.
posted by xarnop at 11:44 AM on July 7, 2013 [4 favorites]


Wow. All I can say is that my experience has been different than yours. In 2+ decades of involvement with various party scenes, I have not encountered the sort of peer pressure you describe. People who will tell you that LSD/MDMA/pot/whatever will expand your mind and that everyone should do it? Yeah, I've encountered that, and I think it's irresponsible. But telling you that you need to "heal from your issues" so you can enjoy a recreational drug? I'm sorry you had to deal with that.

Likewise, I'm not sure I've witnessed drug users demonizing addicts in the way you describe. Certain drugs -- like heroin, crack, and meth -- tend to be pretty under-the-radar, such that people don't do them openly. That makes it easier for some to think of addicts as "those other people". However, many drug users know at least one person who went off the deep end, and wouldn't be so callous. If someone equated drug addiction to immorality around me, I'd be pissed off and I'd tell them so. I have friends who've died from ODs. Good people who didn't deserve it.

Regardless of my own experience, I think what you're seeing are the effects of prohibition, not the drugs themselves. We're lied to about drugs from a very early age, their effects exaggerated to the point of absurdity. Dr. Hart is very on-point about this : it's easy to lie to people about something they're unlikely to encounter. So what happens is, a young person tries drugs, realizes they've been lied to, and then starts to wonder what else they've been lied to about. And the problem is, a lot of these drugs can be really dangerous, even if they're not as dangerous as a DARE cop will tell you.

We have to start telling people the truth about drugs. Sure, LSD can open your mind to some things, but it can also be the most frightening experience of your life. Yes, opiates are great for killing pain, but there's a really good reason you should only use as directed. No, trying coke or crack once will not make you into an instant addict. But if you're spending all your time and disposable income on it, you won't have much left for anything else. That kind of thing.
posted by evil otto at 12:25 PM on July 7, 2013 [1 favorite]


I'm in favor of decriminalization-- just not with making statements ignoring the potential harms of their use, or acting like the people who get harmed by it were already damaged anyway so they're necessary collateral damage in the quest for making partying easier.

Did I miss in this thread where people say that?

I've been given so much bullshit lectures about how I need to take MDMA to heal or I need to take methadone for my stress or I need to take acid if I ever want to expand my mind-- and these drugs really fucked me up.

I'm very sorry you've had these experiences. I know no - as in, none, at all - people who work in harm reduction who have this attitude. Harm reductionists do not advocate "Just expand your mind with this drug, dude, and let's make everything legal and fuck the consequences!" and people who advocate that kind of thing are not harm reductionists.

I'd bet money that Carl Hart would slap the stupid out of anyone he heard who tells you to ignore potential harm, damn the consequences, and fuck those junkies. I don't know who you're arguing with, but it's not any of the people I know and read who advocate decriminalization and harm reduction policies.
posted by rtha at 12:29 PM on July 7, 2013 [1 favorite]


localranger, i think I know what you were thinking. Really did not intend to get you so worked up. Acetaminophen is clearly labeled inside and out with warnings. It clearly states the recommended and maximum dose. There are clear warning of potential damage to the liver. The fact that one does not read a clearly marked label does not make a drug dangerous. But throwing back handfuls of any drug ( OTC or prescription) is much more dangerous than the drug itself. And I bet if I asked 100 adults if they have ever taken toxic doses I would have to ask thousands, if not tens of thousands, of people because it just is not that common. In fact it might be considered "rare". Which does not mean people do not overdose on it ( intentional and unintentional). But to even put it on the same level of toxicity as alcohol and other drugs simply denies reality. As for drug company conspiracy--I am confident that the fear of litigation and a long and large track record of safety is all they need to be commercially successful. There are over 40,000 poisoning deaths a year. Acetaminophen accounts for less than .01% of them yet 24 to 28 billion doses are sold each year. There are an estimated 43,000 cases of acetaminophen poisoning a year and over 700,000 hospital admissions that are alcohol related. The point--acetaminophen can be dangerous if misused and very seldom deadly--it is not nearly as dangerous/deadly as alcohol and other drugs.
posted by rmhsinc at 12:34 PM on July 7, 2013


I am thinking that the number of people who actually read the directions is approximately zero. I am thinking that if you were to go out and buttonhole 100 people at random and ask them if Tylenol was a dangerous drug you would be doing very good to get five positive responses.

The label really should be clearer that exceeding the maximum dose can and will cause irreversible and life threatening liver damage. If one sticks to what the label does say, i.e. max 4g/day at 1g/6hrs and do not use with alcohol, the liver can metabolize the stuff without issue though. Personally, I do research the substances I take and only buy single formulations, so I did know that exceeding those doses would be very bad.

I think this is the core of the issue though. People who don't take drugs seriously (OTC or not), don't research them, don't even read the freaking label and proceed on their own uninformed assumptions. There's a certain mentality there of not caring about seriously important things that I don't understand. Exceeding the label dose for some drugs CAN be safe, but you have to research it and proceed cautiously. Understand how they work, what bodily systems they stress and what can go wrong.

A related issue is that there are a ton of varying formations of common drugs across shelves and shelves of products, and a large proportion includes unnecessary doses of acetaminophen, all of which has to be added together if you take more at once. I had an awful time finding a formulation containing dextromethorphan for my cough WITHOUT including acetaminophen that I didn't want or need. At least they are starting to warn about that situation specifically and highlighting the acetaminophen content.

Also, because alcohol is legal, it's regulated for dosage, purity etc ... but not heroin. Which gets us to one of the most horrific aspects of the drug's criminalization -- the number of people who aren't addicts (not yet anyway), who are just dabblers, who overdose (and sometimes die) because they simply screwed up on the dosage.

If there is no label on the drugs, no standards for strength or adulterants, those street drugs can't be used responsibly, even where it should be possible. If they were sufficiently legalized and regulated, the FDA could enforce purity, strength and accurate labeling standards that would go a long way in reducing harm.
posted by Foolhardy at 12:35 PM on July 7, 2013


Thank you thank you thank you Carl Hart.

Every. Damn. Time. a FPP comes up about methamphetamine or other ADHD drugs and people insist I'm wrong wrong wrong to say that methamphetamine and things like Adderall are more alike than they are different I want to slap them with a trout. Now I can point to this article and tell them that yes, Virginia, little Bobby and Janie really are taking medication which is very similar to methamphetamine and so maybe its time we stopped pretending meth is a DEMON DRUG FROM HELL coming to steal your children and turn them into toothless ravening hordes.

Everyone should read this article so we can have real conversations about the effects of drugs and the need for decriminalization.

Even small differences between closely-related chemicals can render them utterly different in pharmacological terms, can't they?

But can isn't the same thing as does. The point is that those small differences do not have nearly the difference in this particular case as people like to believe. Because meth is a crazy bad street drug for gross people and Adderall is for upper middle class children, dontchaknow.
posted by Justinian at 12:37 PM on July 7, 2013 [3 favorites]


The fact that one does not read a clearly marked label does not make a drug dangerous.

Look rmhsinc there are people who will not read the directions for anything. I recently had to get an Android phone, even though I have zero desire for a smartphone and hate the battery life relative to my old dumbphone. But my wife got one, and she is one of those people who absolutely will not read the directions and she absolutely could not figure out how to use the damn thing until I figured it out for her and showed her.

There are lots of people like this. I was once hounded for three weeks by the president of the American division of a major EU company asking how to use a terminal I'd supplied for them, when the answers to his questions were all present in the manual IN PICTURE FORM e.g. "well on page 4 it shows a picture of the screen you're on, with an arrow going through the SELECT key pointing to the screen you want to reach." I fielded at least 20 calls like this because he was obviously allergic to the idea of reading the manual.

So I repeat, where is the skull and crossbones? Where is the warning that taking too much Tylenol is not at all the same as taking too much Aspirin or Ibuprofen? Because all those pills come with limits printed on the can and most of those limits are well known, as with the Ibuprofen, to be ass-covering bullshit.

Tylenol is an astonishingly dangerous drug for how it is marketed and labeled and the insidiousness with which its harm is done and it is unconscionable that such a drug is treated so cavalierly by a society that thinks other much more harmless drugs should be so heavily sanctioned. I will take your desire to protect people from dangerous substances seriously when you are equally strenuous in your demand for the skull and crossbones and packet limits on Tylenol.
posted by localroger at 12:53 PM on July 7, 2013


The point is that those small differences do not have nearly the difference in this particular case as people like to believe. Because meth is a crazy bad street drug for gross people and Adderall is for upper middle class children, dontchaknow.

In 2003 I wrote what turned out to be a very popular article on kuro5hin detailing my journey to Tijuana to have my teeth reconstructed after a disastrous period of bruxism.

Nowadays the much more up to date followup to that article has been written by another patient of my same TJ dentist who was one of the people I referred to him. That post is on the site quittingadderal.com and its author's problem was not bruxism.
posted by localroger at 1:04 PM on July 7, 2013


Here's the thing about the drug war. Even if they were all as bad as proponents of the drug war claim, they would still not be as bad as the effects of the drug war itself.
posted by empath at 2:12 PM on July 7, 2013 [9 favorites]


Can you cite a source for the pure heroin part, and also for the deaths per million doses part?

The one for the pure heroin data I give upthread. Gerry Stimson and Edna Oppenheimer. This book.

The deaths per million data, I don't have. I'm simply extrapolating from what I know about the prevalence of heroin use and mortality rates compared with the prevalence and mortality rates of over the counter painkillers.

I'm very sorry you've had these experiences. I know no - as in, none, at all - people who work in harm reduction who have this attitude.

But there's no shortage of retarded harm reductionists who happily ignore or distort the evidence when it doesn't fit their worldview -- and I say this as someone who has worked in harm reduction since 1987.

I've heard plenty of stuff at least as retarded as the stuff xarnop is claiming from all segments of the drug treatment industry. Abstentionists don't have any monopoly on the stupid.
posted by PeterMcDermott at 2:41 PM on July 7, 2013


Re: the meth vs. amphetamine thing, chemicals that look similar can sometimes have surprisingly different effects in practical terms. This is especially true when a compound can bind to a variety of related proteins - a quantitative change in the balance of targets it prefers can get you to a qualitative change in what the drug makes you experience.

But ultimately, meth and dex appear to be more similar than they are different. For example, it looks like meth is around 2x more effective at releasing serotonin than dextroamphetamine (source). This is probably significant, but as a comparison, MDMA has around 1000x greater effects on serotonin release than either meth or dex, while it has ~10-100x less on dopamine.

Anyway, meth and dex are very close analogs. Meth is even still prescribed and effective for ADHD and "exogenous obesity" (ok, not touching that one). The comparison to ADHD meds is not perfect but it seems to be apt.
posted by en forme de poire at 2:48 PM on July 7, 2013


Exogenous... obesity... does that mean what I think it means? "You're fat and eat too much?" I'm not being sarcastic.
posted by Justinian at 2:59 PM on July 7, 2013


Acetaminophen accounts for less than .01% of them yet 24 to 28 billion doses are sold each year. There are an estimated 43,000 cases of acetaminophen poisoning a year and over 700,000 hospital admissions that are alcohol related. The point--acetaminophen can be dangerous if misused and very seldom deadly--it is not nearly as dangerous/deadly as alcohol and other drugs.

"Between 1994 and 2000 inclusive there were 3878 deaths due to poisoning in Scotland, 644 of which involved paracetamol. Thus 16.6% of deaths due to poisoning in Scotland involved paracetamol."

From here.
posted by Sebmojo at 3:07 PM on July 7, 2013


I think it refers to obesity that is attributed to caloric balance and not, e.g., a malfunctioning thyroid gland. But I didn't want to cause a big derail over obesity and about whether or not these categories are actually all that meaningful, so yeah.
posted by en forme de poire at 3:24 PM on July 7, 2013


Exogenous... obesity... does that mean what I think it means? "You're fat and eat too much?" I'm not being sarcastic.

It's due to overeating. Methamphetamine is an appetite suppressant.
posted by Jalliah at 3:39 PM on July 7, 2013


To add to my above post using non prescribed street drug meth is a 'thing' known as a meth diet.
posted by Jalliah at 3:50 PM on July 7, 2013


That sounds completely safe. Nothing could possibly go wrong.
posted by Justinian at 5:13 PM on July 7, 2013


Because meth is a crazy bad street drug for gross people and Adderall is for upper middle class children, dontchaknow.

Those of us who have meth addicts in our family are biased in the other direction. Say what you will about the foulness of upper middle class children (and I frequently do) at least being able to get Adderall through their health insurance means they're not robbing their families to support their habit.
posted by winna at 5:25 PM on July 7, 2013


There are plenty of people in power who care about black communities. But there are more who do not. And in a democracy, the ayes have it.
posted by Halogenhat at 5:39 PM on July 7, 2013


The problem is in the dose. Meth users aren't taking the stuff 10mg at a time like ADHD patients.

And it is ridiculous to say that meth is the same as dex. I mean, methamphetamine is sold over the counter as a nasal decongestant. It's the exact same molecule, just in a left handed orientation. Hydrogen peroxide is practically water! Different chemicals do different things, even though they are similar. Look, for example, at the nightshade family. All based on the same basic chemical. If you eat a few berries, you'll probably die. But your eye doctor puts it right into your eyes!

It's almost as if there are different reasons to use different drugs, and that different varieties and doses are relevant.

Just because some doctor says something that is easy to agree with doesn't make it true.

A painkiller isn't intended to go after the cause of the pain, only diminish the pain itself. And the categorization of the activity of a drug into effects and side effects is a social act, not some intrinsic taxonomy.

Sort of. But there really are different kinds of painkillers that do different things by different routes. And I don't think you are correct about it not being an intrinsic taxonomy. But I can't figure out how to express my point, so maybe I'm wrong.
posted by gjc at 5:50 PM on July 7, 2013


"Very similar" is not "exactly the same". Also I have my trout ready.
posted by Justinian at 6:44 PM on July 7, 2013


I mean, methamphetamine is sold over the counter as a nasal decongestant. It's the exact same molecule, just in a left handed orientation

No, that's levoamphetamine. You are thinking of pseudoephedrine and ephedrine, which have a hydroxyl group in mirror image from each other.

Anyway, you're right that linking structure and function is non-trivial (butylmethamphetamine seems to be considerably less potent than meth or dex), but ephedrine and pseudoephedrine appear to have around two orders of magnitude lower affinity for dopamine and norepinephrine transporters than either meth or dex, which are roughly equal on those counts. Which is not to say the two drugs are totally the same, but they are very similar.
posted by en forme de poire at 8:08 PM on July 7, 2013 [1 favorite]


It seems like you have much more direct experience with addicts then I do but I did spend a good number of years in a party town (ski resort) where all sorts of drugs were the norm. -- Jalliah
I would imagine the experience of a bunch of rich druggies is different from the experience of poor people who use it.
I have never, ever heard an addict of heroin say they started using because they were in pain. -- gjc
Well, what about the people who take it and aren't addicted? If you're using it for pain management, aren't you less likely to become addicted? In fact, someone with a chronic pain condition might use it regularly without considering themselves an "addict"
That sounds completely safe. Nothing could possibly go wrong. -- Justinian
Probably safer then being Obese, which is why it's allowed. It means the FDA thinks being Obese is more harmful for your health then losing weight by taking meth with medical supervision. Methamphetamine was always legal - it's just that it recently became THE drug that gets demonized the most now that crack is passe.
posted by delmoi at 8:09 PM on July 7, 2013 [1 favorite]


gjc: People are not taking heroin to cure pain. They are taking it because it gets them high.
And your point is?
posted by mistersquid at 8:37 PM on July 7, 2013


I would imagine the experience of a bunch of rich druggies is different from the experience of poor people who use it.

Just to clarify. I'm talking about the working crowd not the tourists who visited. Heck knows what they did, we ignored them when not being compliant service reps. Though not poor, we were living shoved into dorms or multiple people in one place and working for not much more then minimum wage. Most people I knew had a full time and at least a part-time job during the season.
posted by Jalliah at 8:42 PM on July 7, 2013


Probably safer then being Obese, which is why it's allowed. It means the FDA thinks being Obese is more harmful for your health then losing weight by taking meth with medical supervision. Methamphetamine was always legal - it's just that it recently became THE drug that gets demonized the most now that crack is passe.

I think he was commenting not on medically prescribed meth but the type of dieting in my meth diet link. People using street meth, on their own to lose weight which is quite different. Like I have to lose 20 pounds for the prom/wedding type dieting and with people that have other eating disorders. Not necessarily obesity.
posted by Jalliah at 8:49 PM on July 7, 2013


Anyone with two brain cells to rub together will conclude the War on Drugs is a dismal failure. But make no mistake: it is a whopping success. There are any number of police and governmental agencies (local, state, federal), pharmaceutical companies, private prison corporations, among many more...some I'm sure I can't even imagine. They are winning. They get money and power from this War, and they will not give it up without a big fight.

The roots of this "War" are deep, and have been around for close to a hundred years. And what better way to tug on the short leashes of most people in the U.S. than with this? It's a rather excellent technique to keep people in line.

Remember this: there are a lot of people who benefit, financially and professionally, with the continuance of the "War." To them the war is a BIG success. People who would lose that power were drugs to be legalized. And surprise, surprise, these are much the same people who write the laws, or who push to have the laws made.
posted by zardoz at 8:56 PM on July 7, 2013 [6 favorites]


All this emotive handwringing is an exercise in futility. We know the exorbitantly expensive, "War on Drugs", an has completely and utterly failed. We know a significant proportion of the population will use recreational drugs irrespective their illegality and inherent risks, and, unfortunately, we also know a certain percentage of these recreational drug users will become addicts. Realistically, if more affordable and standardised/regulated formulations in terms of the removal of unnecessary toxic additives and predictable potencies are available to both recreational users and addicts, how is this anything but a positive on an individual and societal level? Citing the possibility of addition as a reason not to decriminalise and provide a significantly less harmful option for all drug users equates to throwing the baby out with the bath water. Ultimately, this isn't about right or wrong, good or bad, but the necessity of managing an existing situation as responsibly and humanely as possible.
posted by Nibiru at 8:57 PM on July 7, 2013


The problem is in the dose.

Not completely, or, I would argue, not nearly. The "problem" is also in the delivery system: Adderall is designed to be ingested orally and further formulated in various compounds so that the amphetamine component becomes bioavailable in a staggered fashion over time. Methamphetamine is generally snorted, smoked or injected so it becomes bioavailable much more quickly. Thus Adderall's primary effect is increased attention span and attentiveness, whereas methamphetamine's primary effect is the ecstatic rush.

However, in my younger days, some of the gay guys I knew when negotiating a particularly appointment-heavy weekend with minimal opportunity to sleep would sometimes start their day drinking what was then called "gay coffee," i.e., strong java with a teeny pinch of meth. I saw them do it and I saw the aftereffects, and I am telling you, nobody got high: they just got awake and lively and focused. (Of course they crashed, hard, at the end of the day, but the point here is that it is possible to use meth to obtain Adderall-like effects just as-- I imagine--if you really put your mind to it, you could get really fucked up on Adderall.)

Better than anything, of course, is an interesting, happy life filled with flow-producing activity, but not everyone has that figured out.
posted by La Cieca at 9:59 PM on July 7, 2013 [2 favorites]


Wow. All I can say is that my experience has been different than yours. In 2+ decades of involvement with various party scenes, I have not encountered the sort of peer pressure you describe.

Just chiming in to say that it isn't just xarnop, a lot of people have exactly the kind of bullshit attitudes and preachiness in the way she's describing about how you just have to do bla bla bla drug, or deal with your problems so that you can do bla bla drug because it enhances your life so much etc etc.

And xarnop,

My experience with party people is that they do have impaired ability to have empathy for people harmed by that lifestyle, and sometimes put down "real addicts" to make their personal use look more responsible. But that's just based on things I've seen and how I've been treated and crowds vary.

I know so many drug users who have given so many lectures about how I need "heal" from my issues so that I can smoke pot like they do, or how their drug use is find because they hold their job and an unemployed addict is a terrible person who needs to stop using drugs--- when they're both people who are addicted and simply have different side effects.

The person lucky enough to not have side effects just hasn't been given that challenge of having to quit so they don't really know what they're made of. I've been given so much bullshit lectures about how I need to take MDMA to heal or I need to take methadone for my stress or I need to take acid if I ever want to expand my mind-- and these drugs really fucked me up.
(and basically the rest of your post too)

A lot of this really speaks to me and it's really like, yes, exactly at a lot of points.

It's almost the way how with bullying or other forms of victimization "shit rolls down hill". Everyone needs someone lower than them on the totem pole that they can look down upon and shit on, and it's really really gross.

And the thing is, i get it. I know how this attitude forms and how it happens. It's one of those things that is just impossible to imagine if you haven't experienced, with the added layer that as you said that person putting other people down for being "bad addicts" might be in exactly the same place the instant they lose their job/break up with their partner and have to find their own place/a million other sudden circumstances. The only thing between a pretentious ass who "doesn't have a problem" and one of the "dumb addicts" they look down on is generally a sheet of tissue paper of circumstance.

And yea, while i think the social issues surrounding drugs and those plus the circumstances that lead to people trying hard drugs or really climbing on the horse with them are bad, but i agree with you(and others!) here that it can be a bit of a barney on the simpsons thing. Some people are predisposed to addiction or having serious issues with drugs(and i'm including alcohol in here) who have great family/social/societal circumstances, support, etc and still just get fed in to the meatgrinder.

So yea, i take issue with the same kind of thing you do xarnop. That some people are fucked anyways because they had addictive tendencies, or grew up on a reservation(and this one hits pretty close to home for me), or whatever. I'm for the legalization of drugs, but i think there's some real problems with "The drugs aren't the problem, the individual low percentage of people or socio-societal circumstances are!" since the end of that chute always seems to end with going too far in to "that person would have done something like that anyways because of XYZ reasons".

There are definitely plenty of people who try drugs/alcohol once and fall off the wagon like that simpsons scene. and saying drugs should be at every 7-11 doesn't really address that at all*

*to be clear, i'm pro legalization. i just never see this adressed in a satisfying way
posted by emptythought at 10:52 PM on July 7, 2013 [1 favorite]


"Instead of war on poverty, they got a war on drugs so the police can bother me!"
-2pac
posted by Uther Bentrazor at 11:03 PM on July 7, 2013 [1 favorite]


Adderall is designed to be ingested orally and further formulated in various compounds so that the amphetamine component becomes bioavailable in a staggered fashion over time.

It's a good thing nobody has figured out how to open the caplets and grind the time release sphere thingies into a powder which can then be insufflated! /hamburger.
posted by Justinian at 11:14 PM on July 7, 2013 [1 favorite]


It still seems a bit muddled to me. Dr. Hart is saying that drugs are not a cause of crime, poverty, and other societal problems. OK, I'm not sure that many thoughtful people were claiming that. The limited time I've spent looking at studies show convincingly that the rates of illicit drug use and marijuana use are similar across income levels generally speaking. The exception: people at the lowest level of total family income are significantly more likely than those in the other income categories to be drug users. In a 1997 study, 18% Households with members on welfare reported someone haviong used illegal drugs in the past year while only 11% of the rest of the population reported this. The gap isn't as wide as it might appear from the disparate treatment by the justice system received by the poorer and darker-skinned citizens of our country.

But, ok, then what? More drugs for everyone is not the answer.
posted by Cassford at 11:56 PM on July 7, 2013


From the interview, Dr. Hart's answer seems to generally be broad anti-poverty and educational programs. A lot of his work is about showing that "war on drugs" isn't even the right question, let alone the right answer.
posted by klangklangston at 12:06 AM on July 8, 2013 [1 favorite]


More specifically - that the devastation in the African American community in the 80s and 90s stemmed from the social and economic policies of the Reagan and Bush administrations and that the mythology of the Crack Epidemic in particular and the Drugs War in general was developed as a scapegoat for those policies and a pretext for the development of a militarized police machinery, thought to be needed to keep that community under some kind of control. Enough people are now making enough money out of that machinery that it has become self-justifying. However, the rhetoric of the Drugs War is not now, nor was it ever, about "helping" the black community, and is of no value whatsoever as a drugs policy.

The video is very interesting, too, though I was surprised that he didn't know about the demonising of the Chinese community with reference to cocaine (this was in the 1920s, I think) - the construction of racist narratives combined with moral panics over pharmaceuticals goes back a lot further than 1980.

It's also worth bearing this in mind if you see cop shows and movies from the 1970s - two themes that go hand in hand in a lot of them are the mythology of Drugs (like there's a single monolothic thing called Drugs, which comes packaged in plastic bags and does something or other to your teeth if you rub it on them) and the mythology of how the Miranda rights meant that The Law Protects the Criminal Not the Victim and what you needed to fight the Evil of Drugs were rogue police officers who were prepared to bend the rules in order to procure justice (and that ideally what was required was a police force with no controls on it at all). The most obvious example of this was the Dirty Harry series, of course, but it also runs through series such as Starsky and Hutch (albeit to a lesser extent). However, although there was a fair amount of racism in all this, it's very interesting to see how the Problem of Drugs is increasingly centred in the public narrative on the African American community rather than generally the Inner Cities as the 80s drew on.
posted by Grangousier at 2:37 AM on July 8, 2013 [2 favorites]


(Actually, I got carried away when I implicated Dirty Harry, there - the movies don't have a drugs narrative, and Magnum Force, for example, is more complicated than that with reference to the Constrained Justice narrative. Harry is the popular archetype of that kind of rule-bending cop, but I probably shouldn't oversimplify for political effect if I'm criticising it in other people.)
posted by Grangousier at 2:43 AM on July 8, 2013


saying drugs should be at every 7-11

Is anyone saying this? Did anyone ever say this?
posted by La Cieca at 4:50 AM on July 8, 2013


But, ok, then what? More drugs for everyone is not the answer.

For starters, we stop incarcerating drug users and treat addiction as a health problem. That alone would be a monumental shift in the right direction.
posted by zardoz at 5:52 AM on July 8, 2013


It's a good thing nobody has figured out how to open the caplets and grind the time release sphere thingies into a powder which can then be insufflated! /hamburger.

In fairness there are some formulations like Vyvanse where the extended-release comes from a chemical and not a mechanical modification. But the point still holds.
posted by en forme de poire at 7:35 AM on July 8, 2013


or acting like the people who get harmed by it were already damaged anyway so they're necessary collateral damage in the quest for making partying easier.

Did I miss in this thread where people say that?


I did more or less. Although I wasn't arguing that those with serious addiction issues were getting in the way of my right to have a good time. Just putting forth the point (which I believe the linked interview supports) that at the heart of every addiction is not some failure of character but a deep-seated pain (often emotional) that has not been effectively treated (or even acknowledged).

I'm not a big fan of Bill Maher (particularly of late), but I did catch him recently scoring a few hits against the anti-marijuana crowd by effectively saying, "Seriously? We need to some ban something for everyone because it's not safe for children? Guess we better ban driving then, too."

And then there's something I overheard a few years back at a cafe. An ex-druggie-born-again-Christian type evangelizing against ALL drugs (because he knew the damage they did) versus a guy wearing a Bob Marley t-shirt. "Dude," said Bob Marley guy, "Just because drugs fucked you up doesn't mean they fuck up everybody."

And so on.
posted by philip-random at 9:24 AM on July 8, 2013


oh dear, aspirin is acidic and might upset your stomach?

Maybe someone has already covered this, localroger, but over 100000 Americans are hospitalized every year with ulcer complications due to chronic Aspirin/NSAID use. 15000 to 20000 of them will die from it.

The US numbers for acetaminophen are 2600 hospitalizations and 450 deaths.

From what I can tell, the rates of use for each analgesic are in the same ballpark.

Those are some pretty upset stomachs.
posted by tapesonthefloor at 9:37 AM on July 8, 2013 [1 favorite]


but over 100000 Americans are hospitalized every year with ulcer complications due to chronic Aspirin/NSAID use. 15000 to 20000 of them will die from it.

...and the vast majority of those involve NSAID's other than aspirin, many of which are known for causing gastric complications through more direct means than simple acidity. Meanwhile, how many chronic OTC acetaminophen poisonings go down as generic liver failure? I'd guess a lot.

The US numbers for acetaminophen are 2600 hospitalizations and 450 deaths.

According to Wiki the number for single ingredient aspirin in the year 2000 was 52 deaths, all but 3 of which were deliberate suicide attempts. It is nearly impossible to accidentally kill yourself with aspirin. With Tylenol it is very, very easy.

Also contrast sebmojo's far more believable link showing over 16% of all poisonings in Scotland being due to acetaminophen.
posted by localroger at 9:52 AM on July 8, 2013


saying drugs should be at every 7-11

Would still be a better policy than the current Drug War. Even if you find the philsophical arguments unconvincing (I guess you don't think you own your own body), the pragmatic argument is quite clear.

Any and all forms of drug liberalization, right up to complete legalization for all drugs, would be less destructive than current policy. Thinking change should wait because it needs to be the exact level of change you are personally comfortable with is pretty silly.

or acting like the people who get harmed by it were already damaged anyway so they're necessary collateral damage in the quest for making partying easier.

There's nothing "necesary" about it. Regulation and legalization would allow managed doses and greater assistance. You wouldn't make your argument about any other item- should hamburgers be banned because of other people's weight problems- so why make it here?
posted by spaltavian at 1:46 PM on July 8, 2013 [4 favorites]


The War on Poverty could create a huge amount of jobs. Imagine... well staffed schools for every child... training programs to turn welfare moms into welfare interviewers... paths to science and business degrees for newly released ex-convicts. The possibilities are endless. Instead of the Prison Lobbies, we could have the Food Kitchen Lobbies.
posted by _paegan_ at 6:52 PM on July 9, 2013 [1 favorite]


Reefer Madness, an Unfortunate Redux
posted by rtha at 9:18 AM on July 12, 2013 [1 favorite]


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