Ain’t No Such Things as Dangerous Drugs
For almost a century Americans have been warned against “dangerous drugs”. In this context, the term is usually synonymous with “illegal drugs”. However, this term as used is totally without meaning. It is strictly a propaganda tool. Even worse, this misleading concept has led to counterproductive, expensive, and dangerous public policies.
The problem with the misidentification of illegal drugs with dangerous drugs is that it leads to misconceptions in the formation of policy. These misconceptions arise mainly in three areas: that illegal drugs are a separate category, medically distinguishable from legal ones; that illegal drugs are a distinct category, related to each other physically and biologically; and that the dangerousness of drugs can be measured on some kind of absolute scale.
However, the only distinction between legal and “dangerous” drugs is the arbitrary delimitation drawn by Congress in a rather zigzag fashion. Two of the scariest dangerous drugs are cocaine and methamphetamine, but each of these is also a legal drug that can be prescribed by a doctor. Cocaine is used by doctors as a local anesthetic in some nose and throat procedures for which the synthetics are not as effective. Methamphetamine, under the trade name Desoxyn, is prescribed for children with affective spectrum disorders and as a diet pill for some cases of extreme obesity. For most people methamphetamine and amphetamine, also used for ADHD either directly or in a time-release form as Adderal, can be used interchangeably.
Heroin is the classic dangerous drug. Chemically, it is diacetylmorphine, and it is converted to morphine in the body. Experienced addicts cannot tell whether an injection they receive is heroin or morphine; the two drugs are indistinguishable to the user. The other opioids all have the same effects on the body although they may differ in strength, speed of onset, and duration of effect. These include the synthetics like methadone and fentanyl as well as the opiates derived from opium like OxyCotin, Percoset, and Vicodin. Surveys indicate that today the majority of new heroin users developed dependencies on prescription opiates and turned to heroin because it was cheaper and more readily available than the OxyCotin or Vicodin they had been using.
OxyCotin is a time-release formulation of oxycodone, one of the two active ingredients of Vicodin. Ironically, the other ingredient of Vicodin is acetaminophen, a “safe” drug available over the counter under trade names like Tylenol. Acetaminophen is actually the more dangerous of the two drugs, causing severe liver damage and resulting in more deaths each year than all of the opioids combined.
One surprising development of the past decade or so has been that many problems of dependencies and fatalities have involved legal prescription drugs like Valium, Xanax, and Paxil. Many seem confused by the idea that these “safe” legal drugs can cause such problems.
If the line separating legal drugs from illegal ones fades to invisibility when examined, the fence gathering the illegal drugs into one “dangerous” category never existed. When the Harrison Narcotics Tax Act was passed in 1914, it classified both opiates and cocaine as narcotics, and the confusion has worsened ever since. If heroin, cocaine, LSD, and marijuana, are taken as representative of the four major classes of illegal drugs – opioids, stimulants, psychedelics, and euphorants – one would be hard pressed to find any similarity other than legal status among them.
The opioids – along with legal drugs like alcohol, Xanax, and Valium – lead to classical addictions, with reward, tolerance, craving, and withdrawal. They can cause death by overdose, but have no other significant medical or behavioral consequences.
The stimulants, which include cocaine, the amphetamines, Ritalin, and caffeine, can lead to habitual dependency in heavy, frequent users, although this is not a classical addiction. They are frequently involved in binge usage, with paranoid behavior accompanying the binges. Death can result in users with pre-existing heart conditions. Long-term heavy use can result in psychotic episodes.
The psychedelics – which include LSD, psilocybin, and mescaline – are non-addictive and have little or no risk of overdose deaths. They induce visual hallucinations and some time distortions in users but do not interfere with normal intellectual functioning. Many of them have significant evidence of medical effectiveness.
The euphorants are marijuana and MDMA. They are non-addictive, although a small number of marijuana users develop weak habitual cravings. They are non-lethal, although in the early days of MDMA, a few users died of associated heat exhaustion. They elevate the user’s mood and may temporarily decrease muscular coordination and reaction.
The last irony is that no relationship exists between dangerousness and illegality. Danger in this sense includes both short- and long-term risks to the user’s health and risks imposed on surrounding non-users. Dangerousness is not an absolute measure, but is relative to the intended use. After all, a few dozen people die each year from water overdose, and over-the-counter pain relievers kill more each year than all of the illegal drugs combined. Many of the Drugs for cancer chemotherapy are deadly poisons that are used only in carefully controlled hospital settings, but as alternatives to certain impending death, most assume them to be reasonable risks.
By any measure, the most dangerous drugs are alcohol and tobacco. They cause deaths and injuries in numbers many times greater than any other drugs.
Over 400,000 people die each year from deaths medically related to tobacco consumption. Although tobacco is used primarily as a delivery mechanism for nicotine, tobacco is the main problem since most of the diseases come from ingestion of the smoke from burning tobacco, not from the nicotine. Acute overdoses from nicotine are rare. Most direct injuries are caused by fires started by negligent smokers.
Alcohol probably wins the title of most dangerous drug. Although the 150,000 or so deaths from alcohol-related illness are not nearly as many as those caused by tobacco, it presents two other risks. First, overdose deaths from binge drinking are significant. Second, alcohol use imposes severe social costs. Alcohol-related traffic deaths are around 16,000 a year – more than the total deaths from all illegal drugs. Alcohol is the only drug the use of which has been causally related to violent behavior, domestic violence being the prime example.
On the other hand, the risks associated with the illegal drugs are primarily the costs of their illegality. Almost all crime associated with drugs are crimes arising from the black markets in which they are bought and sold. Even the illnesses associated with illegal drugs are actually the illnesses of poverty brought on by the exclusion of users from normal economic activities.
Even the drug risks themselves are law-related. Opioid addicts in legal regimes, like heroin users in Switzerland or the Netherlands or methadone users in the U. S., practically never die of overdose and function normally in work and family.
These three misconceptions have led the country into a failed, expensive, and harmful set of drug laws. The time has come to recognize the failures of these policies and look for a new reality-based approach.