The case of neuroscientists for the legalization of all drugs


What are our biggest misconceptions about drugs and drugs? And how can a better education help?

One of the biggest myths is that most people who use drugs like crack cocaine and heroin are addicted. That is simply not true. The vast majority of people who use any drug do not become addicted. Another myth is that recreational drug use causes irreversible brain damage, which means injury or death of neurons. But it has not been proven that drugs that people take in recreational doses damage the brain. The evidence to support this assumption is weak and overestimated and has serious implications for the way we enact and implement harmful drug policies.

One of the main myths I want to address is specific to opioids. People think people die from opioid use, period. And it is true that people who die with opioids in their system usually die out of ignorance. Let me break this down for you: When people die with opioids in their system, we count it as opioid death, but the vast majority of those people have more drugs in their system. And so often we don’t know which agent caused the death.

Mixing opioids with other strong sedatives, such as antihistamines or large amounts of alcohol, becomes dangerous and sometimes deadly. We could do a better job of informing people that if you’re going to take sedatives like opioids, don’t mix them up, especially if you don’t have a lot of experience with sedatives. Because when you mix sedatives, it increases the potential for respiratory depression and, ultimately, death.

When we think of prescription opioids – something like Percocet or Vicodin – these drugs contain a low dose of opioids and a large amount of acetaminophen or Tylenol. These drugs contain about five to ten milligrams of opioids in a tablet. A regular opioid user can usually take 50 or 100 milligrams of opioids and be fine. But then the drug can also contain 325 milligrams of acetaminophen per tablet. If they take enough for an opioid effect, they need up to about four to five grams of acetaminophen. And that dose of acetaminophen for several consecutive days can cause liver toxicity. In fact, acetaminophen poisoning is a major cause of liver toxicity. These are things that the general public, including many opioid users, simply does not know. That’s how people die out of ignorance. We can easily deal with this if we are willing to have honest conversations and drug education.

Opioid-only death is a rare type of death, unless a long period of abstinence follows, when an individual might be more susceptible to an overdose, or if he would take something like fentanyl. Often people take fentanyl without knowing them instead of what they thought was heroin, and take that fentanyl in the same dose as the heroin they thought they were taking. That can be fatal.

The solution to all these problems – and especially the problem of fentanyl – is drug testing, in which people can hand over small amounts of their drugs and get back an analysis of the chemical composition of that substance. If they are handing over heroin and it contains something like fentanyl or some other impurity, they can decide not to take it or to take smaller doses. These drug testing facilities are not expensive. If we really cared about our population, we could do so to reduce people’s ignorance of what they are taking.

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