Are drugs bad?

I have been pondering this question for a long time, and here are some thoughts. (This is an ongoing debate even in my head, so I might change my stance on the issue.)

First of all, what do we mean when we say »drugs«? I am not talking about over-the-counter or prescription medicine, but those natural or synthetic substances that are used recreationally, which may or may not be illegal in your jurisdiction. (For this reason, it’s bad practice to refer to »illegal drugs«, which is increasingly ambiguous today.)

What are these recreational drugs? It is important to understand that this is not some well-characterised group of substances that all act somewhat similar. Far from the truth. In fact, they comprise a very diverse range of substances with a very wide range of effects.

Let’s look at some of them.

These drugs can be categorised based on the typical effects, or on their chemical structure, which often includes a substructure common to a number of similar-acting substances. It is no coincidence that effects and chemical structure are usually related.

Opiates and opioids: these are very strong painkillers that also tend to cause euphoria. Opiates are substances originally extracted from Opium, which is the dried latex obtained from the opium poppy. The main ingredient is morphine. Many derivatives have been created from the base morphine structure, the most well-known of which is heroin, which is more powerful than morphine, and was originally developed as a cough suppressant. You may know codeine, which is another morphine derivative that is still used in cough syrup today.

Opioids are synthetic substances that cause the same, or very similar effects to opiates, as they operate on the same group of biochemical receptors in the neurosystem. Using another definition, opioids are all substances that operate on these receptors, which then includes the opiates. Some opioid-based painkillers are or were available as over-the-counter-medicine, but due to the addictive potential of all opioids, they are usually very strictly controlled. Fentanyl is a common synthetic opioid painkiller. Some opioids are a few orders of magnitude more powerful than morphine (which itself serves as the reference for opioid potency). An example is carfentanyl, which is reportedly 3,000 times as powerful as morphine.

Wait a minute, these aren’t illegal drugs, or are they? No, originally they weren’t, and many drugs that are used recreationally, even if banned for this use, are still used legally and professionally as medicine. I will show that this is true for many of the drugs that I am going to mention, but it is especially true for opioids. In fact, there is, as of today, no replacement for opioids when very strong painkillers are required. This is despite their well-established addictive potential. The »high« that is obtainable from opioids, as well as their strong pain-subduing effect, of course, is what makes these substances attractive for personal use outside of a medicinal context. (Though it could be argued that recreational use of such drugs, not only opioids, is a kind of self-medication.)

Cocaine: an euphoriant stimulant that everybody has heard of, which is extracted from parts of the coca plant, where it occurs naturally. It was in widespread medicinal use until at least the beginning of the 20th century—when it was, for a brief time, one of the defining ingredients in the then-medicinal drink Coca-Cola, next to cola extract, after which it is named (from Coca leaves and Cola nuts). It is still (rarely) used in medicine today, such as in some applications of surgery. Cocaine also has an anaesthetic effect, for which it was used medicinally, and the working principle of which led to the development of many synthetic anaesthetics in use today, including Benzocaine, Lidocaine, and other pharmacological substances whose name ends in -caine.

Amphetamines: these are stimulants that typically cause wakefulness, alertness and increased focus, as well as euphoria and other effects associated with a »high«. The base compound, amphetamine itself, has been used by German forces in WWII to allow soldiers to overcome exhaustion. It is used medicinally as a remedy for ADHD today, particularly in the U.S. As amphetamines also tend to suppress hunger, they have been used as medicine to facilitate dieting for weight-loss.

Some substances that are built on the amphetamine substructure have, in addition to being stimulants, what is called an entactogenic or empathogenic effect, which causes the user to become more socially communicative, more aware of his/her own self, and helps dissolve certain kinds of anxiety. The most well-known example of this is MDMA (Methylenedioxymethylamphetamine), the original ingredient of Ecstasy pills, which has been well-researched. (Be aware that what is sold on the street as »Ecstasy« may or may not contain actual MDMA, which is a source of a number of tragic accidents and, unfortunately, deaths, due to accidental overdose and unexpected effects.)

The amphetamines are a very large group. They include not only methamphetamine, the dreaded »meth«, which is chemically just a methyl group away from amphetamine (the ADHD medicine you may know as Adderall). They include all of the substances that have been sold as »bath salts«, which are usually synthetic members of an ampetamine sub-group known as the cathinones, named after the main ingredient of the Cath (Khat) plant drug. Methylphenidate, another substance used as a treatment for ADHD, also contains the amphetamine substructure, as does bupropion (Wellbutrin, Elontril), which is an antidepressant. (Bupropion is a cathinone, as well.)

A number of amphetamines are hallucinogenic, while often retaining the stimulant effect. Amphetamines are usually synthetic (i.e. produced artificially), but some members of this group occur naturally in plants, such as the aforementioned cathinone. A related substance, ephedrine, occurs naturally in the Ephedra plant, and is structurally similar enough to amphetamine that it can be used as a starting material for producing amphetamines.

Benzodiazepines: they are synthetic compounds available as prescription drugs that typically cause sedation, as well as relief from anxiety and panic, and in larger doses, sleep. Some short-acting benzodiazepines (or »benzos«, as they are colloquially called), are used as first-line treatment for epileptic seizures. Benzos are commonly used as sleep aid, but due to their addictive potential, this is not a recommended long-time choice. Recreationally, benzos may be used to counteract the effects of stimulants or hallucinogens, or generally as a »countermeasure« to the desired or unexpected effects of any drug use, such when trying to get sleep after using stimulants, or to stop a »trip« on psychedelics that may have become too overwhelming. Continued benzo use may become habitual (an addiction) after as little as two weeks; possibly less, possibly more.

Cannabis: the various forms of pant material obtained from the Cannabis plant, most commonly marihuana and hashish. The active ingredients are called cannabinoids, which are fat-soluble terpenoids (and not alkaloids, as are the majority of psychoactive plant ingredients), the most important of which are THC (tetrahydrocannabinol) and CBD (cannabidiol), though the plant contains many other cannabinoid compounds, which in sum are responsible for its rich and varied effects. Cannabis has mild to strong painkilling effects and can cause euphoria, increased appetite, as well as psychedelic (mind-extending) effects, such as intensified perception, and increased introspection and self-reflection. At least for its painkilling and appetite-enhancing effects, cannabis products have been used medicinally in the distant past and are increasingly being used for these purposes again today.

Academic research into the working principle of cannabis has led to experimental, synthetic cannabinoid-imitating compounds, which have since been produced as alternatives to natural cannabis, some of which are available, even legally, on the »research chemicals« gray market. The number of synthetic cannabinoids is very large; many hundreds of these compounds have been produced for research, and some tens have been produced and sold for recreational use.

Psychedelics and hallucinogens: this isn’t really a defined, exclusive group, as members of some of the aforementioned groups (in particular the amphetamines and cannabinoids) may have psychedelic and/or hallucinogenic effects. »Classical« psychedelics and hallucinogens are either phenethylamines (which includes the amphetamines) or tryptamines, after the base structure they are derived of. Well-known examples for psychedelics/hallucinogens with a tryptamine base structure are LSD (lysergic diethylamide, »Acid«) and psilocybin, the active ingredient of the »magic mushroom«. LSD is a synthetic derivative of lysergic acid, which can be obtained by chemical treatment of ergot alkaloids (natural substances produced by the ergot fungus), but which also occurs naturally in a number of plants. It is a member of a tryptamine sub-group known as the lysergamides. Dimethyltryptamine (DMT) is a hallucinogenic compound found in a number of plants, which forms one part of the active principle of the shamanic brew, Ayahuasca.

The effect of a psychedelic is to enhance the user’s perception and awareness of him/herself and his/her surroundings, often leading to greater understanding of the self and its relation to the outside world. Due to this, both LSD and psilocybin have been used experimentally in psychotherapy, including the treatment of addiction to other illicit or legal drugs, such as alcohol.

Hallucinogens cause alterations of perception, such as visual distortions or illusions of movement, for instance in detailed, organic structures such as wood grain. Hallucinations need not be visual (although that is often implied); they can occur with any kind of perception, for example, acoustic hallucinations (which may manifest as repeated echos).

The two terms psychedelic and hallucinogen are often interchanged and confused, although they do not strictly denote the same effect. Substances that cause purely visual hallucinations, for example, aren’t necessarily psychedelic, and psychedelics do not necessarily produce hallucinations. Cannabis is an example for a drug that readily acts mildly psychedelic, but rarely, if only at exceptionally high doses, produces hallucinations.

Ketamine is a dissociative anaesthetic that is widely used in veterinary medicine, but also recreationally. Chemically, it is grouped with other substances that share its arylcyclohexylamine base structure, including PCP (»Angel dust«). A number of more recently developed members of this group (such as MXE) have been sold on the designer-drug gray market.

If have barely scratched the surface by naming only the most well-known examples and sorting them into groups based on structure/activity. This list is very far from complete. There are more than a hundred unique substances that have been used recreationally in the amphetamine group alone. I am going to finish with naming just four other more or less familiar substances that don’t belong in any of the aforementioned groups:

GHB (gamma-hydroxybutyric acid) has alcohol-like effects, as does its closed-ring-structure variant GBL (gamma-butyrolactone), which is used industrially as a solvent. Alkyl nitrites (»poppers«) cause very short-lasting but intense euphoria. Methaqualone (Quaalude) is a sedative that acts similarly to the benzodiazepines, but also seems to have euphoriant effects. Salvinorin, the active ingredient of Salvia divinorum, a kind of sage (as in the herb), is a very strong but (if smoked) short-acting hallucinogenic which is chemically a terpenoid, as are the cannabinoids, but it’s not structurally related to either the cannabinoids nor any of the substances named here.

Of course, we need to remind ourselves that alcohol (ethanol), nicotine (tobacco) and caffeine (coffee, tea, maté, etc.) are all drugs with psychoactive effects that are used recreationally, and are not principally distinct from the other named drugs based on their effects or the amount of harm that they may cause. It is simply that they are generally socially accepted and legal in most jurisdictions.

We also need to remind ourselves that legal, OTC or prescription medicine is not in principle safe or »harmless« just because it is legal. Legal medicine has been the cause of serious health problems, including deaths, often from prolonged use, from accidental overdose, or from unknowingly taking it with other medicine that is »incompatible«, causing toxic interactions.

We have also seen that many of the recreational drugs in use were originally legal medicine, or are still legal medicine today, such as members of the opiates, benzodiazepines, amphetamines; and ketamine. Even if a substance never had an accepted medicinal use, or has only recently been accepted into such use, it often has a history of ancient or »primitive« medical use, such as plant-based drugs that have been used in religious or spiritual contexts as healing agents for hundreds or thousands of years, and often still are used in this way today. Cannabis, magic mushrooms, cocaine (as coca leaves) and ayahuasca are just a few of the more well-known examples for this kind of ancient »natural medicine«.

So, are drugs bad?

You will realise by now that this question cannot be answered easily. After all, many of these substances have a history of being medicine. In fact, one way to look at recreational drugs is to consider them a form of medicine. Even if a substance is not officially prescribed by a medical professional, such use may be regarded as self-medication by the user.

Using medicine implies that there exists some kind of illness, or pain, that the medicine should address. For example, a user of opiates such as heroin may be using the drug to counteract pain, including emotional pain. Such use may or may not worsen the user’s health; let’s assume that he or she is using the drug in a controlled, sensible way and that it helps him or her to get along in life. This appears to be the case for the large majority of users of opiates, and it could be argued that this is a strong motivation for long-time users of cannabis as well, for instance.

According to most countries’ drug policies, such use is criminalised. Not only does the user of such drugs perpetrate a criminal act in purchasing and consuming the drugs, he or she may engage in additional criminal activity to obtain the funds for purchasing the drugs.

If the use of drugs such as opiates were regarded as a health issue, not a criminal one, many problems associated with drug use would solve themselves. Portugal and the Czech Republic have partly or completely decriminalised recreational drugs in the past, leading to a drastic reduction in drug-related crime, as well as fewer hospitalisations and deaths attributed to improper drug use. The Netherlands are a country known for a more liberal approach to drugs, even if their drug laws are still comparably strict, if much less so than those of its neighbours.

Instead of criminalising drugs, a sensible policy could offer guidance and education for drug users, be it that they want to take it for celebration (partying) or self-medication. If a person’s drug use is deemed to be detrimental to his/her health, such as when it is obvious that the use is habitual, he/she may be offered appropriate counseling, including psychotherapy, to possibly overcome what drives him/her into the addictive behaviour.

If recreational drugs are decriminalised or even legalised, opportunities arise for the controlled production and sale of these drugs, such as in pharmacies or specialised drug stores. This would have several advantages. Not only would the drug market move from the street into legal businesses, which could be taxed. In the U.S., where a number of states have legalised the sale of cannabis products, this has already turned out to be a large source of tax income.

Also, drugs could be produced to pharmacological standards of purity, guaranteeing not only that what the user wants to purchase is actually what’s in the package, but also that the substance in question is exceptionally pure, and free from both by-products of the (illicit) production process (which can be much more toxic than the actual product) and from potentially dangerous adulterants that street dealers like to add to their drugs to push their profits.

If the drug being purchased is a naturally grown product, such as cannabis or magic mushrooms, such businesses could ensure that the drug is produced to the highest standards that are applicable to other agricultural produce, such as limitations or bans on the use of pesticides or other possibly harmful substances that are involved in growing the plants. Any respectable legal plant drug business would strive to be »organic«; as pure and clean as possible.

Legal drug purchases could come with instructions for use, in the same way that medicine is. The user could be informed of the recommended dosages for certain kinds of effects, severely limiting the possibility of overdose, because the user can now make an informed decision about how much he/she will take, and what the expected effects will be. No longer will potentially fatal guesswork be involved as with street drugs, where the actual identity and purity of the substance is often questionable, and where there is usually no way for a user to tell, unless he/she goes to a lab to have a sample of his/her material tested (which is not only expensive but entails the risk of criminal prosecution).

The instructions accompanying legal recreational drugs should furthermore caution the user about any associated dangers of use, such as not to operate machinery or vehicles when under the influence. They should warn the user of potentially dangerous interactions with other substances, be they recreational or legal/prescription drugs. All in all, if properly applied, this kind of instruction and education would minimise, if not abolish completely, the most prevalent causes of drug accidents, namely overdose, inadvertent use of an unexpected substance, and hazardous drug combinations.

As more and more well-known recreational drugs are banned due to prohibition laws, new designer drugs appear that try to imitate the banned substances’ effects as closely as possible. These drugs are risky because they often have a less favourable side effect profile than the »original« they are imitating, and they usually hit the market before they have been verified to be safe.

»Classical« recreational drugs are well-established not only because large numbers of people have tried them and reported on their effects, but also because most of them have been researched extensively in academic contexts due to their interesting properties. »Legal« pharmacological drugs need to undergo the scrutiny of clinical trials before they may be sold, which makes dangerous adverse effects very unlikely.

Designer drugs are neither well-established nor have they undergone clinical trials. Using them may cause any number of unexpected issues. This is reflected by media reports of hospitalisations and deaths from the use of such drugs, in particular, when a less well-established designer drug is sold as a well-known drug, as is very widespread with »Ecstasy« (which is expected to be MDMA, a very well-known substance today, but could be pretty much any other amphetamine-like substance, some of which are really too toxic to be used recreationally at all).

If recreational drugs were obtainable legally, the incentive to use the lesser-known, potentially dangerous designer drug alternatives would all but disappear, preventing another widespread cause of drug accidents.

So if we can fix the problems of the illicit drug market by making drugs available legally, and offering appropriate educational measures to make sure that the drugs will be used safely and sensibly, are drugs still bad?

We can probably agree that not using drugs is the safest option. After all, what I don’t take can’t do me harm. Many countries’ drug policies are based on the idea that drug use must be completely outlawed, and that people will cease using drugs if we punish them sufficiently harshly. We know today that this strategy has failed. People still use drugs no matter what.

Instead of denying the reality that people will use recreational drugs, we could look at the reasons why people do use drugs. We could establish that a lot of recreational drug use is actually safe and causes little to no harm; certainly less harm in total than, for example, the widespread use of alcohol. In those cases were drug use is actually harmful, we could establish that those users have a certain predisposition or condition that drives them to using drugs in a dangerous way. Instead of looking at them as criminals, we should look at them as individuals who need our help, so that they may overcome their drug use completely, or possibly reduce their use to levels that are manageable in terms of health effects.

Well then, are drugs bad?

If we accept that drug use is an expression of personal freedom, that large numbers of people are going to use drugs no matter what, and that we can do much to make this use clean and safe, in the same way that prescription drugs are used, then the question turns out to be more of a moral issue (i.e. politics) than it is about harms.

If recreational drugs are bad, then prescription drugs are bad also. It is best not to take any drug, be it an »illegal« one or one that is given to me by a doctor.

As a bit of a side thought, let’s focus on the idea that some people may use recreational drugs as a measure to handle life’s challenges. If your knee-jerk reaction is that taking drugs in order to handle life is some kind of cop-out or cheat, and that people should be able to handle life without such »help«, then think about all the various real psychological conditions that exist where people are unable to cope, such as in depression, or crippling cases of anxiety.

People with such conditions are given psychological treatment such as therapy, but also very often psychiatric medicine, which shares many of its principles of action with the aforementioned recreational drugs. Although engineered not to be addictive, there are numerous cases where people are driven into taking psychiatric medicine for very long periods, if not for the rest of their lives. For the pharma-corps that produce these medicines, it is very lucrative to have large numbers of patients take their pills for large stretches of time, so there is no incentive to develop psychiatric medicine that will only be used a few times, or to reduce the number of people taking them.

However, some banned drugs such as psilocybin (from magic mushrooms), LSD and MDMA have shown to be very effective if used in combination with psychotherapy, due to their mind-opening properties, allowing patients to solve psychological issues much more quickly and sustainably. Under most governments, this use is outlawed, and patients and therapists are pointed to the availability of non-banned antidepressants, anxiolytics and neuroleptics.

If effective, a patient on these »official« drugs is rendered more or less »fit to function« again, but he/she is never really cured. In effect, the psychological issues are replaced by an addiction to a drug—usually several drugs—that suppress the symptoms of his/her condition. And the companies that produce these legal drugs make large profits.

This, to me, is bad. It would be best if people who suffer from depression, anxiety, compulsive behaviour and other such issues would be given a treatment that actually solved the issues, instead of putting them on medicine for years or decades.

To end the side thought, there are people who don’t get along in life, and they need proper help, not drugs. If drugs must be given, then we should use drugs that allow them to actually solve the issues instead of just suppressing symptoms, which is what psychopharmacological medicine usually does, and which is why a patient on these drugs is pressed to take them indefinitely.

Are drugs bad now?

If your stance is that people should never take drugs, I will point you at legal medicinal drugs and ask you how these are so different from our outlawed drugs that this can be justified. I have tried to show that there is no such distinction, neither from a scientific viewpoint, nor from the actual experiences of users. It is purely a construct based on policy, which in turn has little to no factual basis.

I will remind you that people have been using drugs since ancient times, when the use of certain plant drugs was an important part of our culture, embedded within recurring religious or spiritual rituals. Even if such rituals may no longer be acceptable in modern society, it should become apparent that there is no such thing as a natural predisposition to avoid drugs. The very idea is a moral construct. Even animals have been observed to use drugs recreationally (think of cats using catnip, or dolphins sucking on pufferfish to get high).

If you say that illicit drugs can cause harms then I will agree, but so do a number of things that we don’t outlaw, not only drugs. Alcohol causes enormous health problems and is a source of violent behaviour. It is socially acceptable and fully legal. Cars are exceptionally dangerous machines that are involved in horrible accidents and deaths every day. Based on the sheer number of these accidents, we should outlaw cars immediately. We don’t. Sitting in an office all day looking at a computer screen causes many serious health issues in the long term, but we don’t outlaw it. You get the idea.

Moreover, the harm argument is invalid not only because our perception of the dangers of recreational drugs is extremely distorted. We hear about the few drug-related accidents that do unfortunately happen, but we never hear about all the people that use drugs with no ill effects. The argument is invalid especially because most of the drug-related accidents happen due to the very nature of drug prohibition, forcing people to obtain drugs on the street, which is extremely unsafe. If drugs were obtainable legally, these accidents could be all but prevented.

What this all boils down to is that drugs are neither good nor bad. They are neutral. As anything else in the world, they can be used in a safe and sensible, even beneficial way, and they can be used in a destructive way.

The one thing that is actually bad because it causes much more problems than it solves is most governments’ stance on drugs. Yes, drug prohibition is seriously bad.

The time has come to wake up from four decades of propaganda. If we want to minimise the problems associated with drug use, then we should make drugs obtainable legally, under strict quality control, in combination with any and all appropriate safety measures, such as education, and counseling or therapy for those people who use drugs in a way that causes them more harm than it helps them.

I firmly believe that a world in which we no longer need to fight drug use, but allow it and make it safe, ultimately turning it into either a non-issue, or, at worst, a health issue, will be a much better world.

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Author: schoschie

I like to see the wiring under the board™

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