What are some of our greatest misconceptions around drugs and drug use? And how can better education help?
One of the greatest myths is that most people who use drugs like crack cocaine and heroin are addicted. That’s simply not true. The vast majority of people who use any drug don’t become addicts. Another myth is that recreational drug use causes irrevocable brain damage, meaning neuron injury or death. But the drugs that people take in recreational doses have not been shown to cause damage to the brain. The evidence to support that supposition is weak and overstated, and it has serious implications for how we make and enforce harmful drug policies.
One major myth I want to address is specific to opioids. People think that folks are dying because of opioid use, period. And the truth is that folks who die with opioids in their system usually die because of ignorance. Let me break that down for you: When people die with an opioid in their system, we count that as an opioid death, but the vast majority of these people have multiple drugs in their systems. And so we often don’t know which agent caused the death.
Mixing opioids with other powerful sedatives, like antihistamines or large amounts of alcohol, becomes dangerous and sometimes deadly. We could do a better job at informing people that if you’re going to be taking sedatives like opioids, don’t mix them, especially if you don’t have much experience with sedatives. Because when you mix sedatives, it increases the potential for respiratory depression and, ultimately, death.
When we think about prescription opioids—something like Percocet or Vicodin—those medications contain a low dose of opioid and a large amount of acetaminophen, or Tylenol. These medications contain about five to ten milligrams of an opioid in a pill. A regular opioid user can typically take 50 or 100 milligrams of an opioid and be fine. But then the medication may also contain 325 milligrams or so of acetaminophen per pill. If they’re taking enough for an opioid effect, that takes them up to about four to five grams of acetaminophen. And that dose of acetaminophen over several consecutive days can cause liver toxicity. In fact, acetaminophen poisoning is the number one reason for liver toxicity. These are things that the general public, including many opioid users, just doesn’t know. That’s how people die because of ignorance. We can easily deal with this if we’re willing to have honest conversations and education about drugs.
Death by opioids alone is a rare sort of death unless it follows a long period of abstinence, when the individual might be more susceptible to overdose, or if they take something like fentanyl. Oftentimes, people take fentanyl unbeknownst to them in place of what they thought was heroin, and they take that fentanyl in the same dose as they would take the heroin they thought they were taking. That can be fatal.
The solve for all of these problems—and for the fentanyl problem specifically—is drug testing, in which people can submit small amounts of their drug and get back an analysis of the chemical composition of that substance. If they submit heroin and it contains something like fentanyl or some other impurity, they can choose not to take it or to take smaller doses of it. These drug-checking facilities are not expensive. If we really cared about our population, we could do that to lessen people’s ignorance about what they are taking.