Giving kids accurate information about drugs is particularly critical right now, because we are currently experiencing a dramatic increase in opioid use. This is hardly surprising, given the massive amount of advertising dollars pharmaceutical companies have invested in these drugs. More than a decade of intensive marketing and overprescription of painkillers like Oxycontin, Percocet, and Vicodin has led to skyrocketing use and abuse rates.
It’s important to recognize that these drugs aren’t in and of themselves evil. They are invaluable for treating acute pain. The morphine I was given immediately after my Caesarean sections helped alleviate what otherwise would have been intolerable agony. Moreover, opioids, if taken under proper conditions and without adulteration, aren’t particularly physically harmful. If you take opioids in appropriate doses and don’t mix them with alcohol, you will not die. When opioids are given for limited periods of time to deal only with acute pain, such as the pain of surgery or the pain of dying of a disease like cancer, addiction is generally not an issue. To the dying, addiction is irrelevant, and for those dealing with acute pain, once the pain resolves, so generally does the need for the drug.*6 Only rarely does a patient become addicted after just a few days of opioid use.
It is when these drugs are prescribed over the long term for chronic pain that problems occur. There is a growing consensus that there is little evidence that opiods are reliably useful in dealing with chronic pain.*7 Patients report that the drugs become increasingly ineffective over time.*8 Moreover, with prolonged use, the risk of addiction rises.
The CDC believes that the best way to stem the tide of opioid abuse is to reduce the number of “unnecessary prescriptions” by physicians. Though on first blush this seems sensible, it ignores the fact that the rise in heroin use is not so much a result of the overprescription of opioids but of overprescription followed by prohibition. When patients are no longer able to receive prescriptions for the opioids on which they have become dependent, when pills are reformulated to make them more difficult to abuse, or when pills become prohibitively expensive, patients start searching for alternatives to stave off withdrawal. That’s when they discover heroin, a cheaper and more potent way to get the same kind of high. According to the CDC, the numbers of people who report using heroin has doubled in the last decade.*9 Heroin is, next to tobacco, the most addictive drug we know of. According to the National Institute on Drug Abuse, nearly one-quarter of the people who use heroin end up becoming dependent.*10
This has led to a dramatic increase in overdose and death.*11 In particular, the fatal heroin overdose rate, which was stable throughout the early years of this century, has gone through the roof. Heroin is produced and distributed by criminals operating outside of any regulatory system and, unlike prescription opioids, is not regulated for potency and purity. Fatal overdose is thus far more likely. Recently, for example, heroin dealers have begun lacing their product with easily obtainable fentanyl, a highly addictive synthetic morphine alternative that is thirty to fifty times as potent as pure heroin. The results have been catastrophic.
My older kids go to college on the East Coast, and we spend part of the year in New England, which is ground zero for the heroin epidemic. In the increasingly likely event that one of my kids witnesses an overdose, I want them to know that they must immediately dial 911. I don’t want them to follow the fatal course of action of so many other frightened teens, desperately immersing an overdosing friend in a tub full of ice water, or dumping the person in a hospital parking lot, to expire in a pool of his or her own vomit.*12
I have recently changed the message I give my kids when it comes to stimulant drugs such as methamphetamine. My kids tease me that my three phobias are rats, sharks, and methamphetamine. As disgusted as I am by rats (even the cute ones my eldest keeps as pets), as confident as I am that I will be chomped in half by a Great White if I so much as paddle in the ocean, the street drug known as “crank,” “ice,” or “crystal” has, for years, really scared the shit out of me. When I was a federal public defender, I had a client with cardiomegaly and congestive heart failure caused, according to his cardiologist, by repeated exposure to methamphetamine. I used to tell my kids that methamphetamine is so toxic that it would kill them, and so addictive that a single experience with the drug could lead to dependence. It was only while researching this book that I realized I’d been inadvertently lying to them.
We’re going to take this next part slow, because it’s going to contradict everything you think you know about meth. It certainly contradicted everything I thought I knew. What I learned was so hard for me to believe that I had to read and reread the studies several times. I asked Dr. Carl Hart, a Columbia University neuropsychopharmacologist and the country’s pre-eminent researcher on methamphetamine,*13 the same questions so many times that eventually he got sick of repeating himself and stopped answering my e-mails.
Here goes:
Stimulant drugs like methamphetamine are dangerous. According to the Drug Policy Alliance, “Increased or prolonged use of methamphetamine can cause sleeplessness, loss of appetite, increased blood pressure, paranoia, psychosis, aggression, disordered thinking, extreme mood swings and sometimes hallucinations.”*14 There is some evidence that it causes long-term cognitive harm. A 2010 study found that methamphetamine users performed worse than nonusers on tasks associated with daily functioning (dealing with finances, communicating, managing medications and transportation).*15
However (and here’s where you’re going to start hearing things that will surprise you), the extent of this impairment seems to be less dramatic than we’ve been led to believe. According to Dr. Hart, though long-term effects have been observed, cognitive functioning of meth users generally falls within the normal range.*16 We hear a lot about the deleterious effects of the drugs, Dr. Hart says, because researchers studying drugs like methamphetamine or crack cocaine tend to view any and all differences, no matter how small, as clinically significant. This, he says, is a reflection of bias, not of fact. Researchers see effects from drug use because they anticipate seeing effects from drug use.
And what about those negative behavioral effects of stimulant use? The crimes and violent outbursts? These do occur, though Dr. Hart insists that the dangers associated with stimulants are over-reported in the media. The evidence shows that antisocial behavior associated with methamphetamine is less common than we think, and more likely to be a function of circumstances such as poverty, trauma, and the presence of a criminal marketplace than of drug-fueled rages.*17