A Neuroscientist’s Case for Legalizing All Medication

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

One of the biggest myths is that most of the people who use drugs like crack cocaine and heroin are addicted. That’s just not true. The vast majority of people who use drugs do not become addicted. Another myth is that recreational drug use causes irreversible brain damage, resulting in neuron injury or death. However, the drugs people take in recreational doses have not been shown to damage the brain. The evidence to support this presumption is weak and exaggerated, and has a serious impact on how we conduct and enforce harmful drug policies.

One important myth I want to address is opioid specific. People think people are dying because of opioid use, period. And the truth is, people who die with opioids in their system usually die from ignorance. Let me summarize this for you: when people with an opioid in their system die, we count it as an opioid death, but the vast majority of these people have multiple drugs on their system. And so we often don’t know which agent caused the death.

Mixing opioids with other strong sedatives like antihistamines or large amounts of alcohol becomes dangerous and sometimes fatal. We could better educate people that you shouldn’t mix tranquilizers like opioids, especially if you don’t have a lot of experience with tranquilizers. Because when you mix tranquilizers, the potential for respiratory depression and ultimately death increases.

When we think of prescription opioids – something like Percocet or Vicodin – those drugs contain a low dose of opioid and a large amount of acetaminophen or Tylenol. These drugs contain around five to ten milligrams of an opioid in one pill. A normal opioid user can typically ingest 50 or 100 milligrams of an opioid and be fine. Then the drug can also contain 325 milligrams of paracetamol per pill. If they are taking enough for an opioid effect, they will ingest up to four to five grams of paracetamol. And this dose of paracetamol over several consecutive days can cause liver toxicity. In fact, acetaminophen poisoning is the main cause of liver toxicity. These are things that the general public, including many opioid users, just don’t know. This is how people die from ignorance. We can easily deal with this when we are willing to have honest conversation and education about drugs.

Death from opioids alone is a rare form of death unless followed by a long period of abstinence, when the person is more prone to overdose or when they are taking something like fentanyl. Often times, people take fentanyl instead of heroin without their knowledge, and they take that fentanyl at the same dose that they would take the heroin they thought they would take. That can be fatal.

The solution to all of these problems – and specifically to the fentanyl problem – is drug testing, where people can submit small amounts of their drug and get an analysis of the chemical composition of that substance back. If they submit heroin and it contains something like fentanyl or some other contaminant, they can choose not to take it or take smaller doses of it. These drug control facilities are inexpensive. If we really cared about our people, we could do that to reduce people’s ignorance of what they are taking.