A Simple Truth About Drugs That Punctures Decades of Drug War Lies
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What is the most dangerous activity you can engage in? If you guessed doing illegal drugs, you would be wrong. Extreme sports like big wave surfing, heli-skiing, cave diving, white-water rafting and mountain climbing all have a higher rate of risk to life and limb. Yet the question of a ban on these behaviors beloved by "adrenaline addicts" is viewed as ludicrous, even when the risk of death, say, in climbing Mount Everest once (until recently, about 1 in 3) is greater than the annual risk of dying from heroin addiction (around 1% to 4%).
Or consider mundane activities like driving: Car accidents are responsible for 1% of annual deaths nationwide. Cigarettes and alcohol do at least as much, if not more, harm to each user than heroin or cocaine. Alcohol, cocaine and heroin have a 3% to 15% rate of addiction, depending on how it is measured—and tobacco's rate is higher. Yet the risks don't align well with their legal and social status, especially when you consider that marijuana is safer than any of the legal drugs.
The reasons for this inconsistency around risk are complicated. Driving has huge personal and economic benefits. Risky sports are seen as noble challenges that foster the human will toward exploration, adventure and growth. When it comes to nonmedical drug use, however, discussion of benefits tends to be either dismissed as delusional or stifled in favor of “risk” talk.
I mention these facts not to promote drug use. That I feel compelled to immediately include such a disclaimer underlines my point: Our values shape our perception of risk and the way we make drug policy. If we recognize only the risks and ignore the benefits, we fail to understand that the real problems are addiction and harm—not the substances themselves and the people who use them.
For instance, when we talk about the “epidemics” of Oxycontin, methamphetamine or heroin, we rarely acknowledge that the majority of users never become addicted: Over the course of a lifetime, only about 10% to 15% ever get hooked. That risk is not insignificant: Few people would fly on a plane that crashed every tenth flight. But focusing on use as the main factor in addiction obscures what is actually at stake.
There are, decade after decade, headlines about the fall of one drug and the rise of another. Yet the overall rate of people with addictions remains fairly constant. Although population differences and other variables make the numbers hard to compare exactly, a large national survey in 1990 found a 3.6% rate of illegal drug problems (DSM-defined “abuse” or “dependence”) in people ages 15 to 54 during the previous 12 months. The most recent National Survey on Drug Use and Health, which includes people from age 12 to those in their 80s or older, found a 2.5% rate of abuse or dependence in 2011. While that rate may seem much lower, the difference is probably due to the later survey’s inclusion of people over 55, who are numerous and had a 2011 addiction or drug misuse rate of a mere 0.8% or less. It is worth noting that 1990 was the peak of fears about a non-ending crack epidemic; by contrast, today, while there are concerns about growing prescription opioid addiction, the actual rates have been steady since 2006.
Now, this fairly constant long-term rate of drug use problems isn’t the end of the story. There are periods when dangerous drugs like opioids that have serious effects on people’s health replace the use of comparatively low-risk ones like marijuana. Similarly, addiction rates can sometimes change dramatically—for example, populations with a high exposure to early-life trauma are more likely to become addicted than those who have happier childhoods. Fashions can also pull large groups of people to use at dangerous levels (alcohol and cigarettes in the Mad Men era, for example, or the coke-happy early ‘80s).