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5 Tips for Decreasing Drug-Related Harms

These five tips will decrease your chances of drug-related harms like overdose and death.
 
 
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Over the past 15 years, I have given thousands of doses of drugs like cocaine, marijuana and methamphetamine to people. I do this as part of my research to understand how the drug affects the brain, behavior and physiology.

Late one summer night, I picked up my 17-year-old son from a party, a graduation celebration for one of his friends. As he got in the car, I noticed that he was chewing a heavily mint-scented gum. It occurred to me that some of the partygoers might have brought drugs and that he might have indulged. Given what I know from the Monitoring the Future surveys and my own research, this shouldn’t have come as a surprise to me. It did. I was now faced with the horrifying thought that my little son (by the way, he’s taller than me) might have taken illegal drugs.

Alarmed, but attempting to appear cool, I asked, “How was the party?”

“It was wack,” he replied.

Meanwhile, I was secretly looking for signs of drug use. Apart from the obvious ones that occur following heavy drug use, which is rare, there are few, if any. So I decided to just ask if he or others had taken drugs at the party. He explained that he had not, but some others had drank alcohol and a few had gone to the park to smoke marijuana. As we drove home, I asked what he remembered from our talks about drugs over the years. I was so impressed by what he said I thought it might be helpful to share with others. Here are the five simple lessons that I have taught my own children about drug use and ways to decrease associated harms.

1. The police are a bigger threat to people who look like my son, than illegal drugs themselves. It is a well-documented fact that black people are more likely to be arrested for drugs than other groups, even though they don’t use or sell drugs at higher rates. As a result of an arrest and conviction, individuals may not only lose their freedom, but they may also lose many civil rights including the right to vote or serve as a juror; they may be ineligible for federal or state aid and certain types of employment; and some may be barred from obtaining state licenses or holding public office. In other words, those convicted of drug-related offenses can be legally discriminated against and people who share my son’s skin complexion are at greater risk. The fact is that black people are more likely to have their lives damaged by an arrest or conviction than they are to suffer serious drug-related consequences. So, if one must use illegal drugs, s/he should do so only in secure places; outdoor illegal drug use is simply unwise, especially if you’re black.

2. The adulterants (or cut) in some illegal drugs are far worse than the drug itself. There are few quality controls for manufacturing illegal drugs. As such, many street drugs contain other components, and in some cases, these chemicals can be more dangerous than the intended drug. One recent example of this is cocaine being cut with levamisole, a drug used to treat cancer and used to deworm animals. Taken in large doses, levamisole can reduce a person’s white blood cell count, making them more susceptible to infections. In severe cases, the drug can lead to death. Thus, it is critically important to know and trust the source of your supply; it can literally be a matter of life and death.

3. Inexperienced drug users should not model the behavior of experienced users. Experienced users tend to take drugs in ways that get them to the brain quickly. Smoking and intravenous injections are popular among this group. Not only do these routes produce the most intense high, but they also require less amounts of drug to produce desired effects. Given these appealing features, why should novices be discouraged from smoked and intravenous drug use, at least initially? Inexperienced users will not have developed tolerance. This means that smaller doses are likely to produce greater toxic effects, including overdose. Because smoking and shooting drugs intravenously produce more potent effects, the likelihood of harmful consequences is increased with these methods. 

Alternatively, taking a drug by mouth is usually safer than other ways of consuming drugs because the stomach can be pumped in case of an overdose, something that is not possible to do with smoked or injected overdoses. In addition, when a drug is taken by mouth some of it is broken down before reaching the brain, which means the total drug dose and potential drug-related negative outcomes are reduced. In part, this is why experienced drug users seeking intense highs tend not to eat their drugs or swallow them as pills. The bottom line is that inexperienced users should: a) avoid using via methods that increase a drug’s potency; and b) use lower doses than experienced users.

4. Users of any drug, whether legal or illegal, should maintain healthy sleep habits. Adequate sleep is an essential physiological function for the health and survival of an individual. Deterioration of mental functioning is one of the most noticeable and consistent manifestations of sleep loss. During prolonged sleep deprivation, there is an increase in fatigue and a decline in cognitive and perceptual ability. In severe cases, hallucinations and paranoia may also occur. Because amphetamine (e.g., methamphetamine, Adderall, MDMA) reliably reduces fatigue and offsets performance decrements, some may repeatedly use this class of drug as a strategy to mitigate problems associated with sleep loss. Why would this approach be less than ideal? One of the most consistent effects of amphetamine use is the disruption of sleep, which means that repeated use could exacerbate problems related to sleep loss. Given the vital role that sleep plays in healthy functioning, regular users of amphetamine should be mindful of their sleep durations and make the appropriate adjustments (e.g., avoid drug use near the sleep period) to ensure they get adequate amounts of sleep.  

5. Certain drug combinations should be avoided because they increase the risk of harm. Opioids are often used in combination with other drugs. For example, heroin users frequently use the drug simultaneously with alcohol. Another popular opioid-sedative combination is oxycodone with the benzodiazepine diazepam.While it is theoretically possible to die from an overdose of any of these drugs alone, in practical terms this is very rare. But, each year there are several thousand deaths in the United States involving the use of these combinations. In virtually every overdose death involving a prescription sedative or opioid, for example, some other substance is present. Most of the time it is alcohol. One should always take care when combining two drugs or any drug with alcohol, and read and pay attention to warnings provided with any prescription drug.

Like most parents, I have discouraged drug use among my children. But, as my 17-year-old prepares to go off to college, I am heartened to know that he is equipped with these important lessons because they will decrease drug-related harms, and ultimately save his life if he does decide to experiment. 

Carl L. Hart is an associate professor of psychology in the departments of psychiatry and psychology at Columbia University and a former member of the United Nations reference group for intravenous drug use and HIV. He is the author of the new book, "High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society."

 
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