Drug Information Isn’t Just for “Druggies”

Jonathan Caulkins sketches a little of the history of recent drug education policy in the United States, but it’s not clear what position he takes with regard to the government actively promoting misunderstandings and inaccuracies about disapproved drugs and their use. While Jonathan states that “accurate information about drugs is generally preferable,” [emphasis added] he appears to be so strongly focused on reducing the use of illegal drugs that accuracy takes a clear second place. If a blatantly false information campaign about illegal psychoactives could be crafted that would dramatically reduce use, would it be appropriate to run it? Does the answer depend at all on what possible harms are being avoided by reducing use (is it different for heroin or cannabis)? Is the standard for whether it’s acceptable for the government to lie about scientific facts a simple legislative majority?

In our view, the corrupted information about psychoactive drugs that is currently prevalent in the United States has taken over a century to develop and will take more than a few years to correct. It will likely take a generation or two for views to be moderated by access to balanced, comprehensive information. Legislators who banned LSD in the 1960s were influenced by the erroneous news reports trumpeting that it caused “chromosome damage.” The generation of representatives who wrote and passed the Controlled Substances Act were raised on Reefer Madness. It won’t be until 2040 that the average U.S. legislator will have been raised with online access to information about psychoactive plants and chemicals.

Highlighting our difference in views, Jonathan has repeatedly rejected the idea that caffeine is reasonably considered a psychoactive drug. He also seems to reject the idea that there are pertinent parallels between caffeine and psychoactive pharmaceuticals or illegal recreationally used drugs. We aren’t sure why he thinks it helps or changes the discussion to exclude caffeine, but we will offer a few points to consider.

Caffeine is a habit-forming drug, with daily use leading to both psychological and physical dependence. Physical withdrawal effects are similar in scale to those from discontinuing daily cannabis use. Caffeine overdoses can and do result in death. Caffeine abuse is a diagnosed condition. Caffeine use is associated with a variety of negative psychological and physical health symptoms including anxiety, insomnia, restless leg syndrome, and bruxism (teeth grinding). Caffeine is used recreationally and causes euphoria and sociability in higher doses. Caffeine use is ad libidum, not on a schedule prescribed by a doctor. We consider caffeine a classic example of a psychoactive drug, and a useful one for discussing the importance of dose, individual reaction, and risk while sidestepping the complex political and moral landscape that dominates discussions about disapproved psychoactive drugs.

It is, perhaps, illustrative to also mention purified sugar as an interesting parallel to psychoactive drugs. In a 2007 paper titled “Intense sweetness surpasses Cocaine Reward,” researchers demonstrated that both cocaine-naïve and cocaine-addicted rats chose natural and artificial sweeteners over cocaine.[1] We are not contending that sweet foods should be considered “psychoactive,” but it is important to keep in mind that there are many ways that behavior is deeply affected by everyday substances we ingest.

Jonathan countered our statements about the widespread use of psychoactives (~98% lifetime use) by arguing that only illegal recreational use should be considered in such statistics. He chose to quote figures for past month use of any illicit drug, a number he cites as around 8%. He uses that to argue that “drug use […] is far from normative,” also implying that information about psychoactive drugs is only valuable to the 1/10th of the population who has used an illicit drug in the past month. We have a handful of comments about that.

First, the data he cites is from the National Survey on Drug Use and Health (NSDUH). Because of its data collection methods, NSDUH is known to underestimate general levels of illegal drug use and massively underestimate levels of heavy illegal drug use.[2] Despite this, we agree that it is the best large survey on illegal drug use in the United States for populations not (yet) covered by Monitoring the Future (MTF), another major drug-use survey. MTF provides noticeably higher estimates for the prevalence of past-month use of illegal psychoactives.[3]

Second, we generally regard past year use as a better measure of “current use” than past month use when talking about psychoactive drugs across the board. The definition of “current use” is probably best defined on a per-drug basis: Those who take psilocybin mushrooms likely consider themselves “current” users for considerably longer than a month after their last experience, while tobacco or crack cocaine users may no longer consider themselves “current” users after a few weeks of abstinence. Once-every-few-years smokers of cannabis who would consider taking a hit on their vacation are still involved with making decisions about illegal drug use.

Third, we would argue that the appropriate age range to consider when discussing current illegal drug use is adults aged 18 to 59. It is a little strange to talk about whether illegal drug use is “normative” in the population and include 12-year-olds (NSDUH statistics include 12 and older). It is also important to note that those over 60 are not part of the “normative” cohort for illegal drug use, according to the NSDUH. They are old enough not to have been exposed to widespread cannabis use in their youth like the rest of Americans have been. The percentage of people over 60 who have ever tried an illegal drug is well under 30%, whereas the number is substantially over 50% for 18-55-year-olds, according to the NSDUH. Using NSDUH 2007 data, the past-month use of any “illicit” drug among 18-59-year-olds is around 10% and past-year use is around 17%.[4]

Fourth, we would argue that since over 50% of the adult population of the United States born after 1950 has tried an illegal drug, it is reasonable to call that “normative,” regardless of what current use levels are or how one defines current use. It may not be normative to continue to use cannabis after the age of 30, but it is clearly normative for adults in the United States to have broken the prohibition against illegal drug use.

By arguing that psychoactive drug use is non-normative in the context of a discussion about the value of accurate information about psychoactive drugs, Jonathan seems to be attempting to marginalize the need for such information. It’s a common error to think that drug information is only for “druggies.”

While Jonathan clearly disagrees with us on this point, we believe that there are many useful parallels to be drawn between responsible use patterns and decisions around ubiquitous drugs such as caffeine and strongly prohibited drugs such as cocaine. But, even if we accept Jonathan’s focus on recent illegal drug users, if we broaden the target audience for drug information to include friends, family members, co-workers, and employers (even if they don’t use illegal drugs themselves), we are probably looking at a majority of the U.S. population. If we also include educators, medical professionals, researchers, academics, law enforcement, policy makers, and government employees in the list (as Erowid Center does), then there is no question that there is a broad need for more accurate information about psychoactives. Every citizen who has a need for information about illegal psychoactive drugs should, as a bare minimum, be able to expect that government-provided information does not misrepresent facts.

We do not argue that “a pure information approach” is a panacea. We believe that widely available, accurate, and balanced information is necessary, though not sufficient, for developing a culture of responsible use of psychoactive drugs and technologies of all kinds.

[1] Lenoir M, Serre F, Cantin L, Ahmed SH. “Intense sweetness surpasses cocaine reward.” PLoS ONE 2(1), 2007:e698.

[2] Erowid E, Erowid F. “How Do They Measure Up? Part II: The Problems.” Erowid Extracts 9, Nov 2005,16-21.

[3] NSDUH gives 2006 past-month use statistics of any illicit drug for 45-49 year olds as 6.7% while MTF gives past 30 day use statistics for 45 year olds of 10%. This is similar to the difference for most age groups.

[4] SAMHSA. “Results from the 2007 National Survey on Drug Use and Health: Detailed Tables.” 2007. Table 1.1A.

Also from this issue

Lead Essay

  • In their lead essay, Earth and Fire Erowid stress the importance of developing responsible, fully informed relationships toward psychoactive drugs. Although drug prohibition has persisted for decades, the overwhelming majority of adults have tried at least one illegal drug, and these substances aren’t going away any time soon. Sadly, prohibition itself has stunted our knowledge of these substances, and, as in so many things, ignorance is both dangerous and irresponsible. Provocatively, they criticize even the word “drugs” as a tag for illegal psychoactives: Lumping them all together, they write, betrays a lack of understanding of their vastly different effects, risk profiles and — yes — benefits.

Response Essays

  • Jonathan Caulkins argues that the responsible use of psychoactive drugs is an overstretched concept, if by “psychoactive drugs” we mean everything from caffeine to heroin. In many cases, he argues, temperance may be the only responsible “use” of a given substance.

    Further, state prohibitions on pleasurable but risky acts are hardly confined to this area of law; their violation is not a genuine form of civil disobedience as long as pleasure itself is the real goal of the act. And the risks remain regardless. Duly enacted laws in a democracy deserve far more respect than this, and following the law is a part of the responsibility of all citizens.

  • Jacob Sullum notes that temperance and abstinence have been wrongly conflated, and that the Aristotelian view of temperance encompassed all of the moderate, reasoned, and honorable pleasures of life. He reiterates that virtually everyone uses psychoactive drugs of one kind or another, and that the overwhelming majority of use is responsible. He challenges the notion that the state has any interest in the private actions of individuals that do not harm anyone else, and he terms the impulse to protect people from themselves “unethical” and “an open-ended rationale for government intervention that logically leads to totalitarianism.”

  • Mark Kleiman takes up a theme already addressed by the other participants, namely the distinctions to be found within the catchall category “illegal drugs.” He notes that the risk profiles, motivations for use, and public health considerations of these substances are so far removed from one another that it may make no sense to continue to treat them as similar in public policy. Given the choice between full legalization and the status quo, he would choose the status quo, but, he argues, these alternatives should not be the only ones we consider.