Health
Rationalizing Modern Drug Prejudices
Value judgments seem inevitable in trying to establish the relative comparisons between drugs, and any attempt to compare apples and oranges will inevitably fall short of the scientist’s objective goals.
Congressman Jared Polis: Is crack worse for a person than marijuana?
DEA Agent Michele Leonhart: I believe all illegal drugs are bad for you.
Congressman Jared Polis: Is methamphetamine worse for somebody’s health than marijuana?
DEA Agent Michele Leonhart: I don’t think any illegal drug is good for you.
Congressman Jared Polis: Is heroin worse for someone’s health than marijuana?
DEA Agent Michele Leonhart: Again, all drugs.
Congressman Jared Polis: I mean either ‘yes’, ‘no’, or ‘I don’t know.’ I mean if you don’t know you can look at this up. You should know this as the Chief Administrator of the DEA. I’m asking you a straightforward question, is heroin worse for someone’s health than marijuana?
DEA Agent Michele Leonhart: All illegal drugs are bad.
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How dangerous are different substances compared with each other, and do the laws get it right in banning some substances but not others? This question is not as immediately answerable as it might seem. For a start, no final and absolute answer can ever be given to the age-old question of how relatively dangerous different substances are to each other. Tobacco for instance will likely contribute to a shorter life for half of its smokers while the vast majority of ecstasy users will remain unscathed by the drug. But tobacco doesn’t snatch away a teenager’s soul in the prime of life the way an ecstasy pill might. Nobody has ever died of a marijuana overdose, but people do slip in and out of psychosis and harm themselves while using marijuana – and it likely induces long term psychosis in predisposed individuals. But how does a life of schizophrenia compare to the risk of a fatal overdose of heroin? Value judgments seem inevitable in trying to establish the relative comparisons between drugs, and any attempt to compare apples and oranges will inevitably fall short of the scientist’s objective goals.
Sana Al-Badri and Marco Vega
To try to get a grasp on the complexity of this problem, forty scientists met in 2015 to carry out a ‘multi-criteria decision analysis,’ an analysis of drug harms that encompasses multiple categories of harm including mortality rates, bodily damage, dependence, mental impairment, loss of tangibles, relationship breakdowns, injury to others, crime, environmental damage, economic costs and community issues surrounding drug use. Each commonly used drug was looked at and given a harm score on sixteen separate categories of harm, and these scores were then weighted and tabulated together to form an overall harm score:
This ranking shouldn’t be over-interpreted as ‘scientific proof’ that one drug is worse than another. Because this sort of analysis requires value judgments as to how separate harm scores are to be weighted, the scientists carrying out this relative ranking found that significantly changing the weights of different categories of harm sometimes led to a different result. Depending on which weights are changed in the sensitivity analysis, alcohol, heroin, crack cocaine and tobacco all vie with each other in the position of overall most harmful drug. But some familiar patterns appear to be constant across all sensitivity analyses. No matter how many variations in weighting procedures were used by these scientists, alcohol always came out as significantly more harmful than marijuana, and staggeringly more harmful than LSD and magic mushrooms.
While it’s probably not a large surprise to many that marijuana isn’t considered as harmful as alcohol, the nearly non-existent harm score attributed to the psychedelics LSD and magic mushrooms is an eyebrow raiser. Years of misreporting by the mainstream media have imprinted a particularly negative image of these drugs that has little correspondence to reality. By way of example, a 2012 article in The Daily Telegraph ran a story titled ‘Gifted Teen Dies in LSD Overdose.’ The story focused on an Australian teenager’s death after consuming some type of substance, and without any toxicology data on what that substance was, goes on to lambast LSD as a “deadly substance.” This is an extremely bold assertion to make without toxicological confirmation, as a medical review in Neuroscience & Therapeutics found no example of an LSD overdose death in recorded medical history. When one follows up on stories like this reported in the mainstream media, very often you will find the injury attributed to psychedelics is actually the result of some other factor or a mixture of factors. In this case, toxicology eventually found that the boy had died while using some new synthetic drug misleadingly sold as LSD on the black market.
Another headline reads ‘Coroner Warns Students over Deadly Mushrooms,’ in which magic mushrooms were linked to the death of a young New Zealand girl who apparently had “toxic levels of psilocin” in her body (psilocin is a metabolite of psilocybin from magic mushrooms). Once again, the medical literature stresses that no case of toxicity poisoning has ever been recorded from magic mushrooms and that it would be almost humanely impossible to consume enough mushrooms (17kg in fact) to reach toxicity. In this case, later context revealed that the girl had received a heart transplant and was unable to attend university or work due to her heart condition, but had decided to consume magic mushrooms nonetheless. As many people do, she became panicked at the onset of the psychedelic experience, likely placing stress on her heart thereafter suffering heart failure. In this freak case, magic mushrooms played a role in the death, but original reporting by the media was highly misleading in projecting the image of a “deadly” drug like magic mushrooms.
As the above example illustrates, psychedelics are not risk free, especially when one is already facing a life threatening illness. But as I describe in my Quillette article ‘On the Eve of the Great Psychedelic Debate,’ most of the terrible harms attributed to psychedelic drugs like LSD and magic mushrooms turn out to be urban myths. As I describe in that article, scientists agree on four basic things about psychedelic drugs that seem to hold outside of extreme circumstances: you cannot die of an overdose of them, they cause no physical damage to bodily organs, they are not addictive, and they do not seem to attend any net deterioration in mental health in a population of users (they perhaps attend an improvement). On all four of these measures, alcohol towers above the psychedelics as an addictive, lethal chemical that attends overdose, cancer, organ failure, heart attack, stroke, psychological damage and death via withdrawal (delirium tremens). And that’s only half the picture: alcohol’s negative impact in road fatalities, violence, emotional abuse and community breakdown are unparalleled in the drug world. For these reasons, scientists carrying out the multi-criteria analysis give magic mushrooms one-tenth the harm score of alcohol.
In the United States, under the Controlled Substances Act the Drug Enforcement Administration (DEA) holds a great deal of discretionary power in deciding which schedule a substance will be placed in. Marijuana and psychedelics are classified as Schedule I substances alongside heroin, a classification created for drugs that are considered medically useless and highly dangerous (though heroin is used medically outside the United States). Other schedules contain less stringently controlled substances, such as ketamine, cocaine, anabolic steroids and methamphetamine, as these drugs may not be considered quite so harmful or may have medical uses. Alcohol and tobacco, of course, are unscheduled and perfectly legal to purchase. This means that possibly the safest of all psychoactive drugs is classified as the most severely punishable while one of the most dangerous drugs available is not even scheduled (the other drugs are spread throughout the scheduling system in a seemingly random fashion). While some people see conspiracy theories at play to explain this paradoxical situation, the question that most peaks my curiosity is how defenders of the status quo could attempt to defend drug laws as they currently stand, which seem like historical artifacts rather than the product of a well thought through process.
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Congressman Steve Cohen: Would you agree that marijuana causes less harm than meth, crack and cocaine?
DEA Agent Michele Leonhart: As a former police officer, as a thirty-two year DEA agent, I can tell you that marijuana is an insidious drug.
Congressman Steve Cohen: That’s not the question I asked you mam. Does it cause less damage to American society and to individuals than meth, crack, cocaine and heroin?
DEA Agent Michele Leonhart: I can tell you that more teens enter treatment.
Congressman Steve Cohen: Can you answer my question please?
DEA Agent Michele Leonhart: I’m trying to.
Congressman Steve Cohen: You’re trying to answer the question like I’m Senator Sessions. I’m not Jeff Sessions. I’m asking you a question…Does heroin and meth cause more deaths than marijuana?
DEA Agent Michele Leonhart: All drug trafficking causes deaths.
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Some people simply refuse to accept that the relative risks of psychedelics or marijuana are not as harmful as other drugs. The DEA implicitly takes this approach by pretending that the question of relativity is incoherent and ignoring politicians who raise it, while others explicitly reject the notion of a relative assessment of harms. Psychiatrist Edward Gogek takes the explicit approach. In his 2015 book Marijuana Debunked: A Handbook for Parents, Pundits and Politicians who Want to Know the Case Against Legalization, Gogek declares, “There is no way to say one drug of abuse is safer than another. Each drug has at least one way in which it’s worse than all the rest.” According to Gogek, people drop like flies using heroin, but teenagers using marijuana are more likely to drop out of school than other drugs, and being worse than any other drug in this one dimension we are therefore debarred from a conclusion about its relative risk to other drugs. So marijuana cannot be said to be less dangerous than heroin. Not only does Gogek fail to demonstrate in his book that teens addicted to heroin are more likely to stay in school longer than teens addicted to marijuana, the argument is clearly fallacious. A diet of excessive calories might lead to a higher risk of obesity than a diet of cyanide, but it would foolish to say that because both diets are worse than the other in at least one way that neither is safer than the other. It should seem blatantly obvious that some drugs are safer than others. And what if Gogek’s argument holds anyway? He has simply asserted that alcohol and tobacco are just as dangerous as any illegal drug, hardly escaping the pressing question of consistency in our drug laws.
While Gogek denies that one drug is worse than another, other defenders of current drug laws busy themselves in trying to find some disqualifying criteria to establish the harmfulness of illegal drugs in contradistinction to legal ones. For example, conservative commentator Ann Coulter argued on The John Stossel Show, “I think there is a difference between [other] drugs and alcohol. People can drink wine over dinner without getting drunk, people smoke and stay up all night working. A lot of work gets done on tobacco, whereas [other] drugs are pretty much specifically just to get high.” Coulter here takes issue with the moment of temporary mental impairment while intoxicated on a drug, a moment in which one is unable to function in ordinary life and carry out daily tasks such as work. Should this mental impairment be taken into account? Certainly. And the multi-criteria analysis previously discussed does take mental impairment into account, as one of sixteen forms of recognisable harms caused by drugs. The entire harm score attributed to magic mushrooms in that report came merely from mental impairment while intoxicated – on this one measure it receives a higher score than alcohol. But despite carrying a higher harm score on this one specific measure, it is evidently clear that alcohol is worse in every other way. The harms of drug use are multivariate, so Coulter’s attempt to establish a justified demarcation between legal and illegal substances on the univariate measure of mental impairment alone simply begs the question as to why this one particular form of harm categorically trumps all others. Once again, this vacuous evasion doesn’t offer any answer to us.
Once defenders of the status quo have reached the bitter realisation that marijuana and other drugs may be less harmful than alcohol and tobacco, they may try confounding a discussion of relative risk with absolute risk. Conceding the case that alcohol and tobacco may very well be more harmful drugs than marijuana, William J. Bennett and Robert White excrete chapters of effort in their 2015 book Going to Pot: Why the Rush to Legalize Marijuana is Harming America to convince the reader that this does not mean that marijuana is harmless. “The point is this: There is no level of marijuana use that is actually completely safe,” evince Bennett and White, “Let us repeat: we have found no serious scientific or medical study that concludes marijuana use is actually safe or healthy.” Obviously. Nothing on earth is “completely safe.” People have been killed by exploding lava lamps and whipped cream cans, impaled on beach umbrellas, lit on fire by sodium covered seashells and had their skulls crushed by rocks thrown by animals in zoos. No study on anything, anywhere in the world, ought to describe of anything as being completely safe and healthy. But since when did “completely safe” become a sensible criterion for being permitted to carry out some activity in any society? Wouldn’t that obviously cripple a society? And why doesn’t this formula apply to alcohol or tobacco? The question of inconsistency remains open.
Matthew Roy Ackerman
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