Each year, millions of people use both illegal and legal drugs.

If you use drugs, or are likely to use drugs in the future, please read this.

definition: drug

noun

“a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.”

General guidelines for all substances

Test your drugs where relevant, as adulterants are common in many drugs. “My guy gets pure stuff” is a very popular but dangerous belief. A dealer knowing their stuff doesn’t tell you anything about their supply chain. Start low (dosage), go slow Have at least one friend who serves as a sober sitter, especially for first experiences with any drug Be aware of the laws where you live. Unfortunately, in many cases, the harms of criminalization of drug users substantially exceeds the harms from the drug use itself. Spend ~2+ hours researching any drug you’re considering using (reading trip reports doesn’t count) before taking it for the first time Most US states, though sadly, not all, give you immunity when the ambulance/police arrive from drug possession if you call 911 for someone who needs help. See a map of state laws here. Call an ambulance if someone needs help. Try and avoid using drugs to deal with anger or sadness.

1. Drugs - nicotine, alcohol and opioids in particular - kill thousands of people each year

Drugs Involved in U.S. Overdose Deaths. Source: CDC

Top 5 drugs by number of deaths per year in the US:

480,000 deaths per year: nicotine in the form of cigarettes 88,000 deaths per year: alcohol 60,000 deaths per year: opioids including fentanyl, heroin, codeine, hydrocodone (Vicodin), oxycodone (Oxycontin), methadone 10,500 deaths per year: cocaine 7,500 deaths per year: methamphetamine

These numbers are of course biased, because more people use alcohol than use methamphetamine.

2. Addiction and dependence rates vary wildly depending on the kind of drug

Drug Proportion of people who used outside of medical settings that become dependent Tobacco 32-68% Alcohol 15-23% Heroin 23% Cocaine 17-21% Stimulants 11% Anxiolytics (includes benzodiazepines) 9% Analgesics i.e. pain relievers 8% Cannabis 9% Psychedelics 5%

This surprised me when I read it, too. I was expecting to see that 50%+ of heroin users would become dependent, but, that isn’t the case.

3. Before you use any substance, you should research two things

How safe or dangerous is it? How does it compare to other drugs? What are the downsides? What are the upsides? If you choose to use it, how can you do so in a way that minimizes potential harms to yourself or others, and maximizes potential benefits?

As a good approximate rule of thumb, plan on doing at least 2 hours of thorough research (reading trip reports does not count) into any substance you’re considering trying, before using it. Avoid ever using substances on a whim without research beforehand if e.g. offered at a party.

Part of researching safe use will involve researching which drug combinations are dangerous.

Comparing upsides of substances

From this we can see that caffeine has a upside-downside curve that is weighted much more to the positive, in contrast to Facebook and tobacco which are weighted much more to the negative.

Note: E-cigarettes were not surveyed separately. Their upside-downside profile would likely be different compared to tobacco/cigarettes more generally.

Drugs kill thousands of people each year - we do not endorse the use and acquisition of drugs, legal or illegal. If you make the choice to use any substances, including alcohol, please do your research.

Substance % Worse without Respondents that had tried Number worse without The internet 83.4% 862 719 Psychedelics in general 80.1% 819 656 Smartphones 73.4% 848 622 YouTube 72.0% 832 599 LSD 71.9% 1023 735 MDMA (100% MDMA or high MDMA content) 67.8% 723 490 Smoked cannabis 65.7% 1316 865 Magic mushrooms 64.6% 845 546 Caffeine 63.1% 1298 819 Reddit 61.6% 856 527 Vaporized cannabis 59.1% 975 576 Television (including Netflix) 56.0% 811 454 Edible cannabis 53.2% 1074 571 Amphetamine (incl Adderall) 51.3% 874 448 DMT (N,N-DMT, the one with entities) 48.2% 432 208 MDMA (Ecstasy, purity/contents unknown) 47.9% 774 371 Porn 45.7% 851 389 Stimulants in general 44.8% 669 300 Ketamine 42.6% 516 220 Alcohol 42.6% 1297 552 Sugar (including in food) 41.9% 821 344 Kratom 36.4% 516 188 2C-B 36.2% 473 171 Benzodiazepines (Xanax, etc) 35.1% 816 286 Nitrous oxide 30.8% 591 182 Codeine 29.1% 553 161 Opioids in general 25.3% 498 126 Peyote (mescaline) 24.8% 298 74 Oxycodone 23.7% 510 121 Hydrocodone 23.7% 532 126 Tobacco (nicotine) 22.6% 1123 254 Twitter 21.7% 635 138 Cocaine (snorted) 19.9% 693 138 5-MeO-DMT (contained in one psychoactive toad and some plants) 19.0% 274 52 Facebook 15.5% 768 119 Salvia 14.3% 427 61 Methamphetamine (incl Desoxyn) 13.4% 344 46 Other 2C-x (2C-I, etc) 13.0% 324 42 Heroin 10.3% 331 34 Crack (smoked) 4.3% 301 13 Synthetic cannabis (Spice, K2, etc) 3.9% 539 21

View these results as images instead: https://imgur.com/a/ElbJh.

Comparing downsides of substances

Substance % Better without Respondents that had tried Number better without Synthetic cannabis (Spice, K2, etc) 59.2% 539 319 Facebook 55.0% 768 422 Tobacco (nicotine) 49.9% 1123 560 Heroin 43.5% 331 144 Alcohol 35.4% 1297 459 Methamphetamine (incl Desoxyn) 33.7% 344 116 Crack (smoked) 33.6% 301 101 Sugar (including in food) 33.3% 821 273 Benzodiazepines (Xanax, etc) 32.2% 816 263 Oxycodone 32.0% 510 163 Opioids in general 31.7% 498 158 Hydrocodone 29.9% 532 159 Cocaine (snorted) 28.7% 693 199 Porn 28.3% 851 241 Twitter 25.8% 635 164 Codeine 23.2% 553 128 Stimulants in general 19.1% 669 128 Television (including Netflix) 18.7% 811 152 Reddit 18.7% 856 160 Salvia 18.5% 427 79 Amphetamine (incl Adderall) 17.7% 874 155 MDMA (Ecstasy, purity/contents unknown) 17.4% 774 135 Smoked cannabis 17.1% 1316 225 Smartphones 14.5% 848 123 YouTube 12.6% 832 105 Nitrous oxide 12.4% 591 73 Vaporized cannabis 10.3% 975 100 Other 2C-x (2C-I, etc) 9.9% 324 32 Caffeine 9.9% 1298 128 The internet 9.5% 862 82 Edible cannabis 9.5% 1074 102 Ketamine 7.6% 516 39 MDMA (100% MDMA or high MDMA content) 7.5% 723 54 Kratom 6.8% 516 35 5-MeO-DMT (contained in one psychoactive toad and some plants) 6.6% 274 18 LSD 5.2% 1023 53 2C-B 5.1% 473 24 Psychedelics in general 3.3% 819 27 Peyote (mescaline) 3.0% 298 9 DMT (N,N-DMT, the one with entities) 3.0% 432 13 Magic mushrooms 2.6% 845 22

“These people must be lying to themselves - only 56.5% (100% - 43.5%) of people don’t think they’d be better off without heroin”, you say? Remember, around 77% of people who use heroin outside of a medical setting *do not* become dependent, so it makes sense why 56.5% of people who had used heroin in a survey wouldn’t be particularly concerned about it, because based on the research 77% of those who had tried it in non-medical settings wouldn’t have become dependent.

Comparing safety of substances

A paper by David Nutt compares the harms of drugs.

The blue bars (harm to users) are independent of the popularity of the drug, while the red bars (harm to society) are dependent on the popularity of the drug. Even if the same number of people used MDMA as use alcohol, their blue bars/harm to users scores would still be the same.

“Finally, we should note that a low score in our assessment does not mean the drug is not harmful, since all drugs can be harmful under specific circumstances.”

4. Sugar is considered a drug under some definitions

My understanding is that sugar has a physiological effect, and so then at least using the definition of ‘drug’ provided by Google, sugar would be considered a drug.

I used to believe that fat people were lazy, and I was a strong advocate for the ‘calories in, calories out’ model, where all you need to do to lose weight is to eat fewer calories than you burn.

I now believe it’s not so simple. The things that changed my mind were:

Sugar dependence seems to be very real. I’ve talked with someone who struggled from sugar dependence, and their sugar dependence seemed to cause them immense pain and heartache, and they had extreme difficulty finding effective treatments.

5. Safety information to read first if you’re likely to use specific substances

Opioids, benzos, crack, meth, alcohol, tobacco, or spice

Think about re-considering. These are the substances which the highest percentage of people who believe their life would be better if those substances didn’t exist.

Also, tobacco seems to have the highest rate of dependence of all drugs, with 32-68% of people who use tobacco once ending up dependent on it. Even heroin is substantially lower, with 23% of people who use heroin at least once outside of a medical setting becoming dependent.

For people who have used alcohol or nicotine (cigarettes) in the past 12 months, it’s even worse - 50% (!) of people who used alcohol in the last 12 months in this study were clinically defined as alcohol dependent, and 80% of people who used nicotine in the last 12 months were defined as nicotine dependent.

Opioids

Watch this: The Drug Classroom.

Readings: One, two, three, four, five, and finally six (more thorough). Information for friends of opioid users: one.

Crack

Readings: crack harm reduction.

Benzos

Video:

Websites:

Alcohol

Watch: Alcohol - The Drug Classroom

Read: alcohol harm reduction, this, and another guide.

Methamphetamine

Watch: Meth - The Drug Classroom

Cocaine

Watch: this video

Read: this, this awesome guide, this and this

Tobacco

Watch: Tobacco - The Drug Classroom

Spice

Read: this PDF about Spice/K2 harm reduction.

Other stimulants such as Adderall, Vyvanse, Ritalin, Amphetamine

Watch: Adderall - The Drug Classroom

Read: This guide, this, AddySafe, this and this

Caffeine

Watch: Caffeine - The Drug Classroom.

Readings:

MDMA

Watch: MDMA - The Drug Classroom.

Read: How to Take MDMA - RollSafe.

LSD, Shrooms, other Psychedelics

Watch: Psilocybin (Mushrooms) - The Drug Classroom.

Read: How to take LSD and how to take Shrooms, and this guide on LSD

Ketamine

Watch: Ketamine - The Drug Classroom.

Read: Ketamine - DrugScience and this great set of ketamine harm reduction strategies, and this guide, and this

Salvia

Read: Salvia - TripSafe and Salvia - DrugScience. This list of supplements for reducing anxiety is meant for classic psychedelics but should apply to salvia also.

Sugar

Listen to this podcast episode by Robert Lustig.

Limit intake to 10% of calories - on average, this would mean less than 50g total sugar per day for women, and less than 63g total sugar per day for men.

Facebook, Twitter

Read this article about app addiction.

If you need help, try:

Cannabis

Just because a substance has exceptionally low risk of acute harm doesn’t mean that you won’t learn useful things from a small amount of research!

For smoked cannabis, read: this guide. If you get anxiety when smoking, this list of supplements for reducing anxiety is meant for classic psychedelics but should apply to cannabis also.

For edibles, read: edibles guide by TripSafe and this guide.

Generally, read this.

References