Towards a Culture of Responsible Psychoactive Drug Use

Psychoactive drugs are everywhere. Any discussion of drug use needs to take this into account. The broad category of “psychoactive drugs” consists of natural and synthetic substances that alter a person’s thoughts or feelings. There exist hundreds of plants, which, if eaten, smoked, snorted, or injected, will affect the mind—whether acting as a stimulant, depressant, or psychedelic. Thousands of known chemicals will do the same. Used recreationally, medicinally, or for work, some are illegal and others not: They include coffee, wine, and tobacco; prescription pain medications, sleep aids, and antidepressants; as well as cannabis, LSD, and heroin. Psychoactives are in the kitchen, in the hardware store, in the greenhouse, in home medicine cabinets, and in fuel tanks across the country.

Everyone uses them. Would you believe that nearly 90% of 45-year-olds in the United States have tried an illegal drug in their lifetime?[1] As of 2006, more than 35 million Americans had taken an illicit drug in the previous year.[2] Monitoring the Future (MTF), the best current survey about illegal drug use in the United States,[3] reports that one in five college students used an illicit drug in the past month. Nearly all adults in the U.S. have tried alcohol, while over 80% use caffeine daily.[4] Last year there were over 180 million prescriptions written for opiates alone,[5] and a diverse assortment of psychoactives are increasingly used by older Americans from coast to coast.[6]

They are not going away. Humans have used psychoactive substances for as long as we have records[7] and some of the largest corporations in the world are actively developing new ones for the future. There is no magic bullet that will suddenly make these compounds disappear from our society. If there were, the past century of ever-increasing penalties for possession and sale of recreationally used drugs, along with massive anti-drug “education” campaigns, would have reduced use. But they have not.

The United States has implemented random drug testing of junior high and high school students who participate in chess club. No-knock warrants allow police to invade private homes with guns drawn in case a suspect might try to flush illegal drugs down the toilet. Taxpayers spend 8 billion dollars each year to incarcerate drug law offenders,[8,9] and pay for ideologically driven, abstinence-only education programs that are so factually misleading that they often fail to acknowledge the pleasurable or useful effects of the substances they teach about.

Despite these extreme measures, a majority of the population age 18-65 has chosen to try an illegal drug.[10] The mainstream reaction is to continue the calls for “getting tougher.” Instead of working towards unrealistic, naïve goals such as a “drug free century,” our response has been to step back and reassess, asking: How can society adapt to the realities of the communication age and develop more sophistication and balance regarding the use of psychoactive drugs?

Modern humans must learn how to relate to psychoactives responsibly, treating them with respect and awareness, working to minimize harms and maximize benefits, and integrating use into a healthy, enjoyable, and productive life. But above all else, in a world filled with materials and technologies that affect the mind, adults must have the robust education and accurate, pragmatic information necessary to help them take charge of their relationships with psychoactives and teach their children how to do so from an early age.

EVERYONE MAKES CHOICES

Many people would agree that drug culture reform is needed, but we must recognize that “the drug culture” now includes everyone. Modern life involves daily decisions about psychoactives. The option of caffeine use is encountered multiple times a day. It is rare to watch an hour-long television show without seeing an advertisement for a mind altering pharmaceutical or a legal recreational drug. Late night coverage of the 2008 Summer Olympics was sponsored by Ambien, a popular sleep aid with memory-scrambling side effects whose commercials enticed audiences nationwide with comforting images of dreamy, refreshing, sedative-assisted sleep. A large portion of the population is exposed to the possibility of taking LSD, even if only 10-20% ever try it.[11,12] In today’s world, everyone must choose how they relate to innumerable psychoactive drugs. Whether or not one decides to use a specific drug, that decision should be made with skill, knowledge, and self-awareness, supported by accurate information.

Struck by the quantity and complexity of choices being made about psychoactives, and dismayed by the poor quality of accessible information, in 1995 we began a project called Erowid. Dedicated to providing an online library of information about psychoactives to the public through its website Erowid.org, the project has grown to serve over 60,000 visitors per day.[13] In 2008, Erowid became an educational 501(c)(3) non-profit under the name Erowid Center.

In thirteen years of learning about both legal and illegal psychoactives, we have collected over 30,000 documents and 75,000 self-reports that catalog the choices people make and provide insight into the results of those choices. These reports include everything from pedestrian recreational use to life-changing spiritual experiences and personal tragedies. We have also learned that there are many subcultural niches in which responsible use of psychoactive drugs is taken very seriously. These communities disapprove of recklessness, and consider care a top virtue, regardless of whether use is for recreational, medicinal, self-improvement, work-productivity, or spiritual purposes.

WHAT DOES RESPONSIBLE USE LOOK LIKE?

“Know your body. Know your mind. Know your substance. Know your source.” One of Erowid’s earliest slogans, this directive encourages people to pay close attention to multiple aspects of their psychoactive substance use. These include understanding the individuality of response; avoiding drugs contraindicated because of health issues; learning enough about each substance to avoid unexpected effects and overdoses; and choosing both substance and information sources carefully in order to reduce risks. While these principles may seem obvious, they are seldom taught in contemporary drug education.

Alcohol is a good case to study, as its use is accepted in our culture and is not illegal for those over 21. Yet healthy and pragmatic drinking practices are seldom taught by parents, schools, or the government. By the time young adults reach the legal drinking age in the United States the vast majority of them have already consumed alcohol. In 2006, according to the National Survey on Drug Use and Health, the average age at which Americans first tried alcohol was 16.5, with only one in ten waiting until they were legally of age to drink.[14] And they haven’t just had a sip; nearly 40% of 20-year-olds have gotten drunk in the last month.[15] The opportunity to teach responsible use of alcohol—the most commonly consumed and arguably one of the most dangerous strong psychoactives[16]—is missed. The situation is much worse for controlled substances.

Teaching responsible, intentional use to young people does not require giving detailed instructions on how to use illegal psychoactives. The general principles can be taught through education about prescribed medications, alcohol, or other legal drugs. There are many practical lessons about how to safely and responsibly use psychoactives, whether learned from personal subjective experience, research, or the hard-won wisdom of others.

Fundamentals of Responsible Psychoactive Use

Investigate the health risks and dangers of the specific psychoactive and of the class of drugs to which it belongs.

Learn about interactions with other recreational drugs, medications, supplements, and activities.

Review individual health concerns, predispositions, and family health history.

Choose a source or product carefully to help ensure correct identification and purity



(avoid materials with an unknown source or of unknown quality).

(avoid materials with an unknown source or of unknown quality). Know whether the drug is likely to reduce the ability to drive, operate equipment, or pay attention to necessary tasks.

Take oneself “off duty” from responsibilities that might be interfered with (job, child care, etc.), and arrange for someone else to be “on duty” for such responsibilities.

Anticipate reasonably foreseeable risks to oneself and others and employ safeguards to minimize those risks.

Choose an appropriate occasion and location for use.

Select and measure dosages carefully.

Begin with a low dose until individual reactions are known and thereafter use the minimum dose necessary to achieve the desired effects: lower doses are safer doses.

Reflect on and adjust use to minimize physical and mental health problems.

Note changes in health over time that may be related to use.

Modify use if it interferes with work or personal goals.

Check in with peers and family and accept feedback about one’s use.

Track reactions to specific drugs and dosages in order to avoid repeating mistakes.

Seek treatment if needed.

Decide not to use when the time isn’t right, the material is suspect, or the situation is otherwise problematic.

People are usually willing to modify their behavior to reduce harms and increase benefits. Just as most of those who drink alcohol prefer to avoid hangovers and dangerous levels of consumption (so long as they can still enjoy alcohol’s intoxicating effects), most users of other psychoactive drugs would also happily take steps to minimize risks. In a pilot paper looking at the impact of web-based data about psychoactive substances, Boyer et al. found that:

”[…] all respondents in our cohort modified their drug use after reviewing online drug information. This observation suggests that the Internet has a profound ability to affect decisions related to psychoactive substance use in a cohort of innovative drug users. Interestingly, 8 of the 12 participants adopted behaviors intended to minimize the risks associated with drug use, a finding that suggests that attempts to reduce the harm associated with psychoactive substances are fostered by online information.”[17]

Some might argue the same point that professor Mark Kleiman makes in his book Against Excess: “The fact that some people can use a drug responsibly and even beneficially does not imply that it is safe. We all know people who drink and take no harm from it, and we all know people whose lives have been wrecked by alcohol.”[18] But as Kleiman also notes, just because some people do not work to minimize risks and use a drug dangerously or to their own detriment does not mean that is true of everyone who tries it.

OBSTACLES TO RESPONSIBLE USE

Unfortunately, some actions that are part of a responsible relationship with psychoactives can also expose individuals to social and legal problems if applied to illicit drugs. Current policies and programs pose complex challenges for those wishing to use these substances as conscientiously and safely as possible.

Twentieth-century drug control policies were largely based on the idea that prohibition was the most effective way to reduce problems associated with psychoactive use. Disturbingly, prohibitionist policies have compromised individual responsibility as well as the integrity and objectivity of education, medicine, and science.

One of the fundamentals of responsible use is to know the identity and purity of psychoactives that are consumed. Yet current policies make it difficult to be sure that materials purchased on the black market are pure or even correctly identified. For example, the Drug Enforcement Administration (DEA) prohibits most testing that would help identify street drugs. Erowid Center operates the only public ecstasy testing program in the United States (www.ecstasydata.org). However, the program is hamstrung by a 1974 DEA policy that prohibits laboratories from providing quantitative data about anonymously submitted samples of controlled substances—a policy that was enacted out of concern that such testing would provide “quality control” for the black market.[19] When forced by circumstances, most people will use illicit psychoactives without quality control. The DEA’s censorship policy is an ineffective control strategy, which stands in the way of responsible use and public health, and which gives the DEA exclusive access to information about the contents of black market drugs.

Clearly, the population should be educated about the potential harms associated with psychoactive use, but providing any other, more practical information is heretical and potentially criminal. Our government explicitly discourages nuanced education about psychoactives.[20] For example, for state-funded programs related to illicit drugs or alcohol, California legislates that “No aspect of the program may include a message on ‘responsible use.’”[21] Media campaigns and educational materials almost universally share a single target message, prioritizing a decrease in use over accuracy and balance. Further, many web filtering systems, including those employed by hospitals and schools across the country, explicitly censor sites such as Erowid.org because they provide useful information.

While physicians are the primary experts available to give medical opinions about drug-related health issues, current policies cause many psychoactive users not to seek treatment or advice. Those who do so may risk legal trouble, insurance problems, and disclosure of their use to employers and family. Teens, faced with a friend who has overdosed, often hesitate to call an ambulance for fear of serious repercussions; they are well aware that physicians and the health care system can not be trusted as confidants or allies when it comes to psychoactive drugs. It is important for the public to have access to the sort of personalized medical advice that is only available when they can talk to their physicians without fearing the consequences.

Current policies also skew the science. With over a billion dollars per year in public financing, the National Institute on Drug Abuse (NIDA) funds 85% of the world’s research on recreational drugs.[22] However, it is narrowly dedicated to studying “the addictive and adverse health consequences of drugs of abuse.”[23] NIDA’s mandate artificially stacks the deck with findings that show negative effects. Policy makers, judges, and even experts in the field can draw mistaken conclusions from this imbalanced collection of research, leading many to dismiss responsible use as an unreasonable objective.

PRECISE LANGUAGE

Developing and promoting more sophisticated language, thereby learning to better discriminate between different types and classes of drugs, is the first step towards a culture of responsible use. Unfortunately, it is common for those on the national stage to use the unqualified term “drugs” when discussing psychoactive substances, as if everyone knows exactly what is meant. But cannabis is not oxycodone, nor do stimulants behave like depressants.

This “drugs” meme has done long-term damage to the public’s critical thinking skills due to the unspoken assumption that everyone knows which drugs are the bad ones. Certainly they’re not talking about ibuprofen, and probably not coffee—but how about Viagra, Prozac, or dextromethorphan (a common ingredient in cough medicines, also used recreationally)? One often hears that people should not drive while on “drugs,” but this is much truer of depressants and psychedelics and less true of stimulants. The right dose of caffeine or amphetamine has been shown to improve driving, especially among tired individuals[24,25]—a fact well known to long-distance drivers and the U.S. military.[26] Specificity in language is necessary for making good personal decisions, teaching others, and drafting appropriate laws. Not everyone has to be an expert on all psychoactive drugs, but we do need to be critical thinkers.

EDUCATION AND ACCURATE KNOWLEDGE

Responsible psychoactive use requires access to accurate, detailed, and practical information. Education is more important than changes to control policies or social reform. Those who choose to use caffeine, cannabis, LSD, amphetamine, Ritalin, or heroin need to know how much is too much, which drugs might interact dangerously, and how to minimize risks and optimize benefits. People need to be trained to seek this information and to put it to use.

As Boyer et al. found, people are willing to modify their behavior in order to reduce risks, but this is only possible if they know what the actual risks are. Unfortunately, there are severe problems with partisan, policy-driven information sources. While the quality of government-sponsored sources has improved over the last decade, sites such as Freevibe.com, a youth-oriented website funded by the federal government, still include laughable exaggerations like “heart and lung failure“[27] as a general effect of hallucinogens—a deceptive claim they have made for more than eight years. Scientific literature reviews on the most common hallucinogens do not support their claims; most recently, Johns Hopkins researchers found that, “hallucinogens generally possess relatively low physiological toxicity and have not been shown to result in organ damage.”[28] Once people realize that a source is deceptive, as is the case for those teens visiting Freevibe who know someone who has tried LSD or psilocybin-containing (“magic”) mushrooms, they will be inclined to distrust all information from that source.

Public information sources should prioritize accuracy and completeness over maintaining a single, politically driven message. It is inconsistent with the democratic ideals of American culture to corrupt information in order to support public policies. The issues are complex and sources should reflect that.

In government-sponsored information, the benefits of disapproved drug use are absent, a void obvious to all but the least curious reader. Individuals try psychoactives largely based on the belief that they will be beneficial in some way: fun, enlightening, anti-depressive, anxiolytic, inhibition-reducing, etc. A recent study has confirmed what many users of “magic” mushrooms have described for decades: In the right context, the effects can be profound and can improve quality of life. According to the researchers, “67% of the volunteers rated the experience with psilocybin to be either the single most meaningful experience of his or her life or among the top five most meaningful experiences of his or her life.”[29]

While there is no question that the specialized, supportive circumstances of this research made positive reactions more likely and reduced the chance of negative outcomes, the findings are also consistent with a large survey conducted on Erowid.org in 2005 that asked about the life impact of LSD use. With nearly 50,000 valid responses, 53.4% of those who reported having taken LSD said that it had affected their life positively, compared to 3.4% who said it had a negative impact (21.9% reported “no effect,” 17.2% reported a “mix of positive and negative effects,” and 4.1% did not answer or didn’t know).[30] As of September 2008, none of the top government-funded public drug information websites had a single mention of any benefit associated with psilocybin.[31]

Misrepresentation and oversimplification in this complex field of study damage society’s ability to engage in accurate and honest dialog about issues that affect everyone’s daily lives. When private or government-sponsored prohibitionist organizations are found untrustworthy, people seek information elsewhere. Unfortunately, advice provided by peers about the risks and benefits of recreational drugs can also be of dubious value. Teenagers, especially, can not provide each other with the quality of information they need and deserve.

Public educational resources need to provide comprehensive, honest information in order to be worthy of trust. To climb out of the well of distrust our culture has dug, students, teachers, parents, law enforcement officers, medical professionals, marginalized subcultures, and the general public all need to look to the same libraries, rely on the same sources, and expect balance and neutrality in the reporting of scientific findings. Establishing a culture of responsible use—built on a foundation of unbiased, factual information—is essential to the practical long-term management of psychoactives in our society.

[Conflict of Interest Disclosure: This article was written partially under the influence of oolong tea, diet cherry Coke, and California chardonnay.]

Fire and Earth Erowid are the co-founders of Erowid Center, an IRS-approved 501(c)(3) non-profit educational organization which runs Erowid.org, an online library of information about psychoactive plants and chemicals.

References

[1] Johnston LD, O’Malley PM, Bachman JG, et al. “Monitoring the Future National Survey Results on Drug Use, 1975-2006. Vol II.” NIDA. 2007. 98.

[2] SAMHSA. “Results from the 2006 National Survey on Drug Use and Health: Appendix G.” 2007. Table G.3.

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

[4] Griffiths RR, Mumford GK. Caffeine: A Drug of Abuse? in Psychopharmacology: The Fourth Generation of Progress. Edited by Bloom FE, Kupfer DJ. New York, Raven Press, 1995.

[5] Volkow ND. “Statement on Scientific Research on Prescription Drug Abuse before the Senate Judiciary Subcommittee on Crime and Drugs.” Mar 12, 2008.

[6] SAMHSA. “Older Adults: Substance Use and Mental Problems.” http://www.oas.samhsa.gov/aging.cfm Accessed Sep 4, 2008.

[7] Erowid. “Alcohol Timeline.” Erowid.org . Jul 9, 2006. Available from http://www.erowid.org/alcohol/alcohol_timeline.php. Accessed Sep 2, 2008.

[8] Drug War Facts. “Prisons, Jails and Probation – Overview.” drugwarfacts.org . Aug 1, 2008. Available from http://www.drugwarfacts.org/prison.htm. Accessed Sep 2, 2008.

[9] Federal Register . Jun 6, 2007;72(108):31343. http://cryptome.org/bop060607-2.htm.

[10] Substance Abuse and Mental Health Services Administration (SAMHSA). “Results from the 2006 National Survey on Drug Use and Health: Detailed Tables.” 2007. Tables 1.11A.

[11] Substance Abuse and Mental Health Services Administration (SAMHSA). “Results from the 2006 National Survey on Drug Use and Health: Detailed Tables.” 2007. Tables 1.1+.

[12] Johnston LD, O’Malley PM, Bachman JG, et al. Monitoring the Future National Survey Results on Drug Use, 1975-2006. Vol II.” NIDA. 2007. 108.

[13] Erowid. “The Distillation: Erowid Traffic Statistics.” Erowid Extracts. Jun 2008;14:25.

[14] SAMHSA. “Results from the 2006 National Survey on Drug Use and Health: National Findings.” Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293. 2007.

[15] SAMHSA, Office of Applied Studies, “National Survey on Drug Use and Health.” 2002, 2003, 2004, 2005, and 2006. http://oas.samhsa.gov/NSDUH/2k6NSDUH/AppG.htm#TabG-20. The statistic comes from the survey’s definition of binge drinking, namely consuming five or more drinks on a single occasion.

[16] BBC News. “Scientists Want New Drug Rankings.” news.bbc.co.uk. Mar 23, 2007.

[17] Boyer EW, Shannon M, Hibberd PL. “The Internet and psychoactive substance use among innovative drug users.” Pediatrics. 2005;115(2):302-5.

[18] Kleiman MAR. Against Excess: Drug Policy For Results. Basic Books. 1992. 386.

[19] “Effectiveness of Drug Analysis Curbed.” The PharmChem Newsletter. 1974;3(4):1.

[20] Safe and Drug Free Schools and Communities Act. U.S. Code, Title 20, Ch. 70, Subch. IV, Pt A, Subpt 4, § 7162.

[21] California Health and Safety Code Sections 11999.2 and 11999.3.

[22] National Institute on Drug Abuse. “NIDA Research Identifies Factors Related to Inhalant Abuse, Addiction.” Sep 28, 2004. http://www.drugabuse.gov/Newsroom/04/NR9-28.html. Accessed Sep 2, 2008.

[23] Volkow ND. “Statement by NIDA Director Nora D. Volkow. Nida.nih.gov. Jul 11, 2006. http://www.nida.nih.gov/about/welcome/messagepsilocybin706.html. Accessed Sep 2, 2008.

[24] Silber BY, Croft RJ, Papafotiou K, et al. “The acute effects of d-amphetamine and methamphetamine on attention and psychomotor performance.” Psychopharm. Aug 2006;187(2):154-69. http://www.ncbi.nlm.nih.gov/pubmed/16761129.

[25] Michael N, Johns M, Owen C, et al. “Effects of caffeine on alertness as measured by infrared reflectance oculography.” Psychopharm. Jun 9, 2008. http://www.ncbi.nlm.nih.gov/pubmed/18537025.

[26] Borin E. “The U.S. Military Needs Its Speed. Wired. Feb 10, 2003.

[27] Freevibe. “Drug Information: Hallucinogens.” http://www.freevibe.com/Drug_Facts/drug_info.asp. Accessed Sep 2, 2008.

[28] Johnson MW, Richards WA, Griffiths RR. “Human hallucinogen research: guidelines for safety.” J Psychopharm. Aug 2008;22(6):603-20.

[29] Griffiths RR, Richards WA, McCann U, Jesse R. “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” Psychopharm. Aug 2006;187(3):268-83.

[30] Erowid F, Erowid E. “Erowid Visitors on LSD.” Erowid Extracts. Jun 2006;10:10-12.

[31] Sites searched on September 3, 2008 included Freevibe.com, AboveTheInfluence.com, TheAntiDrug.com, MediaCampaign.org, and WhiteHouseDrugPolicy.gov.