Drug Abuse

[Ensign_Edison]

@inkleberry

Gar! This is getting very lame! Drugs a bad idea! Cocaine is immensely stupid! If any thing whether coke, alcohol, toothpaste, coffee, or crossword puzzles gets you in trouble at work, home or school, and you spend a lot of time figuring out when and how you’ll get your next one, you have a problem.

Just say no. Live like a buddhist monk with only one robe and a bowl and no posessions or vices and things will be just fine. Boring and distinctly lacking in fun, but fine.

Once again, you’re showing your bias by going immediately from “any use” to “use which gets you in trouble”. It is a fact that people can use cocaine without getting in trouble with it, or addicted to it. They may use it only rarely, or semi-regularly without incident. Is it your contention that a person who uses cocaine once a year on their birthday for 23 years - as someone in my acquaintance has done - without becoming addicted or ever having problems as a result is an addict/abuser/immensely stupid person? This person would be disqualified from being seen by you, as a recreational user - why?
Or is your contention merely that such a person is an outlier? I believe evidence has already been presented in this thread that the latter is not the case, that people who use without a problem are statistically significant.

You asked someone else to “move this hijack”, but I don’t see how this discussion isn’t perfectly relevant to the question at hand - we are in fact trying to define the line between use and abuse. You have stated that it is set in one place and some of us believe it is set in another.

This might be better off in GD, though.

A personal note: I hate cocaine and I hate cocaine people, even casual recreational ones, when there is cocaine around. I think it’s a nasty drug. I believe I have an excellent reason for feeling this way, as I was raised by cokeheads. But I still think even with cocaine there is a line between use and abuse, because that is what the facts tell me. This is just an aside to respond anyone reading who might think that those of us insisting there is indeed a real, practical difference even with ‘harder’ drugs just must not have any experience with users.

[Kalhoun]

@copperwindow

I drink a glass or two of wine a day. It’s intended use is to protect my heart.

That’s YOUR intended use. The intended use of the manufacturing of alcoholic beverages is to get a buzz. A happy side-effect is that it’s good for your heart.

[copperwindow]

@Kalhoun

The intended use of the manufacturing of alcoholic beverages is to get a buzz.

It is? Well, this is all news to me. I have a recipe here a nice steak sauce and it calls for whiskey. If I call the friendly folks at Jack Daniels and ask them what their prodect’s intended use is, will they tell me it’s to get a buzz?

[Kalhoun]

@copperwindow

It is? Well, this is all news to me. I have a recipe here a nice steak sauce and it calls for whiskey. If I call the friendly folks at Jack Daniels and ask them what their prodect’s intended use is, will they tell me it’s to get a buzz?

If they didn’t they’d be lying. Steak sauce is another nice secondary use for booze. And the alcohol is cooked off anyway so it doesn’t count.

[copperwindow]

@Kalhoun

The intended use of the manufacturing of alcoholic beverages is to get a buzz.

How would I go to determine what other products intended uses are? Such as bleach. I can’t just go ask the makers for fear of them lying to me. I’ve been using rubber bands to tie my hair back for years, I don’t know what I would do if one day I found out that I was using them for a purpose other than their intended use!

[II_Gyan_II]

Thread Abuse? Has copperwindow relapsed?

It is expected, yet disappointing when politicians ignore the advice of their own appointed investigaters, but that’s precisely what’s happened with the term ‘drug abuse’.

In 1970, President Nixon assembled a ‘National Commission on Marihuana and Drug Abuse’. They produced a few reports, one on marijuana recommending depenalization of possession. Their last report (1973) was Drug Use In America: Problem in Perspective

From its introductory chapter

Drug abuse is another way of saying drug problem. Now immortalized in the titles of federal and state governmental agencies (and we might add, in our own), this term has the virtue of rallying all parties to a common cause: no one could possibly be for abuse of drugs any more than they could be for abuse of minorities, power or children. By the same token, the term also obscures the fact that “abuse” is undefined where drugs are concerned. Neither the public, its policy makers nor the expert community share a common understanding of its meaning or of the nature of the phenomenon to which it refers.

The Commission has noted over the last two years that the public and press often employ drug abuse interchangeably with drug use. Indeed, many “drug abuse experts,” including government officials, do so as well.

. . .

The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong. Continued use of this term , with its emotional overtones, will serve only to perpetuate confused public attitudes about drug-using behavior.

Drug abuse, or any similar term, creates an impression that all drug-using behavior falls in one of two clear-cut spheres: drug use which is good, safe, beneficial and without social consequence; and drug “abuse” which is bad, harmful, without benefit and carrying high social cost. From either a descriptive or an evaluative standpoint, the matter is much too complex to be handled in such a polarized fashion. The Commission urges that the public and its policy makers avoid such labels and focus instead on the relative risks and social consequences of various patterns of drug-taking behavior.

[CC]

Much as I find it difficult to commend anything that came from President Nixon’s era, the quoted material is quite remarkable in its directness and correctness. They were right then and they are still right. And, the poster is correct that it’s a shame that such recommedations are not followed. It’s not, however, unremarkable that the government ignores the recommendations of its own committees, commissions, or policy-making bodies. It is probably the rule rather than the exception. xo, C.

[msmith537]

I don’t agree with these moral absolutists who say that any drug use is bad and abusive. A guy who does coke or drinks three times a year certainly has his drug use under control.

The problem is that drug and alchohol use is insideous. People who drink tend to hang out with other people who drink. People who do coke or pot like to hang out with other people who share their vices. It creeps into more and more of their lifestyle. Your weekends focus on getting smashed.

That said, there does seem to be a difference between people who use drugs and people who abuse them. I like to drink a lot. I hang out with a lot of friends who drink. But I generally have a limit where I’m like “ok…all done” and I go home. I have a few friends, however, who when they drink, get completely smashed. We’re at a company function and they’re passing out or acting like a jackass on the dance floor. It’s like they lack that little voice that says “ok…you don’t have to go home but you can’t stay here”.

[CC]

It’s the same thing with hammers. If you let a guy buy a hammer, the next thing you know he’s hammering a few nails into some wood. Before you know it, he’s hammering nails all day. Some guys find ways to hammer nails morning to night. I know a guy who hammers nails almost every day. I get concerned about guys like that. There are people who have hammers and only hammer nails once in a while, but most guys who own hammers use them a lot. I think the government should control hammers. Maybe even outlaw them completely. Or if not, at least tax them heavily to see that only the people who really need them get them. It’s not that guys can’t control themselves, but hammers are designed with handles that fit the hand in such a way that make them perfect to hold and anyone who has ever held one tends to move it in a swinging way. They are simply dangerous and people can’t be trusted to control themselves around them. They are inherently dangerous. And mixed with nails they are a combustable combination. There have also been cases in which they were used to harm people, even though that’s not what they are designed for. If it were up to me, they’d be banned altogether.

[gabriela]

I found the initial few posts here interesting for a different reason than the argument which occupied most of the subsequent posts. (The argument has its own interest.) The reason was that IAAD, although only a doctor of dead people, and I use these words on a weekly basis, but it never occurred to me to think about the line between use and abuse. Now you would think that of all doctors, I have the easiest job diagnosing “abuse”, since if it killed you, surely it pushed you all the way down that continuum of negative outcomes that Shagnasty described. But it turns out that doesn’t jibe with my actual word usage. Abusage.

I am now in agreement with a number of people, including the wonderful 1973 excerpt from the Nixon commission, that says they’re used almost interchangeably. I would add that one uses “use” when one wishes to show that a drug has been taken, and “abuse” when one wants to add a flavor of derogation or blame.

Specifically on death certificates. Suppose I got a guy who’s 33, at autopsy has a perfectly normal heart, and he comes back with cocaine on board. I know there’s no level of safe cocaine (because if it causes death in small amounts, it does so by triggering a ventricular arrhythmia, which is unpredictable; a dose which you’ve survived two hundred times over ten years can kill you the nex time). After review of the case and the microscope slides and all the ancillary studies, the only conclusion I can come to is that the cocaine killed the guy. So what do I write on the death certificate?

“Acute cocaine toxicity” for the cause of death. Under the box marked, “How death occurred,” I have written interchangeably as the whim takes me, “Abused cocaine” and “Used cocaine.”

Hunh.

[gabriela]

I keep forgetting to bold Shagnasty’s name. It’s not out of disrespect.

[gabriela]

@copperwindow

Why doesn’t the very nature of cocaine defy an acceptable level? It is the number one cause of heart attacts for people between the ages of 16-49. It’s extremly toxic to the heart. Are you implying that it doesn’t get in the way of your health if it doesn’t kill you??

I need a cite for this, copperwindow. Let me tell you why.

In my jurisdiction, all people who die suddenly and unexpectedly whether in the ER, at home, or outside the home, are referred to the medical examiner. All the people below 49 are autopsied (except for a small subset between 45 and 49 with very obvious and well established disease, or injury which makes cause of death obvious). All dead people falling under the jurisdiction of the medical examiner who are not autopsied have blood drawn. All decedents below 60 who have blood drawn have it tested for cocaine. (And some who are over 60, but all below 60.)

I see a hell of a lot more heart attacks due to hypertensive and atherosclerotic cardiovascular disease than I do to those triggered by cocaine. Lots more. Way more. I cannot give you a cite at this moment as I’m at home, but if you need me to, when I get back to work I can count the numbers up.

In fairness to you, my early training I saw more cocaine-related heart deaths than I am seeing now, and maybe your quote is old. But I think it’s either out of date, or wrong. Sorry.

[gabriela]

And not to hammer you, copperwindow, but I disagree that cocaine is extremely toxic to the heart. Yes, it can trigger ventricular arrhythmias at no predictable dose, and if it does that to you, you’re dead, barring extremely rapid EMS response and a big dose of luck. But it is a neurotransmitter analog, and as such, it exerts its effects by combining with a receptor on cell membranes, which endogenous molecules are intended to trigger. That’s not toxic. Then it disappears completely once it has been cleared from the bloodstream, likely leaving no permanent effects behind. So I cannot agree with you that it is a toxin.

There is only one literature-supported area of heart damage I can think of for cocaine, and this is based on ten-year-old research. Wonderful study in Texas (where else could they do this stuff?) where they put a bunch of volunteers on exercycles, got them cathed and wired up to test their coronary arteries, and then gave them cocaine up their noses. (I wonder did they pay the volunteers, or did the volunteers pay them.) The stated purpose of the research was to find out if cocaine up the nose in nasal surgery endangered the heart. The unstated purpose seemed to me to be to fiind out if recreational cocaine use endangered the heart.

Interesting finding. Cocaine, while it functions as an analog neurotransmitter, is a paradoxical inotrope. (Paging Qadgop the Mercotan - QtM, are you in the house?) This means that it makes your heart beat harder, but narrows your coronary arteries while it does so. Note, Copperwindow, that this does not cause permanent damage to the heart, even if it’s temporarily trying. Not a toxin by my definition (think snake venom).

The interesting thing was this. Usually, we think of a dangerous arterial narrowing as one that’s over 75%, although with plaque fissuring, we have learned that even a 35% coronary artery stenosis (narrowed spot) can lead to a heart attack in unlucky people. However, in these volunteers, even a 10% stenosis caused a much more significant temporary narrowing of the coronary artery while under the influence of cocaine. (The temporary narrowing is due to muscle cells in the outer coat of the artery constricting to narrow it down, because the muscle cells are responding to the fake neurotransmitter in their membranes, which is how cocaine exerts its paradoxical inotrope effects. The heart cells also respond by contracting harder than normal. That’s how it makes your coronaries narrower and your heart work harder. But that’s a completely temporary effect, not like deposits of atherosclerosis.)

The researchers theorized that maybe the cells that line cornary arteries, the endothelial cells (paging KarlGauss, are you in the house), normally secrete a substance which counters the effects of the fake neurotransmitter cocaine, but that when they are stretched across even a small atherosclerotic plaque, they can’t.

That was speculation on their part to explain their observed data, and I never followed up the article to see if they went on to prove that.

Still, even coronary artery narrowing, if it does not bring on a thrombosis on the stenosis, is a completely temporary effect on the heart, and does not qualify for what I would call toxic.

By the way, I am not a cocaine user (have never been), and I see people who die from it monthly if not weekly.

Sorry for the string of posts - interesting topic, and I seem to be the only one up this early on a Saturday morning.

[aldiboronti]

Simple…

Drug use is what you do; drug abuse is what someone else does.

[indecisive1]

@gabriela

word usage. Abusage.

That was a great thread. Did it ever make threadspotting? I was on the OPs side but didn’t dare post because I was afraid I’d use a poorly structured sentence. Or spell something wrong.

gabriela can you tell how often someone has used a drug? Do you think you’ve ever had someone die from their first use of a drug? In that case did you list whatever drug use? And if they are all scummy and worn down looking then list abuse? I imagine that that is what I would do.

A problem I see with using the idea of abuse being defined by something that interferes with important parts of life is who gets to decide what is important in life, and who gets to decide if those things are being interfered with?

I guess I agree with the government commision statement that was posted.

[CC]

@gabriela

So what do I write on the death certificate?

“Acute cocaine toxicity” for the cause of death. Under the box marked, “How death occurred,” I have written interchangeably as the whim takes me, “Abused cocaine” and “Used cocaine.”

Hunh.

It seems to me that you have actually answered your own question. You have to write in to the box “How death occurred” “Used cocaine,” particularly since you have said that a person can use it 200 times and survive it and use it once and die. All you know is that they used it. Seems fair and non-judgmental to me.

[gabriela]

@indecisive1

gabriela can you tell how often someone has used a drug? Do you think you’ve ever had someone die from their first use of a drug? In that case did you list whatever drug use? And if they are all scummy and worn down looking then list abuse? I imagine that that is what I would do.

No, I can’t. I can’t even tell if they took a whopping dose several hours ago, or a teensy dose several minutes ago.

When I see that someone dead is all scummy and worn down looking, I never know to what to attribute it. Maybe it’s being strung out on meth. Maybe it’s depression. Maybe it’s homelessness. Maybe it’s a choice because all they care about is their violin concerto. So I don’t attribute it to drug abuse.

A rare exception is excited delirium, or cocaine psychosis, which requires many days or more likely weeks of cocaine abuse. But then it’s not the drug level in the blood that tells me so. It’s the rectal temperature, and the report of the behavior before dying - acting insane, breaking glass, lying down in the road, etc.

[gabriela]

@CC

It seems to me that you have actually answered your own question. You have to write in to the box “How death occurred” “Used cocaine,” particularly since you have said that a person can use it 200 times and survive it and use it once and die. All you know is that they used it. Seems fair and non-judgmental to me.

Well, you could also make the argument that if death doesn’t constitute abuse, then nothing does.

[diggleblop]

I heard a saying once and it stuck with me:

“The difference between a drug user and a drug addict is this: When a person is a drug user, all their stuff starts disappearing. When a person is a drug addict, all your stuff starts disappearing.”
And with my brother being a heroin addict off and on for 7 years, that saying couldn’t be anymore true. I’ve come home and my TV and surround sound system were gone.

Once my brother got arrested in D.C. for heroin and I had $600 saved in my dresser. Oddly his bail was 10% of 7000 so I was going to use most of that money (like a good brother) to bail him out. Well, I go in my dresser and the money was gone. To make a long story short, he had stolen the money.
Now, not all drug addicts are theives. And technically, I would say the difference in scientific terms is that a user uses to have fun. An addict uses to feel normal.

[CC]

@gabriela

Well, you could also make the argument that if death doesn’t constitute abuse, then nothing does.

I know what you mean, and I don’t want to actually debate this, but I don’t think you can make that argument. If, in your statistics, 1 out of 200 cases happen to result in death, and it is a random event, then that doesn’t seem any more like abuse than any other behavior that could randomly result in a seriously negative result. An extreme example might be driving. I guess we will eventually get into some sort of gray area here, too. Of course there is dangerous and risky driving behavior that I would equate with drug abuse. So nothing in this realm is crystal clear, but the Nixon era commission did make some excellent points and the term “abuse” is certainly laden with judgment and vagueness that make it very difficult to work with. You’ve detailed the problems that you, yourself, have.