Busting myths about drugs

We extract some myths from Dr Suzi Gage’s new book, ‘Say Why to Drugs: Everything You Need to Know About the Drugs We Take and Why We Get High’, with kind permission from Hodder & Stoughton.

Green tea has no caffeine
This one really depends on your brewing technique. Green and black tea leaves on average contain similar amounts of caffeine, so again it comes down to personal preference – the amount of caffeine that makes it into your cuppa will be dependent on how long you steep it for, how much you stir the pot, how hot you have the water when you add it to the leaves, and such like. But green tea isn’t a caffeine-free alternative to builder’s tea.

Everyone dies of something, so why not smoking? Smoking just means I’ll miss the last few years, which are the worst ones
This is a frequent comment I’ve heard when giving talks or chatting to libertarians on the internet. And it’s true that we will all die of something. However, it’s not true to say that smoking means you’ll miss the old and ill years at the end of life. Smoking-related illnesses and deaths are often extremely unpleasant, protracted, and earlier than non-tobacco related deaths. Yes, you might miss the later years of your life if you smoke, but you might also find yourself seriously ill at an earlier age, and you might lose your life many years earlier than you would otherwise.

Cocaine sobers you up
While the effects of cocaine on top of alcohol might make a person feel like they’re sobering up, this is not the case. Taking cocaine after you’ve had alcohol might make you feel like you’re more sober, but the effects of the cocaine are merely masking the alcohol intoxication. And as cocaine intoxication lasts for only a short time, once the cocaine wears off, you’ll feel just as drunk, or even more so if you’ve carried on drinking. 

You can’t overdose on cocaine
Er, yes – you absolutely can. It’s really dangerous to take too much cocaine, and it can be fatal.

E-cigarettes cause ‘popcorn lung’ – bronchiolitis obliterans
This myth came about because a study analysed a number of e-liquid samples in the USA, and found that some e-cigarette liquids contained a buttery food flavouring called diacetyl. This chemical is used in popcorn making (it’s approved safe to eat, but tests didn’t assess risks from inhalation), and became linked to bronchiolitis obliterans in 2002, when a research article reported about eight cases of the disease at a popcorn factory over a period of eight years. However, the paper itself was somewhat inconclusive about whether diacetyl was a causal factor in these cases. 

Since 2016, the UK requires that e-liquids do not contain diacetyl, so the somewhat tenuous link between e-cigarettes and popcorn lung doesn’t exist anymore, certainly not in the UK anyway. It is also worth highlighting that to date there have been no reported cases of popcorn lung in people who use e-cigarettes, and that diacetyl is also found, and at far higher levels, in tobacco cigarette smoke. Yet you never hear that smoking will cause popcorn lung.

One dose and you’ll be hooked [to heroin]
It is impossible to get addicted to a substance, any substance, after one use. It’s possible to enjoy it after one try, to be really keen to take it again because the experience was so pleasurable, whether in a hedonistic way or in a way of making your circumstances or situation more bearable for a few hours. But you cannot become dependent on a substance from using it once. And fewer people than you might think actually develop dependence on heroin. According to the American Society of Addiction Medicine (ASAM), around 23 per cent of those who try heroin will develop opioid dependence, suggesting that 77 per cent of those who try it won’t.

Other experts have questioned these figures, believing they might underestimate the number of dependent heroin users, because of how they are conducted. General population surveys or household surveys, for example, may underestimate the number of dependent users, as these individuals are at a higher risk of being in prison, or without a fixed address, due to their heroin dependence. If these people are systematically under-represented in these surveys, it would lead to a bias that would suggest heroin was less dependence forming than it truly is.

So what is the real figure? It’s hard to say. A small study attempted to account for this bias, and found some evidence that the figure might be closer to 50/50, or even that around 60 per cent of those who try heroin will develop dependence, although their estimate is very uncertain due to assumptions they had to make, and the small sample size. Animal studies also suggest the risk of dependence is higher than the ASAM’s estimate, but humans are not rats, so again it’s hard to conclude anything definitive.

But whatever way you slice it, there’s absolutely no truth in the idea that you only need to try heroin once to become addicted to it.

Khat’s not a drug – it’s more like coffee, or alcohol
Likening khat to coffee is not far off in terms of its intoxication effect. But as we know, caffeine and alcohol are drugs! And not considering a substance as a drug can be problematic if a person does get ill. For example, if a person presents to their doctor with liver problems and is asked ‘Do you use drugs?’ they might answer ‘No’, meaning the doctor will not consider the impact of khat on their liver, and the problem might go undiagnosed while their condition deteriorates.

Orange juice will impact on LSD intoxication
Some people believe that drinking orange juice will reduce a bad trip, while other people believe it’ll enhance the intoxication experience! Clearly both can’t be true. There’s also another urban myth about a man on LSD believing he was an orange, or sometimes a glass of orange juice, and believed this for the rest of his life.

There’s no evidence that orange juice, or vitamin C, has any effect on LSD. I don’t know how this myth started, but I wonder whether it’s linked to another citrus fruit – grapefruit. Individuals prescribed a variety of medications that are metabolised by a particular enzyme, the catchily titled CYP3A4, are advised not to drink grapefruit juice, because it can block the action of this enzyme and affect their action. Drugs that might be affected include certain types of statin, blood pressure drugs, anti-anxiety drugs, and a number of others.

The effects are also seen from Seville oranges, pomelos and tangelos, other citrus fruits and hybrids. There’s no evidence that LSD is affected by these fruits, but it’s possible something got lost in translation somewhere and an urban legend was born. 

MDMA (powder) is safer than ecstasy (tablets), because it’s not cut with other things
Not true. While tablets are often cut with anything from caffeine to amphetamine, it is perfectly possible for a powder to be mixed with these substances as well, and samples have been found that contain synthetic cathinones (such as mephedrone), or other substances such as PMA that have been found in both tablets and powder – some of which might be more harmful than MDMA at the same, or even at smaller doses.

Nitrous causes intoxication by starving the brain of oxygen
When nitrous is inhaled without oxygen, the risk of hypoxia, where the brain can be starved of oxygen, is increased. However, this isn’t what causes nitrous to have the effects that recreational users seek. If it was, maybe we could all simply hold our breath and get the same effect? When nitrous is administered in a medical setting, the ratio of gas to oxygen is required to be fifty-fifty, to minimise the risk of hypoxia, as it can be extremely dangerous, as detailed above.

Salvia is like cannabis
Because salvia is often purchased as either fresh or dried leaves, and is commonly smoked, some can erroneously believe that the effects will therefore be similar to cannabis, or perhaps similar to synthetic cannabinoids. As can be seen clearly from the descriptions above, this is very much not the case. Salvia has also been sold under the name ‘herbal ecstasy’ or sometimes ‘horse killer’, but the intoxication experience is not very similar to MDMA, so this is not a particularly accurate description either.

Read our interview with Dr Suzi Gage.

Find out more about the book, and listen to the podcast.

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