My Favorite Books: Drugs Edition

I have been reading like crazy this year…at least compared to the last five or so years. Recently I have been reading about a lot of illicit substances. There are some fascinating books out there about these compounds and today I’m going to recommend a few of them. This is another updated post, but I have added a LOT to it. I continue to read about drugs and drug prohibition, and continue to be surprised. I strongly encourage you to read a few of these books.

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Featured Image Attribution: 51fifty / CC BY-SA, image cropped to 16:9 ratio.

Drugs Are Bad, M’kay?

Before we get into this I’m going to talk just a little bit about my philosophy on drugs. I don’t use illicit substances. I don’t say that with a knowing wink – I really don’t. I have been in direct or indirect government employee for my entire adult life, and one bad piss test would ruin that. However…

It bugs me to no end that I don’t have the choice. I understand that some jobs that require instantaneous, correct decision-making and I have worked in such jobs. Being at work while intoxicated – or with an intoxicated coworker – would be extremely undesirable. Yet somehow we permit alcohol and have managed to find a way to make its use tolerable. I find it irritating that as a fully actualized, intelligent, competent and capable adult, I can choose to alter my consciousness only with certain, approved substances…even though they are demonstrably harmful, while other substances (LSD, psilocybin) are about as close to harmless as a substance can get.

“It’s a fundamental wrong if I as an adult am not free over my own consciousness. Then I am absolutely not sovereign over anything. I can’t claim any kind of freedom at all.”

-Graham Hancock

I find it even more bizarre that after attending a year-long vocational course I can choose to give a patient powerful opiate and opioid narcotics on my own judgment. I have at my disposal morphine, fentanyl, and hydromorphone – all extremely addictive substances, and all with the power to end life in a just a few minutes if I accidentally overdose the patient. Yet, unless I am really egregious in my dispensing of these drugs, no one is going to question me.

However, if I attended four years of college followed by four more of medical school, worked through my residencies, then gained twenty years of experience as a physician I would still risk a lengthy prison sentence by recommending that a patient smoke a joint instead of taking federally-approved narcotics (that, coincidentally, are made by companies that pay lobbyists millions of dollars a year). An 18-year-old with a high school diploma and a paramedic card can administer fentanyl but it is a federal crime for a physician to dispense marijuana. Does anything seem strange about that to you?

You may disagree with me and that’s fine. Drug still impact society deeply and are worth knowing about on a deeper level than what you got in your DARE classes. I have really enjoyed learning about the various substances out there. My intellectual curiosity is not bounded by the limits of what is “legal.” Below are some of my favorite books about drugs.

Alcohol

I didn’t include this category last time because I hadn’t yet read a book about alcohol that looked at it as a drug. Make no mistake: alcohol is a drug. I have come to loathe the phrase “drugs and alcohol” as if alcohol isn’t a mind-altering drug. Many of you (and myself) look at alcohol more kindly than other drugs, out of familiarity. However, I strongly recommend you read Drink: The New Science of Alcohol + Your Health by David Nutt.

Drink talks about all the ways alcohol is harmful to your body. And it is extremely harmful; alcohol kills 40,000 Americans a year. As Nutt points out, if alcohol were invented today there is absolutely no way it would be made legal; it is simply too harmful. Alcohol harms your brain, your liver, your stomach. It interferes with your sleep. It causes dependence and addiction. Alcohol is closely correlated with violent behavior and other anti-social behaviors. Alcohol does tremendous social harm in the form of dollars spent on healthcare, time lost at work, time and money spent in court, rates of homelessness, etc.

Drink completely changed my view on alcohol, and my drinking habits. I have curtailed my drinking back to a couple nights a week only, usually weekends. Even then I’m not drinking 10 drinks a night – I’m mindfully enjoying a couple. Your body is very good at healing itself, but you have to give it a chance to do so. Your liver will literally grow itself back, but you have to give it time to do so. If you drink, you definitely owe it to yourself to read this book.

Marijunana

Alcohol kills some 40,000 people a year and Tylenol kills 150 Americans per year (!!). On the other hand marijuana kills pretty much no one. It is one of the most studies substances on Earth, yet it is still illegal. Why? Smoke Signals: A History of Marijuana – Medical, Recreational, and Scientific by Martin A. Lee covers a lot of the “why” of marijuana prohibition.

Marijuana prohibition is largely the result of the efforts of one man: Harry Anslinger. The first part of the book reads like a conspiracy theory. I would probably think it was had I not read so many similar account since, and looked into a lot of Lee’s source material. Anslinger found his agency, the Federal Bureau of Narcotics, with a tiny budget and not much to do. Anxious to keep his agency funded Anslinger worked tirelessly to demonize marijuana to give his agency a purpose. He was successful beyond his wildest dreams and your tax dollars continue to incarcerate Americans for simple possession or personal use of this relatively benign substance.

The way we have treated marijuana as a nation is absolutely astounding. It is almost impossible to conduct legal medical research on marijuana. If we are really interested in the truth and best possible practices as a result, that doesn’t really make sense. Secondly, marijuana was hastily scheduled as a Schedule I drug with the promise to reexamine and reschedule as soon as “more research” was in. Of course it is still a Schedule I substance while OxyContin and fentanyl (which have spawned an entire epidemic), cocaine, and methamphetamine are Schedule II drugs. Don’t believe me? Check it out for yourself on  the DEA’s website.

It’s also incredibly interesting that marijuana is in Schedule I which definitionally means “no accepted medical use.” However, Marinol, a pill made from THC is an approved prescription drug. If there’s “no medical use” how is Marinol an approved drug? That smacks of hypocrisy to me.

I’m not a marijuana user but I simply cannot understand the desire to jail people for using it. We tout America as a “free” country yet it is a crime to possess a plant that occurs on the side of the road. Tobacco kills hundreds of thousands of Americans each year, but we’re going to jail people for using marijuana? Tens of thousands of people are prescribed powerful, addictive narcotics to relieve chronic pain, or pain from surgeries, injuries, etc., but we’re going to take a Citizen’s freedom away for alleviating that pain with a joint (lest you think I’m being Pollyanna about the people that smoke weed there are some rather well-documented cases of the government ruthlessly prosecuting people with well documented medical conditions)?

Maybe the craziest thing addressed in this book is drug forfeiture laws. I’m familiar with these laws but Smoke Signals offers a great refresher. If you are suspected of using your car (or home, or cash, or whatever) to traffic drugs, your property can be seized. The agency seizing your property essentially gets to keep it, auction it, whatever. It is ON YOU to prove that you weren’t using said property for drug trafficking. That is so bizarre to me – murderers and rapists don’t have their property seized and have to fight to get it back.

If you don’t agree with me that’s fine – I absolutely support your right to disagree with me. But if you’re disagreeing based on dated, alarmist rhetoric, you owe it to yourself to read Smoke Signals: A History of Marijuana – Medical, Recreational, and Scientific. I almost guarantee you’ll learn some things. I did.

The Opioid Epidemic

Dopesick: Dealers, Doctors, and the Drug Company that Addicted America by Beth Macy: one component of any first responder class these days is the opioid overdose reversing drug, Narcan. The prolific nature of Narcan (I’m going to post a little rant about Narcan soon and I’ll warn you: it’s probably not going to go they way you expect) really got me thinking about the opioid epidemic, which has morphed into a huge fentanyl problem. I realized I really don’t know much about it except stereotypes, and since I’ll probably be dealing with it firsthand soon I wanted to educate myself.

Dopesick was the first stop along that journey and I highly recommend it. Like many, I have said “it’s criminal” how drug companies and doctors get away with over-prescribing pain medication. Like most, I suspect, I used the term colloquially, but had no idea how real and how widespread – and how actually criminal – the problem was (yes, individuals from Purdue Pharma were criminally prosecuted, but got off pretty lightly – mostly by purchasing licenses to traffic paying fines for promoting opioids to aggressively – in my opinion, considering the death and destruction they caused.).

Purdue Pharma, the company that makes Oxycontin, was wildly aggressive in their promotion of their hydrocodone-based drug. They lied about Oxycontin’s addictive potential. Even though their own, internal study concluded that it was highly addictive they told doctors it was not, and was safe to prescribe. Purdue Pharma insisted Oxycontin pills were “abuse resistant” even when it was widely known they were being abused. They took doctors on all-expenses-paid “pain management clinics” on Caribbean islands; doctors who attended these clinics were twice as likely to prescribe Oxycontin as doctors who did not. Pharmaceutical reps gave lavish gifts to doctors who prescribed the drug, and in turn were rewarded with annual bonuses that best most Americans’ annual salary.

We like to look down on drug addicts. I admit that I’m guilty of it, too – guilty of saying things like, “why would I help that guy?” This book sheds a little bit of light on who some of these addicts are. They weren’t all criminal low-lives that we like to make them out to be. Many of them are just hard-working folk who were prescribed – and over-prescribed – powerful opioids for legitimate problems. The book details one such farmer who became addicted in his 70s and began selling off his family land to fund his habit, a few acres at a time until it was gone. The book talks about a doctor who broke his own leg so he could get surgery and subsequently be prescribed Oxycontin.

Dopesick gave me a much more thorough understanding of some of the complex issues the opioid epidemic has caused. This is absolutely fascinating material, and should be required reading for anyone in emergency services.

An alternative read is Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones. If you want to read a single volume on the opioid epidemic, you can read one or the other; if you’re intensely interested in it, read both. They cover a lot of the same ground, but both are really good.

Fact of the book: Kermit, West Virginia is a town of about four hundred people. Over a two year period, Purdue Pharma shipped over 9,000,000 Oxycontin pills to Kermit. That’s enough Oxycontin to give every man, woman and child in Kermit thirty Oxycontin pills, every single day over for two years.

Opioids: Honorable Mention

Fentanyl, Inc.: How Rogue Chemists are Creating the Deadliest Wave of the Opioid Epidemic by Ben Westhoff. Fentanyl, Inc. delves deeply into the chemical make up of the titular drug. Fentanyl is an opioid that is many times more powerful than heroin. This makes the same amount of drug more powerful, making shipments of pre-cut drug more compact, and more likely to evade detection. Fentanyl is also completely synthetic, eliminating the need for huge poppy fields that can be eradicated or struck with disease.

Unfortunately fentanyl is often cut inexpertly, leading to drugs of unreliable potency – some are OK and some are really hot. Because fentanyl is so cheap, so potent, and so readily avaialble, it is now being used to stretch all manner of other, non-opiate/opioid drugs, like cocaine and the otherwise fairly safe MDMA. The fact that many users have no idea they are consuming fentanyl, and the varying potency has lead to the mass number of overdoses we’ve seen in recent years. Though a little dry at times, Westoff does an admirable job at detailing how these drugs are manufactured, sold, and abused. Westhoff even travels to China to visit a commercial manufacturer of fentanyl.

Fact of the book: despite the illegality of fentanyl production, Chinese tax law incentivizes production of fentanyl manufactured for sale in foreign countries.

Psychedelics

Psychedelics are a fascinating class of drugs. Many of them were criminalized with very, very minimal testing for medical purposes. Many of these drugs are showing promise in treating conditions like PTSD. Almost all of these drugs are extremely safe by any reasonable standard. Yes, a few people die each year in the US ingesting MDMA. Compare that to tobacco, which kills approximately 480,000 people per year (think about that number for a moment – almost HALF A MILLION – then ask yourself why no one is talking about the “tobacco epidemic”) but is perfectly legal.

DMT: The Spirit Molecule by Rick Strassman, MD. This book is absolutely fascinating. N,N-Dimethyltryptamine, more commonly known as “DMT” is a powerful psychedelic substance (as I understand it, DMT is the active ingredient in ayahuasca). DMT: The Spirit Molecule details Dr. Strassman’s medical research on the substance. Strassman talks about his research’s goals, the planning, and the execution. Interestingly he describes participant’s trips, often in their own words. It is amazing how many recurring themes occur across his range of patients.

As fascinating as DMT is (and it is incredibly fascinating) it is nothing compared to the labyrinthine process of licenses and approvals necessary to undertake testing on Schedule I substances. Dr. Strassman details the approval process for his study of DMT and it is mind-numbing – back and forth with his state’s pharmaceutical board, the DEA, and the FDA. This is to say nothing of convincing his university to grant permission for human study of a psychotropic substance.

Honestly, this was the most interesting – and frustrating – part of the book to me. Like many other psychedelic substances such as MDMA, DMT was criminalized not because of a large body of evidence demonstrating its danger. It was not criminalized after exhaustive testing that completely ruled out any legitimate medical use. It was criminalized because a lot of club kids were using it. In fact, we know next to nothing about its short- or long-term health effects…but there don’t really seem to be many. Because it is categorized as having “no medical use” it is almost guaranteed to never have a medical use regardless of its potential benefits because studying it is almost impossible. It’s a true Catch-22.

Psychedelics: Honorable Mention

How to Change Your Mind: What the New Science of Psychedelics Teaches us About Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan. How to Change Your Mind is far more wide-ranging than DMT: The Spirit Molecule. In it Pollan details a number of psychedelic compounds including DMT, 5-MeO-DMT, MDMA, psilocybin (the active ingredient in psychedelic mushrooms), and LSD. More importantly Pollan – a serious and well-respected author and professor – takes almost all of these drugs himself and reports his experiences.

Drug Control Policy

One of the best books I’ve read this year – on any subject – is Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari. In fact, I got so much good stuff out of this book that it’s hard to even know where to start. Hari starts way back at Anslinger and works his way forward in an extremely detailed look at America’s war on drugs – a war that has cost trillions of dollars, countless thousands of lives, encroachment of laws on our freedoms in the interest of “getting drugs off the street,” and it is a war that the harder we fight the less successful we seem to be. After over fifty years of all out “war” we still have similar rates of addiction and massively higher rates of occasional drug use. What, exactly, has all this money bought us?

Hari offers some alternatives to the war on drugs as it is fought right now. Again, it is ironic that I have such a hard time talking about this book because it truly was on one of the best books I’ve read in along time. Check it out!

Closely correlated with this book is a work called American Prison: A Reporter’s Journey Into the Business of Punishment by Shane Bauer. Bauer gets hired at a corporate prison. In the United States many prisons are operated by for-profit companies. For-profit prisons get paid a daily rate per prisoner housed, and have all the interest in the world to keep staff minimal (and minimally paid; Bauer made on $9/hour which is insane when you consider that the McDonald’s in my town pays $11/hour).

In my opinion this creates a conflict of interest of the first order. If money is being made by the state to keep people in prison (and it is, in the form of taxes paid by these companies), the state has an incentive to keep more people in prison. This causes the state to make more stuff illegal, make sentences longer, etc. The state should have every disincentive in the world to avoid imprisoning someone, especially in a country where freedom is so valued. Instead we imprison more people than any other country on earth, both per capita and in raw numbers.

American Prison talks about Bauer’s personal experience working for a corporate prison, but also details some stats about imprisonment in the United States. This book is must-read for anyone interested in both law-and-order and freedom.

Closing Thoughts

I’m not a drug user and I never intend to use most of the drugs on this list (that’s right, I said “most”). My guess is that neither do you. That doesn’t mean you should not be informed about them. You should and these books are a great place to start!