High Price

Unfortunately, this knowledge is rarely disseminated to the public, primarily because of the irrational belief that it might lead one to engage in drug use. In light of the fact that there are already more than 20 million Americans who use illegal drugs regularly, it seems that a rational approach—one that aims to reduce drug-related harms—would be to share what we’ve learned with drug users and those in positions to help keep them safe. Otherwise, it seems that we do society a major disservice.
    If more people were aware of a few simple facts that we’ve learned, this would substantially enhance public health and safety. First, inexperienced drug users should be discouraged from taking drugs in the manner in which experienced users do. Experienced users tend to take drugs in ways that get them to the brain quickly, that is, by smoking or intravenous injection. Because smoking and shooting drugs intravenously produce more potent effects, the likelihood of harmful consequences is increased with these methods. Alternatively, taking a drug by mouth is usually safer than other ways of consuming drugs for two reasons: (1) the stomach can be pumped in case of an overdose, which isn’t possible with smoked or injection overdoses; and (2) some of the drug will be broken down before reaching the brain, resulting in fewer drug effects.
    Second, healthy sleep habits should be stressed for all drug users because prolonged sleep loss can cause deterioration of mental functioning. In severe cases, even without drugs, hallucinations and paranoia may also occur. Because amphetamines and cocaine reliably reduce fatigue and offset performance decrements, some may repeatedly take these drugs to lessen problems associated with sleep loss. This is a less than ideal approach. One of the most consistent effects of stimulants is the disruption of sleep, which means that repeated use can exacerbate problems related to sleep loss. Given the vital role that sleep plays in healthy functioning, regular users of stimulants should be mindful of their sleep durations and avoid drug use near bedtime.
    Finally, certain drug combinations should be avoided because they increase the risk of overdose. The heroin-alcohol combination and oxycodone-diazepam combination are two popular examples. While it is theoretically possible to die from an overdose of any of these drugs alone, in practical terms this is extremely rare. But each year there are several thousand deaths in the United States in which the use of these combinations is mentioned. In virtually every overdose death involving an opioid, for example, some other substance is present. Most of the time it is alcohol. One should always take care when combining two drugs or any drug with alcohol.
    “Thank you for your time and thoughtful questions and comments,” I said to the secret-science clubbers as I prepared to exit the stage. But before I could leave, dozens of people lined up and huddled around me. Some had pressing follow-up questions, while others wanted to share their stories, seek advice, or just say thanks. It was reminiscent of a time when I used to watch my DJ mentor and brother-in-law, Richard “Silky Slim,” skillfully convey to each person that his or her opinion mattered. Unfortunately, Silk didn’t go on to become the well-known entertainer that we all thought he would. Instead he was convicted of a drug charge and served more than a decade in federal prison.
    Since his release, he and I have spoken at great length about his experiences with the justice system and the unfairness of our current drug policies. To be honest, his story is one that provides motivation for me to do my best to change the way we regulate the illegal drugs discussed in this book. Whenever I write something relevant on the topic, I send him a copy. Here’s a recent text message I received from him in response to an op-ed that I published calling for the elimination of the sentencing disparities between powder and crack cocaine: 3 “Hey brother Carl, Great fucking piece you wrote man. That made my heart start racing again just thinking about the injustice I had to endure. Thanks man, that was beautiful! God Bless.” I sincerely hope that my efforts help to prevent many of the policy mistakes that were made in the past.

Acknowledgments
    I would like to thank two people who helped nurture this book along a path that proved to be more difficult than I initially thought: Claire Wachtel and Maia