Dope

When I was a youth, use of certain psychoactive drugs -- specifically cannabis and hallucinogens -- was associated with a rich countercultural movement that posed a radical, moral challenge to the political establishment; set out to reinvent social relationships and the individualistic and material values of the dominant culture in the U.S.; and to create new forms of spirituality based on metaphysical exploration. The drugs were not seen as mere recreation or escape, but as tools for insight and rediscovery of the relationship between perceptions and the world. Of course this was ultimately misleading for many people. Nevertheless, I still believe that the potential of hallucinogens to contribute to positive emotional development and mental health, if used under properly controlled conditions, is substantial, and has not been investigated as it should be due, essentially, to prejudice. There is good, though incomplete, evidence that LSD-like drugs can be highly effective in treating alcoholism, palliating terminal illness, and otherwise benefit people.

People I knew, at least, recognized a sharp distinction between these kinds of drugs, which have very low potential for addiction, and opiates, barbiturates, and other drugs of abuse. To a typical hippie, the idea of using heroin was repulsive.

Nowadays, adolescent drug use, of any kind, is not associated with any potentially progressive or even particularly interesting cultural movement. It's about alienation, but with no place to go. Adolescent opioid use and addiction is increasing. According to the National Survey on Drug Use and Health (available here if you want to wade through some tables) 3% of 8th graders used hydrocodone (Vicodin) in 2007, and the prevalence went up to 10% by the 12th grade. Forty-three percent of people admitted for treatment for opioid dependence started before they were 20, according to the Treatment Episode Data Set (also available from the SAMHSA web site.)

Because illicit prescription opioids are very expensive, young people commonly move on to heroin, which is, believe it or not, comparatively very cheap -- thanks to the U.S. invasion of Afghanistan, which created conditions under which poppy cultivation and the heroin trade exploded. 77% of injection drug users acquire Hepatitis C infection within a year, and many of them also acquire HIV infection. Unfortunately, opioid dependence is highly intractable. The vast majority of people only succeed with long-term maintenance therapy using methadone or buprenorphine -- opioid substitutes. Recent studies which tried weaning young addicts off of these drugs within a short time were failures.

I can't tell you exactly why this is happening. Adolescents have always experimented with the forbidden, and have never had terrific judgment. The adolescent brain is uniquely vulnerable to addiction; the psychological and biological risk is nothing new, and opioid drugs were certainly available when I was in high school and in college. It just never would have occurred to me or my friends to try them. We knew they were dangerous, we associated them with losers and criminals, and we weren't looking for oblivion, we were looking for experience. So the difference is cultural. What does this say about the state of our society?