Great post but I would caution using the terms "recreational user" and "abuser" interchangeably. There are a good many people who slip through the cracks with these studies because researchers have motive to show a big difference when publishing so they typically use abusers in their studies who are taking doses at the extremely high end, and clinical users are taking doses near the very low end. This is also the case in many in vitro and in vivo animal studies where doses and concentrations that far exceed what a normal recreational user might take or. There are likely many more recreational users that use drugs intermittently, say for concerts or outings with friends and may take in excess of what would be considered a therapeutic dose but are still well below the consumption rates of an abuser given that they don't take the drugs all the time. It's not at all clear that these users should be lumped in with "abusers", nor should they expect the same level of side effects.
“ The average crystal meth addict uses about 500 mg a day.”
One minor point - as far as I can tell thats the average for someone who thinks they have enough of a problem to seek treatment. I would say the average dose is more like a gram a week. Coke and meth are expensive. The average users needs to hold down a job.
Per the study: “One hundred and eighty-three stimulant users from a longitudinal cognitive study (120 MA and 63 cocaine) were included in this study. One hundred and fifty-three of them were enrolled in treatment in either the Matrix Rancho Cucamonga Clinic in San Bernardino County California, or the UCLA Integrated Substance Abuse Programs’ Torrance Clinic in Los Angeles County”
Re: your comment in section II. Many organic chemicals have completely different functions when modified slightly, such as nicotine and nicotinic acid (niacin); one is a toxin and the other is vitamin B-3. Also, chlorophyll and hemoglobulin; one converts carbon dioxide and water to oxygen and simple sugars, the other transports oxygen and carbon dioxide. This is because evolution doesn't usually create uniquely new structures, whether morphological or chemical, but more typically modifies existing ones.
"Although ketamine might seem like a promising antidepressant that could relieve treatment refractory depressive symptoms, the induction of memory impairments in the longer term is of concern"
I take legal, cheap, widely-prescribed antipsychotics that leave me with the memory of a goldfish and do much worse. Where are these people when it comes to that? Or do older drugs with bad side effects get grandfathered in?
Most of my concerns* about occasionally using nicotine gum as a nootropic went away when I realized just how much nicotine a typical smoker is getting. A pack/day is like 300mg/week or something, whereas a few pieces of gum per week is like 10-15mg.
*that is, my concerns that remained after learning that nearly all of the risk from tobacco has nothing to do with stimulants
So now the trick is to get some test subjects to go from zero to 100,000 mg of some drug over the course of some months and see if we can identify the break point.
I hope some country does an experiment where they make literally every drug available over the counter to adults, but in low-dose pills so that it's hard to take enough to do harm. Prescription gating sometimes feels like a jobs program for very expensive rubber stamps.
The study of the safety and efficacy of the vast majority of drugs is so profoundly inadequate as to be criminal. Even"gold standard" designed and executed clinical trials are too short term, too small and subject to statistical manipulation as to be near useless. Post marketing studies are few a far between and adverse event reporting a joke.
Physicians are left to "ask around" and spend time most don't have searching for literature that many are ill equipped to judge. Most don't bother and shy away from drugs that might help and prescribe based on pharmaceutical advertising consumed by either themselves or their patients.
What little system there is is vastly inadequate, economically driven and morally corrupt.
Imagine a world where the most ruthless drug dealers cut their drugs so hard that they end up curing their customers' depression and turn them into diligent straight-A students.
This reminds me of when I decided to stay on my ADHD meds through my pregnancy (baby is fine). I was sent to the maternal fetal medicine doctor for an assessment and the guy rolled his eyes and told me "the data we have on amphetamines and pregnancy is from meth users, so everyone is going to act like you're on meth when they talk about risks. You're not, you're basically here for my blessing, and you have it."
I wonder how this relates to anabolic steroid usage. Every slightly academic source I've ever read on steroids always says 'of course, we know that IRL users are consuming much much larger quantities than standard dosing'. Could it be possible that smaller steroid cycles are..... not as bad for you? Testosterone prescription is now a thing (yes I know there's a distinction between test and actual anabolic roids).
Anecdotally, I know several people who said that they consumed steroids in their youth for a decade or longer, just not in huge quantities. They all, I dunno, seem to be in fine health in their 50s & 60s? The two guys that I'm thinking of in particular both have a full head of hair, in addition to seeming like normal, highly fit older folks
A while back I was researching phenibut to see if I should take it for anxiety. The first things I see when I google are recreational users talking about how horrible it is, how quickly you build up a tolerance, how easy it is to get addicted, and how terrible withdrawal is. I finally found one that talked about how much he was taking--14 grams three times a week! Yikes! Even the lower-dosage users were taking several grams at a time at least, multiple times a week.
So I decided I'm not at all worried about taking 250 mg, or even 500mg, every few weeks when I need it.
Don't Air Force pilots sometimes take amphetamines to fly for so many hours straight? Is this why they also don't seem to have problems? Is it why they are not likely to get addicted to them?
Am I off in believing that the opioid epidemic is a result of doctors generously/carelessly prescribing opioids? That doesn't mesh with the idea that clinical doses are overly safe and clinical prescribers are overly cautious.
I think my favorite kind of example of this personally was having coca tea in Peru, in comparison to the awful energy drinks I usually go with. The boost with the coca tea was so smooth, so much less "buzzy" than with caffeine, that it seems criminal it's not legal in the US. I know, apples and origins, but very mild, low-dose coca seems really great, and too much caffeine seems kind of bad.
This excellent post reminds me of the standard admonition against supplementing liberally with vitamin D, which says that doing so will give us all kidney stones and soft tissue calcification.
All the published evidence I have been able to find on this is old, and it mostly documents food fortification mishaps of the kind that result in a litre of milk containing 1,000,000 IU. Those stories do not have anything remotely to do with vitamin D as it would be used in any reasonable supplementation regime, but they sure are effective in scaring everybody, closing minds and shutting down inquiry.
"Throughout my preparation of this review, I was amazed at the lack of evidence supporting statements about the toxicity of moderate doses of vitamin D. Consistently, literature citations to support them have been either inappropriate or without substance. The statement in the 1989 US nutrition guidelines that 5 times the RDA for vitamin D may be harmful (3) relates back to a 1963 expert committee report (5), which then refers back to the primary reference, a 1938 report in which linear bone growth in infants was suppressed in those given 45–157.7 μg (1800–6300 IU) vitamin D/d (119). The citation is not related to adult nutrition and it does not form a scientific basis for a safe upper limit in adults. The same applies to the statement in the 1987 Council Report for the American Medical Association that “dosages of 10,000 IU/d for several months have resulted in marked disturbances in calcium metabolism…and, in some cases, death.” Two references were cited to substantiate this. One was a review article about vitamins in general, which gave no evidence for and cited no other reference to its claim of toxicity at vitamin D doses as low as 250 μg (10000 IU)/d (120). The other paper cited in the report dealt with 10 patients with vitamin D toxicity reported in 1948, for whom the vitamin D dose was actually 3750–15000 μg (150000–600000 IU)/d, and all patients recovered (121). If there is published evidence of toxicity in adults from an intake of 250 μg (10000 IU)/d, and that is verified by the 25(OH)D concentration, I have yet to find it."
This post shows that this kind of unconsidered overreaction is a more general problem. I guess I'm relieved?
Come on...Just one article I want to read "This is definitely medical advice and these drugs are really fun so go nuts"
Reminds me of psychedelic therapy. Is anybody going to be getting a massive dose legally, or will clinical doses be so much smaller that they are qualitatively different drugs? There is a major difference in experience between ketamine abusers and patients being prescribed ketamine by a doctor. If you read trip reports from massive ketamine doses, you can see there is much more going on. I would expect ketamine abusers to be less depressed, all else equal, but curious if there is actual data on that.
This reminded me of a long time ago when I was reading about lean, a drink combining prescription cough syrup with sprite and jolly ranchers. I cannot find the exact dosage currently, but I believe I read it was around 25 times the prescribed dosage. I'm sure there is a wide range. It would seem that one would quickly run out of cough syrup.
I am not sure if there is the same phenomenon with lean. People don't seem to have much qualms with taking cough syrup but a lot of rappers have died or had health problems as a result of lean usage.
Relevant clip from a superb film, 32 Short Films About Glenn Gould (this is film #23). GG took all these— a drug user who took a *lot* of drugs. https://www.youtube.com/watch?v=7eBotiHABdo
related: alcohol is a much more social drug than a lot of pills and other such things, because you take your full dose in sips over several hours. Allows you to manage your level of intoxication via feedback. Whereas a tab of LSD or a pill can really fuck you up for hours and there's an expectation you should just take the whole thing at once. LSD would probably be much more popular if it came highly dilute and you could have a wee bit at a time (have I just reinvented microdosing, maybe.)
I'm way out of my wheel house here as a non-biologist and non-drug user (I rarely even drink, pretty much stick to caffeine and sugar), but could this be read not just as an explicit argument against medical dosing guidelines, but also tacit argument *for* microdosing? Like, you're not wealthy, you don't have great insurance, but you need antidepressants, so you buy street drugs and then carefully stretch them out to a hundred doses?
"A lot of our impressions of drugs, what side effects they have, and how dangerous they are, get shaped by the recreational users, not the patients."
I'd suggest a variation on this: our impression of drugs is shaped by their mode of delivery, which in recreational contexts tends to be a mode that delivers a faster rate of onset and/or higher peak plasma. I think this matters more than the total dose.
So I can ingest vast quantities of caffeine in the form of coffee every day and still enjoy moral superiority vs. someone who injects the same quantity of stimulant at the weekend.
Of course they are probably getting a totally different high and side-effect profile too so it's not as if the moral stereotype is baseless. But I suspect it does feed into sub-optimal public-health outcomes. See: vaping.
Still confusing to me as a non-English speaker: in Dutch we have two words: "drugs" are recreational (sometimes illegal) substances that change your mood or cognition, medicijnen are physician prescribed substances. This makes reading a piece like at times confusing:"Which of the two is he talking about now?"
As others have pointed out, it's unfortunate that you seem to be using some of the terms interchangeably which leads to casual drug users and drug abusers being conflated.
Obviously taking a large vs small quantity of a drug has differing effects but so does taking the drug daily vs occasionally. This is especially true given that the examples used seem to mostly refer to long term, frequent abuse. Most recreational drug users do not use so frequently.
In terms of meth, I think you're also missing some important confounds
I have a friend who used to take a lot of recreational ketamine. (This is a friend, not a "friend" ;-P ) He had a sports injury and wound up in the ER. When the anesthetic they gave him didn't work, they gave him more. Then they asked him if he took recreational ketamine, lol! He kinda demurred but was like, "Yeah, well, kinda..." Bottom line: recreational drug users take a lot of drugs!
"They find that severe abusers, who are taking an average of 60,000 mg/month, experience cognitive problems. But mild abusers, who take more like 3,500 mg/month, don't. Again, psychiatric patients are taking about 280 mg/month. I think this is pretty strong evidence that the psych patients shouldn’t worry that much."
I remember a post you made a while back about melatonin having greater effects at lower doses. Is this a possibility for ketamine?
My biggest issue with s-ketamine is its broad agonist on over 30 receptors. While it’s dissociative properties are why I would use it in a pinch, I prefer pharmaceuticals that are much more targeted. Also, I think the literature supports more novel psychedelic treatments such as psylocibin and MDMA as better effective depression and addiction treatments than ketamine - which has a very short duration of efficacy and is just about one step better than ECT.
I have friends who use ketamine and those doses are on the extreme high end. I would say the average dose for a normal non-addict ketamine user would be a gram every 1-2 weeks. Still higher than the therapeutic dose buy not by such an extreme margin
Every so often I see an article about how e.g. soldiers in WW2 were on amphetamines all the time-- now I'm curious where their dosage fell between "Adderall" and "recreational drug user".
I find it hard to believe that frequent ketamine users take around 3g/day. Just from a financial perspective, 3g/day equates to £2100/month (~$3000) at £25/gram. Given how disabling K is, I don't think that the kinds of people that are doing 3g/day could afford it. I had a quick look at the Morgan et al. paper, and although it says the frequent group uses about 3 grams, it doesn't specify over what time period. Perhaps they mean 3grams per week or month? Happy to be proven wrong here if I've missed it. The chinese paper does specifically say 3g per day though, so maybe my instincts are wrong. Anecdotally, I've heard of bladder issues in people that wouldn't be consuming more than a gram a month.
So.... Why don't we prescribe Adderall to just anyone who wants it at those low dosages? Or do we? Does this same kind of logic apply to steroids? Sure, body builders take huge dosages and can do damage to themselves. Can relatively low dosages work as treatment for obesity?
Right up until that last paragraph I was really considering taking a micro-dose of DNP. Maybe I still should, but I would feel bad doing it without your blessing!
Could one call this phenomenon “replicability crisis two: electric boogaloo”? Sure seems the thrust here is that a large portion of drug studies won’t replicate in clinical settings, which feels like a big deal? And also implies we can’t really understand a drug’s risk unless we legalize it medically first and then study possible side effects?
I understand the point you're trying to make here, but as a recreational ketamine user I just want to let you know that 3g/day figure is way too high and nobody is taking those kind of doses, most certainly not everyday for a month. To get an idea of how much a typical recreational user is taking, you can refer to this harm reduction website. https://drugsand.me/en/
This site states that heavy dose for oral ingestion of ketamine is around 500mg which is also referred to as the K-hole dose. K-hole is the term used among users to refer to the state of total dysfunctionality when you take a large enough dose of ketamine. Going by these numbers it just seems absurd to believe that an average ketamine user is dysfunctional everyday over months.
Moreover the LD50 for ketamine for a 70 kg human is 4.2 grams. There's no way an average ketamine user is steering so close to the levee all the time.
Is there any evidence at all that energy drinks are harmful in low doses? I'm suspecting the entire stigma comes from case series where people took too much or had pre-existing heart problems.
Also I saw a review paper where a weight loss supplement providing -2kg over 3 months was described as "not clinically significant", but 1.33 pounds per month is a lot of weight loss. If that could be safely extrapolated over a long time it adds up. Adding it to the water supply might reduce obesity rates by more than half. Again I suspect thermogenic supplements have a bad name because of people who take too much.
"and you wouldn't believe how many hoops the psych patients have to jump through to get their 280, or how terrified their doctors are that something could go wrong"
This is pretty much why I gave up trying to get medications that I actually NEED to treat my ADHD and depression; it's actually less work to just go unmedicated and be mostly-functional than it is to deal with all the bullshit involved with getting stimulants and ketamine.
There's bits of this all over pharmacy lore. Metronidazole is the only antibiotic you're supposed to actually not take with alcohol because there's a theoretical disulfiram-like reaction (disulfiram is normally used to treat alcohol addiction does so by severely magnifying its effects so any tiny amount with have you throwing up like you went on a full bender) but I was told once (tbh I've not personally looked into this one) that there's straight up never been a case study of this actually happening.
Recreational users of non-meth amphetamine also take huge doses like 500-1,000mg on a single day. So it seems surprising they don't seem to get the same health problems and addiction. Though to be fair they probably don't take this every day. But that also suggests the addiction potential for non-meth amphetamine is lower. (Maybe because it can't be smoked?)
It is well known fact that ketamine high make urination difficult. It's not really a physical difficulty, but rather you forget how to contract and relax appropriate muscles. Also, having full bladder stops being so unpleasant on ketamine.
So I guess if you do lots of ketamine, then you're high most of the time and may hold your urine for long periods of time - and that can cause UTI and bladder injury.
Excellent post. Just the right dosage of all the ingredients for a splendid article. No side effects!
Drink water and stay healthy. Drown in water and die. #DosageMatters
There should be a website where Scott recommends studies/clinical trials and university students carry them out and publish results.
Great post but I would caution using the terms "recreational user" and "abuser" interchangeably. There are a good many people who slip through the cracks with these studies because researchers have motive to show a big difference when publishing so they typically use abusers in their studies who are taking doses at the extremely high end, and clinical users are taking doses near the very low end. This is also the case in many in vitro and in vivo animal studies where doses and concentrations that far exceed what a normal recreational user might take or. There are likely many more recreational users that use drugs intermittently, say for concerts or outings with friends and may take in excess of what would be considered a therapeutic dose but are still well below the consumption rates of an abuser given that they don't take the drugs all the time. It's not at all clear that these users should be lumped in with "abusers", nor should they expect the same level of side effects.
“ The average crystal meth addict uses about 500 mg a day.”
One minor point - as far as I can tell thats the average for someone who thinks they have enough of a problem to seek treatment. I would say the average dose is more like a gram a week. Coke and meth are expensive. The average users needs to hold down a job.
Per the study: “One hundred and eighty-three stimulant users from a longitudinal cognitive study (120 MA and 63 cocaine) were included in this study. One hundred and fifty-three of them were enrolled in treatment in either the Matrix Rancho Cucamonga Clinic in San Bernardino County California, or the UCLA Integrated Substance Abuse Programs’ Torrance Clinic in Los Angeles County”
Re: your comment in section II. Many organic chemicals have completely different functions when modified slightly, such as nicotine and nicotinic acid (niacin); one is a toxin and the other is vitamin B-3. Also, chlorophyll and hemoglobulin; one converts carbon dioxide and water to oxygen and simple sugars, the other transports oxygen and carbon dioxide. This is because evolution doesn't usually create uniquely new structures, whether morphological or chemical, but more typically modifies existing ones.
"Although ketamine might seem like a promising antidepressant that could relieve treatment refractory depressive symptoms, the induction of memory impairments in the longer term is of concern"
I take legal, cheap, widely-prescribed antipsychotics that leave me with the memory of a goldfish and do much worse. Where are these people when it comes to that? Or do older drugs with bad side effects get grandfathered in?
Everyone should know the paraphrase of Paracelsus: the dose makes the poison.
Most of my concerns* about occasionally using nicotine gum as a nootropic went away when I realized just how much nicotine a typical smoker is getting. A pack/day is like 300mg/week or something, whereas a few pieces of gum per week is like 10-15mg.
*that is, my concerns that remained after learning that nearly all of the risk from tobacco has nothing to do with stimulants
So now the trick is to get some test subjects to go from zero to 100,000 mg of some drug over the course of some months and see if we can identify the break point.
Pay me $200 a day, I’ll volunteer as tribute.
I hope some country does an experiment where they make literally every drug available over the counter to adults, but in low-dose pills so that it's hard to take enough to do harm. Prescription gating sometimes feels like a jobs program for very expensive rubber stamps.
The study of the safety and efficacy of the vast majority of drugs is so profoundly inadequate as to be criminal. Even"gold standard" designed and executed clinical trials are too short term, too small and subject to statistical manipulation as to be near useless. Post marketing studies are few a far between and adverse event reporting a joke.
Physicians are left to "ask around" and spend time most don't have searching for literature that many are ill equipped to judge. Most don't bother and shy away from drugs that might help and prescribe based on pharmaceutical advertising consumed by either themselves or their patients.
What little system there is is vastly inadequate, economically driven and morally corrupt.
"The dose makes the poison" --Paracelsus, Swiss physician, alchemist, theologian, and philosopher of the German Renaissance
Imagine a world where the most ruthless drug dealers cut their drugs so hard that they end up curing their customers' depression and turn them into diligent straight-A students.
This reminds me of when I decided to stay on my ADHD meds through my pregnancy (baby is fine). I was sent to the maternal fetal medicine doctor for an assessment and the guy rolled his eyes and told me "the data we have on amphetamines and pregnancy is from meth users, so everyone is going to act like you're on meth when they talk about risks. You're not, you're basically here for my blessing, and you have it."
As always, the danger is the dose. Which is why water poisoning is a thing.
Maybe the difference is dosage, but there are lots of other differences. I think the main problem with recreational meth users is dehydration.
How much did various thinkers choose to use? Erdős and Auden used about 20mg/day, but Sartre used 500mg/day.
So is this post tacitly saying that we should be less afraid of meth? I think thats accurate
I wonder if there is a population of people who take meth recreationally but a lower dose and more responsible and therefore fly under the radar.
Which is to say nothing about the fed gov grants making perverse incentives for exagerrating the very real negative effect of drugs.
I wonder how this relates to anabolic steroid usage. Every slightly academic source I've ever read on steroids always says 'of course, we know that IRL users are consuming much much larger quantities than standard dosing'. Could it be possible that smaller steroid cycles are..... not as bad for you? Testosterone prescription is now a thing (yes I know there's a distinction between test and actual anabolic roids).
Anecdotally, I know several people who said that they consumed steroids in their youth for a decade or longer, just not in huge quantities. They all, I dunno, seem to be in fine health in their 50s & 60s? The two guys that I'm thinking of in particular both have a full head of hair, in addition to seeming like normal, highly fit older folks
A while back I was researching phenibut to see if I should take it for anxiety. The first things I see when I google are recreational users talking about how horrible it is, how quickly you build up a tolerance, how easy it is to get addicted, and how terrible withdrawal is. I finally found one that talked about how much he was taking--14 grams three times a week! Yikes! Even the lower-dosage users were taking several grams at a time at least, multiple times a week.
So I decided I'm not at all worried about taking 250 mg, or even 500mg, every few weeks when I need it.
Don't Air Force pilots sometimes take amphetamines to fly for so many hours straight? Is this why they also don't seem to have problems? Is it why they are not likely to get addicted to them?
Am I off in believing that the opioid epidemic is a result of doctors generously/carelessly prescribing opioids? That doesn't mesh with the idea that clinical doses are overly safe and clinical prescribers are overly cautious.
Isn't the same thing true of the papers that claimed salt is bad for you? Something like 3000x the normal daily dose?
I think my favorite kind of example of this personally was having coca tea in Peru, in comparison to the awful energy drinks I usually go with. The boost with the coca tea was so smooth, so much less "buzzy" than with caffeine, that it seems criminal it's not legal in the US. I know, apples and origins, but very mild, low-dose coca seems really great, and too much caffeine seems kind of bad.
This excellent post reminds me of the standard admonition against supplementing liberally with vitamin D, which says that doing so will give us all kidney stones and soft tissue calcification.
All the published evidence I have been able to find on this is old, and it mostly documents food fortification mishaps of the kind that result in a litre of milk containing 1,000,000 IU. Those stories do not have anything remotely to do with vitamin D as it would be used in any reasonable supplementation regime, but they sure are effective in scaring everybody, closing minds and shutting down inquiry.
From Reinhold Veith's 1999 paper on vitamin D safety (https://doi.org/10.1093/ajcn/69.5.842):
"Throughout my preparation of this review, I was amazed at the lack of evidence supporting statements about the toxicity of moderate doses of vitamin D. Consistently, literature citations to support them have been either inappropriate or without substance. The statement in the 1989 US nutrition guidelines that 5 times the RDA for vitamin D may be harmful (3) relates back to a 1963 expert committee report (5), which then refers back to the primary reference, a 1938 report in which linear bone growth in infants was suppressed in those given 45–157.7 μg (1800–6300 IU) vitamin D/d (119). The citation is not related to adult nutrition and it does not form a scientific basis for a safe upper limit in adults. The same applies to the statement in the 1987 Council Report for the American Medical Association that “dosages of 10,000 IU/d for several months have resulted in marked disturbances in calcium metabolism…and, in some cases, death.” Two references were cited to substantiate this. One was a review article about vitamins in general, which gave no evidence for and cited no other reference to its claim of toxicity at vitamin D doses as low as 250 μg (10000 IU)/d (120). The other paper cited in the report dealt with 10 patients with vitamin D toxicity reported in 1948, for whom the vitamin D dose was actually 3750–15000 μg (150000–600000 IU)/d, and all patients recovered (121). If there is published evidence of toxicity in adults from an intake of 250 μg (10000 IU)/d, and that is verified by the 25(OH)D concentration, I have yet to find it."
This post shows that this kind of unconsidered overreaction is a more general problem. I guess I'm relieved?
Come on...Just one article I want to read "This is definitely medical advice and these drugs are really fun so go nuts"
Reminds me of psychedelic therapy. Is anybody going to be getting a massive dose legally, or will clinical doses be so much smaller that they are qualitatively different drugs? There is a major difference in experience between ketamine abusers and patients being prescribed ketamine by a doctor. If you read trip reports from massive ketamine doses, you can see there is much more going on. I would expect ketamine abusers to be less depressed, all else equal, but curious if there is actual data on that.
This reminded me of a long time ago when I was reading about lean, a drink combining prescription cough syrup with sprite and jolly ranchers. I cannot find the exact dosage currently, but I believe I read it was around 25 times the prescribed dosage. I'm sure there is a wide range. It would seem that one would quickly run out of cough syrup.
I am not sure if there is the same phenomenon with lean. People don't seem to have much qualms with taking cough syrup but a lot of rappers have died or had health problems as a result of lean usage.
Relevant clip from a superb film, 32 Short Films About Glenn Gould (this is film #23). GG took all these— a drug user who took a *lot* of drugs. https://www.youtube.com/watch?v=7eBotiHABdo
A couple big spoonfuls of pure caffeine powder can be lethal
The question is how much more likely you are to start doing recreational megadoses eventually if you get a prescription.
related: alcohol is a much more social drug than a lot of pills and other such things, because you take your full dose in sips over several hours. Allows you to manage your level of intoxication via feedback. Whereas a tab of LSD or a pill can really fuck you up for hours and there's an expectation you should just take the whole thing at once. LSD would probably be much more popular if it came highly dilute and you could have a wee bit at a time (have I just reinvented microdosing, maybe.)
Is there a similar dosage delta between people who "microdose" LSD or other psychedelics and those who take more typical recreational doses?
Hey dude, what if you just fuck off?
This was a fun article to read! (That was true and kind ;)
One thing I was repeatedly told as a child (from a non-medical family!) was: Only the dose makes it poison.
I'm way out of my wheel house here as a non-biologist and non-drug user (I rarely even drink, pretty much stick to caffeine and sugar), but could this be read not just as an explicit argument against medical dosing guidelines, but also tacit argument *for* microdosing? Like, you're not wealthy, you don't have great insurance, but you need antidepressants, so you buy street drugs and then carefully stretch them out to a hundred doses?
It seems to be a standard practice to greatly big up the risks of taking any medication with recreational/abuse potential.
"A lot of our impressions of drugs, what side effects they have, and how dangerous they are, get shaped by the recreational users, not the patients."
I'd suggest a variation on this: our impression of drugs is shaped by their mode of delivery, which in recreational contexts tends to be a mode that delivers a faster rate of onset and/or higher peak plasma. I think this matters more than the total dose.
Morally: oral ingestion > inhalation > insufflation > intravenous injection.
So I can ingest vast quantities of caffeine in the form of coffee every day and still enjoy moral superiority vs. someone who injects the same quantity of stimulant at the weekend.
Of course they are probably getting a totally different high and side-effect profile too so it's not as if the moral stereotype is baseless. But I suspect it does feed into sub-optimal public-health outcomes. See: vaping.
Only users lose drugs.
3g of ketamine is by no way recreational, that's hardcore addicted in my book.
Still confusing to me as a non-English speaker: in Dutch we have two words: "drugs" are recreational (sometimes illegal) substances that change your mood or cognition, medicijnen are physician prescribed substances. This makes reading a piece like at times confusing:"Which of the two is he talking about now?"
As others have pointed out, it's unfortunate that you seem to be using some of the terms interchangeably which leads to casual drug users and drug abusers being conflated.
Obviously taking a large vs small quantity of a drug has differing effects but so does taking the drug daily vs occasionally. This is especially true given that the examples used seem to mostly refer to long term, frequent abuse. Most recreational drug users do not use so frequently.
In terms of meth, I think you're also missing some important confounds
Is it fine if I dont mention you to the cops?
I have a friend who used to take a lot of recreational ketamine. (This is a friend, not a "friend" ;-P ) He had a sports injury and wound up in the ER. When the anesthetic they gave him didn't work, they gave him more. Then they asked him if he took recreational ketamine, lol! He kinda demurred but was like, "Yeah, well, kinda..." Bottom line: recreational drug users take a lot of drugs!
"They find that severe abusers, who are taking an average of 60,000 mg/month, experience cognitive problems. But mild abusers, who take more like 3,500 mg/month, don't. Again, psychiatric patients are taking about 280 mg/month. I think this is pretty strong evidence that the psych patients shouldn’t worry that much."
I remember a post you made a while back about melatonin having greater effects at lower doses. Is this a possibility for ketamine?
My biggest issue with s-ketamine is its broad agonist on over 30 receptors. While it’s dissociative properties are why I would use it in a pinch, I prefer pharmaceuticals that are much more targeted. Also, I think the literature supports more novel psychedelic treatments such as psylocibin and MDMA as better effective depression and addiction treatments than ketamine - which has a very short duration of efficacy and is just about one step better than ECT.
I have friends who use ketamine and those doses are on the extreme high end. I would say the average dose for a normal non-addict ketamine user would be a gram every 1-2 weeks. Still higher than the therapeutic dose buy not by such an extreme margin
Every so often I see an article about how e.g. soldiers in WW2 were on amphetamines all the time-- now I'm curious where their dosage fell between "Adderall" and "recreational drug user".
Can I have my cocaine back now please?
"The dose makes the poison"
~ Paracelsus
I find it hard to believe that frequent ketamine users take around 3g/day. Just from a financial perspective, 3g/day equates to £2100/month (~$3000) at £25/gram. Given how disabling K is, I don't think that the kinds of people that are doing 3g/day could afford it. I had a quick look at the Morgan et al. paper, and although it says the frequent group uses about 3 grams, it doesn't specify over what time period. Perhaps they mean 3grams per week or month? Happy to be proven wrong here if I've missed it. The chinese paper does specifically say 3g per day though, so maybe my instincts are wrong. Anecdotally, I've heard of bladder issues in people that wouldn't be consuming more than a gram a month.
So.... Why don't we prescribe Adderall to just anyone who wants it at those low dosages? Or do we? Does this same kind of logic apply to steroids? Sure, body builders take huge dosages and can do damage to themselves. Can relatively low dosages work as treatment for obesity?
"one (1)" has an astounding comedy-to-character-count ratio.
Right up until that last paragraph I was really considering taking a micro-dose of DNP. Maybe I still should, but I would feel bad doing it without your blessing!
Could one call this phenomenon “replicability crisis two: electric boogaloo”? Sure seems the thrust here is that a large portion of drug studies won’t replicate in clinical settings, which feels like a big deal? And also implies we can’t really understand a drug’s risk unless we legalize it medically first and then study possible side effects?
I understand the point you're trying to make here, but as a recreational ketamine user I just want to let you know that 3g/day figure is way too high and nobody is taking those kind of doses, most certainly not everyday for a month. To get an idea of how much a typical recreational user is taking, you can refer to this harm reduction website. https://drugsand.me/en/
This site states that heavy dose for oral ingestion of ketamine is around 500mg which is also referred to as the K-hole dose. K-hole is the term used among users to refer to the state of total dysfunctionality when you take a large enough dose of ketamine. Going by these numbers it just seems absurd to believe that an average ketamine user is dysfunctional everyday over months.
Moreover the LD50 for ketamine for a 70 kg human is 4.2 grams. There's no way an average ketamine user is steering so close to the levee all the time.
Is there any evidence at all that energy drinks are harmful in low doses? I'm suspecting the entire stigma comes from case series where people took too much or had pre-existing heart problems.
Also I saw a review paper where a weight loss supplement providing -2kg over 3 months was described as "not clinically significant", but 1.33 pounds per month is a lot of weight loss. If that could be safely extrapolated over a long time it adds up. Adding it to the water supply might reduce obesity rates by more than half. Again I suspect thermogenic supplements have a bad name because of people who take too much.
"and you wouldn't believe how many hoops the psych patients have to jump through to get their 280, or how terrified their doctors are that something could go wrong"
This is pretty much why I gave up trying to get medications that I actually NEED to treat my ADHD and depression; it's actually less work to just go unmedicated and be mostly-functional than it is to deal with all the bullshit involved with getting stimulants and ketamine.
There's bits of this all over pharmacy lore. Metronidazole is the only antibiotic you're supposed to actually not take with alcohol because there's a theoretical disulfiram-like reaction (disulfiram is normally used to treat alcohol addiction does so by severely magnifying its effects so any tiny amount with have you throwing up like you went on a full bender) but I was told once (tbh I've not personally looked into this one) that there's straight up never been a case study of this actually happening.
Recreational users of non-meth amphetamine also take huge doses like 500-1,000mg on a single day. So it seems surprising they don't seem to get the same health problems and addiction. Though to be fair they probably don't take this every day. But that also suggests the addiction potential for non-meth amphetamine is lower. (Maybe because it can't be smoked?)
It is well known fact that ketamine high make urination difficult. It's not really a physical difficulty, but rather you forget how to contract and relax appropriate muscles. Also, having full bladder stops being so unpleasant on ketamine.
So I guess if you do lots of ketamine, then you're high most of the time and may hold your urine for long periods of time - and that can cause UTI and bladder injury.