The Invisible Majority: People Whose Drug Use Is Not Problematic

For years, Mark* woke up each morning, made breakfast for his two young children, and dropped them off at school before continuing to his own job as a pre-school teacher in Baltimore, Maryland. His life was ordinary—except that each day before breakfast, he went into the bathroom and injected black tar heroin into his veins. He took another shot at lunchtime, one after work, and a final hit before bed. Now 33 years old, he has been injecting heroin for six years.

Alice* is a health educator from Denver, Colorado, who works primarily with people living with HIV and hepatitis C. She and her partner will soon celebrate 20 years together. Alice, who is 40 years old, has lived on the same tree-lined street for 15 years. She attends neighborhood association meetings, stays involved in local politics and spoils her cats. She also injects heroin 5-7 times each day.

Mark and Alice might seem like anomalies, rare superhumans who can conquer heroin’s primal pull towards chaos. Popular wisdom tells us that all illicit drug users teeter on the brink of collapse. The media depicts them as scavengers in a desperate, perpetual search for the next fix—liars and thieves who are incapable of maintaining steady work and families.

Drugs are just too addictive, people say. No matter how strong you think you are, they will get you in the end.

But the evidence tells a very different story.

 

Double Standards

Myriad studies have investigated the prevalence of addictive behaviors in everything from work to drugs to sex. One comprehensive evaluation of dozens of them published the following information on addiction rates among the overall population of U.S. adults:

Eating—2%

Gambling—2%

Internet—2%

Love—3%

Sex—3%

Exercise—3%

Illicit drugs—5%

Shopping—6%

Work—10%

Alcohol—10%

Cigarettes—15%

Note that only one item on this list is preceded by the word “illicit.” Despite approximately half of us being affected by addiction of one kind or another in any 12-month period, the other substances and activities on this list are not only legal, but often actively encouraged.

Every day we endure a blitz of commercials, billboards, sale signs, click-bait, coupons and ads. The siren call of the Internet keeps our noses glued to our phones. The porn industry has swollen larger than Hollywood. And alcohol, though it’s experienced addictively by twice as many Americans as experience illicit drugs in this way, is heavily embedded in aspects of our culture. Yet we reserve our guns, handcuffs and cinder-block cells for a war against one thing only: drugs. Or rather, the people who use them.

Imagine if such a war were waged against exercise. Picture the nightly news splaying pictures of hollow-cheeked gym rats with spidery limbs forged from hours on the elliptical. The TV shows following interventions to save a marriage doomed because a husband neglected his wife for the gym. Imagine police arresting fitness instructors for hooking customers onto $150/hour “training sessions;” The Slammer hawking morbid photos of balding exercise freaks, their hair falling out in brittle clumps from mineral depletion; public hysteria over injury and premature death via workout overdose; the demands that justice be served to anyone caught peddling illicit free weights and packets of powdered Gatorade.

Silly, right? And yet this is what we do with drugs, despite the fact that the prevalence of illicit drug addiction—5 percent—is on par with addictions to other substances and behaviors.

Of course, it is true that there are far more drug-related deaths than exercise-related ones. But it is equally true that the very stigma against drugs prevents people from accessing safer forms of substances or safer modes of ingestion—and is therefore directly responsible for many of those deaths.

It wasn’t the heroin that took everything from him. It was the discovery that he was using heroin.

It is not easy keeping a stigmatized secret. Many functional illicit drug users are forced to live a double life, under constant threat of losing everything because society has decided to scapegoat their particular activity.

During the first year he started injecting drugs, Mark was ashamed to tell even his wife about his heroin use. “I wore long sleeves all the time. I made sure we only had sex in the dark,” he tells me.

When he couldn’t bear to hide anymore and finally blurted out his secret, his wife reacted with shock and disbelief. She was no longer willing to live with him, and Mark became homeless. Divorce papers soon followed.

But it wasn’t the heroin that took everything from him. It was the discovery that he was using heroin—and the fear and stigma that discovery unleashed.

Alice has a partner who also uses heroin, so they hold their secret together, choosing to share it with some loved ones and to hide it from others. Alice says that most of her co-workers are aware of her drug use, but her mother does not know.

“It’s not that she wouldn’t love me, I just don’t want her to worry,” says Alice, who acknowledges that it is unusual to be open about drug use with co-workers. “Even being in a supportive environment, I still deal with the same shame and fear that everyone else does.”

Alice has also previously suffered periods of homelessness and chaotic use. But, just as Mark found, this occurred only when a family member—in Alice’s case, her mother—found out that she was using drugs and decided she could no longer live under the same roof.

Often, the first reaction from a loved one upon discovery of drug use is to resort to “tough love” in the hopes that it will teach the user a lesson. In reality, that kind of reaction often fuels chaotic use. “When you have already had everything taken from you, it is hard to fight the voice that says ‘let’s get high’ in your mind,” says Alice.

Certainly for people who use drugs regularly, even those who do not develop problems, the specter looms large. For many, a job loss due to a random drug test unrelated to performance, an unsupportive family member, or a stint in jail could precipitate a decline in overall health and coping skills, which could fuel chaotic drug use. Chaos triggers consequence, which breeds more chaos. Some people never break the cycle. For lifelong drug users who oscillate between periods of stability and instability, the volatility is often sparked by policy, legal or stigma-related events—not the chemical effects of the actual drugs.

Dr. Carl Hart, a neuroscientist at Columbia University, has studied and published books on drugs and addiction. He notes that illicit drugs are physiologically no different from equivalent licit drugs on the market—and that both can be used responsibly to benefit people.

It makes no sense to criminalize methamphetamine while marketing its sister drug, Adderall—chemically almost identical—to people with ADHD. Hart’s study, among others, showed that regular meth users were unable to distinguish between the two when ingesting equivalent forms and doses. Similarly, fentanyl is legal or illegal depending on where it is manufactured—or who profits off its sale.

So how is the myth—that drug use inevitably causes chaos, rather than the other way around—allowed to continue? Why do we focus so heavily on the 7.4 million Americans addicted to illicit drugs and ignore the 32 million-plus addicted to work—people who are also at risk of losing their families, their health and therefore even their lives?

 

An Entrenched and Harmful Myth

The answer is complicated, with roots deep in history, economics, race and power. But one simple answer is that drugs are easy to demonize because they can readily be classified as “other.” Most Americans don’t use illicit drugs, whereas most of us do engage in work, exercise, shopping, sex and drinking. We may be aware that a small percentage of the population becomes addicted to these activities, but we also know that most people do not. We tell ourselves that although any activity is potentially addictive, drugs are particularly addictive, hence they should be prohibited.

But here, too, statistics beg to differ.

“Blaming drugs for our problems detracts the public from other factors such as job loss or a broken mental health system,” Dr. Hart tells Filter.

According to data from the most recent National Survey on Drug Use and Health (2016), 48.5 million U.S. residents ages 12 and older report using illicit drugs in the past year (about 15 percent of the population). Of these, 7.4 million (15 percent of illicit drug users) exhibit possible signs of dependence (more than half of these—4 million—to marijuana). And of these, 2.1 million (4 percent of the total) meet criteria for “abuse.”

Put another way, 85-96 percent of people who use illicit substances do not develop problematic behavior.

This figure roughly matches those reported internationally. According to the anti-drug United Nations Office on Drugs and Crime, a little over 10 percent of worldwide drug users are “problem” drug users—which leaves almost 90 percent who are not.

This reality does not tally with our portrayal of drug users as slaves to a poison that hijacked their brain. To be sure, some people do become problematic users, and the consequences can be tragic and even deadly. But pop culture enormously exaggerates the percentage of people who develop chaotic behavior through drug use, while ignoring the same symptoms when they develop through legal activities. We obsess over the 2.1 million people who “abuse” illicit drugs, while forgetting the other 46.4 million users who quietly blend in with the rest of us.

“Blaming drugs for our problems detracts the public from other factors such as job loss or a broken mental health system,” Dr. Hart tells Filter. He notes that this allows politicians to vilify people who use drugs rather than focus on solving larger problems. Demonizing drugs also directs resources towards law enforcement, the prison-industrial complex, and more recently, “treatment” centers that often lack any basis in evidence.

Dr. Hart is currently working on a book about the other side of drug use: the medicinal, social, recreational side. “[Drugs] can enhance the human experience, improve performance, facilitate better social interactions and intimacy,” he says. He hopes that science can help explode myths about drugs and lead us to a place where drugs are legally available to responsible adults.

For Mark, that day can’t come soon enough. He recently decided to be open about his heroin use in his Baltimore community. Today he lives once again with his former wife, so they can co-parent their children. He works for a nonprofit in Baltimore that provides health services to people who use drugs.

The decision to be open about his drug use has cost him some job prospects and friendships. He has neighbors who won’t let their kids play with his children if he is the only adult present. But Mark does not regret his choice. “We have to acknowledge that non-chaotic use is possible and to help people through the harm reduction way of thinking,” he says. “I’m not hurting anyone by choosing to imbibe poppies instead of beer.”

Mark emphasizes that there are many paths to recovery, which include getting healthier, building positive relationships and being honest with yourself and others. He dreams of one day taking a bike trip from New York to Atlanta to show people that you can be healthy and active on large daily doses of opioids. “I want to post pictures of myself eating kale and drinking methadone,” he laughs.

“As soon as we find out a person is an IV drug user, we strip away all the reasons for them to be anything different,” says Alice.

Perhaps reasonable drug policy will someday arrive, but in the meantime, it is difficult to reverse decades of fear, hype and false information. With exhaustive media coverage of opioids, a death toll that continues to climb, and many people witnessing addiction in their families and neighborhoods—coupled with the obvious disincentives for people who use illicit drugs non-problematically to “come out”—it can be easy to disbelieve that the overwhelming majority of people who use illicit drugs do not develop problematic behaviors. But the numbers don’t lie.

“As soon as we find out a person is an IV drug user, we strip away all the reasons for them to be anything different,” says Alice.

For the people who do become chaotic users, we should increase our resources for mental health, education, training, coping skills and economic development to help build positive relationships and fulfilling lives that may or may not include drugs.

For the rest—the Marks and Alices of the world—we should ensure their right to pursue life, liberty and happiness without hindrance. It is one thing to criminalize harmful behaviors such as theft or intoxicated driving that are carried out under the influence of a substance. It is quite another to criminalize the substance itself when no crime or harm has taken place.

Why punish anyone for merely ingesting something? Why encourage fear and stigma to rule personal relationships instead of honesty and love? Why give people reasons to use chaotically?

The invisible majority, the tens of millions of Americans who use illicit substances each year without significant negative consequences, deserve peace—and the right to respond to their own needs without fear of being caught, criminalized and caged.

*Names have been changed.

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Photo via 13on on Unsplash