Harm of Each Drug Type – Drugs of Abuse

00:00 Now we will discuss the significant harms associated with substance use and abuse, focusing on alcohol, tobacco, fentanyl, and heroin. Starting with alcohol is responsible for approximately 95,158 deaths annually in the United States, contributing to a staggering 2.8 million years of potential life lost. The relative harms include a high risk of addiction, liver disease, and impaired judgment, which can lead to accidents and other negative consequences.

00:32 Next, tobacco use results in around 480,000 deaths each year, with about 65,000 of those due to smoking-related illnesses. This translates to over 2.5 million years lost due to disability.

00:46 Tobacco has a high addiction potential and is linked to severe respiratory diseases significantly impacting public health. Fentanyl poses an alarming risk as well, with nearly 100,000 overdose deaths reported annually. It is extremely addictive and can lead to impaired driving, creating further dangers for users and others. Heroin contributes to approximately 15,000 annual overdose deaths. It carries a high risk of addiction and is associated with the spread of infectious diseases, largely due to needle sharing among users. Methamphetamine presents significant risks, with rising overdose deaths reaching into the thousands annually. This substance is associated with severe addiction and serious mental health issues, such as anxiety and psychosis, which can have lasting effects on users. Turning to cannabis while it typically results in fewer direct fatalities compared to other substances, its risks can still vary. Cannabis has a lower potential for addiction, but it can impair driving, which poses safety concerns for both users and the public. Across all these substances, we see notable societal harms.

02:00 Increased health care costs strain our medical systems, while crime and violence often rise alongside substance abuse. Additionally, lost productivity in the workplace can impact economic stability, and family disruptions lead to significant social challenges. Public health crises emerge as communities struggle to cope with the fallout from substance use. The graphs displayed illustrate two important trends related to drug overdose deaths in the United States.

02:27 The first graph on the left shows the provisional number of drug overdose deaths over a 12-month period, ending in September 2024. From around 2015, there has been a steady rise in overdose deaths, reaching a peak of over 110,000 deaths in recent years. The curve has slightly dipped as of 2024, but the overall trend reflects a sharp increase in deaths related to drug use, with no significant decline. The second graph on the right breaks down overdose deaths by specific substances. It highlights the alarming surge in fatalities involving fentanyl and synthetic opioids, which are the leading cause of overdose deaths, peaking around 100,000 deaths. Psychostimulants, which include methamphetamine, as well as cocaine and heroin, also contribute to overdose deaths, though in lower numbers. Notably, deaths related to fentanyl have risen sharply since 2016, surpassing other substances by a wide margin. Cannabis, as a general rule, are not as bad as some of the other drugs, so it is considered a soft drug. However, we also have to take a look at cannabinoids and decide if it's a good drug or a bad drug. Now, from a pharmacology perspective, let's ignore the politics of cannabis. Let's ignore the hype around it. Let's just talk about a good drug versus a bad drug. From a pharmacology point of view, a good drug is one that is water soluble, so it loves water hydrophilic. A bad drug is one that is lipid soluble, or loves lipids, or lipophilic. A good drug is rapidly metabolized. A bad drug is slowly metabolized. A good drug has very localized receptors in the brain, and it works in a very specific area, say for example the antidepressants. If you look at my antidepressant lectures, I start off from the most broad, kind of worst antidepressants, and I move to the more specific ones that have fewer side effects and are more effective. A bad drug on the other one has very generalized effects in all kinds of tissues. It could be all kinds of tissues in the brain, in multiple areas with multiple receptors. It could even have receptors in the stomach, in the bowel, in the kidney, whatever. So if there's lots of receptors all over the body, that drug that's affecting those receptors could be defined as a bad drug.

04:56 Another aspect of a good drug is that it's very specific to a very small number of receptors, or even receptor subtypes. So it's not just something that acts on the opioid receptor, but it acts specifically on, say, the mu opioid or the kappa opioid receptor only, and it doesn't act on a whole bunch of different receptor subtypes.

05:16 A bad drug, on the other hand, is active against multiple receptor types. It can be active against serotonin. It can be active against the cannabinoid system. It can be active against the opioid system. That's a bad drug. A good drug will have few active compounds in the product. So if your product has one single pure product, it's a good product.

05:36 If your product has many active compounds in the product, I would consider it a bad product.

05:42 So when we start talking about cannabinoids, we want to say that really, every single one of the criteria on the bad drug column is being fulfilled by the cannabinoids. It is lipophilic. It is slowly metabolized. It has ubiquitous receptors all over the brain, and in fact, even in the stomach and other organs, it is active against multiple receptor subtypes. And there's many active compounds in cannabinoids. There could be hundreds of active compounds in a joint. So we really have to be aware that by every single criteria that we use in pharmacology, cannabinoids are bad news.