"The dose makes the poison." Most have heard this wise saying but few understand how important it truly is, and how much it applies to things like drug policy/education. Not only is dosage vital in determining a substance's effects, the route of administration/ROA (oral, inhaled, topical, rectal, IV, IM, etc) play a critical role in the outcome with most things. Not only recreational drugs but everyday medications & supplements.
Take Vitamin E oil: Still the standard for treating severe burns & other skin injuries, research now suggests that taking the supplement orally might increase the risk of certain cancers. Worse, inhaling it can lead to EVALI/vaping lung disease, an often-fatal lung condition. This is the perfect example of ROA causing wildly different effects.
And Vitamin E isn't alone. Many vitamins & minerals become toxic at high doses, building up in the body's fat & causing liver damage or other serious issues. Vitamin A is a prime example: kids given RFK's "protocol" of high doses of Vitamin A for measles turned orange & developed liver injury because they were OD'ing on the shit. The same can happen with Vitamin D. Meanwhile, several vital minerals are toxic in anything more than trace amounts: copper, potassium & iron for instance. While some heavy metals like mercury or lead are toxic at any dose, others are required for good health like the ones mentioned above. It's a balancing act that can kill if you get it wrong.
Everything Has a Fatal Dose
The dose "making the poison" with several common substances
All substances from salt to water to oxygen have an LD50, aka the dose at which 50% of test animals die from overdose. Even things like cannabis, which is promoted as non-toxic and impossible to OD on, could in theory kill you if you ingested enough at once, though you'd have to smoke the equivalent of 4 telephone poles' worth of joints in a few minutes to actually die. And many scientific studies attempt to do just that, seeing just how much of a drug they can give the poor lab animal before it croaks. Then they spin the results as "OMG, Ecastasy eats holes in the brain!" or similar.
All '90s kids remember this horrific (retracted) study
Only later do we find out in a quiet retraction that, oopsie, none of it is true. That infamous MDMA study "accidentally" used extreme doses of methamphetamine, and many pot studies involve strapping a mask to a primate's face & substituting pot smoke for oxygen until it expires, such as the infamous "pot kills brain cells" study from the '70s by Dr. Robert Heath. This quack has a long history of extremely sketchy behavior that borders on criminal. Meanwhile the horrifying link between schizophrenia and tobacco/nicotine, which is stronger than the link between lung cancer & smoking, is spun as "These poor folks are using tobacco to self-medicate! We musn't take it away from them." Never mind that most schizophrenics started smoking BEFORE the onset of the disorder. Only 8 of 10 lung cancer patients EVER smoked; 9 of 10 schizophrenics currently do. This is why you need to not take scary drug headlines at face value. They spin them in favor of certain drugs and against others.
The same applies to all those kratom deaths. Aside from the fact that the vast majority involved other opioids like fentanyl or serious underlying health conditions, nearly all involved extremely high doses of potent extracts & enhanced products with soaring, unknown mitragynine and 7-hydroxymitragynine levels. Amounts that do not occur naturally in the plain leaf.
People hear words like "heroin" or "meth" and instantly picture strung out junkies, but few are aware that a high dose of Adderall is equivalent to a low dose of meth, or a high dose of oral oxycodone is equivalent to a low dose of IV heroin. Long-acting opioids like methadone, buprenorphine (in Suboxone) or opium cause longer, more severe withdrawals than things like heroin or even fentanyl--so bad that nearly all addicts in the know avoid starting the meds unless they plan to be on them for life. Yet they also save lives by "scratching that itch" and blocking receptors for long periods, making for convenient dosing & giving addicts back their freedom to not chase opiate highs all day. Again, it's a balancing act.
Perhaps the most striking example is that of meth, a known neurotoxin that kills dopamine receptors. When taken within 12 hours of a brain-damaging event like ischemic stroke, it actually has neuroprotective effects up to the 10 mg range. Perhaps the best available proof that dose = poison.
Revolving Door Between the FDA & Big Pharma
This two-way relationship damages FDA credibility
Exhibit A: Scott Gottlieb, Chief of the FDA. Or should I say, former Chief. You see Scotty stepped down 2 years early to "spend time with his family" in 2019, something that's never happened in the history of the FDA. A chief resigning early? Is he crazy? This was before the COVID shitshow, mind you, so it wasn't that he was stressed out about that. Why would a young, healthy guy with that much authority just quit early? I'll always believe it was due in part to Twitter users calling him out on his kratom hypocrisy & conflicts of interest. They/we simply highlighted his former position as drug procurer/dealer for pharma company Cephalon, which was already in trouble for overprescribing when he came in. Scott went directly from that job to FDA Chief, then proceeded to spend every waking moment trying to drum up support for a nationwide kratom ban. The drug he was helping score for Cephalon? Fentanyl.
From his POV, you can hopefully see the issue with a cheap, abundant plant supplement like kratom that helps people quit opioids, sleeping pills, antidepressants, etc. It's not the safety risk that concerned Gottlieb & Co. but the fact that kratom directly competed with many existing pharma drugs. Just as they'd done with marijuana for 80+ years, they wanted to ban the whole kratom plant while patenting select components or creating synthetic versions of the active alkaloids (Marinol, Nabilone, Epidiolex) & selling them back to us for a disgusting profit. How can you take them seriously about important shit like vaccines when they are clearly biased in favor of drug companies & private insurers?
This explains the attempted ban on over-the-counter CBD supplements.
When Epidiolex (CBD in a spray bottle) was coming on the market, there was a simultaneous push to ban over-the-counter CBD supplements. Annual cost of Epidiolex: $32,000 (but occasionally over $80,000). Cost of CBD supplements: No more than $100 per package, usually closer to $20.
THEN there was the attempted ban on supplemental N-Acetylcysteine, a supplement without psychoactive effects that's never killed a soul in its 30+ years on the market. This GRAS (generally recognized as safe) substance is already used in emergency rooms & is the only thing that will save you from a Tylenol overdose if administered in time, but it also has potential benefits for mental health & other conditions when taken orally. It's those "other" benefits that prompted the drive to ban it. You see, when they found out that NAC decreased both the severity & duration of COVID infections and thereby reduced mortality, they tried to give it the ol' cannabis/coca/khat treatment, making it illegal to buy in supplement form so they could make a killing off the Rx form. This is highway robbery & points to a conspiracy between pharmaceutical companies/private insurers & the FDA to create a monopoly on our health based on nothing but profit motive.
The COVID Cares Act brought them one step closer to achieving that goal, quietly removing many meds & supplements from the OTC market to make them "prescription-only". Again, something I used was affected: hydroquinone cream, a skin bleach that not only "lightens" skin a la Michael Jackson, but reduces the appearance of severe scars, dark marks, etc. In combo with Retin-A imported from overseas, this stuff saved my skin after a bad COVID rash left my legs scabbed & scarred for years. I couldn't even wear shorts in the heat of summer because I'd get stares in public--it was bad. The dermatologist's (expensive) treatment did fuckall to help, but this combo worked wonders in a very short space of time. Hydroquinone can cause cancer when slathered all over the body daily & worn out in the sun, but is pretty harmless when used at the lowest dose for the shortest time.
Check Your Own Biases
Healthcare provider biases
I can do this all day with various drugs and examples of their relative safety/danger in different settings, but I'll stop here. My goal isn't to cause distrust of government institutions, but to raise awareness of the common myth that, because a substance is bad for one person at one dose, that means it should be banned for everyone at all doses or made available only via prescription (to those with insurance). Throwing the baby out with the bathwater is dangerous when it comes to things as nuanced as our responses to different substances. The U.S. has a disturbing history of painting new drugs as miraculous cure-alls with no downsides only to swing in the opposite direction, deeming them too addictive/unsafe to even remain legal. The truth is nearly always somewhere in the middle. They did this with amphetamines in the '40s/'50s, methaqualone (aka "Quaaludes") in the '70s and opioids in the '90s/2000s.
So how can you, the everyday Joe Blow or Jane Doe, know what's true when it comes to medications & supplements? Read articles beyond the scary headlines, click links to the actual studies cited & be careful about making assumptions or stereotyping substances or their users. "One man's poison is another man's cure" also holds true. Differences in metabolism, neurology, genetics, set/setting & subjective expectations can all influence how a substance affects a person, which is why the exact same medications can cause such a wildly different effects in different people. Generalizing your experience & applying it to everyone else just doesn't work here. Paradoxical effects are a thing & they tend to be more common in certain populations, such as children, the elderly or people with a "neurodiverse" condition (autism, ADHD). A paradoxical effect is when a drug known for causing one effect causes the opposite, such as a sedating drug like diphenhydramine or Valium causing mania/agitation/hyperactivity, or stimulants like amphetamine having a relaxing or even sedating effect. Yet another reason why YOUR drug preferences, whether medicinal or recreational, can't be applied to everyone.
If you're a healthcare provider, please believe your patients when they report a side effect or trust you enough to disclose the use of an illicit or stigmatized substance. Not everything positive reported about a stigmatized drug is "denial" or a product of hopeless addiction & shouldn't automatically influence the patient's credibility or your treatment decisions. Wrongly attributing problems to the very thing the patient views as the most effective treatment they've ever found will only lead to delayed diagnosis of actual root problems & foster distrust in the medical profession, which can cause its own set of serious problems. Not everything is as cut-and-dried as it's made out to be in medical textbooks or afterschool specials, especially when it comes to something as complex as the human brain/body.
My Anecdotal Experience
If most people took the dosage of amphetamine that I do daily, they'd be scrubbing the toilet with a toothbrush & looking out the windows for black helicopters, yet it barely has any effect on my outward presentation. And I can barely get out of bed without it or a similar drug. And my blood pressure readings confirm my outward presentation: 120/70 or less despite my long-term stimulant use. Yet alcohol, a drug almost everybody uses occasionally, disagrees with me so violently I can't tolerate even small amounts & haven't touched it since 2005. Actually, all depressants that affect GABA make me an aggressive, depressed sack of shit, whether it's benzos, barbiturates or booze, and Ambien is the worst of the bunch, making me suicidal after a single dose.
Likewise, while opioids disable most folks even at low doses (causing "the nods", nausea, dizziness or sedation), they have either a neutral or positive effect on alertness & energy for me. It's disturbing how high a dose I can take & still not show signs of intoxication or impairment tbh. And for some reason, I don't have typical withdrawal symptoms even after quitting high doses cold turkey after prolonged use. This goes for everything from kratom to OxyContin. At worst, I get a little sweaty & poop more than usual, but it's nowhere NEAR as bad as people describe. Yet innocent old cannabis is too debilitating for me to use even in microdoses during the daytime, making me drowsy, paranoid & anxious.
I'd much prefer if weed & other socially acceptable drugs agreed with me, but they don't. Should I be labeled an addict in denial for this even though I have no problem quitting my drugs of choice & do so frequently with no help? Why should one person be punished for another's inability to exercise moderation & self-control?
Answer: They shouldn't, and our lawmakers who often have major undisclosed profit motives & are not medical experts themselves, have no place making that call for us. Medical decisions and indeed the substances a consenting adults chooses to ingest should be their decision alone, perhaps with a doctor's input at times.
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