Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Friday, January 28, 2011

Drug Use is Never Involuntary

It is very important to understand that just the fact that a certain behavior is influenced by changes in the brain, does not make the behavior involuntary.

Consider this excerpt, quoted from an “addict in recovery” - “Addiction makes all of us do things we would never have dreamed of".

Herein lies the problem. Addiction does not “make” anyone do anything.

These behaviors being referred to are not involuntary, nor are they beyond our control. Addiction often leads the affected person to do things they would’ve previously never imagined they would do because the brain has adapted to prioritize drugs in the same way it prioritizes food and water. This doesn’t necessarily cause the addict to behave in any certain fashion, but it creates an emotional disposition in which doing so might seem more appealing, or even essential, thus making it more likely that the addict will choose to behave in a fashion which accomodates his every whim to the detriment of other values or priorities in his life.

Addiction affects our emotional disposition and feelings, whereas we as individuals are left to rationally analyze these feelings and to choose our behaviors accordingly. Feelings, emotion, and instinct must be differentiated from behavior - yet in the case of the disease model of addiction, these two very distinct factors are incorrectly conceptualized as one in the same.

Being human, we take comfort in believing that those who continue to use drugs despite negative consequences really don't want to be doing so, but can not control this behavior because they are the victims of a medical affliction, a disease which causes them to use drugs recklessly and involuntarily. This is, unfortunately (or perhaps fortunately, depending on ones perspective), not the case.

Let’s use the analogy of the motorcross racer - most of these individuals love to race their dirtbikes, so much in fact that they will continue to race and ride in spite of multiple accidents, serious injuries, and near death experiences. Furthermore, their racing of dirtbikes has led to changes in certain areas of the brain associated with this particular activity.

Many people in the profession of extreme sports are not deterred by the prospect of death, and in fact they would be happy to die doing what they love. Is their incessant passion for extreme and dangerous sports, along with the associated changes in their brains, indicative of a disease which causes involuntary behavior? Does their continuation of dangerous sports despite broken bones and the risk of death indicate they are not in control of their behavior?

Perhaps the pro motorcross racer wants badly to stop racing, but he simply cannot resist, and, is compelled to climb on his bike involuntarily at the sight of a racetrack..

Sound a bit ridiculous? That's because it is.


  1. "Snorting the powder of a 4mg hydromorphone tablet will be similar in strength to snorting the powder of a 30mg oxycodone tablet - a blue 'roxicodone' pill for example; or to snorting the powder of 60mg of morphine - or an orange 'MS' 60"

    I dont know about this one. 4mg of hydromorph is sooooo sooooo weak when sniffed. a 30 is actually ok. i could sniff 6 8mg dillys (tons of powder mind you) and not feel too much of anything, but 3 roxis and im rocked. idk, maybe just me

  2. Hey there, I'm not shocked to hear that. Bioavailability for a given ROA will vary between individuals; however 50 percent nasally (VS 25% oral) is generally the average absorbtion for hydromorphone, assuming it's the hydrochloride salt and in a relatively pure form - Because consider this; a 4mg Dilaudid/HM tablet will contain only 4 milligrams of the active hydromorphone, a MINISCULE, tiny amount of actual powder, with the large majority of the pill being inactive binder, which will largely affect the absorbtion of HM into mucus membranes. On the other hand, a blue Roxicodone tablet will contain 30mg of active oxycodone, not much powder but a relatively higher ratio of oxycodone powder to inactive filler.. this difference is likely to make roxicodone tablets slightly (not too much) better absorbed by the intranasal route - This is only likely to make a minor difference; versus say if you snorted a pure form of hydromorphone USP grade powder.. The main difference I believe with these two by the nasal route, is that oxycodone is pharmacokinetically more suited for non injection routes, mainly in the sense that oxycodone is still highly euphoric by oral or nasal ROA, regardless of how gradually it may rech the brain. Hydromorphone on the other hand, carries a euphoria/high/rush which is largely dependent upon how rapidly it reaches the brain/CNS. A large part of hydromorphone's pleasure lies within that sudden rush when injected - this applies to most morphine derivatives. Hydromorphone (along with morphine and oxymorphone), in a general sense, do not have the especially euphoric/buzz-like properties of oxycodone or hydrocodone. With any non injected route, hydromorphone is often less euphoric than oxycodone regardless of potency - some peole could snort dilaudid after dilaudid, to the brink of respiratory failure and overdose - without feeling the same strong sensations associated with an Oxy-buzz. All opioids are essentially very similar, yet so unique at the very same time in regards to "what they do", "how they feel", and which route "feels" better; this is not always consistent with the absorbtion and bioavailabilty; but often more-so with brain penetration, tissue distribution, and pharmacokinetics of the drug.

  3. On a final note: I could bet my left nut that 16-20mg of hydromorph in the form of a 2ml purified nasal spray, would get you nicely rocked... And be much more effective.

  4. Oral Codeine to IV Codeine is 1.33/Death. IV Codeine is quite likely to kill you with a anaphalactic shock!

  5. Indeed it is, I've corrected that section to refer to "Parenteral" rather than Intravenous - Codeine administered intramuscularly is what I was referring to.

    Thanks for pointing that out.