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Why get high? - (12/4/2018)

By Dr. Ron Gasbarro

When Sandy walked into the pharmacy, the pharmacist knew exactly what she was after. “Here’s my new Xanax prescription, sir,” Sandy said. “Can I wait for it to be filled?” Since the pharmacist was not busy, he filled the prescription and said to Sandy, “I see the doctor raised your dose of Xanax, so now you are taking it 4 times a day instead of 3. Has your condition worsened? Why have you been prescribed this?” “I have a fear of spiders,” she replied. “Oh, do you work in a zoo?” the pharmacist asked. “Well, no. Anyway, it makes me feel good.”

In other words, Sandy uses Xanax to “get high.” Is this wrong? After all, her prescriptions are valid. They come from the same doctor. She does not get refills early. She may be developing a tolerance to the drug. Hence, her dosage has gone up. The pharmacist admits that he likes a cocktail or two after work. Maybe even three if the day has been rough. His martinis or manhattans make him feel good too. So, is he being judgmental? Is he a hypocrite?

Whether it is liquor, pills, or weed, a little goes a long way. According to the 2015 National Survey on Drug Use and Health (NSDUH), 86% of people ages 18 or older reported that they drank alcohol at some point in their lifetime. Needless to say, there is a difference between a glass or two of wine after work, and binge drinking all weekend. Approximately 88,000 Americans die from alcohol-related causes annually, making alcohol a leading preventable cause of death. By comparison, marijuana is nontoxic and cannot cause death by overdose. A 2014 study found that a fatal dose of TCH, the potent chemical in marijuana, would be between 15 and 70 grams. That means that you would have to smoke between 238 and 1,113 joints in a day to overdose on marijuana. It can cause coughing and affects short-term memory. Pot is illegal, yet that is changing state-by-state. Pills are another story. The opioid crisis has notably shortened the lifespan of Americans. As for Xanax (alprazolam), the dose it takes to overdose is extremely high – much higher than the dose Sandy is taking. But, as Sandy said, “It makes me feel good.” 

Why do we use substances to make us feel good? They make our body relax. When our body is relaxed, stress is diminished. Because substances stimulate the brain’s reward system, one feels that something special is about to occur. The “feeling good” part about substance use can be attributed to the release of the body’s own opioids, also called endorphins or internal opiates. Example: The martini – which consists of 3 ounces of gin and a molecule of vermouth – feels particularly pleasant for one reason. The faster the alcohol gets into your bloodstream, the more internal opiates are released. Benzodiazepines, such as Xanax, affect a chemical in the brain called gamma-aminobutyric acid (GABA). This neurotransmitter has an inhibitory effect on motor neurons, thus the presence of GABA slows or stops nerve activity. Benzodiazepines enhance the activity of GABA, effectively slowing nerve impulses throughout the body. 

Life can become oppressive. Anxieties seem to spring from every train of thought. Yes, people do play tennis, or write, or paint to relieve stress. Arguably, these may be superior methods to get a buzz. However, getting high did not start with the hippies during the 60s. Opium is undoubtedly the most widely used drug in ancient history first cultivated by Sumerians in southern Iraq around 3400 BC and also used by the Romans, Greeks, Native Americans, and Egyptians. The human body is hardwired to feel good when it can. And the use of substances – in moderation – is a very human activity. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 


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