Over the past fifty years, a period of time that sometimes seems like only a blink of the eye, a number of different substances have held the position of society’s most-favored drug of choice.

Some substances have been more popular in one group of people or another, but there have been broad trends toward the use of certain classes of substances that to some extent have defined, and have been defined by, the decade of their popularity. 

The late 1960’s, for example, were heavily influenced by the popularization of LSD by the media and by some segments of academia.  And at the same time, the image of LSD was influenced by the culture of the 1960’s; a chemical capable of inducing psychosis in microgram amounts becoming associated with daisies and light-hearted dancing. How appropriate that LSD has become an icon of the 1960’s—a decade when many social norms were challenged, just as the receptor actions of LSD challenged perceptual realities!

I graduated from high school in 1978, the year that marijuana use peaked among high school seniors. Since that time, the potency of marijuana has dramatically increased.

A weed that was intoxicating when smoked like a cigarette has been engineered, over thousands of growing cycles, into a cannabinoid-laden substance with potent effects in only ‘one-hit’ doses. I will leave the debate over medical marijuana to someone else’s blog, as the use of marijuana is in my opinion qualitatively different than the current epidemic of opioid dependence. Everything appears less harmful when viewed in retrospect, but I cannot imagine that we will ever view the current pain-pill problem as ‘innocent.’

Powder cocaine became emblematic of the decade of the 1980s. And in the 1990s designer drugs and ecstasy became popular in the suburbs as crack cocaine ravaged inner-cities.

At the turn of the millennium, methamphetamine destroyed families throughout rural America. Each miniature epidemic led to focused efforts by law enforcement to reduce the problems from specific chemicals. Similar efforts are underway now for opioids; the DEA has increased measures aimed at reducing the influx and illegal trade of heroin and pharmaceutical opioids, and the FDA has tightened regulations over the medical use of opioid pain relievers.

Our brains on drugs?

There are important differences, though, between prior substance-use epidemics and current problems with opioids. There has always been a clear division between substances used for illicit intoxication, and chemicals that make up medicinal products. That division made it relatively easy to show the folly of drug use, for example in the famous public service announcement depicting an egg in a skillet as representative of ‘your brain on drugs.’

Unfortunately, people tend to trust prescription medications even when they are taken without a doctor’s prescription. I frequently hear the claim repeated by patients who are severely addicted to narcotics that “I never took street drugs—I only used prescription medication!” Some people don’t seem to realize that a prescription medication IS a street drug– if not taken by the person holding the prescription.

As 2010 comes to a close, the decade that ended with a great deal of economic pain will undoubtedly be remembered, in addiction terms, as the decade of dependence on pain relievers.  Only time will tell if a new substance will take the top spot as our society’s ‘drug of choice.’  Given the damage to society wrought by opioids, I for one am ready for a change.