Stopping the scourge of street drugs—and saving lives and livelihoods in the process—is a daunting task. They’re everywhere, including on gas station and convenience store shelves. But we’re seeing some successes in this fight, and it’s important to highlight those successes so we can build on them.
Before we get to that, a few thoughts on where we are with this challenge.
Why It Feels Like These Drugs Are Everywhere
As the chief medical officer of a large addiction treatment center based in Jacksonville, Florida, I have a front-row seat to this street drug phenomenon. Kratom. Ketamine. Spice. ISO. K2. Phrenze Red. Delta 8 Gummies. Tianeptine—aka “gas station heroin.” I read about these drugs all the time in news reports, magazine articles, and even in academic journals.
And in terms of what we’re seeing at our treatment center? Here’s the deal: The number of people who are addicted to these street options remains relatively low compared to those addicted to alcohol, heroin, methamphetamines, cocaine, and the other traditional culprits. That being said, even if people aren’t showing up in treatment centers in large numbers from street drugs, these substances are still wreaking havoc on people’s lives in all sorts of other ways.
One problem is that the drugs are so easy to find. Many of them—kratom is the classic example—can be bought in smoke shops, mini marts, and pretty much anywhere online. A second example: During a recent outbreak of the antidepressant tianeptine (“gas station heroin”) in Alabama and Mississippi, even young teens were buying this drug legally at 7-Elevens and other convenience stores. So yes, easy availability is a factor.
Another factor is demand, which is always going to be high for these sorts of products. Often, these addictive drugs are sold with attention-grabbing claims to improve mood, boost energy, reduce muscle pain, or depress appetite. And let’s face it, a lot of us want those things, so if a relatively inexpensive, over-the-counter product on the store checkout counter is going to promise it, people will try it. And if it seems to work that first time, they’re going to try it again.
One more aspect of this street drug challenge: Any smart (and corrupt) chemist sitting in a lab can add a hydroxy group (composed of an oxygen atom and a hydrogen atom) to an existing drug or chemical to change its structure. This can make it hard to track and control by the FDA, it allows the drug to evade urine tests, and it can increase the drug’s addictive properties. Then it just becomes a matter of scaling up production, marketing the drug, distributing it on the internet or on social media, and suddenly the substance starts showing up on the street—and on people’s drug screens in emergency rooms.
How Can We Possibly Fight All That?
In my opinion, the best way to tackle this street drug challenge is with a “whole of society” approach, whereby everyone at all levels is communicating with each other, from the federal government down to concerned private citizens, family members, and friends. What do I mean by this exactly? Let’s start at the top.
Federal response:
The DEA, FDA, and CDC all play key roles in this fight by controlling the flow of illegal substances (DEA), regulating and banning drugs (FDA), and tracking hot spots in terms of where ER cases and overdoses show up across the country (CDC). I collaborated on a project with the FDA a few years ago on the street drug Spice, a synthetic cannabinoid, and I was amazed at their oversight speed and response.
Unfortunately, what can happen is that when the FDA publishes an alert on a certain drug, someone quickly figures out how to manufacture it slightly differently, and that new variant evades capture and is out on the street in no time.
State and local response:
These authorities—usually public health departments—help cover the gaps the federal authorities can’t always cover. The tianeptine outbreak in Alabama and Mississippi I mentioned above is an example of state and local authorities playing a key role in getting a dangerous drug banned from gas stations and convenience stores. In Alabama, that state’s Department of Public Health shared overdose and ER visit data with other states and the CDC. This led to tianeptine being pulled from store shelves.
Health Essential Reads
From Blame to Understanding: Transforming Obesity Treatment
Taking Health Literacy to the Next Level
Treatment centers and hospitals:
Two key points to make from where I stand as a chief medical officer in addiction treatment. First, street drugs sold over the counter at convenience stores as mood enhancers, energy boosters, and pick-me-ups can be dangerously addictive and even deadly. We have had patients who come through our center who are clearly addicted to them. These patients go through serious withdrawal that can look just like heroin or alcohol withdrawal. So yes, these substances are quite powerful in high doses, and we have the data to back that up.
Second point: Those of us who work in treatment centers and ERs are a key part of the communication network I’m describing that needs to share information to help contain the ongoing street drug threat. We’re on the front lines of this fight, so we’re constantly providing our (anonymous) patient data to local, state, and federal authorities to make everyone aware of trends and outbreaks. This allows for better coordination of treatment resources and public awareness efforts.
Concerned citizens, family, friends, all of us:
All I can say regarding this grassroots level of watchfulness is to pay attention to what’s going on around you and let your local health department know about it. If you see online advertisem*nts or storefront ads for these problematic products, or encounter the products themselves, email or write to your local representative about it.
If you suspect your child may be getting into street drugs, and may even be buying them on social media, ask your child about it. And consider doing a little online snooping yourself. Whenever a parent asks me if they should stay out of it or get involved, I always say get involved. Go in with eyes wide open, and be ready to get your child help if he or she needs it.
One final point relates to the proliferation of street drugs and the seemingly bottomless appetite for them. At my place of work, we are seeing more people with co-occurring conditions than ever before. That is, people who are addicted to drugs or alcohol and have at least one other mental illness, like depression or PTSD.
People are hurting these days. Times are hard in so many ways. Unfortunately, many are turning to street drugs as the answer, as a way to cope. All of us need to be aware of this and do what we can to help. If we work together and communicate about what we see and hear, we can fight back against this challenge—and beat it.
