Can snorting cocaine really cause your nose to collapse?

Can snorting cocaine really cause your nose to collapse? Have the photos you see online of people with one nostril been photo-shopped or can that really happen?

Snorting cocaine can irritate and damage the nose. In extreme cases, such as the ones you may have seen online, the wall that separates the left and right nasal passages (the 'septum') can perforate, making a hole. This can lead the appearance that the two nostrils have become one.

Understanding how the nose is constructed and the characteristics of cocaine will help explain why this happens.

The nasal passages are very delicate and blood vessels in this area are extremely close to the surface. This explains why the drug reaches the brain quickly when snorted. When coke is sniffed mucous production increases. This helps to protect the delicate nasal membranes from ‘foreign bodies’ including cocaine. Apart from a runny nose, some users may find it difficult to breathe through their nose properly as it becomes increasingly stuffy, while others may start to experience nosebleeds. This can lead to the nasal septum dividing the nostrils developing a hole and possibly causing the nose to collapse.

Why does cocaine cause this? Medically speaking cocaine is a vasoconstrictor. This means that the blood vessels constrict, leading to the blood supply being reduced and less oxygen delivered to the nasal passages. This process can cause the delicate nasal passages to shrink and perforate. Put simply, the cocaine puts a 'chemical tourniquet' on the blood supply to the septum leading it to become 'weaker' and more susceptible to damage.

This kind of damage is not the norm. Most cocaine users will not experience this problem. That said, it can happen in extreme cases and is just one of the risks associated with snorting any drug, including cocaine.

First published: April 2018

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Why can cannabis be found in a drug test for longer than other drugs?

You've said in a previous post that cannabis can be found in a drug test much longer than other drugs. Why is that?

The time that cannabis (or any other drug) can be detected in the body can vary and is influenced by many factors. It can be different for each person, with the same individual possibly even getting different results each time they are tested. There are no guarantees in this area but it is certainly true that cannabis is likely to be identified in a drug test for much longer than other substances.

One of the main active components in cannabis is THC – that's what gets you stoned. Drug tests measure THC, or to be more specific a THC metabolite that shows your body has broken down THC. These metabolites can stick around in the body for a reasonable amount of time mainly due to the fact that when you use cannabis, unlike other drugs, it is stored in the body’s fatty tissue. It is then, over a period of time, released slowly back into the bloodstream.

Drugs such as amphetamine or cocaine are not stored in fat, leading to them leaving the body relatively quickly through a range of bodily functions such as urinating and sweating.

The length of time cannabis can be detected depends on what method of testing is used and the nature and extent of someone’s cannabis use. The more frequently and heavily cannabis is used the longer it may be detected in the body, especially in urine.  Drug tests in the workplace usually use saliva or urine tests. In Australia, police conduct roadside saliva tests for a range of drugs, including cannabis. Blood tests are expensive and invasive, so are used less frequently.

For an occasional light user, cannabis may be detected in the urine for 1 to 5 days following use. For frequent heavy users such as those people who use most days, cannabis may be detected up to 2 months or even longer. Most other drugs, even when used frequently or heavily, are only detectable in the urine for 1 to 3 days.

Cannabis can usually be detected in saliva for up to 6 hours, depending on the test procedure and the person. Government road safety guidelines in Australia state that cannabis can be detected for up to 12 hours in a saliva test. Some people have claimed that cannabis has been detected in their saliva beyond the 12-hour period, in some cases days and weeks after having used the drug.

Cannabis can usually be detected in blood for 24 to 36 hours after use.

First published: April 2018

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What is fentanyl and why is it so dangerous?

I read that fentanyl was the drug that killed Prince. What is fentanyl and why is it so dangerous?

Fentanyl was first manufactured in 1960 and has become one of the world's most important and frequently used painkillers. It is a synthetic (or man-made) opioid. Opioids, such as heroin, are derived from a substance produced by the opium poppy, morphine. Other opioids include prescribed medications like codeine and oxycodone.

The drug hit the international headlines when it was established that Prince died as a result of a fentanyl overdose. In the US, fentanyl is one of the drugs blamed for the recent increase in drug overdose deaths. Fentanyl-related deaths have been reported in many parts of the world, including the UK. In Australia, 498 deaths were linked to the drug between 2010 and 2015.

Fentanyl is a short-acting opioid that is similar to, but much more powerful than morphine or heroin. As with heroin, in addition to its pain relief properties, fentanyl use can lead to drowsiness, shutting down of the respiratory system, coma and death. There are also many compounds that are similar in structure (referred to as fentanyl analogues) that vary in strength, effects and toxicity. Some of these are far more dangerous and have received a great deal of media attention, e.g., carfentanil.

Pharmaceutical fentanyl is used for managing acute or chronic pain and is available as lozenges, tablets and nasal sprays, patches placed on the skin and an injectable medicine. These prescribed medications can be misused by people for whom it was not intended. Fentanyl is also illicitly manufactured for use in the illegal drug market. In some parts of the world, fentanyl has been reported as being used as a low-cost additive to increase the potency of street heroin.

What makes fentanyl so dangerous? Quite simply, it is all to do with the strength or potency of the drug. A fatal overdose can be caused by a tiny amount of the drug. Fentanyl is reported to be 50-100 times more potent than heroin and carfentanil is 100 times more powerful than fentanyl. This means that a fatal dose of fentanyl may be equivalent to just 4-6 grains of table salt and a fatal dose of carfentanil may be equivalent to a speck of dust so small it may be very hard to see!

It is no surprise that fentanyl has received a great deal of media attention in recent times. It is a powerful painkiller that, when used as prescribed, can make a huge difference to people's lives. Unfortunately, when misused it can lead to people becoming dependent and, as we have seen in the Prince case, overdose and death.

First published: March 2018

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Is drinking 'straight' spirits more or less dangerous than drinking 'mixed' spirits?

I was wondering if it is better off to drink straight spirits or mixed drinks? For example, in the long-term is drinking vodka more dangerous or damaging on the liver than drinking mixed alcohol? I'm aware that vodka can be consumed faster making it more dangerous but say I was to have the same number of standard drinks over the same amount of time, would straight or mixed alcohol be better health wise?

Is drinking 'straight' spirits more or less dangerous than drinking 'mixed' spirits? Well, it depends ... 

To help drinkers understand the relative strengths of alcoholic products, a 'standard drink' is used as measure of alcohol. In Australia, one standard drink contains roughly 10 grams of pure alcohol. This means that one standard 30ml serving of vodka (a 'shot') is roughly equivalent to a 285ml serving of full-strength beer and a 100ml serving of wine. Therefore, one standard drink of vodka is exactly the same as the equivalent standard drink of beer and wine.

Spirits aren't necessarily any more harmful than other types of alcohol if you drink them at 'safe levels'. Unfortunately, as you have stated in your question, you are able to consume a lot more alcohol by drinking a smaller amount when you drink products like vodka, whiskey or rum. For example, two shots of vodka (60mls) could be consumed in under a minute, whereas for most people it would usually take much longer to drink the equivalent amount of beer (two 285ml glasses). Shots are particularly problematic as they are designed to be drunk in one go.

The speed and ease of drinking spirits increases the risk of a range of acute problems including alcohol poisoning or overdose and, potentially, long-term health problems including liver damage.

Recent studies in Australia have shown that the risk of young people being admitted to hospital with alcohol-related liver disease has risen more than tenfold over five years. The most worrying increase in alcoholic cirrhosis has occurred in those aged 20 to 29, many of whom would have begun drinking in their early teens. Researchers have suggested that this increase could be due to the increase in the consumption of products with high alcohol content, such as spirits. Young women could potentially be at greater risk due to their livers developing at a later age.

So, would it be better to drink 'straight' or 'mixed' spirits? If you were to drink the same number of 'standard drinks' over the same period of time, as you have stated, it should not make a great deal of difference. Drinking spirits 'straight' is not necessarily more dangerous than mixing them with other drinks. But realistically, many people (but certainly not all) would be likely to drink a mixed drink faster than they would a straight spirit, increasing the risk to some degree …

First published: April 2018

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Why are some drugs legal and others that aren't as dangerous illegal?

Why are some drugs legal (like alcohol) and other drugs that aren't as dangerous (like cannabis) illegal?

Firstly, it is important to acknowledge that different drugs affect different people in different ways. Even though some people can use cannabis and not experience any major issues, there are others who will have great problems with this drug. Comparing one drug to another is problematic – all drug use, whether it be legal, illegal or pharmaceutical entails some degree of risk …

With that out of the way, back to your question …

A range of different substances have been consumed for medical, religious and recreational reasons for thousands of years. Western society started to make non-medical drug use illegal in the late 19th and early 20th centuries and when this began to happen, a range of factors determined whether a drug was to be controlled by the full force of law or through taxation and regulations such as age restrictions.

The health or social harm of a drug is not the only the reason why some substances are illegal and others are not. If it were, alcohol and tobacco would surely be made illegal and some illegal drugs may even have some legal restrictions relaxed. Societal attitudes, often reinforced by the news media, moral panics, racism and powerful commercial interests have been proven to play a major part in why we have the drug laws we do …

If we look at some specific examples across time, it may help to illustrate that many of the laws in this area were not originally passed due to concern about health or social harm related to a particular drug.

In the United States, the first drug law was passed in 1875 banning Chinese opium-smoking dens in San Francisco. The reason cited was that women and young girls, as well as "young men of respectable family", were being induced to smoke opium. No action was taken against the producers of opium-based 'cure-all' medicines, which were widely taken by white Americans. The first Australian laws in this area also restricted the smoking of opium whilst allowing the sale and consumption of opiate medicines. Historians have asserted that the primary purpose of the laws was clearly to discourage the entry of Chinese people to Australia, rather than to restrict the importation of opium itself.

In 1937, once again in the US, moral campaigners were able to make cannabis an illegal drug with the introduction of the Marijuana Tax Act. They were able to do this with the help of newspapers that successfully created great fear and concern amongst the general community about the impact of cannabis on American youth, including stories of cannabis smoking Mexican immigrants seducing white women. The ensuing public anxiety led to the drug being banned. Around this time, cannabis was not consumed on a large scale in Australia, although it was available for sale as cigarettes called 'Cigares de Joy' until the 1920s. Partly to comply with international pressure, cannabis use and importation was prohibited in 1926.

The United Nations drafted the Single Convention on Narcotic Drugs in 1961, effectively criminalising drug production, cultivation, possession and supply across the globe, even though few countries actually experienced domestic drug problems at this time. In the late 1960s and early 1970s many countries including Australia passed laws to enforce the UN Convention.

Unfortunately there is no simple reason to explain why some drugs are legal and others are not. It is quite clear, however, that the legal nature of a particular substance is not always related to the harms associated with the drug. When you closely examine the original reasons behind the introduction of specific laws, they often have to do with a range of historical factors, whether they be based on moral panic, racism or greed. Over time, as we have learned more about the harms associated with a particular substance, the reasons behind laws may actually make more sense in some cases, while in others the decisions may be difficult to justify.

First published: April 2018

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Myth: Anyone Experiencing GSA Needs Therapy

Reality: Therapy won’t always be necessary, but since there is so much prejudice against those who experience Genetic Sexual Attraction, someone who is experiencing it might benefit from therapy.

Experiencing GSA is not an indication that anything is wrong with the person experiencing it. GSA is a normal, natural reaction to the circumstances.

Being reunited with, or introduced to, a close genetic relative who hasn’t been in your life can be enough to prompt therapy, depending on the situation. Add GSA, and yes, therapy can be helpful.

The prejudices, stigmas, and taboos involved in GSA situations, internalized by those involved or not, can be enough of a burden to make therapy beneficial.

However, not everyone who experiences GSA needs therapy. Some people who experience GSA continue to function well without having had therapy.

If someone does need therapy, it would be helpful if they weren’t ostracized or criminalized, and could find a therapist familiar with the issues involved. This is one reason we need to bring GSA and consanguinamory out of the shadows.

See Myth: Only Someone Who Was Abused or Neglected Experiences GSA

See Myth: GSA is Unnatural

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National Siblings Day

It’s National Siblings Day, at least here in the US. 

In keeping with the interests of this blog, we want to celebrate all people who love their siblings, especially if that includes supporting your sibling as they face discrimination for their gender identity, their sexual or relationship orientations, or their relationships or sexuality.

We also want to celebrate all siblings in consanguinamorous relationships. For many of them, there is no more important person in the world than their sibling(s).

So if you have a good sibling, let them know you appreciate them.

Here's one of many interviews I've done with consanguinamorous siblings. There are more here.

If you have siblings or children or a parent or some other close relative or friends in such a sibling relationship, this is for you.

Sometimes middle-aged siblings experience a change in their relationship dynamic. Unfortunately, siblings are still denied their freedom to marry in most of the world.

Finally, there is some really wonderful, painfully realistic fiction about a sibling relationship.

Comment below or email fullmarriageequality at protonmail dot com if you have something you want to share about your sibling(s).

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Myth: Only Someone Who Was Abused or Neglected Experiences GSA

Reality: While some people who’ve experienced Genetic Sexual Attraction have been abused or neglected in the past, many people who’ve experienced GSA never experienced serious abuse or neglect.

People who experience GSA come from a wide variety of backgrounds, including warm and loving families as well as abusive childhoods. The only thing, so far, determined to be common to all people experiencing reunion GSA is that they were introduced to, or reunited with, a close genetic relative post-puberty. Abuse is not the cause of GSA.

If you don’t want someone to be abused, don’t abuse people experiencing GSA. Don’t ostracize them for having their feelings. Don’t criminalize their love. Don't deny them their rights.

See Myth: Sex in GSA Relationships Always Means Someone is Being Abused

See Myth: Anyone Experiencing GSA Needs Therapy

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If you give your teen two drinks to take to a party, is that all they're likely to drink? A group of 16-year-olds tell it from their perspective ...

Last week I got into a fairly heated discussion with some Year 11 students at a school I was visiting about a blog entry I had written about parents providing alcohol to teens to take to a party. Apparently when one of them had asked their parents to give them a couple of bottles to take to a friend's gathering (as they had a number of times before), they were told they were not going to be given any alcohol. They were then shown what I had written and told something along the lines of "Paul Dillon said ..." Now, as I've said many times before, I don't believe anyone can tell a parent what to do with their child in this area - you've got to make the decision for yourself. But when you've made that decision, whatever it is, own it! Firstly, to change your rules (i.e., provide alcohol for parties and then stop doing so for no real reason - this young man had not done anything wrong) is unfair and will undoubtedly lead to conflict. But most importantly, from my perspective, to put it all on me is totally inappropriate and, to be quite honest, demonstrates pretty poor parenting ...

Understandably, these students were not impressed! Considering what had gone down, they were incredibly respectful and polite. They could have gone on the attack but instead they just wanted to express their frustration and make it very clear to me that what I had written had affected their lives. The article they were referring to was one in which I discussed new Australian research that found that proving alcohol to young people is not protective and the best option for parents is 'delay, delay, delay'. The section that riled these students up was the claim the researchers made that "parental supply is associated with increased risk of other supply, not the reverse", i.e., if you give them alcohol, they're more likely to go and find more! They were adamant that in their case, this was simply not true - what they were given is what they drank, no more, no less!

Now I can only go by my experience over the years and what I have been told by teens about their drinking behaviour and when these research findings were released I wanted to shout the results from the rooftops! Finally we had some hard evidence that this idea of giving a 15-year-old a couple of drinks will result in them only drinking that much and could actually be 'protective' in the long-term was not true. Of course, there are always going to be some young people who do the 'right thing' and only drink what is provided but, we're dealing with teenagers and developing brains - even though they may have the best of intentions, bad decisions are likely to be made when surrounded by their peers in a party environment ... So when this group of five 16-year-olds (three young men and two young women) wanted to challenge me (and the research findings) I grabbed the opportunity to find out what they thought about this issue and what was actually happening amongst their peers.

As far as they were concerned, there were a few key points they believed that parents needed to be made aware of in terms of parental provision of alcohol. After I had taken those on board and agreed with them on most of what they said, I raised other issues and asked them to think about themselves and their peers and tell me their thoughts. To their credit they were incredibly honest and were willing to accept almost all of what I said ... I told them that I would be writing another article on the topic based on our discussion and wanted to come up with a series of key statements that they believed could assist parents to make a decision about whether or not to provide alcohol to their teen. Here are those statements, placed in order of importance according to those five young people:

• All young people are different and trying to come up with rules for teenagers as a group is unfair and is not going to work.  They felt strongly that they were often lumped into a group with kids who they felt 'did the wrong thing' and, as a consequence, their social lives were affected. A number of them felt that rules within one family could be different in some cases, with one boy believing that he and his older brother should have dramatically different rules. His brother drank to get drunk, whereas he only drank a little to socialize - the rules his parents imposed should reflect that 
• If parents want teenagers to develop into responsible adults, they need to trust them to do the right thing, particularly around alcohol.  They talked a lot about trust and how important it was that their parents trust them to make good choices. When I asked them whether they had ever lied to their parents about anything to do with alcohol and parties, it took a while but eventually all five of them said that they had ... Did they think they would lie again? All of them said they most probably would, mainly to protect their parents from knowing something that could upset them ...
• When parents do provide alcohol to teens to take to a party, some of them only drink what has been given to them, others do not. They were willing to accept that many of their friends certainly did drink far more than their parents had provided but this did not happen all of the time. It apparently depended on a range of things, including what type of party they were going to, if the teen was going to have to go home after the party or not and what other alcohol was available
• Some young people intend only to drink what has been given to them but when put into a social situation with peers can end up drinking far more. This was most probably the one statement I had difficulty getting them to agree with because all of them, particularly the young man who had initiated the conversation, insisted that they had never drunk more than had been provided. After a lot of discussion, all of them finally agreed that they had actually drunk more at least once, with a couple of them admitting to becoming quite ill as a result. The important thing they wanted to highlight was that this was not their intention (i.e., they had not meant to break their parents' trust) but it had to do with where they were and the social pressure of being around peers who were having a good time drinking more ... One girl also admitted that if she drank the two drinks she was given too quickly, she was much more likely to drink more due to her feeling a little more disinhibited
• In some cases, when parents provide low-alcohol drinks to their children, these are traded to younger teens and stronger alternatives are obtained, usually bottles of spirits.  The young men wanted to make it clear that when parents insisted on providing low-alcohol beers to 16-year-olds, they were rarely, if ever actually drunk. The girls said that it was a similar story for young women with low-alcohol pre-mixed spirits. Amongst those groups of teens who drank spirits, alcohol provided by parents was usually on-sold or traded to younger partygoers

The one thing I could not get agreement on was around the 'messages' that teenagers were likely to pick-up from their parents should they decide to provide them with alcohol. As far as these young people were concerned, the message they would be getting was that their parents trusted them enough to give them a couple of drinks. The problem was that they all admitted that they had broken that trust at some time or another and were likely to do it again. As much as trust is incredibly important in a parent-teen relationship, so is safety. Research evidence suggests that when we follow-up teens who are given alcohol by their parents the only real message that they takeaway from the experience is 'my parents gave me alcohol'. They don't report that it made for a more trusting relationship with their parent or that it taught them to drink more responsibly.

Most importantly, when these five young people were asked what other information their parents had ever given them when the alcohol was handed over to them on a Saturday night, there was almost no response. Most agreed that one or both of their parents had probably said something like "Be careful" or "Now you know that we trust you" as they got out of the car or left the house, alcohol in hand, but not one of them could remember an actual example of that type of conversation. All of these teens had, at one time or another, been provided alcohol by their parent and not one of them could think of one safety message that had ever been discussed ...

At some point you are going to have to trust your teen to do the 'right thing' around alcohol, but are you actually able to trust them to always make good choices and not make mistakes - of course not! Trust is vital in a positive parent-teen relationship but when it comes to your child's safety, it's not just that simple ...

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