Wednesday, January 22, 2014

Snorting Smarties

"Throughout the history of the United States, popular attitudes and legal responses regarding the consumption of mood-altering substances have oscillated from tolerance to disapproval and back again in cycles roughly the length of a lifetime."   David F. Musto, MD; Drugs in America, 2002 (p 3)

I heard about this story on my way in to work this morning.  Middle school kids crushing a particular brand of candy and snorting it.  I prefer the term insufflation but that is probably a bit too stodgy for a talk radio venue. I will let any readers who are interested in it Google it and look for relevant links and significant complications.  Before we go any farther I will say that I am unequivocally against snorting anything.   I am commenting on it here as an observation of two cultural phenomena - children's behavior mimicking adults and possibly predisposing them to the adult behavior and the cultural phenomenon of permissive versus prohibitive use of intoxicants.

I had an immediate association to a Psycritic blogpost that I responded to last night on whether marijuana legalization puts children and adolescents at risk.  Having lived through the era of an 18 year old drinking age, I would say that it definitely does.  The idea that you will now "tax and control" a newly legal intoxicant is a myth that only a politician or marijuana advocate would believe.  My high school class of predominantly 17 year olds was one of the first locked up in an all night graduation party in order to prevent drinking and driving deaths.  I don't imagine that anyone will be any more successful in keeping marijuana out of the hands of underage marijuana smokers than they were in keeping alcohol out of the hands of underage drinkers.

I found this behavior interesting because I observed a similar pattern of behavior among some of my classmates as early as the sixth grade.  People were smoking various materials that were not meant to be smoked.  They were ingesting materials that they believed would make them high, even when it was pharmacologically impossible.  Even before that I remember candy cigarettes.  They were in packs that resembled the real thing.  My father was a two pack a day smoker of high tar and high nicotine cigarettes and I had asthma so smoking even at a dress rehearsal level never interested me.  Candy cigarettes were frequently bought for children when I was growing up and everyone seemed to enjoy watching kids pretend to smoke.

It raises a larger question about addictive behaviors and whether modelling and rehearsing them can lead to practicing with the real thing.  A related question would be whether a society that is permissive about a particular drug would be more likely to support behaviors that mimic using the actual drug.  In the addiction field it is common to encounter these behaviors using both addictive and non-addictive compounds.  For example, many people in the first stages of stimulant, sedative,  or opioid addiction will start by crushing prescription tablets and smoking, snorting, or injecting them.  Using a prescription in this manner is typically not a good sign in terms of controlled use of a potentially addictive medication because all of these methods of use are designed to deliver high levels of drug to the brain in a shorter period of time.  That will often produce a temporary high after tolerance occurs to the oral form of the medication.  In some settings, non-addicting medications like antihistamines, antidepressants, and others will be smoked, injected, or snorted.  This can occur in correctional settings or situations where people may be trying to block out their conscious state and choose to produce a delirium consistent with that goal.  It can get to the point where medications in general are banned from a certain setting because there is a black market for them right in the prison even though they have no value out side of the prison setting.

Getting back to the mimicking of addictive behavior and whether it may predispose you to using the compound at risk it was investigated for smoking.  The authors of the study take a look at incomplete and indirect evidence and conclude that there is some evidence that candy cigarettes were possibly used as a marketing device by cigarette manufacturers.  In one survey 5.3% of adult smokers attributed their smoking to a past use of candy cigarettes.  I want to be clear that I am using the current trend of snorting candy as an example of mimicking addictive behavior with a substance that is meant to be eaten as candy.

I don't consider myself a crusader for one law versus another.  I have beaten my head against the wall on numerous political issues in the past and know that there are many hidden forces in this country that you can bet have much more leverage than I do either as a private citizen or a member of a medical professional organization.  There is one thing that you can count on in America and that is money will carry the day.  Politicians believing that there will be new tax revenue from the sales of an intoxicant is very reinforcing for them.  Their friends in the business world creating a monopoly product that people will line up to buy is another.  Don't forget that in 1884 Heroin was the brand name of an over-the-counter patent medication that was originally marketed by a pharmaceutical company.  At about the same time a competitor was selling 15 different brands of cocaine for smoking, injecting, and sniffing.  All of them were available over the counter without a prescription.  The restriction on that practice did not occur until the Harrison Act in 1914.

The coming rush to see who sells marijuana in this country will be an interesting one.  The outcome should be as predictable as the previous oscillations toward tolerance in this country.

George Dawson, MD, DFAPA

Klein JD, Forehand B, Oliveri J, Patterson CJ, Kupersmidt JB, Strecher V.  Candy cigarettes: do they encourage children's smoking? Pediatrics. 1992 Jan;89(1):27-31. PubMed PMID: 1728016.

Klein JD, Clair SS.  Do candy cigarettes encourage young people to smoke?  BMJ.2000 Aug 5;321(7257):362-5. Review. PubMed PMID: 10926600; PubMed Central PMCID: PMC1118335.


  1. I'm kind of fascinated by society's rush to ban e cigarettes while enthusiastically passing MJ legalization.

    1. The usual pro-marijuana smoke argument I hear these days is that it is less toxic/carcinogenic because you inhale a relatively small volume of smoke. It is as if most daily smokers are taking only 1-3 hits a day.

    2. I think the affordable care act's plan to make all physicians have to be affiliated with a managed care company is going to lead to legalization of substances. While i advocate legalization of substances, i'm not surprised if they are legalized so tax dollars can be saved for surgery and other essential healthcare