Hmmm...well, for me, the whole issue isn't clear cut.
It's confusing.
It seems accepted that Sam and all the other special children were changed by the blood of Azazel to give him and the others their powers.
Sam's powers also seem to be connected to Azazel in some way so when he died Sam's powers disappeared.
As for the blood itself...it really doesn't matter how it reacts in a normal body because we're dealing with the supernatural here. Like how vampires can walk and talk when they have no beating heart. Same principal. So it can behave how the writers want it to behave. But they should make it consistent.
When Sam was drinking Ruby's blood it seems he needed it to develop his powers...but Ruby went on to say that Sam didn't get any enhanced powers from drinking it (he was only addicted) but the powers he developed were already in him which he, with Ruby's help, brought out.
But then this happens which seems to contradict that:
When Sam drank all that blood so he could become Lucifer's vessel it seemed that he needed it to power himself up for it. So the blood does have an effect on him.
But then again maybe I need to have a re-watch...
