April 14, Drugs good or bad?
Several states in the USA have recently legalised herbal cannabis to various degrees. This prompted an online discussion on an American forum that I frequent. The gist of the discussion was that if we make cannabis legal then why shouldn’t we make all recreational drugs legal?
My views on this are on the liberal side. It’s a free world. If people want to harm or damage themselves with drugs then let them. We let them smoke and drink alcohol, hell we even collect taxes on these. So where do I draw the line? When they start harming others. At a basic level drink driving is illegal because of the damage that it causes. Smokers have become social pariahs due to the effects of second hand smoke. Sure you’re damaging your health and costing society more in health costs but you also save society money in the long term in reduced pension costs. In Ireland we have community rating for health insurance. So there is no extra premium for smokers, but try to get life insurance as a smoker, you pay extra.
So let’s run up the drugs tree.
I’ll start with the over the counter drugs such as codeine, caffeine, herbal sleeping aids and the older antihistamines. Fine as long as you can pay for them and function normally. However one person’s normal can be another’s excessive or another’s frugal. We would all be familiar with the notion of the functioning addict. It almost seems to be de rigeur with some celebrities. The most recent guidelines in relation to the sale of codeine containing products have become a dead letter. Those who we perceive to have an addiction know all the correct answers and have their list of preferred pharmacies. While those with a legitimate need have to jump through hoops. We should not forget that there is a lot of hidden poverty about. There are patients out there who are using OTC medicines to manage conditions that might be better treated by doctors with prescription meds. They may not be able to afford GP fees or prescription costs so using OTC meds is the most affordable way that they can get by. Who are we to say in these situations that we will not supply any more and that they should see a doctor. When we know in our heart that they cannot afford it. At some point we may make a professional or personal decision at where we draw the line and stop selling the product.
Next we have cannabis. My former tutor Des Corrigan would be more of an expert in this. For myself I put it on a par with alcohol. Yes there is a longer longer duration of action so a longer break before driving etc.
Next we have the prescription only drugs. Everything from benzos, hypnotics and through to opiates. Again I say fine as long as you pay for them yourself and you can find a doc happy enough to prescribe. But with these you can quickly reach a level where you can’t function. If you can’t function then you can’t earn money. After you have milked family and friends then crime is the only real option to get sufficient cash. Then you hurt society. Experience has shown us that it is better to try and prevent damage rather than fix it after the event (This applies generally, not just to drugs) so I can accept that society needs to regulate these.
Needless to say by the time that you move on to illegal street drugs all the above counts double.
In Ireland we have a pharmacy regulator who takes the view that we should be protecting people from them themselves. I only go along with that to a certain extent. If they have decided that they don’t want to be protected or helped then as pharmacists I see our role as protecting society. If they want to stop smoking then we will help. We will dispense methadone to help with opiate addiction. But if they decide that they want to continue why should we shout “Stop!” In a state with socialized medicine such as Ireland and the UK that the government pays for healthcare. Because of this an argument can be made that they should be allowed to take steps to prevent damage that they will have to pay for. So if you want to kill yourself, fine. If you hurt someone else I’ll try and stop you. Addiction is seldom a simple case of “Oh, these tablets made me happy, I’ll take more.” And drugs are not the only thing that people get addicted to.
At the end of the day it comes down to do we have absolute free will or absolute state control or something in between. And where do we as pharmacists and citizens stand on this spectrum and why. Who do you trust more? The state, society or the public. And should one element of society have the power to decided how all society lives?
I would much prefer a “controlled supply” situation whereby such substances are produced in pharmaceutical grades and at affordable prices. That way anyone who wishes to indulge can do so without worrying that their drugs are going to be cut with rat poison or whatever.
At the same time I would put a good proportion of the tax money which could be raised from the legitimate supply into education and rehabilitation schemes to teach people what the real risks are. Move the profits from big criminals to government and big pharma. Although I’m not sure which is worst.
The fact of the matter is that you’re far more likely to die in a road accident than by taking recreational drugs. But we have much stricter controls on drugs than we do on cars. We as pharmacists have a role to educate the public and to help patients who wish to break their drug habit. People will make lifestyle choices and it is part of our job is the help them pick up the pieces.