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NON-MEDICAL DRUGS, SOCIETY AND MEDICINE: A PERSPECTIVE WITH SUGGESTIONS
Tod H. Mikuriya, M.D.
Despite continuing efforts to suppress the practices of taking psychoactive substances other than alcohol through enacting and enforcing punitive laws, the number of illicit users continues to grow. Born out of the activism of the sixties, fed, nurtured and encouraged by the mass media, there is little else that we could expect form a generation that has learned form their elders and from TV commercials the benefits of taking psychoactive substances have been around for some time, the new fanciful semantics such as “psychotominetic”, “psychedelic”, “psychotoxic” and “fantastica” actively encourage interest and experimentation. These words produce expectations of exciting new, yet frightening worlds of introspection. Some advocates of these drugs imply, if not actively sate, that individuals who take these substances will learn new insights and thus grow toward self-individuation.
Defenders of the status quo, on the other hand, regard these non-alcoholic drugs with fear and describe them as destructive poisons of the mind, personality, or career. They understandably seek ways to suppress and discourage their use. This latter group is generally older and empowered with the ability to generate formal social sanctions; i.e. laws.
Somehow, in the climate of heated advocacy, scientific fact, medical knowledge and principles of human behavior are either distorted or forgotten. This is indeed unfortunate, as effective means of dealing with the situation are thus made impossible. The extent of ignorance throughout the general public as well as the healing professions staggers the imagination.
Much of the ignorance may be traced to false assumptions. One of these specious beliefs is that punishing individuals will deter them form the use of drugs. Lessons from the failure of prohibition in this country, with our continuing diet of the bitter fruits of organized crime nurtured under those experimental laws, seem to have been forgotten.
A corollary to the assumption that enforcement of punitive laws will deter the use of illicit drugs is that the nature of the “problem” is moral. While physicians, legislators, educators, and enforcement officials speak of non-alcoholic drug use as a “medical problem”, the nature of the rules of the game, wherein the user is defined as a criminal, contradict in a real and crippling way, such hypocritical statements. It would be interesting to compare the number of “social casualties” resulting from arrest and incarceration compared to the number of physical or psycholic disasters due to eth effects of non-alcoholic drugs.
This confusion of disease with moral transgression is, perhaps, the keystone of our current difficulties in dealing with the non-alcoholic intoxicants.
In order that a disease is amenable to treatment, both physician and patient should be in agreement as to the existence of disease. When the non-alcoholic drug user does not see himself as suffering from disease, he sill hardly be willing to submit himself to the rigors of “treatment” with coercion and incarceration of one kind or another. Currently, the physician finds himself in the uneasy situation of collaboration with enforcement where he becomes an “enforcer” himself. The Hippocratic Oath with its admonishment to “Above all, do no harm” is often difficult to reconcile with practices of imprisoning individuals for “treatment” who have chosen to use non-alcoholic drugs and who do not see themselves as patients in the usual sense.
It would appear that emphasis upon the choice of a drug in itself, in the definitions of drug abuse, is misplaced. It is unfair and incorrect that criteria of behavioral nature are applied to the abuse of alcohol, whereas the use of marijuana, LSD, mescaline, etc., per se, is considered to be abused.
Considering what is known scientifically about the effects of the various intoxicants, it is bizarre to overlook the ten million or so alcohol addicts and the over fifty per cent alcohol-involved traffic fatalities, while regulating this substance in lenient, casual manner. Although less is known concerning some of he other mind altering drugs, their effects on the body are no worse than alcohol. In many instances, especially with marijuana, the toxicity appears to be significantly less than that of alcohol. Chromosomal effects with LSD or marijuana are, at this writing, not proven.
If rational principles are to be entertained in coming to grips with non-alcoholic euphorients and society, certain incisive steps must be taken:
1. It must be recognized that the individual has the right to introduce any substance into his veins, stomach or lungs. As with the ingestion of alcohol, the individual does not relinquish responsibilities for his behavior while under the effects of the substance.
2. Stringent restrictions must be placed on advertising of every psychoactive substance, including aspirin products, proprietary stimulants, proprietary tranquilizers and sedatives, alcohol and tobacco.
3. Enforcement functions must be limited solely to the tasks of preventing illegal diversion of psychoactive substances and ensuring purity, accurate labeling and freedom from adulterants.
4. Systems of regulation parallel with these as applied to alcohol and tobacco must be developed but with advertising strictly forbidden. Taxation, standards of assay and control of distribution are integral parts of such control methods.
5. The role of medicine is to educate and council society as to the dangers of drug dependence and toxic effects, and to treat inevitable individual casualties.
6. Development of massive educational programs for both the public and healing professions based on scientific fact must be undertaken without further delay.
While these suggestions may not be feasible in our contemporary context of
ignorance, advocacy, fear, and political expedience, it is hoped that leaders of circumspection and empathy may work towards the enhancement of society through recognition of, and respect for, the varied individual proclivities of its embers for the various practices. Medicine must reassume its mandated responsibility to council society on hazards involved in the injudicious use of drugs with material based on scientific fact. Failure to do so will allow other entrepreneurial groups to further erode aesculapian authoritativeness by defining psychopharmacologic casualties as criminals.
We have seen over 60 years of failure to deal with non-alcoholic social drug use by enforcement, the courts, and corrections.
The enforcement-correction solutions to the drug problem have failed miserably with central policy-making a shambles. The country enters a period of malign neglect unless medicine can appropriately respond to the challenges.