The Risky Business of Using Criminalized Drugs as Therapies
As Brian Bingham aptly pointed out in his blog post, everyone must take action to reduce stigma – both that of using “criminalized drugs,” and that of having disorders like alcoholism, depression and anxiety. Since the turn of the 20th century, the public, the American government, and several other countries have been cultivating a culture of:
A. Drugs are bad.
B. People who take drugs are bad.
C. There are no exceptions to points A and B.
As a neuroscientist, I believe Congress and the public should champion basic, translational, and clinical research on how psychedelic drugs could impact affective disorders, addiction, and PTSD. We lack adequate treatments for these conditions, and similar to chronic pain patients forced to fight for narcotic-based relief, to perpetuate the uneducated belief that criminalized drugs and drug-takers are all bad is to do an extreme disservice to millions of Americans coping with these disorders.
Of course, drug abuse destroys individuals, families, communities, and negatively impacts the American economy in many ways. But, as we learn more about how illicit drugs like psychedelics and narcotics modify the brain and our behavior (my dissertation investigated the mechanisms underlying cocaine addiction), we have been much, much slower to adjust our legislative, judicial, and personal responses to their use and abuse. What brought us to this point where we would rather let patient groups suffer than work toward establishing better treatments that may rely on these substances?
In 1970, Congress enacted the Controlled Substances Act (CSA) as part of the Comprehensive Drug Abuse Prevention and Control Act, to provide legislation that could reduce the generation, use, and trafficking of “controlled substances.” The laundry-list of considerations for the degree of regulation include, but are not limited to: international treaties, actual or relative potential for abuse, scientific evidence/state of current scientific knowledge, and risk to public health and safety. It is worth noting, of course, that in any considerations of controlled substances, Congress did acknowledge that “many of the drugs included… have a useful and legitimate medical purpose and are necessary to maintain the health and general welfare of the American people.” While this was the first declaration of the CSA, our current culture would suggest that it is rarely called upon should a case, like the use of ketamine to treat depression, arise.
The extreme danger and abuse potential for opiates and opium derivatives has been documented for hundreds of years - from anecdotes to government-funded scientific investigations. The same is true for the slightly-less-addictive cocaine. Few would argue that cigarettes are not addictive, and Alcoholics Anonymous certainly exists for a reason, but evidence that psychedelic substances have significant abuse liability? Not so much. Yet, we live in a society where 18-year-olds can legally smoke three packs a day, a large percentage of the population has been drunk before the age of 21, and alcohol penetrates many social (or networking) opportunities thereafter.
Clearly, the scientific evidence for the potential medical benefit (or lack thereof) for some of these compounds is not infiltrating legislation. As bad as this situation is, if those who were affected only included researchers and pharmaceutical companies, the failure to evolve congressional and cultural opinion would be understandable. But it is the ever-growing patient populations who we fail by maintaining this antiquated view of drugs.
Of course we cannot blithely start doling out psychedelics - that would be just as irresponsible. But we can directly address the need to understand, much more thoroughly than we currently do, how these drugs work in the brain in patients and in addicts. We can improve efforts to track appropriate prescription drug use, should there be evidence-based concern that a treatment could be abused. We can increase public-private partnerships that generate abuse-deterrent formulations of treatments that rely on controlled substances. And we can realize that it is no longer 1970, that the levels of depression, PTSD, and addiction have become a public health crisis, and that, instead of shying away from the risky business of prescribing criminalized drugs, we owe it to ourselves to find a solution.
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