Drugs: Legalize and Regulate (6)

Medicine and Recreation

To feel better, take a pill.

That’s the logic behind use of drugs for recreation; and it’s exactly the same logic behind too much modern medicine.

The difference is this. If a person decides of their own volition to take a pill – or smoke a joint or inject something or whatever – to make themselves feel good, then they are a depraved criminal fit for punishment. If they take a pill to make themselves feel good because an authority figure in a white coat tells them to, they are a good and responsible citizen; in fact they are bad if they fail to “comply” and don’t take the pill.

I’m not saying that there is no difference between medicinal and recreational use of drugs. Obviously there is, and obviously there is a role for health professionals.

The problem is that these different things lie along a spectrum of use, and frequently involve the same substances; and yet our current legal structures creates an artificial divorce between them.

Historically, most recreational drugs have had a medical application: opium, marijuana, LSD, and so on. Similarly, many medical prescription drugs are commonly used for “recreational” purposes, whether licitly or illicitly.

The structure of current medical use of drugs is intended to manage their use so as to limit their harmful effects. This is never more than partially successful, as very few patients actually follow their doctor’s orders in taking medicine. Doctors are well aware of this fact. There are countless people who are addicted to prescription medicines, and who take them in ways that are just as harmful as any illicit drugs; the death of Michael Jackson is proof enough of this.

The more fundamental problem, I believe, is that by creating a very effective aura of authority, the medical establishment contributes to a culture that fervently believes that taking pills is a solution to problems, and leads to happiness. I believe there is a flow-on effect from this pill-positive tendency in modern medicine to cultural attitudes around drugs at large. In this way, I believe that modern medicine contributes to the drug problem both directly – by making massive amounts of drugs available to addicts – and indirectly, by conditioning society to seek solutions in pills.

Any effective approach to addressing the drugs issue has to start with the understanding that there are three areas of concern: medical drugs, legal recreational drugs (alcohol, tobacco), and illegal recreational drugs. These are currently treated as virtually independent issues, with clear-cut divisions in law and social attitudes. But in reality they are part of the same issue, the same fundamental principle that by putting some mind-altering chemical in our body we can be happy.

As long as we insist on separating them into watertight, radically opposed categories, we are going to avoid noticing the harm that is caused by the legal substances, and will exaggerate the harm caused by the illegal ones, and our policies will be unbalanced, hypocritical, and ineffective.

The rational response to this, in the fields of both mental and physical health, is to move away from a pill-centric approach to a holistic one. Treat the whole person, not the disease. Pills have their uses, but doctors should be more cautious in prescribing them, and should whenever possible seek alternatives. This approach is especially relevant in mental health, where mindfulness-based therapies have proven to be more effective than drugs in dealing with a range of problems, including depression.