Saturday, October 17, 2009

All Drug Use is Self-medication -- Not

All Drug Use is Self-medication -- Not

Anyone following the drug law reform debate for very long will run into the slogan: “All drug use is self-medication.” The problem is that not only is this claim not supported by fact, it also works against several more legitimate claims.

The first issue is to look at the basis of this assertion. I have found no researcher who has claimed this proposition as the result of his studies. One generally accepted proposition is that a significant number of those with drug dependencies or who abuse drugs also have some personality, mood, or character disorder that causes them some degree of discomfort and for which they seek, consciously or unconsciously, some form of relief. (I use this weasely “significant number” as an admission that the data do not tell us whether that number is ten per cent, ninety per cent, or somewhere in between) Extending this proposition to the assertion that all drug use is an attempt to alleviate some mental disorder is unwarranted.

If this exaggeration stood alone, it could be shrugged off as the kind of rhetorical over breadth we all commit from time to time. But this concept has the effect of delegitimizing several other valid claims for recognition.

Drug use as a religious exercise is one of the claims competing against this self-medication concept. Religious use of psychoactive substances dates back to pre-history. Modern claimants use a variety of substances. Federal law recognizes the use of peyote by the Native American Church and yagé, or ayahuasca, by O Centro Espirita Beneficiente Unido do Vegetal and Santo Daime. Even the old Volstead Act allowed Christians and Jews to procure and use alcohol for religious purposes. The Rastafarians and Coptic Zionists are seeking legal recognition for their religious use of cannabis (so far only recognized by the U. S. Court of Appeals for the Ninth Circuit [Guam Terr.]).

Many of those using psychedelics do so for the purpose of enlightenment or self-awareness. While this claim may look similar to both the medical and the religious, it is really quite different. It is epistemological in nature, asking the questions “What can I know of the world and how can I know it?” During the 1950s and 60s, large numbers of outstanding figures in arts, literature, science, medicine, and politics tried – and many used repeatedly – psychedelics for this purpose.

By far the most popular use of drugs is for social or recreational purposes. While the beer with buddies after work or the joint when one gets home may serve to relieve some stress, their primary function is pleasure. A joint with a movie and a bowl of popcorn or Ecstasy pills shared by a couple at a dance club are used to enhance pleasure, and for no other purpose. Cocaine in its heyday was primarily a social drug, with lines being shared at parties.

One recent claim is related to, but distinct from, medical claims. Many are now using stimulants, particularly Ritalin and amphetamines, as “brain boosters”, or drugs to make them smarter, more alert, and more fatigue-resistant. Doctors and nurses discovered this effect of amphetamine when it was first introduced in the 1930s and by the 1940s, armed services around the world were using them, as they still are today. For at least a half a century truck drivers have used amphetamines to extend their driving hours. Today’s brain boosters are college students, professionals, and middle-management who get their drugs legally through doctors’ prescriptions, and some have been using them for over a decade. While traditionally medicine has been viewed as remedying a disease, disorder, or deficiency, this use of drugs does the opposite. It is aimed at helping the user attain the superior, not just to return to the normal. It is more like an athlete using steroids or human growth hormone or an aspiring starlet getting breast augmentation in order to outdistance the competition.

One claim I almost forgot because it is so far removed from the world of medicine. The Controlled Substances Act defines the prohibited drug marijuana as being any part of the plant Cannabis sativa, which includes the extremely low THC-content varieties grown as hemp for use as fiber, oil, or food. No matter how many hemp shirts one wears, they will have no medical effect.

In fact, the claim that all drug use is an attempt at self-medication is a claim for more, not less, regulation of those drugs. Diagnosis is a notoriously difficult art, and diagnosis of mental disorders particularly so. The prescription of anti-depressants is, at best, a trial-and-error process, with doctor and patient often going through as many as five or six different drugs before finding one that is effective and without unacceptable adverse consequences. The rate of failure of self-diagnosis and treatment, as evidenced by the high rate of resultant dependency, calls for more professionalism in the diagnostic process, not less.

The Jeffersonian appeal to the right of each to determine what food or medicine he ingests does not negate the intervention of medical professionals in the process. The growth of modern medicine since the days of Jefferson, with its potential for great help – and great harm – requires mitigation of an extreme libertarian interpretation.

We can all join together to seek the rights of those advocating medical, religious, enlightenment, and social uses of drugs as well as the right to grow and use hemp. In this struggle facts and rationality are the strongest weapons. We only hurt ourselves when we resort to easily falsifiable propaganda like the utility of self-medication.

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