Sunday, 22 December 2013

Legal illegal drugs

Legal illegal . . . what?  What the hell does that even mean?  Based on the title, you might think I've been using some of these drugs that I seem to hate so much.  Don't worry though - I haven't, and it'll all make sense by the end.

My last post about marijuana stirred up some sentiment, as I fully expected it would.  It seems to be a hot-button issue for a lot of people.  One of the arguments I hear all the time is that more people have been hurt by the "War on Drugs" than by the drugs themselves.  That may or may not be true, and to be honest I'm not sure if that could ever be proven.  But even if it were true, does that mean that we should legalise marijuana just to prevent violence?  By that logic we should also legalise heroin, methamphetamine, cocaine, ecstasy, LSD, shrooms, and PCP because they all are implicated in drug violence.

The major argument for legalisation of marijuana seems to be that it has so many benefits and so few drawbacks that it should be legalised for recreational use.  The argument states that marijuana has beneficial medicinal effects, so that lends more support for legalisation.  Well now we've finally gotten to the point of this post.  Let's look into that, shall we?

I will be the first to admit (and I have said it many times in the past) that marijuana has numerous positive medicinal effects.  It is a very potent anti-emetic, it is highly effective in controlling pain, and it lowers intra-ocular pressure in patients with glaucoma.  So what's my problem with marijuana?  If it's such a great medicine, why am I so against it?  To answer that question, we only need to look at the list of other illegal drugs, starting with the health benefits of heroin.

"THE WHAT??!  Benefits of heroin?  Everyone knows how horrible heroin is!  Are you high, Doc?" I hear you ask.

Nope, I'm not high at all.  Heroin was initially marketed as a cough suppressant and a cure for morphine addiction (Bayer didn't know at the time that heroin is actually metabolised to morphine in the body).  And I'm sure most non-Brits reading this will be surprised to find out that heroin (IV, epidural, and oral) is widely used for the treatment of pain in the UK where it is known as diamorphine.  So because it has medicinal purposes just like marijuana, it should also be legalised for recreational use, right?

Moving on to good old cocaine, the rockstar drug of the 80's which devolved into its own degenerate brother, crack cocaine.  Indigenous populations in South America have been chewing coca leaves for thousands of years as a mild stimulant and appetite suppressant, but it has real medicinal effects as well.  It is a very potent vasoconstrictor and local anaesthetic, and ENT physicians in Australia commonly use it for mouth ulcers and nasal surgery.  Ever heard of lidocaine?  They both end in "-caine" for a reason.

So we should legalise recreational cocaine too, right?  Oh, but I'm not stopping there.  I'm just getting warmed up.

Ever heard of Sernyl?  Probably not, since it was only tested as a surgical anaesthetic for a few years in the 1950's and 60's before being banned when it was found to mimic schizophrenia and cause general fucking insanity in people.  Then some idiots caught on to how much fun they could have by smoking it, and the PCP boom was born.  That's right, PCP was almost used in medicine before smart people banned it.  But it has medicinal purposes, so it can't be all bad and people should be able to use it legally for recreational purposes! 

"Ok fine," you potheads may be thinking.  "Those are a few examples of illicit drugs which have some medicinal use.  But surely not meth!  Surely Walter White and Jesse Pinkman were cooking a purely bad drug, right?  Methamphetamine couldn't possibly have any medicinal purposes, right?"

No, you're not seeing things.  That's Desoxyn, also known as methamphetamine hydrochloride, approved in the United States for the treatment of ADHD, similar to Adderal and Ritalin.  Look, it's an actual medicine!  So we should definitely legalise recreational use of crystal meth!  Who cares that's it's highly addictive and will completely fuck up your life?

I won't even mention how MDMA (also known as Ecstasy) is being researched for use in treatment of Post Traumatic Stress Disorder and how 83% of study participants were essentially cured with a combination of MDMA and psychotherapy.  I also won't mention how LSD is being re-examined for its effects in psychiatric patients.  But I don't hear anyone (except idiot drug users and stupid drug advocates) screaming that Ecstasy and LSD should be legalised for recreational use.

My point here is that sure, marijuana has some benefits for certain patients, but that isn't nearly enough to justify its legalisation for recreational use.  I'm sure many of you are moaning and groaning that marijuana isn't the same as other "hard" drugs, marijuana is a plant, marijuana is harmless, blah blah blah.  You're just itching to tell me that no one has ever overdosed on marijuana, it isn't addictive, and alcohol is worse.  Save it, because it's the same bullshit I've heard over and over again.  I'm 100% positive you won't change my mind, just as I'm sure I won't change your mind.  That is not and never has been my intention, because those people are so firmly convinced that their weed is so completely harmless that they will never listen to any arguments to the contrary.  They continually tell me to ignore the "government propaganda" and do my own research.  The difference between them and me is that I clearly have done the research, and I have clearly come to the conclusion that the bad outweighs the good.  So you people can go piss off and smoke your herb to your heart's content, as long as you do it far away from me so I don't have to deal with you or the stupid things it makes you do.


  1. A stupid way marijuana is being used is to alleviate the symptoms of morning sickness. Yep, pregnant women smoking pot.

  2. Replies
    1. The main reason it's worse is because too many people believe it is harmless, leading them to use it freely without thinking of the consequences. But new research shows that it DOES affect the developing brain permanently, causing long-term cognitive deficits. The younger you are when you start, the worse it is. MRI scans show significant brain abnormalities in heavy pot users.

      Pot alters your brain function, chemistry, and structure. For all you pot advocates, this is OBJECTIVE FACT, not opinion, so it is not up for debate.

    2. From your quoted research, which you call OBJECTIVE FACT:

      "Smith stressed that it does not prove cause-and-effect, and neither did the PNAS study. The differences in brain geography in Smith’s study could have existed before the young people used weed — it’s possible that their brain differences made them more likely to smoke pot in the first place."

      A man hears what he wants to hear, and disregards the rest. Paul Simon

    3. Yes, I'm sure every single cannibis user in the study had pre-existing changes in their brain anatomy, while none of the non-users did. That would be a rather wild coincidence, don't you think?

  3. So you're saying a drug's health benefits should be completely separate from its evaluation for recreational use. Good! Makes perfect sense. But what's the bad part of recreational marijuana?

    There have also been periods in history, as I'm sure you're aware, where alcoholic drinks were also illegal. Was the decision to legalize it a bad one?

    1. The decision to legalize alcohol was, indeed, a terrible idea. It not only causes addiction, but it tears families apart, kills more than most drugs do, and impairs decision making. My mother was an alcoholic for most of my childhood and after she tried to kill herself and I found her she quit. So yes, alcohol should have never been legalized.

      That is not to say I don't have the occasional drink, but its all in moderation and knowing your limits. But if it had never been legalized, how in the world could I miss it?

    2. Neatnit - See my response above for your answer.

      Ashly - Alcohol is a very sensitive subject, and that's why I haven't spoken much about it. Prohibition was an abject failure in the United States. I do sometimes wish alcohol (and tobacco, for that matter) could be universally banned. At least alcohol does have some redeeming qualities. Tobacco has none.

    3. It's great that you've reached a solid conclusion after much consideration, but being so sure of your conclusion seems slightly irrational. You've basically decided that no future ' evidence' could change your mind.

    4. You misunderstand me. My conclusion is based on years of research and experience. If further research comes out that shows me I'm wrong, I can always change my opinion. But repeating the current stupid arguments will change nothing.

    5. Alcohol is so easy to make it's essentially impossible to ban - you only need to leave some fruit in a jar in the sun and really quite palatable wine/beer can be made pretty easily with a minimum of equipment. Even distilling it is close to trivial. Cooking meth or growing opium are comparatively difficult and indiscreet. Growing weed is perhaps the next easiest to do after brewing and is one of the reasons making it illegal is not terribly effective.

  4. I didn't know that other countries don't use heroin as an analgesic! Seems like the UK is the only one then... (medstudent in the UK)

  5. I would want all drugs to be legalised, just so it can be controlled. The quality, the maximum quantity, the price, the minimum age of the buyers... Everybody nowadays talk about beer and sigarettes and their negative consequences, while no one talks about weed, heroin, LSD... If they were legalised, they couldn't be neglected anymore.

    1. Deborah - your idea has some good points, but in practice legalising does not help very much in controlling drugs - alcohol being legal does not stop anyone abusing it and makes a pretty feeble attempt at stopping under-age use. Would legal regulation be any better at controlling other drugs?

      It might stop the profits going to the criminals and put them into government revenues instead (the profits, not the criminals - government has enough of those). This would be a great thing, but can you see any government getting away with that: "we are going to crack (hah!) down on drug crime by legalising everything and taking the money for ourselves!" Who would vote for that?

      The UK government keeps toying with putting a minimum price on alcohol because it's a proven way to limit consumption. However, people like cheap booze. The same would apply to drugs - either they are cheap and you have a national epidemic of drug abuse or they are taxed to hell in which case people hate you and you drive a black market anyway.

      It might also help with quality, but of course beautifully pure pharmaceutical grade drugs are much more expensive to make than black-market knock-offs and are likely to be taxed massively. You get counterfeit cigarettes and booze in the UK - if you legalise drugs you will get cheap counterfeit drugs too and they circumvent your attempts at control of both use and quality.

      In the longer term, it's much harder to convince your kids etc that drugs are a bad thing if they are legal - if they were that bad surely they would be banned! There is therefore a risk that in a generation or two, a raging crack habit becomes a socially acceptable lifestyle choice. I don't see how this can ever be a good thing.

      You can't everything that's fun but risky - somewhere between fatty food and crack cocaine you need to draw a line and indicate that anything beyond that is consider unacceptably hazardous/antisocial. One of the few viable ways to do that is to make those beyond the line illegal. Few people can agree on where that line is but if you don't have one you lose one of your few controls.

      Being illegal need not stop you teaching kids why they are illegal. Would anybody really object to kids being taught why cannibalism or incest are illegal? Same with drugs - you can teach people that they are illegal and why without having to make them legal!

      You may be right, but it's pretty risky and not at all clear to me that it will be of benefit in either the short or long term.


      PS here in the UK they give diamorphine to mothers in childbirth.

    2. I have to say, that was very well written and your argument is very clear. Thank you for that :)

    3. You're very convincing, but the problem is that I (nor anyone else, I pressume) don't know for certain what the best method is to prevent people from taking drugs. It's illegal now, yet how much people have tried it? Are addicted? Would that number decrease or increase if drugs would be legalised?

      If I look at sigarettes (and the war against them that's currently going on everywhere) I believe it would. If I look at how people handle alcohol, I'm not that sure anymore. It all depends on how strictly governement/police will act and, even more important, on the national view on drugs. Drugs are not cool for mum and dad, but they are for many youngsters. The government could use their profit from the legal drugs for campaigns to make them uncool.

      I've heard some nations are thinking of legalising weed. Maybe we should wait till then for the results. As a libertarian, I hope it would be for the benefit of legalisation.

    4. There are arguments both ways and I certainly don't claim to know the best way. However, I do think that there is a better argument for legalisation for some drugs rather than others.

      You mention weed and there are some places where that is at least partially legal - Amsterdam is the classic example. I think, however, that the authorities are considering reversing that because of the trouble it causes. To be fair, however, that trouble is largely from weed tourists who wouldn't need to go to Amsterdam if it was legal everywhere.

      With some drugs the level of harm is comparatively low - weed is one, I believe. With others the harm and risks are much higher. As I said above, it's difficult to know where to draw the line. I would add perhaps that it's not clear to me that weed, alcohol or tobacco are on the correct side of it. Perhaps weed should be legal. Perhaps tobacco or alcohol not. However, I do believe that the line should exist and there are some substances that I think would be a mistake to legalise for the reasons above. Crack cocaine, LSD, crystal meth; some of these drugs are incredibly risky.

      With a pharmaceutical the dose you take for medicinal purposes is generally many times lower than the harmful dose. Paracetamol is risky because the therapeutic dose is comparatively close to the harmful dose.

      The thing about many illicit drugs is that you have to take damn close to the lethal/harmful dose before you get the desired effects. That makes them incredibly dangerous because you can easily slip over the edge. Drugs with those types of risks, or with risks of significant long-term harm fall the wrong side of the "don't do this" line in my view.

      Legalise some? Perhaps.
      Leaglise all? Too risky in my view.

  6. Okay, I'm not talking recreational drugs even though that is the subject here. I have a congenital heart problem that comes along with a six page list of medications that I can't take that can be found at Included in that list is Promethazine, ondansetron and granisetron. Aprepitant was briefly on the list. I'm not sure why it was added and then removed. So I had breast cancer and was doing AC&T. Almost all effective anti-emitics were contraindicated on the simple grounds that they were on the list of medications I shouldn't take. As I was already taking many contraindicated medication in the chemo cocktail my oncologist and I were going over the list and trying to decide if there were safer alternatives. The one safer alternative was marijuana in the form of medical THC. But in the state that I live in, it would be illegal for both of us. Other illegal drugs are used in the medical setting, what would have been the difference for my doctor to prescribe that for me on the grounds of using it as an anti-emetic. You say marijuana is a dangerous drug, so are adrimycin and cytoxin. Used appropriately in a medical setting this illegal drug could have been theraputic. I'm not advocating legalizing every drug out there. All I really want is for the drugs to be available when they are appropriate.

    1. You are one of the few people for whom medical marijuana would be appropriate. But dronabinol could also work well for you. The active ingredient is 6aR-trans)-6a,7,8,10a-tetrahydro-6,6,9- trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol, also known as delta-9-THC. If medical marijuana is illegal where you live, Marinol should be available by prescription.

    2. Worst thing is, that you can say "thank you" to all the potheads, who use THC just to get high :-/ And also to the incompetent idiots, who banned it for you...

    3. There is no excuse for anything to be banned where there is a proven medical benefit. If there is a risk of diversion or addiction (morphine or any opioid for example) then you have to have careful controls in place but banning medicinal use is throwing the baby out with the bathwater.

    4. Ugi: And isn't this the reason, why you have the famous "Medical marijuana cards? :)

    5. What I (73, smart, familiar with the recreational drug scene since 1958) see here is a trauma doctor stepping quite far out of his field of expertise in order to blow off steam in a very gray area that isn't really medicine, but practical governance, at which I'd venture to say he'd be a regular Chris Christie.

      I've seen the other side of his observations, hundreds of happy people getting high without the hangover, liver damage, aggression and its pitfalls.

      DocBastard really IS one, and his cute nom de Blog doesn't hide the way he bends the evidence to his side, and summarily dismisses viewpoints different from his own.

      Not worth reading, really.

  7. Hey doc, this is off topic but I have some questions. Do you by any chance know what being a neuroscience researcher is like? What other fields of neuroscience are there other than a surgeon or researcher? And what courses should I take in college to be a researcher? Thanks in advance.

  8. Why do you think that MDMA should be banned? In proper doses it seems to have therapeutic benefits without adverse effects. Is it because it would be easy to overdose on? I'm not a pro-drugs advocate, but I'm not entirely sure why some drugs are banned.

  9. Heroin certainly should be legalised. It does indeed have benefits, plus, why is it such a terrible thing to want to feel good? The only real issue with heroin is withdrawal. Aside from that, it isn't going to do you any harm. With enough heroin, there won't be any withdrawal.
    But here is the really interesting thing. If you actually want people to quit, then the best thing to do is prescribe the heroin to them, as much as they want and without any insistence on going to the clinic every day. And nearly everyone, probably around 85% will quit.
    Let me explain. First, if you force someone to quit cold turkey, the appalling trauma will leave them in a state called PAWS, Post Acute Withdrawal Syndrome. It is a feeling of exhaustion and misery that goes on for at least 18 months and makes it nearly impossible to allow the person to get a job etc, thus leading to a great chance of relapse. Second, trying to force someone abruptly into abstinence is also doomed to fail, and this includes 3 month rehabs. The PAWS won't allow the body to take advantage of the rest and exercise so the person is not prepared for the outside world. Afterwards? What then? A job. What kind of job? A menial McJob...this is what most rehabs demand people go and do. Take the first job offered, earn almost nothing, live in some wretched room, come home exhausted every night, unable to improve because of PAWS taking all the rest of energy, bored, lonely, trying to cope and getting nowhere...back to drugs.

  10. What people dont appreciate is that heroin use is exciting. It is stressful, but every day has a clear goal. It takes ingenuity and resource to raise the money. The people, the junkie community, is made up of interesting and intelligent people: dull people just don't go for it. And those people all understand, don't judge, and are one with you.
    Now, compare this. You give a person their heroin. Immediately, they are removed from the community. They cant hang out there, or people will want to share the drugs, or even steal them and they sure dont want you just sitting around. So, the addict is now out of the milieu and alone.
    But not sick! Not in PAWS!. For the first few days, he gets wasted. How great. He also has money for food, so eats some. Energy starts to return with nutrition. Previously, he was living on the Kit-Kats he bought to use the foil for smoking the gear. After a day or two, the energy impels him to do something. He goes for a walk. Gets better. Gets more energy. Sees a gym or a yoga class and really needs something to do. Sitting about stoned all day isnt really so great. The heroin allows him to push easily through the initial pain of exercise and if he's careful not to get injured, he'll do well.
    Yet more energy. But gym can't fill the whole day. We are at the end of the first fortnight now. Rested, recovered from the worst physical damage of stress and poor nutrition (remember, the drug itself did no harm, unlike smoking and booze). Next comes a job or education. Perhaps part-time at first. A few classes and a part-time or temp job. He's likely getting benefits right now, so must take care about this. Time goes by and he is interested in his classes and/or job, improving physically all the time and by the end of the first two months, he is feeling that the drug is starting to interfere. He doesn't want to nod out in class. No need to worry, if he changes his mind, it is still there. So do a little cut down. Just a quarter. Adjust carefully, no need to get sick, but steadily, consumption goes down. Study improves. By now, he has made new friends. Perhaps, there's a girl. He may like to go somewhere overnight. The heroin is beginning to seem irrelevant. He doesn't want these new people to find out about it. So he cuts more, never telling the doctor, because he needs to know he can backslide if necessary. It piles up in the drawer.
    The final transition. After about 12 months, the addict is down to the last little bit. It's very hard to drop. However, that part-time job allowed him to save some money and he has a cheap holiday, takes some sleeping pills and kicks it entirely.

  11. But there's the problem, right? It's painless. It allows intelligent people to find their feet steadily. It doesn't force them into abstinence, a constant fight against craving, misery, depression and above all, long hours in a wretched job. There is NO PUNISHMENT. And that's why this will never happen in the US or even the UK, except for a lucky few. For all the bullshit about 'disease' the idea that someone could recover in 1 or 2 years, without trauma, without withdrawal, without misery, is anathema. They have to be punished. They have to suffer. They have to keep the memory front and centre, keep the craving ongoing, keep the sponsor on call.
    Witness Russell Brand, who has been clean 5 years and yet every single piece he writes he drools over his addiction. He is seconds away from relapse all the time and he lives in terror of it. What if he knew he could go and get some nice clean stuff from the doctor? He wouldn't do it, because, by the time he drove there, he'd have no craving. It isnt just the stuff itself, you see. It is the FORBIDDENNESS of it. The underworld milieu. The whole film noir, Christiane F William Burroughs stuff. Take that away and I guarantee the problem will solve itself.
    Plus, can anyone explain to me why opium smoking shouldn't be allowed?

  12. I wrote "He' throughout because I cannot personally testify. But the Swiss guy who told me all this certainly could. He said he had tried for years and years to go to rehabs, etc with zero success, but this programme really worked. He said that 85% of the people on his programme quit. They were happy productive taxpayers. And the ones who didnt quit had other issues that possibly the drug helped with, or maybe just preferred to be stupefied: whatever, they were not breaking into people's homes or shoplifting anymore. This kind of crime would vanish if heroin were legalized. I for one, would rather let people sit doped on the sofa than have to put wire screens on the windows.

  13. I can't believe the above comments i just read to legalize recreational heroin. Said person must have never had a relative overdose, tolerance builds up which requires a higher dose to avert withdrawals. They also must not have seen how useless an addict can be once they get their high and are nodding out, falling somewhat asleep standing up then bending at the waist. I call it kissing the floor. I understand in other countries than my own it is used in a medical setting but I'm sure it is not used on a regular basis on the same person causing addiction. It is becoming very devastating where i live and causes more deaths annually inn the past year than car wrecks.

  14. Referring to true evidence as BS tips your hand. You never were open to the idea, you can't objectively learn cuz you're too smart. If you don't know whether the harm from the drug war is worse than the harm from drugs, you really havent done wide ranging research. I don't mean to sound insulting, yes you're a doctor. almost all doctors are against marijuana even for medical uses. But marinol or some artificial substitute is ok even though less effective. Vicodin, morphine, these are fine even though u feel heroin is too dangerous (is it ripping apart the UK?) can u explain an effective difference between these opiates? not chemically, but practically. Anyway i have also done quite a bit of research. You don't offer an argument besides "all drugs are bad". thats not the point. People don't want to legalize heroin cuz its so great. They want it legal so people aren't commiting crimes to get it, using dirty needles, etc., being locked up for years for making the mistake of using it. So that thousands of people are not killed in the US, Mexico, Columbia, Afghanistan, etc. by cartels or law enforcement/ drug war forces. many of these people are innocent. Our drug war has partially destroyed Columbia and Mexico. What good does illegality do? people really think every kid will start doing crack simply because its not a crime ?

    1. You've made several glaring errors in your assessment, the most egregious of which is putting words in my mouth. I've never said Vicodin or morphine are "fine" - they are terrible drugs with terrible side effects which are unfortunately necessary for a good proportion of my patient population. This is why I use them judiciously. Unfortunately not all doctors are as thoughtful when it comes to narcotics. The reason I don't like heroin for medicinal use is that it is ineffective in oral form (unlike morphine, hydromorphone, hydrocodone, oxycodone, etc) so it must be injected, it does not last as long as morphine, and it is more potent than morphine. It also carries a stigma, and other narcotics (ie OxyContin) are developing similar stigmata.

      I've also never said "all drugs are bad". In fact I've done the exact opposite here - I've highlighted the medicinal uses of many illegal drugs. Would legalising drugs make things better? I've seen evidence to suggest it would, and I've seen evidence to suggest it wouldn't.

      In Portugal, for example, all drugs were decriminalised in 2001. Since then, drug costs have dropped and new HIV infection rates have dropped, drug deaths initially dropped then rebounded, overall drug use increased at first and then decreased mildly, and drug-related crime may have improved. It's promising, but by no means a cure for anything.

  15. I finally disagree with something you wrote. Drug policy in this country has caused mass incarceration, death, unwillingness to report overdoses due to fear of arrest and a war in Mexico. People should be free to ingest whatever they want as long as they do not endanger others. Do all the weed, cocaine , heroin, crack, hash , MDMA or amphetamine you want -just do not drive, commit crimes to support your habit or assault people and I have no problem with it and neither should you. People telling other people how to live their lives and using laws to enforce their beliefs upon others is disgusting and wrong. This is the only time I have ever read anything on you blog that I thought made no logical sense-I guess no one agrees with anyone 100 percent of the time.

  16. I finally disagree with something you wrote. Drug policy in this country has caused mass incarceration, death, unwillingness to report overdoses due to fear of arrest and a war in Mexico. People should be free to ingest whatever they want as long as they do not endanger others. Do all the weed, cocaine , heroin, crack, hash , MDMA or amphetamine you want -just do not drive, commit crimes to support your habit or assault people and I have no problem with it and neither should you. People telling other people how to live their lives and using laws to enforce their beliefs upon others is disgusting and wrong. This is the only time I have ever read anything on you blog that I thought made no logical sense-I guess no one agrees with anyone 100 percent of the time.

  17. Basically to make a drug requires years of research in the laboratory first and then once prepared the drug has to undergo many clinical and market tests.
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