Drug Use, Paternalism, and Freedom

N.B. has been such a bad blogger lately. That's okay. Unlike many well-established bloggers who provide handy reposts of old material for their readers, I, being a much newer member of the blogosphere, have no such easy out. In any case, I'm hoping I can make it up to you eventually.

I have an unusual position among those in my profession when it comes to the subject of recreational drug use. A lot of pharmacists have a strongly negative knee-jerk reaction to the idea, probably because they're concerned they'll potentially be held responsible for problems created by socially dysfunctional addicts. There are plenty of reasons for them to be upset; drug-seekers are frequently very abusive toward pharmacists who stand between them and the drugs they want. Many pharmacists I've worked with, knowing that their licenses are potentially on the line, weigh heavily on the side of strictness when it comes to dealing with these "patients." It's easy to see where the reaction comes from.

Personally, I'm a big proponent of harm-reduction principles. Give needles away freely. Legalize marijuana. The drugs that have been made illegal in the US are illegal because of politics and paternalism, not because they are necessarily more dangerous--or even physically addictive--than other recreational drugs that are completely legal.

Unfortunately, I do not think I will live to see the day when the government opts to loosen its grip on the recreational use of mind-altering substances. This is at least partly because of multiple political issues and a certain flavor of moral panic, but I think there might be yet another reason. As something of a libertarian, at least in the social sense, I don't think the government has a right to tell me what I can and cannot do with my own body. I think it's wrong for the government not to trust adults to take care of themselves.

The problem, as it often is, is that people are idiots.

Ever heard of "Lean?" It's the street name for a commonly-prescribed cough syrup containing codeine and promethazine. Intended to control coughs, dry out nasal secretions, and reduce nausea, "Lean" has enjoyed success in the club scene as, of all things, a mixer for alcoholic beverages, an idea that has been popularized by hip-hop music, especially in the southern US. Mixing opiates and alcohol is bad enough from a health risk standpoint, but the thing that really terrifies me about this business is that the people who are doing it have no idea what they are doing. Only click that link if you feel like wading through some really bad internet-speak explanations as to how to make "the purple drank [sic]."

A remarkable number of people posting do not know what they are taking to get high. Some of them think the promethazine is responsible for the "high" (not hardly) and suggest acquiring promethazine suppositories while others think that the trip can be attributed to dextromethorphan (which isn't even in the formulation). Everyone has their own recipe, some of which have nothing to do with cough syrup (crushing up Xanax and methadone, for example). Others swap advice for how to get prescriptions written by physicians. Perhaps the scariest of all, though, is one poster suggesting that the best way to get "Lean" is not to pay the outrageous street prices but to "straight rob the muthaf$^@in' pharmacy." Let me tell you, this is the kind of thing that keeps pharmacists awake at night--the idea that someday someone is going to hold them at gunpoint for Vicodin, Oxycontin, or, apparently, codeine-containing cough syrup.

This is the reason that most people, including those running our government, assumes that recreational drug use will turn you into an addled, violent menace to society. I've known smart people who occasionally used drugs as a social outlet, much the same way that many people drink socially, and most of them have not "become addicted" or become socially dysfunctional as a result. But it's clear that many people do not have this sort of self-control. What's worse, many recreational drug users are stupid enough to put pharmaceuticals into their bodies without knowing what they are or how they work! This sort of behavior is incredibly foolish.

I'd like to think that people can be trusted to make their own decisions and take care of themselves without interference from paternalistic governments. But sometimes it really feels that the evidence is against me. What do you think?