Doctor as Dealer: The Use and Abuse of Drugs in Medicine

By: Jacob Dahlke

Consider a paradox of sorts. There is currently a variety of otherwise illegal drugs that patients use legally for the treatment of medical conditions. Likewise, there is a variety of legal drugs that are abused, often illegally, to sustain a person’s drug addiction. Does anyone else see a problem with this?

Opiate addiction and abuse has had its share of news cycles lately, and for good reason. Celebrity musician Prince is only the latest to succumb to an overdose of prescription opiates. Such drugs, available legally by prescription, or illegally bought elsewhere, can lead to continued addiction to those drugs, or even open the door for addiction to other drugs like heroin. Vermont has made efforts to address its heroin epidemic, and other states are working on responses to their own respective crises.  This is a real problem that destroys lives and communities and I applaud the efforts to find solutions.

Alternatively, marijuana is on a different path into America's collective contemporary consciousness. Marijuana's modern ambiguous legal status (it was federally legal in the U.S. until 1937) began in 1996 when California legalized marijuana for medicinal use. Medical marijuana is now legal in 25 states (and Washington, D.C.), and has been notably headlined when Colorado and Washington legalized marijuana for recreational use in 2013.

Medical marijuana, although a federally illegal, Schedule 1 drug, has had a relatively limited amount of research devoted to it, although its claims for relief remain popular and broad. Most studies study specific chemical components in marijuana, specifically parts that don’t produce the feelings of euphoria. The focus is often on treatment of symptoms associated with cancer and cancer therapies, although early results indicate the possibility of actual tumor inhibition. One promising area of research is in one cannabis-derived drug’s effectiveness in treating pediatric epilepsy. Another illegal drug that has piqued the interest of researchers is LSD. A recent study indicated promising results in reducing anxiety among patients with life-threatening diseases.  Additionally, ecstasy has been studied - again, with preliminary but promising results - in treating post-traumatic stress disorder.

The line between legal and ethical can often be a fine one. Where the law sets the acceptable limits for actions (and penalties for violating those limits), ethics helps to explore why or whether we ought to perform that action. They are separate entities that do often overlap, but this is one area in which they diverge. From an ethical perspective, beneficence dictates that we are to promote actions that can provide a maximum of benefits with minimal harms. As such, it can certainly be beneficial to study a drug with promise. By monitoring these otherwise illegal compounds within the context of a controlled research environment, the otherwise significant harms and risks of harm are minimized, for the patients and researchers. Additionally, the core ethical principles of non-maleficence (avoiding actions that might harm) and justice should compel us to advocate for not only a better system of distribution of some of our most addictive, yet powerful, drugs. These principles should also promote more effective, compassionate approaches to treating people who have become addicted, as some of our current methods are not without concerns.

So we return to our paradox. We have illegal drugs that show potential in the medical field, but are blacklisted from most of the funding dollars to actually find out their value (if any). We have legal (if prescribed) drugs that are being massively abused, causing them to be restricted in significant ways. How can one reconcile this? Are researchers acting unethically by pouring in money and resources into studying an illegal drug? Or are they acting ethically by studying the most promising drug for their respective conditions or patients, legal or not? Science can, but does not always, align with public service campaigns and advocacy. But what good scientific research can do is compel us as a society to rethink the status quo, which in this case is that legal drugs are good, and illegal ones are bad.

One possible solution is a better mechanism to distribute best practices for managing potentially addictive prescription drugs. There are places across the country that have demonstrated success in this area, and there ought to be a way to expand such programs. Additionally, if researchers can access federal funding for testing currently illegal drugs with therapeutic potential, it would be beneficial by providing a heavily regulated and controlled environment in which to manage – and study – such drugs. Second, the federal government’s involvement could bolster the authority and validity of research results – whether they favor or discourage the benefits of the drug in question – and promote more funding for research from other non-governmental entities.

Perhaps we should more broadly reconsider how we interact with all drugs: illegal ones and legal ones, prescribed ones and recreational ones. Popular ones like alcohol and tobacco, and taboo ones like LSD or marijuana. Perhaps we need a new social reclassification into a single category: drugs. From there, we as a society, as a medical profession, and as individuals, can rebuild how we interact with them.

Jacob Dahlke is a clinical ethicist for Nebraska Medicine in Omaha, Nebraska, and an instructor in the MS in Health Care Ethics program at Creighton University.