June 18, 2005
Debating drug use openly
A Personal Account in this week's Lancet contains an intimate description
of an individual's dependence on -hydroxybutyrate (GHB), used as a method
of combating social anxiety. An accompanying Review surveys the evidence
for management strategies to treat complications of the recreational use
of new drugs. These two provocative pieces serve a common purpose: they
highlight the need for accurate, impartial information about the long-term
effects of illicit drugs, and lay bare the difficulties doctors face when
dealing with the consequences.
Recreational drugs are an undeniable, even routine, part of many people's
lives. Indeed, the British Medical Association reported last week that one
in 15 practising doctors in England and Wales will be addicted to drugs or
alcohol at some point during their lifetime. Their statement continued: we
do not think the figure is higher than in the general population. But, as
is characteristic of statistics purporting to inform about drug use, this
number carries considerable uncertainty.
The societal debate over how to combat illegal drug use focuses mainly on
when to legislate and to what extent. But from the perspective of health,
the problem of illicit drug use, which is nurtured by stringent laws, is
pragmatic. How can one treat a patient who may not admit to an illegal
addiction? Or conduct research into management of conditions resulting
from habits that the law urges doctors to oppose?
The Lancet does not endorse illegal drug use, but we believe that the
cloak of secrecy shrouding those who use illicit substances is the most
destructive feature by far of the cultural condemnation of recreational
drug use. Discussions framed by moralising or by adherence to social
ideals have little utility in a society of which drug use is an
Without open debate, we cannot know the true extent of the problem.
Without open debate, there can be no accurate quantification of the risk
of harm. And without open debate, doctors remain starved of the knowledge
necessary to cope with the acute and long-term effects of drug use. We
proffer our website as the forum for your comments.