Pint-Sized Pot and Hospice Hallucinations: The Role of Illicit Drugs in Medicine

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012)

Consider a paradox of sorts: there is a variety of illicit drugs that are used legally for the treatment of medical conditions, and there is a variety of legal drugs that are abused illegally to sustain 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. Access to prescription opiates continues, and addiction has reopened the door for heroin to make a resurgence in a big way. Vermont has recently taken efforts to address this epidemic head on, 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 has taken a different path into America’s collective consciousness. Marijuana’s contemporary legal status (it was federally legal in the U.S. until 1937) was first introduced in 1996 when California legalized marijuana for medicinal use. Medical marijuana is now legal in 21 states (and Washington, D.C.), and marijuana’s most notable recent headline was when the states of Colorado and Washington legalized marijuana for recreational use in 2013.

Medical marijuana, with it being 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 have revolved around treatment of symptoms associated with cancer and cancer therapies, although preclinical trials (in animals) have indicated the possibility of actual tumor inhibition. This push has been increasing, with stories about children finding relief bolstering pro-pot advocates.

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 promising results – in treating post-traumatic stress.

So we return to our paradox. We have illegal drugs that show promise in the medical field, and we have legal drugs that are being massively abused illegally and causing them to be restricted in significant ways. How ought one reconcile this? Are the researchers acting unethically by studying an illegal drug? Are they acting ethically by studying the most promising drug for their respective conditions or patients, legality be damned?

The line between legality and ethicality can often be a fine one. They are separate entities that do often overlap, but this is one area in which they diverge. From an ethical perspective, it can certainly be beneficial to study a drug with promise. Beneficence dictates that we are to promote actions that can provide a maximum of benefits with minimal harms. By encouraging of 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.

Our paradox requires a final consideration, that we reconsider how we interact with drugs in America. Illegal ones, legal ones. Prescribed ones, recreational ones. Popular ones like alcohol and tobacco, and taboo ones like LSD or marijuana. They are all in need of social reclassification and put 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. Sometimes, as it turns out, the most ethical choice could also the most illegal.

[This blog entry was originally posted in a slightly different form on Mr. Dahlke’s blog on April 19, 2014. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

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