Stop treating prescription meds and illegal drugs differently

·8 min read
overhead view of marijuana in an orange prescription bottle, pills in a little plastic zip bag, and a hand using a credit card to line up pills on a green background with chemical structure details
The line between illegal drugs and prescription medication is largely arbitrary and unhelpful. Marianne Ayala/Insider
  • When Sha'Carri Richardson was banned from the Olympics for marijuana use, people were rightly furious.

  • But we must realize that the use of all drugs, not just marijuana, must be destigmatized.

  • The line between drugs and medications is so blurry that it is no longer helpful.

  • P.E. Moskowitz is an author, runs Mental Hellth, a newsletter about capitalism and psychology, and is a contributing opinion writer for Insider.

  • This is an opinion column. The thoughts expressed are those of the author.

  • See more stories on Insider's business page.

Earlier this month, when USA Track and Field handed down a one-month suspension to rising track star Sha'Carri Richardson for testing positive for marijuana, the world was outraged. Why should the immensely talented athlete be banned for using a drug to cope with the stresses of her life that tens of millions of Americans regularly consume; a drug that's legal in 18 states and counting?

The ban was derided by everyone from sports fans to medical experts.

"My reaction to that is, 'what, what, and what?'" Peter Grinspoon, a Harvard Medical School instructor told the Boston Globe.

The decision, according to Grinspoon and others, didn't make sense mostly because there are no studies that suggest marijuana is a performance-enhancing drug - indicating the decision stemmed from a retrograde attitude within sports when it comes to marijuana.

Marijuana has been gaining mainstream support as a medicine for years now, so it seems like an obvious drug to allow at the Olympics. But our cultural shift in how we talk about substances should go further. Americans should be destigmatizing every drug - not just at the Olympics, but everywhere.

Marijuana is a good example of the false distinction between "medicine" and "drug" that persists in the United States. For decades, despite many people benefitting from its use, the government considered cannabis an illegal drug. Now, as marijuana gains more mainstream acceptance, Americans more and more see it as a medicine, on par with legal medications like SSRIs - safe, effective, and not in need of policing.

But as weed's leap from illicit substance to medicine shows, the line between a drug and a societally sanctioned medicine is blurry. And the more research that comes out showing other illegal drugs - MDMA, LSD, ketamine - can have beneficial effects, the blurrier the line becomes.

By maintaining an arbitrary separation between legal medicine and illegal drugs, we stigmatize the legitimate needs of drug users and the beneficial uses of many drugs, and we potentially ignore that substances deemed "medications" can be harmful in the same way that illegal drugs can be.

The difference between drugs and medication is largely social

It makes sense that at the Olympics, where unfair performance enhancement is a concern, the line between medication and illicit substances be very well defined. But even within the current rules, we can see this untenable hypocrisy. Stimulants are banned for athletes, but if you have ADHD, you are allowed to use Adderall and other ADHD medications while you compete - a distinction that makes no sense as the medications would give athletes with ADHD the same advantages physically, such as increased stamina, as they would athletes without ADHD.

Even looking beyond the realm of sports, Adderall provides a good case study for society's untenable distinction between medication and drug. The stimulant, which is a combination of amphetamine and dextroamphetamine, is chemically nearly identical to methamphetamine - aka meth - the illegal drug that's so feared by Americans that the government spends billions of dollars as part of its never-ending War on Drugs to prevent people from making and ingesting it.

That's not to say that the drugs are exactly the same - the small chemical difference in meth helps it produce a more intense high, and thus it has a higher potential for abuse than Adderall. But Dr. Carl Hart, a neuroscientist at Columbia University, has done research suggesting that medications for ADHD and meth affect people in much the same way: In a study he performed and outlined in his book "Drug Use for Grown-Ups," participants often couldn't tell the difference between being given meth and dextroamphetamine - one of the stimulants in Adderall. According to Hart, the main difference between the drugs is how they're administered - meth is usually smoked, snorted, or injected and at higher dosages.

The same, largely superficial, differences exist between many drugs - heroin is nearly the same as morphine and oxycodone, and all produce similar effects. But doctors were able to overprescribe opioids, leading to addiction and tens of thousands of deaths, precisely because the drugs were viewed as safe and given the legal stamp of approval.

The difference between whether a drug has positive or negative outcomes for someone - whether that drug is legal Adderall or illegal heroin - has less to do with the chemical makeup of the drugs, and more to do with the society and structures we've built around them. Morphine and ADHD medications are highly regulated; they're distributed in uncontaminated doses that are taken the same way each day; they're de-stigmatized - which means you can comfortably ask your doctor about the effects they have on you - and they're readily available, which means you don't have to do anything risky or illegal to use them. Every drug, legal or not, has inherent dangers, but the risks of illegal drugs are greatly exacerbated by the stigma - legal, social, medical - attached to them.

Even the earliest legal distinctions between what was acceptable and prescribed versus outlawed largely grew out of social - not medical - preferences. The first federal criminalization of drugs in the United States, 1914's Harrison Narcotics Tax Act, came about not because the government found a sudden problem with opiates, but because Americans were scared that Chinese immigrants were corrupting white innocence by introducing them to opium. The same racist motivations lie behind the stigma around cocaine.

A dangerous, false dichotomy

Today, the drugs we've stigmatized and made illegal still have plenty of beneficial uses. Marijuana is now used to treat a host of issues - chronic pain, PTSD, depression. And we're starting to see the light with other drugs - ketamine, MDMA (which is an amphetamine similar to meth, but for whatever reason is less stigmatized), shrooms, and LSD are all being studied for medicinal use, and seem to be on a path to decriminalization, or at least limited legal use.

But even the drugs deemed most dangerous and taboo still have their medicinal uses. Research suggests opioids might treat depression in people who've tried SSRIs and other interventions without much help. The same goes for amphetamines.

But we don't need to medicalize illegal drugs to justify their use. People use drugs, whether SSRIs or heroin, for the same reason: to feel better, to reduce stress, to cope with the realities of late-capitalist life. Needing a diagnosis such as depression or ADHD might help you feel more legitimate for taking drugs on a daily basis, but that doesn't mean the use is any different, at least morally, than someone taking drugs that have been unfairly stigmatized by the US government.

By creating subclasses of drugs, we not only push drug users to the margins of society - where they're more likely to die of overdoses, receive contaminated drugs, and be forced into a carceral cycle that's often impossible to escape - we also unfairly give "medications" a pass, considering them safer and less problematic than their illegal counterparts.

We can see this most clearly in the opioid epidemic, which was started in large part because doctors believed prescribing oxycodone and other opioids was safe, simply because they were medications - i.e., produced by big drug companies, given the stamp of approval by the FDA, legal.

But even with less "dangerous" drugs, their stamp of legal approval allows these drugs to get off scot-free: After decades of increasing antidepressant prescriptions, evidence now suggests SSRIs can be nearly impossible to withdraw from, and that withdrawals are often similar to that of other, illegal drugs.

This doesn't mean we should glorify the use of illegal drugs, or stigmatize the use of legal ones. Instead, we should view all drugs, whether legal or illegal, as drugs, with all that entails - possible benefits and possible risks. And we should create systems around these drugs that minimize these risks.

Just as you can go to a doctor if you're having a problem with your SSRI, you should be able to go to a mental health professional if you're using heroin, without fear of stigma. Just as the government ensures prescription drugs are free of contaminants, governments should provide testing supplies to users of illicit drugs to make sure they're safe. And, most critically, users of illicit drugs should not be sent to prison simply for using drugs - it makes no sense for Adderall to be legal and meth to be illegal. The law is totally arbitrary.

While it might seem unrealistic to ask governments to suddenly treat all drugs the same, and provide drug users with support, we can see progress already being made toward this end. In Vancouver, Canada, groups are starting to hand out free, tested, uncontaminated heroin, cocaine, and meth to users. Vancouver also allows chronic heroin users to get prescription heroin, and evidence shows it's very effective at preventing overdoses.

When scandals like the banning of Sha'Carri Richardson happen, it can be tempting to frame the problem as a draconian attitude toward marijuana specifically. But we shouldn't try to make weed respectable while leaving this much larger problem undiscussed. All drugs can be medications. All medications are drugs. The line between them must be abolished - it's literally a matter of life and death.

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