Open debate about illegal drug use is needed

Open debate about illegal drug use is needed to gain accurate, impartial information about the true extent of usage and the acute and long-term health effects, states an editorial in this week’s issue of The Lancet.

Recreational drugs are an undeniable, even routine, part of many people’s lives. The societal debate over how to combat illegal drug use focuses mainly on when to legislate and to what extent. But from a health perspective, doctors cannot address the problem of illicit drug use because patients may not admit to an illegal addiction, and research into the management of conditions resulting from drug habits is lacking, states the editorial.

The Lancet comments: “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 moralizing or by adherence to social ideals have little utility in a society of which drug use is an inescapable part. 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.”

In an accompanying Review in this week’s issue George Ricaurte and Una McCann outline how doctors can recognize and manage complications associated with the use of recreational drugs, such as methylene-dioxymethamfetamine (MDMA) and ketamine.

An accompanying Personal Account in this week’s issue describes an individual’s dependence on the drug gamma-hydroxybutyrate (GHB), which has been classified as an illegal substance in the UK since June 2003. The author of the account uses GHB for combating social anxiety.

“I’ve been using GHB (gamma-hydroxybutyrate) for about 5 years, mostly for its effect on social interaction . . . I would rather that I could overcome such difficulties without GHB, but I am not sure how. Although psychotherapy may help with my anxiety, in the UK it is not readily available on the National Health Service. And it is not within my means to pay for it privately. By comparison, GHB costs me about £15 per week,” states the author.