Sunday, July 01, 2007

The Cult of Pharmacology

Are drugs the Devil? We talk like they are. "One time and you're hooked." "Lost my will." "Took control of my mind." "The Drugs Made Me Do It." Of course, this doesn't apply to all drugs. Just the evil ones. Not the ones that were evil a century ago but are okay now. Like alcohol. The ones that were okay a century ago but evil now. Like coke and pot.

The story is fundamental and easy to understand. There are "saintly" drugs and "demon" drugs. (No, not "demon rum." That's so century-ago.) The "saintly" ones may be indistinguishable from the "demon" ones chemically, may be just as toxic and harmful at the same doses, may in fact be given to our children at lower doses perfectly legally while adults who had them at higher doses are spending the rest of their lives in prison, but there are "saintly" drugs and "demon" drugs. And those associated with the "demon" drugs deserve the worst we can do to them because they're, well, demonic, while the "saintly" people using the "saintly" drugs shouldn't be accosted by our intrusions into their private lives. Prozac may be well linked to deaths, murders, and suicides, and marijuana to none of those, but "saintly" people use Prozac freely and "demons" use the evil weed and threaten us all, so move along, nothing to see here.

Doesn't this sound more than a little like an acid trip gone bad? Welcome to America in 2007, folks.

This is basically the point of Richard DeGrandpre's The Cult of Pharmacology: How America Became the World's Most Troubled Drug Culture. We as a culture have decided to scare ourselves with stories of how all "evil" drugs affect, no, "enslave" anyone the same way, taking away will and self-determination of all users. This justifies our frenetic crackdown on them despite the reality revealed by, you know, research that shows this is just not true. The irony is that our telling of the stories of "instant addiction" and "everyone gets addicted" creates a common meta-story called a "placebo text" that gives the drugs even more power. (The research is clear that context of drug use, including cigarettes and alcohol, affects the impact, just like placebos, and that very small and even no actual amounts of drug can "cause" drugged behavior simply from the belief that the drug is there, is powerful, is affecting them. Folks given the same drugs with no or different contexts react with little or no similar effect.)

If there were ever a case study of how myth trumps reality, hyperbole trumps research, chest-thumping trumps sense, the way we look at drugs in this period of US history is it. Experiments have repeatedly and conclusively shown that "patterns of drug use are strongly affected by assumptions and attributions about drugs and withdrawal that derive more from prevailing context of drug use and prevailing placebo texts that from the drug itself." People respond to drugs differently not only physiologically but also psychologically and socially. (How do people "get addicted" to gambling or videogames when nothing is ingested? And if you say, the context creates the neurochemical reward, . . . well, yeah.)

Yes, people can be harmed physically by drugs, but they have proven themselves harmable (???) by their expectations of the drugs, regardless of actual dosage. Yes, rats have starved themselves while pressing levers for more cocaine, but only when their environments and histories were extremely restricted and barren (something the tellers of that famous little story somehow always forget to mention). Yes, some vets came home from Nam and now Iraq hard-core drug users, but the overwhelming majority of soldiers using drugs in both wars, many really hard-core during war conditions, resumed non-drug lives (as do most patients who have to have serious painkilling while recovering). No, the point is not that drug ingestion is a good thing (I, as an ingester, of only "good" drugs in my life am living proof of that, thank you), but that the myth of pharmacology--that drugs inevitably and always harm users and require drastic methods that coincidentally maintain the empires of everyone from drug corporations to criminal justice bureaucrats and practitioners--is not supported by what we know from science.
After all, we live in a world in which cocaine, yet to be formally and scientifically labeled "addictive" (only craving-causing), is outlawed while its functional equivalent, Ritalin, is prescribed for children (although, after reading this book, you can't help but feel its day of going from saintly to demonic can't be far off). The Dutch legalized, controlled, and most importantly taxed about everything druggy and saw their abuse rates decline (giving the lie to those who argue that legalizing drugs would cause an abuse explosion).

All drugs come with stories and histories, both of their use and those of their users, and it's those stories and histories which separate the "saintly" from the "demonic," not the inherent qualities of the drugs themselves. When the users of coca products were primarily middle-aged women scared away from "demon rum" use, we didn't demonize it. Those days have clearly changed as those types of women have moved to other "saintly" drugs. In the meantime, propagandizing and empire-building bureaucrats on all governmental levels have mobilized the stories of "demons" and their drugs to support their careers, images, and own psychological needs (while the real killers of the drug world--alcohol and nicotine--remain legal, although DeGrandpre would argue that the "placebo text" thing applies to nicotine as well). He is masterful in telling the sorry and predictably human history of our drug delusions, good and bad, and the interests they have served. I doubt that he is surprised that medical marijuana is getting the opposition it does while our saviors from drug harm let Prozac and its cousins go off motivating suicides and murders. After this week's latest professional wrestling horror, do we really have to pretend pot is worse than steroids???

Frankly, as someone who's read several of these kinds of histories and analyses, I can tell you it's very hard to read this and not finish enormously depressed by the politicization of our drug policy and our failure to let real authorities--the medical community--address our problems here instead of guys who get funds from busts and other rewards professionally and personally from spreading fear instead of sensible info and advice about how to prevent and respond. And I'm not getting into the violence and destruction that anyone who paid attention during Prohibition knew would happen when more substances got this kind of government focus. Like the eventually acknowledged failure and later more effective treatment of alcohol as a "demon" substance have shown, as DeGrandpre says, "No doubt the war on drugs will one day rank among the most shameful periods in American history." The final thing you might take from this book, which despite the depression it will cause I encourage you to read, is the realization that our war on (some) drugs has itself become an addiction, complete with the denials and scoffing of those most addicted, that will take hard truths to break. DeGrandpre's book is that hard truth. It's out there, as are other books. And few are paying attention.

What does that say about how this addiction will end?

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