Friday, June 23, 2006

The Other Drug Legalization

The other day I needed to refill a prescription on which I had no refills left. Since I'm uninsured, this involved going to a local medical clinic franchise and paying $100 to obtain a piece of paper from a doctor authorizing me to take something I knew very well I needed with no $100 consultation from him, thank you very much. As it was, I felt ridiculous, an adult grovelling for magic paper like a high schooler trying to beg, borrow, or steal a precious hall pass.

It got me thinking about what I might call the Other Drug Legalization, the absence of which I had previously taken for granted. Why, exactly, do we have prescriptions at all? The best answers I can come up with are that it:
--prevents antibiotic overuse
--buttresses the idiotic War on Drugs by limiting the potential for homebrewing
--makes sure people don't kill themselves with drug interactions
--makes easy money for doctors

Two of these (preventing antibiotic overuse and fatal drug interactions) are great. And my gripe about the cost aspect of my visit to the clinic could be cured by the simple, common-sense expedient of universal health insurance. But I'd want to see more drugs available over the counter, even if we all got health insurance tomorrow and antibiotics remain safely rationed behind the counter to prevent overuse.

Why? Because people ought to be able to decide for themselves what they want to put into their bodies. (I might say they have a "right" to do so, but that's another discussion!) Making more drugs available over the counter helps eliminate the medical community's ability to enforce the pernicious distinction between therapy and enhancement. If, for instance, people want to take an anti-depressant to feel better than well rather than just baseline, they shouldn't need to lie to an anti-enhancement doctor to get a prescription for it.

There is at least one problem I can foresee, however, (I assume commenters will foresee others!) if such liberalization is introduced while the U.S. is still in thrall to its heartless and wasteful for-profit health insurance system: people who can't afford a doctor are going to self-prescribe even if they need someone's help to sort out drug interactions, and they're going to end up dead--for reasons that have nothing to do with liberty, and everything to do with poverty.

Ah, well. I guess it'll have to wait until universal healthcare....


Dale Carrico said...

It seems to me that universal single-payer healthcare, more stringent fraud regulations on drug company (and other) advertising, reform of patent regimes associated with pharmaceutical companies, a more liberal licensing of nurses and other healthcare practitioners to dispense proper prescriptions, stronger protections of doctor-patient confidentiality, and a general shift of drug policy discourse from the catastrophic irrationality of the so-called War on Drugs to a harm-reduction paradigm are the priorities here. Most of these have strong progressive constituencies already, and taken together they would go a long way to ameliorating the sting of what you are talking about here.

You say: "[P]eople ought to be able to decide for themselves what they want to put into their bodies." Of course I agree with this, but I also know that what people want to put in their bodies usually changes according to the level of knowledge they have about what they are putting in their bodies and how well they understand the connection between the things they are doing and the outcomes they are hoping for.

I am a strong advocate for what I call a culture of consent, but for me it is always crucial to insist that by consent we always mean informed nonduressed consent.

If consensus science establishes a set of strong prescriptive or cautionary recommendations it makes good sense that there be some way to demonstrate that a citizen who consents to the use of a substance or to participation in some therapeutic intervention is truly informed about its probable effects.

As something of a morphological freedom fighter I certainly think that once we have secured the scene of legible informed nonduressed consent then it is a very difficult thing indeed to justify denying an adult person consensual recourse to a substance, personal practice, medical modification, or the like.

But this matter of securing the scene of what I call substantiated as opposed to vacuous consent is far from trivial -- and we are far from securing it as of now. Too often civil libertarian commitments, whether from the right or the left, to the value of "consent" -- or worse, its domesticated consumer cousin, "choice" -- amount to pro forma commitments at best, and alibis for indifference to duress at worst. The terrain here is incredibly tricky, I fear.

Tom FitzGerald said...

Tricky, indeed.

Certainly the other topics you mention in your first paragraph are of far more proximate importance than this one.

And informed nonduressed consent is indeed the core of the issue. One doesn't want consent duressed by, say advertising for lifestyle drugs, nor does one want informed consent to be merely pencil-whipping unread legalese. I certainly don't object to their being actual human verification of informed nonduressed consent by doctors/nurses/pharmacists/whoever, my problem is more the penumbra of parental authority and ability to deny even informed requests that surrounds doctors in the current prescription rites.

Still, compared to the many imprisoned in the gulags of our racist war on drugs, or to the uninsured pulling out their own bad teeth with pliers (I've known two guys that had to do this) this is a tiny issue. But it was worth raising to elicit your great comment, and those I look forward to from the rest of the folks hereabouts, as well....

Linda Wallace said...

It seems we're discussing more than one concept. If a person were interested in mood or body altering drugs and was able to sign an informed consent and waiver to prevent future litigation....then I'm all for that freedom. I also endorse automatic renewals for longterm drug therapies where the underlying medical condition does not warrant a medical face-to-face. Even then, this could often be done by a nurse practioner at reduced costs (either personal of governmental depending on the country and the health coverage). However, there can be valid reasons to require a consult prior to prescription determine the status of the medical condition and/or to check for possible complications from the drug therapy, as these are often not ones a person would be aware of (bone marrow depression, retinal changes, etc.).

Linda Wallace

Tom FitzGerald said...


That all sounds very sensible indeed, Linda. I particularly like the distinction between chronic conditions with likely side-effects that need to be checked and without, and the mention of nurse practitioners, one of the most underutilized grades in the medical profession in this country.

Thanks for a great comment!