GDS 2020: How ‘drugs of abuse’ are becoming new medicines
Professor Adam R Winstock Consultant Psychiatrist and CEO, GDS
The difference between what we choose to call a drug (‘of abuse’) and what we call a medicine is rather arbitrary and varies across time and culture. But terminology is important and alludes to some important differences in key areas such as quality control, the perceived risks and benefits of use, source and the stigma associated with different motivations for use.
Drugs tend to be viewed as medicine only after a certain amount of evidence for its efficacy has accumulated and there is international consensus on the value it may have to people with a specific disease or condition. However, given the pharmacological difference between a medicine and a drug can be quite small (Oxycontin is basically heroin in a pill) I think the 2 defining characteristics that differentiate a drug from a medicine are why you take it – to either get high or to treat an illness – and whether it’s prescribed and do you get it from a pharmacy, dispensary or a dealer.
Most medicines offer their greatest benefit when provided following medical assessment and accurate diagnosis, supported by appropriate supervision, monitoring and lifestyle advice. Nonetheless given that many medicines can be obtained through sources independent of a prescription, self -treatment may be attractive for many people, especially when barriers to access, real or perceived exist. The latest recruits making the transition from being called drugs to being viewed as medicine are psychedelics and cannabis-based products.
Long before doctors, researchers and funders aligned their priorities and interests and regulators permitted basic scientific and clinical research, millions of people around the world had already figured out that psychedelics and cannabis offered more than transient changes in cognition, emotion and perception. Modern medicine is catching up with forgotten lessons and big pharma is reviewing missed opportunities. The evidence for these substances in many areas is promising and is causing a headache for regulators who are having to revise the rhetoric that for decades was used to schedule many of these drugs out of therapeutic conversations.
Many states in the USA and other countries such as Australia and parts of the EU now have regulations in place to support the provision of medical cannabis. However, work done by GDS and others suggests that the overwhelming majority of ‘therapeutic use’ consumers of cannabis don’t get their medicine prescribed, instead obtaining it from illicit sources or recreational outlets. Similarly, although there is promising evidence for drugs such as LSD, (es)ketamine and MDMA in the treatment of defined psychiatric conditions, the delay in translating this early clinical research into treatment modalities that are accessible and widely affordable, leaves many tempted to self-medicate without guidance.
Although it’s too early to say who will benefit most from these substances, evidence and experience suggests that careful assessment, highly skilled therapists and post psychedelic sessions to help individuals integrate the experience are essential components. GDS worries that these important aspects may be poorly highlighted and that some people may be tempted to figure it out for themselves or seek support from less well trained and experienced persons who may be offering guidance and monitoring during the drug experience. Bad outcomes from poorly supervised psychedelic episodes are bad for individuals and if recklessly reported, could be bad news for the fledging psychiatric renaissance.
While I suspect many people do their homework and are pretty well-informed about the effects and potential benefits of these drugs, there are still many risks with self-diagnosis and self-treatment. As a doctor I worry most about an incorrect self-diagnosis and delays in accessing care. Thinking you know what’s wrong and starting to treat yourself might delay a person seeking assessment and getting the appropriate investigations, which might uncover a progressive and/or deteriorating condition. As a self-treater, the uncertainty of product composition and quality are also serious issues, especially since dose is so important. Combine uncertain diagnosis and uncertain substance and you have the potential for things not to turn out as well as you might have hoped for.
While wearing my doctor’s hat I can’t recommend that people self-medicate with largely unregulated product. However, I am not blind to the opportunity of what can be learned from the shared experience of 1000s of people. Actually, any doctor will tell you that patients and people more generally are the greatest teachers.
This year GDS is seeking to pool that experience with 2 special sections dedicated to the better understanding of the healing potential of cannabis and psychedelics. We’ll ask what conditions you’ve tried to treat with cannabis (including CBD) and a range of psychedelics, how you consume them and how often, as well the positive effects and any unwanted consequences that might follow. Building on what we have already learned, we will compile a report that will inform future research as well as offer some guidance on existing best practice based on the experience of everyone who participates in GDS2020.
Don’t keep your expertise and experience to yourself – share it with us and we’ll share it with the world. Please take part now in GDS2020: www.globaldrugsurvey.com/GDS2020