A Personal Account in this week’s Lancet contains an intimate description of an individual’s dependence on Gamma-hydroxybutyrate (GHB), used as a method of combating social anxiety. An accompanying Review surveys the evidence for management strategies to treat complications of the recreational use of new drugs. These two provocative pieces serve a common purpose: they highlight the need for accurate, impartial information about the long-term effects of illicit drugs, and lay bare the difficulties doctors face when dealing with the consequences.
Recreational drugs are an undeniable, even routine, part of many people’s lives. Indeed, the British Medical Association reported last week that one in 15 practising doctors in England and Wales will be addicted to drugs or alcohol at some point during their lifetime. Their statement continued: “we do not think the figure is higher than in the general population”. But, as is characteristic of statistics purporting to inform about drug use, this number carries considerable uncertainty.
The societal debate over how to combat illegal drug use focuses mainly on when to legislate and to what extent. But from the perspective of health, the problem of illicit drug use, which is nurtured by stringent laws, is pragmatic. How can one treat a patient who may not admit to an illegal addiction? Or conduct research into management of conditions resulting from habits that the law urges doctors to oppose?
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 moralising 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. We proffer our website as the forum for your comments.