Legalizing Drugs (Cocaine, Marijuana, etc)

[CardiacCoug]

Is it your contention that our society is not over medicated?

I didn't mean to lay all the hyprocisy at the feet of the pharmaceutical companies. I should have included the medical profession in that hypocrisy. If I want morphine, I'm well within my rights to consume it. Provided, of course, I first pay a doctor to green light it.

If you're talking about anti-depressants, there are many physicians who believe these medications are in fact underutilized. Many people actually substitute alcohol for anti-depressants in self-medicating their symptoms of depression and anxiety.

Good doctors don't prescribe narcotics for long-term use or without a definitive diagnosis of a painful condition. In fact, doctors that prescribe narcotics "on demand" for a fee will lose their medical license and could go to jail. It's illegal.

Many doctors believe that narcotics are actually underutilized for patients with cancer-related pain and other painful, terminal conditions.

As to the general topic of the thread, I'm in favor of legalization of marijuana, but not narcotics or stimulants like amphetamines or cocaine.

[Non Sequitur]

Yes, I tend to think we're overmedicated. In some cases, that's the fault of the doctor. In many more cases, it's a patient who would much rather take a pill than change his diet, exercise, develop coping mechanisms, etc.

I don't even know where you're going with the second paragraph. Trust me--I would absolutely LOVE to get out of the narcotic prescribing business. And I'm not alone. There are plenty of primary physicians who simply tell their patients that they don't "do chronic pain" and they'll need to seek that help somewhere else. In the ER, we have to treat pain, or we get a career-ending EMTALA violation.

If you're arguing that people should have the right to consume morphine if they wish, that's hardly the fault of physicians--that's the system we've chosen as a society. (Well, that is, if you ignore the little kickback we get each month from Morphine, Inc based on how much morphine we prescribe.) Get back to the benefits and costs of drug legalization if you want to tackle that debate. It has absolutely nothing to do with conflicts of interest.

Where are you getting this stuff? Besides not having any evidence for it, you're not even making sense.

It's not really the fault of the doctors or the drug companies. It's a consumer issue. We are consumers and we like to consume drugs. We like pain killers and we like anti-depressants and we like alcohol and we like marijuana and we like cocaine. I just have a hard time understanding why someone can't smoke a little pot, but they can get prescriptions for opiates. Doesn't that strike you as a little odd?

[ERCougar]

It's not really the fault of the doctors or the drug companies. It's a consumer issue. We are consumers and we like to consume drugs. We like pain killers and we like anti-depressants and we like alcohol and we like marijuana and we like cocaine. I just have a hard time understanding why someone can't smoke a little pot, but they can get prescriptions for opiates. Doesn't that strike you as a little odd?

Sure. I've already shared my thoughts on marijuana--it's certainly less dangerous and less addicting than opiates. But the system we've chosen as a society doesn't have a thing to do with doctors or pharmaceutical companies. That's all I'm sayin....

[ERCougar]

If you're talking about anti-depressants, there are many physicians who believe these medications are in fact underutilized. Many people actually substitute alcohol for anti-depressants in self-medicating their symptoms of depression and anxiety.

Good doctors don't prescribe narcotics for long-term use or without a definitive diagnosis of a painful condition. In fact, doctors that prescribe narcotics "on demand" for a fee will lose their medical license and could go to jail. It's illegal.

Many doctors believe that narcotics are actually underutilized for patients with cancer-related pain and other painful, terminal conditions.

As to the general topic of the thread, I'm in favor of legalization of marijuana, but not narcotics or stimulants like amphetamines or cocaine.

I have to disagree with a few points here. A ridiculously high number of patients I see are on some antidepressant. I simply can't believe that all of these patients are clinically depressed. Even if they are, that speaks to our society as a whole, and a need to change something--be it the constant stimulation, the sedate lifestyles, the materialism, something--rather than put more people on medications. I guess SSRI's are better than other self-medicating behaviors, but they are a lot worse than learning some coping skills. I'm not talking about the truly clinically depressed here--I'm talking about your average Joe who feels like he should be happier more often and wants a pill to make it happen.

Regarding pain medication--you're right that we undertreat pain. There are a lot of studies that show this. My point to NS was that doctors don't particularly like writing pain medications, and certainly don't write more as a conflict of interest. Any drive they feel is purely ethical and not financial. In general, even the patients who truly have chronic pain problems are not the easiest or most pleasant patients to treat, and that's not even touching the task of sorting out the drug-seekers from the truly sick.

[CardiacCoug]

I have to disagree with a few points here. A ridiculously high number of patients I see are on some antidepressant. I simply can't believe that all of these patients are clinically depressed. Even if they are, that speaks to our society as a whole, and a need to change something--be it the constant stimulation, the sedate lifestyles, the materialism, something--rather than put more people on medications. I guess SSRI's are better than other self-medicating behaviors, but they are a lot worse than learning some coping skills. I'm not talking about the truly clinically depressed here--I'm talking about your average Joe who feels like he should be happier more often and wants a pill to make it happen.

It would be nice to have a psychiatrist weigh in on this. Too bad we don't have one on this board. I agree that some patients without clinical depression, an anxiety disorder, or another appriate medical indication take SSRIs. Probably a lot of "frequent flyers" in the ER take SSRIs because they are the type of medication that is associated with overutilization of health care. If you go to enough doctors, eventually one of them will probably put you on an SSRI, if not for a psychiatric diagnosis, then for fibromyalgia or similar pain syndrome.

But I also think many patients with clinical depression don't receive the psychiatric medications that they would benefit from. In that sense, SSRIs are probably both overutilized in inappropriate patients and underutilized in appropriate patients. Your probability of being on an SSRI correlates more with how often you seek medical attention than with whether or not you have depression, generalized anxiety disorder, or another appropriate psychiatric diagnosis.

[ERCougar]

It would be nice to have a psychiatrist weigh in on this. Too bad we don't have one on this board. I agree that some patients without clinical depression, an anxiety disorder, or another appriate medical indication take SSRIs. Probably a lot of "frequent flyers" in the ER take SSRIs because they are the type of medication that is associated with overutilization of health care. If you go to enough doctors, eventually one of them will probably put you on an SSRI, if not for a psychiatric diagnosis, then for fibromyalgia or similar pain syndrome.

But I also think many patients with clinical depression don't receive the psychiatric medications that they would benefit from. In that sense, SSRIs are probably both overutilized in inappropriate patients and underutilized in appropriate patients. Your probability of being on an SSRI correlates more with how often you seek medical attention than with whether or not you have depression, generalized anxiety disorder, or another appropriate psychiatric diagnosis.

I can see your point--I do see a different patient population than the norm, and you're probably right in that some people aren't getting properly treated. What got me thinking about this was a debate I heard on NPR a few months back between two psychiatrists. One had just written a book called "Steps to overcoming depression" or something similar to that. He ran a clinic where they used medications as a last resort and claimed that he rarely had to use them. The other psychiatrist agreed with him that SSRI's are overused but did feel that his numbers were a little too optimistic. Both agreed that counseling is very underused. Since the interview, I've been a little extra vigilant in noticing who is on an SSRI, and I'm not exaggerating when I say that of my adult patients, over 75% are taking an SSRI. True, it could be for anxiety or fibromyalgia or whatnot, but 1) the vast majority are taking them for depression; 2) most who are anxious are also depressed; and 3) there are lifestyle modifications for anxiety and fibromyalgia as well--I bet 75% of my patients don't exercise, for instance.

In your field, how successful are you at getting people to stop smoking? To exercise? To improve their diet? Huge benefits to all of these, but most would rather just take Lipitor. Maybe I should just resign myself to living in a society where pills fix our problems.

[CardiacCoug]

In your field, how successful are you at getting people to stop smoking? To exercise? To improve their diet? Huge benefits to all of these, but most would rather just take Lipitor. Maybe I should just resign myself to living in a society where pills fix our problems.

Bypass surgery and heart attacks are actually pretty good motivators for a lot of people to stop smoking and improve their diet. We do see a lot of middle-aged people who have never had any health problems who just need that wake-up call to become a lot healthier. Behavioral patterns are so entrenched by the time people reach their 50s and 60s, though, that I think it's definitely less than 50% of people who make significant lifestyle changes, even after a major surgery or MI.

A lot of people won't even take medication as prescribed. It's all a big conspiracy by doctors and drug companies to make money, right? You get a big kickback for drug companies for every med you prescribe, right?

(People don't realize that it's actually better for a cardiologist's finances if patients don't take the meds you prescribe them -- more heart attacks and more stents is good for business).

[SoCalCoug]

This is a little overly cynical. First of all, no drug company is profiting off of either Prozac or Soma, as both are generic drugs. I agree that antidepressants are overused, but I would hardly call it an addiction, at least by any clinical or useful definition. We have the occasional Soma addict, but these are actually pretty rare and certainly not as devastating as some of the illegal drugs. Narcotics, benzos, and stimulants all are very addicting with devastating consequences--but again, drug company profits have nothing to do with this, as the vast majority of them are generic. Drug companies contribute to problems to be sure, but this ain't one of them.

Having spent the last 4-5 years of my first (failed) marriage with a wife who spent most of my waking hours in a drug-induced stupor (thanks, Soma, Abilify, Xanax, and Oxycontin), I suppose I am not qualified to comment on this, as I have only personal anecdotal evidence, and not scads of studies bankrolled by the pharmaceutical industry.

Wait - are you talking about this Soma? http://www.soma.com/store/browse/she...catId=cat40089

[CardiacCoug]

Having spent the last 4-5 years of my first (failed) marriage with a wife who spent most of my waking hours in a drug-induced stupor (thanks, Soma, Abilify, Xanax, and Oxycontin), I suppose I am not qualified to comment on this, as I have only personal anecdotal evidence, and not scads of studies bankrolled by the pharmaceutical industry.

Wait - are you talking about this Soma? http://www.soma.com/store/browse/she...catId=cat40089

Did you consider an inpatient rehab program? Her doctors were irresponsible if they were prescribing these drugs without a good indication.

But are you really blaming the maker of Oxycontin for providing a drug that provides hundreds of thousands of cancer patients with pain relief and increases their ability to enjoy their last months of life? Abilify prevents many schizophrenic and bipolar patients from requiring permanent institutionalization.

The abuse of these drugs that takes place is inevitable and regrettable, but not the fault of drug manufacturers. Do you blame companies that make knives and hammers when these tools are used to kill somebody?

[wuapinmon]

DevilDog and I were briefly discussing this in another thread. He said I stated my opinion as fact. Here's more to back up what I said.

Remembering that sociologists should strive to only recommend policy to politicians, it would seem that the overwhelming consensus of the last 25 years is that a "punitive" approach to drug policy is a failure, and that other avenues should be attempted, especially with regard to marijuana. However, the consensus about the outcomes of that change is not in any way agreed upon, they just agree that a punitive approach carries far more repercussions in society that most believe carry a larger negative impact than increased availability of legalized production, sale, purchase, and consumption.



http://www.drugpolicy.org/docUploads...ollegeCUNY.pdf

http://www.jstor.org/pss/3487894

http://books.google.com/books?id=5QE...page&q&f=false

[frank ryan]

as a long time user of anti-depressants they are not addictive and don't give you a high. you can't go and buy prozac on the streets.

is abilify dangerous? i just got put on it

[ERCougar]

Interesting article with a blurb on decriminalization in Portugal.
http://m.huffpost.com/us/entry/6506936

[Joe Public]

Interesting article with a blurb on decriminalization in Portugal.
http://m.huffpost.com/us/entry/6506936

There's plenty to consider there. Thanks for posting it. I would be interested to learn more about how Portugal approached getting drug users to bond more with their community/society.

[ERCougar]

There's plenty to consider there. Thanks for posting it. I would be interested to learn more about how Portugal approached getting drug users to bond more with their community/society.

Yeah, me too. The 180 degree change in opinion of the Portugal drug enforcement officer is telling, I think. And on a more personal level, I wish I had read this when my sister was still alive. Tough love doesn't work.

I'm curious to read the book.

[pellegrino]

Interesting article with a blurb on decriminalization in Portugal.
http://m.huffpost.com/us/entry/6506936

Ha! I just finished reading that after a friend posted it on facebook a few days back. I think it's a very convincing argument that makes sense.