01 May 2008

Drugs: worth the risk?

We are a drug-dependent society. From tranquilizing our kids with Ritalin to reinvigorating our old men with Viagra, we are a cradle-to-grave drug culture. In between birth and death we almost all rely on drugs at one time or another to mitigate or cure disease, relieve pain, or simply to enjoy ourselves. Good stuff, but always there are side effects. Always we must balance the benefit against the harm. We must deal with risk.

Unfortunately, we often aren't aware of what the risk is. A spate of lawsuits against the pharmaceutical giant Merck & Co. illustrates just that. In 2004, Merck pulled its top-selling pain-reliever Vioxx from the market when research indicated it increased the risk of strokes and heart attacks and may have contributed to thousands of deaths. Furthermore, recent studies allege that Merck manipulated public and professional opinion in order to promote the medication. Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba says, "... all of modern medicine is floating on a sea of drug company money and the result has been utterly corrosive."

So even the medical use of drugs is often much riskier than the user might reasonably expect. What about recreational drug use then? These products range from those which have been used extensively, and studied extensively, to those relatively new. We are quite knowledgeable about the commonly-used drugs nicotine, alcohol and marijuana, yet oddly we have legalized the first two but not the latter. Particularly odd considering it is less harmful than the others.

And so what if a recreational drug is risky? Does that justify criminalizing it? Everything is risky. Driving your car is risky. Sports are risky. Every year people maim or kill themselves skiing, mountain climbing, sky-diving, etc., but we don't demand criminalization. It's their life, we say. So why isn't it "their life" if they want to smoke, drink, toke, snort or shoot up? If it's legal to take a big risk skiing down a mountain, why is it not legal to take a small risk smoking a joint?

How then does the public decide what risks it will allow individuals to take? One approach is to evaluate the risk to society. If a behaviour has little effect on the general public but only on those engaged in it, why should they be deprived of their pleasure?

But are we not our brother's keeper? If we see individuals doing harm to themselves are we not morally obliged to help them? The answer lies in the state of their knowledge and the state of their mind. If they are acting in ignorance, they deserve advice; if they are mentally disturbed, they deserve medical assistance. If they are mentally sound and refuse help, they are on their own. If they are mentally incapacitated and refuse help, we may have the right to interfere. And of course if they are harming others we have the right to restrain them.

Consider marijuana use. Does the relatively minor harm caused to the individual and society justify restraint? Does it justify the enormous cost of policing, trying and incarcerating people for marijuana infractions? To the contrary, it seems grossly disproportionate. Oddly, the biggest risks -- harm to the user and expense to the public -- are caused not by the act but by its illegality. Legalize it and most of the risk vanishes. The answer here would seem to be obvious.

Or consider an example outside the realm of drug use -- driving a car for pleasure. This carries a not insignificant risk. Automobile accidents are a major cause of injury and death, and we all pay the price. If someone out for a Sunday drive is seriously injured, we all pay the medical bills. And, through our insurance, we all pay for the property damage. And we all pay for the policing. And of course we all pay for the pollution the car emits. And so on. It's an expensive pleasure. Yet we don't even consider making it illegal. Perhaps we should. It's certainly more expensive, to the individual and to the public, than smoking marijuana (except of course for the cost society has imposed upon itself by making marijuana illegal).

Our approach to drugs is irrational. Two that are guilty of broad social harm, tobacco and alcohol, we legalize. One that is more innocuous, marijuana, we don't. And many recreational drugs are no more harmful to the individual or society than a host of other activities we never consider criminalizing. Obviously deep prejudices are at work. Alcohol for some reason, perhaps because it has become intricately involved in our habits and traditions, has reached a plateau of respectability. Marijuana, perhaps because of its association with the socially marginalized, remains an outcast.

Our attitude to recreational drug use should sensibly depend upon risk analysis, drug by drug, including comparison to other behaviours. Only then will we escape mischievous biases and develop rational responses.

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