A Really Good Day(61)
Like marijuana, classic psychedelics such as LSD and psilocybin don’t cause substantial harms if taken in appropriate doses. Gutwillig suggested online drug markets as a way to distribute psychedelics in a controlled and safe manner.
“How would that work?” I asked. “Would I be able to just go online and buy LSD?”
“Yes,” he said. An adult would be able to go online and order a small dose of a psychedelic or of MDMA. She would be assured that what she received was in fact pure and unadulterated. In addition, she would receive warnings about potential dangers, and clear information about safe dosages relative to body mass, age, and experience. Such a system would have a substantial impact on individual and public health outcomes, because the harms associated with MDMA, and to a lesser extent psychedelics, are generally a function of dose and adulteration. As Dr. Hart says, “Focus on purity, focus on unit dose, focus on education.”
If classic psychedelics and MDMA were available in a well-regulated and safety-tested manner, people would be far less likely to turn to new psychoactive substances, sometimes referred to as NPSs or alphabetamines,*7 synthetics with which all sorts of harms have been associated, including death.*8 Franklin suggested that in an ideal system there would be a role for psychedelic guides, perhaps centers where one could go to take psychedelics, offering a setting that maximized the potential for positive experiences and minimized the potential for harm. Kind of like a day spa, for tripping.
The topic of opioids is far more fraught, given the current surge in heroin use, the drug’s high addiction rate (24 percent of users become addicted), and the recent dramatic spike in overdose and death. Any potential medical model for regulated heroin legalization would have to take these dangers into consideration. Fortunately, we have evidence that shows that there are far better ways to treat heroin and opioid addiction and overdose than through interdiction and imprisonment. Back in the 1990s, a psychiatrist in Liverpool, Dr. John Marks, experimented with an alternative model of treating addicts. Rather than incarcerating them or attempting to cure their addictions, he simply focused on keeping addicts alive, healthy, and out of the criminal justice system. He did this by prescribing to each addict her drug of choice, including heroin.
The U.S. government responded with outrage, demanding that British authorities put a stop to Marks’s project, but for a while at least, he was allowed to continue. His results were striking. Patients in heroin maintenance, those who actually received heroin from their physicians, did not suffer high rates of HIV and AIDS, because they were not sharing needles. There were far fewer overdoses and deaths, because the drugs they used were clean and carefully administered. Plus, the patients didn’t commit crimes. All of this is to be expected: with ready access to their drugs, they didn’t need to rob, cheat, or steal. The addicts in Marks’s heroin maintenance program were healthy, most of them had jobs, and they had strong family ties.
What surprised everyone, however, was that addiction rates actually decreased in places where heroin maintenance was offered. Giving heroin to addicts didn’t make them use more, or even make more people use. It actually stopped the spread of drug use and abuse. Why? The easiest way to think of this is like a scale. On one side of the scale is heroin. Addicts are obsessed with one thing, and one thing only: getting the next fix; doing whatever they can to get that fix takes up all of their time and energy. Marks simply removed the desperation and effort from the equation. Addicts in his program got their drugs in the morning and then spent the day with their families or at their jobs, just like Halsted, the founder of Johns Hopkins, the cocaine-and-morphine addict who invented modern surgery. Slowly but surely, the other side of the scale began to fill up with the satisfactions of work and relationships. When the scale reached the tipping point, when the pleasures of normal life outweighed the pleasure of the drug, the addicts were inspired to get clean. Every year, 5 percent of Marks’s patients simply stopped using, without the help of methadone or rehab or any other intervention.
Who knows what might have happened had Marks been allowed to continue his project? But the United States wields a mighty sword when it comes to international drug policy. It put pressure on the British government, and Marks’s program was eventually shut down. Within two years, twenty-five of his patients were dead, and all the rest were back on the streets or in jail—collateral damage of the unending, unwinnable worldwide war on drugs.
Inspired by Marks’s results, Swiss researchers carried out a comparison study. Eight hundred volunteers were given heroin, one hundred were put on methadone, and one hundred were given morphine. They were followed for three years. The results for the eight hundred? As the author Mike Gray writes in Drug Crazy: How We Got into This Mess and How We Can Get Out, “Crime among the addict population dropped by 60 percent, half the unemployed found jobs, a third of those on welfare became self-supporting, nobody was homeless, and the general health of the group improved dramatically. By the end of the experiment, eighty-three patients had decided on their own to give up heroin in favor of abstinence.”
In the United States, we spend more than twenty billion dollars a year on rehab, the majority of that not on evidence-based programs but on programs that have been shown again and again to be ineffective. The success rates for typical abstinence-based rehab programs are less than 25 percent. By some estimates, 90 percent of addicts who go through rehabilitation relapse within the first year.*9 Medication-based opioid rehabilitation programs that prescribe drug-replacement medications that alleviate the symptoms of detox, such as buprenorphine, trade name Subutex, and Suboxone, a compounded mixture of buprenorphine and the opioid antagonist naloxone, are more successful, but they, too, have substantial limitations.