Thursday, May 13, 2010


The whole social paradigm for drug regulation needs to shift. The bankruptcy of current theories and methods is widely recognized. We are wasting way too much blood and treasure. I say turn the whole thing on its head with two fundamental reforms:

1. Medical authority and control over legal access to drugs should be converted to a legally mandated education/consulting role.

Individuals would not need medical permission, and they would not be legally prevented from buying or using any drug - whether it be a psychotropic medication, a painkiller, marijuana - or for that matter, LSD or crystal meth - for any purpose. However, drugs of certain classes (perhaps DEA schedules I through IV) would be considered to have potential consequences significant enough in terms of individual health and community safety, that any person choosing to buy and use such drugs would be required to document basic competence and familiarity with potential risks and benefits.

Pharmacists could demand "informed certificates", even as they currently demand prescriptions, proving that a customer has consulted with and been briefed by a medical or other suitable expert regarding the particular drug they wish to buy and use.

Such medical consultations/briefings could be meticulously prescribed by statute, to require particular and balanced, empirical information about risks and benefits relevant to any drug consumer's own purpose for taking any particular drug.

E.g., if a parent wanted Ritalin to help a child get better grades, the law might require that the parent be told about evidence that it works and evidence that it doesn't work for that purpose, in proportion to what is generally extant in scientific literature. It would also require that the parent be told about possible addiction risks, common side effects, etc.

Or, let's say, if a twenty-something bachelor wanted meth to intensify promiscuous sexual encounters, the law might require that he be briefed about unpredictable efficacy, as well as various concomitant severe dangers and long term trade-offs.

But once a consumer would be certified as fully informed, his or her possession and free use of a particular drug would be a matter of choice. NO legal prohibition, NO enforcement.

2. Individual responsibility for accurate information, and for the consequences of behavior, should be strictly enforced.

Consumer drug consultations/briefings performed by medical experts who issue "informed certs" would be standardly video-recorded by law, and this documentation would have to be maintained for a time corresponding to statutes of limitations on tort or criminal (or contract) liability. Then, if a consumer wanted to claim any damages from false or insufficient information about any drug used, a court or jury could evaluate the claim with some objectivity, through a reliable evidentiary and legal process.

Any drug consumer would also be utterly responsible under the law for all consequences of his/her behavior while taking any drug for which a valid "informed cert" was issued. If crimes or misdemeanors are committed, if adverse health effects or harms are suffered, or if bystanders are offended or harmed, then traditional jail sentences, fines and/or financial liabilities would be unmitigable by any "intoxication" or "substance-induced" excuse.

Statutes of limitation might be tolled until majority, to enable children drugged for their behavior to bring abuse claims, if they suffer from earlier decisions made for them by adults. 


I agree strongly with Dr. Thomas Szasz that the basic problem with psychiatry is coercion, and that absent coercion, psychiatry as we know it will wither away and cease to exist.

I also agree with the Citizens Commission on Human Rights, The Law Project for Psychiatric Rights, and other groups who point out that psychiatric drugs are ineffective, dangerous and fraudulently marketed.

Maybe my philosophical allegiance to Tom Szasz's libertarianism can be reconciled with an obvious need to protect the public. If everyone were fully responsible for their own health and well educated about medicine, this would be easy enough. But for the present purpose of evolving in the general direction of such a golden age, these two fundamental legal reforms might serve pretty well.

One not-insubstantial advantage of this scheme would be that no one would be out of a job. Physicians would be as much in demand as they are now. Pharmacists, government bureaucrats, researchers, lawyers, etc., would all still be needed in large numbers.

For such a paradigmatic shift, very few completely new processes or institutions would have to be created. It would be a cheap evolution, and it could happen quickly.

The value, in theory, would be exponentially increased participation, awareness and individual responsibility regarding drugs, health and medicine, from all levels and segments of society. Even as wider diffusion of economic participation and production beginning in the Seventeenth Century dramatically improved basic human conditions which had stagnated for millenia, the intractable "drug problem" might be solved, and people might improve in a rather basic way.

This is really just trusting our own and our fellows' common sense over the authority and final beneficence of some mythical expert betters.


  1. Randy,

    Great article. I think your final sentence sums it up perfectly.

    We live in a society where even while the "experts" are uncertain about the real efficacy and effects of many drugs, their judgment is nevertheless supplanted for everyone's individual judgment about what to put or not to put in their own bodies. It's a shame that, even when a person's life is at stake e.g. with cancer, they often have to leave the country to pursue the course of treatment which they believe is in their own best interest.

    The foundation of the whole thing is a king of paternalistic, philosopher king kind of thinking... But instead of benevolent philosophers, we have the capitalistic, greedy big pharma lobby effectively calling the shots for Congress and the American people.

    Thanks for doing what you do to try and make things better in spite of its seeming futility. You're a good man.


  2. You're right. We're coming up on the 100th anniversary of the Harrison Act of 1914. We should admit it was an abject failure, just like Prohibition, and move on to a different model.

  3. Randy, I agree completely with your proposed solutions. Those measures would eliminate all sorts of arbitrary special interests in favor of (God forbid!) individual responsibility. Great blog.

  4. See the discussion about Informed Consent at

    1. It’s easy to be cynical about informed consent, because psychiatrists have become highly adept at denying it covertly.

      But part of the problem lies beyond any medical expertise or science. Individuals have to be more responsible. People want machines and magic solutions.

      The right question is NOT, “Which process and which expert is right?” It’s actually, “How can I know for myself?”