E-DRUG: Drugs or Medicines? (3)
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Dear e-drug readers,
The idea expressed by Subal Basak is not new, and it has not been
successful in the past due to a fundamental flaw in thinking. Very few
substances are uniquely and exclusively used for health purposes, or
social-recreational reasons, or even to end life. Heroin and cocaine are
prescription medications in many countries (and soon cannabis). Wine and
beer have a long history of medicinal use. While tobacco use is not
related to health, nicotine replacement therapy is an accepted medical
application. Prescription drugs are used in euthanasia (permissible in
some places) and in capital punishment (lethal injections, which may
require a prescription). The vast majority of drugs with addictive
properties and drugs used illegally are pharmaceutical agents.
Appeals for labeling a substance as a medicine (only used in a health
context), or as a drug (only used for non-health purposes or illegally),
or as a chemical (only used in capital punishment) ignore two basic
aspects. First, the original concept of the word "drug" (the Greek word
pharmakon) has four meanings: remedy, poison, magical charm, and
scapegoat (the last meaning is another interesting story in itself).
Thus, any substance used to produce an effect could result in healing,
harm, something miraculous or mysterious, or some combination of all of
these. Second, words that humans give to these chemicals, their effects,
and the reasons they are used are social constructs and represent the
beliefs, perceptions, and attributions of humans and their experiences
with them (thus entering into cultural, legal, political, moral, and
other contexts).
What I have always found frustrating is that pharmacists, who are the
best educated and trained of any discipline or occupation to understand
pharmacologically active chemicals, have continually refused to assume
societal responsibility for all of these chemicals, whether they are
called medicines, drugs, herbals, tonics, nutritional supplements,
poisons, or any other word. We need to be much less concerned about
being identified with substances that people assume produce only healthy
or "good" effects (an impossibility) or about any wrong impression that
is inferred when a substance is used for a "bad" purpose (there is no
simple dichotomy in human behavior!). We instead need to assume
responsibility as society's expert on any substance that can produce any
effect, good or bad, in a human being who uses it for any reason.
In other words, more than just focusing on the substance, regardless of
what it is called, pharmacists must give greater attention to how and
why that substance is being used.
Michael Montagne, RPh, PhD
Professor of Social Pharmacy
Associate Dean of Graduate Studies
Department of Pharmaceutical Sciences
Massachusetts College of Pharmacy & Health Sciences
179 Longwood Ave
Boston MA 02115
phone: 617-732-2995
email: michael.montagne@bos.mcphs.edu