Saturday, October 08, 2016

Not learning from history: legalization of drugs

History doesn't provide any comfort about the legalization of drugs. Per Alan Schwarz in ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic, in the 1960s:

Dexedrine had become perhaps the most widely abused drug in the United States—more than hippies' marijuana, more than Timothy Leary's LSD, more than the heroin that would soon kill Jimi Hendrix and Janis Joplin. In the 1960s, doctors prescribed amphetamines so willingly—for weight loss, depression, all but hangnails—that an estimated four billion tablets were dispensed by American pharmacies per year, or enough for every man, woman and child in the United States to have twenty apiece.

The United States military handed out Dexedrine so freely that an estimated 7 percent of its Vietnam forces became abusers and addicts. About eight hundred thousand Americans were dependent on amphetamines, about three hundred thousand of them flat-out addicted—and many of them average housewives. These addicts weren't the young beatniks and hippies so reviled by the establishment; they were, in many cases, the establishment itself.

There was talk in about banning amphetamines in the United States altogether, its medical uses be damned. Instead the federal Controlled Substances Act placed unprecedented restrictions on the handling of addictive pharmaceuticals like Dexedrine and Ritalin. Prescribers were now required to maintain a special government license, fill out much more paperwork, and prescribe no more than a thirty-day supply at a time. Drug companies could not produce such medications in quantities higher than the government deemed clinically necessary.

It was the ultimate buzzkill. US production of amphetamine plummeted an astonishing 90 percent in only a few years. Stimulants could no longer be handed out as mere pick-me-ups for tired professionals, but only for narcolepsy or short-term weight loss. And for a children's malady just now hitting America's living rooms: minimal brain dysfunction.

Minimal brain dysfunction is simply the old name for Attention Deficity Hyperactivity Disorder (ADHD). The author says it is a real malady, but where about only 5% of children are actually affected by ADHD, about 15% are diagnosed with ADHD, leading to a massive over-prescription of drugs. Why?  There are simply too many perverse incentives in the system.

I expect there is a similar story behind opioids and their widespread abuse today; and in a few years, I expect the states busy legalizing pot, whether for medical purposes only or more comprehensively, will have similar findings.

FYI: alcohol use is a leading cause of death in the USA and in the world; but in the USA the deaths due to alcohol are parceled up among many different buckets to disguise that fact.  While Daniel J. Levitin's very timely book A Field Guide to Lies: Critical Thinking in the Information Age does not mention this example, it does mention the template of this lie. Levitin calls it "specious subdividing".
Suppose you work for a manufacturer of air purifies, and you're on a campaign to prove respiratory disease is the leading cause of death in the United States, overwhelming other causes like heart disease and cancer. 
 But respiratory disease is only the third leading cause of death, and doesn't make for an impressive ad campaign.  So subdivide heart disease into categories like rheumatic heart disease, hypertensive heart disease, acute myocardial infarction, and so on, and likewise with the various cancers.
By failing to amalgamate, and creating these fine subdivisions, you've done it! Chronic lower respiratory disease becomes the number one killer.  You've just earned yourself a bonus.