Stoned, Inc: The war on drugs’ whack-a-mole problem

LONDON, UK — Traditionally, scoring drugs was an illicit, seedy business. The stash made its way to your body from lawless peasant hinterlands, via drug mules and cartel kingpins. And dealers were backstreet brigands who would just as likely stab or scam you as get you high.

And, as Lou Reed once sang, they were always late.

Today, for many, it’s a different proposition. The dealers wear white coats, or own online mail order companies. The deals are often done in brightly lit clinics, or with a simple mouse click. And the guaranteed high may arrive by next day delivery, or immediately, over the counter.

While the world has prosecuted a brutal war against heroin, cocaine and marijuana, it has blithely overlooked a flourishing trade in pharmaceuticals and other legally manufactured intoxicants that are now almost as popular, and arguably more harmful.

Authorities waking up to the dangers of this lucrative drug industry find themselves in an exhausting game of whack-a-mole. Attempts to beat its wily and sometimes outlandishly wealthy participants into the ground are easily dodged.

In 2008, the United Nations Office on Drugs and Crime raised concerns that this uncontrolled tide of “psychoactives” was leading to “substance displacement.” As an unintended consequence of prohibition on pot, coke and smack, users and suppliers were turning to stuff you could score from the local pharmacy.

Among these widely available drugs are opium-based pain relievers (or “opioids,” such as Vicodin and Oxycontin) depressants (Valium) and amphetamines (Adderall).

Their corporate manufacturers — big names such as Abbott, Pfizer, Purdue and Roche — have reaped billions of dollars thanks to a surge in prescriptions issued by doctors, apparently willing to see them as the solution to conditions that often lie beyond the drugs’ legally approved uses.

Once out in the world and beyond the control of manufacturers or medical workers, some of these pharmaceuticals, either through theft, misappropriation or misuse, also acquire new lives as party pills. Adderall lifted from family medicine cabinets, for example, is regularly traded by college students in pursuit of a study aid or an all-night bender.

“There are so many more drugs out there than there used to be,” says Professor Richard Miech, a University of Colorado sociologist who has conducted studies into how and why today’s adolescents are switching from marijuana to the medicine cabinet in pursuit of narcotic nirvana.

In the United States, 6.3 percent of the population over 12 years of age abuses prescription drugs, a rate second only to marijuana (nearly 12 percent), and more than twice that of cocaine (1.8 percent), according to the latest annual report from the UN Office of Drug Control. Prescription opioids are the most widely abused (4.8 percent), followed by tranquilizers (2.2 percent), and stimulants (1.1 percent).

According to Miech’s research, abuse by young people of these drugs is now 40 percent higher than it was for previous generations. That, he says, is partly due to increased availability. The UN reports that global quantities of oxycodone (generic Oxycontin) jumped from two to 135 tons between 1991 and 2009. It blamed the increase partly on the lack of social stigma attached to using these pharmaceuticals. 

The US Centers for Disease Control and Prevention says that about half of the 28,754 American deaths from drug overdoses in 2009 involved prescription painkillers. At least one person dies from a drug overdose every 19 minutes in the US, according to the CDC.

“Adolescents think those drugs are safe,” Miech told GlobalPost. “If they have a friend using heroin or cocaine, then they would look down on that person. If someone was using prescription drugs, they wouldn't hold it against that person so much.”

Miech and others are now warning that misuse of prescription drugs among young people — who they say are often influenced by the pharmaceutical habits of their parents — is on the brink of becoming an epidemic in the US. Other countries, such as Australia, are also at risk.

Bruce Levine, a US clinical psychologist and campaigner for mental health care reform, puts the blame for this at the hands of manufacturers who, he says, have driven profits by allowing people with no real need of medication to view painkillers, anti-depressants and even anti-psychotics as life-improving panaceas, despite a host of risks.

Pharmaceutical companies are often restricted in what they can say in product advertisements, so they target doctors with what is known as “off-label marketing” — recommending their drugs as treatment for a range of conditions not listed on the official literature.

“What they have done is market these drugs as chill pills,” says Levine. “The drug companies have salesmen that go to doctors in nursing homes, etc., and they have sold these drugs as a way to control … old people or little kids.”

Also at fault, Levine says, is a regulatory process that trusts drug companies themselves with the responsibility for testing new pharmaceuticals. As he points out, several major manufacturers have been fined in recent years both for overzealously marketing their products and for filing misleading data about their efficacy.

In the past three years, Eli Lilly, Pfizer, Merck and Abbott Laboratories, all Fortune 500-listed pharmaceutical companies, have been subjected to millions of dollars of fines relating to fraud or illegal drug promotion. In 2011, British multinational GlaxoSmithKline agreed to a $3 billion settlement for promoting an anti-depressant for use with under 18-year-olds, despite lack of official approval, and for failing to disclose safety data about an anti-diabetes drug. To date this is the largest health care fraud settlement in US history.

After the settlement, GSK chief executive Andrew Witty said his company would learn from its mistakes and pledged such marketing techniques were a thing of the past. Others have also pledged reform.

Such punishments, argues Levine, will do little to bridle a multi-billion dollar industry. Instead, the companies press on, aggressively lobbying psychiatrists to define new disorders that their drugs can treat.

The result: legions of young people are unnecessarily diagnosed with mental health disorders, he says. And by being prescribed drugs whose benefits are uncertain, they enter a realm where drug use, and misuse, is normal.

Asked to respond to Levine’s comments, the Pharmaceutical Research and Manufacturers of America, or PhRMA, which lobbies on behalf of drug manufacturers, said it supported “truthful, non-misleading communication with healthcare providers about life-enhancing, life-saving medicines that may benefit their patients.”

“PhRMA member companies are committed to abiding by the legal and regulatory requirements regarding communications about medicines, and have invested considerable resources to institute systems to ensure compliance,” the organization’s vice president, Mit Spears, told GlobalPost via email.

Misuse of prescription pharmaceuticals isn’t, however, the only mole waiting for a whack from lawmakers.

In many parts of the world, and especially here in London, young hedonists are turning to new, legal brands of designer drugs that deliver highs — but can also induce unpredictable and sometimes lethal reactions.

Many of these substances are sold openly under misleading but seemingly innocuous labels like bath salts, plant food or potpourri. The packaging typically notes, with a wink and nod, “not for human consumption." Their emergence usually triggers a familiar pattern: widespread use, followed by horror stories of overdose and death, followed by a government ban.

But just as fast as such substances are outlawed, new ones appear on the market. By tweaking the chemical makeup of their products, manufacturers are quickly able to sidestep the regulations and deliver new highs to their customers.

In the past few years in the United Kingdom, a potent amphetamine-style “designer drug” called mephedrone —  also known as “miaow miaow” — hit the streets. Its effects were alarming even to some of its regular users, before a spate of highly-publicized deaths led to a government ban in 2010.

“People who wouldn't have sought out and called a dealer to pay £50 (about $77) for a gram of cocaine could and were ordering 10 grams of a drug not all that different from cocaine on the internet for £100 and having it delivered to their home the next day,” one user, a 29-year-old professional from east London, told GlobalPost on condition of anonymity.

“We were simply doing a lot more of mephedrone than we would have done if it had been difficult to get or more expensive. It wasn't destroying our lives because it was still just a weekend thing, but it wasn't difficult to see how, had it not been banned, things could have got out of control.”

Scientists have not yet probed mephedrone’s health effects in detail, but at least one account suggests that it’s unsafe. “I don’t think anyone is going to be super-surprised if [mephedrone is] found to be neurotoxic,” wrote Hamilton Morris on Hamilton’s Pharmacopeia, a blog that Hunter S. Thompson would certainly read if he were still alive. Morris continues:

“Its cardiovascular toxicity is almost certain. Although it does feel (breathtakingly) good for two hours, in the following weeks your heart beats like a djembe every time you ascend a single stair. Mephedrone is a great candidate for being flushed down the toilet, and if you’ve never flushed a drug down a toilet you should really try it — it’s surprisingly cathartic. In the case of mephedrone, the toilet will actually sigh and pat you on the back.”

In the US last year further alarm greeted the emergence of stimulants labeled “bath salts,” ad hoc substance mélanges that are typically close chemical cousins to mephedrone. These have induced violent and psychotic behavior in some users.

Last year, one woman was charged with assaulting staff in the Pennsylvania hospital where she had just given birth after smoking “bath salts.” This followed several months of sensational headlines which demonized “bath salts” as the cause of numerous attacks — including a notorious face-chewing incident in Miami, later blamed on cannabis and mental illness.

More recently, however, there has been a spate of headlines about the dangers of synthetic cannabis.

Governments in Europe and the US have faced criticism for being slow to respond to the evolving legal high industry. Officials are found scrambling to ban substances that have already been reformulated.

Some countries are now seeking to follow the example of New Zealand, which is pioneering new controls on synthetic highs that will force manufacturers to prove — via an independent regulator — that substances are safe for human consumption before they are cleared for sale.

Peter Dunne, New Zealand’s associate health minister and the driving force behind new legislation likely to come into force in August, said the steps are being taken following the outlawing of 30 products and 55 chemical formulations in the past 18 months.

He says the move has received substantial public support, but also the backing of many of the synthetic high industry’s more legitimate players, who insist the tests will prove their products were safe all along.

“You can take that with a grain of salt,” Dunne told GlobalPost. “But the fly-by-nighters are the ones who will be most affected. We’ve already seen a number of cheap and nasty operations come along — and they will go.”

When it comes to prescription pharmaceuticals, there are doubts that current legislation is enough to curb the behavior of manufacturers and the medical profession or discourage young people from misusing them.

Miech, the sociologist, says the current situation calls for tougher federal controls over drug companies and a shift in government focus from illegal to legal drug misuse. Without these, he argues, modern teens will use prescription drugs as a gateway to riskier substances in the same way that some marijuana users once moved on to cocaine or heroin.

“Drugs come and go, in and out of fashion, and I think illegal drug use has largely gone out of fashion and if we could somehow restrict prescription drug abuse that would lead to an overall reduction in drug use,” he said.

But psychologist Levine says the only option is tougher measures for the executives of drug giants who, he says, dismiss multi-billion dollar fines as a cost of doing business. “It's called jail. That's the only way you'll stop them.”