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TAMING DRUG-DEPENDENCY WITH A CREDIT CARD

By: Tod H. Mikuriya, M.D

originally published Medical World News/December 21, 1981

Imagine using a credit card to get heroin or nonprescription amphetamine form the neighborhood druggist.  It’s part of my proposal for putting both physical or psychological drug addictions under the control of county medical societies instead of street dealers and “feel good” doctors.

            In my proposal, those hooked on narcotics, barbiturates, and other psychoactive drugs could seek help from a local nonprofit group called a Drug Control Agency (DCA).  Run jointly by the county medical and pharmaceutical societies and staffed by physicians and other addiction specialists, it screens applicants medically and offers drug seminars that culminate in written exams.  Anyone judged a safe bet for participating responsibly in a dispensing program receives a credit card for purchases at designated pharmacies.

            There are no prescriptions and no purchase ceilings.  But a DCA has predetermined a safe dosage ceiling for each participant, and computers handling the credit transactions would spot possible abuse form drugstore invoices. A DCA, for instance, might refer a true heroin abuser to a methadone maintenance program.

            The program won’t burden taxpayers.  Participants will pay out of pocket for their drugs at prices just high enough to support he DCA and provide modest profit for the druggist.  Without criminal drug-suppliers leaching off huge profits, a heroin addict-to use one example-might spend $3 a day instead of an illicit $100.  This program couldn’t begin en masse without changes in narcotic and controlled substance laws, but a pilot program could pave the way.

            Health and narcotics officials complain that my plan isn’t geared to break drug-dependency.  But, often, that’s neither possible nor desirable.  Both the literature and my own experience as a psychiatrist in drug programs suggest that 40 % of those dependent on psychoactive drugs are self-medication for pre-existing psychiatric ailments.  There’s evidence that heroin is being used for schizophrenia and other psychoses, methaqualone for anxiety, and amphetamines for depression.

            There’s also evidence that people addicted to such drugs can learn to control their intake so as to lead long and productive lives.  So why demand abstinence form self-medicators as well as those who originally sought a drug thrill?  It hasn’t worked, anyway.

            The success of the British drug-store dispensing program for heroin addicts suggests that DCA programs would virtually purge heroin of criminality here.  They’d cut off the financial lifeline to illicit suppliers and other parasites who’ve defied the most strenuous efforts of law enforcers.  And addicts who could afford their drugs honestly even form welfare checks-could abandon shoplifting and more violent crimes.

            Methadone maintenance programs, serving about 10% of heroin addicts, are no panacea.  They set arbitrary doses instead of letting addicts self-titrate responsibly.  And, by gathering addicts together each day, they reinforce abuse and criminality.

            This country’s “controlled substance” policy is an Orwellian euphemism.  It’s only succeeded in igniting wildfire in the streets.  The realities of drug-dependency call for a well regulated but no punitive dispensing program.  It’s best for both addict and society.