017. Drugs

A discussion on the manipulation of our biochemical status


Essays of possible interest

  1. Towards responsible use of cognitive-enhancing drugs by the healthy
  2. Adverse health effects of marijuana use
  3. Practical, legal, and ethical issues in expanded access to investigational drugs


Questions to ponder

1. How do drugs differ from other things?

2. What does responsible drug use and administration require of the user and the administrator? Should such responsibilities be codified in a nation’s laws?

3. After Congress mandated that the U.S. Food and Drug Administration (the “FDA”) “validate substantial evidence of safety and effectiveness for new drug products based on adequately controlled clinical trials,” Darrow et al states “the average development time for a new drug predictably rose from 2.5 to 8 years.” Assuming these are the two reasonable bounds, towards which of these time points would a healthier society’s drug approval rate skew?

4. “Three categories of expanded access now exist” Darrow et al tells us. “The most common request is for individual use, a subset of which involves emergency circumstances leading to treatment even before a formal written request has been submitted to the FDA. The second situation relates to requests by intermediate-size patient populations (tens to hundreds) who are eligible to receive a drug early in its development. The final situation is widespread use under a treatment protocol, such as might occur after a successful trial of an experimental agent has been concluded but before it has received FDA approval.” Should these levels of expanded use be met with different ethical and regulatory standards? If so, how should they differ? If not, why should there be uniform standards?

5. How much would it cost for you to take a random pill?

6. Volkow et al. notes, “The regular use of marijuana during adolescence [can be] of particular concern, since use by this age group is associated with an increased likelihood of deleterious consequences”. Such consequences include those from short-term use (e.g., impaired short-term memory, impaired motor coordination, altered judgment, paranoia, and psychosis) and long-term use (addiction1, altered brain development, cognitive impairment, diminished life satisfaction and achievement). With the ever-burgeoning “legalize it” movement pushing for a loosening of federal restrictions on marijuana use, sale, and distribution, what restrictions should remain (particularly with respect to adolescent)? What should accompany them?

7. Is it better to use more drugs or fewer?

8. On the subject of using a substance like Adderall to do “better” on an assignment: “Whether the cognitive enhancement is substantially unfair” Greely et al contends, “may depend on its availability, and on the nature of its effects. Does it actually improve learning or does it just temporarily boost exam performance? In the latter case it would prevent a valid measure of the competency of the examinee and would therefore be unfair. But if it were to enhance long-term learning, we may be more willing to accept enhancement. After all, unlike athletic competitions, in many cases cognitive enhancements are not zero-sum games. Cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world.” Do you agree?

9. What is it that drugs do to us that gets us so curious about them?

10. “Popular weed killer may be to blame for honey bee deaths, study suggests” a headline from today that were but two words flipped would have made for an excellent discussion.

1. Marijuana addiction occurs in about 9% of users overall, 17% of those who begin use in adolescence, and 25 to 50% of those who are daily users according to Volkow et al.