What is the rationale behind the prescription drug laws?

Should competent adults need the "permission" of a doctor before being allowed to use the pharmaceutical products they think they need?

Published April 19, 2007 12:09PM (EDT)

I will likely be posting today about the Alberto Gonazles testimony before the Senate Judiciary Committee as it unfolds in all of its splendor, but until then, I am limited in the time I have to post. For that reason, I am going to post an exchange between myself and a physician-commenter that occurred at the end of the comment section from yesterday's post concerning the massive prescription drug data bases which the federal government is funding.

I've always been interested in the topic of prescription drug laws because -- even more than laws which prohibit adults from using recreational drugs -- it seems absolutely unjustifiable for the government to prevent adult citizens from deciding for themselves which pharmaceutical products they want to use. Put another way, it seems unfathomable that competent adults are first required to obtain the "permission" of a doctor before being "allowed" to obtain and consume the medications they think they need -- and that they are committing crimes if they do not first obtain that permission (or, worse, if they try to obtain that permission and are unable to do so).

This is not a topic I write about much -- actually never -- because I realize it is a view shared by such a small minority and is not exactly of interest to everyone. But I'm always interested in hearing the rationale from those who believe in such laws, and in particular hearing responses to the point raised by the below-excerpted exchange from the comment section. Since I don't have time to post much this morning -- and in light of the attention paid yesterday to the "Prescription Drug Monitoring Programs" -- it seems like a good opportunity to paste these two comments (slightly edited for clarity) and elicit responses:

Comment from David78209:

Antidepressants aren't "scheduled" at all

Schedule I is stuff that's always illegal -- heroin, marijuana, etc.

Schedule II is legal but in most states requires a special written prescription. Morphine and other heavy-duty pain medicines are Schedule II, and so are amphetamines and similar stimulants (including, perhaps inappropriately, some medicines used mostly to treat attention deficit disorder, like Ritalin).

Schedule III includes medium-duty pain medicines. Tylenol with codeine PILLS are Schedule III -- but Tylenol with codeine LIQUID is Schedule V. That's not quite as odd as it sounds, if the liquid is dilute enough that you'd have to drink huge amounts to get a dangerous buzz.

Schedule IV includes Darvocet, Valium, and Xanax.

Sometimes you'll find one drug that's been pushed up to Schedule II mostly because it has become a popular drug to abuse, while equally strong drugs that haven't happened to develop a 'street following' are still Schedule III.

Marinol, which is THC (the active ingredient in marijuana) is now Schedule III. I think it got 'demoted' from Schedule II out of boredom. Apparently it rarely gets sold illegally, perhaps because it seems to be more expensive than street marijuana.

Antidepressants, such as Paxil, Prozac, and Elavil, aren't 'scheduled' at all, though in the USA they do require a prescription. The same goes for most anti-psychotic medicines used to treat schizophrenia, like Thorazine and Haldol. The same also goes for antibiotics, blood pressure pills, pills for cholesterol like Lipitor, birth control pills, and Viagra.

As a doctor who worries about civil liberties, I'm happy somebody keeps track of the Schedule II prescriptions, ambivalent about any tracking program for Schedules III, IV, and V, and opposed to Big Brother poking his nose into the non scheduled stuff.

My reply:

Let me ask you this question: let's say I come into your office (I'm a mentally competent adult -- at least in our hypothetical) and tell you that I want to take a Schedule II drug (or Schedule III or IV) for Medical Problem X (or even just for garden-variety insomnia, depression, or anxiety). You tell me that I shouldn't, that there is a high risk of addiction, that the problem doesn't warrant that treatment. I tell you that, after listening carefully to everything you have said, I disagree with you and I want to take it anyway.

Why should your judgment prevail over mine for what I take? Why, as a competent adult, should I need your permission before I can take the substance I decide is best for me?

I ask that, in part, with reference to the attorney-client relationship. Often times in that relationship, there is as much at stake as there is in a doctor-patient relationship -- the individual's life savings, or financial security, or liberty, or even (in the rarest of cases), their life.

Yet the decision about what to do always remains the client's. The lawyer can advise them, warn them, urge them in the strongest possible terms not to opt for Choice X because Choice X is stupid, self-destructive, risky, irrational, etc. But it is always an advisory role, never a parental role where the lawyer can override the client's choice for his own interests. In fact, whether to have or listen to a lawyer at all is completely optional. The client can always proceed purely on his own, even in the weightiest of matters.

Why should the doctor have the ability to override the decisions of the patient? Why should the doctor's permission be required before the patient undergoes the pharmaceutical treatment he chooses? That really makes no sense to me, and for that reason, I am vehemently opposed to these prescription laws.

Beyond all of that, there is even less reason for the Federal government to be monitoring what substances anyone takes. In addition to all the other reasons I listed in the post and commenters have added, I am also convinced -- reading around everywhere today on this topic -- that there are substantial numbers of people foregoing pharmaceutical treatments that they think they should have (and which even their physicians recommend) because they fear having that information registered in data bases with the government.

Adults have the right to do all sorts of things that other people, including experts in a particular field, think are stupid and self-destructive, even when the person's livelihood or even life are at stake. That is, more or less, a defining attribute of being an adult.

What is the difference between the attorney-client and doctor-patient relationship, where the former is purely advisory but the latter becomes parental? And other than consumption of medicine which can actually affect the public health (such as excessive consumption of antibiotics), why should an adult be deemed a criminal for using a particular medicine all because a doctor (for whatever reasons, including self-interest) will not give permission?

By Glenn Greenwald

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