Abuse liability and the regulatory control of therapeutic drugs: untested assumptions

Abstract

The drug abuse crisis now apparent in the U.S. has raised questions about some of our oldest and most fundamental assumptions regarding the effects of our systems for controlling the availability of drugs of abuse. Indeed, we have been compelled to reconsider whether we might not be better off with out our venerable legal sanctions against these substances, especially when the clearest effects of these laws has been to make illegal commerce in these drugs so competitive as to imperil the safety of our streets and neighborhoods and so lucrative as to corrupt and destabilize the governments of whole nations. In the case of drugs with abuse liability that also have significant medical value, the issues of regulatory control, though less dramatic, may be even more difficult: Here the aim of societal controls is not only to restrict the availability of these substances for abuse, but to do so without restricting their appropriate medical use. However, we generally assume that the regulations by which we choose to safeguard society will have the intended effects; and we assume no less of the regulations we apply to therapeutic drugs. This assumption has by and large gone unexamined and untested. In fact, considering the history of these