Monday 20 April 2015

What is a drug?

Last Tuesday I gave a rather rambling lecture at LJMU about how although the big picture in substance misuse policy in terms of national and international developments is interesting and important, it’s also crucial to think about local decision-making.  (Of course, I’m bound to say this as I’m involved in that local decision-making, and I am of course terribly important…)

Rather than summarise the whole thing here, though, I wanted to reflect on points that arose in the discussion afterwards.  I was asked a very perceptive question about the nature of drug misuse and public perception, with particular reference to users of performance and image enhancing drugs (PIEDs) such as steroids.  The point is that such substances don’t fit neatly into standard understandings of drug misuse.

Of course, that isn’t news to harm reduction professionals, who’ve been grappling with this particular issue for decades (though maybe it’s got a new face with ‘smart’ drugs and things like injectable tanning enhancers).  And to some extent this is precisely the issue I’ve drawn attention to in my academic work, when I’ve tried to highlight that what we find problematic isn’t simply health harm, but intoxication, pleasure and disorder, combining in some kind of class and gender infused carnivalesque.

Writing that in that way makes it sound particularly pretentious, but the point is something more than the fact that society and users think and worry about PIEDs in a different way to substances where the attraction is ‘recreation’, ‘pleasure’ or ‘intoxication’.  I actually want to make a fundamental point: this difference actually undermines the very idea of what we mean by a drug.

What ties all these things together?  It’s not that they’re mind altering or intoxicating – tanning enhancers needn’t be.  And it’s not that everything that’s mind or body altering is a ‘drug’ according to this definition – nutmeg and various other unexpected substances are listed on Erowid.

So we often fall back on the terminology of ‘substance’ use/misuse/abuse.  But practically everything’s a substance – and this word makes me think back to my attempts to understand philosophy.

And this isn’t just a game of semantics.  These definitions and understandings, even if they’re only implicit, shape national and local policy.  There’s a drug treatment budget within local public health teams, but is this the right place for interventions to address PIED use?  Should separate facilities be provided for users of PIEDs?  These sorts of questions come down to our definitions of what a ‘drug’ is.

The facetious way out of this impasse is to say that (at least in this context, rather than a medical one) a drug is simply something that is disapproved of.  That is, ecstasy is a ‘drug’, but alcohol isn’t.  And people do often refer to the area I work in as being about ‘drugs and alcohol’, and now sometimes ‘alcohol, drugs and tobacco’.

And to be honest, perhaps this is the unspoken truth of drug policy: yes it’s an incoherent fudge, but would a coherent, solely evidence-based rational policy work any better?  It’s not just policymakers and the public who see PIEDs as different from other ‘drugs’ – it’s also the users themselves.

Not for the first time, I’m uncomfortably leaning towards a position the likes of Michael Oakeshott and Edmund Burke would be happy with, but I think I’d actually welcome a politician or policymaker – and perhaps especially an academic – who stepped forward and said, well it’s not perfect, and it’s not rational, but maybe this is makes as much sense as we can handle.