Pharmacies: The drug dealers of the future?

If you wish to see the decriminalisation and regulation of the sale of illegal drugs, be careful what you wish for, as if you legalise cannabis you would also have to add heroin, fentanyl, cocaine and crystal meth to the list, advises Dr Des Corrigan

In a report on the workings of the Citizens Assembly on Drugs, The Irish Times quoted a representative of Youth Workers Against Prohibition as saying that the assembly should take the “really bold” step of recommending decriminalisation and regulation of the sale of currently illegal drugs through state outlets and pharmacies in order to take the trade out of the drug gangs.

The recommendation that pharmacies should supply legalised recreational drugs might provide another, perhaps not unwelcome, income stream for some pharmacists but is it really the profession’s role to sell intoxicating chemicals for so-called recreational purposes? As far as I am aware, no pharmacies sell cigarettes, alcohol or nitrous oxide (for non-medical use), so why should they be expected to sell over-the-counter cannabis products (smokable and edible) as well as heroin, fentanyl, cocaine, MDMA etc. Legalisers might argue that regulated supply need not necessarily involve OTC sales but individuals could be prescribed or otherwise licensed to purchase their highs of choice. The subsequent ethical dilemmas facing a prescriber/licensee or dispenser when an 18-year-old wants to try heroin or cocaine or whatever for the first time will be horrendous.

While most people could agree that eliminating Organised Crime Groups (OCGs) from the drug trade would be a good thing, doing so by having pharmacies or some nebulous state outlet replace them seems far-fetched and impracticable. For a start, society would need to legalise the sale not just of the cannabis drugs including natural, semi-synthetic and fully synthetic cannabinoids but, also, every other so-called recreational drug including heroin, fentanyl, cocaine and crystal meth.

You might think I exaggerate, but leaving any drug controlled under the Misuse of Drugs Acts would inevitably invite the OCGs to undertake the supply of that drug to compensate for the income lost from the sale of those substances that had been legalised. It is not just the Misuse of Drugs Acts that would need to be repealed, but there would also be implications for the functioning of the Poisons Act since drugs such as morphine, cocaine, and so on are scheduled poisons.

In addition, the retail price of legalised drugs – inclusive of those taxes that legalisers always promise as a bonanza for taxpayers during their well-funded legalisation campaigns – would have to be lower than those charged by the OCGs, otherwise those gangs will exploit any price differential. As evidence that this happens, I would invite you to look at the situation in a number of states in the USA that have legalised cannabis and where the black market continues to thrive despite the widespread availability of legal products through so-called marijuana dispensaries. The situation in California for licensed sellers is so bad that the governor, Gavin Newsom, recently proposed spending $20 million of taxpayers’ money to support the legal cannabis industry so that it could compete with the black market in selling cheaper cannabis. Would it really be acceptable for our government to provide a financial subvention to the legalised drug industry in this way when we do not support the alcohol or tobacco industries with taxpayers’ money but rather tax them to the hilt? Would those industries with their enormous lobbying power and skill stand idly by while the cannabis industry was not subjected to some form of excise duty and VAT not to mention corporation profit taxes?

An unintended consequence of the cannabis-focused legalisation policy in those US states has been the move by the Mexican drug cartels away from cannabis growing and smuggling to the illicit synthesis of the fentanyls that are driving the overdose crisis in North America. This crisis is now recognised as being in its fourth wave where stimulants such as cocaine and crystal meth adulterated with that Mexican fentanyl have taken over from fentanyls on their own as the leading cause of overdose deaths. So, unless all drugs are made legally and cheaply available, national and transnational OCGs will find a way to make a profit.

Another question that arises is that of who will approve of the placing on the market of these highly potent substances. Would it be the HPRA or a new body that presumably would have to duplicate (at some expense to the taxpayer) some or all of the expertise that the HPRA currently brings to the evaluation of pharmacologically active materials? Would the same criteria (safety, efficacy and quality) that we rightly demand of our medicinal products before authorising their placement on the market, also apply to recreational forms of say heroin and cocaine? Is it actually acceptable to apply less stringent evaluation criteria to recreational fentanyls or the newer nitazenes compared to those the HPRA or EMA would apply to medicinal products containing these substances? Expecting recreational drugs to meet standards of safety and quality (efficacy can presumably be taken as a given) along with a requirement for manufacturing under GMP conditions or similar, would inevitably add to the cost of producing such drugs compared to street forms especially since quality assurance is a totally foreign concept to OCGs at present.

I have long believed that damaging OCGs financially as CAB have done so spectacularly well is our best hope but newer ‘godfathers’ need to be identified and their ill-gotten gains tracked as early as possible in their drug-dealing careers. Replacing the Kinahans with some undefined state body or our overworked community pharmacies is just plain daft. By all means divert users away from the criminal justice system by nudging them into evidence-based treatment programmes as an alternative to a court appearance. One way of doing this would be to extend the existing Juvenile Diversion scheme to include those up to and including age 25 because the research shows that it is those in that age group and those that are younger that are most likely to experiment with illicit drugs. It is worth remembering that experimentation is an essential precursor to the development of a substance use disorder/dependence no matter what other psycho-social or environmental factors might subsequently predispose an individual to a lifetime of dependence on one or more drugs. To those libertarians who reject the so-called ‘nanny state’, believing that it has no right to control what chemical intoxicants a citizen puts into their own body, I say that the ultimate logic of that position is that the state then has no obligation to intervene when such an individual is harmed by providing access to state-funded treatment. Such indifference would be abhorrent to me and to most other people but it is the logical consequence of ill-judged attempts to respond to problem drug-taking by making drugs more easily and cheaply available. Yet expanding access to these highs will be the inevitable consequence of what seems likely to happen to our drug laws.