The motto of the Web site Erowid Experience Vaults is \"You Cannot Deny
the Experiences of Others.\" Erowid is the Web\'s best known site for
recording drug experiences. Thousands of contributors describe in
vivid detail their experiences with this or that pharmaceutical,
creating something like a Zagat Guide for the discriminating drug
user.

Erowid makes for an engaging read, if you\'ve ever wondered what taking
PCP is like (\"began to feel weird. � my head detached and wriggled
itself backward through some plants\"). There are some surprises, such
as the commonly noted observation that heroin is \"overrated.\" But
what\'s particularly interesting about the Experience Vaults is how
many of the drugs reviewed there aren\'t actually classic \"illegal
drugs,\" like heroin or cocaine, but rather pharmaceuticals, like
Clonazepam.

That\'s because over the last two decades, the pharmaceutical industry
has developed a full set of substitutes for just about every illegal
narcotic we have. Avoiding the highly charged politics of \"illegal\"
drugs, the pharmaceutical industry, doctors, and citizens have thus
quietly created the means for Americans to get at substitutes for
almost all the drugs banned in the 20th century. Through the magic of
tolerated use, it\'s actually the other drug legalization movement, and
it has been much more successful than the one you read about in the
papers.

Since 1970 and the beginning of Nixon\'s war on drugs, the Justice
Department has regulated drugs likely to be abused under the
Controlled Substances Act, which categorizes such drugs into five
\"Schedules.\" Those in Schedule I�the most tightly controlled�are
supposed to have a \"high potential for abuse,\" and \"no currently
accepted medical use in treatment.\" These drugs cannot be prescribed
by a doctor. Those in Schedules II through V can be prescribed, and
that is what makes all the difference.

Since the beginning of the war on drugs, the \"formal\" drug
decriminalization movement has focused on trying to change the status
of marijuana, often through state referendums. While in the late 1970s
and late 1990s advocates were quite hopeful, the extent of real legal
change they\'ve achieved must be described as relatively minor.
Certainly, several states have passed medical marijuana laws, which
provide doctors and patients with an immunity when the drug is used
for medical purposes. And some cities, like Seattle, do not arrest
people for possessing small amounts. But there\'s been no significant
change in federal drug laws, or in the political conversation
surrounding them, in decades. A leading presidential candidate from
either party endorsing a \"free weed\" movement seems unimaginable. And
beyond marijuana, the drug legalization movement barely even makes an
effort.

That\'s why drug legalization is happening in a wholly different way.
Over the last two decades, the FDA has become increasingly open to
drugs designed for the treatment of depression, pain, and
anxiety�drugs that are, by their nature, likely to mimic the banned
Schedule I narcotics. Part of this is the product of a well-documented
relaxation of FDA practice that began under Clinton and has increased
under Bush. But another part is the widespread public acceptance of
the idea that the effects drug users have always been seeking in their
illicit drugs�calmness, lack of pain, and bliss�are now \"treatments\"
as opposed to recreation. We have reached a point at which it\'s
commonly understood that when people snort cocaine because they\'re
depressed or want to function better at work, that\'s drug trafficking;
but taking antidepressants for similar purposes is practicing
medicine.

This other drug legalization movement is an example of what theorists
call legal avoision. As described by theorist Leon Katz, the idea is
to reach \"a forbidden outcome � as a by-product of a permitted act.\"
In a classic tax shelter, for instance, you do something perfectly
legal (like investing in a business guaranteed to lose money) in order
to reach a result that would otherwise be illegal (evading taxes). In
the drug context, asking Congress to legalize cocaine or repeal the
Controlled Substances Act of 1970 is a fool\'s errand. But it\'s far
easier to invent a new drug, X, with similar effects to cocaine, and
ask the FDA to approve it as a new antidepressant or anxiety
treatment. That\'s avoision in practice.

Are the new pharmaceuticals really substitutes for narcotics? The
question, of course, is what counts as a substitute, which can depend
not just on chemistry but on how the drug in question is being used.
But as a chemical matter the question seems simple: In general,
pharmaceuticals do the same things to the brain that the illegal drugs
do, though sometimes they do so more gently.

As many have pointed out, drugs like Ritalin and cocaine act in nearly
the exact same manner: Both are dopamine enhancers that block the
ability of neurons to reabsorb dopamine. As a 2001 paper in the
Journal of the American Medical Association concluded, Ritalin \"acts
much like cocaine.\" It may go further than that: Another drug with
similar effects is nicotine, leading Malcolm Gladwell to speculate in
The New Yorker that both Ritalin and cocaine use are our substitutes
for smoking cigarettes. \"Among adults,\" wrote Gladwell, \"Ritalin is a
drug that may fill the void left by nicotine.\" Anecdotally, when used
recreationally, users report that Ritalin makes users alert, focused,
and happy with themselves. Or as one satisfied user reports on Erowid,
\"this is the closest pharmaceutical *high* to street cocaine that I
have experienced.\" In the words of another, \"I felt very happy, and
very energetic, and I had this feeling like everything was right with
the world.\"

The Ritalin/cocaine intersection is but one example. Other substitutes
are opoid-based drugs available in somewhat legalized versions, with
names like Vicodin and OxyContin.* Clonazepam and valium may not be
exact substitutes for marijuana, but they all seem to attract users
seeking the same mellowing effects and loss of some forms of anxiety.
In short, the differences between pharmaceuticals and illegal drugs
may ultimately be much more social than chemical.

So, as the FDA has licensed chemical substitutes for what were once
thought to be dangerous drugs, does that mean roughly the same thing
as the legalization of cocaine, marijuana, and heroin? Not exactly.
Drugs prescribed are usually taken differently than recreational
drugs, of course, even if at some level the chemical hit is the same.
More broadly, the current program of drug legalization in the United
States is closely and explicitly tied to the strange economics of the
U.S. health-care industry. The consequence is that how people get
their dopamine or other brain chemicals is ever more explicitly, like
the rest of medicine, tied to questions of class.

Antidepressants and anxiety treatments aren\'t cheap: A fancy drug like
Wellbutrin can cost anywhere from $1,000 to $2,400 a year. These drugs
also require access to a sympathetic doctor who will issue a
prescription. That\'s why, generally speaking, the new legalization
program is for better-off Americans. As the National Center on
Addiction and Substance Abuse at Columbia University reports, rich
people tend to abuse prescription drugs, while poorer Americans tend
to self-medicate with old-fashioned illegal drugs or just get drunk.

The big picture reveals a nation that, let\'s face it, likes drugs:
Expert Joseph Califano estimates that the United States, representing
just 4 percent of the world\'s population, consumes nearly two-thirds
of the world\'s recreational drugs. In pursuit of that habit, the
country has, in slow motion, found ways for the better-off parts of
society to use drugs without getting near the scary drug laws it
promulgated in the 20th century. Our parents and grandparents banned
drugs, but the current generation is re-legalizing them. That\'s why
Rush Limbaugh, as a drug user, is in a sense a symbol of our times.
He, like many celebrities, is a recovering addict. But with Limbaugh
being somewhat outside of the 1960s drug culture, the medical
marijuana movement was not for him. Instead, Limbaugh, the addicted
culture warrior, has become the true poster child of the new drug
legalization program.

URL: www.slate.com/toolbar.aspx?action=print&id=2175730