Doctors face illegal substances
Doctors must relate to how the use of illegal substances has positive or negative effects on the patient and the fact that treatment opportunities in some contexts are restricted because the drugs are illegal. Doctors with patients in opioid maintenance treatment (OMT) programmes are affected by the issues involved in legalisation, since the prohibitionist policies force them to implement control measures that engender distrust, such as urine testing and strict regulation of dispensing.
At the same time, doctors often need to make decisions on the basis of guidelines that have been established with a view not only to what is medically acceptable, but also in light of societal concerns, such as prevention of ‘leakage’ of OMT drugs. They also face restrictions in their prescribing of some medications because they are encompassed by anti-drug laws. Against this background, some doctors suffer medical pangs of conscience, and those who circumvent the guidelines may be stripped of their prescribing rights.
In the city of Bergen, when arrested for use and possession of small amounts of illegal substances, mainly cannabis, young people under the age of 25 whom the Hordaland county police refer to as resourceful, are offered participation in the programme «Tidlig ute» (Early start) as an alternative to other penalties. The programme refers them for health assistance and follow-up, including urine-sample monitoring. Such referral for health assistance of resourceful young people who violate the anti-drug laws may possibly come into conflict with the right to prioritised health assistance laid down in the Patient Rights Act – because non-criminal young people who have a greater need for help than those caught for smoking cannabis are pushed backwards in the queue. This could, for example, include young people who are in the process of developing an alcohol problem.
Doctors should realise that the anti-drug policies themselves have an impact on treatment and thus may have negative health effects for the patients. Recent research shows that GPs and doctors in the specialist health services have a strong tendency not to enquire about somatic illness in patients with known addiction disorders (2). Somatic diseases therefore remain untreated. I believe that this may be a result of a traditional, stigmatising prohibitionist mindset with zero tolerance for illegal substances – the doctor’s attention is deflected from physical and mental ailments and directed towards the elimination of substance use (3).
Doctors also need to relate to patients who engage in self-medication with illegal substances. These substances have medical as well as adverse effects that may interact with medications prescribed by a doctor. The patient may have medically valid grounds for his or her use of them.