Just over a decade ago, the idea of medical marijuana seemed to most Americans a back door to marijuana legalization. Both weren’t much more than pipe dreams.
Today, cannabis is hailed for its therapeutic value by many sick and dying patients and their caregivers across the country—though not by the federal government, which still considers marijuana a dangerous, Schedule I drug with no known medicinal value.
Yet, cocaine and methamphetamine are both acknowledged as Schedule II drugs, just like OxyContin—that means they have recognized medicinal value in the eyes of the U.S. government.
So how are cocaine and meth used medicinally? And can you get medicinal cocaine from a pharmacy?
“Cocaine specifically is still used as a topical anesthetic,” says John Halpern. “It’s vasoconstrictive,” he says, which means when used in surgery, there is less bleeding at the point of incision. “Ophthalmologists might use it rather than lidocaine. Some plastic surgeons may use it, because many of them have office-based surgery suites, to do minor cosmetic procedures.”
“It’s not common,” to use cocaine, says Halpern. “But it’s available. People like to use what they’re familiar with. An older generation of physician, practicing since the 1970s,” he says, might still use it.
The Drug Enforcement Administration monitors the use of cocaine. (Yes, one could potentially dry down the cream or liquid it’s sold in to create the illicit drug form.) Since it’s normally used in surgeries, doctors order it and file with the DEA—so your local CVS probably isn’t going to have it in stock. “Diversion is one of the key ways prescription meds get out there for illegal use,” continues Halpern. “That’s how OxyContin got out.”
In other words, other Schedule II drugs can leak into the non-prescribed population. But we don’t see that with cocaine.
Cocaine comes from the coca plant, which grows in the Andes and is considered sacred. Coca has its own therapeutic value, too, says Pedro Enrique Huertas, MD, PhD, including use as an antibiotic and blood-glucose regulator, and to treat altitude sickness. It’s also “rich in trace minerals, flavonoids, B vitamins, and antioxidants” and has been used as folk medicine by indigenous peoples for thousands of years.
Cocaine in the late 19th and early 20th century America has a bit of a notorious history. John Pemberton created his Coca-Cola with the coca leaf as an alternative beverage to wine to appeal to the alcohol-free temperance movement. Freud gave it to his patients. And then there was the idea if you gave it to your black sharecroppers, they would work twice as hard with less food—that worked until the media started reporting the cocaine gave these black men superhuman powers and the ability to withstand multiple bullets. Cocaine products faded into the underworld with the Pure Foods and Drugs Act and the Harrison Narcotics Act, and by the time Prohibition was repealed, cocaine had made itself at home in the jazz and showpeople scenes of the 1930s. It’s been quite comfortable in the entertainment world ever since.
Today, though, “purified cocaine has limited medical use as a topical anesthetic and should remain Schedule II until such time as other potential medical uses are verified in controlled trials,” writes Huertas by email.
Coca leaf, on the other hand, was criminalized after the UN Single Convention on Narcotic Drugs of 1961 (PDF), says Huertas. “This report has been criticized for its racial overtones, lack of scientific rigor and arbitrariness. No study has ever demonstrated that use of coca leaf leads to addiction, drug abuse, or that the practice has deleterious consequences.”
Coca leaf is also found in Schedule II. Says Huertas: “Coca leaf should be decriminalized.”
“Medicinal” and “methamphetamine” are two words that don’t go together too often, and yet, it exists. It comes in a 5mg pill—a much lower dose than on the street, where meth can be 25-100mgs smoked, snorted, or injected. The low-dose pill is used for ADHD and weight loss, though today it is rarely prescribed.
Halpern prescribes the medi-meth for patients who get recurrent urinary-tract infections—a side effect from Adderall or Ritalin. “Meth is much more efficient at going to the brain. It’s an effective treatment with a lower amount. That’s been my clinical experience.”
In addition, “Sometimes I have patients with HIV and on HIV meds, and ADHD is a side effect [of their meds]. With the meth, there are less interactions with their other drugs, and less anorexia.”
“Side effects is what drives us to these medications,” Halpern continues, explaining some patients become too agitated on Adderall, or get headaches on Ritalin. “It’s used, not commonly, but that’s the whole point. Doctors may need to turn to a second-line or even third-line agent, depending on the patient.”
The system, says Halpern, strives for “checks and balances, to make sure we don’t deny a patient a medicine that is truly needed.” Hence, methamphetamine and cocaine are both available, and tightly controlled.
Researcher Carl Hart, an associate professor at Columbia University, just published the report Methamphetamine: Fact vs. Fiction and Lessons from the Crack Hysteria. His research has found that there are approximately 52 million users of amphetamine-type stimulants in the world, compared with 36 million opiate users, and 224 million marijuana users. While the meth market seems to be growing globally, fewer than 15 percent of people who try the drug will become addicted.
“Methamphetamine is approved to treat weight loss and ADHD,” says Hart. “It’s the same as Adderall, except it has a methyl group. Why does the public have this perception that meth and cocaine are negative? What happens in the society is you pair the illicit use with groups we are not fond of.”
“Meth is paired with poor whites and gay people,” he continues. “We don’t like those people, but we can’t say we don’t like those people, so we go after the drug.” Hart explains that when cocaine is associated with wealthy whites, that’s not as problematic as crack cocaine is with poor blacks.
“People make a lot of money because of these pairings,” Hart continues, pointing to the $26 billion a year price tag of the war on drugs. “Most [of that money] goes to law enforcement and prisons, and treatment, too, because they profit by the vilification of these users.”
Hart also notes that prescriptions for methamphetamine have gone down, and that doctors “have cut back on the prescriptions because of the hysteria. So they turn to Adderall.”
Adderall is an inferior drug, asserts Hart, because of its side effects. Yet Adderall, he says, is the medication of choice because of good marketing—not because it’s safer. “It’s all marketing,” says Hart. “The view of the drug is sociological. Not pharmacological.”
So what to do with the illicit cocaine and methamphetamine users? John Walters, former head of the Office of National Drug Control Policy under George W. Bush, wrote in 2012, “…drugs cannot be accepted in civilized society… Irresponsible talk of legalization weakens public resolve against use and addiction. It attacks the moral clarity that supports responsible behavior and the strength of key institutions. Talk of legalization today has a real cost to our families and families in other places. The best remedy would be some thoughtful reflection on the drug problem and what we say about it.”
Others say that treating addiction as a health issue is to tolerate drug abuse—and that zero tolerance with criminal sanctions is the only way to keep people off drugs.
Technically, cocaine and methamphetamine are already legalized, regulated drugs with accepted medical uses.
The myths surrounding drugs and their therapeutic value, “doesn’t do anything to enhance the public’s education about these drugs,” either, Hart says.
“There is a belief—a religious belief, because there is no science to support it—that stimulants are too dangerous for stimulant abusers,” says Hart. There is no pharmacological treatment for stimulant addicts, nothing like methadone or heroin maintenance for a person addicted to methamphetamine. As a result, “Many users go to jail.”
The scheduled system the U.S. has placing methamphetamine and cocaine into a class that is medically valued, while placing cannabis in a class with zero therapeutic value, also has people confused. “People think because a drug is legal, like alcohol, it must be safe,” says Hart.
Education, asserts Hart, is the solution. “The major point is [these drugs] can be used safely,” he says.