Is it weird or what, that a huge proportion of our law enforcement resources are dedicated to keeping one group of people from taking one set of drugs, and an equally huge proportion of our mental health resources are dedicated to making another set of people take another batch of drugs? Sounds to me like a failure in marketing. And that’s not even taking into account what the pharmaceutical establishment spends on direct advertising, to get yet another group of people to take yet another batch of drugs.
Psychoactive drugs have a lot of problems. For one thing, some of them are dangerous if not carefully monitored. Most of them can be dangerous in combination with other psychoactive drugs, or other kinds of medication, or even some common kinds of food or drink. There is no drug that works for everybody with a particular diagnosis, and there are some people for whom no psychoactive drug works. But what makes it worse is that, even when a drug “works,” that does not necessarily entail making the patient feel any better. Normally, we 21st-century Americans expect a drug to be something you take when you’re feeling bad, and then it makes you feel better. But for people with mental illness, especially the manic phase of bipolar, a drug may well be something you take when you’re feeling absolutely terrific, and then it makes you feel awful, or at best, blah. This makes medication compliance problematic.
Cocaine dealers have no such problem. They have no marketing budget. They advertise only by word of mouth. They don’t have to wine and dine physicians to get them to prescribe their product (though, if we are to believe Sudhir Venkatesh in Drug Lord for a Day, they do have to cultivate a structure of lower-level dealers.) They dispense their product to people who are feeling blah, or even worse, and the purchaser ends up feeling terrific for a while, and then really awful until the next dose. Which pretty much guarantees that there will be a next dose. Psychiatrists should be so lucky.
Cocaine dealers, of course, might have trouble getting their product past FDA (unless it has been around so long as to be Generally Regarded As Safe, which maybe it has.) Quality control in manufacturing is spotty at best, and the distribution chain may degrade the product even further. But nobody has to stand over the cokehead to make sure the dose is properly ingested, or remind him/her to be sure to come back for the next one.
At any rate, what the manufacturers of psychoactive drugs obviously need is a pinch of cocaine or a spoonful of sugar or something to make those who take their products feel good, or better still, terrific, at least for the first few hours after taking it. (Yes, I do remember the intoxicant invented by sci-fi writer Robert Heinlein, which made you feel absolutely awful after drinking it in the evening, and the next morning you would wake up feeling utterly blissful. It was called, if I remember correctly, “Scrotch.” Much though I respect a lot of Heinlein’s imagined futuristic products, most notably the water bed, I think Scrotch is a behavioral loser. Most people, especially those in search of a good high, just aren’t that good at deferring gratification.)
Maybe we just need to condition patients to associate taking their meds with something else really pleasant, like good food, or sex, or music. Something, at any rate, more fun than having a social worker stand over you to make sure you’re really swallowing. Or maybe we need to play tricks on patients to make them see the medication as a reward (the way we condition small children to want candy by giving it to them when they follow the rules.) “Eat all your spinach or you can’t have your meds tonight,” “Last one in the water doesn’t get meds,” or whatever.
Or maybe we should just sack all the psychiatrists and psychiatric nurses and social workers and replace them with drug dealers who know their job, and who, furthermore, don’t get paid unless the patients actually take the meds. This solves two problems at once, providing lawful and socially useful employment for drug dealers, and keeping psychiatric patients properly medicated. We could put all the disemployed shrinks and their flunkies to work in the newly expanded ObamaCare system caring for all the people who have finally gotten access to health care, thereby solving yet a third problem. Tune in next week for the latest proposal to combine high-grade cocaine with a contraceptive. You heard it here first.