Prohibition, the Harrison Act, and Non-physician Prescribing

Restriction of prescribing of controlled substances to physicians as enacted in the Harrison Act may have not only corrupted many physicians, but actually caused harm by encouraging a black market in these drugs, possibly leading to more, rather than less, morbidity and mortality from overdoses, contamination and dirty needles, as well as filling prisons. I believe that the model used for alcohol and tobacco minimizes harm, and that similar harm reduction will result from changes in regulation of marijuana.

I do not see our lawmakers mustering the courage in the near future to make all drugs “over the counter,” but maybe we are moving in the right direction unawares. Although many physicians oppose allowing midlevels or physician extenders to encroach on our territory, it occurs to me that granting privileges to prescribe controlled substances to this growing group, and maybe even to pharmacists, might reduce the harm. Incentive for physicians to operate “pill mills” might fall with the increased competition, yet prescribers could still limit kids’ access to dangerous drugs. Responsibility for use and abuse, including overdose, would move in the direction of the user where it belongs. The black market would shrink, and use of unsafe, non-pharmaceutical drugs might paradoxically fall.

Many physicians, myself in particular, do not want the gatekeeper role for drugs. Let us support extending prescribing privileges to as many non-physician providers as possible. We can still advise our patients, but as always the user will decide what they put in their body.

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