Q: Is it true that some illegal drugs have medicinal uses?

A: Medications work biochemically, interacting with certain body cells and organs. These interactions have benefits for certain patients, but of course may also have risks due to potential side effects or other harms. The specific type and dosage of a medication is determined on a patient by patient basis to maximize the desired benefit while minimizing the possible negative effects.

Controlled substances (illegal drugs) also have biochemical interactions, and depending on the details of these interactions there is potential for medicinal use. Clinical trials must be done to identify the specific patients, conditions and diseases for which these drugs may be helpful, and also to determine their potential side effects, toxicities, and the optimal dosage.

Some controlled substances are already utilized for their medicinal benefits. These include:

Narcotic medications; used to help control pain, and sometimes to treat severe diarrhea or cough
Marijuana; used for glaucoma, appetite enhancement (for cancer, and other, patients), pain, nausea and other symptoms
Cocaine; used for its analgesic effects (lidocaine, commonly used to “numb” patients for procedures, is a chemical compound related to cocaine) as well as for its vasoconstrictive properties (it causes blood vessels to constrict, so may aid in bleeding control in certain situations).

Over the years other controlled substances have been studied. In these studies the specific drug is used, and the dosage is closely monitored. Even with these precautions, potential toxicity, as well as the possibility of addiction and misuse, must be considered.

Street drug abuse is NOT the same as using the controlled substance as a medication. Street drugs are often “cut” (contaminated) with other substances, and there is no quality control or consistency of dosage. These are just some of the reasons that street drugs can be dangerous. Several years ago I took care of a patient who tried one dose of ecstasy (which contains the chemical MDMA, a methamphetamine) at a rave, her first time taking this drug. Unfortunately, she developed intractable seizures, and despite aggressive medical care, including three days in the intensive care init, this previously healthy 19-year-old girl died; from one pill she took at a rave.

It is estimated that up to 7 percent of Americans experience PTSD at some point in their lives (it is more common in women, too often triggered by sexual abuse, physical abuse or other traumas, and is also more common in returning veterans who have bravely served our country). PTSD can be very difficult to treat. Present treatment involves talk therapy, medications, group counseling and other treatments. Despite this, it is estimated that over a third of patients do not have adequate improvement in their symptoms, and their PTSD continues to negatively impact their daily lives.

A couple of recent small studies administered MDMA to PTSD patients in carefully controlled doses, under the supervision of a trained clinician. It was found that after just three doses most of the patients had long lasting benefit (demonstrated by a significant improvement in symptoms that lasted a year or longer). Based on these trials the Food and Drug Administration (FDA) has approved a larger trial, to begin in 2017, which is expected to last four years. In addition to evaluating the benefit patients derive, this trial will closely monitor for side effects (such as sleep changes, appetite changes, concentration difficulties, and many others) and look for the potential for abuse or dependence.

Depression and/or anxiety are experienced by almost a third of cancer patients, in comparison to 5 to 10 percent of the general population. A small study of patients treated with a single dose of psilocybin (the active drug in "magic mushrooms") has demonstrated encouraging results in these patients, with over 80 percent showing significant symptomatic improvement (versus only 14 percent treated with placebo). Even more encouraging was that the benefits from this single treatment dose lasted for over 6 months in around three quarters of these patients.

The take home message is that there is potential for medicinal use of certain controlled substances. As with all medications, the risk/benefit profile must be carefully studied. Self-medication using street drugs is NOT the same thing as using these substances as medications, and may be very dangerous, so these drugs should only be used when they are approved as medications, and then only under the supervision of a trained clinician.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com