Intended for healthcare professionals


What should be done about mephedrone?

BMJ 2010; 340 doi: (Published 24 March 2010) Cite this as: BMJ 2010;340:c1605

Re: What should be done about mephedrone?

Since any question about the problem with mephedrone is also a question about the problem with illegal, recreational substances in general, I will answer in the broader sense.

There is a need above all else for the reduction of harm, and the most obvious course is regulation and legalisation of sale rather than criminalisation of it.

Mephedrone (and similar compounds of recreational potential) should be first subject to intensive study, clinical trial and finally, provided their safety profile matches an agreed-upon level, released to the adult population for purchase in small amounts at specialist retailers.

Customers at these retailers could be potentially required to provide full identification, and register as a "member", in order that their purchasing habits are recorded and therefore kept within reasonable levels. If this is decided to be, or becomes, unfeasible, then complete deregulation of sale in the fashion of alcohol and tobacco are perhaps advisable. Since regulation in the former draconian manner may only serve to fuel illicit supply, it is perfectly likely that the latter option may be the most reductive in public harm.

Finally, treat dependency as a clinical problem, rather than a criminal one.

I have made no arguments, but rather outlined a strategy which might bring about the desired goal: the reduction of harm within the inevitable segment of the population who choose to imbibe chemicals for recreational purposes. I have done this because I believe the consequences of these actions are relatively assured, and require little argument. There is scant doubt, to my mind, that legalisation of sale would both reduce harm directly, through assurances of purity, and indirectly, through lessening of crime which ought to arise once this artery of revenue to the criminal world is let.

Of course, this answer is in the broadest sense, and cuts a swath across many disciplines; medical, judicial and political. However, there is much within the power of the medical profession which could, if it unanimously desired it, if its myriad voices were raised in chorus on a particular issue, help to set a particular course for the policy of the nation in general. Testament to this: the ban on tobacco advertising, on indoor smoking, and the requirement for discouraging messages to be emblazoned upon tobacco products. All of which are to the distaste of the general public, as drugs are a distaste to them. But if the voice of medicine, to which this country is prepared to listen, were to insist on a new law, for the sake of "do no harm", it could not but be taken up and passed.

I believe it is the duty of the medical establishment to influence policy in this way, if the end result would be less harm to people. I would call upon them now not to hold their tongues meekly, as perhaps many have, and go about the business of healing on an individual basis, but to use their staggering collective influence to make a broader advance toward the goal of health.

Competing interests: No competing interests

07 January 2012
David Redman