Dubljević Veljko
Department of Philosophy and Religious Studies, North Carolina State University, Raleigh, NC, United States.
Science, Technology and Society Program, Interdisciplinary Studies Unit, North Carolina State University, Raleigh, NC, United States.
Front Pharmacol. 2018 Aug 20;9:898. doi: 10.3389/fphar.2018.00898. eCollection 2018.
Drug scheduling within the international system of drug control and national legislation has been recently criticized as having insufficient footing in scientific evidence. The legal harms related to non-medical uses of certain drugs (e.g., cannabis) have arguably exceeded their physiological and social harmfulness compared to legally available substances (e.g., tobacco), which prompted some states to explore alternative regulation policies, similar to the drug regime in the Netherlands. Other legally prescribed drugs (e.g., stimulants) created a surge of interest for "better than well" uses, while yet others (e.g., opioids) caused an epidemic of dramatic proportions in North America. The evidence-based multi-criteria drug harm scale (MCDHS) has been proposed as a way of grounding policy in the actual degree of harmfulness of drugs. Indeed, the scale has had great ramifications in several areas of policy, and it has been used extensively in distinct lines of interdisciplinary research. However, some aspects of MCDHS remain disputed. For example, the way the data has been generated has been criticized as suffering from "expert bias." This article reviews strengths and weaknesses of evidence provided with the use of MCDHS. Furthermore, the author argues that the shortcomings of MCDHS can be resolved by offering methodological improvements. These include (1) dissociating the harms of use from harms of abuse, (2) adding the perspectives of people who use drugs, pharmacists, and general medical practitioners along with the expert assessments, and (3) focusing on subsets of drugs to allow for comparison without mixing different social contexts of drug use. The paper concludes with outlines of substance subset-specific extensions of the MCDHS and related policy proposals in the four areas identified as generating the most controversy: non-medical use of opioids, "study aid" uses of stimulants, shifting trends in nicotine containing products, and regulation of medical and recreational uses of cannabis.
国际药物管制系统和国家立法中的药物分级最近遭到批评，认为其缺乏充分的科学依据。与某些药物（如大麻）的非医疗用途相关的法律危害，与合法可得物质（如烟草）相比，其生理和社会危害性可能更大，这促使一些国家探索类似荷兰毒品管理制度的替代监管政策。其他法定处方药（如兴奋剂）引发了对“追求更好状态”用途的热潮，而另一些药物（如阿片类药物）则在北美引发了大规模的流行。基于证据的多标准药物危害量表（MCDHS）被提议作为一种将政策建立在药物实际危害程度基础上的方法。事实上，该量表在几个政策领域产生了重大影响，并在不同的跨学科研究领域得到广泛应用。然而，MCDHS的某些方面仍存在争议。例如，数据生成方式被批评存在“专家偏见”。本文回顾了使用MCDHS所提供证据的优缺点。此外，作者认为MCDHS的缺点可以通过改进方法来解决。这些改进包括：（1）将使用危害与滥用危害区分开来；（2）除专家评估外，增加吸毒者、药剂师和普通医生的观点；（3）关注药物子集，以便在不混淆不同药物使用社会背景的情况下进行比较。本文最后概述了MCDHS针对特定物质子集的扩展内容以及在四个被认为争议最大的领域的相关政策建议：阿片类药物的非医疗用途、兴奋剂的“学习辅助”用途、含尼古丁产品的趋势变化以及大麻医疗和娱乐用途的监管。
