“People use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure. They are estranged from their families and their neighbours. It should tell us something that in healthy societies drug use is celebrative, convivial, and occasional, whereas among us it is lonely, shameful, and addictive. We need drugs, apparently, because we have lost each other.” ”• Wendell Berry.

This week one of the most respected people currently on this planet raised the bar and called for the legalisation of drugs in general.

I have listened to the commentary following his statement and noticed with glee how his views haven’t been meet with the usual barrage of insults. Indeed, reputation is everything and with it man can even walk barefooted on broken glass.

Amongst other things he argues that, “In my experience, good public policy is best shaped by the dispassionate analysis of what in practice has worked, or not. Policy based on common assumptions and popular sentiments can become a recipe for mistaken prescriptions and misguided interventions. Nowhere is this divorce between rhetoric and reality more evident than in the formulation of global drug policies, where too often emotions and ideology rather than evidence have prevailed.”

Truth is analysis of international drug policy gives an interesting disconnect.

Often many drugs that are banned on the street are legal for medicinal purposes. A look at morphine for example indicates that in the management of acute pain especially in terminal situations, there is no upper limit or permissible dose.

The emphasis of treatment is to obliterate the pain and make the patient comfortable. In such situations, one may find patients on doses much higher than anyone can afford to tolerate on the streets. Similar analogies can be made for diamorphine which goes by the street name heroin.

In Ghana, however, the emphasis of this debate has been as though Busumburu was referring only to the legalisation of Cannabis Sativa with its many street names (wee, ntampie, boolewah etc.).

Truth is even the scientific evidence for the medicinal use of extracts from this very emotive herb is growing. Currently Sativex® (a drug containing an extract from cannabis) has been launched in fifteen countries (including the UK, Spain, Italy and Germany) and approved in a further twelve. This drug is licenced for treatment of spasticity due to multiple sclerosis which is also in development in cancer pain. From my experience I have known patients that have sworn to the benefits of this drug especially when conventional opioids have failed to alleviate their pain and suffering.

Another product Nabilone is a man-made form of cannabis (also known as marijuana). Nabilone is used to treat severe nausea and vomiting caused by cancer chemotherapy. Nabilone is for use only when other medications have been unable to control nausea and vomiting. It is known that under certain circumstances this drug has been used in the management of nausea and vomiting brought on by the use of conventional narcotic pain killers like morphine. In Ghana the plant Erythroxylum mannii a cousin to the coca plant grows freely in many mountainous parts of the Eastern Region. Alkaloid decoctions of this plant are used locally as a pain-killer and in the management of pulmonary troubles amongst other diseases. This plant contains Ecgonine (a tropane alkaloid found naturally in coca leaves) and a precursor in the synthesis of cocaine.

From an academic point I have often argued that no drug is banned in its entirety. It is the street and unregulated forms of many that are not authorised. I have often said colloquially that many pharmacist (myself included) are licenced drug barons. Many of the drugs we happily dispense and recommend today in our everyday professional practice were subject to illegality not long ago. Many have been jailed and others put to death for handling same, yet today we make a living out of them and make no apologies. I have never had a problem with availability of drugs, I have a view that the more the merrier as long as they are well policed and regulated.

This is where I worry most about this call from a person to whom I cannot even light a candle. I worry because in Africa especially in countries like Ghana we have shown that regulation of medicines is a tad too far. For medicines regulation to be effective, the regulatory framework should be devoid of governmental interventions. It should be strictly based on the scientific evidence and legal framework. Sadly, this is not the case in our neck of the woods. It would interest readers to know that many pharmacists in Ghana may not be conversant with a controlled drug register. Neither would they be well clued on the process of procurement, storage and distribution of controlled drugs. This sad state is not an indictment on the profession of pharmacy locally but a result of a lack of transparency of the controlled drug laws and regulations in Ghana.

If those trained for years to be expects and custodians of most knowledge on medicines are in the dark how can one expect that legalising the cultivation of hemp for example on a large scale for the production of say designer jute bags or for the hair food industry would not lead to a massive expansion in the illicit supply chain? An argument can be made for the fact that legalisation in itself removes the secrecy and mystique that the use of these drugs carry and result in a decrease in its attraction to the citizenry especially the youth. Kofi Annan argues that, “Initial trends show us that where cannabis has been legalized, there has been no explosion in drug use or drug-related crime. The size of the black market has been reduced and thousands of young people have been spared criminal records.” This view is another I strongly support, in my view many are in jail in Ghana for drug offences that just don’t make sense and are the result of the ambiguity of our narcotic laws.

What we must understand is, “a regulated market is not a free market. We need to carefully think through what needs regulating, and what does not.” This is why I think though internationally the former United Nations Secretary General is on solid ground we should hasten slowly in our local discourse. My view is as a country we are not ready for total deregulation of all illicit drugs. For a start the illiteracy rate is too high to allow the public education required to ensure that the benefits of such an action would far outweigh the risks. The economic potential of such a move versus the public and mental health risks have not been clearly elucidated and do not seem to be priority at this point in time. The diseases for which many of these products are licensed e.g. multiple sclerosis are not common in our part of the world and the professional body of scientific evidence or data is not available.

I will conclude by arguing, this call is laudable and should not be disregarded in its entirety, however as a people we have more pressing issues than to go down a route many developing countries have taken years to grapple with. Perhaps we should use the energy, time and money to improve our mental health provision and ones that is done streamline our drug regulatory framework. When all that is done and literacy rate improved I would be in the same corner with Busumburu.

We must know that, “A drug is not bad. A drug is a chemical compound. The problem comes in when people who take drugs treat them like a license to behave like an asshole.”

This article was first publised by Kwame Sarpong Asiedu on his Facebook page on Sunday, February 28, 2016.