“Go Ask Alice”: The Case for Researching Schedule I Drugs, Kenneth V. ISERSON , 2019

“Go Ask Alice”: The Case for Researching Schedule I Drugs

Kenneth V. ISERSON

Cambridge Quarterly of Healthcare Ethics, 2019, 28, 168–177.
© Cambridge University Press 2018.

doi : 10.1017/S0963180118000518


Abstract :

The available treatments for disorders affecting large segments of the population are often costly, complex, and only marginally effective, and many have numerous side effects. These disorders include dementias, debilitating neurological disorders, the multiple types of drug addiction, and the spectrum of mental health disorders.

Preliminary studies have shown that a variety of psychedelic and similar U.S. Drug Enforcement Administration Schedule I drugs may offer better treatment options than those that currently exist and pose potentially the same or even less risk than do legal psychoactive (alcohol, caffeine, nicotine) and nonpsychoactive (aspirin, acetaminophen, ibuprofen) substances. The pharmaceutical industry and academia, however, have largely avoided this avenue of research.

Fairness to the affected populations demands that these drugs be adequately studied and, if they or their congeners are shown to be effective, made available with the proper caveats, instructions, and protections that other potentially abused medications (e.g., narcotics) receive. These substances may prove to relieve patients’ struggles with less effective treatments and decrease mortality from nontreatment of some conditions.

Keywords : bioethics; pharmaceutical research; Schedule 1 drugs; drug and narcotic control;
untreated/undertreated diseases


One pill makes you larger, and one pill makes you small
And the ones that mother gives you, don’t do anything at all
Go ask Alice, when she’s ten feet tall
(“White Rabbit,” sung by Jefferson Airplane, written by Grace Wing Slick)

Diseases without Good Treatments

As evidence continues to mount of an epidemic of opioid-related deaths in the United States, the entire world is plagued by addictions to multiple other drugs including ethanol, cocaine, amphetamines, and nicotine; the ever-present and increasing scourges of Alzheimer disease and other dementias; debilitating neurological disorders including Parkinson disease; and a multitude of mental health disorders.

Depression and anxiety, for example, are the world’s most common mental disorders. The World Health Organization estimates that, globally, the total number of people with depression exceeds 300 million. Depression is not only the single largest contributor to global disability (7.5% of all years lived with disability in 2015), but it is also the major contributor to the nearly 800,000 suicides worldwide annually.

It is most common in older adulthood (55 to 74 years), and women (7.5%) are more commonly affected than men (5.5%).1 In the United States, almost 7% of adults suffer from at least one major depressive episode each year, and more than 19% suffer from anxiety disorders. Almost 13% of 12- to 17-year-old adolescents have had at least one major depressive episode, and almost one-third have had
anxiety disorders in their lifetime. Severe impairment accompanied depressive episodes in about two-thirds of the individuals in both groups.2

Posttraumatic stress disorder (PTSD) affects about 3.6% of U.S. adults and 5% of 13- to 18-year-old adolescents annually.3 In the United States, 15.1 million adults ages 18 and older (6.2%) and more than 600,000 adolescents 12 to 17 years of age (2.5%) have alcohol abuse disorder. About 88,000 people per year die from alcoholrelated causes, and alcohol-impaired driving fatalities account for about 10,000 annual deaths (31% of all driving fatalities).4 Parkinson disease affects about 1 million Americans, and approximately 60,000 new patients receive the diagnosis annually.

More than 10 million people worldwide have the disease.5 Opioid addiction and overdoses have become epidemic in the United States. From July 2016 through September 2017, opioid overdoses increased 30% across 45 states, with a 70% increase in the Midwest and a 54% increase in large cities.6 Cigarette smoking is the single largest preventable cause of death and disease in the United States, killing more than 480,000 Americans each year. Nearly 29 million American adults smoke daily.7