Sun. Jan 19th, 2020

Drug Research Ignores Stable or Pleasurable Use—And That’s a Problem

By Aliza Cohen

In the United States and beyond, drug research ignores most people who use drugs. While the large majority of people who use drugs (PWUD) do not suffer from substance use disorders (anywhere from 80-90 percent), research in the field predominantly focuses on the minority experience of harmful use.

In part, this is an issue of the needs and urgency surrounding severe substance use disorders. At the same time, it is also an issue of funding.

The National Institute of Drug Abuse (NIDA), which funds around 80 percent of all drug research around the world, has the stated goal of funding research on “drug abuse and addiction.” The question of what drug research is “fundable” and/or “publishable” in this context incentivizes researchers to continue to do more research on the harms of drugs, often at the expense of other questions they could also explore.

Compounding the problem are the challenges of identifying a self-regulating population of PWUD. The considerable stigmas of drug use—worsened by racism, classism and sexism—create an environment in which people who use drugs are discouraged from being forthright.

Meanwhile, people who have been criminalized or medicalized for their drug use are more easily recognized as “problematic users” (whether true or not) because of their systems-involvement. This makes them more identifiable and available for researchers to study, skewing outcomes.

Why Does This Matter?

Too often, drug research proceeds from the assumption that self-regulated drug use is unlikely or extraordinarily rare. Yet people engage with drugs on a continuum of use, from abstention to addiction. The focus on harmful drug use not only vastly overemphasizes the extent to which people struggle with their use, but also muddies the waters by conflating any or occasional use with “misuse” or “abuse.”

We know relatively little about people’s motivations for drug use, and the body of research on the conditions that allow people to control their use is limited. More closely examining self-regulating drug use will help illuminate that PWUD have agency and should be able to determine if, when, and how they use—as well as the complex decision-making in which people engage.

The multifaceted motivations of functional drug use include much more than the desire to be intoxicated.

The Global Drug Survey’s Net Pleasure Index and other research reveal that people who manage their drug use make intentional, informed decisions about that use based on multiple factors. Research into these choices (motives, decision-points and influencing factors), and into the benefits of self-regulating drug use, will give us a much more nuanced understanding.

The multifaceted motivations of functional drug use include much more than the desire to be intoxicated (in the many forms one might experience that). Motivations range from desire to feel less anxious or more balanced, to other aspects of life management and performance enhancement, as well as psychological and spiritual self-exploration. We imagine that a myriad of other reasons for using substances would emerge from additional research in this area.

Investigations into self-regulating drug use could also shed light on the ways in which our current drug policies impact use choices: from which substances people choose to use and in what combinations, to modes, frequency and contexts of use.

There is a whole body of information to be gleaned about the complexity and subtleties of why and how people moderate their drug use, the strategies they employ to enhance pleasure or other desired effects while reducing harms, and cultures of use (e.g., how do friend/family groups introduce and use drugs together?). Such research also has the potential to help us better understand why some people are able to use substances in ways that enhance their lives, while others struggle to control their use.

Researchers want their work to be accurate and rooted in representative data. Currently, that’s not always the case.

As advocates and policymakers explore legalizing substances, including marijuana and psychedelics, research into self-regulating use can help us better understand how legal markets will impact use. It can lend insight into how to create regulatory systems that maximize the benefits for people who choose to use drugs while minimizing public health harms. Similarly, such research could inform discussions, like those happening in Canada, about creating a safe supply for opioid users to reduce the risk of overdose from illicit substances, such as fentanyl.

Researchers want their work to be accurate and rooted in representative data. Currently, that’s not always the case. An explicit recognition that most people can and do self-regulate their drug use may reorient drug research toward more balanced study of the full spectrum of use.

It could also help policymakers to think beyond the framework of prohibition to envision policies that, rather than criminalizing self-regulated drug use, allow and account for it.

The Good News?

Experts from across disciplines are recognizing these research gaps—about pleasure, normative drug use, self-regulation and cessation—and want to improve our research on motivations and contexts of drug use. Both outside of the US—and, more recently, within it—researchers are taking note that our current approach to drug use is reductionist and inaccurate.

Over the past two years, Drug Policy Alliance’s* Department of Research and Academic Engagement has convened some of these experts through a project called Unbounded Knowledge: Envisioning a New Future for Drug Policy Research. Researchers from over a dozen disciplines have come together to identify the constraints of the current drug research landscape and to develop an aspirational research agenda—one that will better equip policymakers to make informed decisions and ultimately transform drug policy.

This November, the Department of Research and Academic Engagement will host a pilot project: a one-day research incubator to address the lack of research on self-regulating and pleasurable drug use. This incubator expands on the Unbound Knowledge project, advancing rigorous research that reflects the dynamic, diverse realities of people who use drugs.

Researchers will convene to develop interdisciplinary, collaborative projects. The group will then work together to seek funding for these research projects. Scholars from all disciplines and at all stages of their careers are encouraged to submit proposals by September 13.

Understanding self-regulating use allows us to envision an end to the drug war that doesn’t require an end to drug use.

Researchers and funders have the opportunity to shift our focus to the potential benefits of drug use, to the skills and knowledge of people who use drugs non-problematically, and to the roles of self-regulation and pleasure in drug use. We can capture a better, more complete picture of people who use drugs.

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