- Strange Trips: Science, Culture, and the Regulation of Drugs by Lucas Richert
In Strange Trips, Lucas Richert provides a fascinating, engagingly written, and broadly scoped introduction into the complex history of a number of drugs as well as several key themes in the history of modern drug regulation. Focusing on North America with briefer forays into the United Kingdom, the book examines the debates surrounding the medical legitimacy of a number of contested medicines—or entire drug categories—as it aims to "move beyond examining substances in silos" (p. 4). The focus is on charting how drugs have crossed the boundary between legitimate medicine and demonized narcotic—or dangerous quack remedy—over their lifecycles, in different ways, and in different countries.
Strange Trips is broken into three parts that examine different categories of drugs. Part 1, "End-of-Life Medicine," features two chapters that examine efforts in the 1980s to return heroin to medical legitimacy to ease the pain of dying cancer patients—successfully in Canada and unsuccessfully in the United States—highlighting the different contexts that influenced these outcomes: while similar debates around the comparative effectiveness of available pain killers and the threat of stoking drug abuse featured in both countries, Canada was heavily influenced by Britain's positive experience with medical heroin, while a more heated War on Drugs and a more racially charged drug landscape prevented the United States from altering its conservative stance. A third chapter explores the celebrity-endorsed alternative cancer treatment Laetrile, which the FDA rejected as ineffective and dangerous despite vigorous support in the 1970s from advocates disenchanted with mainstream medicine who championed freedom of choice.
Part 2—"Hippy Medicines"—begins with LSD's complex and incomplete journey, as it evolved from a potential medical marvel in the 1950s, through struggles to find mainstream support for unconventional therapies in the turbulent 1960s, to the slow but growing return of psychedelics to medical legitimacy in recent decades. Next, Richert closely charts the liberalization of cannabis policy in Canada since the start of the 2000s, first for medical use and recently for recreational. Legalized through the Federal Court of Appeal rather than Health Canada, medical cannabis retains an awkward outsider status, as access is controlled through physician prescription yet its use is opposed by the Canadian Medical Association based on a lack of acceptable scientific evidence for its safety and effectiveness. With full legalization on the horizon, Richert highlights the regulatory challenges of balancing concerns for public health and consumer freedom given the added influence of major commercial interests and tempting tax revenues.
Part 3 focuses on the controversies surrounding, and changing regulation of, approved pharmaceuticals. The first chapter examines the significant controversy over Americans accessing Canadian pharmaceuticals in the 2000s. Although the drugs were approved in the United States and manufactured by the same [End Page 635] multinational companies, politicians and industry representatives argued that the safety and effectiveness of foreign-sold drugs could not be ensured, while others supported consumers' rights to access cheaper medicines overseas. Next, the focus turns to weight loss fads and the scientific and regulatory debates over the safety and efficacy of the weight loss drug phenylpropanolamine (PPA) that led to its eventual removal from the market. Finally, in concluding, Richert discusses the parallel uses and regulation of ketamine as a valuable anesthetic, a controversial party drug, and, increasingly, as an experimental treatment for depression that can be legally provided off-label in the United States, attracting foreign patients.
Overall, the focus of Strange Trips is less on the regulatory frameworks that underlay the career paths of these contested drugs than on the debates, conflicts, and negotiations between key stakeholders—consumer advocates, physicians, medical authorities, industry representatives, politicians, and regulators—in each instance. The transnational focus not only provides comparison for the regulation of drugs in different contexts but also is used to highlight the limits of regulatory reach as consumers...