Strange Trips: Science, Culture, and the Regulation of Drugs by Lucas Richert (review)

This is a book about strange medicine: the rebel drugs on the fringes whose overlapping histories are complicated by political ideologies, national interest, and contested science. This is also a book about the strange trips that drugs take: through the regulatory system, the medical network, and even across national borders. Placing recreational drugs, palliative drugs, and pharmaceutical drugs into conversation with each other, Richert examines how struggles over product innovation, consumer protection, and freedom of choice governed the perception of multiple drugs in the North American medical marketplace. In so doing, Strange Trips presents compelling object biographies of stigmatized "radical" drugs—heroin, the cancer treatment Laetrile, medical marijuana, and LSD—to rethink how their medical values hinged on shifting economic and political climates.

Strange Trips is not the typical story of how drugs were objects of the pharmaceutical industry and the FDA. Instead, Richert traces the strange trips drugs make during their lifetimes: the journeys from radical and illegal consumption to an acceptable part of medical practice, and from respectable manufacturers to dangerous counter-culture networks. As Richert argues, drugs have specific careers that circulate through consistent patterns shaped by medico-scientific, economic, and sociocultural influences (p.9). These career cycles follow periods of therapeutic optimism and criticism, such that twentieth- and twenty-first-century drugs "have been invested with degrees of legitimacy and illegitimacy, as well as legality and illegality" (p.3). Each chapter chronicles the career cycle of a drug, in three sections: (1) "End-of-Life Medicines," which centers on palliative care drugs; (2) "Hippy Medicine," on psychedelic and tranquilizer class drugs; and (3) "Demonized Pharmaceuticals," a broader examination of how approved drugs end up rejected due to political and medical regulations. Unpacking these case histories within their broader contexts—including Nixon's "War on Drugs," Regan's "Anti-Drug Abuse Act," the crack-cocaine rhetoric, the "Just Say No" campaigns—Richert outlines how drugs occupy interstitial spaces and how different economic strategies and health systems have reframed the role of the consumerpatient and the choices that are available to them.

First synthesized in 1874, heroin eventually was marketed as a cough suppressant before being classified as a narcotic in 1924 and banned by U.S. Congress. Its status in western culture as a "demon drug" or "junk" has overshadowed its emergence in the 1980s as a more humane treatment for terminally ill cancer patients (covered in Chapters One and Two). Disputes about the analgesic use of heroin and fears that medicalized heroin would hit the streets as junk "aroused such passion because it linked cancer, the most feared disease, with heroin, the most feared drug of the era" (p.39). Yet, since 1955, heroin was a staple in the doctor's toolkit, even as it occupied a position of illegitimacy in the medical marketplace, a mascot of anti-drug campaigns. The bifurcated politics of pain and end-of-life treatment debates, however, raised broader arguments of moral considerations and ethical formulations: "To what extent, legislators and physicians asked, should government limit access to heroin for the terminally ill? What was the proper balance between research, medical authority, and consumer protection for those patients who were suffering excoriating pain?" (p.22). In debating these questions against the backdrop of the American war on drugs and broader medical discussions about the rights of the dying, in 1984 Canada followed the British implementation of medical heroin—thereby representing, as Richert argues, a return of colonial medicine (p.33).

Historicizing how medical and policy experts addressed proper approaches to terminally ill cancer patients, in Chapter Three Richert places heroin in conversation with Laetrile, a popular cancer drug that emerged in the 1970s. The primary difference, however, was that heroin was used to mitigate pain, whereas Laetrile was promoted as a life-saving treatment. The popularity of the drug as an alternative cancer remedy—dubbed as "Laetrilomania"—connects to the long history of patent nostrums...