Smart drugs harm minimisation doesn’t condone abuse

hand with pills

Pharmacists can’t stop people misusing so-called “smart drugs” but we have an obligation to minimise their risk of harm, writes Sabrine Elkhodr

A few weeks ago, a friend of mine from the startup world called me to discuss a health problem she was having trouble with.

“Hey… so I’ve been using modafinil to help me work longer but I haven’t been able to sleep properly for weeks…”

As a pharmacist, my gut reaction was to instruct her that taking this medication without her doctor’s knowledge was not only illegal, but potentially harmful too.

However, as an entrepreneur, I intrinsically understood the pressure she was under to perform and compete in the fiercely competitive startup world and knew that she would continue taking it, regardless of my advice.

This created a rather perplexing dilemma: do we advise patients who are abusing medications to stop and end the conversation there, or do we also provide appropriate advice to reduce the risk of harm, knowing they’re unlikely to heed the warning to stop (eg. take neurostimulants in the morning to reduce the risk of insomnia)?

Drug misuse in the startup world is rampant but we don’t like to talk about it. It’s Silicon Valley’s worst-kept secret: smart drugs are a dime a dozen in startup circles.

With so much drug misuse occurring among entrepreneurs (undoubtedly without the knowledge or authorisation of their doctors) the question has to be asked: where are they getting these drugs and who do they go to for professional advice when they need help?

A cursory Google search for “buy smart drugs online” answers the first question very quickly and raises concerns about what they’re actually receiving when they order these medications online. The answer to the second question is just as concerning: they have no-one to turn to but each other (and Google, which is arguably worse).

Whilst policy-makers like to wax lyrical about the benefits of taking a zero-tolerance approach to drug abuse, the reality is that it can cause more harm than good.

The Transtheoretical Model posits that behaviour change is a function of six clearly defined stages that every person must go through before they can maintain a behaviour change. This is particularly pertinent in the context of medication abuse, where the perceived benefits of drug use to the user appear to outweigh the risks.

We’ve been great at implementing strategies such as methadone programs and rehab clinics to take people in the contemplation stage through the remaining stages but what about those who have no desire to change?

How do we implement harm minimisation strategies for those who will find a way to abuse drugs regardless of the barriers we put in place to try and stop them?

When President of the Australian Drug Law Reform Foundation, Alex Wodak (also the pioneer of Australia’s first heroin injecting centres), vowed to conduct pill testing at music festivals earlier this year he was met with stark opposition by the NSW Government.

Their argument against pill testing is based on the notion that drugs are “illegal and inherently dangerous”.

In a written response to the NSW Government by Professor Alison Ritter from the National Drug and Alcohol Research Centre, she argues that creating a safe environment for recreational drug users to discuss their intentions creates dialogue and an opportunity to provide relevant information about the drug in question thus reducing risk of harm.

With the Turnbull Government’s #ideasboom spurring new growth in the startup sector, the prolific and undocumented use of “smart drugs” in Australia is likely to increase.

As easily accessible drug experts, pharmacists are naturally the best people to engage in harm minimisation by offering a safe environment to create dialogue with entrepreneurs who do use these smart drugs and be able to advise about the risks of using these drugs and the risks of procuring them from unvetted sources.

As pharmacists, we’re no strangers to harm minimisation strategies addressing drug abuse.

We already operate needle and syringe programs for drug users to reduce the spread of bloodborne diseases through needle sharing. Providing clean syringes to reduce the risk of harm does not mean we condone the fact that they’re injecting illicit drugs.

Likewise, providing professional advice with the express intention of reducing harm from nootropic misuse is not the same as condoning this behaviour.

There will always be people who abuse medications regardless of what we tell them and as health professionals, we have an ethical obligation to minimise their risk of harm by exploring ways to provide appropriate advice whilst simultaneously educating them about the dangers of medication misuse.


Sabrine Elkhodr is a community pharmacist and Director of HealthClick, a digital pharmacy and innovation consultancy based in Sydney. She founded PharmHack, the world’s first pharmacy hackathon, and works with community pharmacies to develop effective innovation strategies.

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