Neurocops: the politics of prohibition and the future of enforcing social policy from inside the body.

• Author: Boire, Richard Glen

1. INTRODUCTION II. FROM DEMAND REDUCTION TO DESIRE REDUCTION III. PHARMACOTHERAPY DRUGS A. Target: Opiates B. Target: Cocaine C. Target: Marijuana D. Targeting legal Drugs 1. Target: Nicotine 2. Target: Alcohol E. Pharmacotherapy Drugs: Good, Bad, Both, or Beyond? F. From Drug War to Drug Epidemic IV. NEUROCOPS: LEGAL ISSUES RAISED BY COMPULSORY PHARMACOTHERAPY A. Privacy and Liberty Interests Implicated by Involuntary Pharamacotherapy B. Informed Consent C. At Risk Targets for Coercive Pharmacotherapy 1. Pharmacotherapy and Public Education 2. Pharmacotherapy and Public Assistance a. Reimbursing Voluntary Pharmacotherapy b. Financial Incentive to Undergo Pharmacotherapy c. Conditioning Public Benefits on Pharmacotherapy 3. Pharmacotherapy and the Criminal Justice System a. Informed Consent i. Prisoners ii. Parolees and Probationers b. Cruel and Unusual Punishment V. CONCLUSION I. INTRODUCTION

   With funding and other encouragement provided by the United States Federal Government, pharmaceutical companies are developing a new breed of drugs specifically intended to diminish or entirely block the effects of illegal drugs. The aim of these new "pharmacotherapy" drugs is to inhibit at the biochemical level the very ability of a person to experience the psychotropic effects of certain illegal drugs. Section II examines various factors that raise a reasonable concern that these pharmaceuticals will migrate from voluntary use to compulsory use within certain population segments. Section IN of this article begins with an overview of these new drugs: how they work, who is designing and marketing them, and how they may benefit those seeking a chemical aid in limiting problem drug use. Section IV identifies and discusses a number of constitutional and other legal issues that will arise should use of these drugs be mandated for some people.

2. FROM DEMAND REDUCTION TO DESIRE REDUCTION

   The United States is currently leading the world in an all out "war on drugs." The modern version of this war was declared on June 17, 1971, when former United States President Richard Nixon called on Congress to approve the Special Action Office of Drug Abuse Prevention that would consolidate Federal resources against "America' s public enemy number one." Nixon declared that, "[I]n order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive." (2) The ambitious goal of the drug war is to eradicate all use of illegal drugs, giving rise to "Drug-Free Workplaces," (3) "Drug-Free Borders," (4) "Drug-Free Families," (5) "Drug-Free Communities," (6) and ultimately a "Drug-Free America." (7)

   On June 17, 1971, President Nixon requested a $155,655,000 budget to wage the war on drugs for the 1972 fiscal year. (8) Thirty-three years later, the federal budget requested for the war on drugs reached $12.6 billion dollars for the 2005 fiscal year. (9) Despite the federal government's dedication to its task and heavy-handed threats of imprisonment, fines, property forfeiture, loss of employment, and even removal of one's children, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 19.5 million Americans (age twelve or older) defy the law each month by using an illegal drug. (10)

   Even with widespread violation of the drug prohibition laws and amidst rising national and international recognition of the folly of fighting a "war" on drugs, the United States Drug Enforcement Administration (DEA) has vowed not to "punt on the third down." (11) Alongside efforts to reduce the supply and demand of illegal drugs, the federal government has begun pursuing a new tactic, one that expands the drug war battlefield from the Colombian coca farms and the Middle Eastern poppy fields to a new terrain directly inside the bodies and brains of drug users.

   In this new extension of the drug war termed "pharmacotherapy," the federal government is partnering with large and small pharmaceutical companies to develop a new breed of pharmaceutical drugs designed to padlock the brains of drug users so that even if a person ingests an illegal drug, the drug will be intercepted within the blood stream or otherwise blocked from entering the brain. The American Government's hope is that demand for illegal drugs can be reduced, in part, by chemically eliminating the very desire to use an illegal drug.

3. PHARMACOTHERAPY DRUGS

   The pharmacotherapy drugs that are the subject of this paper fall into one of three general classes: brain receptor blockers; molecule binders; or metabolism modifiers.

   The first class of drugs works by entering specific drug receptor sites on the surfaces of brain cells or neurons, thereby blocking illegal drug molecules from plugging into those receptor sites. Of these blockers, there are three basic types: agonists, partial agonists, and antagonists. Agonists are compounds that bind to receptors and produce significant physiological activity. (12) Partial agonists are compounds that bind to receptors, but cause a relatively small amount of activation. (13) Antagonists are compounds that enter receptor sites, but do not produce any physiological activity; they simply block the receptors. (14) All of these compounds work by occupying receptor sites on the surfaces of neurons, thereby preventing molecules of the illegal drug from docking and producing their psychotropic effects.

   In addition to receptor blocking compounds that act upon the neurotransmitter system, the second class of pharmacotherapy drugs works within the bloodstream, binding to an illegal drug molecule and thereby making it too large to pass through the blood-brain barrier. (15) Because the illegal molecule is then unable to make it into the brain, it is prevented from producing any psychotropic effects.

   The final class of pharmacotherapy drugs alters the metabolism of certain target drugs, thereby causing a build up of toxic metabolic products that make a person feel extremely ill. (16) The best known of these metabolism-modifiers is Antabuse® (disulfiram), a drug primarily used to discourage people from drinking alcohol.

   1. Target: Opiates

      Some pharmacotherapy drugs that block or reduce the effects of psychotropic drugs are already available. The best known is an agonist named methadone, which was initially developed as a long-acting analgesic. Methadone has been used for over thirty years as a government-sanctioned substitute for heroin and other illegal opiates. Methadone occupies the same opioid receptor site as heroin, but whereas heroin produces a significant feeling of euphoria, methadone, when used orally as prescribed, reportedly produces little euphoria. A methadone user who takes a typical street dose of heroin will feel practically no effect from the heroin because the methadone will have already entered the brain's opioid receptor sites thus blocking the heroin from entering. Additionally, by occupying opioid receptor sites, methadone substantially reduces the unpleasant effects associated with heroin withdrawal.

      Another drug currently used to treat heroin addiction is naltrexone. This drug was created by DuPont Merck Pharmaceutical Corporation and has been available for use since the 1980s. Unlike methadone, which produces mild pleasurable effects, naltrexone is an antagonist that blocks the brain's receptors for heroin and other opiates and does not produce any pleasurable effects. When initially marketed as a treatment for heroin and other opiate addiction, it was named Trexan®. In 1994, the United States Food and Drug Administration (FDA) also approved the use of naltrexone for alcohol addicts. Naltrexone is currently sold under the trade name "reVia," for the treatment of alcohol addiction. (17)

      DuPont has encountered several hurdles in marketing naitrexone to heroin and alcohol addicts. Presently, naltrexone is used by less than one percent of self-reported opiate addicts. (18) There are a number of reasons why naltrexone has not been a popular medicine. The brain's receptors cannot be labeled as "good" or "bad," or as "government approved" versus "unapproved." The opioid receptors play multiple roles, from pain reduction to euphoria production. Naltrexone fills the brain's opioid receptors indiscriminately, which means it cannot tell an illegal opiate (like heroin) from a legal opiate painkiller such as Vicodin® (hydrocodone). As a result, a person taking naltrexone is placed in the precarious position of not being amenable to conventional opiate-based painkillers. For this reason, people taking naltrexone are advised to carry a card with them at all times, advising emergency medical personnel that the most common medications used to treat serious pain will have little or no effect on them. (19) Second, naltrexone cannot be given until after a patient is fully detoxified from opiates. If an active opiate user takes naltrexone, it will precipitate sudden and violent withdrawal. (20)

      Another problem for the marketers of naltrexone was recently uncovered by researchers testing the drug on marijuana smokers. To the researchers' surprise, people who were given naltrexone and then smoked marijuana reported that they felt greater psychotropic effects from the marijuana than if they had simply smoked marijuana alone. (21) In other words, while naltrexone blocks the psychotropic effects of alcohol, heroin, and opium, it appears to increase the effects of marijuana.

      In October 2002, the United States Food and Drug Administration (FDA) approved two new medications for treating opiate addiction, both developed by Reckitt Bencldser Pharmaceuticals. The new drugs, Subutex® (buprenorphine hydrochlofide) and Suboxone® tablets (buprenorphine hydrochloride and naloxone hydrochloride), contain buprenorphine, a partial opioid agonist. (22) Like methadone, buprenorphine binds to the brain's opioid receptors, but produces significantly reduced pleasurable effects than heroin.

      Subutex and Suboxone are unique not so much for...