“A drug-free world — we can do it!” was the unconvincing soundbite of the 1998 UN General Assembly Special Session. With hindsight of the two decades since—which saw a continual increase in global drug production, distribution, and use—this could be seen as delusional self-reassurance in the face of a developing crisis. The UN, like most of us, is still navigating a world of drugs and drug users.

“This is pot — this isn’t drugs!” is a rather different attitude to drugs expressed in the zeitgeist HBO comedy High Maintenance. A swinger’s birthday party is unravelling around him, and just as the drama peaks, there is a knock at the door. Opening it, Mark is angrily confronted by a neighbour for trafficking drugs into the building, causing the moral corruption of his 18-year-old daughter. But his fear is met with a calm confusion. To Mark, cannabis is no more a drug than alcohol or caffeine, and certainly no cause for shame or apology. We may find this justification ridiculous, or agree with his response and laugh at the terrified father—either way, it is a brilliant joke at a time of shifting attitudes and language. Even if we do find Mark’s assertion arbitrary and indefensible, it forces us to confront our own, equally arbitrary, positions.

Strictly, a drug is defined as any compound that elicits a change in physiology. But outside specialised contexts, the word takes on particular meanings, assumptions, and stigmas. It is useful here to make a distinction between ‘drugs’, a precise category of substances including everything from aspirin to heroin, and ‘Drugs’, a monolithic, emotive term, with such common usages as “don’t do Drugs”, “Drugs and alcohol”, “the war on Drugs”. How we as a society decide which substances are and aren’t categorised as Drugs, and colloquially which drugs to call drugs, is a shifting, inconsistent process. Ultimately, this use of language says far more about the society than the substance, and observing how language use evolves through time can be a strong indicator of the changing tides of public opinion and policy. At the centre of this process is the dualism of recreation and medicine, itself stemming from the dualism of mind and body.

Recreation, originally meaning “the refreshment or curing of a sick person”, is an essential life ingredient for the healthy psychological functioning of all human beings. This is recognised socially, with many sports and hobbies being met with esteem, despite some posing non-trivial risks to the individual. However, recreational Drug use, the consumption of certain psychoactive substances outside of a doctor-sanctioned medical setting, stands alone as vicious and self-destructive—decidedly ‘decreational’. So terrifying a possibility is recreational Drug use, in many societies it must be prevented at any cost. All too frequently, that cost has included the burying of effective medical applications for the same substances. MDMA, LSD, cannabis, and heroin have all suffered this fate to different degrees, with effective medical treatments being denied to millions of patients as a result.

Interestingly, some medicines have escaped this pattern, despite being the same substances maligned for their recreational use, and in some cases are not even recognised as such. Walter White gave popular culture an education in methamphetamine throughout Breaking Bad, to such depths that many of its viewers could probably describe stages of its organic synthesis. But far fewer people recognise that the dangerous Drug ‘crystal meth’ is a prescribed medicine under the brand Desoxyn, for the treatment of ADHD, narcolepsy, and assisting weight loss. A child being treated for ADHD is not a Drug user, because while Desoxyn is obviously a drug, it is not categorised as such. It is a medicine, and is welcome in the 1998 UN’s Drug-free fantasy world.

Several substances are not seen as Drugs, despite having no medical applications. Undoubtedly, the 1998 UNGASS would have served intoxicating refreshments to delegates and guests, without striking dissonance with their Drug-free mission. Alcohol consumers are ‘drinkers’, enjoying a ‘drink’, while the consumers of many other substances are ‘users’, enjoying a ‘hit’ or ‘fix’. In modern colloquial English drug-related language is invariably negative and fear-provoking, with the exception of the quaint American term ‘drugstore’, while few consumables have such an exclusive reputation and market as wine. Caffeine is not identified as a chemical substance except in particular cases such as pregnancy, despite many users (coffee and tea drinkers) exhibiting a physical dependency. “I need a coffee” is, for many of us, a socially acceptable and inviting way to say “I’m in caffeine withdrawal”.

So what are the factors influencing these positions—whether the UN’s, swinger Mark’s, or our own—and can understanding these factors inform our approach to policy reform? While governments may try to convince us otherwise, there is often no relation between the relative harms (and benefits) of substances and their place in society. This certainly calls into question if accurate information alone will be the road to progress in reforming drug policy. Instead, what may be more successful is tackling the fear, stigma, and stories that come with such an inflammatory topic. Ecstasy is safer than horse riding, but simply saying so carries its own associated risks—backlash, misrepresentation, disbelief. Instead, a safer route may be to share the life-changing benefits patients suffering treatment-resistant PTSD have received from MDMA-assisted psychotherapy. Human stories have the potential to engage at a level far deeper than statistics, a level that kindles conversation and compassion.

Medical understanding could be the route back to societal acceptance and rehabilitation for practically all Drugs, as we can begin to see with cannabis. While other arguments for regulated legalisation and ending prohibition may convince those who are already convinced—the enormous human and economic cost of the war on Drugs, its complete inefficacy to reduce the availability, use, and harms of Drugs, the racist applications of incarceration—it may take human stories of suffering and healing to bring about widespread reform. In Argentina, a group of mothers whose children suffer a range of cannabis-treatable illnesses were instrumental for the recent legalisation of medical cannabis. Through human stories, addiction can be more accurately understood for what it so often is, the desperate self-medicating of emotional and psychological pain. As these stories challenge assumptions and break taboos, recreational use can be met with the same cautious appreciation that we afford activities posing similar risks to the individual.

And, given time, we may see that this terrifying monolith of Drugs is made not from chemicals and compounds, but from prejudice and people. People ignored through their treatable pain, stigmatised in their most desperate hour, dehumanised and excluded from society. A world without ‘Drugs’—a world that listens to people’s pain, evaluates risk responsibly, and places wellbeing over panic and fear—we can do it.

Lead image by Patrick Gruban / Flickr.

Joshua Harvey is a PhD student at the University of Oxford researching sensory perception.