Antidepressant Vending Machines

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Antidepressant Vending Machines

some thoughts on pharmacology in the age of AI and drug prohibition

by Brian Ballard Quass, the Drug War Philosopher

August 1, 2026

Thanks for sharing those articles with me. Such papers are helping to fill in the many blanks in my knowledge about American pharmaceutical policy and history.

I find the current prescription system highly problematic, both for the reasons that you have highlighted and for some of my own that it seems that no one has ever highlighted. The striking thing to me about the system, given my backstory as a psychiatric patient, is that there is no distinction made between a doctor deciding on the propriety of use of a "physically" acting drug and a doctor deciding on the propriety of the use of a "psychologically" acting drug. The two situations, however, are entirely different. I could easily admit that a doctor would be more knowledgeable than I am about the former kind of medicine, about whether to take a certain pill to combat the growth of a tumor, for instance, but the doctor (or pharmacist) is completely unqualified to decide for me whether it is safe and wise for me to use a psychoactive substance for any non-medical purpose. He or she can certainly tell me the risks of such use in the abstract, but in order to tell me if the use were worth it in my case, they would have to be God him or herself, given the endless variables involved, including the idea of what constitutes what philosophers would call "the good life." The opium-loving Avicenna is quoted as saying that he desired a wide life, not a long one. The doctor can tell him that he is wrong to do so, but that is not a scientific verdict, that is just the expression of either a metaphysical preference or, which is far more likely, the doctor's fears about lawsuits and license revocation that might ensue from acting contrary to America's drug-hating mindset.

I feel we have to reexamine the assumption that scientists (including doctors and pharmacists) can, even in theory, objectively decide on the "genuine danger" of a psychoactive medicine when viewed in the abstract, without reference to any usage protocol or user. There is inherent subjectivity here. To see this, we have only to consider antidepressants. I would argue that antidepressants are far more dangerous than cocaine and even heroin, insofar as lifetime dependency for antidepressants is a feature of such "meds" and not a mere bug as is the case with most outlawed medicines. When our scientists say otherwise, they are not being scientific but prudent. They know that their job depends on adopting the prejudices of the majority when it comes to opining on such substances. Yet how am I supposed to honor their verdicts on drug safety when they simply "look the other way" when it comes to the fact that 1 in 4 American women have been turned into wards of the healthcare state thanks to drug prohibition ¹ -- the drug prohibition which has shunted those women off onto underperforming antidepressants that I have found harder to kick than heroin? This is why GK Chesterton said, in connection with liquor prohibition, that the state would have to become God in order to decide what is beneficial for an individual in any specific case -- they would have to know all of the endless factors that we choose to ignore when we send ourselves on the fool's errand of trying to decide if a psychoactive drug is good or bad in the abstract. ²

Let us suppose, however, that our scientists found a psychoactive drug that has to be used particularly wisely, especially by drug-naive Americans -- drugs like ayahuasca, for instance -- else there could indeed be physiological problems for the user, especially for a gringo whose body is not accustomed to the very different diets of the curanderos of the Andes. It might be argued that here, at least, is a case in which we should supply the drug by prescription only. And yet the appropriate use of that drug (or in this case that drug compound) could inspire the creation of entire new religious sects, even in America. With that possibility in mind, why would we give a doctor the ability to veto such an eventuality by insisting that the would-be user forebear? In fact, the use of ayahuasca has indeed inspired the creation of new religions in the last few decades, both in South America and now even in the States. The stateside church was fought tooth and nail by the DEA until a rare 9-0 ruling in the church's favor by the Supreme Court. But that has not stopped the DEA from imposing onerous bureaucratic and logistical controls on the use of the drug for religious purposes at the UDV, the União do Vegetal.³ The drug could indeed pose a risk to the unwary. But in saying this, we must remember that we are spending over $50 billion a year to arrest drug users and zero dollars to educate them. With this backstory in mind, should we really be blaming ayahuasca for being dangerous -- or should we not rather be blaming our society for making ayahuasca dangerous by taking the superstitious view that drugs are bad in and of themselves and that education about safe use is therefore superfluous and even immoral?

Finally, Botox is one of the most toxic substances on the planet, and yet it has recently been found to have benefits, at the proper dosage, for fighting migraines.⁴ If we had obsessed about the abstract danger of Botox on the grounds of its toxicity, then those beneficial uses might never have been discovered. This is the problem for those who seek to enlist fighters in the war against drug prohibition, by the way: most of the downsides of that policy are inherently invisible to us. We cannot miss the medical treatments that we never even knew were possible thanks to our drug-hating propensities. We cannot see the millions of chronic depressives who are suffering unnecessarily behind closed doors. But we cannot help but see the handful of young people who manage to spectacularly misuse a drug on a film clip on the Six O'Clock News. And so we draw the rash conclusion that the only stakeholders in the drugs debate are white American suburban mothers.

But I digress.

What I'm really saying here is that drug prohibition is the big problem with the current prescription system. It has deprived the pharmacists and doctors of all credibility when it comes to their role in safeguarding us against dangerous substances. And the problem here is enormous, though it is still off the radar of almost all Americans. We have always assumed as a country that we could have a sane medical system while yet imposing an unprecedented wholesale ban on psychoactive medicines. It turns out that the two are incompatible. And until we recognize this fact, the problems with the prescription system will continue to appear to be inexplicable to us: just as inexplicable as inner-city gun violence, school shootings, and our inability to give powerful relief to autism and dementia patients, all of which problems could be ameliorated by what we have been falsely told to believe is the oxymoronic expedient of beneficial drug use. We demand our world to be both healthy and drug free, and we cannot have both. We will eventually have to choose between our current policy of Christian Science Sharia and the kind of healthcare progress that one can only expect in a free world.

Finally, some thoughts about which drugs, if any, should be classified as "prescription-only" (noting here that the first step in making this determination is to remove self-interested parties from the committees that decide such things).

Now, I am not a doctor, and I do not even play one on TV. But I cannot think of many drugs that I believe should require a prescription. I have already stated some of my concerns about requiring prescriptions for psychoactive drugs based on the naive assumption that "doctor knows best" when it comes to that category; as for physically-acting drugs, I assume that most people would not think of buying them unless the doctor asked them to do so and therefore there should be no need for a prescription. Perhaps one could argue for the use of a prescription to purchase pills that fight cancer on a radiological basis, the justification being that cancer victims might use too many of those pills under the misguided belief that dosage increase can only improve results.

I end this section with a pertinent quotation from Thomas Szasz, which speaks to the folly of turning to doctors and pharmacists for 'scientific' (i.e., objective) judgments about psychoactive substances:

'Drug policy,' Judge [Pamela] Alexander concluded, 'should not be set according to anything less than scientific evidence.' Unfortunately, this is a very naive statement. There is no scientific basis for any of our 'drug policies' -- a term that, in this context, is a euphemism for prohibiting pharmaceutical and recreational drugs. Warning people about the risks a particular drug poses is the most that science can be made to justify. ⁵

Thomas Szasz -- Our Right to Drugs

There is another downside of the prescription system in the States that I have never heard mentioned, and that is the cavalier way in which prescription holders are treated, especially in the behavioral health field. I have learned from long experience that if I run out of dependence-causing meds on a weekend, no one is going to move one muscle to help me, notwithstanding the fact that the drug literature itself cautions against the sudden cessation of the drugs in question. I have had this situation arise at least a half-dozen times over the past 40 years. In one instance, I had driven 50 miles on a Saturday night only to find that a doctor had not followed through as promised on a refill. The answering service gave me the usual spiel about calling back at 9 a.m. on Monday morning. I finally told the lady that I was contemplating suicide. This was a complete lie, of course, but I realized that it was the only way that I could get them to actually bother the doctor who had cost me this fruitless two-hour round trip to the distant pharmacy in Harrisonburg, Virginia. (The head of the clinic called me back shortly and phoned in the refill after I brought him up to date on "the facts on the ground.") Nor has this problem just been mine alone. About 15 years ago, I was trying to get a weekend refill for my elderly mother on a med without which she was panicking. The staff spoke to me like they were sitting on a raft in a local swimming pool eating corn chips. Their very tone made it clear to me that this was not their problem, as far as they were concerned, not on a Saturday. They would be delighted to talk to me on Monday morning, but until then, they were sorry, but they had some swimming to do.

This is what happens when we give a monopoly to doctors on mind and mood medicine -- they know that they are the only game in town. So they do not bother to hire more staff, or to use the present staff, in a way that would meet the sudden urgent needs of their patients. There are no sudden urgent needs, as far as the staff are concerned when it comes to prescription refills. They only recognize needs that have been duly communicated to the office by phone at least 48 hours prior to the promised satisfaction of those needs. In other words, they have come to take their prescription-related monopoly as a right without responsibilities.

Finally, a few notes on points raised in specific papers:

RX Only as Definitional Capture

Although the sulfanilamide disaster did not lead directly to prescription requirements, it's interesting to note that a prescription requirement would not have prevented the 107 deaths associated with Elixir Sulfanilamide.

There seems to have been no major negative impact on health resulting from the failure to require a prescription for insulin, and yet that is the epitome of the type of drug for which one might suppose that a prescription should be necessary.

I find this paper begs a question that I hope will not sound rude to pharmacologists: namely, why couldn't a machine replace pharmacists just as an ATM has replaced tellers?

Note: I would tend to err on Szasz's side on the subject of drug dangers, not because of an abstract principle, but because drug prohibition implicitly controls how we can think and feel about the world around us -- and this is a fact that will become increasingly apparent to the extent that we study psychoactive drugs and new states of consciousness (things which indigenous people have investigated for ages). This gets into the very business of who I am as a person and who I am allowed to be. It is monstrous to think that the government or medical personnel get to decide this for me, who I am deep inside. This is why I call drug prohibition a meta injustice: it does not simply seek to control what I can think, as did the tyrants of yore, by burning books. It seeks to get into my very pores, as it were, and control how I can think about the world in which I live. It is, in fact, the ultimate government tyranny, worse in some ways than death itself.

Note 2: American drug policy is all about spending billions of dollars to make drug use as dangerous as possible, by failing to regulate product and by forcing buyers to consort with gangs and cartels. When we attribute that socially created danger to the drugs themselves, by blaming drugs as "hard" and as "dangerous," we are giving drug prohibition a Mulligan for the problems that it causes. We are helping to normalize drug prohibition, just as city leaders do when they fight against gun violence without ever mentioning the drug prohibition that brought guns to the city in the first place.

Pricing Their Own Work

It's interesting that the RUC is considering the value of autonomous AI -- and yet they do not seem to value the autonomy of "patients" -- given the fact that I cannot be trusted to take my "meds" without a tri-monthly visit to a doctor's office. Imagine if they were that skeptical about the abilities of AI.

I like the polycentric approach of adding various disciplines to the RUC, including "patients," laypeople (i.e., potential patients), philosophers, ethicists, etc.

One wonders how the RUC values the cost of a completely unnecessary office visit for a refill on a drug that someone's been taking for 40 years. No wonder they don't want civilians on the RUC. If I were on the committee, I would calculate the value of that drug refill office visit at 0 -- and that would only be because I would be too polite to suggest a negative number for it.

Note: One wonders why "meds" could not be dispensed by a kind of modified soda machine. After verifying my identity, the machine could ask me the usual questions about whether I have considered killing myself lately and so forth. After receiving the correct responses, the machine could prompt me to enter my debit card and pin, after which it would place the appropriate refill in the product slot in front of me and wish me a great day.

The Surveillance State Did Not Arrive with the Internet

The issues raised in this latter paper deserve a separate essay. However, there is relevant overlap in subject matter. This paper gives us a new reason to limit the use of prescriptions: namely, the fact that the recipient of a prescription is added to a database and thereby subject to prejudicial future treatment based on the whims of the powers that be.

Notes:

1: Richard Louis Miller. 2017. Psychedelic Medicine : The Healing Powers of LSD, MDMA, Psilocybin, and Ayahuasca. Rochester, Vermont: Park Street Press. (up)
2: Eugenics and Other Evils: An Argument against the Scientifically Organized State Chesterton, GK (up)
3: Paradoxes of ayahuasca expansion: The UDV–DEA agreement and the limits of freedom of religion Labate, Beatriz Caiuba, Taylor & Francis Online, 2011 (up)
4: Reddy, Sashank. 2024. “Botulinum Toxin Injectables for Migraines.” Www.hopkinsmedicine.org. 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/botulinum-toxin-injectables-for-migraines. (up)
5: Szasz, Thomas. 1992. Our Right to Drugs. Praeger. (up)

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We should hold the DEA criminally responsible for withholding spirit-lifting drugs from the depressed. Responsible for what, you ask? For suicides and lobotomies, for starters.

We drastically limit drug choices, we refuse to teach safe use, and then we discover there's a gene to explain why some people have trouble with drugs. Science loves to find simple solutions to complex problems.

We deal with "drug" risks differently than any other risk. Aspirin kills thousands every year. The death rate from free climbing is huge. But it's only with "drug use" that we demand zero deaths (a policy which ironically causes far more deaths than necessary).

This is why "rock stars" use drugs: not just for performance anxiety (which, BTW, is a completely UNDERSTANDABLE reason for drug use), but because they want to fully experience the music, even tho' they may be currently short on money and being hassled by creditors, etc.

Saying "Fentanyl kills" is philosophically equivalent to saying "Fire bad!" Both statements are attempts to make us fear dangerous substances rather than to learn how to use them as safely as possible for human benefit.

Most people think that drugs like cocaine, MDMA, LSD and amphetamines can only be used recreationally. WRONG ! This represents a very naive understanding of human psychology. We deny common sense in order to cater to the drug war orthodoxy that "drugs have no benefits."

It's disgusting that folks like Paul Stamets need a DEA license to work with mushrooms.

"The depression lifted from my mind like the sun coming out of the clouds." -- Arthur Crowley after using cocaine

I've always wondered why we don't just let heroin users be -- or better yet, re-legalize drugs and give them choices. Why are they punished for using heroin daily while we praise 1 in 4 women for taking an even more dependence-causing drug every day of their life?

It's funny to hear fans of sacred plants indignantly insisting that their meds are not "drugs." They're right in a way, but actually NO substances are "drugs." Calling substances "drugs" is like referring to striking workers as "scabs." It's biased terminology.

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Unless otherwise indicated, no AI is used in the creation of site content. These essays represent the original ideas of their author and not the ideas that the author SHOULD have based on an algorithmic parsing of existing data. For more on this subject, consider the AI-related viewpoints to which the author subscribes as delineated in the New York Times opinion piece entitled "What 370,000 College Essays Tell Us About A.I.’s Effects on Creativity" by Rebecca Winthrop of the Brookings Institution.

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Antidepressant Vending Machines

some thoughts on pharmacology in the age of AI and drug prohibition

Ten Tweets

against the hateful war on US

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