Illicit Drugs Approved for Medical Use

There are several illicit drugs approved for medical use besides ketamine and gamma-hydroxybutyrate (GHB) that have taken detours through illicit use before and/or after (!) being approved (or re-approved) as pharmaceuticals.

Here are some notable examples:

Table of Contents

1. MDMA (3,4-Methylenedioxymethamphetamine)

Illicit Use: Known recreationally as ecstasy or Molly, MDMA became popular for its euphoric and empathogenic effects, particularly in rave and nightclub settings.
Pharmaceutical Development: Originally synthesized in 1912 by Merck, MDMA was later explored in the 1970s for potential therapeutic uses in psychotherapy.
Current Status: The FDA has granted Breakthrough Therapy designation for MDMA-assisted psychotherapy for treating Post-Traumatic Stress Disorder (PTSD). Phase 3 clinical trials have shown promising results, and FDA approval is anticipated in the near future.

2. Psilocybin

Illicit Use: The active compound in “magic mushrooms,” psilocybin has been used recreationally for its psychedelic effects.
Pharmaceutical Development: Psilocybin is being studied for its potential to treat depression, anxiety, obsessive-compulsive disorder, and addiction.
Current Status: The FDA has granted it Breakthrough Therapy designation for treatment-resistant depression. Clinical trials are ongoing, and some regions have decriminalized its use for therapeutic purposes.

3. Cannabis (Marijuana)

Illicit Use: Despite historical medicinal use, cannabis was widely prohibited in the 20th century, leading to extensive illicit recreational use.
Pharmaceutical Development: Research has revealed potential benefits in treating chronic pain, epilepsy, multiple sclerosis spasticity, and nausea from chemotherapy.
Current Status: Many countries and states have legalized medical cannabis. The FDA has approved cannabidiol (CBD) products like Epidiolex for certain types of epilepsy.

4. Cocaine

Illicit Use: Commonly abused as a powerful stimulant with high addiction potential.
Pharmaceutical Development: Before its illicit popularity, cocaine was used medically as a local anesthetic, particularly in ophthalmology and otolaryngology.
Current Status: It remains a Schedule II drug in the U.S., acknowledging its medical uses despite high abuse potential. It is occasionally used in medical settings for topical anesthesia.

5. Methamphetamine

Illicit Use: Widely abused for its stimulant and euphoric effects, leading to significant public health issues.
Pharmaceutical Development: Initially used in the early 20th century for various ailments, including narcolepsy and obesity.
Current Status: The FDA approves methamphetamine under the brand name Desoxyn for Attention Deficit Hyperactivity Disorder (ADHD) and obesity, though it’s rarely prescribed due to abuse risks.

6. Amphetamines

Illicit Use: Misused for their stimulating effects, particularly in the form of illicitly manufactured pills or powders.
Pharmaceutical Development: Used since the 1930s to treat ADHD, narcolepsy, and certain cases of depression.
Current Status: Medications like Adderall and Vyvanse are widely prescribed for ADHD but are controlled substances due to potential for abuse.

7. Ketamine

Illicit Use: Although you mentioned ketamine, it’s notable that its illicit use as “Special K” predated its re-emergence in medicine.
Pharmaceutical Development: Originally an anesthetic, it’s now approved in the form of esketamine (Spravato) for treatment-resistant depression.

8. Heroin (Diamorphine)

Illicit Use: Known for its high potential for addiction and abuse.
Pharmaceutical Development: Initially synthesized from morphine and used medically for pain relief.
Current Status: While banned in many countries, diamorphine is still used medically in the United Kingdom and other nations for severe pain and palliative care.

9. Phencyclidine (PCP) Analogs

Illicit Use: PCP itself became notorious as an illegal hallucinogenic drug.
Pharmaceutical Development: Originally developed as an anesthetic in the 1950s but discontinued due to severe side effects.
Current Status: While PCP is not used medically today, research into related compounds continues for potential therapeutic benefits.

10. Synthetic Cannabinoids

Illicit Use: Compounds like Spice or K2 have been abused recreationally, often with dangerous side effects.
Pharmaceutical Development: Synthetic cannabinoids like nabilone and dronabinol are FDA-approved for nausea and vomiting associated with chemotherapy.

Implications and Considerations

Regulatory Pathways: The journey from illicit use back to medical acceptance often involves rigorous clinical trials to establish safety and efficacy.
Public Perception: Stigma associated with prior illicit use can impact public and professional acceptance of these drugs in medical settings.
Safety and Control: Re-approved drugs are usually subject to strict prescribing guidelines and monitoring to minimize abuse potential.

Conclusion

The re-emergence of these drugs in the pharmaceutical realm highlights the evolving understanding of their potential benefits and risks. Ongoing research continues to explore how substances with complex histories can contribute to modern medicine, particularly in fields like mental health and pain management.