Dr Jonny Anomaly, of Duke University, Durham in North Carolina, USA, says that concerted collective action is needed to tackle the excessive and casual prescribing of antibiotics, which has led to a worrying rise in resistance to these medicines.

"Government action is both more appropriate and more likely to be effective in regulating antibiotics than it is in criminalising narcotics," he writes.

Dr Anomaly says the arguments put forward for continuing to plough resources into the war on illegal drugs, such as the need to curb the related violence and social harms, should, of course, be taken seriously.

But he contends that "most of the violence and crime associated with narcotics is caused by laws that prohibit drug use, rather than drug use itself." And the argument that stimulant drugs increase violent tendencies is not based on strong evidence, he says.

He accepts that a drug habit takes its toll on friends and family, but argues that this does not justify treating this behaviour as a crime.

And while supporters of tough action on illegal drugs fear that the absence of harsh penalties will simply make it easier to get hold of them, Dr Anomaly points to the evidence in Portugal -- the only country that has decriminalised recreational drug use.

This "suggests that consumption has not significantly increased for most drugs, and has actually declined for some…greater accessibility does not necessarily lead to more drug use by either adults or children," he writes.

At the very least antibiotic resistant infections have the power to harm others and make illness more costly to treat, and they can often kill, he warns.

"This feature gives antimicrobial drugs a fundamentally different moral status from recreational drugs, and it suggests that current policy priorities are based on moral confusion, scientific ignorance, or both," he suggests.

He puts forward several possible ways of tackling antibiotic resistance.

These include phasing out the use of these drugs in farming, along with factory farming; cash incentives for pharmaceutical companies to conserve existing drugs; banning over the counter sales of antibiotics in developing nations; and global surveillance of resistant bacteria, spearheaded by the world's wealthy nations.

In addition to this, a flat user fee should be levied on courses of antibiotics, the monies from which could be used to fund antibiotic research, he suggests.

"A user fee would not be a panacea. But it could be a crucial part of a multidimensional approach to the problem of resistance. User fees are especially attractive because of their fairness and simplicity," he says.

[Collective action and individual choice: rethinking how we regulate narcotics and antibiotics Online First doi: 10.1136/medethics-2012-101160]

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• Pharmacology
• Controlled Substances

• Bacteria
• Microbes and More

• Public Health
• World Development

• Narcotic
• Drug addiction
• Stimulant
• Dopamine hypothesis of schizophrenia
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• Forensic toxicology