Chapter 5 Psychoactive drugs and the medical management of drug‑addicted prisoners 5.1 Psychoactive drugs There has been no culture in history without psychoactive drugs. They have been used in three ways: for religious or mantic rites, as medicine and “recreationally”. In the old cultures, the knowledge and possession of psychoactive drugs were restricted to privileged persons – priests, shamans and physicians (often one and the same) – holding a powerful position in society. Access to and consumption of psychoactive drugs by non‑privileged people was regarded as subversion and was punished by those in power. This explains in part the history of the regulation of psychoactive drugs and the terms “licit/illicit” and “legal/illegal” applied to drugs. From the medical and sociological point of view, the use of any psychoactive substance entails risks to the individual’s health and to society. Consequently, there is a need for regulations in which risks are taken into account. Psychoactive drugs that are currently socially and legally accepted for recreational use, such as tobacco and alcohol, are also subject to regulation to a certain extent (on the roads, in the workplace, for juveniles). However, induced by the massive increase in production, trade, trafc and consumption of psychoactive drugs for recreational use in the 20th century, three UN conventions on psychoactive drugs1 laid down a strictly prohibitive approach (rather than a regulatory 1. UN Single Convention on Narcotic Drugs 1961; UN Convention on Psychotropic Substances 1971; UN Convention Against Illicit Trafc in Narcotic Drugs and Psychoactive Substances 1988. Page 69