the blurry line between recreational and medical

18 Apr, 2025

This post uses pregabalin—a drug uncommonly prescribed for anxiety and even less commonly used recreationally—as an example. But it applies to more drugs than just that, specifically the way cannabis is used by many people.

As a background, I have been prescribed almost every psychiatric medication under the sun. Nearly all of them have at best done nothing and at worst given me horrible side effects without much of a positive effect at all. I only remain on lamotrigine, a drug prescribed to "reduce my mania from bipolar disorder not otherwise specified", whatever that means. I just feel more stable on it is all. That being said, I still have severe OCD and anxiety and it does nothing for that.

So after many rounds of different medication to try to treat those, I eventually ended up being prescribed pregabalin—a drug officially approved for treating neuropathic pain or as an anti-epileptic, but also prescribed off-label for anxiety.

So one evening I tried my first dose, and I loved it. It cut my anxiety down somewhat, or at least covered it up. More importantly it totally slashed my OCD symptoms down by ~80%. It was like magic.¹ But I also felt high. I felt a bit intoxicated, with reduced inhibitions, not entirely dissimilar to a beer or two. I was less stuck in my head, had a more positive outlook on life, and even had some mildly hallucinogenic effects—little bits of wavy vision here and there or vague cartoonish flashes of color when I closed my eyes.

But I was immediately certain that I would not be able to live my daily life like this. My analytical skills that are so integral to my software development job were trashed. But this made sense—the analytical skills used at my job also fuel my OCD. You can't reduce one while not reducing the other.

So this left me with a question. If I were to take pregabalin, not daily as prescribed, but instead occasionally in the evenings, would this really be drug abuse? It's giving me a much needed break from my OCD, but also getting me high. But it's not the type of nod-off-and-avoid-the-world high of opioids or anything like that. I'm still totally engaged in my life—if anything more engaged—playing my guitar, hanging out with my friends or girlfriend, or whatever it happens to be. Mood boost, energy, mild intoxication, positive outlook, some music enhancement, and even feeling more horny, how lovely.

So I began this usage pattern, and even though I generally found it energizing, I also found that, paradoxically, it helped me sleep better too. And I even noticed that the mood boost and relaxation would usually carry over into the mornings too, without major disruptions to my analytical skills or substantially reduced inhibitions. If that's not a medical effect than I don't know what is.

It's been a year or two now and I'm still taking it like this. It has drastically improved my life. I've developed a bit of a tolerance which mostly subsides when I don't take it for a week or two. During those breaks I do miss it a little bit but I don't have any cravings or withdrawal symptoms or anything like that.

But the funny thing is that I don't care about this distinction. At all. I am pro-responsible drug use, recreational or not. But I do think where exactly this distinction lies for any drug that affects the mind—if the distinction exists at all—is greatly lacking in common discourse. I've used pregabalin as my personal example, but the obvious implication here is the usage of cannabis as the US continues to slowly move towards legalization. It seems quite important to our lawmakers and oftentimes our society at large that this distinction is made clearly, as many view medical use as acceptable but recreational use as not.

I personally don't like cannabis. But I know there are many people out there who do and have usage patterns similar to what I've described with how I use pregabalin—regardless of whether they have a prescription or get it on the street. The effects of pregabalin and weed may differ, but categorically speaking they both fall into "both reducing anxiety and 'feeling high'". It just feels a bit silly to me to rebrand the usage of cannabis to reduce anxiety and unwind at night or aid in sleep as "medical", while ignoring the fact that most people who use it this way are also enjoying mild euphoria, music enhancement, and the like.² The truth is that people have been smoking weed like this for decades, and how we label it simply doesn't matter. It's never been just one or the other.

I think that when it comes to drugs used for psychological effects, we should just throw this distinction out the window. Adults should have the right to use drugs—especially soft drugs—for whatever purpose they want. It shouldn't be up to the government or a doctor or a psychological evaluation to prove there's something wrong with you in order for you to use stuff like weed or pregabalin however you'd like.³

Just my two cents. Thanks for reading :)