The argument for making marijuana legal despite its health risks is that so many people use it anyway that it creates a society of casual criminals at best - maybe they are getting a bogus prescription for 'pain' or glaucoma or inventing some way it helps them. And at worst it makes criminals rich and puts users at risk because the quality is unmonitored and perhaps even dangerous.

That's the same reason to get the erectile dysfunction drug sildenafil (e.g. Viagra) over the counter sooner rather than later. At least two-thirds of sildenafil consumed in the Netherlands may be illegal, warn researchers in BMJ. The consumption of illicit versions dwarfs consumption of legitimate versions, they determined after doing "sewage epidemiology" – an established method of monitoring drugs of abuse.

They measured sildenafil levels at sewage treatment plants serving three cities in the Netherlands (Amsterdam, Eindhoven and Utrecht) over a seven-day period. Consumption of legitimately dispensed sildenafil was estimated from the national dispensary database 12 months prior to the study until three months after.

They found that at least 60% of the drug could not be explained by dispensing records (Amsterdam 61%, Eindhoven 79% and Utrecht 66%).

"Despite major differences in tourism and commuting, the illicit fraction is similar for each city," say the authors. "Consequently, the unexplained fraction is primarily ascribed to the use of illicit sildenafil."

It's a health risk, since obviously fake versions could be dangerous versions. If the illegal users outnumber the legal prescriptions, it might be worthwhile to buy out the Pfizer patent, which will expire in 2017, and just make it over the counter for everyone. If government can force businesses to pay for birth control pills, they should be forcing erectile dysfunction also - and under a patent the cost would be astronomical.

Source: BMJ