A new scientific controversy provides us with yet another chance to take a look at the response of the 'scientific community' to the war on cannabis. As is usual with such comparisons, because the critical implication involves appreciating something which is NOT happening, it may be less than obvious to those with a casual interest; and easier for those with a vested interest to deny. 
 
In a nutshell, Pluto was discovered in 1930 at a time when scientific instrumentation and observations were more primitive than they are now. Interestingly, the respected astronomer who first described it is still alive and understandably don't want Pluto downgraded from its  planetary status. That's only one of several possibilities being considered by the International Astronomical Union now meeting in Prague. Because there are several other implications of what will clearly be an arbitrary decision, its ultimate impact will be more political than scientific–– yet still within Union's sole power to amend.

They are the features which beg comparison with the 'war' on drugs.

Also, since neither national governments nor various police agencies seem to have any stake in the outcome of the debate over Pluto,  the present discussion is a lot more honest and uninhibited than the endless wrangle over cannabis; and so far, at least, no tax supported federal agency has  seen fit to sponsor 'research' to influence it; nor has Congress, the White House, or the Supreme Court attempted to do so either.

Doctor Tom

Posted by tjeffo at 08:18 PM | Comments (0)

August 14, 2006

More Absurdity

Even though I have little time for this sort of thing, there are some news items which so perfectly illustrate the absurdity of our drug policy that I must point them out. One such appears in today's Salinas Californian. Consider what's reported there: at a time when the economy is threatened by inflation, we are engaged in a losing (and unnecessary) war against 'terror' and the tax burden has been cruelly shifted to the poor and the middle calss, our police 'heroes' in the front lines of the drug war are still able to get away with simultaneously admitting they are not up to the job and complaining they don't have nearly enough money to do it.

One is also forced to wonder when the drug policy 'reform' community will finally get around to asking the cops and feds to explain that mysteriously persistent popularity.

Oh, yes. Don't forget that although we are worried about global warming and the diminishing global supply of petroleum, NASCAR tacing is now our favorite sport.

Posted by tjeffo at 08:45 PM | Comments (0)

August 12, 2006

A Letter from the Gulag

Just over a year ago, on August 10, 2005 my friend and associate, Dustin Costa was arrested in his own home by six California 'peace'
officers with drawn guns. At first they seemed a motley group indeed, but to anyone familiar with the details of the case, there was a certain cruel logic in that police overkill because they represented every California police agency with the most remote claim to jurisdiction in Merced, CA where the bust was carried out; however, they were really on a mission from the DEA, because they were there to  arrest Dustin on federal drug charges and  take him into federal custody at the Fresno County Jail. He has been there ever since–– completely ignored and  nearly forgotten by the medical marijuana 'movement' that claims to represent him

What makes his case a nearly unique and especially obscene miscarriage of justice is that, at the time of his arrest, he had been out on bail on state charges for the same offense, a substantial 'grow' intended for medical use. He had already made eighteen court appearances and was orchestrating his defense so adroitly that no trial date had even been set. Clearly the development that had changed the equation enough to allow his controversial arrest was the Supreme Court's June ruling in the Raich case, which approved federal  prosecution of those charged with violating its drug laws; even in states with 'medical marijuana' laws. Although the Supremes clearly hadn't considered the issue of double jeopardy, there were posts from lawerly types to 'reform' lists pointing out that as separate 'sovereigns' each government was entitled to pursue its own case.

So much for fairness and collusion.

Although Dustin has been held under extreme conditions in a hell-hole, he has continued to work for what he believes in and has been interviewing many of his fellow prisoners (nearly all of whom are short term county jail prisoners). The following letter is an example of how well he has been using his time to understand what is happening and refine his message:


Received From Dustin Costa, dated  August 9, 2006

Very few of those now attempting to restrict use of 'medical marijuana' in California claim it isn't medicine. Even such recent enemies as Merced County Sheriff Mark Pazin and San Diego District Attorney Bonnie Dumanis now claim to support its use by the 'seriously ill.' However, the most powerful, influential, and perhaps most self-interested 'dog' in the state-wide fight over medical use remains the federal government, which continues to insist that marijuana has no medical value whatsoever, and further, is both a dangerous drug and a menace to society. Because of the dangers it represents, they claim, anyone using or supplying it deserves a long term in prison. The government then offers local police additional resources to make sure medical marijuana offenders wind up behind bars. They claim, and perhaps even believe, that they only want to make America a safer place to live.

Wouldn't it be ironic if we were one day to discover that the real menace to society has been our federal government? Wouldn't it be a real twist of fate to discover that marijuana has the awesome potential to make America a safer place?

What if you were to discover that the government has borne false witness against marijuana, beginning with Congressional testimony in the Spring of 1937, and that the deceit and suppression of truth continues to this day?

Would you be surprised to learn that the biggest victims of the government's big lie are suffering from debilitating mental conditions like ADD, bipolar disorder, post traumatic stress disorder, autism, depression, and the whole range of anxiety-related disorders?

Did you know that people with those conditions now make up 70% of America's  prison population?

America currently has 2.2 million people behind bars, a number which is growing at the rate of 1000 each week. 80% of them are there through the war on drugs. In the 38 years since the drug war began, America has become the largest per-capita jailer on Earth. Would it surprise you to learn that most of those new prisoners are  those with potentially the most to gain from marijuana; who, if allowed to self-medicate with it, wouldn't be 'criminals' at all?

Imagine what it would mean if it turns out that marijuana is one of the wisest choices for treating adolescent mental disorders and also 'safer than aspirin and more effective than Ritalin?"

The logical implication would then be that the government has been relying on the false information it has gathered and spread with our  tax dollars to further its agenda of incarcerating and brutalizing our poorest and most defenseless citizens in a campaign that relies heavily on fear, bigotry, and hatred.

 It is that campaign which has transformed our prison system into our principal source of 'Mental Health Care.' If you agree with that policy, then you also agree with Mark Pazin, Bonnie Dumanis and the DEA.

Dustin Costa
T 229755
P.O. Box 872
Fresno, CA 93712

I'm sure Dustin would appreciate feedback my readers.

Doctor Tom

Posted by tjeffo at 08:45 PM | Comments (0)

July 30, 2006

Politically Correct Pot

An interesting aspect of NIDA’s defense of pot prohibition has been a slow shift from reflex denial of any possible therapeutic benefits to claims that other agents can treat the same conditions just as effectively without any need to be ‘smoked’ and without ‘unwanted’ cognitive effects. In other words, the same theme with which Barry McCaffrey greeted the IOM report in 1999: the disadvantages of cannabinoids which limit their medical benefits will also discourage investor interest in developing ‘crude’ or ‘raw’ ‘marijuana’ extracts as  commercial products.

As a recent article in Wired,  and Fred Gardner’s report of the 2006 European IACM meetings in CounterPunch suggest, nuance is all important.  What one quickly understands from a little further reading, is that our real problems with pot policy may have more to do with trying to cover up the mistaken beliefs originally cited  as reasons to ban it.  One dilemma is that it may not be possible to obtain the desired clinical benefits from products in which all cognitive effects have been ‘successfully’ blocked.

I’m betting that won’t be possible; in any event, the politicians responsible should never live down all the human misery their arrogance has already caused.

Posted by tjeffo at 12:10 AM | Comments (0)

July 27, 2006

An Impertinent Question

The first of several  lessons I've learned from my immersion in the medical marijuana issue for the past four years is that American drug policy has been an even more dishonest and destructive fraud than I’d ever imagined. What allows me to say that is data I've acquired from chronic users; data medical marijuana 'activists' simply refuse to either acknowledge or discuss; with a degree of unanimity that is itself very revealing

The second is that there seem to be at least two important reasons why the drug war has become such a widely supported global policy despite its multiple obvious failures (indeed it has NO lasting ‘successes’). One is that such a policy seems ideally suited to the secret desires of most governments to snoop on their citizens while maintaining well funded police and intelligence services; the other is that the political opponents of drug prohibition are at least as clueless and ideological in their own thinking as the most doctrinaire drug warriors–– and they have a lot less money to spend.

The third–– and from an existential point of view, perhaps most important–– lesson is that the highly evolved brain which has allowed humans  to establish mastery over the rest of the planet seems deeply flawed in  at least one critical respect: its singular inability to study our own behavior with anything like the same objectivity that allowed our recently discovered scientific method to ‘solve’ the 'problems' once constraining human population growth. The dirty little secret, which can't even be discussed at the moment, is that our sheer numbers may have already trapped us aboard a planet which is simultaneously undergoing sudden climate change while we are forced to deal with the possibility that the international 'rule of law' that facilitated the concentration of so much wealth in the hands of so few may not be enforceable for much longer.

Once one considers the cascade of possible catastrophes that could be lurkng around the next corner and realizes how little we seem able to control the raw emotions now so evident on the nightly news, it's difficult to believe that 'business as usual' will persist for long.

Again; the obvious connection to cannabis is that it's clearly being used by a majority of its chronic users to deal with the dysphoria of everyday life. One relevant question then becomes why do the chronic cannabis users I've been questioning for the past four years seem to know so little about the organizations claiming to represent both them and 'medical' use?

Posted by tjeffo at 03:04 AM | Comments (0)

July 16, 2006

Listening to cannabis

The title was chosen to highlight one of the first things I learned about cannabis and its users after agreeing to screen candidates for 'pot recommendations' at an Oakland  Buyers' Club (not the OCBC) in late 2001. I had seen several references to Kramer's book after it was published in 1993 and may have even read a review or two, but had no more than passing interest in Prozac or any of the other SSRIs at the time because I was then a chest surgeon, who had yet to discover drug policy issues and hadn't ever been actively involved with treatment of  "depression." Besides, I'd gone semi retired in '94 and wasn't writing many prescriptions.

Today, when I read a review of Kramer's book by someone even more committed to regressive psychoanalysis than he apparently was, I quickly caught a sense of both his (and Kramer's) disapproval of Prozac's potential for obviating so much of what Psychiatry is/was all about. Yet, Kramer had obviously been so impressed with Prozac's therapeutic benefits that the reviewer faithfully reported that fact before adding a note of disapproval so mild that it would be easily missed by a casual reader.


That review made me eager to read the book, but I was completely frustrated by the impenetrability of my old sources at Amazon.com; thus I started Googling 'cannabis, Prozac' and soon found an item by Phillip Dawdy which had appeared both in the Seattle weekly and on the Alternet in August 2004.

Dawdy's article was enlightening in a number of ways:

1) A lot of what I had been somewhat surprised to learn from and about patients had already been suspected in 2004. Nevertheless, my work goes a lot further than those suspicions because it's based on longitudinal data supplied by real people who now are organized as a registry.

2) The drug policy reform 'movement' which claims to speak for medical users has missed the most important way in which pot is being used as 'medicine.' That includes Lester Grinspoon whose quoted complaint about IRBs is very weak tea; compared to the stir that would be caused by endorsement/replication of my work by those (relatively few) California physicians in a position to do so. So far, that hasn't happened; for reasons neither they nor reform will discuss with me.

3) The links supplied by the Alternet Drug Reporter are contemporary; in other words, the people who wrote articles on behalf of DPA, MPP, and ASA are clearly way behind where Phil Dawdy was in 2004.

Doctor Tom
 

Posted by tjeffo at 02:45 AM | Comments (0)

July 14, 2006

Cognition, Science, and the Emotions

Through modern Archeology and Antropology, we have accumulated detailed knowledge of several hitherto unknown 'civilizations' that flourished for sigificant periods of time, only to eventually fail for a variety of reasons such as climate change, deforestation and political implosion.

In the last entry, I suggested that the emergence of scientific thought in the middle of the last millennium radically changed the world.  That's because Western Europe, was soon encouraged by its superior weapons and deep water navigation capabilities to 'explore' (and pillage) a world previously inaccessible to them. That quickly led to an orgy of exploitative colonization which is still going on and has often been justified by notions of  cultural, 'racial'  or religious superiority.

The process of forced cultural diffusion gradually 'opened up' not only the Americas, but the entire world; it was soon accompanied by sustained growth of the human population despite two 'world wars' during the Twentieth Century. Significantly; the only war with the potential to arrest population growth–– a nuclear World War Three–– was narrowly averted in 1962. Nevertheless, the detonation of a third nuclear weapon in anger now seems more likely than at any time since then.

  In fact, all modern wars, including those now either in progress, threatened, or smoldering around the world, are clearly related to colonial and post-colonial resentments, a judgement still not acknowledged by 'world' leaders, who can't seem to admit that the  intensity of those resentments and the manifest impossibility of ever addressing them within the context of the global economy has never been more apparent.


We can also see in retrospect that the  avarice and cruelty of European colonizers toward those they exploited was nearly universal; yet, the same behavior  quickly  became the norm for the leaders of former colonies who came to power after World War Two. Like earlier imperial expansions, the pivotal one enabled by European science also delivered a measure of economic 'progress' to those it exploited; however, unlike them, the economic expansion launched from Europe in the the Fifteenth century never collapsed of its own weight;  probably because it also marked the beginning of today's  competitive global economy.   Human population growth has been sustained through the plethora of scientific advances (many of them unexpected) generated by economic and military competition. That a global economy can thrive on greed, fear, and dishonesty has remained evident despite the nearly constant background of wasteful open warfare somewhere on the planet.

Unfortunately, the rigorous intellectual honesty required for success in science and technology has not spilled over into the political domain. World leaders have continued, to retain enough tacit approval from the people they govern to cling to the same time-honored political rhetoric employed throughout history.
 
As noted earlier, the consequences of such intellectual schizophrenia can be seen all around us. Cognitive dissonance is openly embraced as national policy with no sense of shame; Indeed, it's brandished; with little evidence that those doing so are even aware of the ignorance they are admitting to; nor do 'responsible' scientists who should certainly know better ever speak out.

American drug policy, is simply one of the world's oldest, most irrational, cruel, and counter-productive policies. it survives only because it has become too politically correct to challenge; however, it's not the only such example.

Also, because a unique study of recalcitrant cannabis users was  (unexpectedly) enabled by passage of a fiercely resisted state initiative, it is both distressing  and revealing that those with the most reason to be curious about the phenomenon of pot use have solidly committed themselves  to embracing many of the same irrational assumptions of their political opponents.

Doctror Tom

Posted by tjeffo at 08:38 AM | Comments (0)

July 12, 2006

March of Folly

The title was borrowed from the late Barbara Tuchman, it refers to her insight that governments often work against the best interests of own their people for extended periods. She also described some of the mechanisms by which they do so.

Never before have the follies of human existence been more evident; nor has the denial of their absurdity by world ‘leaders’  been greater. However, because we are also learning that nothing in ‘nature’ remains constant, it’s very likely that next week–– and next year— both phenomena will have gotten measurably worse.

Admittedly, that’s a profoundly pessimistic assessment of the world’s future; unfortunately, the evidence favoring it is all around us. Everywhere we look on the international scene, we find evidence of festering disagreements between rival groups that have been violent for years and are further from resolution than ever. No longer is violence confined to relatively orderly wars between readily identifiable nations; modern wars are increasingly waged between belief systems commanding constantly changing sectarian allegiances of the sort found both within and between nations; the important divisions are more often economic, religious or racial than purely national.

When we attempt to trace the present global chaos to its origins, we are soon left with only one culprit: human cognition. In other words, the agency which allows us to be informed with lightnig speed of the latest deadly car or railway bombing half a world away is the same one that enabled our species to create the mess which both generates the carnage and makes restoration of ‘order’ unlikely.

Cognition, the modern ‘in’ term for thinking, involves several functions we humans share with other species, but possess in greater abundance and with a considerably greater degree of integration. The organ integrating and controlling cognition, the brain, is also possessed by other animals; but in demonstrably less complex form. That the modern human brain was eventually produced by a gradually adaptive process (evolution) was first separately intuited by Darwin and Wallace in the mid-Nineteenth Century and is still hotly disputed. However, its accuracy is also very obvious to anyone possessing sufficient background in science and enough ideological freedom to think independently.

Which brings us to a watershed understanding: based on certain pre-existing beliefs, all humans seem to have a variable capacity for accepting  certain ideas as ‘true.’ If we return to the notion that the cognitive abilities which created the present global mess are also rendering its solution difficult, we can see a likely connection. It’s difficult to imagine any phenomenon but ‘science’ that might have allowed the acceleration in human population growth over the past six hundred years. Although we have ample historical and anthropological evidence that agriculture facilitated the emergence of many complex civilizations in various parts of the world,  it wasn’t until the first clear-cut technologic advances produced by empirical science in Western Europe produced a cascade of technologic advantages; and Europeans attempted, with considerable ‘success,’ to extend their hegemony to the rest of the world, that ‘modern times’ really began.

What's the connection between the above essay and the study of pot smokers which impelled me to start  blogging? It's actually fairly direct; once one realizes that the most obvious conclusion of that study is that our cognitive abilities are impacted to a considerable degree by the same emotions which are–– all at the same time–– the source of our noblest ideas, the root of all evil, and inescapable physiological manifestations of human brain function.

 That's a combination which  makes their 'control' a sort of Holy Grail that both government and religion can't seem to resist pursuit of...

Doctor Tom

Posted by tjeffo at 07:14 PM | Comments (0)

July 10, 2006

An Important Case History

An  enduring theme of our highly evolved 'war' on drugs is the notion that 'kids' shouldn't use 'drugs.' So politically correct has that taboo become, most 'anti-drug' laws now provide for enhanced penalties for violations occurring within some arbitrarily fixed distance from a school.

The 'kid' taboo has also made most physicians, including (or perhaps, especially) 'pot docs,' reluctant to use 'kids' and 'drugs' in the same sentence; let alone 'recommend'  that a 'kid' use pot. On the other hand, my routinely taken histories confirm that most adults  'initiate' all the psychotropic drugs they will ever try by age 25 (the obvious exceptions are usually prescribed by physicians; more on that subject later).

Because his patient's remarkable history contains so many of the themes encountered in milder form in many of my own applicants,  I'm urging anyone with an serious interest in medical pot to read the history of Alex P in the current CounterPunch (courtesy of Tod Mikuriya, MD & Fred Gardner).


Doctor Tom

Posted by tjeffo at 05:02 PM | Comments (0)

July 07, 2006

Another Federal Riposte

The Hinchey-Rohrabacher  Amendment, little known to those who aren't drug policy 'reform' insiders, has become an annually recurring  example of their blindness. It began as a well meaning bipartisan plea from two California Congressmen with personal reasons for endorsing the 'traditional' notion of 'medical marijuana' as a reason to grant very ill or dying patients the privilege of  smoking pot. That this year's (predictable) defeat in the House was so quickly followed by a crisp federal riposte has served to confirm at least two of my suspicions. The first is that aside from their opponents in government, the reform movement is relatively unknown to the great mass of Americans.

The second suspicion is that the feds working assiduously to protect current drug policy DO pay a lot of attention to reformers and have carefully crafted their anti-marijuana campaign in California to take full advantage of their ignorance. California's law, by far the nation's liberal pot law, has allowed the largest numbers of ordinary pot smokers to think of themselves as potential 'patients.' What I learned shortly after starting to examine them in 2001, was that virtually all those who would usually be dismissed as 'recreational' users are actually self-medicating, with benefit, for very common emotional symptoms which most people,especally young males, are usually loathe to admit.

That concept had been a tough sell, especially to the generationally blind, pot-smoking reform community which clings stubbornly to the original 'seriously ill' model their opponents are now using so skillfully to hoist them on their own petards.

Yesterday's escalation of a state-wide federal and local police campaign was a case in point;  San Diego is the biggest city with a strident anti-pot tradition and the carefully timed busts plus the accompanying publicity involved all the elements of the recent 'moratrium' campaign and added a new one: a renewed attempt to threaten physicians who write recommendations with punishment by the Medical Board of California.

Whether it will succeed in provoking the Board to resume its harassment of physicians remains to be seen...

Doctor Tom

Posted by tjeffo at 04:13 PM | Comments (0)

July 04, 2006

Human Frailty

Working with chronic cannabis users has led me to believe the question we should really be asking about American drug policy is one often asked about Nazism shortly after World War Two: how could such an inhumane doctrine have become so credible? Its corollary was: how could an 'advanced' nation have fallen for such an obvious fraud?

The answer to both questions begins with the realization that such aberrations are enabled whenever a nation's supreme legal authority is either persuaded or forced to endorse egregious scientific error. Failure to recognize the critical difference between scientific and legal standards of 'truth’ not only allows the imposition of a ‘pet’ policy in a doctrinaire manner, it encourages it.

Nazism and the War on Drugs can thus be seen as extreme examples of the same phenomenon in two different settings. Hitler, who was chosen to lead the government of a demoralized nation in 1933, seized power immediately on the  promise of restoring self-respect to a dispirited, angry populace. He was then able to convert Germany into the strongest military power in Europe in six short years.

Our war on drugs represents similar doctrinaire thinking, but has been forced to proceed far more slowly; literally one institution at a time. The Drug War grew from a presidential directive which suddenly expanded an already erroneous policy; but the policy already included several key characteristics which facilitated its implementation as a 'war:'  it, too, was based on doctrinaire assumptions and control of 'narcotics' had long been usurped from Medicine before much was known about either 'addiction' or the relevant physiology.  Also, Harry Anslinger, the FBN's chief bureaucrat, had efficiently discouraged any interest from Psychiatry or the  Behavioral sciences in addiction or addicts for over thirty years.

Two distinct generic fears are important to public acceptance of  repressions like Nazism and the Drug War: one is fear of those accused of representing whatever new 'threat' they are focused on; the second, and more realistic for those not targeted, is the fear of ordinary citizens that they could find themselves on the wrong side of a fiercely enforced policy.

More than a bit disquieting is the realization that all such aberrations ultimately depend on the tolerance of the populace they are imposed upon; all that would have been required was the courage needed to overthrow them; a fact as true of Saddam as it was of Hitler, Stalin, and Mao. Thus, the critical corollary is that outside  'help' from other nations or sources has nearly always been required to overthrow them; and there is always the risk a new repressive ideology may replace the first.

Our capacity for repeatedly experiencing such follies without ever seeming to learn from them is not very encouraging. The pointless circular debates over drug policy are shocking for their confused ‘science’ and stand in stark contrast to the remarkable ability of scientists in other disciplines to accurately study an unprecedented ‘natural’ disaster like the recent tsunami, in which human behavioral anomalies clearly weren’t causative. Lest we think there’s some IQ difference between them and ‘behavioral’ scientists, we should recall that they, too, have NEVER criticized the shockingly unscientific behavior of NIDA;  nor was any objection voiced when Alan Leshner, its former director, was chosen to head the prestigious AAAP.


Doctor Tom

Posted by tjeffo at 06:42 AM | Comments (0)

July 01, 2006

Revisionism

When I belatedly discovered the war on drugs as a political cause in 1995, it had already compiled a long and complicated history. Although the selection any such date is always arbitrary, the most obvious starting place for any history of federal drug policy had always seemed the Harrison Narcotic Act (HNA) of December 1914. In most considerations of Harrison, the 1906 Pure Food and Drug Act (PFDA) had often been held up as an example of its opposite: a ‘wise’ regulatory measure that had actually done some ‘good' by reducing inadvertent opium addiction among the nation’s housewives by requiring patent medicine labels to list ingredients.

Thus, it was with some mild surprise that I recently (and belatedly) discovered a movement afoot to consider the PFDA as the historical origin of current US 'drug control’ policy; however the more I think about it, the less that should have surprised me. The ‘other side’ in this uneven propaganda contest has enormous advantages of money and time; however, they must also be aware of their policy’s vulnerabiity: most Americans consider the drug war  a hopeless failure. With that in mind, a campaign to parley the FDA’s Centennial and the public’s generally  higher regard for it to brighten the the drug war's image is, at least, logical. What is staggereing, however, is the absolute contempt for truth with which the campaign is being orchestrated.

Such a campaign would also explain the FDA’s ridiculous 4/20 ‘statement’  explaining why “Medical Marijuana” will never be approved (it has to be smoked!). Even more blatant was a gathering of ex-drug czars held on June 17  to commemorate the ‘appointment’ of psychiatrist Jerome Jaffe to be the first such functionary (although he was called a Presidential  ‘Advisor at the time and Dan Baum's 1996 'Smoke and Mirrors' succinctly explained the panic behind his appointment).

A just-published report by John Burnham, its quasi-official ‘historian’ on the gathering, with much emphasis on its significance (a celebration the drug war's ‘victory') just appeared in yesterday's Columbus Dispatch. It  makes for fascinating reading but, so far, has provoked little notice from reformers. Are they out to lunch? Whatever the explanation, their failure to note- and respond- to such blatant revisionism, cannot be regarded as a sign of political strength.

Doctor Tom

Posted by tjeffo at 09:46 PM | Comments (0)

June 25, 2006

Inconvenient Truth

I’ve often mentioned how an early understanding that all candidates for a pot recommendation were already chronic users led me to  screen them with a standardized interview specifically designed to explore not only whatever medical benefits they were deriving from their pot use, but also to identify and sort out whatever common factors might have induced them to become chronic users in the first place.  

It’s now been over four years since that project began and enough of the data accumulated from interviews has been entered into a modern relational database to establish that not only have virtually all of them experienced substantial benefits from their prolonged  illegal self-medication, but also to develop a tentative user ‘profile’ explaining how the current illegal commodity market  for ‘marijuana’ has grown steadily to its present dimensions over the past four decades despite unparalleled police efforts to ‘control’ it.

Beyond that; the unexpectedly complex and changing initiation patterns exhibited by the study population for a menu of other drugs, including alcohol and tobacco, also allows a tentative understanding that all repetitive use of any psychotropic agent may be rooted in a common need to self medicate. Although beyond the scope of the current data to establish with certainty,  that possibility offers a more coherent explanation of the government’s own annual surveys than ‘gateway,’ and also establishes how the gateway hypothesis was arrived at.

Which brings me to the next point: aside from chronic pot use, another behavioral phenomenon I’ve had to explain was the irrational, yet amazingly uniform, rejection by 'reformers' of  a study I thought they would have both understood and supported. Unfortunately, the best explanation of that particular phenomenon seems to be that— just like pot smoking itself—  denial of unpleasant reality is yet another form of human behavior which is both  more common and more characteristic of our species than most of us  seem either able to realize or willing to admit.

It further appears that the need to deny unpleasant (‘inconvenient’) reality may well be our species’ most pervasive and dangerous weakness; one which most accurately reflects not only why American (and global)  illegal drug markets have grown to their current dimensions, but also why so many of the political problems of our increasingly crowded and interdependent planet seem further beyond solution than ever.

In other words,  the implications of ‘inconvenient truth’ may be far more profound than the producers of Al Gore’s movie realize.  

An amazing thing just happened in real time: as I was doing the final checks on the entry, I checked my email (it’s Sunday morning) and immediately encountered a  fascinating article in today’s NYT Magazine; one I’ve only had a chance to skim, but already know I’ll be parsing in detail for quite some time...

Doctor Tom

Posted by tjeffo at 09:26 PM | Comments (0)

June 20, 2006

Comment

There were many reasons for me to relish an opportunity to comment on Mark Kleiman's criticism of Ryan King's methamphetamine study;  so many, in fact, that deciding where  to begin, and what point of view to emphasize became problems. King's study is typical of a genre which is fast becoming pervasive: a researched meta-analysis of a specific drug-war topic published on the internet and/or as a press release. What is unusal is the laundry list of complaints it provoked from Kleiman; their length, prompt appearance, rambling nature,  and tone are ample evidence of the annoyance which inspired them.

From King's point of view, Klieman's fit of pique was probably welcome; precisely because it focuses more attention on his study. As one who has done similar advocacy, I know most such papers are written to influence public opinion; also that access to peer reviewed literature can be almost impossible for an author perceived as even mildly critical of US drug policy. The Sentencing Project has done excellent work, but most of it either has to be reported by, or referenced in, the popular press to reach the public.

In that connection, Kleiman once co-authored a paper in a peer-reviewed medical journal which played an significant role in advancing 'medical marijuana' as a political issue. I also know he  still complains about the fall-out that effort had on the delicate balancing act all prominent academic drug policy analysts must engage in.

The truth about both King's paper and Kleiman's comments is that both contain kernels of truth sorrounded by large areas of uncertainty woven together by strands of outright falsehood- and neither can be certain of what's which. That particular reality has far less to do with their diligence, scholarship and intelligence than it does with the fear, disinformation, and confusion produced by almost forty years of drug war propaganda superimposed upon over fifty years of never-acknowledged drug prohibition, the origins of which are still shrouded in considerable secrecy. Before one can lie, one must first know the truth; the great success of the drug war is that it has blocked unbiased human research so successfully that no one, especially the policy makers themselves, has ever been able to learn the truth about human drug use. Instead, the most compliant 'researchers' all dutifully parrot the prevailing myth about each illegal agent ('drug of abuse') and then support it with repetitive,  limited studies of similar populations with similar results.

My credentials for criticising both authors are based on the fact that, for the last four years, I have been engaged in a unique, ongoing study of Californians seeking to use cannabis medically. Since all had been paricipants in the illegal pot market for a variable interval and many had sampled other illegal drugs aggressively-- and I have routinely collected a lot of other data from them as part of their required evaluations-- one couild describe what I've been doing as market research of the very sort both King and Kleiman, albeit with quite different emphasis, have agreed is so difficult and uncertain. What I have learned is simply amazing. It's also very much at odds with the prevailing pot myth (large chunks of which I'd also believed), yet it's quite convincing and sheds enough light on key aspects of drug war history to show just how various  elements of the myth have developed.

A collateral reason for ambient drug war uncertainty is the fear it inspires. The evidence behind that statement is as overwhelming as it is pervasive; yet the fear itself is never openly discussed. In many respects,  the drug war may be seen as two metaphorical elephants;  the one in the national living room that no one can discuss honestly, and the other at the center of the Indian fable which the blind men struggle to describe, A major difference is that the Indian elephant  has six features over which six analysts disagree. The drug war elephant has an almost unlimited number of features over which an almost unlimited number analysts may argue-- and a host of reasons their opinions aren't honestly stated.

Doctor Tom

Posted by tjeffo at 10:44 PM | Comments (0)

Postponement

I know I promised at the end of yesterday's entry (Set-up) that it was intended to set the stage for deconstruction of Professor Mark Kleiman's latest pronouncement on methamphetamine; and that's still my intention. But when I started looking at the subject in detail, I found some other things I have to get off my chest before dealing with the specific items by Kleiman and King which one would have to read to understand my comments. There's a certain ironic history here;  my first contact with Dr. Kleiman was  in 1995, when he and Sally Satel, MD  co-authored a scare piece in the LAT on the 'methamphetamine epidemic.' and I had a letter published I chiding them for their 'intellectual constipation.' The gambit worked well enough to have the Times to publish my letter; it also prompted Kleiman to (foolishly, as it turned out) join a drug policy discussion list to do battle; ironically, it was just before I left for an unusually long European vacation which- given the primitive quality of e-mail  then available- also made me miss his entire presence on the list without the opportunity to exchange even one e-mail.


I have since read Kleiman's book and, when blogs became popular, I belatedly discovered he was already an avid, prolific, and highly opinionated blogger. The sum of those discoveries  tended to confirm a number of suspicions I'd already developed about drug policy analysis and those who practice it:  we (I must include myself)) have all been victimized to a variable extent by a fundamentally stupid policy which has, nevertheless, survived for nearly a century because it's so fiercely defended;  despite its perennial (and abysmal) failure to accomplish any of its stated goals.

In fact, knowing, and being able to grasp, all that didn't prepare me for the true extent of our drug policy's perversity- and what is, most likely,  the single most important reason for its improbable success: the cognitive function which has enabled humans to dominate all other biota to the extent we have is irretrievably influenced by the emotions we all share with other animals. Human emotions can-- and do-- override logic to a considerable extent. It is those emotions which have now backed us into a corner by allowing us to overpopulate the planet to an unsustainable degree with little recognition and even less discussion of the huge dangers posed by our present numbers.

I will stop right here long enough to say that this realization came only after I'd had the chance to interview thousands of admitted pot users and then analyze their data in a customized data base. The most inescapable conclusion of that experience relating to drugs is that we humans are so impelled to deny the importance of our own emotional responses in our decision making that we have made-- and continue to defend-- a number of implausible judgements about drugs and drug use.

It's even more important to realize that the same denial mechanisms obscuring the realities of drug use can be easily seen at work in all human relations, whether they involve our neighbors or people in nations halfway around the globe. We are all possessed of identical brains with the same metabolic requirements They are subject to the same emotional stimuli and prone to respond in similar fashion to similar stresses. If for no other reason, the similarity of responses by inmates in our maximum security prisons to those of  'detainees' at Guantanamo should have us all buzzing in alarm.

Instead, we remain in denial. Key revelations, like the recent suicides of detainees seem to have been largely ignored in favor of the latest political calculus.

I am certainly aware of the 'heresy' my work with pot smokers has led me to embrace; yet the coherence of the principles revealed-- along with their  applicability to most human interactions–– is so undeniable I must describe them to others. A blog  seems made to order for doing just that...

Doctor Tom



 

Posted by tjeffo at 12:11 AM | Comments (0)

June 09, 2006

A Naive Study

I spent the last few weeks poring over hundreds of clinical histories obtained from pot applicants during  the Spring of 2002; right about the time I was tumbling to an insight which was to gradually  escalate into an obsession: since nearly  all applicants I was seeing were already long term pot users,  perhaps their accumulated experiences would help define the phenomenon of large scale juvenile pot use which had so clearly developed de novo during my own lifetime. In any event, such a study might also shed light on another contentious issue: how should ‘medical’ use of cannabis be defined ?

I set out to develop an unbiased interview format as a research tool. The intrinsic logic of the situation made the proposed study seem such a no-brainer I was almost embarrassed it had taken me so long to come up with it. Little did I anticipate the mixture of disinterest and antipathy the study— and the data— would inspire. It’s now been four years; and even though a lot of data has been accumulated and some of it coherently presented to many people with an alleged professional interest in Medicine, Drug Policy— or both— ‘stubborn disinterest’ is the kindest way to characterize its reception. Significantly; except for a very few individuals, there’s been an almost universal tacit refusal to enter into detailed discussions.

What has changed significantlty–– and just recently–– is that enough of the mountain of accumulated data  has been processed in a brilliant  relational data base to repudiate federal cannabis (“marijuana”) policy as the fraud many have long suspected it was; but could never ‘prove.’  What is also surprising is that such an obvious fraud could have been so durable. In fact, the implcations of its durability for the cognitive processes by which  we dominate our planet may extend far beyond drug policy.

In a more restricted and practical vein, the detailed portrait of modern American pot use provided by the data base— whether it is immediately understood and accepted or not— should ultimately sound the death knell of the drug war that teen  pot use frightened RMN into declaring just over  37 years ago.

Since the details revealed by data base analysis which most apply to its eventual publication in ‘peer-reviewed’ medical literature are  technical  and statistical, I won’t disclose them here. However, I  believe  the extraordinarily destructive nature of our drug policy makes it reasonable to at least list the study’s major implications.

1) The US has been burdened by a deceptive policy of drug prohibition since 1914.

2) It was then, and contrinues to be, based almost entirely on fear of ‘addiction,’ an entity which although uncritically designated as a 'disease' by some and the focus of a putative medical specialty, still eludes coherent definition and cannot be diagnosed with precision.

3) Although outright cannabis prohibition was added to our oppressive 'control' of coca products and olpiates in 1937 for spurious reasons and with shockingly little discussion, it was retained under the omnibus controlled Substances Act (CSA) during the first Nixon Administration in 1970.  The law had been rewritten only because SCOTUS, in a trypically clueless drug policy ruling, had threatened  the legislative basis of  prohibition for reasons which were peripheral to its (probable) unconstitutional flaws.

5) The most important questions about the new phenomenon of widespread juvenile pot use, which should have quickly occurred to anyone professionally concerned with drug policy during the Seventies–– have never even been asked–– let alone answered:

Why did an agent ignored by the public for thirty years suddenly become so popular with youth— not only in America, but around the world?

Why has an inadequate and unpersuasive ‘gateway theory’ remained  both the major focus of cannabis 'research' by the Behavioral Sciences and the major reason touted by policy advocates for its continuing harsh prohibition?

Clearly, the sustained incremental growth of an illegal commodity market for cannabis is just one of many elephants in the drug policy living room; yet one is forced to wonder why such an obvious question was never asked. That’s especially true once one realizes that the mid-Sixties were when the first ‘Baby Boomers’ were sumultaneously coming of age and discovering pot.

That nearly all who became chronic users had first tried both alcohol and tobacco was interpreted by the first researchers ever to study adolescent pot use as evidence that it was a ‘gateway’ to ‘harder’ drugs. Other possible explanations, which might have been investigated then or later, have been largely ignored while ‘gateway’  has remained the major focus of Behavioral Science studies funded by NIDA  since its creation in 1975.

The original ‘sequence’ of initiations is no longer true and pot’s relationship to the other two agents is best explained by the realization that pot soon became the third entry-level drug tried by by anxious teens, along with alcohol amd tobacco. Although alcohol and tobacco are still not perceived or regulated as ‘drugs,’ and both are more dangerous to individuals and society, they remain legal and loosely regulated while mere possession of cannabis is rigorously punished. When it's realized that another finding was that nearly all chronic pot users reduce their use of both agents after settling on pot as their drug of choice, the perverse stupidity of the drug war comes into even sharper focus.

That’s all I have time for today; more later.

Posted by tjeffo at 12:20 AM | Comments (0)

May 20, 2006

I’ve now seen enough pieces of the big picture to understand that what I’ve doing for the past four years has been defining, one interview at a time, the huge illegal  ‘marijuana’  market which has been growing out of public view, one high school graduating class at a time, for thirty-seven years. That’s a study  which became possible only because a window was opened in 1996 by California’s Proposition 215 just widely enough to encourage a  fraction of those pot users  often dismissed as ‘heads’ or ‘stoners’ to apply for ‘medical’ status;  and even then, only because my own age made me just naive and curious enough to wonder how they had all become chronic users of an agent which had been so completely invisible to me during my own high school years ((‘45-’49) and then remained unknown to nearly everyone over thirty  until the world somewhat blatedly discovered how much ‘hippies’ liked ‘pot’ during 1967’s ‘summer of love.’

It further turns out that because the same differences in generational perspective which inspired my question are nearly incomprehhensible to 96% of the pot market participants born since 1946, I’ve had a particularly difficult time getting ‘experts’ with a vested interest in the ‘debate’ to even notice.

Also, because the great majority of buyers in what would only gradually become a huge illegal market weren’t born until well after 1945,  the market’s illegal status was enough to keep both them and those arresting them from an accurate understanding what was really happening. As more time has passed and new pot users have been born— and later become users tehmselves— the truth has been even more distorted by simultaneously evolving ignorant beliefs and dishonest 'research.' An especilly ironic result of that ignorance and fraud is that each side in the modern ‘pot debate’ is wedded to its own fairy tale; a situation which— even more ironically— makes the truth seem the least plausible explanation— and thus readily dismissed.

But it gets worse...

The 10 year evolution of Proposition 215 within California has also been a good example of blind men trying to describe an elephant to each other;  so prolonged, so complicated, so rapidly changing, and so ineptly reported that even those dealing intimately with one or more of its many aspects on a daily basis can remain unaware of developments in other areas— and their significance— for long intervals. It doesn’t seem to matter whether one's primary interest is political, legal, medical, or just shaping of public opinion.   

Sadly; my take on current trends is that although the reform position is much closer to the truth and retains considerable uninformed popular support, it’s  losing political ground because the feds’  simplistic message is being skillfully and aggressively sold to various City Councils and other entities making the key decisions that will directly affect the long term future of medical cannabis: namely, which— if any— of several petitioners hoping to open ‘dispensaries’ in their communities will receive  business licenses and how stringently they will be regulated?

One needs only to grasp that delay is a form of denial and over-regulation by a hostile bureaucracy a good way to prevent something that can’t be banned outright from ever happening to intuit the federal strategy.   Also its ultimate purpose:  forcing as much ‘medical’ pot distribution back onto the street as possible. The feds clearly hope that market participants can then be arrested as before with the same minimal outcry now heard in states with far more restrictive laws.

That scenario also assumes something else which remains to be seen: will all those Californians who have had recommendations for years and been (somewhat) educated by the experience become as docile as they they once were when the old order is re-established?

In another installment, I’ll report how a recent experience with the Richmond City Council provided me with the evidence that confirms this analysis; but first, I want to point out when and how present federal tactics were first revealed. It started with the infamous— and never rebutted— charges arising from the 2004 ‘Oaksterdam’ flap when ‘able bodied young men’ were filmed leavng a local club with large bags (of clones). They were portrayed as irresponsible ‘scammers’ of (what might be) a worthwhile program. The unanswered allegation that they ‘obviously’ weren’t ‘legitimate’ patients and the subsequent propaganda campaign have been cleverly coordinated with local police and is helping  convince many City Councils to either ban pot clubs outright of declare a ‘moratorium’ on licenses pending further study.  Things got a lot worse after Raich when the feds began arresting certain activists already out on bail on state charges. All but one remains buried as deeply in the federal gulag as if in Guantanamo. in fact, the public seems more aware of Guantanamo than of the Californians now mired in cruel double jeopardy within their home state.

Posted by tjeffo at 11:27 PM | Comments (0)

May 08, 2006

Why the 'Serious Illness' Notion has been a Serious Mistake

In the last entry I promised to discuss why I think the notion that permission to use cannabis on medical grounds should be granted only to those with ‘serious’ diseases  is 'unrealistic.'

Actually; I think it's both silly and self defeating

Although several good reasons for thinking that way might become apparent to  an experienced clinician after a bit of critical analysis, most working doctors have already been so intimidated by the drug war they have long since excused themselves from thinking seriously about cannabis. Thus, even the most cogent clinical arguments I might make (and there are several) wouldn’t help much-- and would be Greek to non-clinicians.

No problem; a perfectly good case can be made from basic human nature if we simply consider the almost universal bans on two other human behaviors widely regarded as ‘sinful:’ gambling and prostitution. Those proscriptions have also tended to survive in secular democracies despite their perennial failure. Although cloaked in the garb of Public Health from the time of the Harrison Act, our drug war had its roots in the same quasi-religious logic that led to bans on commercial sex and wagering; they simply had much longer histories in Western society.

One key to understanding the underlying connection between the three bans is that, from the outset, they all relied heavily on the state’s powers of arrest and prosecution. The biggest difference was that, in the case of drugs, the first clamor for a ban came from the top down. However, that difference is also readily understood: our drug policy, like many others, had complex origins. Early in the Twentieth Century there was a desire to curry favor with China; along with an increasing public awareness of ‘addiction’ as an exotic problem. Combining them under the circumstances that existed at the time was both logical and effective.

The next point to be made is that historically,  policies criminalizing specific behaviors which were not regarded as directly threatening by a significant fraction of the affected population have tended to fail. Beyond that, increasing attempts at top-down enforcement in the face of such failure has usually tended to corrupt both law enforcement agencies and the affected society. One would think that such a history— especaiiy if repeated several times— might have triggered some recognition among politcal analysts that moral prohibitions do not make good policy; but such critiques are noteworthy for their absence. All one has to do is search for academic treatises either analyzing or condemning moral prohibitions as failures to be struck by their relative absence–– either in the past, or in the modern glut of books dealing in detail with every imaginable subject.

The only possible conclusion also applies directly to the drug war itself: morality-based policies, no matter how irrational they prove to be, tend to be treated with undue deference at every level of society. Once understood as an intrinsic part of human nature, that scruple goes a long way in explaining both the  persuasive nature of ‘politically correct’ ideas, and the undue deference accorded certain notions in the absence of evidence that they are at all realistic. Examples are the ‘will of the people,’  the 'essential' nobility of humanity, and the idea that we humans were intended to 'rule' over other species.

It thus appears that the ‘seriously ill' scruple is simply the logical default for (typically human) critics of the drug war; the down side of such thinking is that it has prevented them from understanding— and promulgating— solid clinical evidence that our drug policy has actually had far worse consequences than most people imagined.

It also explains why I must rely on this blog to communicate with the demonstrably small nucleus of drug war resisters that 'gets it.' I am still forced by history (and basic human optimism) to believe that truth and logic are ultimately contagious; however, the process is usually erratic and was always been unpredictable. Whether modern IT will accelerate full recognition of the drug war's social consequences is still an unsettled question.

Doctor Tom

Posted by tjeffo at 05:32 AM | Comments (0)

May 03, 2006

On April 20, the FDA released what was clearly intended as an authoritative 'advisory' explaining that ‘marijuana’ shouldn’t be taken seriously as medicine because it must be smoked! That statement has since been parsed more exensively— and critically— than any comparable official statement of drug war dogma I can remember. While I still haven’t read all the critical comments, I’m disturbed that I have yet to see one clearly stating what seems to me its most shocking (albeit unintentional) disclosure: the degree to which ’science’ has been distorted to defend a destructive policy of failiure.

An inescabable collateral realization is that many of  our ‘leading scientific institutions’ have been bullied into grossly compromising their supposedly hallowed scientific principles— without a peep of protest.   

For those still in denial, the drug war’s remote origins were a series of judicial decisions made nearly 100 years ago when the US Supreme Court was sufficiently persuaded by superficial and misleading analysis of what— even then—  was incomplete and biased evidence, to embrace three key fallacies. The first was that ‘addicition’ is the most important risk of using  ‘narcotics’ (that term then applying only to opiates and cocaine) the second, was that abstinence is the only acceptable goal of addiction treatment. The third was that physicians can’t be trusted to prevent addiction in their patients or to treat it properly when it occurs; thus police and criminal sanctions are essential elements of the nation’s Public Health.

The subsequent history of our drug policy is that its inflexible nature— and the prerogatives conferred by the Court on its enforcement bureaucracy — were protected by a single bureaucrat for over three decades after he took over the FBN in 1930. Other than skillfully protecting the Bureau’s intellectual turf, Harry Anslinger’s most important contribution was the 1937 MTA, which added cannabis as a third proscribed agent on scientifically absurd grounds.  Otherwise, his tenure can now be seen as most noteworthy for what never happened: any significant expansion of the three illegal markets created by the policy.

However, his departure in 1962 was followed by three events which would soon dramatically reshape and enlarge all illegal drug markets within a single tumultuous decade: the introduction 'psychedelics' and several other new psychotropic agents, the discovery of cannabis by a significant fraction of American youth, and the 1968 election of Richard Nixon.

 Even before Nixon’s ‘drug war’ was  empowered by the CSA (1970), reinforcd by the DEA (1973), and another agency (NIDA) created to defend its ‘scientific’ purity in 1975, it had been on an upward trajectory. Some momentum was lost following the Watergate disgrace; but it was quickly recovered— and then some— after Reagan’s election in 1980. Since then, the policy has becme so dominant in Washington that its major political risk may be that unwitting revelations like the clueless 4/20 FDA proclamation could trigger enough public recognition of its foolishness to bring about insight and repudiation

In that context, one wonders just when— and if— the leadership of the drug policy reform movemment will ever ‘get it.’

Posted by tjeffo at 11:22 PM | Comments (0)

April 28, 2006

A Different Position on Adolescent Pot Use.

A Different Position on Adolescent Pot Use.

Many drug policy reformers are quick to agree that “kids” shouldn’t smoke pot; but there’s a problem with that statement; large numbers of kids HAVE been smoking it for thirty-five years. Not only are they very unlikely to stop, the best available evidence is that–– aside from the risk of arrest it subjects them to–– the practice is far better for their mental and physical health than the alternatives.

In November 2001, when I began screening medical cannabis applicants at the largest buyers’ club in the Bay Area, I had no idea  I was starting  a project which would soon take over my life. I now also realize that I had bought into the same mind-set that prevents many reformers from agreeing with a concept I’ve been trying to explain to them them since  tumbling to the truth in early 2003:  pure “recreation” is an unlikely explanation for the repetitive use of an agent at the risk of felony arrest over an indefinite interval. In fact, most repetitive use of any drug is for purposes beyond mere recreation— whether the user cares to admit it or not. I’m also of the opinion that–– in any sane world–– self-medication with pot shouldn’t require a prescription any more than one should need a one to buy coffee at Starbucks,  a six pack at the 7-11 or a pack of cigarettes at the local smoke shop. Beyond that, pot not only treats the same symptoms more effectively than either alcohol or tobacco; it also diminishes their use. In other words, prohibition of pot–– to the extent it’s effective–– boosts juvenile consumption of alcohol and tobacco.

I also think getting a “medical marijuana” initiative on the 1996 ballot was a brilliant political move  because it took advantage of the public’s compassionate response to credible news that some very ill patients were being helped by it. What was NOT brilliant was “reform’s” immediate knee-jerk denial of a political motive when defenders of our drug policy accused them being “legalizers” with a political motive.

Of course “medical marijuana” was political.

Do right-to-lifers clamoring for a ban on “partial birth” abortion ever deny that they oppose all abortion and want to overturn Roe vs Wade ASAP? Who said drug policy reformers had to endorse their opponents’ rhetoric by agreeing that pot is ‘bad’ for adolescents; especially when data from pot users themselves shows just the opposite? In fact, my data shows quite clearly that ever since large numbers of troubled teens first began smokng pot in the late Sixties, the age at which they first try it has been declining steadily;  right along with the rate at which they also try heroin.

Some ‘gateway.'

Posted by tjeffo at 06:22 AM | Comments (0)

April 26, 2006

NORML Aftermath

This is the first entry since the ‘06 NORML Convention (San Francisco  from 4/20-4/22) ended. From now on, I intend to post more often and expect to have more time to do so,  because I will be spending less of it trying to  persuade 'organized reform’ to see the complex issues involved from my perspective. Since I know from experience that patients are far more likely to ‘get’ the things I'll be writing about, it makes a lot more sense to to focus my educational efforts on them through the blog.

Last week’s NORML meeting provided the last bits of evidence  needed to reach that conclusion. As is often the case, one item came from an unexpected source; the other came from a plan I’d hit on only after a last minute invitation to participate in a  panel on 'clincal use' of cannabis.

First the unexpected source: it was a brain-dead and ill-considered press release emanating (no other word suffices) from the FDA on Thursday, April 20, allegedly in response to a request from Rep. Mark Souder of Indiana. Whatever the truth of that claim, the timing  coincided with the first day of NORML; that some commentators apparently missed that obvious connection does not inspire much confidence in their abilities. As noted, the press release itself provided some key data; but in a completely negative way: it was simply florid propaganda echoing a former drug czar’s obvious attempt to spin the 1999 IOM report he'd requested— but then been disappointed by— because it (timidly) repudiated 2 key items of drug war dogma:  first, that “marijuana” has unique therapeutic value for at last some patients;  second there’s no compelling evidence to support that the idea that it leads people to try/use other drugs (“gateway” effect).

Thus the ballhooed 'report' was merely repetition ot a medically untrained general's opinion from seven years ago–– entirely without supporting evidence. What it actually demostrated how just how far the credibility of the FDA has fallen. That s commentators were oustspoken enough to recognize that fact and take them to task was encouraging; as was the simultaneous and unrelated concession by a hard core Right Wing SF journalist that pot has medical value.

As for the meeting itself; on Friday evening, I attended a hosted, but informal, dinner conclave of nominal ‘reform leaders’ where the main agenda item was to be medical marijuana framed in a context which had originally been ‘recreational’ versus ‘medical.’ Just before the dinner, I’d learned that ‘social’ had been substituted for 'recrational.’ No objection. I still don’t see the difference; but no objection. As for ‘medical’ I have always understood that to mean prescribed by someone with a medical license— as opposed to used on the person’s own judgement.

The point I wanted to make was that ‘medical’ has picked up so much baggage in the context of pot that there is no chance of any consensus ever emerging. In fact, anyone with much clincical experience in the practice of medicine will tell you that there is constant bickering and disagreement among physicians over the best treatment of certain conditions/problems/diseases. That’s the nature of the beast. Most clinical encounters begin with SYMPTOMS (patient complaints). The doctor then comes up with a working diagnosis and  has to decide how far to go in confirming it (ruling it ‘in’ or ‘out’). It’s a complicated algorythm which can vary with a host of factors; not the least of which is setting. For example, a GP who has known the patient for years is going to be a lot less worried when someone who has always exaggerated their physical symptoms complains of a new one— at least at first. On the other hand, an ER physician, who has never seen that patient before and won’t be able to conduct a follow-up,  might feel the need to order hundreds (or even thousands) of dollars worth of tests— mostly for his own protection against a possible law suit.

That’s one of the key reasons an ER is a bad place to go with minor or vague new complaints. The hardcore uninsured have no such billIng worries, and must be dissuaded by other means— such as long waiting periods in ERs. I’ve wandered off-topic, but I hope I've left you with a feeling for what the working MD gets paid to do: exercise clinical judgement. Now, I'm off across the Bay to exercise some clinical judgement of my own. The next entry will why I think the FDA fiasco may point toward a key strategy change that 'reform' should adopt; I will also describe more adventures at NORML '06.

Doctor Tom

Posted by tjeffo at 11:14 PM | Comments (0)

April 02, 2006

Epiphany (cont'd)

   In the last entry, I stated that Richard Nixon's drug war had actually stimulated the growth of the illegal drug markets it claimed to oppose. Why that was so should be a no-brainer for Americans- if for no other reason than as the World's most aggressive marketers we should realize that until a product is finally introduced to those it has the most appeal for, it may be a tough sell. In the case of pot, that clearly didn't happen until large numbers of adolescents were suddenly exposed to it in the the mid-to-late Sixties- just before "war" was declared on it by RMN.

In addition to availability,  what is most essential to any new product launch is advertising; something the 'war' on drugs has always been able to provide gratis- thanks to the unfailing willingness of the media to hype the latest drug scare. In addition, the public utterances of every non-MD 'drug czar' since Carleton Turner played that role for the  Reagans,  make it painfully clear that 'shill' is a far more accurate job description than 'czar.' What drug czars are paid to lobby for- and some do more vociferously than others- is the policy itself; especially its 'core' principle that there can be no  alternative to rigorous criminal prohibition. The current 'reason' - as voiced by James Q. Wilson while chairing a recent "expert" panel- is that because there is no political will to legalize drugs on Capitol Hill, "legalization" is a "non-starter." What a profoundly inane reason for not even studying a failing, expensive,  and very destructive policy while clinging stubbornly to its untested assumptions for nearly a century!

Next, I'll point out how  how all illegal drug markets, even the one for heroin, had really fallen far short of their real potential until passage of the CSA  in 1970- and how rediscovery of RMN's drug war by the Reagans, combined with a mid-Eighties  "crack"epidemic- finally solidified the drug war's place in history as a thoroughly bipartisan national disgrace.

 Tom O'Connell, MD

Posted by tjeffo at 05:03 AM | Comments (0)

March 31, 2006

A Continuing Epiphany

 Since prolonged silence calls for an explanation and this is the first entry since February 3rd, it seems like a good time to note that this was always intended as a different kind of blog. . Rather than a platform for airing opinions on several subjects, it has focused on an unusual project  I started more or less unwittingly in late 2001 when I began screening substantial numbers of applicants seeking a designation as 'patients' under the terms of California's famous 'Proposition 215.'

The intervening four years have taught me considerably more than I bargained for-- and not just about pot. The effort became a 'study' fairly early; as soon as I realized that the symptoms most applicants wanted to stress were not why most (actually, nearly all) of them had become chronic pot users ("heads")  sometime after first trying  it as adolescents. What I now realize is that they weren't consciously trying to deceive ; rather they were telling me what they either really believed themselves--or simply thought I wanted to hear.

My other belated realization has been that what I've really been studying hasn't been the "medical" uses of pot; rather it's a much larger phenomenon: how the now-huge illegal market for cannabis began to develop slowly and steadily right after a federal "war on drugs" was declared back in 1969-  shortly after pot was first discovered by a substantial fraction of the early 'Baby Boomers' who were then coming of age. It's also clear that the same market has grown incrementally as many older adults have remained users while new users were being recruited from each new class reaching Junior High. Finally, I also now understand why survivors of the early 'hippie' era, who are now in their mid-to-late Fifties, constitute a disproportionately large fraction of my applicant population--  while all  those born before 1946 make up less than 5% .

In other words, what has been most strikingly missed in the ongoing 'debate' about pot smoking in America has been its sharply defined generational nature and pot's continuing appeal for users beyond the ages of forty and fifty. That's probably why the first histories I heard from applicants of all ages struck me as being so wide of the mark. In addition to being  an experienced clinician who could decipher their physical complaints with reasonable confidence, I was also from an earlier generation- and  thus able to recognize something they didn't: the fact that nearly all of them had  also tried alcohol and tobacco at about the same time they tried pot was the clue they may have been trying all three as potential self-medications.

Little did I realize what intense denial that observation would provoke. Again, the problem proved largely generational: the great majority of active 'reformers' were also born after 1945; thus, like my applicants,  they are either 'Baby Boomers' or post-boomers who have grown up with the drug war and can't imagine the reality of my own  high school days  (1945-49) when "marijuana" was an exotic curiosity we had only hearsay knowledge of. The only two drugs troubled youth could try then were alcohol and tobacco. Of course neither were considered "drugs;" thus our first  experiments with them  were thought of as 'normal' adolescent rites of passage; and any subsequent repetitive use was 'recreational; not self-medication or the  possible beginning of life-long 'drug habits.'

But they were. The first important change in that dynamic was the addition of pot, as a third alternative to alcohol and tobacco, in the late Sixties;  just about the time several other 'psychedelic' agents were also  discovered. The world was then abruptly changed forever when an insecure  conservative  politician was elected to the Presidency and responded to what he saw as a drug-fueled youthful rebellion by declaring "war" on all (illegal) drugs.

What has become increasingly clear to me as I have gradually processed the revelations of California pot smokers in response to focused questions about their drug use is that when properly analyzed, that data provides both an excellent time-line of American drug prohibition as policy and is also powerful evidence that none of our now-huge illegal drug markets began  growing to their present size until after a minor-- and chronically failing-- drug policy was suddenly reborn as an all out 'war' on drugs.

More later,

Tom O'Connell, MD

Posted by tjeffo at 01:48 AM | Comments (0)

February 03, 2006

Grim Raich Aftermath

Any fair minded person paying even modest attention to events in California would have to agree that things haven't gone so well since Raich was "decided" of by  a predictably cautious SCOTUS in June.

That the Court refused to deal with even one key issue was no surprise ; predictably, it focused on an obscure  World War Two case involving wheat subsidies. Whether they even looked at a question that SHOULD have been raised by the 1914 Harrison Act-  direct federal intrusion into medical practice- wasn't mentioned; perhaps not even researched. Why  'reform's' brain trust had assumed that a recent Court  expression of distaste for the Interstate Commerce Clause might signal a willingness to overturn our carefully protected drug policy isn't at all clear; however, that's clearly what they did-- and the results aren't pretty.

One result has been sharply increased punishment of California medical users by law enforcement entities at all levels; all of it patently unfair and callously inhumane. Several activists free on bail while defending themselves against state charges were summarily arrested and jailed on federal warrants. There was little publicity and even less protest. Three are still held as federal prisoners in the the Fresno County Jail while their ridiculously complex bond procedures drone on. One (Thunder Rector) was released on unknown conditions to a halfway house in Modesto where he may or may not have  received the Marinol reportedly prescribed for him.

Will Foster, already famous for a 93 year sentence for medical use in Oklahoma (1997),  and grudgingly released on parole after serving over four years, was arrested by California police as a 'parole violator.' He has already been jailed for weeks and will remain in custody in Santa Rosa, at least until February 27th. Significantly, this isn't the first time such a travesty has occurred; but this time it seems more likely Will could be sent back to Oklahoma

Meanwhile, the seven year vendetta pursued by Placer County officials against activist and cancer survivor Steve Kubby has also taken an ominous turn. As this is written, Steve and his family are probably boarding an Alaska Airlines plane to the Bay Area on his way to serving a potentially lethal 120 day sentence in the Auburn jail.  Perhaps as well as any, the Kubby saga
exemplifies the disgraceful tactics used by American police and prosecutors to punish non-violent patients as 'criminals' for daring to seek relief from cannabis. Kubby's case is particularly poignant; not only does cannabis provide palliation; it has probably been the reason for his prolonged survival with a usually fatal malignant tumor. The antics of Canadian authorities who weren't persuaded by the public statements of Placer County officials that Steve would be both promptly jailed and prevented from receiving cannabis are in sharp contrast to the refusal of their predecessors who wouldn't  extradite a serial murderer because he might face the death penalty.

One is left with the idea that when it comes to certain human behaviors- and drug use  is certainly one of them- there is very little honesty to be found anywhere. Just why that may be so is suggested by data gathered from pot smokers; the data itself and the speculation it gives rise to will be aired in due time.

Meanwhile, we can only hope there is enough public support for medical use to  persuade those now in power to reconsider their current inhumane treatment of patients.

But I'm not holding my breath.

Tom O'Connell, MD
 

Posted by tjeffo at 02:03 AM | Comments (0)

January 05, 2006

An Interesting New Site

Because I can only work on the blog during bits of time stolen from other activities and- like everyone else- have been caught up in the Holidaze, it's been a while since the last entry. In it, I talked about the unknown- but enormous- size of America's illegal pot market, which only started growing to its present dimensions AFTER Richard Nixon declared a  'war on drugs' during his first term. Although impossible to measure precisely, evidence of the market's enormous growth can be gleaned from indirect sources: the estimated number of plants being grown continues to increase ; cannabis arrests, which now outnumber all others , have become the engine which maintains the world's largest prison population , and the market's dollar value, although the least verifiable measure of all, is conceded to be billions of dollars in every state.

I'm still working on the promised tabulation of my applicants' ages; but in the meantime, I want to call attention to a web site I just discovered. It's easily the biggest single compilation of information on California's providers of medical cannabis and related  services I've ever seen. In the short time I've had to explore some of its many links, I've found the URLs are generally up-to-date and work well. Among the various activist organizations and medical providers listed are several I have serious disagreements with in terms of their concepts of, and approaches to, 'medical' use. However, I don't regard the listings as a blanket endorsement, but rather as further evidence that there is an enormous amount of pent-up interest in a phenomenon - the contemporary American use of cannabis- which deserves far more intelligent interest and study than has ever been possible under an absurd policy and the repressive bureaucracies enforcing it.

 I've had some brief email correspondence with the author who is very responsive and also has an understandable basis for his own interest. I'm calling attention to his site primarily because it so dramatically reflects the growing interest in medical use stimulated by Proposition 215 despite efforts of law enforcement to stifle distribution and the media's consistently terrible job of reporting news about it.

Of course, I'd be less than candid if I didn't also admit to a certain pride at  his choice of this fledgling effort as "blog of the year."

Tom O'Connell MD

Posted by tjeffo at 06:59 PM | Comments (0)

December 18, 2005

The Elephant in the Living Room: America's huge pot market

Our pot market dwarfs all others for illegal drugs; yet, like them, it's rarely seen by non-users. Whether they consume alcohol or not, Californians encounter its retail distribution network every time they shop for food.  "Marijuana," which may command a comparable dollar volume, was sold through a distribution network that was nearly invisible in California until Proposition 215 created  a 'gray market' of sorts. It's ironic that as this entry is being composed, multiple busts  of medical marijuana outlets are being reported in San Diego. My purpose here isn't to comment on those busts, but rather to call attention to some of the absurdities brought out by standardized questioning of  Californians seeking pot recommendations.

 Just like all illegal drug markets, the pot market has thrived under the noses of the drug warriors; also like them,  it can't be measured directly. Thus police agencies are free to emphasize different points to different audiences. When seeking more money for enforcement, they cite evidence of market growth; when justifying their failures, they inevitably claim things would be much worse without the policy .

Ironically, in the case of pot, there is now convincing evidence that when Richard Nixon declared war on drugs in 1969, its market was still relatively small and just starting to grow.  Even more ironically;  given the emphasis on pot and kids, there is also convincing demographic evidence that virtually all its subsequent growth has been both incremental and a direct result of the recruitment, as customers, of the same fifth graders targeted by D.A.R.E. since the Eighties and surveyed so assiduously as adolescents by MTF/SAMHSA since 1975. Virtually all also tried alcohol and tobacco and many  went on to try several other illegal drugs as well.

In a very real sense, America's still-growing illegal pot market is the most redolent elephant hiding in our national living room.
In 1972, Richard Nixon disregarded the Shafer Commission's recommendation  that cannabis be decriminalized and studied for its therapeutic potential. Instead; he opted to continue  a 'war' on pot- a policy that has since been expanded and intensified several times.  Marijuana possession soon became the leading cause of felony arrests, which now number over three quarters of a million each year. Our total prison population, which has more than tripled since 1980, is well over two million.

It now clear that although the potential for today's huge illegal cannabis market  was created by the MTA in 1937, it didn't begin to be realized until pot was tried by hundreds of thousands of adolescents thirty years later. Ironically, the most important clue to their drug vulnerability was noted by the first researchers to  encounter them; however, it was misinterpreted after NIDA came on the scene at about the same time.

The important clue was that- almost without exception- the juveniles and young adults smoking pot in the mid-Seventies had already tried alcohol and tobacco. The first (and only) assumption by NIDA-- that pot somehow acts as a 'gateway' between legal and illegal drugs- it is still being assiduously investigated by NIDA-funded investigators thirty years later; yet the important nexus seems to be that all three agents can reduce the symptoms of stress and anxiety increasingly plaguing adolescents as life has become more 'modern' and complicated over the past two centuries.

The understanding that a robust illegal market for pot didn't begin for thirty years  after it was banned depends almost entirely on an absence of news during that interval: over twelve million men were in uniform during World War Two and yet the only pot bust to make headlines was that of Dorsey drummer Gene Krupa in San Francisco in 1943. The next celebrity bust involved  then (relatively) unknown Robert Mitchum five years later;  it generated coast to coast notoriety just ahead of television. The important points aren't whether Krupa's and Mitchum's busts were righteous or that they show that a small illegal pot market had always existed; rather that 'narcotic' arrests of relative unknowns could generate such intense curiosity.

What would become the 'counterculture' of the Sixties was foreshadowed in the Fifties by bi-coastal 'beat' writers who also attracted attention for their use of cannabis and newer drugs called 'psychedelics'.  The Fifties also saw the introduction of the first pharmaceuticals specifically intended for mental symptoms. That a surge in drug interest and availability took place between the 1962 firing of drug watchdog Harry Anslinger and Nixon's 1968 election is significant; many young people were being inspired by Civil Rights Movement and other movements that followed on behalf of 'free speech,' gays, and women. Those protests, in turn, had an effect on the "hippie" phenomenon when the 'baby boomers' born after World War Two began to come of age. Multiple protests eventually coalesced into an anti-war movement that would convince Lyndon Johnson not run in '68, and critically affect Nixon's judgement;  eventually driving him from office only two years after his 1972 landslide victory.

As mentioned earlier, the first encounter between researchers and youthful pot users (impossible under Anslinger) had occurred in the mid Seventies; although the association with alcohol and tobacco was noted; it was misinterpreted. NIDA's first major error thus became its obsession with validating a 'gateway' "theory" which has never passed muster as a useful hypothesis. More subtle; and even more egregious- has been NIDA's failure to recognize an incremental pattern as that market has continued to grow- let alone the reasons for that pattern. These elements are persuasively revealed  by a simple tabulation of the age distribution of the thousands of Californians I've interviewed for cannabis recommendations over the past four years. Whatever doubts one may have about the 'legitimacy' of their use, there is no question they are admitted chronic users who first tried pot as adolescents.

All but two were over 18 when first seen and 95% were born between 1946 and 1986.
The next entry will report their demographic specifics as chronologically related  to their initiations of alcohol, tobacco- plus the other illegal drugs they admitted trying from an arbitrarily selected  menu.

Tom O'Connell MD
 

Posted by tjeffo at 03:01 AM | Comments (0)

December 07, 2005

Denial

 

It's been over nine years since California voters endorsed the concept of 'medical' "marijuana" (therapeutic use of cannabis). Thus two different drug czars have had to contend with the shocking idea that a plant used medicinally in the East- possibly, as long as five thousand years before its 'discovery' in 1839-  then  by Western physicians for another hundred years before it was banned by a know-nothing US Congress (1937-- might actually be a safe and effective medicine.

Czar number one, Barry McCaffrey,  was prevented by injunction from punishing physicians for merely discussing cannabis with their patients. Later; frustrated by the IOM report he'd paid for-  he jumped all over the its placatory emphasis on the dangers of smoking. Who ever heard of a "medicine" that has to be smoked, McCzar asked rhetorically. His predecessor, John Walters, who seems even more reactionary and less informed than McCaffrey, was all over the "smoking" argument soon after taking office. His medical advisor, Andrea Barthwell, went on a junket to condemn the absurdity of "smoked  medicine" just before being briefly hired away from federal service- first by commercial interests touting a different route of cannabinoid ingestion (and a different axe to grind)- and then an even briefer exploration of a Senate nomination.

Back to the smoking controversy: neither czar had apparently heard about the relatively new technique of "vaporizing" cannabinoids to permit their safer inhalation. I'm not surprised;  because before I began screening patients in 2001 I hadn't either. Despite a heightened awareness since then, I have yet to see any reference to vaporization in either the popular press or peer reviewed literature. I've also been quizzing applicants on what they knew about it and continue to find that nearly all first timers- including those who've been using pot for years- are still very ignorant. Even those who'd heard something are relatively uninformed: the most common guess of the few who had heard about it is that it's a "safer way to smoke."

One would think the drug czar's office would be on the same page as the DEA on pot issues- and that both would have heard of vaporization in the past nine years; especially since the DEA has been busy blocking a responsible request by a researcher to grow enough high grade cannabis for a credible study on vaporization. Of course, such hypocrisy is of little surprise to anyone familiar with the the way the feds do things; it's just that they  are usually a little less obviously hypocritical.

Which brings me, in roundabout fashion,  to my main point- not that 'reformers' wear white hats and the feds wear black- but that all humans seem to exhibit two major characteristics: a need to compete and a willingness to cheat when they think they can get away with it. Both the DEA and ONDCP rely on the ignorance of the mainstream media and their relative unwillingness to embarrass the drug war; thus their hypocrisy is both safe and deniable.  Even worse for 'reform' is that while it isn't clear whether Walters' ignorance of vaporization is real or feigned, neither possibility is very hopeful for their political cause.

From my better informed (and even more ignored) vantage point, I realize that 'reform's' behavior confronts me with exactly the same dilemma: are they that cynical, or do they really believe; that s__t?

The subject of vaporization-- and of the critical role played the varying ways pot can be ingested-- will be explored in considerably more detail in the near future.

Tom O'Connell MD

Posted by tjeffo at 11:30 PM | Comments (0)

The Retchin-Magbie Fallacy: practicing Medicine without an education.

 
Although hardly as familiar as 'driving under the influence," the phrase. "practicing medicine without a license" has a comfortingly familiar ring which is also misleading in most instances.  Sometimes the alleged miscreant had been educated as a physician,  but for some reason, hadn't been able to obtain,a license. Far more often however, it's someone without any medical training who is simply impersonating a physician. In other words, the real offense is practicing Medicine without the requisite education and training.

The tragic 2004 death of Jonathan Magbie in a DC jail illustrates that difference very well; it also serves as a near-perfect example of what may be the most egregious- and least recognized- consequence of American drug prohibition. Although the faux "physician" in Magbie's case was medically uneducated; she does have a law degree and was legally empowered by our federal government to order the shockingly misguided "treatment" which led directly to an avoidable death. She will also probably escape any significant punishment; In fact, she has already been re-appointed to the same bench from which she imposed her judgement.

What the Magbie case illustrates so clearly is an historic error incorporated into our drug laws by two ill-advised SCOTUS decisions shortly after passage of the Harrison Act in 1914. They essentially empowered the nameless functionaries of a Treasury 'Tax Unit,' specifically created to enforce the untried new law with sweeping legal powers which  not only allowed them to make medical judgements they weren't trained for,  but also to enforce them on real physicians through the  harsh penalties which Harrison added to the federal criminal code.

The same ludicrous 'principle' was followed in the 1937 MTA which banned cannabis ("marijuana"); the critical difference between Harrison and the MTA-  one directly responsible for the current political flap over "medical" marijuana- was that the 'medical exception' allowed under Harrison- for some opiates  (
not heroin) and cocaine- which was continued by the CSA's schedule 2- was not allowed for cannabis. Speculation about what might have transpired had cannabis been placed on Schedule 2 rather than  being completely abandoned to the illegal market is one of the many  reasonable "what if?" questions that history will never get to answer. The parallel anomaly is that heroin- originally an effective and safe opiate patented by Bayer in 1898- was treated the same way when Congress officially banned it in 1924.  We all know how that turned out.

What the Magbie case does illustrate- in a particularly poignant way-is  what can happen when judges are authorized to make medical decisions for which they aren't qualified, and for which they have neither liability nor malpractice insurance. When I first read about it, I wondered how a partially ventilator dependent quadriplegic could possibly have been sent to a facility so lacking in the necessary expertise and equipment. Now that the details have been released, it seems the ineptitude and irresponsibility were even worse than I'd suspected; but the medically unqualified judge may have no liability whatsoever for her lethal misjudgment.

As if to underscore the arrogance and ignorance still rampant in our system of  "justice,"  a trial is scheduled to begin next month in California in which another young quadriplegic, will be  tried by his local DA on charges eerily similar to the ones that did Jonathan Magbie in. The major difference is that Aaron Paradiso has been successfully managed without a ventilator; however, he is also a very high quad and totally dependent on a dedicated team of family and friends who provide him with a remarkable level of around-the-clock care; one which could never be replicated in California's notoriously troubled prison medical system.

A particularly mindless touch is that this will be the second attempt to try Paradiso; the first was thrown out on a technicality before the Magbie tragedy.

If these two cases, both ironically occurring in venues where  voters have already approved medical use of cannabis, can't convince the American public that its criminal prohibition- and, indeed, that of all drugs- is an inhumane fraud; then perhaps nothing will.
 

Tom O'Connell MD

Posted by tjeffo at 11:15 PM | Comments (0)

November 26, 2005

More Connections -- and more Dots

Recently, I called attention to Claude Shannon, whose mid-Twentieth Century work on communication theory had both anticipated and greatly facilitated what we now know as 'information technology' (IT). Another entry promised to connect several 'dots' between the serendipitous study of pot users which originally inspired this blog and how several of its implications clearly point to major weaknesses in current drug policy.

Perhaps my study's most important revelation was that virtually all those applying for a cannabis recommendation in California were already experienced chronic users who had first tried it during adolescence. Two additional revelations were that most (95%) had been born after 1945, and nearly all had first tried (initiated) pot in close temporal conjunction with similar trials of alcohol and tobacco. The same characteristics had been noted by the first behavioral scientists ever to study the then-new phenomenon of youthful pot use in the mid-Seventies. Those observations  eventually led to a 'Gateway' "theory" which-- despite its subsequent inability to earn validation--  is  a major rhetorical argument used by federal policy makers who remain insistent  that harsh punishment for possession of arbitrarily designated 'drugs of abuse' is an essential element of drug policy.

Important differences between mid-Seventies observations cited by Kandel and my more recent ones is that, as the American cannabis market has grown dramatically in size over time , and  pot has become even more available to adolescents , the  average age of  its youthful initiates-- at least, those who eventually apply  for  medical  recommendations-- has declined. The most recent analysis by cohort shows that alcohol, tobacco and cannabis were all tried at the same average age (14.9 years) by those applicants born between 1976 and 1985.

It is to be stressed that although data entry is  incomplete,  demographic data from over half of the approximately 3000 individuals seen during the past four years has been entered.  It's thus quite unlikely that  average ages at initiation will change significantly.

Another  implication,  strongly supported  by  both the demographic data and the aggressive initiation patterns  for  several  other  illegal drugs exhibited by this  population over the same time interval is that their drug initiations are far more likely to represent inchoate youthful attempts at palliating symptoms of emotional origin than reflecting irresponsible youthful hedonism.

Human emotions were not recognized as phenomena worthy of serious consideration by scholars until  the Renaissance;  despite considerable subsequent attention from philosophers, they weren't thought of as producing symptoms requiring pharmaceutical intervention for another 350 years; yet it's quite likely that the humans who left  Africa in the series of migrations completed some 13000 years ago-- and who were the antecedents of all modern humans-- possessed brains which were structurally and physiologically indistinguishable from our own.  Thus, any behavioral differences between them and ourselves almost certainly  results from phenomena we are just now beginning to study seriously under the rubric of cultural evolution.
 
Given the current planetary ecology  and the doctrinal divisions which continue to plague our rapidly expanding species, the importance of a global drug policy based on honestly gathered evidence which has then been accurately interpreted can't be overstated.  That current policy is clearly derived from religious beliefs which are being dishonestly portrayed as Public Health is as obvious as the reticence of the 'scientific community' to object out of fear or feigned disinterest.

The  apparent willingness of so many scientists to tacitly accept such overt perversion of their profession's most essential attribute out of fear is an ominous omen.
 

Tom O'Connell, MD

Posted by tjeffo at 06:13 AM | Comments (0)

November 21, 2005

Historical Background

California's "medical marijuana" initiative just celebrated its Ninth birthday; it was passed in November 1996-- nearly sixty years after cannabis ("marijuana") was first banned by the feds, and twenty-five years after then-President Nixon summarily rejected the cautious recommendations of his own "blue ribbon"  (Shafer) Commission) to decriminalize it and study its potential medical benefits. As we now know, Nixon opted instead for a disastrous war on drugs which soon began a series of dire changes in American society, the most obvious of which has been a steadily growing prison population which is disproportionately poor and dark-skinned. Parallel developments have  been real declines in state educational and health care budgets, a noticeable drop in the performance of American primary and secondary students in public schools, and- more recently- an  obesity epidemic affecting all age groups; especially children and adolescents.

  That the medical marijuana initiative was supported by 56% of  Californians over  strongly voiced opposition from sitting and former federal politicians and bureaucrats-- plus law enforcement bureaucracies at both state and federal levels-- evoked some surprise; but hardly the political soul-searching that might have attended a similar voter rejection of almost any other policy item. The entire federal bureaucracy then closed ranks in declaring  the vote a "mistake" and continued to oppose any implementation of the new law. Thus encouraged, state and local police blatantly denied their obligation to uphold California's constitution as they began harassing and prosecuting the first 'medical' users to be 'certified' by those few physicians then willing to defy federal threats and process applicants as the new law allowed.

In general, the media has continued to treat drug war topics as quirky; especially if they deal with cannabis- it has continued to emphasize word play over fact and give the default to the federal position that 'marijuana' deserves  criminal sanctions because of its presumed danger to youth.

Primarily because the Ninth Circuit upheld the First Amendment and a few communities-- mostly in the Bay Area-- provided a modicum of critical support for the new law (virtually abandoned by the Legislature and vigorously undermined by then- AG Dan Lungren), several pot clubs  survived in the Bay Area. They soon became hubs where patients from other parts of the state could be directed to compliant physicians, obtain more reliable cannabis with a greater variety of cannabis products, and network with other medical users. It was at that point (late 2002) that I began seeing a steady stream of applicants at a popular Oakland club and, soon after, at two smaller clubs; one in San Francisco and another in Marin County.

I soon gained a fairly straightforward insight: perhaps the most greatest potential benefit of the new law had been the (unanticipated) opportunity it provided for physicians to systematically examine a population of chronic pot users which had been previously "hidden" from view by threats arrest/exposure. All that was required would be a willingness to ask them the right questions, a technique that could look past their own excuses for using pot- and a way to elicit whatever other conditions most of them (seemed) to be self-medicating.

Although patient denial-- particularly by males-- that they use pot for emotional reasons is almost universal, a sympathetic approach, plus a demonstration of sincere interest-- when coupled with a "structured" interview have allowed me to elicit  a credible 'profile' of pot smokers. One of several bonuses has been a coherent explanation of the illegal market which had been launched on its present pattern of inexorable growth at about the same time Nixon launched a "war on drugs during his first administration.

That these and other issues have had little appeal to the self-appointed gurus of 'reform' has engendered a lonelier and more intense evaluation of what I've learned from applicants/patients over the past four years. Indeed, as
I've had the opportunity to see a growing number of 'renewals,' the dimension supplied by people newly educated to their own lifetime pot use has only added to my conviction that an opportunity to carry out unbiased clinical evaluations of drug users has been the (critical) missing ingredient which has allowed our feckless and uninformed drug policy to gain such undeserved power.

I look forward to sharing more insights from this ongoing study of pot use as they become available.

Dr. Tom O'Connell
 

Posted by tjeffo at 04:21 AM | Comments (0)

November 18, 2005

More Dots

When I first tumbled to the fact that passage of California's 1996 medical marijuana initiative had provided a serendipitous opportunity for a clinical study of chronic pot use, I was actually embarrassed that it had taken me so long to come to that realization (it was then about mid-March 2002, and I'd been seeing twenty or thirty applicants each  week from mid-November of 2001).
What has since become more than a bit frustrating have been my vain attempts to get self-proclaimed drug policy 'reformers' to  even recognize that such an opportunity exists- along with the stubborn quality of their denial. In fact; my need to understand that denial became a major preoccupation for the simple reason that as the scope of the study has grown, the effort required to complete it has expanded to a point where it now exceeds the resources, time, and technical expertise one individual can bring to bear. Thus, without some key help, further data acquisition may have to either be stopped or severely curtailed.

A limited evaluation of what's already been learned from standardized interviews of cannabis users suggests very strongly that an accurate and unbiased clinical analysis of the appeal cannabis has for humans may well offer the single most effective route to understanding both our urge to use all psychotropic agents and the parallel urge governments have to 'control' such use.</