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April 28, 2006

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 goes well beyond mere recreation— whether the user cares to admit it or not. I’ I'm also of the opinion that–– in any sane world–– self-medication with pot should not require any more scrutiny than is required 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; but 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 27, 2006

NORML Aftermath 2

Yesterday, I said  I'd comment on the FDA 'press release' released on the first day of last week's NORML Convention. Well; it was both pathetic and political: unsigned, covering no new ground and  most noteworthy  for its inaccuracy and political ineptitude. In fact, it was so bad that the mainstream media  jumped on it almost from from the start: the most influential early report by Gardiner Harris of the NYT,  quickly set the tone by  immediately noting its political nature and soliciting critical opinions from a variety of sources, including an annoyed John Benson, one of the senior authors of the original IOM report.

For someone like myself, who has been following the sparring between federal authorities and reformers for years, the shabby pretext for releasing this 'report' on 4/20, its lack of content, plus its scientific and political ineptitude all represented new lows for the other side. Also surprising was the volume of critical media commentary, the degree to which drug war hypocrisy was openly recognized, and the willingness of many sources to  take the policy to task. Clearly, an opportunity to make some political hay had been presented to 'reform.'

What has been very disappointing–– but not that surprising–– has been the manifest inability of 'reform leaders' to recognize the golden opportunity they were just handed by proponents of the policy they are supposed to be opposing. Their timid, business-as-usual attitude was typified by a quote from Ethan Nadelmann who, instead of noting the obvious sins of the press release, took it at face value and simply complained it would make things more difficult.

Obviously Ethan has never heard of the football maxim that the best defense is a good offense. What will it take for 'reform' to wake up to the fact that the dishonesty and egregious manipulation of science by the drug war is that policy's greatest political vulnerability?

Posted by tjeffo at 05:09 PM | 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)