November 30, 2006
It’s probably no accident that just about the time our embattled president is being snubbed in unprecedented fashion both at home (literally) and abroad (in Jordan) for the failure of his war in Iraq that a remarkably candid conclusion was appended to this year’s UN Drug and Crime Report; especially so since this is the international agency created to carry out US inspired drug prohibition on a global basis.
For those with a taste for detail and the time to wade through it, the entire report is also available.
Denial and the War on Drugs
Even as the Bush Administration was desperately pushing to depose Saddam Hussein in the wake of 9/11, many Americans and Europeans were warning that a war of aggression in the Middle East on shaky grounds held great potential for disaster. Now that the Iraq war has lasted longer than American participation in World War Two and it’s painfully clear that there was no exit strategy and even less prospect for credible ‘success,’ it might behoove the nation to recall that the Iraq war has an evil twin in the war on drugs.
The great anomaly represented by the drug war is that it too, is a folly based on wishful thinking, has now lasted ten times as long as Iraq, is just as bereft of credible success, and has had an even more corrosive effect on our nation’s institutions; yet there is no popular move to repudiate it or even rein it in. Quite the contrary, it seems as secure as ever: a cherished policy supported by all branches of the federal government and opposed only by a politically inept and disorganized ‘movement’ which can’t seem to get out of its own way. Indeed, the drug policy reform movement seems to be taken taken seriously only by the drug czar and ONDCP where the ‘P’ stands far less for policy than for propaganda. Both groups are focused on each other and the public seems barely to notice.
Early in my eleven year affiliation with the movement I had the same trouble as many others in understanding its perennial lack of success: it (we) held the intellectual high ground and could produce all sorts of logical arguments on behalf of needle exchange, medical marijuana, injection rooms, shorter sentences, etc. American drug policy was obviously wasteful, destructive, and hypocritical; yet it seemed to thrive on a steady diet of lies, bloated police budgets and failure. Overseas, it was associated with CIA skullduggery in which many early ‘successes’ had morphed into failures: Viet Nam, Central America, Afghanistan, the Andean nations, various Caribbean republics, and Mexico.
The seemingly endless war in Colombia is an example; we instigated the serial destruction of two rival cocaine cartels only to have their lucrative business fall into the hands of a left wing guerrilla movement that has been at war with the central government as long as most people can remember. Plan Colombia may have been pushed off the front pages by Iraq, but it’s as big a loser as ever.
It wasn’t until about five years ago, when I was encouraged to come out of retirement to screen applicants hoping to use cannabis (‘marijuana’) medically under the terms of California’s 1996 law, that I began to understand just how diabolical the war against it really is. In a nutshell, pot turns out to be a valuable psychotropic agent that owes its phenomenal market success to the discovery of its inhaled form by hippies and baby boomers just about forty years ago. Nixon’s war on drugs, launched in 1969, has actually acted as fertilizer for all illegal drug markets, but most of all for pot, which quickly became more popular than all other drugs except alcohol and tobacco, a position it has maintained throughout the entire drug war. In fact, understanding the key role played by pot in the lives of its adult chronic users provides a good understanding of the quite different roles played by other ‘drugs of abuse’ (all are tried as possible self-medications, but psychedelics cannot play that role chronically) as well as a clear idea of how profoundly federal drug ‘policy experts’ and police have misunderstand what they are about; mostly because of the erroneous assumptions made on behalf of the policy they are vainly trying to enforce.
The corollary is that a drug war which was started as alleged Public Health has become a major threat to the Mental Health of the nation. The policy is no longer about ‘control’ of the criminal markets which owe their very existence to the policy, but about justifying the grossly unfair arrest and imprisonment of some drug users. We are far more likely to rebuild Iraq in the face of the present insurgency than we are to ever ‘win’ the war on drugs. Both policies are sapping us economically, intellectually and spiritually; yet we are miles from any serious possibility that our malevolent drug policy will be repudiated, or even significantly softened, in the near future
The blame for this sorry state of affairs does not lie just with the obvious wing-nuts in the DEA and ONDCP; it is shared by most of the American polity from academia, the professions, and the media, down to the man in the street. I don't claim to understand the phenomenon completely, but would submit that understanding the reason behind our nearly universal acceptance of a grievously flawed policy is particularly urgent; if for no other reason than the denial required to do so is not unique to the drug war; it's widespread and affects the welfare of both our planet and our species in many different ways.
November 27, 2006
I ended yesterday's entry by noting that although the possibility of jury nullification (JN) had been created in the Costa case, it certainly didn't happen. To which I would add that until there is a level of popular outrage against the drug war that's at least comparable to the antipathy towards the war in raq that finally surfaced on November 7, the drug war has little to fear from JN. For one thing, it's a concept that's poorly understood by the public. For another, it's opposed on an almost visceral basis by lawyers or all stripes; perhaps because it so directly threatens their professional image.
Finally, as a practical matter, the successful implementation of JN in any given case requires that at least one or two determined jurors be prepared to hold out; thus preventing the others from following the judge's instructions (which in federal drug trials will always be to convict) for as long as it takes to either hang the jury or- even less likely- defy the judge by unanimously voting for acquittal. That Costa's jury was given the case on the day before Thanksgiving points out some of JN's obvious problems.
That leaves reversal by a higher court as the main concern presented by federal trials to drug warriors charged with defending their unscientific and illegitimate policy. One way to appreciate how little they have to fear from public opinion is that although the drug war is just as unlikely to be won as the war in Iraq, and public has known that for a long time, its repudiation as policy seems much further off. The reason for the dichotomy is simple: the bodies of dead GIs may come home in the middle of the night and their caskets aren't photographed, but they are still counted as victims. Most victims of the drug war, on the other hand, remain both unknown and incounted; even the most obvious, those enmeshed in our system of 'justice,' have been so successfully labelled criminals and druggies that fear of them is now a reason for becoming even tougher of drug crime.
In the next entry I'll discuss the skimpy history of federal marijuana prosecutions post 215, and offer several reasons why I think their reluctance to prosecute was so abruptly reversed by the Raich decision in June 2005.
Parsing the Costa Conviction
As noted earlier, on November 22, a Federal jury in Fresno voted unanimously, and with almost no discussion, to follow the judge's instructions to convict Dustin Costa of growing marijuana under circumstances that leave him liable to a twenty year sentence that could easily add up to life for a sixty year old diabetic. I had seen Dustin for his last two medical recommendations in '03 and '04 and was closely associated with his efforts to establish the Merced Patient Group throughout '04 and '05. I had also written to him throughout his federal incarceration from August '05 on, and was one of only two defense witnesses called at his trial last week.
Thus I think I have a more informed position on his case than most; yet what I actually know for sure is both fragmentary and speculative; primarily because both the federal government and their nominal opponents in reform have been less forthcoming than they might have been and both sides also clearly know far less about the phenomenon of cannabis use than they think they do. For the moment, the feds have momentum and seem ready to plunge ahead with a series of show trials in Fresno intended to discourage legal distribution under California's 10 year old initiative. Meanwhile, most of the movement's political supporters still haven't acknowledged the huge setback represented by the Raich decision in June of 2005.
The characteristic emerging most clearly in this short recitation is that the issue of medical marijuana is much more complicated than most people assume; yet it's one that's still being argued on the same simplistic grounds that dominated 'debate' during the run-up to the 1996 election. That's probably as good a sign as any that neither side has learned much in ten years. The tragedy is that my practice confirms that those applying for recommendations possess key information about how (and why) an enormous criminal market has developed around cannabis (marijuana) under the noses of the same bureaucrats who have been directing our lavishly funded drug war for forty years.
That evidence, in the form of the aggregated medical histories of applicants hoping to take advantage of the proposition, also clearly indicts the drug war as an unscientific fraud; however, only if one hasn't first been beguiled by the same scare tactics found at the root of all prohibition policy. In other words, the same uninformed 'thinking' about 'addiction' which led the Holmes Supreme Court to convert the Harrison Act into de facto drug prohibition between 1917 and 1919 is alive and well; not only within the federal government, but also within the drug policy reform movement, where it seems to have become an item of faith for a majority.
That's a lot of complex heresy to digest, so I'll leave it right here until tomorrow, when I'll explain why all was not lost with the Costa verdict; which, although tough on Dustin for the foreseeable future, may actually have been the best possible outcome in the long run.
Certainly, old fashioned jury nullification doesn't seem to have been remotely possible, for the simple reason that his jury definitely knew it was a medical marijuana case and still voted speedily to convict.
November 23, 2006
Yesterday, the day before Thanksgiving, twelve federal jurors from Fresno took the path of least resistance and returned to their holiday preparations after voting unanimously to convict my friend Dustin Costa of illegally growing cannabis ('marijuana') a mere two hours after receiving the case from Judge Anthony Ishii, who will pass sentence at some future date. The maximum (20 years) he could give Costa, who turned both 59 and 60 while spending the last 16 months in the Fresno County jail awaiting trial, and is also diabetic, would amount to a life sentence. Ironically, Ishii is certain to be aware of that because he has a degree in Pharmacy earned before he went to law school.
This egregious miscarriage of justice was reported in an appropriately sketchy account in the local paper, one quite in keeping with the few details jurors were allowed to hear during a trial severely truncated by rulings from the bench. There were only two defense witnesses: Chris Conrad, who was mentioned in the Bee article, and myself, who was not.
One of the few things I know for sure is that the jurors had to know this was a 'medical marijuana' case, yet they all opted to convict and eat turkey; there were no hold-outs for basic fairness. That doesn't auger well for the pending federal prosecutions stacked up behind Costa's trial,which was clearly seen as a dress rehearsal for those to follow. While there is good reason to hope the Ninth Circuit won't go along, Costa's conviction clears the way for a federal steamroller to start in Fresno in 2007 and run unimpeded; at least until the much slower appellate process can catch up.
I'll have a lot more to say about the Costa tragedy (there is no other word to describe it) in coming weeks. Hopefully, the powers that be will allow him out on bond pending the appeal he intends to file, but for the immediate future, federal control over 'justice' is far greater than over the illegal pot market they claim to oppose.
November 22, 2006
Yesterday I went down to Fresno to testify in the federal trial of my friend Dustin Costa (more about that in a few days). The jury now has the case and we'll know their verdict relatively soon. What this entry is about is the local story reported in the Fresno Bee that I happened to pick up while choking down a hasty breakfast in the coffe shop next to the federal courthouse.
I don't know if alcohol played a role in this recently deployed Marine just back from Iraq, if any drug was involved, it certainly wasn't pot. The fact that his infant son had already been treated for a broken arm in that situation means that the functionaries who returned the child to the father's care after the earlier injury were derelict, because it's virtually impossible for an infant to sustain that injury on his own and the circumstances were so suspicious. It wasn't the war in Iraq that overwhelmed this 20 year old father; it was being thrust into a situation he was emotionally unequipped to handle without more help.
I may have never seen a more emotionally obtuse response to tragedy than the one embodied in this story...
November 17, 2006
Is PTSD an anxiety syndrome best treated by cannabis?Last Monday evening, Anderson Cooper 360, CNN's generally worthwhile evening news magazine, focused on the major stresses American military families must cope with: repeated deployments to Iraq, now becoming more common for both active duty and reserve personnel.
As an Army surgeon in Japan from September '63 to August '67, my first substantial experience with wounded GIs began roughly halfway through my tour in mid-November 1965 when forty or so wounded Ia Drang Valley survivors were delivered by helicopter to Zama Hospital on the outskirts of Tokyo just days after I'd become the Chief of Surgery. Zama had, until then, been the only Army Hospital in Japan; personnel for two others, the Seventh Field, and the 106th Evac, had just arrived, and they soon became fully operational after hasty renovation of the two unused military barracks, also near Tokyo, that would house them. Planning for that dramatic medical expansion had begun with the decision to deploy troops to Viet Nam earlier that summer following the Gulf of Tonkin incident.
Just as the nearly-legendary Battle of the Ia Drang Valley has come to be seen as a dress rehearsal for the vicious war that followed, so did the technique for air evacuaton of wounded GIs to Japan that we pioneered in November 1965 become a model that would be improved and expanded until peaking after Tet in February '68 and then gradualliy tapering off as the war was gradually 'Viet Namized.' In fact, it had been the availability of the first version of the same medevac transport now shuttling GIs from Baghdad to Germany that had made it possible
I rotated to Letterman in San Francisco as a chest surgery resident in August 1967 and found myself on the other end of the evacuation chain. I continued to care for GIs with complicated chest wounds until leaving the service in September '71. My exit, earlier than planned, was at least partiallly because I could no longer support a war I had once believed in.
CNN's presentation brought back a rush of memories; along with an appreciation of the many similarities and differences between the Viet Nam and Iraq wars; not only in terms of the quite different tactics employed and wounds produced, but also of the stresses they produced. Along the way, there have been major changes in military culture resulting from the replacment of young conscripts by an 'all volunteer' Army with its greater emphasis on marriage and children.
When CNN segued into a consideration of PTSD, I was quickly forced to acknowledge another major difference between the two wars; one that that certainly wouldn't be mentioned on TV: pot is still being used by thousands of Viet Nam veterans as their main treatment for PTSD. Sadly, thousands of others, many of them homeless, are still using alcohol for the same symptoms. Many boomers, who were just discovering pot, even as as Nixon was opting for a war against it, wound up in uniform: some tried it before they were drafted, others while 'in-country,' and still others after their return. It has been used by many of the vets I've interviewed; some, even as they have continued in support groups at the San Francisco VA, without ever mentioning their pot use to the psychiatrist.
In fact, my education at their hands is a good example of how Proposition 215 has worked to inform: patients who had been
self-medicating on their own, when pressed for details, were often able to educate me (often without realizing they were) to a clinical reality I wasn't aware of. Thus I could place their use in the clinical perspective needed to characterize it in medical terms. That's the key difference between starting a clinical analysis with a nugget of hard fact (cannabis was successful treatment for years), as opposed to being kept in the dark by an enforced misconception (no drug of abuse can be useful or safe).
It has since become easier to recognize how often (non-specific) symptoms of anxiety are a part of PTSD; another fairly common examples have been the odd cases of sexual molestation I began hearing about when I started to take detailed family histories; not because I was looking for them specifically, but perhaps because my questions about the details of school and childhood may have encouraged it. I have vivd memories of middle aged adults of both genders breaking into tears while telling me of events previously confided only to siblings or very close friends. Given the frequency of early divorce, remarriage, and custody battles in this population, sexual abuse at the hands of step relatives has not been that rare; and I am probably still not told of all that occurred. I soon also learned that often, an abused step-daughter is blamed by her own mother for provoking the abuse, if she were believed at all.
Beyond that, the tightening temporal proximity demonstrated by MCAs in their initiations of alcohol, tobacco, and pot suggest that the three agents still compete to become 'drugs of choice' for troubled adolescents. The inevitable conclusion is that young people who are successfully coerced into avoiding, or giving pot up, may become even more vulnerable to use of alcohol and tobacco as stress relievers. That certainly describes our modern Army; beyond that, its better pay, expanded benefits, and greater reliance on women soldiers, has increased the percentage married service members with young dependents. I can imagine no greater emotional pressure on families than the present cruel calculus of repetitive deployments of two young parents to dangerous duty.
Along with the much higher incidence of closed brain injury and lower limb amputation produced by IEDs, the civilian carnage from what is really an urban guerrilla war is already known to be producing an extraordinary incidence of PTSD among Iraq returnees. What I also know to be true, but could never be even hinted at in the CNN report, is that the PTSD care available to them through the military and VA would be not only less effective because cannabinoids could not be a choice, but those daring to use them might well risk all their benefits.