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February 17, 2007

'Progress' in a Glacial Debate

In addition to DEA Administrative Judge Mary Ellen Bittner's non-binding recommendation that Professor Lyle Craker be allowed to grow cannabis for research purposes, a second cannabis-related medical milestone was reached this week: a paper from the University of California Medical School in San Francisco reporting that inhaled cannabis significantly reduced AIDS-related neuropathic pain in a small, but carefully controlled series of human subjects, was published in the peer-reviewed journal, Neurology. Of the two events, the latter seems more likely to have both immediate and lasting impact on drug policy. There is also a decent possibility that the almost simultaneous announcement of the two events might have a synergistic effect by deterring Bittner’s DEA superiors from rejecting her recommendation as they would otherwise be certain to do.

My optimism stems from the historical impact of an earlier peer reviewed paper which ‘officially’ established a medical benefit from cannabis that could not be easily dismissed. It’s significant that by the time Proposition 215 made it to the ballot in 1996, federal rhetoric had shifted from the dogmatic assertion that, as a schedule one drug, pot couldn’t possible have ‘medical utility’ to the significantly different position that other medications worked ‘better,’ and without the ‘undesireable’ (code for immoral) effects of ‘crude’ marijuana. It was also certainly more than coincidence that Marinol, a semisynthetic form of THC,  was developed for oral use by Unimed during the protracted DEA hearings that led to Judge Francis Young's famous opinion and then approved for schedule two the same year.

More recently, the rhetorical argument with which Barry McCaffrey, following cues within the report itself, minimized the impact of the  1999 IOM report by stating that anything 'smoked’ couldn't be 'medicine, was adopted by the FDA this past year as the main reason it would never be approved for therapeutic use. Just coincidentally, vaporization, the technique that the cannabis Professor Craker hopes to grow would be used to study, is of interest primarily because it would obviate most of the theoretical danger from inhaling the products of plant combustion, a danger recent studies have unexpectedly failed to confirm. Such is the glacial progress of the arcane, largely rhetorical, and completely dishonest 'debate' that's been raging between the feds and reform since 'medical use' was first raised as an issue in the early Eighties.  Sadly, that debate has been neither understood nor accurately reported by the media and what my own experience underscores is the enormous advantage the government has always enjoyed from being able to use the criminal code to place millions of self-medicating humans off limits for clinical research.

Of course, the insistence by most lobbyists for medical use that it's only valid for the 'seriously' ill, and that their lifetime use has been strictly 'recreational' hasn't helped to either clarify a murky situation or advance their  cause. Quite the opposite; it has tended to validate the exaggerated Cheech and Chong image of the Seventies.  In that way, opinionated reformers have been more than a little like the Congressional Democrats who painted themselves into a corner by voting for a feckless war in Iraq.

Incidentally, neuropathic pain is a well known, but poorly understood, medical problem which also tends to be under treated; the fact that cannabis can do so effectively wasn't news to me because I'd been enlightened by several patients seeking recommendations; unfortunately, that still isn’t ‘official,’ because it has yet to be published in a peer reviewed journal.

But I'm working on it...

Doctor Tom

Posted by tjeffo at February 17, 2007 04:42 PM