« In the News | Main | Another View on Dispensaries »

March 22, 2007

Coincidence, an Omen, or just Inevitable?

I still subscribe to my local newspaper, the SF Chronicle, even though I’m less than impressed by its performance under the Hearst management that bought it. One reason is habit; I’ve lived in the Bay Area since 1967 and have become used to starting my day by retrieving the Chronicle and reading it with the first cup of coffee. This morning’s edition contained a very pleasant surprise: Robert Collier, a writer I’d learned to respect in pre-Hearst days for his intelligent reporting from Mexico and Latin America, has a front page piece below the fold that deals with the same general issues as the entry I was planning to post this morning.

My answer to the question at the top of this page is that change in the direction of a more rational drug policy is probably inevitable; largely because of all the people who have become pot users since Nixon declared war on drugs. How long it will take and how much damage will be done in the meantime is still anyone’s guess.

With that introduction, here’s the long entry I worked on much of yesterday:

The Political Background of a Clinical Study

What I’ve been engaged in for the past five years has been a study of chronic marijuana use, one that started as an attempt to answer a question that flared shortly after passage of Proposition 215 in November 1996: just what is ‘valid’ medical use anyway? It was an argument which really began on December 30, 1996, when Drug Czar McCaffrey switched from total opposition to all use in a press conference ridiculing tentative guidelines published by proponents of the initiative. The real purpose of the press conference was to threaten any physician for even discussing use of cannabis with a patient with forfeiture of a little known DEA license created by the 1970 Controlled Substances Act and required for hospital privileges within California. That threat, which would have effectively canceled the initiative at one stroke,  was stayed on First Amendment grounds by the Ninth Circuit, an injunction upheld four years later after the first Bush Administration appealed it all the way to the Supreme Court.

The drug czar’s new argument about ‘valid’ use continued to smolder within the state as 215 was being implemented by a small coterie (probably less than twenty) of the first cannabis-friendly physicians wiling to sign recommendations. Gradually, several ‘clubs,’ open only to ‘patients’ with such recommendations, began operating in a few tolerant areas in defiance of the federal displeasure underscored by McCaffrey’s threat.

 Meanwhile, organized opposition from state and local law enforcement agencies would effectively stymie ‘enabling’ legislation for nearly eight years, thus allowing the law to be shaped by Supreme Court decisions at both state and federal levels. Taken together, the rulings of both courts have upheld the initiative’s validity, but failed to address production or distribution in a definitive way. The state court did rule patients could legally grow a limited supply with the aid of ‘care givers,’ while the federal court issued an injunction against distribution by the Oakland Cannabis Buyers’ Club (OCBC), which is still being appealed. The OCBC also began maintaining a confidential voluntary registry of patients with recommendations and tracking their renewals as a service to other clubs not blocked by the federal injunction. After I started seeing patients in November 2001, a source within the OCBC told me that of approximately 20 000 recommendations recorded by the club, 15 000 had been renewed and were then ‘valid.’

As can be seen from this brief description, the situation that existed when I began screening applicants in November 2001 was complex and still evolving. Both characteristics have intensified over the next five years in ways which, like those encountered during first five, could not have been easily anticipated. For example, current estimates of the number of Californians with recommendations range from 250,000 to 350,000, suggesting that the number granted during the first five years was multiplied some ten to fifteen times during the second five; yet no coherent explanation of that increase has been offered by either side of the debate, a circumstance suggesting to me that both may find it embarrassing; although perhaps, for different reasons.

Similarly, the generally clueless articles that have been appearing in small town newspapers throughout the state describing the struggles of local governments with the (suddenly) burning issue of business licenses for pot ‘dispensaries’ almost never speculate why there was no demand for them for the first seven or so years after Proposition 215 was passed. The answer is really quite simple: it had taken that long for the a couple of high volume practices  to develop effective business plans featuring seven day a week, no-wait processing of walk-ins in several locations to generate a huge increase in potential ‘dispensary’ customers. It’s just another variation of, ‘if you build it they will come.’ Also, a relatively complete current list of those physicians willing to sign recommendations shows that their number has also grown considerably in the five years since I got started.

In the first paragraph, I said I originally intended to look at ‘valid’ medical use, however, after discovering the degree to which the first several hundred applicants shared certain characteristics, my focus gradually shifted to a much larger issue, one that had been obscured by political rhetoric since 1975, when MTF studies first disclosed just how popular pot was becoming with the high school set: why had the illegal pot market grown so much faster and become so much larger, in terms of customers, than all other illegal drug markets?

In that context, NORML, founded in 1970, had already committed itself to defending ‘recreational’ use by 1975 and the parental backlash favoring a ‘drug free’ America that would later gain critical support from the Reagan Administration was yet take shape. It was precisely those polarized attitudes toward ‘recreational use,’ a phenomenon which could never be studied on its own merits because of political realities, that were injected, nearly unchanged, into the political arguments which have continued to dominate implementation of Proposition 215 during its first ten years.

In a very real sense, the expansion of America’s illegal pot market was mirrored by the  expansion of its ‘medical’ market in California. A further irony is that the overlooked reason behind growth of both markets has been pot’s appeal for its most important initiates: troubled adolescents who begin self-medicating with it sometime after trying it for the first time.

Uninformed arguments about whether such chronic use is ‘valid’ pale in comparison to the overwhelming fact that it is part of modern reality; yet they continue to dominate the enforcement of a destructive policy and most public perceptions of its value and necessity.

What is really called for is a reasoned look at the reality behind pot’s immense and still growing popularity. One is forced to wonder if such critical thinking about emotional issues is even possible in this country.

Doctor Tom

Posted by tjeffo at March 22, 2007 05:49 PM