March 28, 2007
Differences of Opinion...and the Ability to Change One’s Mind
My comments on Bill O’Reilly’s recent rant on medical use in California clearly didn’t take his apparent endorsement of medical marijuana very seriously; however, some of my ex colleagues in reform apparently did.
In that same vein, it’s also clear that others I once considered hopeless ideologues have proven me wrong by at least a partial conversion to a more compliant mind set on the subject. One such was Dr. Sally Satel, whose more recent piece is a model of rational analysis.
Another, and even more surprising, partial convert was Bob Barr. This ‘surge’ in conversions almost makes me wonder if I could be wrong about O’Reilly...
How Booze & Cigarettes Relate to Pot & PTSD
In an earlier entry, I pointed out that the never-validated gateway theory started with an accurate observation: the first researchers to study youthful pot users in the early Seventies noted that nearly all had already tried tobacco and alcohol. What they couldn’t have realized was that they were encountering the leading edge of what would quickly become a hugely successful youth market and that a large (and still unknown) fraction of pot’s youthful initiates would continue to self-medicate with it indefinitely.
Rather than an unbiased attempt to follow up on those original observations, NIDA has chosen to subsidize "research" which is clearly limited to seeking out pejorative associations between pot initiation and undesirable "outcomes." My own study of admitted pot smokers has come up with a very different explanation for the observed link between the three: after inhaled pot ("reefer") first became available to "kids" in the mid Sixties, the average age at which it was tried declined so rapidly that by 1975, it matched the average age at which they were also trying alcohol and tobacco.
Further, throughout all the hyped drug scares over crack, meth, and club drugs during the Eighties and Nineties, pot has remained the most popular illegal drug tried by young people while its overall market, as measured by arrests, seizures, and estimated dollar value, has continued to grow steadily–– despite an expensive Madison Avenue advertising campaign designed to suppress it.
Predictably, Congress, rather than wondering why its policy was failing, has redoubled spending aimed at making it make it ‘work’ and a grateful police bureaucracy, ably assisted by tax-supported lobbies at ONDCP and NIDA, has accepted the increased funding. The result has been a drug war which behaves much like the war in Iraq, but without any oversight. The most obvious reasons are that those battling ‘drugs’ are not being killed or maimed by IEDs in a foreign land and the great majority of ‘enemy’ casualties are being either hidden in state prisons or sleeping in the parks and doorways of our large cities.
The connection between alcohol, tobacco and pot is real; the tragedy is that it is being misconstrued. All three are being tried as entry level drugs by troubled adolescents. Rather than serving as a gateway into harder drugs, pot has been functioning for at least three decades as a way out of problematic use of booze and cigarettes by serving as the healthier alternative.
The implications of that reality should become even more clear as increasing numbers of returnees from combat in Iraq, hand picked and repeatedly tested for non-use of pot, apply for treatment of their PTSD to a VA prevented by policy from allowing them to use the best palliative agent available.
March 26, 2007
Booze, Cigarettes, and the Presidency
Perhaps the most grotesque inconsistency among the many that characterize our (unadmitted) policy of drug prohibition is that the two psychotropic agents best documented as dangerous to user health are alcohol and tobacco; yet both may be legally bought, sold, possessed and used by legally defined ‘adults’ in every state. That becomes even more absurd when one considers that merely being found with any amount of pot often generates either a misdemeanor or a felony charge, usually the latter.
My first clue that chronic use of cannabis was related to both alcohol and tobacco was the early discovery that everyone applying for a pot recommendation was a chronic user who’d also tried alcohol; and the vast majority (eventually found to be 91%) had also tried cigarettes. Those discoveries, plus my own early weakness for both led me to realize that had pot been available when I was in High School, I’d probably have become a pot smoker and my whole life would have been quite different— not necessarily better or worse, but certainly different.
Of course, such ‘what if’ history can’t change reality, but it does point up the importance of watershed decisions made by nearly every adolescent: which drugs to try, and when? Despite the overwhelming evidence provided by its own studies since 1975, ONDCP continues to insist that advertising can prevent ‘underage’ adolescents from trying illegal agents and also persuade them to wait until they are of ‘legal’ age before trying alcohol and tobacco.
That’s why it was very interesting, although hardly surprising, to learn that both Barack Obama and Laura Bush struggle with a cigarette habit. The only thing I have time to add right now is that of the many ‘other’ agents tried by the chronic pot smokers I’ve interviewed, tobacco retains the tightest grip (at least 1 in five of those who ever tried cigarettes struggle to remain abstinent) and I have spoken to only four current smokers who insisted that they enjoyed cigarettes and had no intention of quitting.
Technology, Stress, Drugs, and Behavior
My own comparatively small 5 year birth cohort was born between 1930 and 1934; we grew up in the Thirties during the Great Depression.Thus most of us were in Grade School druing World War Two and High School between VJ Day (1945) and the Korean ‘police action’ provoked by North Korea’s surprise invasion in June, 1950.
Breaking news from Korea wasn’t disseminated widely by TV in 1950 because the medium was still in its commercial infancy and transcontinental cable didn’t exist. It would be 1960 before a Presidential debate could be transmitted live to TV audiences at home.
Thus, neither those members of my birth cohort who remained safely in college during Korea, nor those killed there between the invasion and an armistice signed in the Spring of 1953 grew up with TV; nor did we receive the educational advantages being optimistically predicted for the new medium as it was being aggressively exploited after the enforced hiatus of World War Two.
What we know in retrospect is that the TV broadcasting industry was dominated by commercial interests that quickly focused on its potential for passive entertainment of mass audiences. Not only did its educational benefits remain relatively undeveloped, but TV’s potent influence over the dissemnation of news and opinion has became increasingly packaged as a commodity and concentrated in the hands of a few media conglmerates, even while the Earth’s human population was exploding during the second half of the Twentieth Century and an economic ‘Cold War’ raged between rival political and economic ideologies.
From our early Twenty-First Century vantage point, a number of clues with the power to challenge traditional views have come to light. They also suggest that changes which didn’t become prominent until the second half of the last century will assume even greater significance for our entire species between now and 2100.
Central to this particular post is the degree to which human emotions affect the behavior of both individuals and political units. Coupled with that is the degree to which ‘drug’ use reflects the increasing role of emotional stress in everyday life...
March 24, 2007
Another View on Dispensaries
The medical use of cannabis in California has intermittently received attention from Bill O’Reilly, who may be the Right Wing’s most famous spinmeister, and was recently moved to devote an entire column to the LA ‘dispensary’ situation.
True to form, Bill didn’t merely exaggerate a little— or even a lot; he just told over-the-top whoppers by claiming that 'thousands’ of pot ‘clinics’ have opened across the state,’and an increasing numbers of kids ‘are arriving at school stoned’ in San Diego;’ all because George Soros donated to Proposition 215 in 1996. Most interesting for me was his attempt to spin a recent rhetorical shift that admits sympathy for ‘valid’ medical users so as to call attention to the able bodied young ‘cheaters’ frequenting dispensaries. He became so carried away on that tack that one of his conclusions was, ‘Society needs to rethink its strategy on intoxicants in general. If marijuana can help those suffering with debilitating diseases, then doctors should have the power to prescribe it and licensed pharmacies should carry it.’
Somehow, I don’t think that’s what John Walters has in mind.
In any event, O’Reilly’s excesses on behalf of a policy defended by NIDA ‘science’ are another reminder of the casual nature of the assumptions about ‘addiction’ our policy has always used to scare the public and Alan Leshner blamed on ‘drugs of abuse.’ Unfortunately, like most other behavioral disorders, addiction is not characterized by any of the abnormal anatomical changes which allow pathologists to diagnose physical disease.
Whatever one might conclude about the difficulties implicit in classifying addiction, as a ‘disease,’ doesn’t excuse another conceptual absurdity: an ‘illness’ that prevents its victims from being examined clinically because they became either criminals or mentally impaired in the process of acquiring it. In essence, Proposition 215 altered that key drug war dynamic by allowing clinicians to grant pot applicants a kind of amnesty for past use of illegal agents, not only cannabis, but any others they might choose to ask about. Unless patients can be reassured to that extent, one cannot place much confidence in any data their screening might have produced.
On the basis of hundreds of examinations of patients who received prior recommendations from other pot docs, I have great confidence in the unique quality of the information they provided me with. Inevitably, they hadn’t been asked in detail about their past use of pot or of other drugs; usually, they had merely been expected to provide reasons justifying their current use. My data is also remarkably consistent and upon analysis, has great internal consistency.
The more one is able to compare NIDA rhetoric with the patterns of drug initiation and use reported in confidence by real people, the clearer it become that we have a drug policy based on myth which is not even remotely ‘scientific.’ Rather than reducing ‘drug abuse’ and ‘addiction,’our most urgent drug policy need is reducing the morbidity and mortality produced by a drug policy that has evolved into an unscientific dogma-driven fraud as absurd as Bill O’Reilly.
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.
March 19, 2007
In the News
This morning’s SF Chronicle (really a Hearst newspaper) had three stories above the fold. The two on the right were arranged under a single headline, Protestors for Peace,” which actually described only one of them. The other, submitted from Iraq by a Chronicle correspondent, dealt with the increasing number of Iraqis exhibiting emotional symptoms and the scarcity of facilities for their treatment.
To which my response was, “better late than never.”
Our modern recognition of emotional syndromes related to the trauma of war began with the ‘Shell Shock’ of World War One. Twenty-odd years later, during World War Two and Korea, that term was replaced with the more clinical ‘Battle Fatique,’ but it wasn’t until well after cessation of hostilities in Viet Nam that ‘Post Traumatic Stress Disorder' (PTSD) found its way into both the DSM and popular speech.
I hasten to interject that, although I have profound disagreements with the DSM as a ‘disease’ taxonomy, I have no problem with the concept of anxiety related syndromes and would count PTSD as one which is both unequivocal and easily defined. While the responsible traumatic event may have been any near-death or similarly unsettling experience, can be acute or chronic, and can take place at any age, my recent clinical experience with a steady stream of self-medicating pot smokers suggests that sentient pre-pubescent children are particularly vulnerable.
That observation becomes especially significant in Iraq, where, as in many ‘developing’ nations, a disproportionately high percentage of the population is under the age of sixteen. Four years after starting an unnecessary war there, we are finally beginning to look at the emotional toll imposed by ‘deployment’ and ‘redeployment’ on American military families, but have been remarkably slow to realize that, for Iraqis, the carnage has become part of everyday life.
I would also suggest that other abrupt changes in the status quo of any society, whether wars, the availability of new drugs, or the imposition of new policies, will have unintended consequences, which, if we refuse to study them or to even recognize their existence; can become both greatly compounded over time and almost impossible to undo.
March 18, 2007
Another Important Case
The silly idea that a valid ‘drug war exception’ exists has probably done more to restrict protections intended by the Bill of Rights over the past four decades than any other lame fascist excuse. Of the protections that still survive, the First Amendment has been both the most important, and the one drug warriors would most like to curtail.
In that context, a case scheduled to be heard next week by the Supremes is not only critical, but should also serve as harbinger of the impact of Dubya's and Papa Bush's appointments on the Supreme Court over the next few decades.
I wish I could be more optimistic...
Evolving Court Battles
That the pusillanimous non-decision in the ill-conceived Raich case went against reform in June, 2005 came as no surprise; however no one had anticipated the extent it would encourage federal and local law enforcement to cooperate in raids on the ‘dispensaries’ which were then popping up like mushrooms, especially in the Southland and the Central Valley, for reasons that were also unclear. The arrests generated by those raids have since produced a growing list of cases heading for federal trial in Fresno. However, that effort may have just been upstaged by the reprise of an earlier San Francisco case with the power to change the political climate.
For those still paying attention, there could be no better example of the religious thinking driving the drug war than US Attorney George Bevan’s dogged efforts to punish Ed Rosenthal as befits his heresy in support of 'medical' marijuana. Although he’d obtained a felony conviction in 2003, the fact that Rosenthal wasn’t punished with a long jail sentence had obviously rankled Bevan. It had been because an unusual and well publicized jury revolt immediately after the trial had given Judge, Charles Breyer, who just happens to be the younger brother of a Supreme Court justice, an opening for a shrewd maneuver. He sentenced Rosenthal to the one day he'd served in custody following his arrest.
When Rosenthal defiantly appealed that conviction, the government responded by opting to retry him on the marijuana charges, plus others for money laundering and income tax evasion. They’d clearly not known that Breyer would once again come to Ed’s rescue and make his distaste for both the logic and tactics of the 'Justice' Department in drug cases even more obvious, by ruling decisively in his favor.
Given that every other federal judge sentencing a medical marijuana activist since 1997 had been supportive of federal policy, Breyer's attitude is exemplary. It also stands in stark contrast to the principle of 'equal justice for all.
This is particularly important in a current setting in which Judge Anthony Ishii, who will soon be trying several cases in the relative anonymity of Fresno, has just shown by his conduct of the Costa case that he shares none of Breyer's scruples.
This is a challenge to the ASA legal team, which has just shown so great imagination in San Francisco, to become active in the Central Valley as well.
March 16, 2007
Letter to an Editor
The following was just sent to the SF Chronicle which, considering that it's been at the epicenter of the medical marijuana movement for over ten years, has done a pathetic job or reporting it, let alone even demonstrating an understanding of what has been happening under their noses. That criticism applies to the previous ownership and even more so to the Hearst Organization which recently purchased the name
Today's chron, which also manages to frustrate attempts at linking to its jealously guarded news items, carried typically clueless stories on developments in both the Raich and Rosenthal cases...
San Francisco Chronicle
To the Editor
An even more convincing example of vindictive prosecution for daring to grow medical marijuana took place last year in Fresno when sixty-year-old Dustin Costa was convicted by a federal jury on the day before Thanksgiving. As proof that not all federal judges have similar views on either 'justice' or what their position entitles them to do, Costa, who, like Rosenthal, had no previous criminal record, and was charged with growing an equivalent number of plants, was sentenced to the fifteen year maximum by Judge Anthony Ishii, whose rulings throughout the trial defied ordinary logic while reflecting a scrupulous respect for all prosecutorial arguments.
Ironically, Costa was one of four people free on bail and defending themselves against state charges who were re-arrested after their cases were summarily transferred to federal jurisdiction following the pusillanimous Raich decision, also discussed in today's Chronicle.
Further evidence of systemic federal vindictiveness is that shortly after his conviction in February, Costa was transferred from Fresno to another county jail in Bakersfield for no apparent reason. There, he continues to await assignment to a federal prison while remaining even more completely isolated from visitors and supporters who have neither the wherewithal nor access to widely read media enjoyed by Rosenthal's supporters throughout his ordeal.
Equal access to equal justice? I don’t think so.
March 15, 2007
Pharmaceutical versus ‘natural’ sleep
I can’t recall a time since 1995, when I bought my first computer, joined the drug policy reform movement and became a news junkie that there have been so many news items reflecting the absurdity of our war on drugs. All that’s required to appreciate the irony is relating some of them to the kind of insider information pot users have provided me over the last five years.
For example, it was announced on TV last evening that a man had been arrested for driving while asleep and there are a number of news and blog items about the FDA seeking warnings for some of the new sleep aids, like zolpidem (Ambien) and eszopiclone (Lunesta), which may not be all that safe. In order to fully appreciate the implicit irony, one also has also to remember that insomnia, was derided as a serious symptom by Barry McCaffrey right after it was listed as a condition treated by cannabis in 1996. Despite McCaffrey’s skepticism, sleep deprivation is increasingly considered a major cause of morbidity in our go-go modern world, and also thought to be fairly frequent cause cause of late afternoon auto crashes. So much for the general’s medical judgement.
Insomnia is also the second most cited medical benefit pot affords my applicants, right after relief of ‘stress and anxiety.’ Although they don’t often volunteer that information, almost 90%, readily admit to insomnia if questioned about whether they use pot for sleep.
How does it facilitate sleep? The mechanism seems disarmingly simple: its rapid and predictable anxiolytic (literally ‘anxiety dissolving’) effect diminishes anxiety just long enough for fatigue to take over. Much insomnia seems generated by worry over things that happened earlier in the day, or uncertainty over might happen tomorrow. It’s quite clear that for many cannabis users, at least, the non-specific ‘relaxing’ effect of cannabis is all that’s required for a night of restful sleep. I’ve heard that scenario enthusiastically confirmed by far too many chronic users over the past few years to question its validity.
There is also a substantial minority of chronic users (perhaps 10%) who find that when used close to bedtime, it has an opposite effect; it acutely stimulates their thought on a variety of subjects to the point where they have trouble falling asleep. However, cannabis is also extremely versatile; if they hadn’t learned to avoid using it shortly before bedtime and continued using it for its other perceived benefits, they probably wouldn’t have been seeing me for a recommendation.
March 14, 2007
Query and Reply
Although I've made no secret of my frustration with the unenlightened attitude of reform, I have continued reading two of its e-mail lists (one national and the other focused on CA) to keep abreast of both drug policy news and reform responses to new developments.
Yesterday (March 13) the following query was addressed to the national list from an unfamiliar source:
Long (24-pages) comprehensive article on the drug war and drug policy
reform with solid suggestions.
Due to it's length I'm not reposting here, but I would love to hear
opinions by folks on this list.
My Response (after a bit of editing):
I've been familiar with Professor Kleiman's views on drug abuse since the mid-Nineties and have continued to read his blog occasionally to keep abreast of his thinking because I recognize him as one of a small coterie of academics that has become somewhat influential in the shaping of US policy.
That said, I disagree that his analysis is 'brilliant' for one compelling reason: it's far more judgmental than he realizes, and for the same reason that both prohibitionists and reformers (ironically the two groups he has built his academic career on criticizing) also remain uninformed: there have been no unbiased studies of a large population of actual users.
Such studies should have been essential in evaluating the impact of any policy predicated on science; yet their prohibition has been, arguably, the ONLY success of an American drug policy claiming to be 'scientific.'
I've been engaged in a study of admitted chronic pot users for over five years and actually tried to interest Kleiman in it shortly after I had the intuition that it was possible. Following an immediate show of interest and a brief e-mail exchange, he suddenly broke off our correspondence without either warning or explanation. His current position as stated in the URL you supplied is essentially unchanged from what it was then.
What I've learned so far from my study, which now involves over 4000 individual pot users, is discussed in a blog which, while not as sophisticated as Keliman's, is firmly rooted in unique data he is unaware of. I'm now trying to get a peer reviewed paper published and hope it will have an impact similar to the paper he helped Doblin publish in 1991. Also, if you take the trouble to search my blog for 'Kleiman,' you'll end up with a fairly detailed answer to your question.
Please note this is a personal reply; it was NOT sent to the list because I don't want it disseminated there. However, I do wish to thank you for bringing the item to my attention because I may use it in the blog as time permits.
March 11, 2007
Reform’s Wrong Turn
There’s a headline below the fold of the first page of today’s San Francisco Chronicle: ‘US effort to kill coca failing in Colombia.’ The longish story is continued on a page it shares with a somewhat shorter NY Times item on Bush’s trip to South America.
My first response was to wonder how anyone could have thought ‘Plan Colombia’ had a chance of success from the time it was first hatched under Clinton. Then I realized I’d acquired a much deeper awareness of our government’s commitment to its ludicrous drug policy than the ‘average’ American because of my four year stint as editor of Drug Sense Weekly. Also, though my more recent experience has been mostly with marijuana users, it provided abundant evidence that the policy’s extreme intolerance of criticism applies equally to pot policy. In fact, judging from John Walters’ priorities, it may be even more intense.
Thus although the ideas that our drug policy is ludicrous, can't ‘succeed,’ and is based on unproven assumptions, may be painfully obvious to me, it’s equally clear that both our media and most reformers resist such overt criticism; one of the reasons that, sometime in the past three years, my biggest problem shifted from trying to understand the failures of pot prohibition to having to understand the resistance of reform leadership to what I was attempting to tell them.
I think I finally have it: the first (small and underfunded) organization to develop in opposition to the drug war was NORML; it quuickly gained a measure of success but unfortunately, took a wrong turn almost immediately, one it has yet to recognize. The best way to understand the wrong turn itself is by realizing that if NORML’s ‘R’ had represented ‘repeal’ instead of ‘reform,’ history might have been different.
‘Reform’ implies an effort to salvage something that has merit; ‘repeal’ implies the policy itself was a big mistake from the beginning. By its uncrtical implied agreement with erroneous assumptions about drug addiction dating to before 1914, NORML, the first large grass roots reform organization, became, ironically, a pied piper leading reform in the wrong direction.
Nor are the reasons that difficult to understand: for one thing, most reformers in other organizations focused on different drug war abuses are also pot smokers; for another, the public, including an unknown number of pot initiates who were themselves chronic users for a while, has entirely diffrent ideas about ‘recreational drug use’ from most reform activists. They see it, at best, as being somewhat dangerous and unattractive behavior which is not entriely benign, thus they contiune to accept a drug war with a much higher price tag than they realize, as a 'logical' alternative to 'legalization.' Ironically, that also translates into accepting chronic (but ’legal’) use of far more problematic alcohol and tobacco, without once realizing that to the extent pot prohibition 'works,' the chances our most troubled youth will use them both are greatly increased...
March 09, 2007
An Alternative to Dr. Minot’s Evaluation of President Bush
I must say that until I began screening a steady stream of Californians seeking my approval of their use of cannabis towards the end of 2001, I had accepted the ‘reform’ version of ‘medical’ and ‘recreational’ use as generally accurate: (valid) medical use was either by obviously sick or dying people suffering from a variety of serious conditions; most notably AIDS or cancer, or for other conditions characterized by severe chronic pain. Included in the mix, were a variable number other conditions known to be helped by pot: migraine, IBS, glaucoma, and a few others. All other use was, by default, to be considered ‘recreational.’
I also should note that I’d received access to applicants after agreeing to screen them at what was then the largest cannabis club in the Bay Area. Although open less than a year, it had become the busiest in California and its owner was intent on complying with the letter of the law by requiring all his customers to produce the required recommendation before they were allowed to buy. As I’ve already written, the mix of applicants was a surprise in that most were younger and less sick than anticipated, but all were chronic users who seemed to share several other characteristics to a surprising degree. Since many had driven a long distance, were obviously expecting a recommendation, and I didn’t have a good basis for telling them why some of their histories impressed me more than others, I decided to go along; at least until I could learn more from/about them.
Almost from the beginning, my curiosity was focused on how their chronic pot use had become established behavior; that led me to ask a lot more searching questions than the other pot docs seen by several who were merely ‘renewing’ with me.
To cut to the chase, the first analysis of results produced by a structured interview confirmed that all applicants were chronic users when first seen and shared certain behavioral patterns and other characteristics to an impressive degree. The most logical interpretation of those early results was that the key arguments of both sides in the ‘debate’ over medical use were based on myth. Further, while nearly all their drug initiations had taken place in adolescence and tended to be sequential, they had almost certainly not been motivated by youthful hedonism. Further, those drug initiations which had later been followed by chronic use could be seen as attempts at self-medication for the same emotional symptoms so often treated with one of the many psychotropic medications approved by the FDA since the mid Fifties; and often prescribed, at various times for many of the applicants.
Finally, applying what has been learned from applicants to President Bush: although there is less behavioral data in the public record than is provided by the structured interview, I have enough to suggest that the President has been suffering from impaired self-esteem from an early age and has compensated for the resultant symptoms of anxiety and dysphoria in a number of ways. Parenthetically, his mild speech impediment and probable dyslexia didn’t help his self-esteem in the critial grade school interval...
He and Bill Clinton were born in 1946, and thus early baby boomers. My applicants’ demographics confirm that the 1946-1955 birth cohort was the first to initiate pot in large numbers, almost inevitably after first trying alcohol and tobacco. Many also tried several of the other agents introduced during the Sixties as well as cocaine and heroin. The most obvious feature of Bush’s drug history is his admission that he drank excessively until about forty when, at the behest of his wife, he became abstinent and switched to a more fundamentalist form of Christianity.
I suspect that although he may have taken a hit or two from a cigarette around the same time he tried alcohol, he never became a chronic cigarette smoker for a significant interval because he was also an avid jogger, even before abstaining from liquor. Daily cigarette smokers rarely run for exercise.
We don’t know for sure if Dubya ever tried cannabis, but I’m reasonably sure it was available to him during his college days, if not before. However, given his family situation, chronic use of pot would have been far less likely than alcohol, which was clearly more favored by circumstances to become his drug of choice. We also know he received a DUI in 1978, and while it’s common for members of his birth cohort who drank heavily to have also tried cocaine, he has famously refused to tell.
Thus my evaluation of Dubya, although based on different criteria than Dr. Minot’s, comes to similar conclusions about his emotional state. As to possible treatment options for Dubya’s mood disorder, I believe that if he’d become a pot smoker while still an underage drinker, he probably would have managed his use of alcohol better an had a much different life.
Alternatively, had he switched from booze to pot instead of to Jesus at age forty, we’d all have been better off: not only would he not have been able to run for President in 2000, he’d probably have become a better adjusted and happier person.
March 07, 2007
What is a Potdoc?
When I posted Doctor Minot’s fascinating clinical evaluation of President Bush and promised to offer an alternative evaluation at some later date, I had only a vague idea of how I’d do that or what I’d say. However I was too intrigued by the opportunity it offered for dealing with several related issues to pass it up. For one thing, it would be another opportunity to call attention to the shortcomings of DSM nosology, which I have come to regard as having a pernicious influence on both Psychiatry and Public Policy.
I was even less certain of how to deal with another requirement that was clearly implicit in the exercise: that of providing a basis for presuming to critique the articulately stated opinion of a practicing psychiatrist with extensive clinical experience. Although cannabis consultation, the field in which I’ve been working since late 2001, is still very new, formally unrecognized within Medicine, and has been subject to unusually rapid change since passage of Proposition 215 brought it into existence in November 1996, it does exist.
By calling for the signed opinion of a licensed physician that use of cannabis was of at least potential benefit to an individual, Proposition 215 demanded an entirely new kind of doctor-patient relationship, one predicated on an expertise no physician could possibly have then possessed for the simple reason that in 1996, all use of cannabis had been illegal for sixty years. While that illegality hadn’t prevented Psychiatry and the Behavioral Sciences from producing a flood of studies of drug users, nearly all had been orchestrated by NIDA, were unanimous in assuming a deleterious effect from any ‘drug of abuse,’ and tended to categorize chronic users as either addicts or criminals.
In brief, there had simply been no unbiased studies of either ‘therapeutic’ or ‘recreational’ use of cannabis by admitted chronic users during the entire historic interval between 1937 and 1996, despite occurrence of an officially admitted ‘marijuana epidemic’ beginning in the mid Sixties. It is my contention that what I’ve been engaged in for the past five years is a systematic study of the existing user population, a study that was impossible before it was enabled by Proposition 215. With the exception of a substantial contribution from a single generous donor for database development, this work has been financed by applicants.
That the study has been misunderstood, misjudged, and/or ignored by most political supporters of the notion of ‘medical marijuana’ is simply another facet of human behavior to be noted, understood, and dealt with along the way to publication in the peer-reviewed literature, a goal of the study ever since my initial patient experiences suggested it could be done.
That initial impression has been amply confirmed by data which could not have been anticipated and which, when promulgated to a competent audience, should have the power to compel further objective analysis in a contentious area that has been completely dominated by religious thinking for a dangerously long interval.
March 05, 2007
Psychiatry and Science; Evidence and Disbelief
I posted a quite different entry with the same title last Thursday (March 1), but then quickly deleted it because it just wasn’t the lucid critique of Doctor Minot’s psychiatric evaluation of George Bush I’d intended. The main reason was that I'd been rushing to get ready for a quick trip to LA to attend a one day course on the current chemotherapy of advanced lung cancer, a subect more closely related to my former life as a Thoracic Surgeon, but one I’d been away from for several years.
As it turned out, that meeting not only brought me up to date on a rapidly evolving field of Medicine, it also dramatically illustrated how the yawning abyss that’s been developing between scientific and religious thinking has been overlooked in the areas of both Psychiatry and Drug Policy (more on the meeting and its lessons later). Briefly, neither Psychiatry nor US drug policy is as ‘scientific’ as claimed; and the same generic reason applies to both: they’ve been following erroneous roadmaps based on controlling assumptions that were both false beyond testing far long intercals.
Because both public policies and scientific nosologies are based on theories, and because theories are primarily intended to organize facts into coherent explanations, they are never ‘true’ or ‘false;’ but, rather coherent and valid or incoherent and invalid. When a theory is demonstrated, usually by new observations, to require some adjustment, it can be modified, a common phenomenon that occurs gradually by consensus in most disciplines without a much public fuss. When, as in the case of Phrenology, an entire field is ultimately shown to be based on a major false assumption, it’s scrapped.
Psychiatry has operated under two separate, but equally unscientific schema for the classification of the clinical entities it deals with for its entire history and should either radically modify or scrap (my preference) the DSM. US Drug policy, on the other hand, been based on simplistic false assumptions about ‘addiction’ for nearly a century. Because those implementing it have never allowed those assumptions to be tested at all, the policy itslef has long been out of synch with medical reality and is based on such inappropriate religious thinking that it should be scrapped forthwith.
I realize how sweeping and improbable these statements may seem to many, especially those without the requisite background in science. That’s why I’m only introducing them in preliminary fashion. However, because they are so critical to any understanding of how an extensive false paradigm could have evolved (and still be evolving) around a protected drug policy, I’ll be returning to them frequently.
To begin with Psychiatry, its modern clinical history begins with two European pioneers, Sigmund Freud and Emil Kraepelin, both born in 1856, and each quickly gaining professional recognition. However, only Freud went on to capture public and literary imagination and thus cause Psychoanalysis to dominate popular notions of Psychiatry throughout the first half of the Twentieth Century while Kraepelin was being almost completely forgotten.
However, because Kraepelin’s memory is now being (mistakenly) credited with inspiring the modern DSM, some accurate knowledge of each man becomes important to any critique of modern psychiatric nosology, and — because these things are never simple— it’s also necessary to consider the contributions of yet another Ninetenth Century European physican, Rudolph Virchow, born three and a half decades before Freud and Kraepelin and, during their lifetimes, was transforming Pathology into the specialty that plays an essential role by serving as modern Medicine’s gold standard for diagnosis. Because the conditions treated by Psychiatry do not produce characteristic anatomic changes, they simply cannot be usefully classified like those that do.
To focus this entry back on the key points I hope to establish: Psychiatry’s error has been in embracing two misleading schema for classifying the clinical entities it deals with on a daily basis. My objection is that while those conditions certainly exist, they do not qualify as ‘diseases.’ Freudian psychoanalysis captured the public imagination, but was never even remotely scientific; however, it effectively displaced the more clinically oriented, empirical approach of Kraepelin until after World War Two, when the nascent reform effort to Freudian influence represented by the DSM first emerged in 1952 . It’s now necessary to introduce another historically important physician: Doctor Robert Spitzer, whose enthusiastic, but ( I believe) completely misguided efforts have transformed the DSM from a minor project into a giant mistake that slavishly reinforces the mistaken assumptions about drugs and addiction our drug policy so oobviously takes for granted.
In the meantime, a number of potent drugs and delivery systems were being introduced throughout the Nineteenth and Twentieth Centuries. Their use eventually inspired a punitive public policy in 1914, but any role that psychiatric conditions might have been playing was lumped under the generic term of ‘addiction.’ The same severely limited Nineteenth Century assumptions about addiction and its only permissible treatment (obligatory abstinence) have remained at the heart of the policy ever since. That policy should be scrapped urgently; not simply because it doesn’t work, as most reformers currently insist (and the public already knows), but because its false assumptions mean it will NEVER work and there is no gradual way to ‘reform’ such gross error; especially while the policy’s doctrinaire adherents control both its enforcement and the national budget.
I realize this still leaves me with the task of addressing Dr. Minot’s evaluation of Dubya, but at least, this sets the stage.
March 01, 2007
I posted Dr. Minot’s devastating ‘psychiatric evaluation’ of President Bush for two reasons. The first was because I emphatically agree with it as political opinion; the second was to point it out as an arresting example of the degree to which Psychiatry has, once again, been seduced into adopting a completely conjectural and misleading nomenclature for the conditions it aspires to treat.
Psychiatry is a clinical specialty that was dominated during the first half of the Twentieth Century by the thinking of Sigmund Freud (1856-1939) the man considered by most as its founder. Almost from its beginning, it was odd man out among medical specialties precisely because it deals almost exclusively with conditions that cannot be placed within the same objective and marvelously adaptive intellectual framework that was created by Pathology, the non-clinical and largely descriptive specialty founded by Rudolph Virchow, an equally brilliant, but less famous Freudian near-contemporary. The reason is simple: psychiatric conditions are not associated with the anatomic and chemical anomalies which provide pathologists with the objective standards they use to diagnose ‘somatic’ diseases.
One way to think of it is that Virchow’s intuition was to Medicine what Darwin’s was to Natural History: both simultaneously created supple intellectual frameworks able to accommodate new discoveries, indeed, whole new disciplines, without any need for radical revision of the underlying theory.
Amazingly (to me, at least), is the general failure of both Medicine and Psychiatry to appreciate those critical differences as they apply to the concept of ‘diagnosis.’ That failure has allowed an absurdity as grotesque as the one enabling our drug policy to become prevalent within Medicine. But it gets worse: because our drug policy and psychiatric absurdities have now been mutually supporting each other for decades, ‘reform’ of either has become more daunting.
Both absurdities were enabled by the same cognitive mechanism: an uncritical extrapolation from an untested ‘theory’ based on a single false assumption. In the case of drug policy, the false assumption has gradually evolved into a (usually unstated) dogma: the ‘disease’ of ‘addiction’ represents the consequence most to be feared from any use of certain drugs and the only way to prevent it is a total ban on all possession for any purpose. The equivalent psychiatric absurdity is that invention a purely conjectural diagnostic framework, also beyond testing, will facilitate the management of conditions that aren’t diseases at all, but merely collections of signs and symptoms. The trap, of course, is that those conditions, even though carefully labeled ‘disorders,’ are assigned equivalent code numbers and used to pigeon-hole patients with the same finality as a biopsy proven case of cancer.
That's all I have time for now, but I plan to add to it soon, because debunking DSM is an essential step in repudiating American drug policy; if for no other reason than that an absurdity like ‘Cannabis Use Disorder’ can be taken so seriously.