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July 07, 2007

Anxiously Avoiding Anxiety (Personal)

Perspective is critical. One way to understand the situation existing when Proposition 215 passed unexpectedly in1996 was that for twenty-five years, our drug war had thrived by successfully translating its bipartisan federal support into steadily increasing financial, bureaucratic, and professional endorsement of the (unlikely) assertions central to the 1970 Controlled Substances Act: cannabinoids, like other ‘drugs of abuse,” are illegal by Act of Congress; therefore, they cannot have any “redeeming” medical value.

It had also helped acceptance of the drug war that a veil of ignorance and confusion was created when the Marijuana Tax Act demonzed “reefer” in 1937. Its acceptance was further reinforced when Nixon summarily buried the timid, (but unexpected) Shafer Commission report in 1972.

Proposition 215 thus represented the first successful political challenge to an enduring sixty-year old policy myth. As such, it was the first opportunity to study several related phenomena which had been evolving beyond direct public scrutiny from at least the mid-Sixties onward. The main one, and most obvious place to start, was the inexorable development of an enormous illegal marijuana market, not only in North America, but in many developed nations where the use of inhaled cannabis had been relatively unknown.

I’ve derived many insights from my own unanticipated obsession developing from the (equally) unanticipated opportunity Proposition 215 created for clinicians: the chance to profile the pot market with relative ease; or at least that fraction consisting of repetitive (“chronic”) users seeking the required doctors’ “recommendation.”

I can now see how fortuitous my timing had been: by not screening applicants until nearly five years after 215 passed, I’d  allowed time for a few pioneering “pot docs,” (the most prolific was Tod Mikuriya) to create a population of buyers for the scattered “clubs” that were developing in response to their needs in a few friendly Bay Area communities.

The owner who recruited me to screen his potential customers is now retired in Costa Rica. He had been one of the few visionaries among those early club owners; perhaps the first to understand how huge the potential demand really was, and thus how critical was the shortage of physicians willing to certify his potential customers. His offer of free use of a large area in his Oakland club on week-ends was brilliant. Upon reviewing the demographics of the applicants seen there over my first eight months, I can see that among the locals from San Francisco and Oakland, were at least as many from Central California towns as far apart as Reddiing to the North to Bakersfield to the South. It was both the volume and variety of applicants seen in that interval that allowed me to appreciate that they possessed so many (unexpected) features in common that  profiling them was literally a no-brainer.

That unexpected consequences may flow from any new law is axiomatic, which is why the stubborn persistence of both sides of the spurious  “drug debate” is so revealing: Ten years after it became possible to study large numbers of pot market participants, both sides were still mired in the rhetoric of the 1996 campaign.  

Three laws directly affecting marijuana policy have been passed since 1937: the  MTA, the CSA in 1970 , and Proposition 215 in 1996; yet vested interests on both sides remain blind to the unique opportunity 215 created for studying the consequences of the first two.

The blindness of the feds is no surprise; that of reform was more unexpected. My (now belated) insight is that it simply reinforces the most obvious conclusion to be drawn from study of pot use: uncertainty, best understood as “anxiety” in its myriad manifestations, is the single most powerful force impelling all human drug use.

The next most obvious conclusion is that inhaled cannabinoids are safe and effective anxiolytics which can be readily controlled by most users according to their needs.

Such was the key  (but unrecognized) discovery made by the first Baby Boomers trying pot in the mid-Sixties. It spread, simultaneously and rapidly, downward to their adolescent successors from about 1970 on; but was fiercely resisted by the same “over thirties” the first Boomers had famously warned everyone against.

Of course “kids” (and most adults) still don’t know anxiolytics from a bale of hay. That pharmaceuticals could treat anxiety directly was itself  a brand new concept to Medicine as recently as the early Fifties. That such treatment is still associated with stigma renders many, especially those of the male persuasion, anxious to avoid any admission they might be suffering from it.

Doctor Tom

Posted by tjeffo at July 7, 2007 08:53 PM