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December 30, 2007

Darwin, Science, Creation, and Drug Policy (Logical Historical)

During his brief five week visit to the Galapagos in 1831,  the islands’ remarkable biodiversity provided the young Charles Darwin with the basic insights that would gradually result in a theory of Evolution. Darwin had been born into comfortable financial circumstances and an almost ideal intellectual environment in which his ideas could be developed; but it was not  a leisurely process and he was well aware of the controversies that were swirling around such heretical ideas, as well as the problems of publishing prematurely. Darwin did not “go public” until his friend and mentor, Charles Lyell, impressed by the parallel observations and similar conclusions of Alfred Russel Wallace, persuaded both men to publish papers on their work to be read together before the Linnean Society in 1858. Surprisingly, that effort excited little notice;  however, when Darwin published The Origin of Species a year later, it became an overnight sensation and he was subsequently forced to defend his ideas against all manner of attacks in multiple republications. The term “Evolution” did not appear until 1871.

While the controversy he ignited was swirling around him, Darwin had no way of knowing that the seas around the Galapagos hid a marine and avian biodiversity equal to what he’d observed on the Islands themselves, or that just a short distance inland in Ecuador, an Andean region known as the Paramo, was the site of an even more unusual ecosystem in which surviving plants and animals had obviously been forced to adapt to combinations of altitude and weather found nowhere else on Earth.

Thanks to modern technology, it has now become possible to explore both the Upper and Lower Paramo in sufficient detail to understand that their fauna and flora represent an almost ideal confirmation of Darwin’s theory;  even as it is under renewed attack from religious fundamentalists who insist that creationist doctrine be given equal emphasis in public schools. That dichotomy illustrates another important concept still hiding in plain sight: most humans will only believe what they are capable of accepting, for whatever reason, as “truth.” Contrary evidence, no matter how convincing, tends to be either ignored or disputed for reasons that make little sense.

Central to the dispute over Evolution and “Creationism” are fundamental differences in opinion over the role of cognition in formulating the rules by which societies are governed: should they be historically older religious beliefs based on a set of unproven ideas that can’t be tested (falsified), or should they be based on the empirical approach of science in which any assumption can be challenged by credible new evidence?

Certainly, if one looks at results, Science has proven the more reliable method. Religious thinking, on the other hand, has been the source of endless conflict in which, ironically,  both our modern weapons of mass destruction and the masses of people they are able to destroy were both enabled by Science.

Once one understands that the drug war is an essentially religious doctrine using pseudo science in its (unsuccessful) attempts to impose an unproven theory of addiction on the whole world, the real questions become why is the policy so widely accepted, and why are both its political proponents and opponents so unwilling to consider pertinent evidence?

Could it be that our cognitive processes are flawed in some basic way?

Doctor Tom

Posted by tjeffo at 05:32 PM | Comments (0)

December 23, 2007

The CIA and the Drug War: a lesson in denial

As so often happens, the best topics to blog about are often suggested by the day’s news or by items airing on TV. Saturday (yesterday) was no exception: the History Channel ran The True Story of Charlie Wilson, which it billed as an authentic version of the same story told in the a just-released movie starring Tom Hanks, Julia Roberts, and Phillip Seymour Hoffman. I’d already been quite familiar with that plot since I first heard a discussion by George Crile of his book in 2003; but my information had come from a quite different source: Alfred McCoy’s earlier and studiously neglected Politics of Heroin originally published in 1974 over the objections of the CIA, and later updated by McCoy himself to include the Agency’s involvement with the illegal drug trade in Central America and Afghanistan during the Eighties.

So, although I saw, Crile’s book as a very readable addition to the story first reported by McCoy, it seemed that by emphasizing the defeat of the Soviet Union as a blessing and the CIA as buffoons who hadn’t seen the the benefits implicit in arming the Mujihedeen, Crile himself, had appeared willing to tell only part of the truth. Unfortunately, he has since succumbed to pancreatic cancer at the age of 61.

Beyond that, one of the phenomena that had struck me most about the appallingly dishonest Dark Alliance episode had been the obdurate refusal of the three pillars of American Journalism that eventually drove Gary Webb to suicide never once referred McCoy’s very credible account. As with so many similar episodes of feigned blindness, it’s the failure to mention the obvious that becomes so incriminating. If one is struck by the frequency with which certain themes have been recurring in the history of the CIA since its creation from the OSS in 1947: graft, corruption dishonesty, incompetence, and the often devastating unintended consequences of earlier “success” (Blowback), one has also to be struck by the degree to which the same characteristics have been shared by the war on drugs and the frequency with which both agencies have interacted in ways the rest of the government, the press, and many of our key institutions seem intent on not noticing.

In other words, the CIA-ONDCP interaction which has itself been stead evolving into a ripening Conspiracy Theory since the end of World War Two has also required the same suspension of disbelief enjoyed by many other institutions, some of which we rely on for protection of our financial markets, our ecology and our health.

The key questions then become: to what degree is man’s penchant for denial of obvious cognitive dissonance an intrinsic part of our nature; and to what degree has it already set our species up for disaster?

Doctor Tom

Posted by tjeffo at 07:44 PM | Comments (0)

December 17, 2007

Components of the Emergent Pot Market 3: distribution (historical)

Previous entries on the subject of a huge (and still growing) gray market for medical marijuana, which suddenly became visible sometime around 2004, pointed out that the initial delay was because very few physicians were willing to risk certifying  customers of the few “buyers clubs” that opened in scattered pot-friendly locales, mostly in the Bay Area, Santa Cruz, and Santa Barbara, as well as in traditional growing areas up North.
In retrospect, the prodigious energy of one physician, recently deceased Tod Mikuriya, was crucial; as was the cooperation of pot-friendly DA Terence Hallinan in San Francisco. The indications are that Mikuriya may have single handedly certified half of the state wide market that existed in late 2001 when I was first broke in as a novice “pot doc.” Also, the refusal of Hallinan to prosecute clubs during the same era allowed the retail outlets thriving within San Francisco to outnumber those in the rest of the state combined.

It should also be noted that Dennis Peron, who was so instrumental in getting 215 on the ballot in the first place, and had created the prototypical buyers’ club on Market Street long before the initiative passed is now almost unknown to younger reformers and disparaged by older ones seeking respectability.

Once the demand for “medical” pot had grown enough to establish a few thriving clubs and a few physicians, including myself, had demonstrated a demand for recommendations, several “scrip doc” clinics began operating around the state on an industrial scale. Their activity soon created enough demand in densely populated parts of the state, Sacramento, LA, and San Diego, to lure a growing numbers of retailers into the “dispensary” business.  The irony is that that roughly equivalent amounts of marijuana were being produced, transported, and sold to users before 215 passed. All that has changed is that a segment of the 1996 black market has become painfully visible to the ignorant, most notably the DEA, local cops, cub reporters, and the self-appointed “experts” now chattering excitedly on drug policy reform e-mail lists. What my data suggest, but can’t confirm, is that the only growth in the overall market has been a result of new initiates (the youngest of whom were under age ten in 1996) becoming chronic users.

Meanwhile, the provisions of 215 are being interpreted within an outrageously unfair and constantly shifting enforcement system that has punished Ed Rosenthal with one day in jail and sentenced Dustin Costa to 15 years in a Texas prison for the same “crimes.”

Even so, chatterers on reform lists contrive to overlook all the absurdity as they agree with the DEA that kids shouldn’t try pot and argue about the wisdom of calling attention to the enormous demand for it that 215 has uncovered. It turns out that a solid majority agrees with the DEA about “kids” and pot, and also has no comment on the obvious: over half of all American “kids” have been trying it since the Sixties.

Go figure. With “friends” like that, plus the DEA and local cops in hot pursuit, the ordinary pot smokers I see every week hardly need any more enemies.

That incremental reform is a delusion is obvious from the few hundred  who have been qualified as “patients” in those states with the tiny and largely invisible medical marijuana markets now totally ignored by the DEA as it struggles to dissuade California landlords from renting to dispensaries.

Doctor Tom

Posted by tjeffo at 01:47 PM | Comments (0)

December 15, 2007

Components of the Emergent Pot Market 2 : patients

Note to chronic readers: this blog is, like everything else, evolving; hopefully in a useful direction. What I hope to do in the future is identify topics I’ve already written about with italics, which can then serve as search terms those interested in more detail.

California’s huge gray market for marijuana, like so many other phenomena dependent on our feckless drug war, is seen quite differently by different observers. In many respects, the old parable of the blind men and the elephant is the most apt description; unfortunately, the disability in this instance isn’t simple blindess.

Rather, it’s the bias that prevents most humans from recognizing or admitting that an earlier judgment, which may have built their reputation and rewarded them with wealth may have also been wrong. That’s especially true of the drug war, which began as a purely intellectual formulation, and has been failing for decades around the world, but is still staunchly defended by most authoritarians as essential public policy. In essence, the greater the error, the longer it has dominated human thought, and the more vigorously it has been defended, the more difficult it becomes to criticize consructively, let alone change.

In the case of the drug war, which, despite lacking either coherence or supporting evidence, has co-opted so many of our important institutions: criminal justice, health care, and  education, for starters; the problem is enormous— especially for those on the wrong side of conventional wisdom.

The backlash against the excesses of the youthfully idealistic “hippie" movement that seemed to spring up suddenly in the mid-Sixties was immediate and intense. Unfortunately; because the counterculture also reinforced the latent fear of youthful rebellion that exists just below the surface in many (perhaps all) societies, the backlash against it has also proved quite durable. As I’ve been emphasizing, the first white people to use pot in a way that attracted notice were members of the “Beat Generation” who were older than the baby boomers they influenced, and would provide the youthful counterculture with substance, purpose, and pot, which unquestionably became (one of) the psychotherapeutic agents that critically enhanced their behavior.

In many respects, the Sixties represented a perfect storm in which America’s largest-ever generation, through no fault of its own, become recipients of affluence and conveniences derived from winning World War Two without any real memory of the pain and sacrifice winning had required. In much the same way, most other nations going through the same war had experienced more pain over a longer interval and would thus be understandably ambivalent toward the lucky Americans who, because they had  suffered less, were in a position to bail them out with unprecedented largess in the post war period...and so oon.

Nevertheless, what the survivors of wars in Viet Nam and Iraq are learning in common, is that the stresses of war can produce an anxiety syndrome (PTSD) and that its symptoms yield to pot in many cases. It was essentially the same lesson that American High School kids have been learning since the early Seventies.

All of which brings me to the points I’d like to leave behind: over half of American adolescents have been trying pot since the late Sixties. A surprisingly large percentage have remained long term users for indefinitely long intervals. Such use isn’t “recreational” (do we risk arrest or career destruction for fun?) and it certainly isn’t addictive (pot smokers find it far easier to give up pot on short notice for cause than to ever quit cigarettes). The available evidence from California is that after 215 let the genie out of the bottle, our commercial natures have created market forces with the power to (perhaps) frustrate the enormous legal advantages of both the DEA and the local cops. Even if they succeed in their short term goal of driving distribution back to the street, the war on pot will never be the same.

Think of how much easier it might have been if Reform had just been able to abandon their misplaced commitment to the “sick and dying”  and see pot smokers as the symptomatic patients I have found them to be. It's another case for the coulda, shoulda, woulda file.

Doctor Tom

Posted by tjeffo at 09:05 PM | Comments (0)

December 14, 2007

Components of the Emergent Pot Market: physicians

The last entry dealt with the sudden emergence of a vigorous multimillion dollar gray market for medical marijuana that didn’t become visible until early 2004 and has subsequently surprised many observers,  particularly in Los Angeles and San Diego. I also implied that perhaps that emergence had been more predictable than might have appeared and that neither federal supporters of the drug war nor their political opponents in Reform seem eager to discuss its size and profitability.  

But enough politics; let’s first take a look at how the peculiar requirements of Proposition 215 influenced the market that followed its passage. 215’s primary requirement was physician participation. It was slow to evolve and took place in discrete phases.

Phase 1,1997-2001
The initiative’s major requirement was that all claimed medical use  had to be approved (recommended) by a licensed physician.  The drug czar’s immediate threat against the icenses of compliant physician was blocked by injunction,  but it served as effective discouragement for a while. and made the first patient evaluations by a small coterie of pot-friendly physicians slow going. However, 20 000 or so (nearly 10,000 by the late Tod M.) were thought to have been issued by the time I began seeing applicants at an Oakland club in November 2001. What I didn’t realize then was that I was part of the leading edge of  second wave of pot docs, most of whom were more attracted by the business opportunities implicit in providing recommendations than in politics. Because I was an older maverick and could easily recall a time when pot was unknown in High Schools and Junior Highs, my own interest had been curiosity about how the phenomenon of widespread pot use had occurred in the first place.

As I would soon discover, but was somewhat slow to realize, that curiosity would put me progressively out of step with most colleagues in the reform movement.

Phase 2, 2003-2004
In any event, what next started to happen sometime in 2003  were fluorishing medical practices, designed to provide pot recommendations to walk-ins seven days a week opened in multipe locations around the state and quickly multiplied the number of potential customers at least four-fold. The ensuing demand for retail locations where newly certified  patients could buy  pot began at about the same time they began calling themselves “dispensaries,” and the few remaining doctors who had been seeing patients in “clubs” to keep overhead down prudently moved to separate offices. For me, that was in mid 2004 when the Oakland club lost its business license.

Phase 3, Early 2005-Present
Other than harassment of some physicians by San Diego and LA police, or the DEA sending in phony patients as snitches, doctors who recommend pot are being left alone. The continued emergence of new clinics suggests further market expansion is a possibility. Also remember that the emergent gray market is only an (unknown) fraction of the overall cannabis market.

The next entry will address the pot market’s demand  (patient) component in more detail.

Doctor Tom

Posted by tjeffo at 06:04 PM | Comments (0)

December 13, 2007

An Emerging Market (Historical, Political)

Proposition 215’s  passage by a comfortable margin in 1996 was an unprecedented repudiation of drug war hegemony that caught most drug policy “experts” by surprise. Even though the federal ban on marijuana had always been illogical, it had also been impervious to logic and seemed to have become  politically invincible from about 1980 on. Beyond that, the nationally prominent politicians from both major parties who could be persuaded to take public positions on medical use prior to the 1996 General Election had also been unanimous in their opposition to the initiative.

It was sensed almost immediately after the election that California would become the key battleground in what had become an unexpected national debate over medical use, but since even the first participants within the state couldn’t possibly have anticipated the twists and turns of the shadowy guerrilla war that has ensued for 11 years; and its major developments have remained obscure to even to the few honest reporters able to stay with the story, I offer this analysis with some temerity.  However, because I now have reason to believe that the decisive issue of the medical marijuana campaign may finally be emerging, and even though even though its outcome is still obscure, I believe defining it at this point will be helpful.  It must also be emphasized that the great majority of that campaign’s major combatants are still laboring under the spell of the partisan rhetoric that’s been driving them since 1996, so I don't expect either side to agree with this analysis.

The final determinant of the medical marijuana wars in California will be whether the combined power of federal agencies and their allies among local law enforcement will be able to thwart the powerful demand for marijuana that has unquestionably emerged in just the past few years, but which both sides have been ignoring; each for their own reasons.

Before ending today’s entry, I should also say that like most others, it was prompted by a recent development; in this case, a flame war that has erupted on drug policy reform discussion lists over an internet campaign launched by a veteran reformer who has always been something of a maverick and loner who has focused primarily on the critical nature of factual truth, which is why he had started his Drug Policy Library long before I was even aware  there was a reform "movement." Interestingly, he has been swayed in this instance by the surge in the (visible) medical marijuana market that’s taken place where he lives in Southern California over the last few years and came to conclusions that were very similar to mine, arrived from observations made from my very different vantage point as a Bay Area "pot doc."

Future entries on this topic will undertake a definition of the medical market in terms of the three components  Proposition 215 required before it could develop at all: physicians to certify customers as “legitimate,” customers willing to obtain the required physicians' recommendations, and a loose association of growers, vendors, and retailers willing to supply them. The key realization is that all those components (except the physicians) had already existed before 215 was passed; what has happened since 1996 is that they have simply become far more visible and another decade's new users have tried pot for the first time.

Doctor Tom

Posted by tjeffo at 04:09 PM | Comments (0)

December 07, 2007

NORML: still the wrong "R" (Historical, Logical)

I can’t be sure when I first read about NORML (National Organization for the Reform of Marijuana Laws), but I clearly remember seeing my first NORML tee shirt. Since I was already familiar with the name, but not the acronym, it must have been sometime before the Summer of 1978, which is when I saw the tee shirt across a crap table in a Nevada casino (we’d gone to North Lake Tahoe that Summer on vacation). However, it would be nearly twenty years later before I would discover drug policy reform as a cause and thus have reason to read High in America, Patrick Anderson’s engrossing 1981 account of how Keith Stroup, then a young lawyer, had founded NORML in response to the thousands of annual pot arrests already being generated by Richard Nixon’s 1969 “War on Drugs.”

As we were told very clearly by Dan Baum  in 1996, but seem to have great trouble remembering, young, white, pot smoking Baby Boomers like Stroup were the primary targets of the drug war; almost certainly because they were opposed to both Nixon and his prolongation of a futile war in Viet Nam. The resonance of the conditions Baum describes in the early Seventies with those of today is striking: another ill-advised overseas war (Iraq) is being supported by another less-than-honest Republican President stubbornly committed to both it and the failing drug war. What is different now is that we should have known better: we now have a prison population four times the size it was in 1970, the obvious beneficiaries of the drug war are so much more easily identified and so deeply committed that pot smokers, although also far more numerous, are understandaby less willing to be identified. We also now know that many of the pot users in California have been chronically (and effectively) self-medicating for a variety of common anxiety syndromes which have not only become common household words, but are being increasingly targeted by the Pharmaceutical Industry; even as they are still targets for self-medication by pot’s legal rivals, alcohol and tobacco.

One thing that hasn’t changed: Stroup  and NORML are still convinced that he and a majority of those NORML claims to represent are “recreational” users.

I’ve just reread Anderson’s introduction to High in America and found it, in the light of the extensive experience I’ve had with pot applicants over the past six years, to be even more prescient and helpful than first realized. It also convinced me that  Stroup’s and NORML’s stubborn refusal to give up their belief that “recreational “ use is the main reason for today’s spectacularly successful illegal market may be hurting their cause even more than their ill-advised alienation of potential allies in the Carter Administration in 1978.

It’s a no brainer: thoroughly bad policies should,  like Prohibition,  be  repealed; campaigning for the drug war's reform implies there’s some benefit in a thoroughly stupid and destructive policy that's worth saving.  

Some concrete examples soon...

Doctor Tom

Posted by tjeffo at 04:51 AM | Comments (0)

December 02, 2007

Beyond Comprehension (Logical, Historical)

For quite some time I’ve been telling anyone who would listen (most won’t) that the drug war is one of the most stupid and destructive policies ever embraced by any nation and that our prosecution of pot users has been a key element of that war ever since Richard Nixon decided it was the best way to punish the anti-war protesters who were disrupting his first term from 1969 onwards.

One of the entities to be more or less definitively described after both Viet Nam and the ascendancy of a new DSM system for classifying mental conditions in the Eighties was PostTraumatic Stress Disorder (PTSD), a condition formerly known as Shell Shock (World War One) and Battle Fatigue (World War Two and Korea). That the same entity was already affecting some of our first units to serve in Iraq was reported in the New England Journal back in 2004. A search of this blog for PTSD will turn up other references.

Two items calling further attention to PTSD among Iraq returnees were just published. The ABC news videos simply document the extent to which it is still being either ignored or punished by the VA (bear in mind that pot has been effectively treating the symptoms of PTSD in many Viet Nam veterans for thirty years, but it’s use is still a federal no-no).

The second, documented in a long Washington Post article published today, is simply unbelievable. The ignorance, stupidity and callous cruelty reported in crushing detail in this article constitute an eloquent indictment of our  federal government, its military establishment, Psychiatry, Medicine, and the entire nation. Although its details are amazing;  the behavior no longer surprises me because I have suspected for some time that we are a species in denial of the primacy that our emotions inevitably exert over our most crucial decision making (cognitive) processes;  also that a deeply ingrained feature of that denial is the tendency to reject what Al Gore’s handlers recently popularized as “inconvenient truth.”

There are many inconvenient truths facing us other  than Global Warming, and denial has long been Humanity's knee-jerk technique for dealing with them. I will have far more to say about this in the future.

Doctor Tom

Posted by tjeffo at 10:23 PM | Comments (0)

December 01, 2007

Questions Never Asked (Political, Historical)

Earlier in the week the nation was treated to another chapter of the rapidly evolving and ever-expanding presidential campaign being conducted by, and for the profit of, our competing TV news networks. CNN’s latest shtick, another  YouTube presidential “debate,” had the remaining GOP hopefuls lined up in a neat row onstage while they responded to “questions” in the form of videos submitted by thousands of allegedly interested citizens and whittled down to a mere forty by allegedly impartial CNN staffers. The two front-runners of the moment, Romney and Giuliani, were next to each other in the middle.  The others were lined up on either side in diminishing order of their latest poll standings.

The hottest topic, according to the pundits interpreting the proceedings afterward, was a bit of a surprise: illegal immigration, a problem often characterized in simplistic terms by (CNN's own) Lou Dobbs: how do we secure our borders against the many “criminals” sneaking into the US to take our jobs and send their kids to our schools?

The major difference between Dobbs’ usual rhetoric and the  debate questions was that there was no mention of illegal drugs, a subject Dobbs inevitably includes when bashing the Bush Administration for our “Broken Government” and “Broken Borders.”  Nor was there any mention of the drug war itself, medical marijuana, or the recent steroid scandals roiling athletics. In fact, anything that might have cast the least bit of doubt on the legitimacy and success of American drug policy was conspicuously absent.

Also absent from either the You Tube diversion or the campaign itself, has been any mention of the amazing change in NYC pot arrest statistics while Giuliani was Mayor. Those statistics, gathered during the course of Jon Gettman’s landmark studies of national pot arrest patterns, eloquently confirm both the failure of our (unacknowledged) policy of drug prohibition and the racist enforcement patterns
it has produced over the past four decades.

The only remaining question is how much longer can we continue ignoring the enormous elephant in our national (and global) living room?

Doctor Tom

Posted by tjeffo at 06:38 PM | Comments (0)