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July 31, 2008

A Personal Note and a Statement

As the twelfth anniversary of California’s Proposition 215 approaches, it’s fair to say that although a cascade of unpredictable responses greeted the nation’s first medical marijuana law, nothing has been resolved. In fact, that particular response, which simply confirms the enormous appeal of pot for its consumers, is now so politicized that it reinforces the same stereotypes that enabled Richard Nixon to declare his mindless war on drugs in 1969.

Although several other medical marijuana laws have also passed, some by initiative and others by the legislative process, it’s fair to say they were so restricted by compromises forced on their sponsors that they are little more than vaguely perceived (and easily dismissed) echoes of support for a change in US drug policy. The real battleground remains California

Profound disagreement continues here over the “legitimacy” of any pot use whatsoever. Consistent with their murky historical records of involvement in Medicine, neither state nor federal courts have rendered very helpful decisions; because each left the initiative process intact, 215 remains the law; however the circumstances under which it should function remain as uncertain as they were when it passed.

What has changed has been the emergence of a large, but impossible to measure gray market, along with the parallel development of a patchwork bureaucracy claiming to regulate it. In the resultant bureaucratic chaos, patients trying to comply with the law are subjected to capricious arrest at the hands of patently dishonest state and federal law enforcement entities that increasingly collude in harassing them, stealing their property, and incarcerating them unjustly while wasting ever scarcer public funds in the process.

Although a firm supporter of the concept of medical use and the campaign for Proposition 215 from 1995 on, I hadn’t realized my own ignorance of pot culture until I began screening applicants in late 2001, and similarly didn’t tumble to the entrenched ignorance of the medical marijuana bureaucracy until I began reporting what applicants were telling me. Although still supporting the goals of the “movement,” I have been forced to conclude they are just as human, and therefore as prone to illogical thinking, as their political opponents.

In that spirit, I’ve tried to use this blog as a workshop for both reporting and understanding what patients have told me in confidence. Such is the essence of clinical research. Although I also realize that it took a controversial new law to recruit my research population, I remain convinced there are sufficient mechanisms for neutralizing whatever bias may have resulted.

At an early point in my involvement, the state’s licensing body, the Medical Board of California, revealed its own opposition to Proposition 215 by several attempts to investigate, or otherwise harass, the relatively few licensed physicians then daring to comply with its requirement for a written recommendation. Because I realized my own activities might also make me vulnerable, I decided to advise the board of my study and the degree to which its results challenge federal policy. The following report was delivered at the quarterly public meeting in May, 2005.

I’m posting the text here because I intend to update it with a more detailed account in the near future. Suffice it to say that the new data is even more supportive of the tentative conclusions reported then.

Doctor Tom

05/06/05: Dr. O'Connell's Statement to Medical Board of California

Although, cannabis had been widely used as an herbal palliative in Western Medicine for nearly a century, all prescriptive use was abruptly ended by passage of the Marijuana Tax Act in 1937. Thus, whatever evidence persuaded California voters to pass Proposition 215 in 1996 must have been provided by individuals engaging in what was- of necessity- illegal self-medication during the late Eighties and early Nineties.

In fact, the disclosure of those illegal experiments by Doblin and Kleiman in the peer-reviewed medical literature in 1991 had called attention to the phenomenon and also provided some initial impetus for what eventually became a successful initiative.

After I began screening cannabis applicants in late 2001, the discovery that nearly all were already chronic users who had originally tried it during adolescence-- at about the same time most had also tried alcohol and tobacco-- led me to develop a structured interview aimed at a better understanding of that same self-medication phenomenon. Over three thousand such encounters have now been recorded and enough data from over 1200 structured interviews has been analyzed to permit the admittedly startling conclusions I will share with you this morning:

1) Demographic data amply confirm that a vigorous illegal "marijuana" market didn't begin until cannabis was first made available to large numbers of adolescents and young adults during the 'hippie' phenomenon of the late Sixties.

2) The subsequent sustained growth of that illegal market, although difficult to measure precisely, is widely acknowledged. Those same applicant demographics also suggest that the continued growth has resulted from chronic use by an unknown fraction of the teen initiates faithfully tracked by annual federal surveys since 1975.

3) The striking temporal association between initiation of cannabis on the one hand, and tobacco and alcohol on the other, first noted by researchers in the early Seventies was confirmed; however, the "sequence" they also noted in which cannabis was usually the third agent tried no longer obtains. All three are now tried at similar ages-- and in random order.

4) Those findings, together with an almost universal acknowledgment of similar emotional symptoms, suggests that rather than acting as a "gateway" to other drugs, cannabis has, since the late Sixties, become a third agent tried unwittingly along with alcohol and tobacco by troubled adolescents-- and for similar emotional symptoms.

In other words, what the three agents have in common is an ability to treat symptoms of adolescent angst and dysphoria; and thus function as self-medications.

5) That interpretation is further supported by several other findings developed by systematic inquiries into their family and school experiences- plus their initiations of a menu other illegal drugs- including both psychedelics and "street" drugs.

6) There is also startling-- yet conclusive-- evidence that once they had settled on cannabis as their self-medication of choice, this population then dramatically diminished its consumption of both alcohol and tobacco in sustained fashion. Federal statistics gathered since 1970 also show a gradual parallel decrease in the consumption of both-- plus some related improvements in health outcomes.

7) The bottom line seems to be that in addition to its better-known ability to relieve several somatic symptoms, cannabis has also been a beneficial psychotropic medication for many of its chronic users since their adolescence.

This unique clinical evidence also suggests that cannabis was a benign and safe anxiolytic/antidepressant long before any pharmaceutical agents were even available for those purposes-- and that it still outperforms most of them in both efficacy and safety.

This evidence further suggests that current attitudes toward cannabis are not only profoundly mistaken; but that continued aggressive prohibition inflicts great damage on both individuals and society.

My primary reason for sharing this information with you at this early phase is precisely because it is so radically at odds with both official policy and popular beliefs; a collateral reason is to point out that gathering such data wasn't even possible until 215 was passed.

Finally, because the 'medical marijuana' laws passed by other states have been so restrictive, the acquisition of such data has only been possible in California.

A more detailed account of these findings is available at:http://www.ccrmg.org/journal/05spr/anxiety.html.


Thomas J. O'Connell MD

CA Lic. G20034

Posted by tjeffo at July 31, 2008 07:00 PM