« An Untold American Success Story; Part 9 | Main | Two Inconvenient American Success Stories »

January 08, 2009

An Untold American Success Story; Part 10

It’s now three weeks since I began summarizing seven years of clinical interaction with California pot smokers seeking to use it legally under the provisions of Proposition 215. That effort, like the initiative itself, turned out to be far more complex than one could have assumed at the outset; and for similar reasons. Both the tendency to underestimate complexity and the reluctance to admit mistakes are very human, but the ability to recognize and correct mistakes becomes increasingly difficult for bureaucracies. All US laws banning "drugs" have been based on morality masquerading as Public Health. That intrinsic confusion had remained intact for decades, and was especially important when "marijuana's" original i937 prohibition was rewritten as the CSA in 1970, despite specific 1972 recommendations that its medical use be studied objectively.

Quite the opposite happened: the CSA intensified punishments for all illegal drug use while expanding the number of banned agents, promulgating irrational criteria prohibiting new ones, and entrusting that responsibility to the least appropriate federal agency. In other words, Congress used the Supreme Court's Fifth Amendment rejection of the Marijuana Tax Act to combine two bad laws into a greatly expanded policy of drug prohibition based on the same uninformed fear of addiction that had inspired the Harrison Act in 1914; all without any additional medical input.

That same policy, now known simply as the drug war, had remained beyond scrutiny until Proposition 215 passed in 1996. Still, it took until early 2002 and the discovery that most applicants had already been chronic users for years before any objective clinical assessment of that particular behavior began. To date, mine seems the only such study to have been published, but before considering its most inconvenient revelations, I'd like to take another crack at psychedelia.

The distinct properties of psychedelics and how they differ from other illegal drugs have yet to be directly addressed by the drug war. Although it’s common knowledge that certain illegal agents are typically used on a daily basis, often at short intervals, it’s less well known that psychedelics maye be used once or twice in an initiate's lifetime and, even when repeated, is often at longer intervals. Indeed, a few experiences (“trips”) seem to have been enough for most of my applicants thus differing significantly from their use of other illegal drugs. That those differences are important is suggested by data revealing that chronic users of different ages and ethnic backgrounds also exhibit characteristic patterns of lifetime psychedelic use.

The agents I selected for specific inquiry were psilocybin LSD, peyote, mescaline, and MDMA. The first three had been readily available to older baby boomers who were also the first to try marijuana in large numbers, MDMA didn’t become available until the early Eighties and wasn’t finally declared illegal until 1988. In general, although the first (now the oldest) baby boomers tried pot and other illegal drugs after alcohol and tobacco, their successors soon began trying pot alcohol and tobacco at a comparable ages and before all others. . Typically, psilocybin, on the form of “magic mushrooms” (‘shrooms) has remained the most popular; LSD had been second most until its market was affected by a huge bust in 2001.

Among other points about psychedelic use confirmed by this study and ignored by the anti-drug lobby: even though a “recreational” purpose may be intended at first, most who do try them discover that their benefits came in the form of insights, qualitatively different and longer lasting than other pharmacologic effects. Finally, not all reactions were pleasant, especially if the drug had been unwittingly ingested.

Finally, before psychedelic agents that are now illegal were banned, their histories, early users, and initial markets were all strikingly different from more typical criminal markets for addictive opioids and stimulants. It’s thus clear that the DEA and the other police agencies defending drug policy make decisions about individual drugs that are far more focused on transient alteration in consciousness than any Public Health concerns.

Two additional points: there has been, and still is, considerable interest in psychedelics' utility in psychotherapy and the treatment of addictions. In that respect, my own data show clearly that chronic use of cannabis is nearly always associated with diminished alcohol intake, especially in those who were already heavy drinkers. Most pot smokers who had become daily cigarette smokers have quit and those still unable to quit have reduced their intake. Finally, AA founder Bill Wilson, tried LSD shortly before his death and was intrigued by its potential benefits; there are current studies (cautiously) exploring the use of MDMA in PTSD,

Another impression gained from my study is that cannabis exhibits psychedelic properties which seem more important to some users than others; in fact, a small minority (perhaps five percent) of all applicants might better be classified as "psychedelic," rather than “therapeutic.”

As with just about everything else in Medicine, “more research is needed.” It’s too bad that the drug war “research” must be directed at defending a failing policy.

Doctor Tom

Posted by tjeffo at January 8, 2009 07:01 PM