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February 27, 2011

Annals of Culpable Ignorance, Denial, & Human Folly

Although Harry Anslinger isn’t as well known to Americans as he once was, his place in history seems secure: he was the federal bureaucrat behind the clumsy “Reefer Madness” campaign that added the Marijuana Tax Act of 1937 to the Harrison Act of 1914, thus compounding the modern drug war’s burden of credibility and testing our contemporary powers of denial. In a world where a sovereign head of state can deny the Holocaust and various assorted autocrats can get away with murdering their own people under color of “sovereignty,” the drug war may seem a minor embarrassment, but its mistaken precepts have ruined countless individual lives and its continued primacy as a favored policy is an indictment of America’s intellectual honesty to anyone with an understanding of clinical Medicine and a modicum of that quality.

Anslinger, by declaring, without credible evidence, that cannabis was a menace to youth, unwittingly set the stage for a youthful drug culture that exploded without warning after millions of Baby Boomers discovered the anxiolytic properties of inhaled “weed,” and the expansion of consciousness enabled by psychedelics in the Sixties. Unfortunately, the American President best positioned to respond to that youthful outburst was the insecure and vindictive Richard Nixon. His administration quickly came up with the CSA, an almost perfect legislative folly which, through an ironic twist of fate had already been promulgated as a UN treaty by none other than the indomitable Mr. Anslinger (thus possession of a small amount of herbal cannabis has been grounds for arrest in every global port of entry since 1964).

Most distressing is that modern variants of the Anslinger-Nixon whopper are still lavishly supported, not only by NIDA, but by other medical agencies of the US federal government. The first example of such gratuitous “mission creep” was the FDA's 2006 statement that just happened to coincide with the NORML convention in April 2006, a coincidence our lap-dog press pretended not to notice.

An unexpected bonus of searching for further FDA malfeasance is evidence confirming both drug warriors and reformers have remained unaware of the difference between inhaled pot and edibles since well before Nixon. A recent press release revealed that both sides endorse edibles without taking any notice of their inherent difficulties (or benefits).

An obvious question becomes, why is "non-smoked” cannabis better? Is smoking a sin? Also, when will pharmacologists get around to designing studies that explain the clinical differences between a joint and a pot brownie? Finally, when will NIDA and the DEA realize they had missed an important clinical detail from well before the Nixon era? Is it because the whole CSA, especially Schedule 1, was simply an exercise in imagination that was simply tacked on to the false assumptions made in Harrison and the MTA?

Doctor Tom

Posted by tjeffo at 07:30 PM | Comments (0)

February 25, 2011

The Consequences of Drug War Ignorance

Even though it has been unable to prevent half (or more) of all American teens from trying (“initiating") "marijuana" for over four decades, the federal government insists its policy of drug prohibition (always referred to officially as "control") is successful and must be continued. Au contraire, I saw President Obama’s inability to admit the drug war's many failures as a major weakness in his recent State of the Union address.

That opinion is well supported by information gathered since 2001 from over six thousand Californians seeking my "recommendation" to use cannabis medically, but remains largely unknown because other physicians in a position to obtain similar data haven't done so; nor have they published their findings in the medical literature.

In any event, the aggregated histories of my applicant population could not compete with the huge volume of NIDA-approved literature that began to appear shortly after passage of the Controlled Substances Act in 1970 and has increased steadily since. Its thrust is that inhaled cannabis somehow functions as a transitional drug which induces young people to progress from (legal) alcohol and tobacco to "harder" illegal drugs such as cocaine and heroin. Quickly popularized as the "Gateway Theory" (but never confirmed by clinical data) that notion soon dominated "anti-drug" medical literature throughout the Eighties and Nineties and is summarized in a NIDA monograph on the, Gateway Hypothesis in 2002.

The critical points brought out in my interviews that NIDA-sponsored researchers either don't understand, or seem unable to believe, is that the majority had been self-medicating with inhaled cannabinoids for long intervals in stable patterns to relieve distressing emotional symptoms. Beyond that, they have been willing to do so at considerable risk to their economic, social, and legal well-being.

Apparently, most authors of peer-reviewed literature and their federal sponsors remain unaware of the impressive range of physical benefits inhaled cannabis can provide. It is a potent anxiolytic, antidepressant, antinauseant, antidiarrheal, anticonvulsant and antinocioceptive agent.

Just when I thought I'd learned a great deal about the therapeutic uses of cannabinoids, I was amazed to stumble across an untouched area of gross ignorance a few months ago, one with inportant policy implications. Although medical users are generally aware that cannabinoid effects can vary a lot depending on whether they are inhaled (the "head high") or eaten (the "body high") federal experts have remained oblivious to that important detail; thus neither side has focused on it or the mechanism responsible with the net result that a potentially important therapeutic benefit of herbal cannabis has remained nearly unknown and is still completely unstudied. A brief outline of the issue and a description of the pertinent differences follows.

Any psychotropic agent that can be smoked and crosses the blood-brain barrier will have rapid onset (seconds) which is why smoked marijuana can be titrated (measured) so accurately from the first toke. Edibles, because they are swallowed, are digested separately in the gastrointestinal (GI) tract, a process that not only takes longer, but cannot be monitored in real time. The products of digestion are then transported to the liver via the portal vein and broken down on a molecular level thus exposing the brain to very different effects from edibles than from smoke. The "high" lasts three hours or longer, arms and legs become relaxed to a point where physical activity is avoided, but relief of severe pain (neuropathic and arthritic pain in particular) is greatly enhanced.

The bottom line is that if appropriate research were to be done, the benefits of cannabis-based medicines might be further enhanced and more precisely focused; however, before that could happen, Congress would first have to admit a huge mistakes of long duration and then either repeal or change a bad law.

Thus have our species' emotional flaws been leading us into foolish and destructive behavior. By enhancing our ability to both reproduce and kill each other, Science has been a mixed blessing at best. Can this species be saved?

Doctor Tom

Posted by tjeffo at 08:10 PM | Comments (0)

February 23, 2011

The Libyan Conundrum

Jim Hoagland’s open letter to the daffy, but unfunny clown prince of Libya strikes me as very close to the mark. Given what I now believe about the need for national leaders to retain credibility in the eyes of their polity, it seems unlikely Gadaffy can hang on to power much longer; however, he is not without assets and could still make a bloody fight of it in terms of the number of innocent victims his supporters might kill before he is forced from power, all of which poses a real problem for the issue of sovereignty upon which the “rule of law” ultimately depends. If a sovereign is corrupt, how can the law be worthy of respect? Put another way: who decides when (and how) the king must go? That principle becomes even more troublesome in the United States where federal laws conflict with newly enacted state laws and prosecutors have the option of what amounts to dual prosecution under cover of dual sovereignty.

To return to the problem represented by a rogue government like Libya that has flouted international norms in the service of a tyrannical dictator versus a rogue nation like Somalia which is run by well organized criminals, precisely because there is no effective government. Both present serious problems for which effective policing is the only reasonable long-tern solution. The problem in each case is how obtain control of the problem nation and then impose credible police power which can eventually be turned over to a legitimate government, a process that has often proved far easier to describe than to carry out.

The pressure is now on the UN Security Council which will, if they run true to form, attempt to stall without taking action. In the meantime, there is growing discontent in a broad swath of Moslem countries across North Africa and the Middle East from Tunisia to Iran. Not all are Arab or oil-rich, but what they do have in common is the Moslem faith, autocratic (or ineffective) rule, and a population bulge concentrated in the 18-30 demographic.

In a real sense, the uprisings that have erupted in the Moslem world are youth dominated and were foreshadowed by the counterculture that sprang up without warning in the United States between the mid-Sixties and the end of the Viet Nam War.

Doctor Tom

Posted by tjeffo at 02:19 AM | Comments (0)

February 18, 2011

How do we correct mistakes we can't admit?

Today there much greater awareness of the connection between economic and emotional depression than existed in the Thirties, but it’s also true that there are well over twice as many people on Earth and waves of angry demonstrations in Middle Eastern Capitals and synchronous eruptions in Midwestern American states seem to have caught most political pundits by surprise. It’s at such times that an accurate analysis would seem to be most important; however fear-driven haste and impatience become difficult to avoid and crucial mistakes become more likely.

Such times also drive home another point: governments now exist at the pleasure of the populations they rule; once they have completely lost credibility as rulers, they are rarely saved by force alone. As Hosni Mubarak discovered last week and the shocking fate of the Ceacescus demonstrates so vividly: once an autocrat's credibility diminishes beyond a certain point, nothing can save them.

Death isn't always obligatory; all three Axis leaders surrendered power in 1945, but with significant differences. Mussolini and his mistress were murdered and hung by their heels in a Milan gas station by Italian communists. Three days later, Hitler married his mistress just before their mutual suicide in a Berlin bunker (but with Adolph's authority intact). Hirohito, survived for decades by giving a speech that allowed his people to surrender. That freed them from had been considered obligatory suicide and thus preserved what eventually became became a peaceful, prosperous post-war rehabilitation.

Although the aftermath of the Second Word War was severely troubled by the Cold War, the winners successfully avoided a global nuclear conflict; perhaps because they were deterred just enough by Hiroshima and Nagasaki. A great bonus is that the crowded European peninsula now seems committed to seeking prosperity through cooperation rather than armed conflict.

However serious new religious and economic fault lines have become uncovered elsewhere in the world. They are especially dangerous because, as 9/11 demonstrated, they cross national borders, and are fueled by religious fervor and suicidal resentment. Thus with a modicum of technical aptitude the artifacts of modern science can converted into devastating weapons. Another crucial characteristic, one that may hopefully impede all but the most fanatic, an implied need for indiscriminate mass murder. That limitation, together with some luck, may be why 9/11 hasn't been replicated; however several near misses remind us that grave danger still exists.

In the same vein, it should also be remembered that recovery from the present economic crisis is not guaranteed and we still face unsettling climatic, tectonic, and epidemiological problems our political leadership seem incapable of understanding, let alone solving.

In that context, I see our feckless drug war as metaphor, symptom, and contributing cause of our unprecedented existential malaise. While still tentative and by no means conclusive, the prognosis for complete recovery must remain guarded.

Doctor Tom

Posted by tjeffo at 05:10 AM | Comments (0)

February 16, 2011

The President’s Cigarette Habit

A significant limitation on my use of cannabis applicant histories as evidence that our drug policy is a huge national mistake is that they are privileged. Thus I’m not free to use them except as anonymous statistics. However, now that I’ve accumulated enough data to make generalizations (that can also be tested by any other pot docs who have taken the trouble to ask similar questions) I also feel free to comment on drug use by public figures appearing in the public domain. One such item is President Obama’s cigarette habit. We already knew that, in addition to having admitted smoking cigarettes in the recent past, he is the only American President to admit trying “marijuana” and getting “high;” also that he experimented with cocaine. What he probably does not realize is that as a biracial male born toward the end of the Baby Boom, he also fits, to a remarkable degree, the profile I’ve been developing for cannabis use as a modern behavioral phenomenon.

The most consistent elements in that profile are:

1) male gender: (75%)

2) born in 1946 or later, (96%)

3) trial of inhaled cannabis to the point of getting “high,” (100%)

4) trial of alcohol to the point of intoxication, (100%)

5) inhaling smoke from at least one cigarette. (96%)

Modern “addiction” research, which wasn't vigorously pursued by Behavioral scientists until after passage of the Controlled Substances Act of 1970, has remained focused on the "risk" that adolescents who try certain drugs will subsequently try others. Although such studies quickly gave rise to a “Gateway” theory in the early Seventies, the theory itself has not progressed beyond a disputed, somewhat incoherent hypothesis. The most obvious reason (although not widely admitted) is that federal funding for drug "research" has been limited by Congress to studies that support the drug war; thus it's hardly unbiased.

To return to the President’s smoking addiction, one of the more prominent characteristics of people who eventually apply for cannabis recommendation is that 96% of them also tried cigarettes and roughly 2/3 became daily cigarette smokers for at least a while. Of those, nearly half were still smoking at the time of their initial interview (one of the benefits of the ad-hoc “renewal” requirement added to Proposition 215 is that it allows for follow-up of those applicants who opt to return). Another unanticipated benefit of the proposition is that it has uncovered subsets of behaviors that might not have been anticipated; for example, nearly everyone now smoking cigarettes feels guilty or foolish and most have tried to quit. One of the variants is “bar smoking,” the practice of accepting (or mooching) cigarettes from friends in social situations, often in association with consumption of alcohol. In fact, another subset are people who only smoke on such occasions and do not progress to full fledged recidivism by starting to buy them again; but, needless to say “bar smoking” is one setting in which recidivism is most apt to occur. Others are increased "stress" or inability to use cannabis. For me, bar smoking or stress preceded each of several returns to cigarettes between 1976 (I had quit completely for the first time in 1974) and 1993.

Since 1993, I have not been tempted and now cannot imagine lighting another cigarette, but also have to acknowledge that my compulsion to smoke them for almost fifty years was not deterred by daily contact with cigarette victims from 1953 on (1953 was my first year in medical school: also when I first pondered the unequivocal link between cigarette smoking and lung cancer established by Wynder and Graham).

I can only wish President Obama well and hope he will not only read these words, but will be inspired to consider his inadvertent culpability as head of the US federal bureaucracy most responsible for an insane global drug policy.

Doctor Tom

Posted by tjeffo at 06:59 PM | Comments (0)

February 14, 2011

Clueless America, as seen through the eyes of TIME

TIME magazine has been reporting and commenting on the world as seen through an American prism since it was founded in 1923 by a youthful pair of Yale Bonesmen. Despite a declining circulation (a malaise afflicting most hard-copy publications) it maintains a prominent web presence which also has an extremely useful archive that allows a patient researcher to read all the text the magazine ever published; minus original ads and illustrations. As such, it’s an invaluable resource for examining ambient American thought as it was expressed at weekly intervals throughout most of the last 100 years. By sheer happenstance, The New Yorker, another New York City based periodical, catering to a somewhat different audience, but similarly rooted in the Ivy League, began publishing in 1925. Their back issues were first made available on digital media in 2004 and are also now available to subscribers.

Once I was aware of a heretofore unrecognized generation gap in the way the tems “drugs” and “drug use” are perceived by most Americans, understanding those difference became important for obvious reasons. Over that same interval, I’d also become progressively disabused of the notion that simply learning and explaining the “truth” about such incendiary issues would be enough to start undoing the enormous damage being caused by the drug war on a daily basis. Just as I came to understand that the policy was even dumber and more destructive than I could have guessed, so have I learned that those for whom it has become a way of life share those characteristics to a similar degree. Thus undoing all the drug war's damage seems as forlorn a hope as undoing the human misery produced by other repressive policies of long standing: the Inquisition, American chattel slavery, and the Holocaust, to name but a few. What they also have in common is the idea that status is a crime; it’s thus OK to carry out savage punishments, up to the point of murder, against other humans based on what they appear to be.

Amazingly, that notion remains as viable in some parts of the today’s world as in the Thirties; just substitute “black”, “gay,” or “druggie” for “heretic,” infidel, or “slave” and you will get the idea: labels can excuse treatment that would otherwise be a crime. When enforced by a police bureaucracy under color of authority such policies become especially heinous.

A good place to look at how naive we were just as both the Viet Nam war and the drug culture were about to sweep over us is to read TIME’s opinion on the state of the nation’s youth just as the class of 1968 was getting ready to graduate.

I’d say TIME's editors were about as clueless then as Hosni Mubarak was last Thursday.

Doctor Tom

Posted by tjeffo at 07:26 PM | Comments (0)

February 13, 2011

Annals of Revolution

Recent human history is replete with popular revolutions that toppled governments. In a sense, the successful American Revolution, by bankrupting France, led immediately to the French Revolution. Considered together, the two may be seen as ending the hereditary monarchies envisioned in the Divine Right of Kings, an doctrine rooted in the questionable idea that temporal rulers derive their legitimacy from divine sponsorship. Two World Wars were then fought in the early Twentieth Century over the remnants of hereditary empires; the Bolshevik Revolution ended Russia's participation in the First World War before emerging at the head of a new kind of imperial autocracy that reshaped the world before failing economically when the West produced better consumer goods after both sides had excluded that nuclear war was not a viable option.

In a real sense, the youthful, and largely peaceful, protest that just ousted Hosni Mubarak after 30 years of authoritarian rule in Egypt may have been foreshadowed by an American precedent: the youthful counterculture that flared in the late Sixties and early Seventies before being swept aside by a combination of its own youthful excesses and Richard Nixon’s “war” on drugs. Ironically, Nixon, the only American President ever forced, a la Mubarak, to leave office by popular revulsion, is now remembered for a disgraceful triple legacy most would like to forget: his futile bombing of Laos and Cambodia, our failing drug war, and Watergate.

It’s still much too early to tell how the vacuum left behind by Mubarak will be filled, but one has to be impressed by the youthful enthusiasm and sincerity of the protesters; also their movement’s potential for threatening other Muslim autocracies. It was also very instructive to learn that the United States, which is increasingly unable to balance its own books, has been keeping peace in the Middle East by bribing Israel and Egypt not to go to war with each other.

Simple logic should tell us that’s not a policy that can be sustained for very long and my instincts tell me that the protesters we just saw in Tahrir Square are not itching to invade Israel.

Doctor Tom

Posted by tjeffo at 01:35 AM | Comments (0)

February 10, 2011

History in the Making

Like so many others, I've been caught up in the drama now unfolding on our TV sets: the clearly related series of of political movements sweeping through autocratic governments of the Arab world. At this moment, Tahrir Square in Cairo is jammed with demonstrators awaiting the downfall of an autocrat who has held power for thirty years with the blessing of the US and Israel. Although it started in Tunisia, the current tsunami of political unrest clearly has its greatest potential for significant change in Egypt because of its control of the Suez Canal and the uncertainty of who might take charge once Mubarak has vacated power.

The public display of emotion by hitherto unknown Egyptian actors in this drama must have a lasting effect; as will the weaseling responses of the minions of our competing news services, all of whom are equally unaware of what might happen next.

One of the characteristics of our species is that someone has to be in charge of every organization, whether a family, a business, or a nation; thus when death or some other form of ouster occurs, there has to be a mechanism for transferring either ownership or responsibility for leftover assets and liabilities.

That this is an historic event of great significance is beyond question. How it will play out is still clearly unknown, but that hasn't stopped various twits from criticizing Obama for not taking a stand. What I'm suggesting here is that his true measure as a political leader will be his response to whatever leadership emerges from the present chaos.

The real courage being displayed right now is by those clamoring for an end to the autocracy that has been oppressing them for three decades. As it is, I already see the sudden, unexpected dominance of emotional truth over a repressive autocracy as a sign that there's still hope for humanity. If Obama can also figure that out in the days ahead, so much the better...

Doctor Tom

Posted by tjeffo at 05:01 PM | Comments (0)