Web Log of Dr. Tom O'Connell

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June 26, 2011

A Clinical Study as Accidental History

Both American drug policy and its current iteration as a “war” on drugs are historical phenomena that should be amenable to study. One of several impediments to any study of an activity that’s been declared illegal is identification of those who engage in it because of their risk of prosecution or other adverse consequences. In essence, Proposition 215, which had been bitterly opposed by all federal and state agencies charged with drug law enforcement, was (and still is) a plea for reconsideration of the 1970 Controlled Substances Act, authored by AG John Mitchell in 1969 and signed into law by President Nixon in 1970. Thus did the initiative implicitly immunize those applying to use cannabis against prosecution for its prior use, and implicitly protect the application process with the same guarantee of confidentiality widely understood to exist in both medical and legal client-professional relationships.

In the turbulent historical context of Nixon's 1968 election, older Americans were being shocked by the behavior of adolescents and young adults who were rejecting traditional social norms, openly using “marijuana” and other drugs, and refusing to fight in a controversial war in Vietnam that was claiming the lives of more draftees every month. A dramatic example of the division between youth and their elders was the general lack of protest over the savage beating of young “hippies” by Chicago Police during the 1968 Democratic National Convention.

The drug policy hippies were flouting had been based on two deceptive pieces of legislation (prohibitions cloaked as transfer taxes). The older one (Harrison, 1914), authorized the arrest of physicians for prescribing unapproved amounts of certain drugs for "addicts;" while the the more recent MTA, (1937), targeted possession by individuals. In 1969, shortly after Nixon took office, the Supreme Court rather unexpectedly declared the MTA unconstitutional because it allegedly violated the Fifth Amendment. Because of its similarity to Harrison, the decision jeopardized our entire policy, , thus providing the new administration with an opportunity to write an new omnibus legislation.

What emerged was Mitchell's Draconian CSA, a law embracing the same muddled notions on “addiction” as before without any discernible Medical input, despite a newly asserted Public Health imperative and enabling severe punishment. Adding insult to injury, sole authority for listing new agents (“substances”) as categorically illegal ("Schedule One") was given to the Attorney General. Thus did a flagrant tautology become a Draconian, yet medically uninformed policy by legislative fiat.

Interestingly enough, after Nixon’s own commission went against his express wishes by recommending that marijuana be studied for its medical benefits, Nixon summarily rejected their recommendation with the same tautology. An uncritical press let him get away with it and he went on to defeat George McGovern by a landslide later that year. Ironically it wasn’t until the Watergate break-in eventually led to the unraveling of his Presidency that Nixon an his AG were held accountable for their lies; but not for the MTA.

Most disappointing is that tapes revealing Nixon’s complicity in the scandal would end up being sealed for another thirty years. In the meantime the CSA has done great damage through the agencies Nixon managed to create by separate Executive Orders issued shortly before his resignation in 1974: the DEA and NIDA. Both have evolved into high-profile agencies, each with a vested interest in expanding its influence with propaganda that portrays "addiction" as a dreaded “disease” for the only permissible therapeutic goal is abstinence, to be coerced by criminal sanctions if need be.

Among several things my limited study of pot users has made clear is that not only has the drug war failed, those who insist on its necessity lack the most basic understanding of marijuana, the "substance" they seem most determined to keep illegal. That pot will ultimately become legal is all but certain, but how long that will take is itself unclear because the repudiation of such a major policy error would require Congress to acknowledge a major mistake.

However, now that the first Boomers are aging into Medicare; I’m confident that enough current and former users will, as Senior Citizens, eventually persuade their Senators and Congressmen to do the right thing.

That the stakes are high is also clear from our national history: the last time similar repudiation of a long-standing policy was called for, Fort Sumter was bombarded by those who refused to go along.

Doctor Tom

Posted by tjeffo at 09:21 PM | Comments (0)

June 20, 2011

More on Mitchell

The discovery that John Mitchell had been the author of the CSA was an important milestone on my journey toward understanding how a policy as invidious as the War on Drugs could have become so dominant in a nation (and World) that had struggled through a two World Wars to make it “Safe for Democracy.” I had also come to see the drug war in a larger context: as metaphor for understanding how various follies have been diverting our species from what should have been its main goal for at least several decades: survival.

Unfortunately there’s no way to sugar coat the main message of the drug war: it’s a cruel anomaly that began with a bad idea in the early Twentieth Century: namely, that criminal prohibitions should function as good public policy. That idea has somehow survived its many historical failures and is now accepted and enforced as global policy in a world that seems to be tearing itself apart at an ever-accelerating rate. As my own interest in the drug war has evolved since becoming an activist in 1995, its focus inevitably began changing as new evidence (information) has been gathered from applicants seeking to use cannabis legally.

Mitchell is important because of his role in critically shaping the course and direction of American drug policy while making it virtually impossible to change within a time frame that might allow its worst effects to be mitigated. In that respect, it is even worse than the fascist evil that led us into World War Two, a war in which Mitchell fought on the “right” side and was decorated for valor. Afterward, he became a successful lawyer specializing in municipal bonds, which is what he was doing when he met a bitterly insecure colleague named Richard Nixon who ended up at the same Wall Street firm after soaring close to the heights of national power as Vice President under a popular war hero only to be defeated in two close elections: first a cliffhanger for the Presidency in 1960 and then by a wider margin for Governor of California in 1962.

Ironically, the friendship that soon developed between the two lawyers would lead both to improbable success: the unsuccessful candidate would reach the heights of political power that had eluded him in 1960 and the municipal bond specialist would embark on an improbable journey from respectability to unsought political power as US Attorney General. Then he would resign as AG to head the new president’s re-election effort. Almost as an afterthought, he would persuade Nixon to focus on drug policy as the vehicle most likely to create the tough on crime image he so desired.

Tragically, the unexpected success that crowned their budding friendship would soon be undone when the insecurity-based hubris of the new president asserted itself in the form of twin ambitions; first to guarantee his re-election and second to avoid being labeled as the first American President to “lose” a war, thus setting the stage for the events that would characterize his unique tenure in the Oval Office: Watergate, the Drug War, Vietnamization, and Resignation. He would be critically assisted in seeking his devious goals by many; but none were more pivotal than two cabinet members he’d met only recently: John Mitchell and Henry Kissinger.

I now see Mitchell as most responsible for writing the opportunistic drug legislation that capitalized brilliantly on fears then just being aroused in the parents of Baby Boomers by their children's drug use and other shocking behaviors. Its rationale and wording would somehow endow the underlying policy with the powerful appeal it still retains four decades later: fear of addiction.

Whether Mitchell even realized the full implications of the CSA, let alone its long term impact, is unknown, More likely he saw it as one of the many favors he later may have regretted doing for his new friend. What is known is that both men suffered professional disgrace that would tarnish their memories years before they died.

We don't know what Mitchell thought of Nixon, but we do have a quote from his wife, Martha: "He (Nixon) bleeds people. He draws every drop of blood and then drops them from a cliff. He'll blame any person he can put his foot on."

Doctor Tom

Posted by tjeffo at 06:47 PM | Comments (0)

June 19, 2011

How Schedule One became the Drug War’s Catch 22

A major stumbling block for opponents of the drug war has been the wording of the Controlled Substances Act passed by Congress in 1970 shortly after the Marijuana Tax Act of 1937 had been struck down by the Supreme Court in the Leary case.

Entirely consistent with the medical ignorance displayed in its earlier deliberations on Harrison, the Court ruled that because the MTA required those wishing to use cannabis to purchase non-existent tax stamps, the law was tantamount to self incrimination! Because the Harrison Act had relied on a similar deceptive transfer tax in limiting prescriptions for coca products and opiates, the striking down of the MTA placed all US federal drug policy in jeopardy- but not for long.

Through a truly unfortunate coincidence of judicial, legislative, and electoral timing, the High Court’s finding in Leary presented the fledgling Nixon Administration with both a clean slate and a mandate to completely rewrite domestic American drug policy. The result was the highly creative CSA, which not only rolled Harrison and the MTA into one Draconian package, it armed the US Attorney General with sole authority to decide which new substances should be listed on “Schedule 1” (as absolutely prohibited). Indeed, LSD and Marijuana were among the first to be named.

In other words, an official who would always be a medically untutored lawyer was armed with questionable and never-validated criteria by which to decide what "substances" could be manufactured, prescribed or sold legally as "medicine." The converse is that any effective medicine erroneously ruled illegal, could become a lucrative product sold by criminals. Add a touch of misplaced morality and you have the modern story Dan Baum subtitled "The Politics of Failure in 1996 and Mike Gray described in Drug Crazy" 2 years later.

The world has now been struggling, without success, to implement the CSA through UN treaty because, by another malign coincidence, Harry Jacob Anslnger was appointed as the first UN High Commissioner of Narcotics in 1962. In that capacity, he successfully championed the Single Convention Treaty of New York which, by virtue of some arcane diplomatic prestidigitation somehow retroactively became responsible for enforcing the failing prohibitions of the CSA as current UN Policy.

Anslinger may have inspired the CSA, but he didn't write it; its impenetrable wording, which has protected it from revision despite four decades of expensive domestic and international failure, was almost certainly a product of the fertile imagination of the one true heavyweight in the Nixon Administration, the only US Attorney General ever to do time: John Newton Mitchell.

Details to follow...

Doctor Tom

Posted by tjeffo at 05:34 PM | Comments (0)

June 11, 2011

On Foxes Guarding Henhouses & Classifications as Guides to the Future

Alan Leshner, who earned a Phd in Physiological Psychology from Rutgers in 1969, has been one of the most visible representatives of American Science since 1994 when he was appointed Director of NIDA. In that capacity, he soon became a well known proponent of the idea that "Addiction" is a "Brain Disease," which just happens to be the mantra of the War on on Drugs; also an essential doctrine of both US and UN policy. In 2001, some five years into California's Proposition 215, Leshner left NIDA to become CEO of the Prestigious AAAS.

Although Leshner may have toned down his strident support for dug prohibition and the idea that cannabis use should be firmly suppressed, there is no reason to believe he's changed his opinion on the basic issue, which he expressed succinctly in a 1997 JAMA interview: " I am ferociously against polarizing the debate. I think that's one of the terrible problems we've made with this issue (addiction). People say that it's either a public health or a public safety issue. The truth is, it's both. And it begins with a voluntary behavior: people choose to use drugs. I don't call it morality, but I call it voluntary. And there's no question it's a medical illness and once you have it, it mandates treatment. It's a myth that millions of people get better by themselves.”

That statement reveals Leshner’s own bias; it's also an unwitting admission of his ignorance of a critical bit of medical history. He is so convinced that “Addiction” must be a “disease,” that he doesn’t bother to question how “diseases” have been defined and classified in the modern era, nor how important accurate systems of classification have become to Science. Until Rudolph Virchow began acting on his brilliant insight that microscopic changes in cellular structure were critical and near-universal reflections of physical disease, the profession lacked a basic vocabulary for rational discussion of its core subject material. In that respect, Virchow’s stroke of intuition did for Medicine what Darwin’s did for Biology as a whole: provided a remarkably useful and accurate skeleton to which could be added as-yet undiscovered "muscles" in the form of new data. To pursue the skeleton/muscle metaphor a bit further: the dynamics of those relationships are also often suggested by new findings.

There are many good examples: Mendel and Darwin never met; its even likely that neither man ever read the others' work; however, the role of Mendelian Genetics in clarifying the mechanism by which Evolution might function was prescient and did nothing to hinder the ultimate discovery of the molecular structure through which genes exert their effects. Even today, as much as we have learned by decoding the human genome; what we have learned about the complexities of genetic expression simply compounds the multiple problems still requiring solutions.

Another example of serendipity: Von Wegener's observation that South America and Africa resemble pieces of a jigsaw puzzle and the subsequent emergence of a coherent Tectonic Plate theory in less than a century is, by now familiar to most. Nevertheless; we are also reminded on a daily basis that plausible explanations of natural phenomena that cast doubt on the existence of an omnipotent deity still face tough sledding in our (not-so) modern world.

Doctor Tom

Posted by tjeffo at 05:27 PM | Comments (0)

June 01, 2011

Why Norman Zinberg is one of my Heroes

As noted in previous entries, America’s national drug policy began when the deceptive Harrison Act was signed into law by Woodrow Wilson in December 1914. Controversial from the start, Harrison generated a series of affirmative 5-4 Supreme Court decisions based on erroneous assumptions about “addiction,” an entity with which the medical profession of that day was just starting to grapple and still had little experience. Unfortunately, the premature intrusion of the criminal justice system into what should have remained a medical problem would politicize it and severely hamper its unbiased assessment from that point forward. Thus was a new facet of human behavior eventually misidentified as a “disease;” an error that can now be recognized as much more than merely semantic; one which has had tragic consequences for victims of a destructive policy still rigorously enforced the world over.

Ironically, politicization of addiction eventually led to its criminalization, even before it could be understood; thus effectively placing it beyond of the reach of unbiased medical scrutiny. That anomaly couldn’t be addressed until similar “Medical Marijuana” initiatives were passed in California and Arizona in 1996. Even then, the dead judicial hand of the past was quickly invoked to strike down Arizona’s law simply because its use of the word, “prescription” was interpreted as violating the letter of the 1970 federal law its sponsors had hoped to clarify and either modify or overturn.

Thus did ninety-two years elapse after the Harrison Act before Prop 215 finally provided opponents of drug prohibition with their first real opportunity to gather the kind of clinical information needed to scrutinize the basic assumptions underpinning our “War on Drugs.” That such an irrational policy could have avoided critical scrutiny and been accepted as necessary by so many for so long is, in my opinion, compelling evidence of a serious flaw in the vaunted cognitive process that has allowed our species to dominate other life forms while also creating so many of our planet’s serious environmental problems. Thus it’s also the main reason I think cannabis prohibition deserves far more attention than it is receiving.

Norman Zinberg MD was a Harvard Psychiatrist who took an unfashionably courageous and intelligent position on the emerging problems of drug use and addiction shortly after the CSA became the law of the land in 1970. His report on that experience, Drug, Set, and Setting, The Basis for Controlled Intoxicant Use, (1984) is available online. His cogent description of the thought process he went through in 1972 before opting to make drug users his research subjects was so remarkably parallel to my own in 2001 that I’m quoting it here: “Only after a long period of clinical investigation, historical study, and cogitation did I realize that in order to understand how and why certain users had lost control I would have to tackle the all-important question of how and why many others had managed to achieve control and maintain it.”

The study Dr. Zinberg describes in that book began before either the DEA or NIDA were created (1973 and 1974 respectively) but his results were compared to similar NIDA-sponsored studies. Sadly, the most important principle his study exemplifies: the need for impartiality in “drug research” has long been ignored. It’s a problem he had also devoted considerable attention to, but not now. Under the influence of drug war inspired fear, most of the drug "research" that’s been done since 1975 mimics the repetitive "Monitoring the Future" studies of youthful initiation that have became the industry standard since 1975 and are intended to show that cannabis initiation by adolescents is "associated" with pejorative outcomes.

That's a technique popularized Joe McCarthy; it was exposed as blatantly dishonest in the early Fifties...

Doctor Tom

Posted by tjeffo at 08:35 PM | Comments (0)