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August 29, 2011

Annals of Self-Medication

Psychoactive drugs that can be ingested as a vapor gain immediate access to the pulmonary (lung) blood flow, travel almost immediately to the left atrium and are then pumped to the brain; thus allowing their pharmacologic effects to be perceived with the first “toke” almost in real time. Experienced cannabis smokers are unanimous that what they feel is an almost immediate sense that the world is a more friendly place than it had been just seconds earlier. The immediacy and unique quality of that response confirms the presence of cannabinoids. Typically, experienced users then take additional tokes, each representing an incremental increase in dose, until there is one that doesn’t change the way they feel- a signal they are “high.” Most stop there because they recognize it as a refractory period and realize that more tokes at that time would simply be a waste of money.

Thus the inhaled marijuana “high” is a unique alteration in mood usually characterized as “relaxation” by users. The necessary dosage is unique for each individual and is reflected by the number of tokes required to produce it. Although there are considerable differences in potency from one strain to another, user memory is what allows them to get the dose right; a process called titration. A corollary is that those who have never experienced the inhaled marijuana “high;” yet insist it is both criminal behavior and analogous to alcohol intoxication, literally do not know what they they are talking about. The whole subject becomes even more complex when one realizes that at least half of all would-be cannabis initiates did not get high on their first attempt and many were forced to try several times before they succeeded. That phenomenon was well described by Harvard psychiatrist Lester Grinspoon. Cannabis seems to be the only drug that tests its prospective users; a phenomenon I recognize, but cannot claim to understand.

The state of relaxation represented by the “high” was described as “anxiolytic,” by the makers of Valium in the early Sixties.. Actually, the first anxiolytic to reach the market was probably meprobamate, a carbamate “tranquilizer” marketed as Miltown in the early Fifties. Then came the phenothiazines later in the same decade. Thorazine became the most famous and is still widely used, along with Sparine, Compazine, and Phenergan. Finally, the benzodiazipines arrived in the early Sixties. Other widely used “benzos” are Librium, Ativan, Versed, and Xanax. In general, the availability of drugs that could moderate disturbed behavior is what allowed the states to do away with the expensive state hospital systems that had been necessary to manage disturbed patients with “mental illness in the first half of the Twentieth century. Patients on oral agents could be managed much more cheaply as outpatients. Unfortunately, those who were less compliant- or who preferred to self-medicate with inhaled cannabis- have been remanded to the criminal justice system for treatment through the efforts of Richard Nixon and John Mitchell, since 1970.

The high produced when “marijuana” is smoked is pharmacologically unique; primarily because its effects can be precisely titrated by the user, a process made possible by the fact that smoking allows its incremental effects to be measured almost immediately following each toke.

To add to the complexity of the clinical pharmacology of cannabinoids, "edibles" behave so differently from smoke that they almost require a separate category. Although many users have discovered those differences and are able to take advantage of them, I have yet to encounter one who could provide a lucid explanation of the relevant anatomy and physiology; nor have I found one in the “literature,” either professional or informal. Most damning of all is the total absence of experimental data that would document the key clinical differences: inhaled cannabinoids are used primarily for their anxiolytic properties while “edibles” are used less often overall and are most prized for pain control, rather than for the anxiolytic effects provided by smoke.

More on this later.

Doctor Tom

Posted by tjeffo at 09:24 PM | Comments (0)

August 19, 2011

One Bright Spot in a Failing Economy

It's difficult to remember that the world hasn't always been this miserable. It seems that every day this summer brings its own quotient of bad news; today it's a resumption of open warfare between Israel and the Palestinians in Gaza; for comic relief we have the latest inanities of Michele Bachmann to remind us that she's still being taken seriously as a presidential candidate, with no evidence the people supporting her realize how silly her public statements really are or the role that the Tea Party played in triggering the recent global sell-off.

As we try to muddle through our current economic insanity, we discover new pitfalls every day: students can no longer afford the fees and tuitions colleges are forced to charge, defense contractors are forced to lay off workers because the government can no longer afford our outrageously expensive (and ill-advised) programs with their huge cost overruns. It now appears there are many ways a failing economy can cause more pain than we ever suspected back in '08 after the initial shock. Each new discovery simply spreads the pain and heightens our sense of futility.

in the midst of the misery there is at least one economic bright spot: so long as ambient anxiety levels continue to rise, the demand for pot is sure to follow. Recent indications that California has become a favored destination for growers from other states. together with the normal mechanisms of supply and demand should guarantee high quality and lower prices for the foreseeable future.

As for "legalization," not to worry. Congress will predictably be very slow to admit that the Nixon-Mitchell drug war was a huge mistake. That probably or won't happen until hell freezes over, or some equally unlikely event.

Doctor Tom

Posted by tjeffo at 04:17 PM | Comments (0)

August 07, 2011

“Legalization” is a safe bet, but could still be a long wait

Pot is even better medicine than many of its ardent supporters realize, but Congress will have to be persuaded to admit to a huge mistake before it can become legal.

America’s war on drugs has been such an abject policy failure that the steadfast refusal of our federal bureaucracy to consider even the slightest change in its prohibition of “marijuana” should raise serious questions about both America’s intellectual competence and the relevance of our federal system of government. Beyond that, the fact that travelers caught with even a small amount of cannabis in any international port of entry face certain arrest reflects badly on our whole species.

I can make such sweeping statements with considerable confidence because I’ve been engaged for ten years in the first-ever objective study of marijuana use, a project made possible when California voters passed proposition 215 in 1996. However I didn’t tumble to the opportunity myself until I had been screening applicants for several months. The study was enabled by the requirement that applicants be evaluated by a licensed physician, but it also required that the physician be willing to seek pertinent information and that applicants be willing to supply it.

Only in retrospect has it been possible to understand that the aggregated histories of thousands of users could create a body of information against which the policy could be measured. Then the information had to be sought and analyzed. Perhaps what inspired me most was a statement by former San Jose Police Chief Joe McNamara, “the drug war is a policy that can’t stand scrutiny.” True enough, but the problem then became getting people to pay attention to the data.

The policy turns out to be based on even more egregiously false assumptions than either Chief McNamara or I could have guessed when he made that statement in 1995. What we also could not have guessed was the role played by fear in protecting a failing and destructive policy.

To restate the problem from a somewhat different perspective: before cannabis can be legalized, the same two legislative bodies that just disgraced themselves in the debt ceiling debate will have to admit that a policy both houses of Congress and both major political parties have staunchly supported since 1937 was a profound mistake. We have only to extrapolate from the cable news broadcasts being aired as this is written to understand how how daunting the problem may become.

All is not lost however; the demographics of cannabis applicants disclose the pivotal role of the Baby Boom in establishing the current marijuana market; also as more medical users age into senior citizenship with each passing year, their voices must eventually be heard. If nothing else, the past 14 years have demonstrated the economic power of America’s most popular illegal drug. If cannabis is addictive at all, it's far less so than cigarettes, the degree of consumer loyalty demonstrated by each birth cohort of initiates is far greater than mere "recreation" can account for.

Doctor Tom

Posted by tjeffo at 05:33 PM | Comments (0)

August 04, 2011

Morning-after Thoughts

Now that the waiting is over, we are seeing that the initial response to US avoidance of its politically generated debt crisis was a sharp drop in financial markets; ironically, worse overseas than here in the United States. Just how that will play out over the next several weeks or months remains to be seen but it should not come as a surprise that the obviously political (and childish) initiative of know-nothing tea party members of Congress should have provoked it. Rather, what should have been evident since (at least) 2008 was that interdependent world markets have been seriously oversold for years, if for no other reason than the almost universal failure of global media to pay close attention to the two biggest problems faced by our species: continuing growth of the human population and its failure to act on the undeniable effect of human energy consumption on our global climate. That the two problems have existed has long been obvious. Less obvious, but of more importance to the day-to-day lives of most people, were how soon and how drastically key financial markets would react to that denial.

In that connection, it is probable that there will be false rallies followed by dips before a bottom is reached; thus how does an ordinary investor with bills to pay and children to educate know when to buy or sell? It’s at moments like this that people can be badly hurt financially because doing nothing can be as expensive as buying the wrong “asset.” Furthermore, it appears that we may finally be bumping up against the fundamental questions that have intrigued cosmologists for thousands of years, with the ultimate answer most likely to be a continuation of the present uncertainty rather than any crisp explanation of who we are, where we came from, or why we are here.

A final consideration is that problems we have remained unaware of (or unwilling to face) usually turn out to be the most costly.

A drug policy related footnote is that one of the more obvious effects of the much-maligned marijuana "high" is that it allows users to be comfortable in the "now," particularly after smoking (when consumed by mouth, it's far more effective against severe physical pain). Thus today's news would seem more bullish for weed than for the war on drugs.

Doctor Tom

Posted by tjeffo at 07:05 PM | Comments (0)

August 03, 2011

The Price of Scientific Ignorance and Denial

Even though our modern world is becoming more dependent on science and scientific technology with each passing day, modern humans continue to exhibit an amazing degree of scientific ignorance. For example, a Gallup poll conducted in conjunction with the 200th anniversary of Darwin’s birth in 2009 revealed that only 40% of Americans believe in Evolution, the scientific theory that has arguably been the most useful at integrating what we now know about the inorganic universe we exist in and the still-mysterious life process we are so clearly a part of. Beyond those basic considerations, Darwin’s intuition was independently verified by the work of Alfred Russel Wallace, another British naturalist working in South America who had arrived at nearly identical conclusions. Finally, it has been abundantly supported by the work of multiple others. For example, Gregor Mendel, the Austrian monk whose work provided a remarkable prescient theoretical structure for modern Genetics, and Albert Wegener whose intuition about continental drift was scoffed at by contemporaries, but ultimately became the basis of Plate tectonics theory which is now the cornerstone of modern Earth Sciences.

At the center of any discussion of science is the role of “theory” in arriving at “truth.” Briefly stated, a theory can be thought of as a coherent explanation linking a series of observations to each other and also fitting in with the concept of uniformitarianism as originally expressed by James Hutton, widely acknowledged to be the father of modern Geology.

If one looks at the array of sciences and scientists mentioned above, one must be struck by their temporal relationships to each other; all were born within the short span of a few hundred years; some knew each other personally, several others corresponded, and all except Darwin and Mendel left behind references to each others' work. In other words, we have abundant evidence of their mutual influence. Thus many of our most important scientific theories took root during a relatively brief interval in European history between the early Eighteenth and early Twentieth Centuries.

If we compare the collegial atmosphere that existed then to the one that exists today, we are struck by their differences; we are now literally swimming in a sea of scientific and technical information that grows larger and deeper by the minute. Without modern electronic communication devices and search engines, sorting it out would be nearly impossible; so much so that without access to the fastest devices for searching and gathering current knowledge in a plethora of technical fields, one would risk missing key insights while simultaneously being exposed to numerous false trails running a gamut from honest mistakes to deliberate hoaxes.

If we turn to government for help, we find that it has long since fallen prey to the blandishments of wealth and power American Democracy was once once intended to save us from. Ironically, that process began as we were becoming independent of Britain, the Industrial Revolution was just getting underway, and the Enlightenment was flourishing; especially in England.

Equally ironically, that was also when an Anglican churchman named Thomas Malthus was publishing a series of papers that would make him famous.

Although based more on intuition than on careful observation and not amenable to experimentation, Malthus' concern has proven both durable and influential. One of the more disquieting aspects of modern thought is that despite the historic Twentieth Century explosion in human population, there is so little modern discussion of our numbers or Malthusian theory.

Doctor Tom

Posted by tjeffo at 04:46 PM | Comments (0)