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November 20, 2011

Culpable Ignorance; How Bureaucratic Solidarity gave rise to a Policy Disaster

The US federal government began using the then-rare term, “marihuana” for cannabis in concert with FBN Director Harry Anslinger’s first hearings on his proposed Marijuana Tax Act in 1937. Although his lurid claims implied an urgent need for such legislation and his assertion that its use by young people was increasing were supported by the Hearst Newspaper chain, they were not corroborated by other sources, nor were they supported by medical literature. The only AMA representative at the hearings complained that he had not been consulted in a timely manner, and characterized the proposed legislation as unnecessary and probably mistaken.

Nonetheless, Anslinger’s poorly drafted MTA (a clumsy attempt to replicate the transfer tax ploy behind the 1914 Harrison Act) was dutifully approved by a bored Congress on a voice vote later that year (the Congressmen were also told the AMA had endorsed the new law). However,"marijuana” use- youthful or otherwise- remained infreqent over the next thirty years (an interval that included World War Two and Korea). It wasn’t until the mid-Sixties that “marijuana” use by teens suddenly became a national phenomenon. Predictably, neither its vaguely defined pharmacology nor that sudden surge in popularity provoked much interest from the FBN, which, in any event, would soon be replaced by the alphabet soup of contesting agencies that emerged following Anslinger's forced retirement in 1962.

After Richard Nixon and John Mitchell salvaged marijuana prohibition with the CSA in 1969, a supportive claque of academic researchers began to thrive on NIDA funding. Its focus, naturally enough, was defense of the policy, and did not include any possible benefits to the "kids" who were using marijuana. Instead, their concomitant interest in both alcohol and cigarettes were quickly identified as a “Gateway" effect, thus reinforcing the need for pot prohibition and generating hundreds of futile studies attempting to demonstrate "causality" between cannabis and heroin addiction.

Some linkage between psychedelics and the emergent popularity of inhaled cannabis could have been inferred from the arrest of LSD guru Timothy Leary for minor possession at the Mexican border in 1965. He was soon sentenced to an amazing 30 years. Four years later, and even more amazingly, his appeal led the MTA to be overturned by the Supreme Court, the same institution that rescued Harrison with several uninformed rulings on “addiction” before 1920, and then reversed themselves in 1925. The 1969 ruling against the MTA posed a dire threat to the makeshift US drug policy because of its reliance on dissimilar transfer taxes (Harrison was actually regulation because it allowed prescriptive use of the targeted agents. However Schedule one, as written for John Mitchell’s CSA allowed no such option for “marijuana,” thus setting the stage for the numerous administrative appeals (as allowed by the law) that eventually convinced Judge Young to make his famous ruling. In an uncanny continuation of the herb’s unfortunate timing, Young would die shortly after being overruled by his DEA administrator (another Mitchell “gotcha”). It would thus take eight more years before Proposition 215 was passed by California voters; meanwhile, both the feds and the “reform movement” would remain mired in mutual ignorance while the criminal market for cannabis continued to thrive and its hippie customers continued to age.

In essence, during the forty years that John Michell's CSA has been the law of the land, the (illegal) use of cannabis has been evolving, both as an "edible" and in its more familiar inhaled form. The opportunity provided by Prop 215 to interview chronic users systematically and repeatedly has provided an unparalleled opportunity to gather data from a large sample of chronic users for whom the chance to become “legal” was important enough to undergo the risk, trouble, and expense of buying what have eventually evolved into one-year renewable licenses grudgingly recognized by state law enforcement on the basis of local rules formulated by loose affiliations of officials in each of California’s 58 counties. The fifteen year evolution of Proposition 215 has also been vigorously contested by federal agencies, thus providing a largely unexpected look at the arrogance, ignorance, and duplicity now rampant in American (and global) society. That a chance to assess how Americans have responded to 4 decades of rigorously enforced drug prohibition would play out against a panoply of worrisome national and global events driven by the same behavioral characteristics as those being palliated by cannabis users may provides an opportunity for the species to recognize (and deal with) some intrinsic flaws it seems to have been in denial about for untold millennia.

Doctor Tom

Posted by tjeffo at 06:07 PM | Comments (0)

November 17, 2011

Is Humanization a threat to life on Planet Earth?

Homo sapiens is the formal taxonomic name for modern humans. We are considered, at least by the scientifically literate, to be a single species that evolved in Africa about 200 thousand years ago and subsequently spread over most of the world in a series of diasporas thought to have begun about 140,000 years later. Those time estimates are considered relatively recent on the deep (geologic) time scale known to Charles Darwin and now accepted by most scientists (but still denied by some organized religions). Indeed, marked differences between religious and political opinions-often bitterly stated- are among the many important issues dividing our species into separate camps in a world being rocked by violent revolutions, engaged in a feckless war on "terror" and now mired in a deepening global economic crisis.

Against that backdrop, one might think that Darwin's hypothesis, since independently confirmed to an unusual degee by Mendelian Genetics, the structure of the DNA molecule (and the fact that it provides a mechanism for inheritance in all known life forms) should be beyond dispute; but such is obviously not the case.

Indeed, we humans, the only cognitive species that is also literate and scientifically knowledgeable, are remarkably prone to irrational disagreements on a scale that, when combined with our technological prowess, pose a unique existential challenge to both our own species and other living things.

In other words the current degree of humanization of Planet Earth may have become the single most immediate threat to both its human population and life in general.

Doctor Tom

Posted by tjeffo at 01:14 PM | Comments (0)

November 13, 2011

Drug War Elephants and Saturday Night Speculation

Any public policy that fails as predictably as our "drug war" (forty years and counting) requires some mechanism to distract attention from those failures while carefully avoiding pointed questions and frank discussion. In the case of the drug war those protections are helped considerably by the widely accepted notion that the designated enemy, drug addiction- especially if it threatens children- is so heinous that any relaxation in the fight against it is unacceptable. Thus has a false doctrine come to rely on an equally false moral imperative. The facile deduction then becomes that anyone criticizing American drug policy must be either a fuzzy headed idealist or a would-be drug dealer who wants to sell drugs to "kids" (defined since by the Reagan Administration as anyone under the age of 21).

As the drug war has evolved since passage of the Controlled Substances Act, its prime objective has became "taking down" evil drug networks and incarcerating (or killing) their "kingpins." Numerous failures to do so have been either glossed over by supportive media or portrayed as partial successes: i.e., keeping bad drugs “off the street,” without acknowledging that what put them there was our stubborn faith to prohibition, a policy of proven failure. The huge tax-free profits produced by illegal markets are only possible under prohibition law (despite its classification as a policy of “control”). They are made available to violent criminals competing in an industry with no rule but survival. The most successful are able to bribe corrupt public officials (never in short supply) and hire the most skilled attorneys to represent them. Eventually, all kingpins are replaced by someone luckier or more unscrupulous than they are. In other words, the prohibition law that has underpinned American drug policy since 1970 really protects a criminal industry that has nurtured some of the worst people in contemporary society.

Another effective drug war tactic has been to refer to any "substance" the US Attorney General lists on “Schedule One” as a (presumably addictive) "drug of abuse” without acknowledging that a) “addiction” has never been precisely defined, b) lacks the characteristics that permit accurate medical diagnosis, c) none of the drugs on Schedule One are as addictive or harmful as cigarettes, and d) the clinical outcomes of illegal drug users under the purview of law enforcement are impeded by unrealistic demands that they remain “drug free;” in other words, the limited success of methadone and nicotine maintenance programs suggest that people with problematic drug habits could become (and remain) productive citizens if they had unfettered access to a safe form of their problem drug and appropriate medical help.

I must admit to having been taken in myself by the steady stream of drug war propaganda that began emanating from the DEA and NIDA, the two federal agencies created in the Seventies to enforce and defend the CSA as policy. Even then, I found it easy to remember that alcohol Prohibition had been an ill conceived social disaster; thus I retained very skeptical of Richard Nixon as President, which may explain why I remember exactly where I was when I first heard about the the Saturday Night Massacre on my car radio (I was returning home from an emergency hospital visit) and realized immediately that it could lead to impeachment.

In retrospect, it's clear that Nixon brought about his own downfall; the break-in probably wouldn't have been regarded as that serious had he not elevated it to that level with his own hubris and refusal to admit a mistake. From October 20, 1973, until his announced departure on August 9, 1974, my car radio and attention remained tuned in to Watergate. I’ve not followed any evolving news story any more avidly and still see its outcome as a rare “win” for the good guys.

What I've also learned about Nixon's drug war in ten years spent interviewing cannabis users is that while it had been a human disaster, it was probably motivated by his own unhappy childhood. Even more ironically its circumstances are uncannily similar to those documented in the histories of patients seeking a recommendation to use it legally.

The tragic irony is that had Nixon been born fifty years later, he could well have become a marijuana user himself; an event that would probably have prevented his political success, but would also have made him a lot happier and the rest of us a lot better off.

Doctor Tom

Posted by tjeffo at 04:55 AM | Comments (0)

November 12, 2011

Presidential Debates, Ripple Effects, and Unintended Consequences

The first decisive TV moment in a presidential campaign took place in 1960 when Richard Nixon’s inattention to make-up and other details made him look untrustworthy. There is now general agreement that the then-unfamiliar debate format portrayed John Kennedy as more youthful and confident and thus helped him win a close decision over a more experienced opponent who was probably in better health. Because Kennedy was assassinated near the end of his first term,we will never know how long he might have lived (or how he might have handled Vietnam); but Nixon survived to the relatively ripe old age of eighty-one.

It's also likely that an innate distrust of the electorate intensified by that narrow 1960 defeat helped persuade Nixon to gamble on the risky Watergate caper that would blight his second term and ultimately force his resignation; the only president ever to endure such disgrace. It's also probable that his fear of being judged by history as the "loser" of the intrinsically hopeless Vietnam war he'd inherited from his predecessors is what motivated his ploy of "Vietnamization:" the gradual withdrawal of American ground troops while compensating for their lost firepower by bombing (and destabilizing) Laos and Cambodia.

We can now appreciate that Nixon’s poor decisions and subsequent fall from grace had enormous consequences for both America and the world at large. For one thing, thousands of avoidable deaths and injuries of Laotians and Cambodians are still beinginflcted by unexploded ordnance forty years later. Beyond that, there has been a loss of trust engendered by our continuing refusal to sign on to an international ban on land mines.

Even more delayed ripple effects and unforeseen international consequences have been produced by the gradual evolution of an ill-considered domestic policy that started when the Harrison Narcotic Act was signed by one Democratic President (Woodrow Wilson) in 1914 and further complicated by another (Franklin Roosevelt) who signed the Marijuana Tax Act in 1937. Although always a failure, America's policy of drug prohibition had remained relatively affordable because the illegal markets it gave rise to remained small until the Sixties when the largest generation in history suddenly developed an unprecedented enthusiasm for "marijuana" and several newly discovered psychedelics within a few years.

Unfortunately that youthful discovery also coincided with Nixon's first term in office. After the Marijuana Tax Act was declared unconstitutional, his immediate response was to persuade fellow Watergate conspirator John Mitchell to draft the far more punitive Controlled substances Act, thus converting a relatively minor policy error into a costly global folly, one still actively pursued by the US Federal Government and the United Nations forty years later. That it's still taken seriously and aggressively enforced despite its enormous expense total lack of success is incomprehensible. It's also a sad commentary on the quality of human political thinking.

The Beat Generation was a small literary movement that gained sudden notoriety in the Fifties. What make the Beats critical to the expansion of a silly drug policy into a catastrophic drug war is that they were were the first whites to try both cannabis and psychedelics and write about their experiences in positive terms. Although those descriptions were largely ignored or discounted by the establishment, they had an huge impact on youthful baby boomers who became so turned on that they frightened Nixon's silent Majority into declaring a "war on drugs" that had even less likelihood of success than his strategy in Vietnami.

To compound the folly, it's now quite clear (although not yet understood) that cannabis, in both its inhaled and edible forms, is so uniquely potent and safe that the greatest damage done by the war against it may not be the millions of arrests and the expansion of our prison system it produced, but the prolonged denial of its benefits to mankind.

A big hint about those benefits: there may be no better palliative than inhaled cannabis for the symptoms of PTSD now attracting increasing attention in our over-crowded and relentlessly competitive modern world.

Doctor Tom

Posted by tjeffo at 11:44 PM | Comments (0)

November 06, 2011

An Important Anniversary and a Belated Lamentation

Yesterday was the fifteenth anniversary of California’s Proposition 215, which allowed use of cannabis (“marijuana”) as medicine, provided it was formally "recommended" by a licensed physician or osteopath. Controversial from the moment it qualified for the ballot, the successful proposition was promptly attacked by Clinton’s drug czar before it could take effect; however his ploy was invalidated by the Ninth Circuit of the Supreme Court on First Amendment grounds. Their ruling was promptly challenged by the incoming Bush Administration at its first opportunity. Fortunately, the senior Court, as it was constituted in 2000, allowed the Ninth Circuit’s ruling to stand. Fortunately that was was long enough before arch conservative justices Roberts and Alito, were added to the court. Thus the first successful voter challenge to the Nixon-Mitchell drug war has been allowed to evolve within California. Even so; it still faces formidable opposition from Law Enforcement at every level as confirmed by recent threats of forfeiture aimed at landlords and the refusal of the IRS to allow deductions for a product voters have declared legal.

Whether the present Supreme Court (which appears to have been configured by Republican Presidents intent on overturning Roe v Wade) would have allowed the state initiative process to stand is probably moot, particularly since a spate of medical marijuana laws been passed; some by initiative and others by state legislatures

Now in its forty-first year, the drug war does not want for vigorous federal backing, but it has also been weakened further by the passage of medical cannabis laws in fifteen additional states and the District of Columbia. With similar legislation now being actively supported in six more, including populous New York, Pennsylvania, and Ohio, a tipping point may be imminent. That medical use legislation has been supported almost exclusively by youthful Democrats sends its own message; it also attests to the power of the black market created, however inadvertently, by the drug war. Beyond that, it confirms the ability of cannabis to attract loyal long term users despite the extreme legal and social risks imposed by its illegality. The underlying message should be clear to anyone with the capacity to decipher it, a growing population that will hopefully include our first biracial President who happens to fit the profile established by an ongoing study of California applicants to an uncanny degree (that he had negligible contact with his biological father, tried cannabis, was able to get “high,” and also had extreme difficulty becoming abstinent from cigarettes are matters of public record).

To return to this entry’s anniversary theme: the real genius of Proposition 215 may have been a Psychiatrist who became a lifelong cannabis user, Tod Mikuriya, who, as brilliant as he was, undoubtedly experienced its benefits on a personal level long before appreciating them intellectually. Whatever the truth of that speculation, I have no doubt that his critical contribution to Prop 215’s wording was what gave me, as a pot neophyte, the courage to recommend it for the “mood disorders” I soon recognized from and the accumulated family and drug initiation histories I began collecting from applicants in November, 2001.

Although there is far from universal agreement among chronic users, I am convinced that most were attracted by the unique anxiolytic benefits of cannabis (especially when when it is inhaled). It was that intuition that gave me the courage to proceed in the face of skepticism from both political opponents and supporters of "medical marijuana."

My profound regret is that although I’d enjoyed limited access to Tod; it was late in his career and mainly during the short remission before he died; thus we had no opportunity for the relaxed, collegial discussion I now miss acutely. Nevertheless, I appreciate the life-long courage and sagacity he demonstrated in such abundance.

Without those qualities and the contributions of a few other prime movers, we might not have had Prop 215 and be still at square one, rather than well on our way to what promises to be ultimate “legalization.” It may not come as soon as many would wish, but the demographics of current medical users and the absence of competitive products among the offerings of Big Pharma make it a very safe long-term bet.

Doctor Tom

Posted by tjeffo at 03:55 PM | Comments (0)

November 02, 2011

A Revealing Handbook

The more I study American drug policy, the more I consider the new specialty of Addiction Medicine to be its creature, the very existence of which depends on mistaken policy beliefs about "addiction." That view was strengthened by reading a publication intended as a Handbook for the practice of Addiction Medicine. I freely admit to my own bias; since I decided US policy was seriously flawed many years ago and have had no reason to change that opinion, I had become more interested in understanding just how such a bad policy had survived for so long. What I learned from reading Addiction Medicine didn’t change my opinion of the policy, but it did enhance my understanding of its acceptance. Although its sub title asserts that it’s “evidence based,” the Addiction Medicine Handbook is an archetypal policy-friendly exercise of the type that began accumulating rapidly in Psychiatric and Behavioral Science literature shortly after passage of the Controlled Substances Act in 1970. The CSA can best be understood as a homologue of the infamous 1937 Nuremberg laws used by Adolph Hitler to arrogate total control of society in a nation made resentful enough by the Treaty of Versailles to accept his preferred assessment of its malaise (betrayal by the Jews) and its necessary therapy (the Final Solution), which, amazingly, was still being implemented in April 1945; even as Germany was being gobbled up from the East by the Russians and from the West by the Allies .

To pursue that analogy a bit further, the drug war’s bureaucracies (The DEA and NIDA) have been permitted to wage the expensive war that sustains them despite its record of failure because it is mostly metaphorical; whereas Germany’s 1945 enemies were using live ammunition. Beyond that, the nuclear weapons we were motivated to produce by Japan’s threat of mass suicide, has yet led to lead our species into nuclear winter (although there have been at least 2 close calls).

As for the Addiction Medicine handbook, its support of our failing policy is disclosed more by what is not explained than by what is, a tactic that has been been critical to the drug war's durability as policy. Once drugs were made illegal, users were placed beyond the reach of unbiased study, whereas self-interested policy supporters within government were given total control of the agenda on the basis of their largely unsupported claims about “drugs” and their noxious effects. Worse; those opposing the policy could be tarred with the same brush as clueless hippies at best and criminals, at worst. That our media simply amplified those claims by accepting them at face value from 1972 on is a matter of record, as is the proliferation of policy-friendly "studies" purporting to show that cannabis functioned as a "gateway" drug.

John Mitchell’s Controlled Substances Act was the legislative master stroke that brought that situation about. By rolling the Harrison and Marijuana Tax Acts into one package, it provided the policy with a single plausible enemy (the addiction of children) and gave the nation enough time time in which to forget the fiasco of (alcohol) Prohibition. Not only had another world war intervened between the criminalization of “marijuana,” and the start of our drug war, but America had rediscovered its taste for booze while women were entering the work force and a new youthful demographic (the Baby Boom) were discovering the blandishments of alcohol and tobacco. In other words, generational amnesia had set in between passage of the the MTA in 1937 and the discovery of “weed” by young “hippies” in the Vietnam-Nixon era.

Rastegar and Fingerhood’s short chapter (11 of 17) on marijuana is especially revealing; both for its brevity- 6 pages of a 295 page book- and for the issues it does not try to address: the history of cannabis prohibition, its sudden popularity with youth, its user demographics, and the claimed medical benefits that have led to medical marijuana laws in 16 states. That both authors are prominent in the new specialty of “Addiction Medicine” and on the Hopkins faculty is both revealing and discouraging.

Doctor Tom

Posted by tjeffo at 04:08 AM | Comments (0)