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January 31, 2012

On the Impportance of Theories and Differences of Opinion

Theories are essential to the scientific investigation of unknowns because they provide tentative narratives which then act as vehicles for the examination of relationships between new observations and information that's been accepted with considerable certainty. Thus areas requiring clarification are readily identified and questions still requiring answers are exposed in ways that facilitate the design of needed experiments.

In other words, quests for new information are not foreclosed as they are by Dogma, the very antithesis of any scientific approach to knowledge. Dogma assumes that a particular world view is absolutely correct and that any questioning of it may require punishment. Not very long ago, those even suspected of questioning dogmatic religious beliefs were systematically prosecuted by their governments. The ultimate expression of that belief, practiced on a mass scale as recently as the last century, was the mass murder of people whose “race” was considered a presumption of guilt.

To return to the subject of theories, one of the best examples of their utility may be Charles Darwin, who as a young naturalist on a long voyage noted some interesting facts about local birds and their apparent adaptation to the different habitats extant on islands in the same archipelago. His hypothesis was subsequently refined into the theory of Evolution following publication of the book that introduced it to a mass audience.

Although both Darwin and his theory have had an enormous impact on Science (the theory anticipated the discovery of DNA and its role in biological reproduction) many still denounce both him and his theory; apparently because they have threatened the grip of both organized religion and other dogmatic beliefs on human thought.

Of great interest to me is that some recent Google searches related to Darwin have turned up evidence that both he and FitzRoy, the captain who was essential to the voyage that made him famous, suffered from symptoms modern Americans have been relieving with in illegal cannabis, the use of which is opposed by a militantly dogmatic policy.

Doctor Tom

Posted by tjeffo at 07:23 PM | Comments (0)

January 23, 2012

With Friends Like This...

If only NORML lawyers would stop playing doctor; when they do, they give aid and comfort to the DEA, one of a very few organizations even more clueless than their own. After over eight years of biting my tongue when cannabis reform "allies" pontificate about "legitimate" medical use, I'm finally breaking my silence to address complaints aired by one Norm Kent, an attorney, NORML board member, and talk radio host in the current Counterpunch. Kent complains that,”Flaws in the California system have allowed critics to expose that access to marijuana has not been legitimately reserved for those who are ill,” Oh, yeah, Norm? What medical school did you go to? How many years of residency have you done? How many medical histories have you taken from sick people? Do you think three years of law school and smoking dope for about 30 makes you an expert on the medical uses of cannabis, even if you are also a lymphoma survivor? For that matter, what do you know about the disgraceful role your own profession has played in creating, enabling, and enforcing America's abominable “war” on drugs. After all, when Harry Anslinger's fatuous Marijuana Tax Act was struck down by the Supremes in 1969, it was an AG named John Mitchell who dreamed up the medically indefensible “Schedule One” and his crony, the insecure Richard Nixon who protected it against revision (it should never have seen the light of day). Oh yes, it was also NORML's founder who scotched any chance of reclassification by a favorably disposed Carter Administration by spitefully alleging that his drug adviser had snorted coke at the 1977 NORML Christmas party. Way to go, guys.

It’s too bad your world is so disorderly that people who should have known that NORML’s strategy of “regulation through medicalization” required all but “legitimate” patients (like yourself) to refrain from selfishly seeking a recommendation for themselves on the mistaken notion that their severe panic attacks, seizure disorders, or debilitating migraines aren't all that serious, especially if they also look healthy from across the street.

I could go on, but you obviously know enough about medical use of cannabis from your own experience that you don’t have to familiarize yourself with the benefits it confers on victims of PTSD, young girls molested by relatives as children, or soldiers who’ve been repeatedly deployed to Iraq or Afghanistan and are prevented by both regulations and random drug testing from smoking cannabis. Too bad they are thus prone to drink excessively, beat their wives, and/or commit suicide between deployments.

You also obviously don’t know that NORML hasn’t lifted a finger to help disseminate my data, which ties the huge surge in the domestic pot market that began in the Sixties to the millions of baby boomers who were discovering the anxiolytic benefits of inhaled cannabis by getting “high,” as teens in that same era. I can see also from your wikipedia bio that you are a gay male who was born into the leading edge of the Baby boom, went to law school and has long been active in both NORML and talk radio. (also that you were a doper before being treated for the lymphoma). That’s enough info for me to make some reasonably accurate guesses about your drug initiation history and important family relationships. I could probably surprise you with what I know about you, but I also surmise from what you've written that you will probably be more comfortable pretending you never saw this.

By the way, all the questions raised in your Counterpunch article have only one answer: the drug war, as it has been enforced under the Controlled Substances Act had effectively blocked unbiased clinical research on users of any "drug of abuse" until Proposition 215 enabled an unbiased study of pot applicants. When I began taking applicant histories, I didn't know that my fellow pot docs were more interested in selling their signatures than in clinical research or that the majority of lawyers and policy wonks would be so confident in their clinical judgement about "valid" use. To say nothing of the stubborn dishonesty of federal drug police and US Attorneys.

BTW, you shouldn't have been so tough on President Obama. He's a post boomer who never knew his own dad, has admitted trying weed, getting high, and snorting coke, as well as having to struggle to quit cigarettes. He fits my profile so closely, so he might just be persuadable if he weren't also a lawyer and a prisoner of ambient drug war rhetoric.

Doctor Tom

Posted by tjeffo at 04:59 AM | Comments (0)

January 13, 2012

Error Correction

When the last entry was posted, I confused the terms "pharmacodynamic" and "pharmacokinetic," for which I apologize. The error has been corrected. The distinction is more than academic, because my criticism was based on significant differences between how lipophilic cannabinoids (fat soluble) reach their receptors and how water soluble "drugs of abuse" reach theirs. As noted in my posting, those differences are clinically significant, but have yet to be clearly addressed by either side in the "debate" over medical applications of cannabinoids that's been raging since 1972.

Doctor Tom

Posted by tjeffo at 05:21 PM | Comments (0)

January 11, 2012

The "Edible" difference, an analysis for the DEA to choke on

When cannabinoids are smoked, they are transported- almost in real time- to the brain, a phenomenon immediately appreciated by those who have have been able to get “high” on smoke at least once, as a sudden feeling that the world is somehow less oppressive than it was seconds earlier, i.e. that they are about to enter a controllable anxiolytic state. As explained earlier, there must be an as-yet unidentified population of cannabis aspirants who disobeyed the law by smoking the forbidden weed on one or more occasions, but were unable to get high.

Since federal drug policy minders have never acknowledged their existence, those unsuccessful initiators are unlikely confess their unlawful attempts unless they are really dumb as well as unlucky.

Because passage of a Draconian omnibus prohibition law, a.k.a. The Controlled Substances Act of 1970, had clearly been in response to the Supreme Court's nullification of the 1937 Marijuana Tax Act, the same absence of scientific scrutiny that existed in 1937 was applied to the CSA, thus the concept of hemp prohibition has never received any scientific (or even critical) scrutiny from within the federal bureaucracy. Beyond that, the idea that prohibition laws simply don't work has always been implicitly denied by modern feds who insist their policy is one of control.

Since the MTA also effectively scotched all production and consumption of “hemp,” (except for wartime emergency duty) the MTA also eliminated the troublesome environmental protection that might have accrued from the multiple other products never produced. The only crying over that spilled milk was an underground classic that has so far, been successfully ignored by the “straight” world.

Back to edibles: since the stomach and the gut digest everything presented to them and those (unknown) digestion products reach the blood stream via an entirely different route than smoked cannabinoids, it thus follows that two never-studied processes affect edibles: first, are the unknown breakdown products of cannabinoid digestion within the intestine. Second are the (unstudied) metabolites produced by their processing in the liver (because unlike inhaled cannabinoids, they enter the blood stream through the hepatic portal circulation, which, as its name implies, goes directly to the liver.

Difficult as it is for me to believe, I seem to be the first to note the pharmacokinetic differences between inhaled and orally ingested cannabinoids. Certainly I have been looking for such descriptions for a few years and have yet to found any. It occurs to me the main reasons for the silence of peer-reviewed literature on the subject may be: 1) the illegality of "marijuana," and 2) the reluctance of researchers to embarrass the drug war's notoriously protective federal agencies. Of course there's also their insistence that a "semisynthetic" analog of THC ( Marinol) the feds paid to develop is safer and more effective than the illegal natural product. Then, there's the entirely unsolicited FDA advisory that "marijuana" couldn't possibly be medicine because it had to be smoked!

If there's a better explanation of either the pharmacokinetic differences I've noted or the failure of either scientific and popular publications to tackle the touchy subject, I'd like to hear/read about them.

Doctor Tom

Posted by tjeffo at 11:32 PM | Comments (0)

January 07, 2012

Federal Duplicity and Chronic Pain

The last entry pointed out that important differences between the clinical effects of smoked versus orally ingested cannabis have remained unrecognized by both the federal agencies responsible for our policy of imposed ignorance and opponents of that policy. Nor, apparently have the bases for those differences been explained by either academic or pharmaceutical researchers despite the enormous volume of peer-reviewed research that has been published in the two decades since the endocannabinoid system (ECS) was discovered.

To return to the issue of edibles, I was about to explain that they are recognized by many chronic users as far superior to inhaled products for their antinocioceptive (pain releiving) effects, another difference that has apparently escaped notice by the army of cannabis researchers.

As I was preparing to get into the subject of edibles and enhanced relief of chronic pain, I came across a sad item in the news: Siobahn Reynolds, a courageous activist who had long opposed the scandalous federal persecution of pain specialists who disagreed with them died in a plane crash last week. The accompanying news stories also reported details of how Reynolds had been deliberately persecuted by the feds in ways I hadn't previously been aware of.

Less well known than their mindless harassment of pot users, has been the federal penchant for literally destroying pain specialists for the "crime" of prescribing adequate doses of legal opioids for a small, but specific group of patients with chronic pain who apparently require larger than usual doses to function. When carried to extremes, this cruel and inhumane policy has produced two victims, a patient driven to suicide and an physician imprisoned for disagreeing with a federal bureaucracy. Thus are medically untrained prosecutors empowered by our drug war to prosecute both a physician they disagree with and the patient they claim to be to "protecting."

Such enlightened "public health" will undoubtedly be retained as part of "Obamacare." Don't Obama's Republicans critics recognize realize faithfully Richard Nixon's public health concerns are being honored by the federal medical bureaucracy he left behind?

On a more realistic note, I'm forced to ask somewhat rhetorically: just how will long the citizens of nation continue to endorse our cruel and hypocritical drug policy to survive? What ever happened to common sense and normal human decency?

Doctor Tom

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

January 05, 2012

Annals of Ingestion: the “Head” versus the “Body” High

Experienced users know there are two different cannabis highs; a head high from smoking and a body high following oral ingestion. However, neither the popular nor the professional branches of the voluminous modern literature devoted to “marijuana” since California's Proposition 215 passed in 1996 demonstrate more than cursory interest in those differences; let alone the basis for them or the possibility they could have important therapeutic implications. In fact, I didn't begin focusing on them myself until I'd been questioning applicants for a few years, and it has only been since I began analyzing their answers that I have been able to come up with a logical explanation. Interestingly, once understood, the reasons for the differences noted by users are not obscure; indeed, they are rooted in basic anatomy and physiology to an extent that suggests they have been literally hiding in plain sight since 1970 or before. Why that should be the case thus becomes a question requiring an answer. Perhaps, like so much other information now coming to light about a subject that's been off limits to honest research for over seven decades, the right questions were slow in coming because not enough was known about the forbidden drug to pose them.

Cannabis was being used medically in Asia long before its benefits were reported to Western Physicians around 1840 by William O'Shaughnessy, an Irish Physician who had been working for the British Raj in India. As far as we can tell, most of the therapeutic applications of Ganja investigated and popularized by O'Shaughnessy were either oral or topical. In that connection, it's interesting that O'Shaughnessy himself considered its use by inhalation "depraved." At about the same time, on the other side of the English Channel, French Romantic authors began gathering for informal experiments using hashhish as an intoxicant. What is immediately evident from the description quoted from Baudelaire, is that they were focused of what would now be called "recreation" and were indiscriminately mixing alcohol, smoked cannabis and edibles. That some might have found such experiences unpleasant is not at all surprising.

Technical Details

The introduction of drugs into the body is technically referred to as ingestion; it may be oral, by injection, or by inhalation, either directly as a gas or by smoking. Agents amenable to inhalation rapidly enter the pulmonary (lung) circulation and are delivered almost immediately to the heart and then pumped to the brain and other parts of the body. In the case of cannabis, the experienced user senses a characteristic, and almost immediate, elevation in mood which is interesting because that mood change is only experienced by those able to get "high." A little known fact is that at least half the applicants I've interviewed did not get high the first time they tried "weed," and many failed several times before it happened. The first (and only) public recognition of that phenomenon I'm aware of is Dr. Lester Grinspoon's frank description of his own initial failures and later success. I now ask all applicants if they got high the first time. At least half didn't, and many required several attempts. To my knowledge, cannabis is the only illegal drug that gives prospective users such a test: anyone unable to get high will almost certainly not become a chronic user. Such people do exist (I have met only one), but they would have little reason to seek a recommendation.

We know cannabis was legally prescribed by American physicians from the Nineteenth Century on and can safely assume that most of its early medical use was oral, but we have relatively little information about its "recreational" use by inhalation during that same interval, nor about its commercial production for those purposes. We do know from other sources that several states passed laws against it when alcohol Prohibition passed. Why? Because they assumed that banning booze would make "muggles" more attractive! Never underestimate the malevolence of moralistic control freaks...

In any event, at least one well known historical figure experienced several of the same benefits from his use of inhaled cannabis that were reported by my patients. Louis Armstrong was a musical genius who played a critical role in shaping jazz into a unique American cultural contribution. There's also little doubt that his lifelong use of inhaled cannabis played a critical role in helping him overcome a childhood spent in an orphanage. Armstrong also had to overcome poverty, racial prejudice, and the perils of a criminal "justice" system that ironically, wasn't as tough on him in 1930 when he was arrested for possession of "gage" as it would have been today.

In another entry, I'll discuss the key differences between edibles and smoke, the reasons for them, and how that clinical evidence impeaches federal dogma as so much imaginative nonsense.

Doctor Tom

Posted by tjeffo at 07:38 PM | Comments (0)

January 03, 2012

Marijuana’s Unsuspected "Daddy" Factor

In a recent entry, I promised to ”tackle what may be the most important question of all: why cannabis became a smash hit with boomers in the Sixties and what that portends for the future.”

When Steve Jobs died in October, I already knew he’d been adopted just after birth; also that the fact of his adoption had played a major role in his subsequent behavior. That intuition was based on a series of unexpected findings from my study of marijuana users: as a group they had experienced an uncanny degree of paternal neglect during childhood; an unrecognized fact that had clearly influenced their decision to try pot as adolescents. Finally; although only 1% of all applicants had been adopted, it was a closely related issue that seemed to affect them with particular intensity.

Thus, I was quite sure that Steve Jobs, who had been born in San Francisco in the “leading edge” of the Baby Boom and raised in the Bay Area by adoptive parents, had almost certainly tried marijuana and used it for at least a while; probably other psychedelics as well. Those suspicions were quickly confirmed by a quick search of Walter Isaacson’s biography. As hinted at in my first Jobs entry I hope residual interest in his remarkable career will provoke the level of intelligent evaluation that will be required to start reversing that most malignant of all American policies: the “War” on drugs.

Examined in a relatively unbiased historical context, American's drug policy can be seen as a close relative of chattel slavery, itself a mind-boggling contradiction of Jefferson's exalted prose in the Declaration of Independence that came about in 1787 when he and other Founders agreed to retain Slavery as the price of retaining states from the Lower South within the Union. The device was to count each slave as 60% of a human being, a compromise that would lead to Civil War in less than a Century and which, as W.E.B. Dubois pointed out in 1896, the nation was lucky to survive.

Based entirely on ignorant assumptions about addiction in the early 20th Century, and protected against scientific scrutiny through the Second World War, American drug policy was greatly intensified under Nixon in 1970 and then quickly forced on the rest of of the world by UN treaty as a “Drug War.” Most importantly, its acceptance by the rest humanity since the Seventies shows it was not just an unfortunate American error; it’s really an indictment of the vaunted cognitive function we humans have long assumed entitles our species to dominance over living things.

If that thought isn’t provocative enough in this "information age," I’ll add another: Barack Obama, like Steve Jobs, was obviously brighter than most of his peers throughout childhood and adolescence. He is also the most improbable of all 44 American Presidents, precisely because of his biracial origins. In addition, he shares two characteristics exhibited by most of the 6600 cannabis applicants I’ve interviewed to date: he tried the forbidden weed by inhaling it, was able to get “high,” and then used it for an undisclosed interval. That he wasn't a long term "head" is implied by the fact that he survived vetting for both the Senate and the Presidency.

With respect to paternal contact, Obama met his biological father only once, an event described in considerable detail by John Meacham in 2008; the occasion was the senior Obama's departure for Kenya, a trip from which he would never return. Comparing two accounts of the impact of absent fathers on famous sons is obviously a stretch; however the additional perspective provided by our detailed study of pot users in searching for similar evidence lends considerable weight to the idea that fathers are far more important to the emotional health of their offspring than is commonly realized.

For me, the implications for American "marijuana" policy are grotesque: we have created a law enforcement industry based on punishing people for the "sin" of self medicating safely and effectively for symptoms unwittingly inflicted on them; often by the circumstances they were born into.

If someone could explain to me why that is a good idea, I'd be happy to listen. Another grotesque irony is that in October, the DEA, a federal agency nominally under Presidential control, just announced a new crack-down on California "dispensaries" based on the federal dictum that cannabis can't possibly be medicine because John Mitchell and Richard Nixon said so.

Doctor Tom

Posted by tjeffo at 09:28 PM | Comments (0)

January 01, 2012

What Pot Smokers Have Taught Me

When I began screening cannabis applicants in late 2001, I didn't realize I was starting a research project that would last more than 9 years and still be in progress in 2012. Nor that such a simple clinical study could answer so many important questions about the policy we have been calling a drug “war” since Nixon pushed the CSA past Congress without anyone in government really understanding it, or how such a grotesque perennial failure could gradually become so untouchable as to become literally beyond criticism. The answers to those questions turn out to be more credible and coherent than either the federal policy minders or many of their political opponents in "Reform” can bring themselves to believe

In truth, the study I've been engaged in reveals far more than just the drug war’s failures; it exposes the critical human weaknesses: fear, greed, and dishonesty, that are most responsible for the many crises now threatening our species, but which our denial won’t allow us to address.

As it turned out, the simplest way to understand the drug war was by studying a large group of pot smokers and then comparing their behavior patterns with the laughably inaccurate explanations being offered by the DEA. That's because the drug war's federal guardians had never performed (or even allowed) an unbiased clinical study of the very complex drug they have been attempting so unsuccessfully to ban since the Nixon Presidency. They have thus been forced to rely on their own mistaken beliefs and have yet to learn the truth.

Meanwhile, the “reform” movement has had some problems of its own. It has been listening to doctors, who despite having tumbled to many DEA errors, are still taking others seriously, usually by misidentifying pot's most important psychotropic benefits as "recreational." Seemingly not a big mistake, but it still gives hard line DEA supporters reason to sneer, and to arrest. In the next entry, I’ll tackle what may be the most important finding of all: why cannabis became a smash hit with boomers in the Sixties and what that portends for the future.

Happy New Year,

Doctor Tom

Posted by tjeffo at 07:46 PM | Comments (0)