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June 29, 2014

Ms Dowd's Rocky Mountain High, Part 2

In the last entry,I pointed out that edible cannabis is processed very differently than smoke, primarily because it is swallowed; which means it must be broken down by the gastrointestinal tract. Thus rather than traveling immediately to the brain like smoke, the cannabis in a pot confection is digested , a process that takes 20-40 minutes and– so far as I can tell– has yet to be studied in detail in the modern era.

As soon as I read Ms Dowd's account of her edible misadventure, I knew her prominence as a New York Times columnist would evoke considerable commentary and was curious as to whether it would reflect any better understanding of the edible-smoke difference than I'd encountered in my patient histories a few years ago. The first author to deal with what I've come to think of as Dowd's Rocky Mountain High was Steve Wishnia, a medical marijuana advocate whose piece in the Daily Beast included quotes from several prominent medical marijuana supporters, all of whom agreed that edibles and smoke are indeed different, but gave multiple conflicting opinions about why that was so. Read in sequence, the reasons offered were laughably out of synch with basic anatomy and physiology as well as with each other.

Wishnia started out well, "the pharmacokinetics of marijuana—the way it is absorbed and excreted by the body—are different for smoking and eating." However, he then quoted psychologist Mitch Earleywine, a pyofrssor at the State University of New York in Albany, “Smoked or vaporized cannabis bypasses the liver and doesn’t create the same 11-hydroxy-THC." Wrong. The 11-hydroxy-THC idea is a canard dating back to a paper published in the Journal of Clinical Investigation in 1973 which did not specify how the 11-hydroxy-thc is produced and certainly did not consider the effect of liver processing on the products of enteric digestion. We now know that a plethora of complex molecules are found in 2 different strains (indica and sativa) of cannabis, each with its own plethora of individual components. The truth is that the liver has the last word on edible effects, which are far more complex than smoke because the liver breaks down complex cannabinoid digestion products (that have also been incompletely studied). The liver is clearly the basis for the "body high" which on the basis of patient data, seems more likely to be responsible for the benefits cannabis provides important (and to date unrecognized) relief to people afflicted by a relatively recent cluster of illnesses known as autoimmune disorders.

One would think that with all of the medical interest in marijuana since California opted to vote for "medical" use in 1996, that the physicians charged with finding out what its users found so good about it might have done a better job of learning why its chronic users liked it so much. One of the reasons for the fog of persistent ignorance has been the malevolence of the DEA, but that still doesn't account for why such a stupid and irrational law should remain the global default on an herb that appears to be the richest source of natural medicine ever encountered.

All of which prompts a logical question: can a species this stupid be saved from itself?

Doctor Tom

Posted by tjeffo at 11:18 PM | Comments (0)

June 28, 2014

Drug War Insanity; Ms Dowd's Rocky Mountain High: Part 1

Relatively early in the unauthorized study of cannabis users I began 10 years ago, I discovered several differences between the "high" produced when pot is inhaled as smoke vs consumed by mouth. Those differences were well known to chronic users, but– as I also discovered– the reasons for them remain obscure.

In a nutshell. one can get high either way, but the "head" high produced by smoke comes on faster, is over sooner, and– perhaps most importantly– can be titrated (measured) on a toke-by-toke basis. That ability to titrate is important, because contrary to cherished beliefs of the DEA and many pot naive people, "stoners," don't always want to be stoned; they simply want to relax, which brings up a critical difference in terminology.

While being under the influence of marijuana and alcohol are both considered being "high," the marijuana high is most often a therapeutic (anxiolytic) state, under the control of its experienced users, especially when it is inhaled. That's because the quickest route to the brain is by inhalation. The experienced user feels the 1st toke and is thus able to follow the progress of the high, toke by toke. There is no alcohol equivalent because alcohol cannot be inhaled. Thus alcohol is always treated as an "edible;" consumed by mouth and processed by the gastrointestinal tract.

Other drugs inhalable drugs are nicotine, heroin, meth, and more recently- crack. All are sensed almost immediately by the brain with the 1st toke (inhalation) thus giving the user a degree of control over the "high." But when we compare the various “highs,” we find significant differences. That produced by nicotine delivered by a cigarette is of the shortest duration and is now conceded to be the most addictive and dangerous to user health. Nevertheless, cigarettes are still legal everywhere and despite their well-recognized dangers, are used chronically by approximately 30% of people in the US and most modern nations.

On a purely rational basis, if a prohibition policy were really effective, cigarettes should be the first "substance" listed on "schedule one." However that's not the case. Despite relatively huge increase in cigarette taxes intended to discourage their use, approximately 1/3, or more of the world's population still smokes. In fact, China, which has a government monopoly on cigarettes and thus profits from their use, is estimated to consume 3 out of every 10 cigarettes smoked the world today. The long term adverse health consequences of such a situation would seem obvious.

As mentioned earlier, edible marijuana affects all users a lot differently than smoke. That's because its processing by the body is entirely different. The gastrointestinal tract does not provide instant feedback because pot digestion products take longer than smoke to reach the brain thus eliminating any rapid titration benefit. Another big difference is that the breakdown products of cannabis digestion have not been studied in significant detail since 1973, nor have they ever been studied as completely as they might have been to which compounds are produced by hepatic processing, a step that smoke is not subjected to.

NYT columnist Maureen Dowd had a typical edible experience during a recent trip to Colorado.

A self-confessed pot novice, the normally unflappable Ms Dowd was still clearly distraught when she reported on her "bad trip" to readers in a column written the next day. Of considerable interest to me was that the explanations offered for her distress were just as uninformed as I have come to expect from both novices and seasoned heads. In the interests of clarity, I will try again to explain the edible mystery in terms of its pertinent anatomy and physiology.

However, this lesson has already become too long and complicated, so in the interests of clarity, I'll complete the explanation of the "edible" difference in another entry.

Doctor Tom

Posted by tjeffo at 09:41 PM | Comments (0)

June 24, 2014

The Approaching Centennial of American Drug Insanty

On December 17th of this year the American policy that matured into a global "war" on drugs in 1970 will celebrate a painful centennial; it was on that day in 1914 that Congress passed the Harrison Narcotics Act, the first of three punitive laws based on the idea that police are the professionals most qualified to define and treat "addiction," a condition that still can't be defined as other than an undesirable behavior. Harrison was the first of 3 major pieces of inept American legislation that would coalesce into a global "drug war" with passage of the most misguided of all in 1970: Richard Nixon's Controlled Substances Act.

In a bizarre twist, the 18th amendment mandating the prohibition of alcohol was not passed until 1918, 4 years after Harrison. The much-anticipated ban on commerce in alcohol, which had been expected by many to bring about an alcohol free utopia, failed miserably and had to be repealed a mere 14 years after ratification. Perhaps the most obvious lesson (not) learned from that failure is that prohibition laws forbidding products or services desired by a significant minority of the population will inevitably create illegal markets which, in turn, induce wholesale corruption and end up doing far more harm than good.

Nevertheless, Harrison remained in force by surviving several 5-4 Supreme Court decisions between 1915 and 1920. Later, the Court ruled unanimously against itself in Linder in 1925, but because no other drug cases were decided after that, Harrison continued to survive under the watchful eye of Harry Anslinger.

In 1937, a 2nd critical piece of prohibitive legislation– known as the Marijuana” Tax Act was pushed through Congress by Anslinger himself, who had been made Chief of the Federal Bureau of narcotics, despite his complete lack of qualifications for the position. However, he had important political connections: his uncle was Andrew Mellon, who just happened to be Secretary of the Treasury and the richest man in America.

The third act in this legislative farce took place over 30 years later when Richard Nixon-possibly the least qualified American president ever– took it upon himself to enhance the scope and power of American drug policy in the complete absence of supporting evidence. He then compounded the felony by announcing criteria for the establishment of new illegal drug markets on a substance by substance basis, a privilege awarded to the Attorney General, thus excluding Medicine completely from both the legal and regulatory processes.

In an astounding example of the blind following the blind, The UN then updated, without significant discussion, its original 1961 commitment to ape American drug policy.

To a degree that has yet to be appreciated, Nixon's need to deal with the hippies then protesting the war in Vietnam, who were also the leading edge of an emergent new “drug culture,” dovetailed almost perfectly with the confusion and distress felt by their parents and elders over their behavior. That mutual generational ignorance led to an uncritical acceptance of Nixon' (and John Mitchell's) Controlled Substances Act which– in retrospect– can be seen as a purely rhetorical exercise aimed directly at the young political rebels then (understandably) protesting America's sadly mistaken war in Vietnam.

Another phenomenon complicating that already complex jigsaw puzzle, was the emergence of the so-called “beat generation” a relatively small but influential bi-coastal literary movement that appeared in the late Fifties and early Sixties. They were the first contingent of young Americans to actually try marijuana and psychedelics and soon wrote about those experiences. Their descriptions contrasted with the cookie-cutter blandness of the Eisenhower Fifties while also encouraging young "boomers" to try marijuana and psychedelics themselves, which further encouraged the behaviors that were puzzling and frightening their parents.

The final impetus for Nixon's anti-drug flight of fancy was the completely unexpected action of Earl Warren's Supreme Court in striking down the Marijuana Tax Act. Thus almost as soon as he took office, Nixon found himself confronted with a youthful rebellion in which the children of the "greatest" generation that had won World War Two were taking drugs and thumbing their noses at their parents' values while also refusing to fight in a deadly jungle war they neither understood nor agreed with.

Add in the demands of other "liberation" movements by Blacks, Gays and women and you have a formula for unprecedented social unrest.

As we now know, Nixon's "solution" was to restore the federal government's power to punish "drugs" and drug users indiscriminately, thus turning what had been an ill-conceived policy into a Perfect Storm of repression that punishes a whole species indiscriminately.

Doctor Tom

Posted by tjeffo at 09:55 PM | Comments (0)

June 03, 2014

The Drug War's Cardinal Errors

America's War on Drugs is a humanitarian catastrophe that evolved from three erroneous beliefs about "addiction," an entity that was not understood in 1914 and has yet to be precisely defined– thanks in large measure to American hubris. In essence, the erroneous beliefs embraced by the Harrison Act of 1914 have not only been retained, they have been amplified and multiplied, thus turning a potentially remedial policy mistake into a global disaster in conjunction with America's greatly enhanced wealth, and concomitant economic and military importance.

The three cardinal errors embodied in Harrison were 1) that the federal government understands "addiction." 2) that it has an obligation to treat it; and 3) that the criminal justice system is the treatment bureaucracy of choice (actually the Treasury Department had initially been charged with that responsibility, but the Controlled Substances Act of 1970, by creating the DEA, clearly assigned the burden of explaining and prosecuting the phenomena of "addiction" and 'drug abuse" to the Department of Justice.

In that respect, our drug policy can also be seen as a prime example of both the "mission creep" and "blowback" attributed to its most obvious counterpart, the CIA, an agency also born out of the exploitation of fear that supports blatantly anti-democratic policies in nations that consider themsleves "Democracies."

To an amazing degree, the CIA and our drug enforcement bureaucracy can both be seen to be insidious, slow-motion counterparts of the fervid Nazi response to the threats presented by Communism to the Weimar Republic in 1932.

We all know how that ended.

Doctor Tom

Posted by tjeffo at 06:25 PM | Comments (0)