February 14, 2010
The Marijuana High: what policy wonks still don’t know
Because the population I’ve been studying since late 2001 consists entirely of Californians seeking a doctor’s approval to use pot under the terms of Proposition 215, all have experienced the marijuana “high;” itself a unique phenomenon erroneously considered by those who never experienced it as the equivalent of alcohol intoxicationAs every experienced pot smoker knows, nothing could be further from the truth; although getting high and getting drunk are the expected effects of both drugs, they are very different. Both are also very common events. With the single exception of seeking a “head rush from a cigarette, getting high on “weed” and drunk on “booze,” at well under the legal age- have been rites of passage for over half of all Americans since the University of Michigan (and later the federal government) began doing their surveys of youth in the Seventies. The cannabis applicants I’ve been studying do report trying all three at about the same average ages and well before trying any other illegal agents.
Their drug initiation patterns and other data also confirm that federal drug policy officials, their critics in "reform," and most academic drug policy experts have not developed an accurate picture of human marijuana use; initially because of imposed ignorance before 1997; more recently it seems to be denial. For over 13 years Proposition 215 has been allowing something the DEA and NIDA had successfully blocked from their beginnings in 1973 and 1975 respectively: unfettered medical access to a large population of illegal drug users. That the drug was marijuana, has been especially valuable because of the (unsuspected) role it has been playing in moderating the use of more problematic agents, literally since before Nixon’s election in 1968.
Perhaps the best way to illustrate still-prevalent ignorance is to discuss the marijuana high in terms of its clinical pharmacology, rather than in the obligatory rhetoric insisted upon ever since Nixon foreclosed unbiased clinical research by rejecting the Shafer Commission's plea in 1972.
The Inhaled High
Getting high begins when the first toke is almost immediately followed by a subjective feeling described by 80% of those surveyed as “relaxation.” The immediacy with which it is experienced confirms that whatever was in the smoke had an immediate effect on the brain, which is interesting, because at least half of all applicants report they failed to get high the first time they tried and many had to try several times before they were successful. Once successful however, a high is readily produced whenever one lights up.
More tokes are taken in relatively close succession until inevitably, one fails to enhance the high. This is important because it signals a refractory period during which additional tokes will simply be a waste of money. In essence the refractory period is also a signal the user is as high as it’s possible to get on that particular strain at that tme. Since both users and strains can vary considerably, it should not be surprising that one user may get high sooner than another, or that intensity vary. The dominant pharmacologic effect is anxiolytic; onset is rapid because the drug is smoked; dosage can be precisely titrated for the same reason. Finally, the high is evanescent; it’s over in about an hour. Another very important consideration is that the good feeling that came with the high can linger for another hour or more, depending on circumstances.
For some users, the termination of the high is an opportunity to light up again; but only if certain conditions exist: they must not be under hostile observation, they must be able to afford it, and they must be comfortable while high in the presence of “straights.” Since the normal response is the famous “paranoid’ reaction (an unpleasant feeling that straights know one is high and disapprove) how to overcome it to the point of being comfortable has to be learned. Thus some users are able to get high repeatedly throughout the day; however the refractory period guarantees that the effect is not cumulative, as it usually is with alcohol. Other than mild ataxia (a cerebellar effect) and a tendency to become hyperfocused on interesting phenomena, cognition is not impaired and is often enhanced.
As most pot users have discovered, the high produced by edibles is strikingly different than the one produced by inhalation. There are good reasons for that difference, but they haven’t been elucidated pharmacologically because “marijuana” is illegal. However 215 has allowed the differences to be recognized clinically and described in some detail. I’ll deal with the “body high” produced by edibles in another entry.
Doctor Tom
Posted by tjeffo at 06:03 PM | Comments (0)
November 19, 2009
Help from an Unexpected Quarter
Although it’s long been clear to me that genetics play an important role in human behavior, I hadn’t expected much help from that quarter because I regarded my investigation as an opportunistic chance to study drug use as a reflection of “nurture,” rather than “nature.” Wrong. An article by David Dobbs in this month’s Atlantic focuses on an easily recognizable sub-set of the population I’d also become attracted to through their illegal self-medication with cannabinoids. In fact, I hadn’t finished the first paragraph before I could have supplied the names of at least two famously troubled children indistinguishable from those Dobbs’ article is about: one for her controversial death at the age of four, the other from a detailed case report I’d first heard presented at a national meeting of cannabis reformers in 2004.Although the initial focal point of his article is a celebrated researcher at the University of Leiden in the Netherlands, Dobbs makes clear that support for the controversial notion summarized by the catch phrase “orchid children” comes from many respected academics in several nations. The basic notion seems to be that gene variants already known to be associated with serotonin transport are not only associated with early development of problematic behavior in toddlers and pre-school children, but there is solid evidence that improving the way mothers deal with those children can modify their problematic behavior in positive ways. Beyond that, and even more exciting: the same heredity that impels similar troubled behavior, when properly nourished at home, may unlock expression of unusual talent.
What my own work has suggested to me is that when vulnerable adolescents have been fortunate enough to begin self-medicating with a drug that, although illegal, allows them to control certain destructive impulses, a vulnerable few will blossom as “orchids,” while the majority who represent the more common (and hardy) “dandelions,” also benefit from the protection cannabis confers against excessive use of two legal alternatives they are still being pushed into using by an ignorant society.
Perhaps we can wake up in time to save ourselves.
Doctor Tom
Posted by tjeffo at 06:04 PM | Comments (0)
October 25, 2009
The Drug War and Academe
Last week’s discovery that the clinically untrained representative of a brand new Academic Discipline was the dominant voice in a forum considering the medical use of cannabis was a reminder that, although the real heavyweights in such policy discussions are relatively few in number and unknown to the general public, they do exert a critical influence in allowing the drug war to confound its many critics.That's because the administrators of our war on drugs could not tolerate public disclosure of even a third of of their failures and disasters without being laughed out of authority. One of the main reasons it hasn't happened yet is the great skill of a small group of policy wonks I've come to think of as the drug war's own "Gang of Four".
All are widely published, often with each other; they are Mark Kleiman of UCLA, Peter Reuter of Maryland, Jonathan Caulkins of Carnegie Mellon, and Rob MacCoun of UC Berkeley. The Gang's considerable strength comes from their deft mutual support while managing to sound sincere and reasonable in defense of a policy that can be counted on to fail ingloriously at whatever goal it sets for itself. They are aided in that feat by not mentioning that US policy has never permitted itself to be measured by reasonable standards, nor allowed its subjects to be studied clinically, except as mentally ill, criminal, or worse.
The Gang typically also cites the unreliability of data from criminal markets but seldom blames that circumstance on a policy that has corrupted all market participants, including law enforcement, for the four decades it has been a top national priority. In other words, the constant default in their analysis is that, despite its many flaws, the drug war is an essential policy.
The hard evidence behind my contrary assertions are unique data supplied by drug users that directly contradict many of the long held beliefs endorsed by policy "experts." Also their demographics and initiation ages, which provide the historical context in which a tiny criminal market suddenly began expanding very rapidly in the early and mid Sixties, data that has always been conspicuously absent from official accounts.
Of course, that might open the door to claims my data isn't representative of the whole criminal pot market, with which I can only agree. In fact, I think that market may turn out to be even bigger than the feds have either realized or dared to admit.
Doctor Tom
Posted by tjeffo at 12:49 AM | Comments (0)
February 23, 2009
Lessons Resisted, 1: Malignant federal bureaucracy as a consequence of pervasive dishonesty
It’s difficult to know precisely what the federal bureaucrats conducting the drug war really think about “drugs;” in other words, do they- especially physicians with some expertise in Pharmacology- really believe their policy’s off-the-wall assertions about “drugs of abuse?” How does one even recognize a drug of abuse apart from its arbitrary listing on Schedule One on the basis of criteria chosen by anonymous authors of the 1970 Controlled Substances Act?It doesn’t take a great deal of research to discover that the legal precedent originally permitting the federal government to arrest doctors for prescribing opiates for "addicts" was based on turn of the (last) century fears of “addiction,” as endorsed by a series of 5-4 Supreme Court rulings upholding the 1914 Harrison Narcotic Act. That precedent was later significantly expanded by the 1937 Marijuana Tax Act, which effectively rendered any possession of cannabis by either physicians or patients lacking a special tax stamp subject to harsh penalties.
The deceptive intentions of the MTA were evident from the beginning; it also relied on the Harrison ploy of a transfer tax and required physicians to purchase the tax stamps. The (significant) difference was that the stamps needed for the MTA were never printed. The MTA also substituted the slang term, “marijuana,” for cannabis, one the government has retained in all official documents ever since. Finally, the MTA significantly extended the powers usurped by Harrison with an (implicit) ban on any future medical use of cannabis. That restriction was hardly noted at first, but is now crucial. It never applied to either cocaine or the opiates "regulated" by the older law because there were no substitutes when it was passed
Just as the MTA expanded dubious federal prerogatives claimed by Harrison, the 1970 Controlled Substances Act authored by Richard Nixon’s Department of Justice further expanded them, also without medical input, a legislative sleight-of-hand made possible because the Supreme Court's 1969 rejection of the MTA was on legal (Fifth Amendment) grounds that were countered by simply asserting a different Constitutional basis for the CSA: Congressional jurisdiction over Interstate Commerce.
Thus does the entire medical basis of current policy rest on the ignorance of Harrison's authors as narrowly validated by a medically ignorant Supreme Court during the second decade of the Twentieth Century. It also follows logically that modern Congressional enhancements of penalties for “drug crimes,” especially numerous in the case of cocaine and marijuana, were also passed without any review of the same questionable amateur medical beliefs.
The bottom line is that America's (and the world's) drug policy is rigidly bound by medically ignorant legal assumptions that run a gamut from those made by Hamilton Wright through Harry Anslinger and Richard Nixon. Worse yet, those assumptions were never validated; nor could they have been formally challenged until a California state initiative was passed in 1996 and these disturbing conclusions could not have been reached except for the relatively relatively simple study of chronic cannabis use that made them possible.
Sadly, that's not the end of this surprising story. Although first announced to insiders within the reform movement in 2003 and 2004, then published in 2005, and updated in peer-reviewed literature in 2007 the data and their implications have been assiduously ignored, a phenomenon demanding its own explanation.
As our contemporary world gradually slides into what may be its second-ever Great Depression, simple extrapolation from the daily news sheds light on my dilemma and vice versa: both appear related to the interplay of emotional and cognitive centers within the highly evolved human brain. Since the emergence of empirical Science some five hundred years ago, our species' ability to affect our planetary environment has been progressively enhanced to a point we are now having major impacts on both our terrestrial and emotional environments.
As a physician, I realize that making an accurate diagnosis doesn't always guarantee effective treatment, but I also know that without an accurate diagnosis, the likelihood of prescribing effective treatment is greatly diminished. That concern probably also applies to Economics, considered by many to be a Behavioral science.
Doctor Tom
Posted by tjeffo at 05:59 PM | Comments (0)
September 10, 2008
Proposition 215 and the Drug War: 1
As the twelfth anniversary of Proposition 215 approaches, I thought it might be a good time to review what a study of applicants hoping to use cannabis under the terms of California’s initiative reveals about use of cannabis (“marijuana”) in contemporary America and perhaps more importantly: what the rigorously enforced criminal prohibition of its use tells us about “human nature.”The following is part 1 of a still undetermined number of entries I hope to finish by November 4. Just how many installments it will take will depend on how busy I am and how much detail I’ll be satisfied with. Like everything else in this blog, it’s very much a work in progress.
In November 1996, 56% of California voters surprised experts by approving the nation’s first medical marijuana initiative (Proposition 215), defying the near-unanimous advice of all living ex-presidents, most state officials, and an overwhelming majority of elected politicians. Although I’d favored the initiative myself, expected it to pass, and thought I was reasonably well informed on drug war culture, the degree to which both 215’s supporters and opponents were lacking a coherent plan for the post election period surprised me. I now realize I had underestimated both the depth of their disagreement and the willingness of drug war supporters to completely disregard the letter and spirit of the new law. Later I would discover the degree to which the reform side was willing to shoot itself in the foot because of rigid commitment to a strategy which, although less implacable, was almost as blind to new information as their opposition.
California legislators usually pass “enabling” legislation to guide the implementation of successful initiatives, but in this case, the determined opposition of police and other key participants froze that process at the committee level for over seven years. It wasn’t until October 12, 2003 that a severely watered down bill (SB 420) was signed by Gray Davis, who would soon be recalled himself, one year into his second term.
After eight years of legislative gridlock, and nearly four of chaotic law enforcement, SB 240 has produced a statewide pattern in which harassment of participants in the emergent gray market varies from county to county and time to time; however the default has consistently been anti marijuana. Nevertheless, the big picture seems to be slowly changing in one important respect: opponents of any marijuana use seem to have finally accepted that the initiative can’t be canceled. They are now using their bureaucratic dominance to obstruct it to the extent possible. That they are enjoying some success is confirmed by scattered press accounts and troubling anecdotes I hear on a weekly basis from people seeking recommendations.
To return to the (almost forgotten) interval between 1997 and 2001, the vacuum following 215’s passage was critically important because it allowed scattered gray markets offering some form of quasi-legal retail distribution through “buyers’ clubs” to spring up in pot friendly areas. After that, passage of SB 420 and the predictably hostile June, 2005 Supreme Court decision in Raich, severely jostled those markets, but it now appears that, in the absence some external calamity, rapidly acting cannabinoids and/or cannabinoid agonists will eventually become legally available by prescription.
I’m basing that prediction on recent developments in those still-evolving markets and a growing public awareness that “stress” is both endemic in modern society and an important cause of individual and societal dysfunction; also an increasing parallel awareness that cannabinoids can safely and effectively counter the most common anxiety syndromes.
This seems like a good place to stop. The next installment will deal with a fundamental issue: inhaled pot’s efficacy and safety as an anxiolytic.
Doctor Tom
Posted by tjeffo at 10:45 PM | Comments (0)
August 09, 2008
Belief versus Knowledge
Although our contemporary world couldn't have evolved without Science, there have been delayed costs. For example the present human population depends on nitrogen fertilization for its nutrition and the plethora of modern technological developments that underpin a constantly expanding economy. Most of the critical discoveries date from the same (mostly European) Enlightenment that inspired the American Revolution and it’s fair to say that a majority of living humans, along with their national governments, have so little understanding of the underlying Science that they are now actively working against the long term survival of our species.In fact, two major crises directly related to that ignorance were narrowly averted during the Cold War with shockingly little recognition of the dangers they posed and— depending on the degree to which the climate changes now recognized as underway result from human activity— a third disaster may already be in an advanced stage of development. Yet there still seems little recognition at a decision making level.
The two close calls in our recent past were the Cuban Missile crisis of 1962 and the less famous Able Archer affair of 1983. ironically, both were averted before Nuclear Winter was proposed as a more immediately deadly consequence of nuclear war than radioactive fallout, but It was another eight years before that scenario was dramatically reinforced when the eruption of Mount Pinatubo temporarily halted the Earth’s established warming trend.
Accelerated research, spurred by both new information and improving tools for exploring the past, is now recognizing that volcanism and sudden climate change have both played significant roles in biological evolution and, more recently, in human history.
Ironically (there’s that word again) this realization comes just as runaway human population growth has greatly magnified the size of all potential disasters, while simultaneously rendering effective mitigation more difficult.
It's my belief that among the list of potential disasters now considered either inevitable or quite likely, there are several that demand urgent attention because they are so directly related to irrational human behavior deeply rooted in human cognitve function, and therefore potentially amenable to correction.
I’m not proposing a cure” for the way we think, or that one even exists; only that there is evidence of serious problems that we still seem to favor treating with denial.
Doctor Tom
Posted by tjeffo at 07:29 PM | Comments (0)
April 19, 2008
Are Election Politics (finally) Catching Up with the Drug War? (Personal)
Enough of what’s been happening both at home and abroad since 2001 has paralleled what pot smokers have been (unwittingly) teaching me over the same interval to be downright uncanny. I believe that a major conclusion to be drawn from my study is that human emotions have always played a greater role in our decision making than most of us care to admit. A recent example, one with a particularly interesting twist, was just aired on PBS.
The Weekly Political Wrap is a moderated Friday program in which David Brooks and Mark Shields discuss the week’s politics; yesterday’s program elicited seemingly different opinions from the pundits in which each recalled the outcomes of American Presidential elections since 1968.
I wasn’t surprised by Shields’ annoyance at what he considers the unfair treatment of Obama by Pennsylvania debate moderators. Brooks, whose personality I’ve always found somewhat smarmy and unattractive, justified that impression by opining that the questions directed at Obama were “fair” and that he had "not come off well.” His main conclusion seemed to have been that Obama is being revealed as a (typical) losing Democrat in the mold of Carter, Dukakis, and Kerry.
i was caught a bit off guard by the fury audible in Shields’ response; although ostensibly not directed at Brooks, he clearly saw his double standard. What also gave me some hope for the future of this benighted republic is that Shields was also specific about a couple of sacred cows: super patriot Dick Cheney’s five (count them five) requests for draft deferment in the Sixties, and his citation of an issue fairly close to the drug war: the high incidence of PTSD among Iraq returnees for which the VA has no plan.
What Shields’ anger suggested to me is that our brighter pundits have not missed as much as I feared; they have simply not spoken out because of the usual concerns about being politically incorrect. Thus Shields’ incomplete melt-down may really be a sign of hope that when things get bad enough, the hypocrisy required to sustain our drug war might finally be discarded by enough people to make a difference.
Although not often credited, it's quite obvious that the Great Depression played a role in the Repeal the 18th Amendment.
OTOH, if this nation is frightened enough of the idea of a black president to elect John McCain, we could be in even more trouble than I suspected...
Doctor Tom
Posted by tjeffo at 09:17 PM | Comments (0)
April 13, 2008
Questions Never Asked and Dots Still Requiring Connection (Historical)
An original intention of this blog was to connect historical dots between today’s huge pot market and the little-known Marijuana Tax Act of 1937. In that context, one might reasonably assume that if the illegal product a national policy intended to dissuade “kids” from even trying, had already been the country's most valuable crop for several years, any discussion of that embarrassing development would be difficult to avoid, especially in the nation claiming to lead the world in "free speech."
But one would be very wrong; the relevant questions are not asked, either by, or of, the very professionals who should be wrestling with them. Instead, the policy is fiercely defended by a scientifically ignorant drug czar as absolutely essential to the national welfare. Nor is his claim that without the drug war our drug problems would be worse even questioned; especially by wonks at the handful of prestigious institutions offering advanced degrees in “Public Policy.”
In fact, drug policy academics have shown so little interest in Harry Anslinger that not a single scholarly biography has ever appeared. For those with short memories, Harry was the bureaucrat for whom the FBN was created in 1930 and which he ruled with an iron fist until departing abruptly in 1962. During that interval he played a dominant role in protecting and shaping the policy that would quickly become Nixon’s drug war without any meaningful review of its (racist and stupid) basic assumptions. Anslinger was also the driving force behind the 1937 MTA, and authored of the 1961 Single Convention Treaty (now the UN's basis for global drug prohibition).
Given those dubious accomplishments, the absence of a definitive biography can only be understood as an avoidance of embarrassment: just enough of his unsavory history is known to make it impossible to construct a bio that wouldn't cast enormous doubt on drug war legitimacy. Clearly, no one wants to risk that; what academics would risk bringing down federal displeasure on either himself or his institution? That’s why a recent study of the FBN; one providing a detailed, but necessarily oblique, look at Anslinger through the unguarded recollections of ex-FBN agents is worth reading by anyone with a serious interest in drug policy (a predictably small market).
While The Strength of the Wolf (Douglas Valentine, Verso, 2004) can't deliver on its subtitle’s claim to be “The Secret History of America’s War on Drugs,” it is, nevertheless, a rare, solidly researched, and historically helpful study of an era that remains shrouded in imposed ignorance. Ironically, it was Valentine's own (understandable) ignorance of American drug policy history that induced him to shift his intended focus from the early CIA to the FBN during an era of great historical importance: the immediate aftermath of World War Two. In his Introduction, Valentine explains the switch: early in his research, he learned that a number of mid-level FBN agents had sought lateral transfers to other federal agencies to preserve their pensions. Several had gone to the CIA, a hated former rival in its early days, but the one favored to prosper during the early Cold War. Generally loyal to Anslinger, neither the ex-agents nor Valentine ever question the wisdom of prohibiting drugs, but their accounts, as collected and assembled by a competent investigative reporter, provide a riveting picture of what was essentially a rogue agency that repeatedly broke the law by conducting grotesque experiments in a search for the (non-existent) drug that would allow "mind control" to become a key Cold War weapon. In that connection, Valentine's descriptions of the antics of George H. White are particularly telling.
Time doesn't permit a detailed account of Valentine's main contribution: clarifying key interactions between FBN, FBI, and CIA in the aftermath of World War Two. The bottom line is that our whole government became so obsessed with opposing Communism that it engaged in tactics that were little different than their opponents. The game was then as now: all about "winning," with little concern for long term consequences to either planet or species.
The picture of Anslinger that emerges is one of an insecure mediocrity whose greatest skill was bureaucratic infighting and greatest concern was the protection of his bureau. The main emphasis within the FBN was on “making cases” (gaining key convictions) despite the limited budgets and scarce manpower necessitated by the Great Depression. After World War Two, as it gradually became clear that "narcotics" enforcement would play second fiddle to the CIA's mission, it seems that FBN agents eventually accepted that need, even as they chafed at having to honor it. Ironically, Nixon's drug war, declared after Anslinger's departure and shortly before his death in 1975, would lead to creation of the DEA, the FBN's most obvious successor agency,
Once one realizes the degree to which protection of its mindless policy, always a driving force behind America's drug prohibition bureaucracy, has contaminated the entire federal government, the political sanctity of the drug war becomes readily understandable. The same is true of "reform," which has allowed itself to be cast in the role of (unwitting) defender of the "drug menace," in the government's prohibition myth.
Ironically, it’s quite likely that when a very sick old Anslinger died in 1975, he had no more idea of where the drug war he'd helped create was headed than Nixon. The same goes for an already-senile Gipper who had dusted it off after Nixon's disgrace at the urging of his spouse to “just say no.” Then came Poppa Bush who invaded Panama to arrest its president for drug trafficking on behalf of his CIA, and Bill Clinton may have never inhaled, but he did appoint Barry McCaffrey drug czar and accepted a bribe for pardoning a notorious drug criminal on his way out the door.
That brings us to the present incumbent, whose administration has set new records for incompetence and dishonesty in its zeal to prove he is more forceful than daddy. The really sad part is that this admittedly inflammatory rant is far more accurate than the alternative, and more widely believed, scenarios because it's based on actual data from drug users. Even worse, that data has been readily available in California to anyone willing to ask the right questions for the past seven years.
Thus several big dots are still there to be connected.
Doctor Tom