The Western Correctional Association's

Institute'92

San Jose, Ca. October 7,1992

Since from time to time I am going to make statements that may startle or even offend you, let me first try to ingratiate myself by mentioning: 1. I have been offering treatment to compulsive drug users for at least thirty years, i.e., I must think that a heroin habit is something to get rid of. 2. I advocate decriminalization of drug use, not legalization in the sense of total deregulation. 3. I am more interested in minimizing the damage to society and to the individual from drug use than in treating a statistic on absolute amounts consumed. 4. I regard parole and probation agents as fellow therapists and worked with state parole workers until it became apparent that they are not able to be of much help under present circumstances.

Having said that, I will, I suppose, destroy any rapport by saying that the war on drugs is neither Dunkirk nor Desert Storm; it is a civil war. A civil war maintained by a small group of guerrillas who appeared at the end of prohibition and now cause frightening problems for our society by making major criminal problems out of minor drug problems.

As you know, the leaders of one platoon in this army, the big men in the C. D. C., have, in effect, ordered their people not to appear at this session; not to engage in discussions of the effectiveness of their efforts; not to acknowledge the impossible milieu in which parole agents dissipate entire careers without making a difference and not even to discuss the objective pharmacology of two common drugs of abuse, which is what I had intended to present today-the other members of the panel being quite able to document not so much the failure as the terrible damage inflicted by the new prohibition .

For the next few minutes, then, I want to summarize for you two or three technical details about the pharmacology of two drugs, marihuana and heroin, and then apply these data to your client management and to the question of what changes might profitably be made in our laws.

Let me explicitly and with emphasis point out that I will not make the mistake of talking about the or a drug problem, but will carefully stipulate the drug and the route of administration. Not only do different drugs have different pharmacologic effects, but the route of administration may greatly alter the risk.

When I tell you that marijuana is simply another anxiety relieving or sedative drug with pharmacologic effects similar to those of alcohol or Valium, you are going to immediately deny that possibility, because you accept the classification of marijuana as an hallucinogen foisted on you by old street lore and lawyers ignorant of pharmacology.

That marijuana is hallucinogenic is a misconception originated largely by two people. One was a sociologist who compared the hippies to the early Christians and believed everything that they told him. The other was Leary. Busted for possession in Texas, the only defense he could dream up was to equate LSD with marijuana as a sacrament in his church. It is true that under certain conditions, rarely achieved by smoking, a dreamy, fantasizing state can occur. Other sedatives cause the same state, the most common example used to be the patient who fantasizes sexual molestation after nitrous oxide in the dental office, but the benzodiazepines now seem to be the common offenders.

If we compare the effects of alcohol with the effects of THC or hash orally ingested, the two look very similar except that the THC acts for a much longer time. Smoked marijuana at first glance seems different from alcohol and THC unless we allow for the different time course and smaller dose of THC required.

The smoke from a marijuana cigarette goes deep into the lungs and the THC is rapidly absorbed into the blood. It is very soluble in fat and on its first pass through the body much of it enters the brain (partitions) because the brain is lipid rich and blood flow is great. Thus a very small amount of THC rapidly causes relief of anxiety and a pleasurable relaxation among other effects. As the blood makes more circuits, fatty organs, notably the liver, take up more THC and it starts to leave the brain. Actual fat receives a limited blood flow compared to other tissues but is great in amount, and it slowly takes up THC. The effect on the brain of the small amount of THC smoked disappears quickly. Exactly how long depends upon the quality of the grass and how it i smoked, but we are dealing with tens of minutes. The THC in the fat is slowly released, changed in the liver to water soluble metabolites and excreted in the urine over a period of weeks.

Contrast that pattern with the picture after a "social" user ingests a large dose of THC in the form of hashish in tea or a patient receiving cancer chemotherapy takes a few doses of THC by mouth. Then it becomes apparent that THC is only slowly changed chemically and, in the larger amounts used, is very long acting. The similarity of the effects to those of alcohol become easier to establish - objectively if not in the mind of the user.

It is difficult to argue with the marijuana smoker that the brief effect is not a definite advantage.

People who prefer marijuana to alcohol as a social drug resist the evidence that the two are similar, but, when grass is in short supply or too expensive, they switch to alcohol just as they use wine or beer to prolong the effect.

So now we have an agent that can impair function and judgment, but the disinhibition is brief and the drug by itself has not been a problem in drivers. Organic toxicity is infinitely less than is the case with alcohol. Excessive use is possible but has thus far been a rare problem. My experience with Rastafarians suggests that it is difficult to accomplish even in the islands.

I don't see how we can with any hope of useful outcome acknowledge that prohibition failed in the case of alcohol and at the same time apply the discredited remedy to marijuana. How can I defend the law when uniformed officers explain to me that the absence of gastritis and hangover allows them to do their job more competently than if they drank. And certainly not many people will seek treatment for the social use of weed.

Yet I do not wish to encourage the use of marijuana; we certainly must not reduce regulation to the point that another cigarette or liquor industry develops. It would also be useful to eliminate the market that bleeds dollars into other economies, and undeniably the criminal justice system would become more useful if relieved of the burden posed by the huge number of people who do not feel guilty.

How can we accomplish these goals? I have listened to every suggestion for reform and look forward to hearing your suggestions. At the moment my best suggestion is that we allow cultivation for personal use in the home of the cultivator.

Our handling of heroin illustrates how the reaction of society to a minor problem can be so misguided that thousands of individuals are criminalized and our whole country changed for the worse.

First of all, heroin and the other narcotics are not inherently very dangerous. That statement is not arguable. Society provides consensus by giving people a daily dose of methadone, a potent narcotic, as treatment for their use of heroin, a potent narcotic. Given ten to twenty times the pain killing dose of methadone each day, the heroin user becomes tolerant to the effects of narcotics and does not feel any additional effect if he shoots up. The drugged state is actually more constantly present and more profound than in a user of the shorter acting heroin, but the user is judged to be a successful patient rather than an arch criminal. Clearly the mere use of a narcotic, whether illegal or "program", does not lead, as a drug effect to criminal activity as does the ingestion of alcohol. The illegal market place does indeed lead to intolerable amounts of associated criminal activity, but that is a consequence of our societal reaction not a drug effect.

This methadone maintained patient illustrates the state that follows the ingestion of a narcotic or that appears after some delay after injection. This condition of euphoria or a lack of concern about any stimulus is actually not of great importance in causing ff addiction."

What is important in leading to the compulsive use of heroin (or iv speed, or iv or smoked cocaine) is the "rush" that the user experiences at the very moment of injection. The early investigators in this area described it as an orgasm centered in the epigastrium; others called this explosive relief of anxiety a total body orgasm. It is a tremendous pharmacologic reward, a kind of chemical masturbation that is more difficult to give up than normal sex. Swallowing a narcotic (including methadone) or injecting it under the skin does not give the rush and is much less apt to lead to compulsive abuse.

The concept of a compulsion is, of course, all too familiar to you. Many of us can understand compulsion to some extent by recognizing the pattern in our own behavior or by observing the driven behavior in friends who smoke or overeat. Most compulsions are not treated as criminal matters: cigarette smoking, obesity, adolescent or adult masturbation, picking or cutting the fingernails down to the quick or kleptomania, for examples. Some compulsions, such as chronic alcoholism, we tolerate but hold the person responsible for criminal acts carried out under the influence. Other compulsions are so clearly and dangerously antisocial that we treat their commission as criminal.

Now why do we put heroin use in the last category? Is the mere possession of the powder a criminal act. Would you call the actual injection heinous or merely distasteful?

Before I give you my answer to the question of why we apply the prohibition approach so viciously, (and disclose why I am actually so eager to talk with people like you). I will state a proposition that you can verify from your own experience and common sense. All of the enforcement and treatment activity as carried out over the past fifty years has been wasted in that the amount of drugs used and the variety of drugs used has grown progressively to its present level. More importantly, the legal approach (incarceration) has damaged countless individuals and placed on society a destructive burden of violence and alienation.

If you examine quality journalism across the spectrum from The Nation to Buckley's conservative journal; if you examine the technical literature of medicine, sociology and economics; if you note the name and political orientation of people supportive of "legalization", you will agree with my statement that no area of informed, disinterested thought disagrees with my conclusion that whatever we have been doing had best be changed and now.

Now I find it necessary to suggest that there is an influential area of thought that is not disinterested. Workers in the enforcement area are given to protecting a special position They are not disinterested informants, just as I am not a disinterested informant in matters of pay and privilege for U.C. professors. They have great influence on those citizens who depend on the daily media, press or TV, or who confuse TV dramas with reality. The daily press is not required to be accurate or comprehensive or to provide follow-up; it is required only to report more or less accurately whatever information, misleading or otherwise, is provided by an informant who may not even be identified. Thus we have had a long series of largest ever seizures, biggest dealer ever, etc., but it is street level users who resort to crime to "maintain" who congest our system of criminal justice.

The leadership of the enforcement industry or bureaucracy has continued the pattern set by administrators now moldering in their graves of misrepresentation to press and public, of deceitful tactics by police and prosecution and of lobbying against the public interest. Your dollars, through the CCPOA, have been used to intensify the budgetary problem of the state and made the problems of certain cities and neighborhoods insoluble.

So I am also not disinterested. I hope that, when you hear of changes suggested during the next session of the legislature, you will consider that the pharmacology that I presented above and the inferences therefrom deserve consideration and that you will comment as individuals and not only through your association.