« August 2005 | Main | October 2005 »
September 28, 2005
v Tee Shirt Responses
Back in the Spring of 2001, when I finally began to realize what had probably
impelled the medical cannabis applicants I was then interviewing to behave
as they had during adolescence- and the critical links between their
frequent initiations of other drugs, their school and family experiences
and their chronic adult pot use- I had an inspiration for a Tee shirt illustrating
at least one of the specific symptom clusters I was also beginning to recognize.
At about the same time, I began half-seriously opining privately that ADD
could easily stand for "Absent Daddy Disorder."
It wasn't until 2004 that one of my patients- Dustin Costa
- who would soon become a colleague and inspiration, took my Tee shirt
idea a long step further by soliciting and purchasing an attractive design.
Since then, several hundred have been distributed and I have started to receive
informal feed-back from those who have worn or distributed them. They generally
fall into four categories:
1) Blacks living in a poor, predominantly black neighborhoods report that outspoken
support for the message is almost universal.
2) In a Central Valley town which is narrowly split over support for the
idea of medical marijuana, the shirt frequently provoke discussions by
its implied endorsement of youthful pot use.
3) An activist who had worn his to a rally on behalf of medical marijuana
told me that pot smoking male activists, who had never themselves applied
for patient status, also disagreed with what they saw as the implied message
that "kids" should smoke pot.
4) In my own experience- wearing it to supermarkets and other venues in a
liberal, upper middle-class suburb, most people simply pretend not to notice.
18 months ago, the negative response from mmj supporters would have surprised
and irritated me; now it doesn't. I also now understand that the same human
emotional needs which impel some people to try pot, and several other drugs
during adolescence probably induce others to treat similar symptoms by working
to punish drug use and many other behaviors they consider objectionable (sinful).
Other behavioral responses to the same symptoms may be a variety of
repetitive behaviors such as yoga, meditation, religion, gambling, hobbies,
athletics, and overeating. In other words, my recent experience, has
enlarged my perspective; I now regard any repetitive drug use as but
one of several ways we humans may find relief from the emotional symptoms
generated in so many of us by having to survive in an increasingly crowded
and relentlessly competitive world.
Doctor Tom
Posted by tjeffo at 12:31 AM | Comments (0)
September 17, 2005
Dr. O'Connell's Statement to Medical Board of California
Although, cannabis had been widely used as an herbal palliative in Western
Medicine for nearly a century, all prescriptive use was abruptly ended by
passage of the Marijuana Tax Act in 1937. Thus, whatever evidence
persuaded California voters to pass Proposition 215 in 1996
must have been provided by individuals engaging in what was then-- of necessity--
illegal self-medication during the late Eighties and early Nineties.
In fact, the disclosure of those illegal experiments by Doblin and Kleiman
in the peer-reviewed medical literature in 1991 had called attention to the
phenomenon and also provided some initial impetus for what eventually became
a successful initiative.
After I began screening cannabis applicants in late 2001, the discovery that
nearly all were already chronic users who had originally tried it during
adolescence-- at about the same time most had also tried alcohol and tobacco--
led me to develop a structured interview aimed at a better understanding
of that same self-medication phenomenon. Over three thousand such encounters
have now been recorded and enough data from over 1200 structured interviews
has been analyzed to permit the admittedly startling conclusions I will share
with you this morning:
1) Demographic data amply confirm that a vigorous illegal "marijuana" market
didn't begin until cannabis was first made available to large numbers of
adolescents and young adults during the 'hippie' phenomenon of the late Sixties.
2) The subsequent sustained growth of that illegal market, although difficult
to measure precisely, is widely acknowledged. Those same applicant demographics
also suggest that the continued growth has resulted from chronic use by an
unknown fraction of the teen initiates faithfully tracked by annual federal
surveys since 1975.
3) The striking temporal association between initiation of cannabis on the
one hand, and tobacco and alcohol on the other, first noted by researchers
in the early Seventies was confirmed; however, the "sequence" they also noted
in which cannabis was usually the third agent tried no longer obtains. All
three are now tried at similar ages-- and in random order.
4) Those findings, together with an almost universal acknowledgment of similar
emotional symptoms, suggests that rather than acting as a "gateway" to other
drugs, cannabis has, since the late Sixties, become a third agent tried unwittingly
along with alcohol and tobacco by troubled adolescents-- and for similar
emotional symptoms.
In other words, what the three agents have in common is an ability to treat
symptoms of adolescent angst and dysphoria; and thus function as self-medications.
5) That interpretation is further supported by several other findings developed
by systematic inquiries into their family and school experiences- plus their
initiations of a menu other illegal drugs- including both psychedelics and
"street" drugs.
6) There is also startling-- yet conclusive-- evidence that once they had
settled on cannabis as their self-medication of choice, this population then
dramatically diminished its consumption of both alcohol and tobacco in sustained
fashion. Federal statistics gathered since 1970 also show a gradual parallel
decrease in the consumption of both-- plus some related improvements in health
outcomes.
7) The bottom line seems to be that in addition to its better-known ability
to relieve several somatic symptoms, cannabis has also been a beneficial
psychotropic medication for many of its chronic users since their adolescence.
This unique clinical evidence also suggests that cannabis was a benign and
safe anxiolytic/antidepressant long before any pharmaceutical agents were
even available for those purposes-- and that it still outperforms most of
them in both efficacy and safety.
This evidence further suggests that current attitudes toward cannabis are
not only profoundly mistaken; but that continued aggressive prohibition inflicts
great damage on both individuals and society.
My primary reason for sharing this information with you at this early phase
is precisely because it is so radically at odds with both official policy
and popular beliefs; a collateral reason is to point out that gathering such
data wasn't even possible until 215 was passed.
Finally, because the 'medical marijuana' laws passed by other states have
been so restrictive, the acquisition of such data has only been possible
in California.
A more detailed account of these findings is available at:
http://www.ccrmg.org/journal/05spr/anxiety.html
Dr. Tom O'Connell
Posted by tjeffo at 05:43 AM | Comments (0)
September 12, 2005
Rehnquist's Placydil habit, the drug war and human behavior
I consider my self reasonably well-read when it comes to drugs and public
figures, but Jack Shafer's revelation that the late Chief Justice
once had a substance abuse problem caught me by surprise.
However, his complaint that the problem had been--and still is--
ignored by the media did not. In fact,
Shafer's articulate and detailed parsing of Rehnquists's Placydil
habit will predictably excite as little interest from 'mainstream'
media and Academia as Nixon's weakness for booze, Bennetts's for tobacco.
food, and gambling-- or Limbaugh's for opioids. yet it's also
an accurate-- albeit unwitting-- metaphor for the multiple layers of
duplicity and self-deception required for widespread endorsement of
our wasteful and destructive policy of drug prohibition-- to
say nothing of the political power that policy exerts-- thanks to backing
from from both major parties.
Its well-documented sins and failures have excited little honest interest
from institutions allegedly devoted to policy analysis; even as the
policy itself has been accepted as necessary for the public welfare--
almost from its historic origins as a deceptive "tax" (Harrison Acy)
in 1914. In a very real sense, the spurious reasoning behind
Harrison (which must be imputed because it was not stated until the CSA rewrote
our drug policy in 1970) is that prohibition is the ONLY possible way
to deal with the imagined evils of addiction. That's still its 'logic, which
remains just as bereft bereft of scientific confirmation as ever. Yet the
drug ware continues to be accepted by the public at large and tacitly endorsed
by most of our institutions. Indeed; in the case of cannabis and "kids,"
it's even endorsed by 'organized reform'..
Isn't it at least possible that such pervasive delusional thinking
is more representative of deeply ingrained patterns of human behavior than
reflective of any 'evidence-based' cognitive process? Isn't it possible--indeed,
even likely-- that what has enabled US drug policy to gain its present
world-wide acceptance may be more dependent on a specific human cognitive
frailty than on responsible thinking and planning?
That the drug war may simply be another instance of the now-obvious failure
of our species to come up with any strategies (aside from war, hypocrisy,
and denial) for coping with its most pressing problems is both depressing
and a real possibility; however there are no indications that the growing
list of dire climatic portents is being heeded-- even as we seek to
rebuild after Katrina.
Tom O'Connell
http://www.druglibrary.org/drtom/
Posted by tjeffo at 10:55 PM | Comments (0)
September 08, 2005
A Reader asks about adolescents and marijuana use
A Reader asks:
Dr. Tom:
Even though I agree with just about everything you write, I believe it
is counter-productive to be seen as in any way advocating that
adolescents use marijuana. I believe the drug war cheerleaders
will get hold of this and claim that you and other reformers advocate
that children use all kinds illegal drugs. In politics, perception
is reality.
I believe that you wrote several years ago that the drug war is
essentially a propaganda war. Therefore, we should not give
the opposition any ammunition...
My answer:
Although I have never recommended that "kids use pot," the fact is
that they have been doing so in large numbers since 1967, the
comparative benefits documented in this population make approval of
(some) juvenile a use logical inference. Nearly all the California
pot users studied had tried it in high school (or before). Actually,
I might have once agreed with you; before I began to screen patients
I was then just as ignorant as the federal government so
obviously remains. The feds a have become upset because the
(much trumpeted) decline in pot initiation rates recorded
between 1979 and 1992 has been replaced by a sustained upward trend.
Now, at least half (probably more) of the nation's adolescents now
probably try pot before turning 19.
Moreover, my demographic profile of chronic users (which they clearly
don't have) demonstrates that the age at which "kids" first try
pot declined rapidly after 1975 and now almost exactly matches
the age at which (nearly all) also try alcohol and tobacco (14.9 years).
Use of alcohol and tobacco by this population also declined
significantly once their use of cannabis became chronic, thus strongly
implying a protective effect against use of the other two-- both
acknowledged to be more physically harmful.
Not only is this information based on the systematic study of a real
population, it directly challenges countervailing government dogma
based entirely on false assumptions and supported by inferential studies
of the only kind allowed under the 'rules' NIDA sets for drug research.
For those reasons, I suspect the government would have little interest
in advertising my data by attacking it. Now; if only drug policy
"reformers" could grasp the same concept...
Any reader with a specific question about either drug use or drug
policy is encouraged to ask; I'll probably have an opinion and should be
able to point towards sources of reliable information. In any event, it's
a chance to both learn and share knowledge.
Doctor Tom
Posted by tjeffo at 05:58 AM | Comments (0)
September 06, 2005
Blogs I read:
Posted by tjeffo at 06:27 AM | Comments (0)
September 05, 2005
More on Professor Kleiman
I've already mentioned Professor Mark Kleiman several times; he is the UCLA school of Public Policy's
leading drug policy analyst. As such, he commands considerable attention
in national policy discussions (although no mere analyst ever exerts much
influence over decisions-- but that's another story). He has also been an
indefatigable blogger, displaying a wide range of political and other interests
for several years.
That should allow me to use both his current postings and his archives to
make some specific points about American drug policy: not only how such a
calamitous error has evolved; but how its critical ability to (nearly) immunize
itself against public scrutiny has been part of its armor- and how that ability
was radically expanded after a spurious "war on drugs" was declared thirty-five
years ago.
To begin with my own experience, my first intense exposure to drug policy
details was motivated by a strong suspicion that the policy itself was mistaken;
thus I was open to what I can (only now) see as the most objective primary
and secondary sources then available. My deepening understanding of the
logic and rhetorical tactics of policy defenders also allows me to understand
that those sources would have been relatively inaccessible to anyone starting
with a pro-government bias.
A more general corollary, only recently appreciated-- and which I have come
to regard as a critical factor in human thought and behavior-- is that whatever
we humans are able to accept as "truth" is critically influenced by what
we already believe. This is a concept Leon Festinger's mid-Fifties notion
of "cognitive dissonance"
attempts (with limited success) to deal with. To understood CD as a
key element in denial is quite useful. Any attempt to parse it beyond that
by becoming immersed in Festinger's original "experiment" becomes counter-
productive and a source of confusion.
The bottom line is that we all process new information in terms of what we
think we know for sure (observations we believe credible on the basis of
objective evidence) and what we believe-- but have no way of proving. That's
my way of understanding the critical difference between a scientific
mind-set (which holds honest skepticism to be the highest virtue) and a religious
one (which must ultimately regard blind faith as the highest virtue).
The critical implication is that, ideally, any 'secular democracy'
should-- to the extent possible-- abjure religious thinking as a primary
basis for its policy decisions.
Any prohibition enforced by police and punishable by law can immediately
be seen as based mostly on religious thinking. The degree to which the legal
system is able review and modify sentences opens the door for empirical (non-religious)
thinking to modify policy.
When one applies those ideas to specific American policies, one finds huge
differences in the degree to which they have been influenced- both in formulation
and execution- by each type of thinking. My contention is that our
"drug war" is one of the most egregious examples of a public policy dominated
by purely religious thinking to be found in any secular democracy. In other
words, drug war dogma is to the feds what Islam is to the Talliban;
and-- just as with Islam-- there's always some wiggle room for adherents
claiming to represent a less fundamentalist view.
That's probably enough for today; more examples from Professor Kleiman very
soon. BTW, he and I agree on many other issues; particularly GWB in general
and the execrable White House response to Katrina in particular...
Doctor Tom
Posted by tjeffo at 07:32 AM | Comments (0)
September 04, 2005
Feds up to Old Tricks
American drug prohibition-- known as the War on Drugs after its enabling
legislation was rewritten by the First Nixon Administration in 1970--
actually began with the Harrison Act of 1914.
A singularly dishonest bit of legislation; Harrison was sold to Congress
as a tax measure intended to monitor the use of medications made from the
opium poppy and the coca leaf. What was unique was is arrogation of a federal
control over physicians-- backed by criminal penalties-- for what actually
amounted to disputed professional judgement. The real intent was soon revealed
when Treasury agents began arresting physicians who were prescribing for
"addicts" for a fee-- but in technical compliance with the new law. Selective
prosecutions of two particularly lurid cases induced the celebrated Holmes-Brandeis
Court to rule narrowly (5-4) in favor of the government.
Those decisions not only established the (still) dubious precedent of allowing
a federal prosecutor to directly challenge the medical judgement of a licensed
physician; it also allowed harsh criminal penalties and converted a nominal
tax law into de Jure drug prohibition. The medical profession was so thoroughly
cowed by its ordeal it was persuaded to abandon addicts and their treatment
to the tender mercies of what eventually became the Federal Bureau of Narcotics
under Harry Anslinger in 1930. During his long tenure (1930-1962),
Anslinger allowed no competitive sources of information on "narcotics." It's
hardly surprising that Interest in-- and research on-- addiction was discouraged.
Nixon's declaration of a "drug war" in 1969 followed the critical hiatus
(1962-68) after Anslinger's departure from the FBN, during which several
new 'psychedelic' agents were popularized, the Supreme Court overturned the
MTA, and the youthful "hippie revolution" combined with protests against
the Viet Nam War to disperse cannabis ("marijuana") throughout the nation's
secondary schools.
Since then, drug "control" has remained a jealously protected federal doctrine,
but the mode of that protection has changed dramatically from the uninformed
authoritarian blackout of science by Anslinger-- completely bereft of medical
or scientific basis. Policy now relies on the mountain of peer-reviewed
'political science' funded by NIDA's since its founding in 1975.
As noted earlier, NIDA is the antithesis of what science is supposed to be
about- as I hope eventually to demonstrate by several specific examples--
however, this post is to call attention to another abomination: the
Bush Administration's recent spate of criminal prosecutions of "pain" doctors;
a reprise of the same tactics which allowed Harrison to evolve into the massive
fraud we now call the "war on drugs."
It's timely because of today's announcement that Dr. Cecil Knox,
a 56 year-old pain specialist in Virginia, has finally succumbed to almost
four years of federal prosecution (persecution) which had produced a hung
jury (11-1 for outright acquittal) in 2003. He is finally accepting a plea
bargain in lieu of a retrial. Significantly; it was only after treatment
for his recurrent lymphoma had produced a remission that the government elected
to retry him. His assets had been frozen and the four charges he's pleading
to were not even in in the original indictment; yet none of that appears
in the government's obnoxiously triumphant press release.
I have never met Doctor Knox, but two things are crystal clear from the
newspaper accounts: he's no criminal, and whatever irregularities he may
have been guilty of would have been better dealt dealt with through either
peer review or tort (malpractice) procedures; and that's clearly what would
have happened if had he had been anything other than a pain specialist. He's also not the only such specialist undergoing a similar ordeal.
What we are now seeing from our arrogant and dishonest "drug control" bureaucracy
is a modern version of the same witch-hunt that started this mess over ninety
years ago.
The players may have changed; but the dishonesty remains the same.
Doctor Tom
Posted by tjeffo at 05:14 AM | Comments (0)
September 03, 2005
(Slightly) Off-Topic
Although this blog is nominally focused on drug policy and related issues, the amazing events now taking place on national television deserve some notice-- especially when one factors in that an emphasis on "law and order" now seems the most important aspect of the (incredibly tardy) White House response. This was written before noon on Thursday and was also posted to a drug policy discussion forum:
We are now witnessing an historic melt-down of state and local government credibility in real time: Government failure, at all levels-- to plan adequately for, or deal effectively with, a type of disaster which has been warned against in the abstract for years-- and had been predicted in this instance for days-- can no longer be hidden from view. Every pathetic ad-hoc measure that's proposed-- only to fail-- (like transferring unwilling inmates from the Super Dome to the Astrodome while refugees already in Houston are being turned away) is merely the most visible. It's also just another example of the same mind-set which has given us wasteful and destructive "wars" on drugs and terror as substitutes for rational, evidence based policies.
Even as this is being written, Scott McClellan is (predictably) emphasizing that "lawlessness" by those who have been starving, suffering life threatening thirst, and marooned in a pestilential hell-hole for over three full days "will not be tolerated."
What's next; a "shoot on sight" policy towards looting? How will we ever know who died from Katrina and who were victims of official ineptitude?
Almost completely neglected: what will be the long term psychological effects of these horrific experiences on the survivors-- especially children?
Significantly, the personal anger and frustration of CNN reporters on the spot is being aired-- along with the anger and desperate plight of those still trapped in the city. Current 'policy' seems to be to allow chaos to prevail until "order" is somehow spontaneously restored. These issues are now being parsed in real time by an on-the-spot reporter and his anchor...
What will be most interesting over the next few months are the answers to four (closely related) additional questions:
1) to what extent will the credibility of the Bush Administration survive this fiasco?
2) To what extent will the US Economy be adversely affected?
3) To what extent will civil rights/liberties be restored after the 'emergency' is over?
4) Who will decide when the emergency actually !S over?
Tom O'Connell
Posted by tjeffo at 05:25 AM | Comments (0)
September 01, 2005
The Anti-NIDA
One of my first responses to learning that many of the chronic pot smokers
seeking my designation as 'medical' users had probably been treating serious
emotional symptoms since high school was to begin reading what (for me) had
been a very unfamiliar genre of peer-reviewed literature; that dealing with
'addiction' and 'drugs of abuse;' particularly as relating to "marijuana"
and "kids."
What I discovered was an enormous body of work extending back to the mid-Seventies.
Most such studies had obviously been designed around the concept that juvenile
use of cannabis is a "risk" to be avoided. The historical origin of that
idea had clearly been a discovery that nearly all the young cannabis users
first encountered in the aftermath of the "hippie" movement had already tried
alcohol and tobacco; and many were still using both. That discovery
quickly gave rise to a "gateway" hypothesis suggesting that cannabis, while
perhaps not as intrinsically dangerous as 'harder' drugs, is still undesirable
for youth because it functions-- in some as yet undisclosed way-- as a 'gateway'
between legal and illegal agents.
A convenient recapitulation of that history, and NIDA's role in sponsoring
the relevant research, appeared in 2002. Also published in the same year,
was a study demonstrating that-- theoretically at
least-- some as yet unidentified "common factor"
could as easily explain those well-known pejorative associations. It didn't
require much imagination to see the 'common factor' is pot's heretofore unrecognized
role as an anxiolytic which allows it to serve as a benign alternative to
alcohol and tobacco-- the only previously available agents for teens afflicted
with similar (and very common) symptoms.
It also doesn't require much imagination to understand why such a formulation
would be rejected out of hand by a majority of those dependent on NIDA funding,
or simply steeped in three decades of federal anti-pot propaganda. What was
mildly surprising was how many 'reformers' of various persuasions had bought
into the same propaganda to a lesser degree-- but enough for them to
distance themselves from any idea of pot as useful self medication.
My 'peer-reviewed' readings had also suggested that policy advocates would
be eager to use the mountain of literature NIDA has purchased at taxpayer
expense to crush any belief in cannabis as medicine-- fears already borne
out in some recent NIDA publications.
There is no time today to parse Dr. Volkow's 'logic ' in detail, but I can
at least suggest an opposing sound byte: "Clinical truth is the best "Anti-NIDA."
More on this subject soon.
Doctor Tom
Posted by tjeffo at 04:50 AM | Comments (0)