Many drug policy reformers are quick to agree that “kids” shouldn’t
smoke pot; but there’s a problem with that statement; large numbers of
kids HAVE been smoking it for thirty-five years. Not only are they
very unlikely to stop, the best available evidence is that–– aside from
the risk of arrest it subjects them to–– the practice is far better for
their mental and physical health than the alternatives.
In November 2001, when I began screening medical cannabis applicants at
the largest buyers’ club in the Bay Area, I had no idea I was
starting a project which would soon take over my life. I now also
realize that I had bought into the same mind-set that prevents many
reformers from agreeing with a concept I’ve been trying to explain to
them them since tumbling to the truth in early 2003: pure
“recreation” is an unlikely explanation for the repetitive use of an
agent at the risk of felony arrest over an indefinite interval. In
fact, most repetitive use of any drug is for purposes beyond mere
recreation— whether the user cares to admit it or not. I’m also of the
opinion that–– in any sane world–– self-medication with pot shouldn’t
require a prescription any more than one should need a one to buy
coffee at Starbucks, a six pack at the 7-11 or a pack of
cigarettes at the local smoke shop. Beyond that, pot not only treats
the same symptoms more effectively than either alcohol or tobacco; it also
diminishes their use. In other words, prohibition of pot–– to the
extent it’s effective–– boosts juvenile consumption of alcohol and
tobacco.
I also think getting a “medical marijuana” initiative on the 1996
ballot was a brilliant political move because it took advantage
of the public’s compassionate response to credible news that some very
ill patients were being helped by it. What was NOT brilliant was
“reform’s” immediate knee-jerk denial of a political motive when
defenders of our drug policy accused them being “legalizers” with a
political motive.
Of course “medical marijuana” was political.
Do right-to-lifers clamoring for a ban on “partial birth” abortion ever
deny that they oppose all abortion and want to overturn Roe vs Wade
ASAP? Who said drug policy reformers had to endorse their opponents’
rhetoric by agreeing that pot is ‘bad’ for adolescents; especially when
data from pot users themselves shows just the opposite? In fact, my
data shows quite clearly that ever since large numbers of
troubled teens first began smokng pot in the late Sixties, the age at
which they first try it has been declining steadily; right along
with the rate at which they also try heroin.
Yesterday, I said I'd comment on the FDA
'press release' released on the first day of last week's NORML
Convention. Well; it was both pathetic and political: unsigned,
covering no new ground and most noteworthy for its
inaccuracy and political ineptitude. In fact, it was so bad that the
mainstream media jumped on it almost from from the start: the
most influential early report by Gardiner Harris of the NYT,
quickly set the tone by immediately noting its political nature
and soliciting critical opinions from a variety of sources, including
an annoyed John Benson, one of the senior authors of the original IOM
report.
For someone like myself, who has been following the sparring between
federal authorities and reformers for years, the shabby pretext for
releasing this 'report' on 4/20, its lack of content, plus its
scientific and political ineptitude all represented new lows for the
other side. Also surprising was the volume of critical media
commentary, the degree to which drug war hypocrisy was openly
recognized, and the willingness of many sources to take the
policy to task. Clearly, an opportunity to make some political hay had
been presented to 'reform.'
What has been very disappointing–– but not that surprising–– has been
the manifest inability of 'reform leaders' to recognize the golden
opportunity they were just handed by proponents of the policy they are
supposed to be opposing. Their timid, business-as-usual attitude was
typified by a quote
from Ethan Nadelmann who, instead of noting the obvious sins of the
press release, took it at face value and simply complained it would
make things more difficult.
Obviously Ethan has never heard of the football maxim that the best
defense is a good offense. What will it take for 'reform' to wake up to
the fact that the dishonesty and egregious manipulation of science by
the drug war is that policy's greatest political vulnerability?
This is the first entry since the ‘06 NORML Convention
(San Francisco from 4/20-4/22) ended. From now on, I intend to
post more often and expect to have more time to do so, because I
will be spending less of it trying to persuade 'organized reform’
to see the complex issues involved from my perspective. Since I know
from experience that patients are far more likely to ‘get’ the things
I'll be writing about, it makes a lot more sense to to focus my
educational efforts on them through the blog.
Last week’s NORML meeting provided the last bits of evidence
needed to reach that conclusion. As is often the case, one item came
from an unexpected source; the other came from a plan I’d hit on only
after a last minute invitation to participate in a panel on
'clincal use' of cannabis.
First the unexpected source: it was a brain-dead and ill-considered
press release emanating (no other word suffices) from the FDA on
Thursday, April 20, allegedly in response to a request from Rep. Mark
Souder of Indiana. Whatever the truth of that claim, the timing
coincided with the first day of NORML; that some commentators
apparently missed that obvious connection does not inspire much
confidence in their abilities. As noted, the press release itself
provided some key data; but in a completely negative way: it was simply
florid propaganda echoing a former drug czar’s obvious attempt to spin
the 1999 IOM report he'd requested— but then been disappointed by—
because it (timidly) repudiated 2 key items of drug war dogma:
first, that “marijuana” has unique therapeutic value for at last some
patients;
second there’s no compelling evidence to support that the idea that it
leads people to try/use other drugs (“gateway” effect).
Thus the ballhooed 'report' was merely repetition ot a medically
untrained general's opinion from seven years ago–– entirely without
supporting evidence. What it actually demostrated how just how far the
credibility of the FDA has fallen. That s commentators were oustspoken
enough to recognize that fact and take them to task was encouraging; as
was the simultaneous
and unrelated concession by a hard core Right Wing SF journalist
that pot has medical value.
As for the meeting itself; on Friday evening, I attended a hosted, but
informal, dinner conclave of nominal ‘reform leaders’ where the main
agenda item was to be medical marijuana framed in a context which had
originally been ‘recreational’ versus ‘medical.’ Just before the
dinner, I’d learned that ‘social’ had been substituted for
'recrational.’ No objection. I still don’t see the difference; but no
objection. As for ‘medical’ I have always understood that to mean
prescribed by someone with a medical license— as opposed to used on the
person’s own judgement.
The point I wanted to make was that ‘medical’ has picked up so much
baggage in the context of pot that there is no chance of any consensus
ever emerging. In fact, anyone with much clincical experience in the
practice of medicine will tell you that there is constant bickering and
disagreement among physicians over the best treatment of certain
conditions/problems/diseases. That’s the nature of the beast. Most
clinical encounters begin with SYMPTOMS (patient complaints). The
doctor then comes up with a working diagnosis and has to decide
how far to go in confirming it (ruling it ‘in’ or ‘out’). It’s a
complicated algorythm which can vary with a host of factors; not the
least of which is setting. For example, a GP who has known the patient
for years is going to be a lot less worried when someone who has always
exaggerated their physical symptoms complains of a new one— at least at
first. On the other hand, an ER physician, who has never seen that
patient before and won’t be able to conduct a follow-up, might
feel the need to order hundreds (or even thousands) of dollars worth of
tests— mostly for his own protection against a possible law suit.
That’s one of the key reasons an ER is a bad place to go with minor or
vague new complaints. The hardcore uninsured have no such billIng
worries, and must be dissuaded by other means— such as long waiting
periods in ERs. I’ve wandered off-topic, but I hope I've left you with
a feeling for what the working MD gets paid to do: exercise clinical
judgement. Now, I'm off across the Bay to exercise some clinical
judgement of my own. The next entry will why I think the FDA fiasco may
point toward a key strategy change that 'reform' should adopt; I will
also describe more adventures at NORML '06.
In the last entry, I stated that Richard Nixon's drug war
had actually stimulated the growth of the illegal drug markets it claimed
to oppose. Why that was so should be a no-brainer for Americans- if for
no other reason than as the World's most aggressive marketers we should
realize that until a product is finally introduced to those it has the
most appeal for, it may be a tough sell. In the case of pot, that clearly
didn't happen until large numbers of adolescents were suddenly exposed
to it in the the mid-to-late Sixties- just before "war" was declared on
it by RMN.
In addition to availability, what is most essential to any new
product launch is advertising; something the 'war' on drugs has always
been able to provide gratis- thanks to the unfailing willingness of the
media to hype the latest drug scare. In addition, the public utterances
of every non-MD 'drug czar' since Carleton Turner played that role for
the Reagans, make it painfully clear that 'shill' is a far
more accurate job description than 'czar.' What drug czars are paid to
lobby for- and some do more vociferously than others- is the policy itself;
especially its 'core' principle that there can be no alternative
to rigorous criminal prohibition. The current 'reason' - as voiced by James
Q. Wilson while chairing a recent "expert" panel- is that because there
is no political will to legalize drugs on Capitol Hill, "legalization"
is a "non-starter." What a profoundly inane reason for not even studying
a failing, expensive, and very destructive policy while clinging
stubbornly to its untested assumptions for nearly a century!
Next, I'll point out how how all illegal drug markets, even the
one for heroin, had really fallen far short of their real potential until
passage of the CSA in 1970- and how rediscovery of RMN's drug war
by the Reagans, combined with a mid-Eighties "crack"epidemic- finally
solidified the drug war's place in history as a thoroughly bipartisan national
disgrace.
