Web Log of Dr. Tom O'Connell

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December 18, 2005

The Elephant in the Living Room: America's huge pot market

Our pot market dwarfs all others for illegal drugs; yet, like them, it's rarely seen by non-users. Whether they consume alcohol or not, Californians encounter its retail distribution network every time they shop for food.  "Marijuana," which may command a comparable dollar volume, was sold through a distribution network that was nearly invisible in California until Proposition 215 created  a 'gray market' of sorts. It's ironic that as this entry is being composed, multiple busts  of medical marijuana outlets are being reported in San Diego. My purpose here isn't to comment on those busts, but rather to call attention to some of the absurdities brought out by standardized questioning of  Californians seeking pot recommendations.

 Just like all illegal drug markets, the pot market has thrived under the noses of the drug warriors; also like them,  it can't be measured directly. Thus police agencies are free to emphasize different points to different audiences. When seeking more money for enforcement, they cite evidence of market growth; when justifying their failures, they inevitably claim things would be much worse without the policy .

Ironically, in the case of pot, there is now convincing evidence that when Richard Nixon declared war on drugs in 1969, its market was still relatively small and just starting to grow.  Even more ironically;  given the emphasis on pot and kids, there is also convincing demographic evidence that virtually all its subsequent growth has been both incremental and a direct result of the recruitment, as customers, of the same fifth graders targeted by D.A.R.E. since the Eighties and surveyed so assiduously as adolescents by MTF/SAMHSA since 1975. Virtually all also tried alcohol and tobacco and many  went on to try several other illegal drugs as well.

In a very real sense, America's still-growing illegal pot market is the most redolent elephant hiding in our national living room.
In 1972, Richard Nixon disregarded the Shafer Commission's recommendation  that cannabis be decriminalized and studied for its therapeutic potential. Instead; he opted to continue  a 'war' on pot- a policy that has since been expanded and intensified several times.  Marijuana possession soon became the leading cause of felony arrests, which now number over three quarters of a million each year. Our total prison population, which has more than tripled since 1980, is well over two million.

It now clear that although the potential for today's huge illegal cannabis market  was created by the MTA in 1937, it didn't begin to be realized until pot was tried by hundreds of thousands of adolescents thirty years later. Ironically, the most important clue to their drug vulnerability was noted by the first researchers to  encounter them; however, it was misinterpreted after NIDA came on the scene at about the same time.

The important clue was that- almost without exception- the juveniles and young adults smoking pot in the mid-Seventies had already tried alcohol and tobacco. The first (and only) assumption by NIDA-- that pot somehow acts as a 'gateway' between legal and illegal drugs- it is still being assiduously investigated by NIDA-funded investigators thirty years later; yet the important nexus seems to be that all three agents can reduce the symptoms of stress and anxiety increasingly plaguing adolescents as life has become more 'modern' and complicated over the past two centuries.

The understanding that a robust illegal market for pot didn't begin for thirty years  after it was banned depends almost entirely on an absence of news during that interval: over twelve million men were in uniform during World War Two and yet the only pot bust to make headlines was that of Dorsey drummer Gene Krupa in San Francisco in 1943. The next celebrity bust involved  then (relatively) unknown Robert Mitchum five years later;  it generated coast to coast notoriety just ahead of television. The important points aren't whether Krupa's and Mitchum's busts were righteous or that they show that a small illegal pot market had always existed; rather that 'narcotic' arrests of relative unknowns could generate such intense curiosity.

What would become the 'counterculture' of the Sixties was foreshadowed in the Fifties by bi-coastal 'beat' writers who also attracted attention for their use of cannabis and newer drugs called 'psychedelics'.  The Fifties also saw the introduction of the first pharmaceuticals specifically intended for mental symptoms. That a surge in drug interest and availability took place between the 1962 firing of drug watchdog Harry Anslinger and Nixon's 1968 election is significant; many young people were being inspired by Civil Rights Movement and other movements that followed on behalf of 'free speech,' gays, and women. Those protests, in turn, had an effect on the "hippie" phenomenon when the 'baby boomers' born after World War Two began to come of age. Multiple protests eventually coalesced into an anti-war movement that would convince Lyndon Johnson not run in '68, and critically affect Nixon's judgement;  eventually driving him from office only two years after his 1972 landslide victory.

As mentioned earlier, the first encounter between researchers and youthful pot users (impossible under Anslinger) had occurred in the mid Seventies; although the association with alcohol and tobacco was noted; it was misinterpreted. NIDA's first major error thus became its obsession with validating a 'gateway' "theory" which has never passed muster as a useful hypothesis. More subtle; and even more egregious- has been NIDA's failure to recognize an incremental pattern as that market has continued to grow- let alone the reasons for that pattern. These elements are persuasively revealed  by a simple tabulation of the age distribution of the thousands of Californians I've interviewed for cannabis recommendations over the past four years. Whatever doubts one may have about the 'legitimacy' of their use, there is no question they are admitted chronic users who first tried pot as adolescents.

All but two were over 18 when first seen and 95% were born between 1946 and 1986.
The next entry will report their demographic specifics as chronologically related  to their initiations of alcohol, tobacco- plus the other illegal drugs they admitted trying from an arbitrarily selected  menu.

Tom O'Connell MD
 

Posted by tjeffo at 03:01 AM | Comments (0)

December 07, 2005

Denial

 

It's been over nine years since California voters endorsed the concept of 'medical' "marijuana" (therapeutic use of cannabis). Thus two different drug czars have had to contend with the shocking idea that a plant used medicinally in the East- possibly, as long as five thousand years before its 'discovery' in 1839-  then  by Western physicians for another hundred years before it was banned by a know-nothing US Congress (1937-- might actually be a safe and effective medicine.

Czar number one, Barry McCaffrey,  was prevented by injunction from punishing physicians for merely discussing cannabis with their patients. Later; frustrated by the IOM report he'd paid for-  he jumped all over the its placatory emphasis on the dangers of smoking. Who ever heard of a "medicine" that has to be smoked, McCzar asked rhetorically. His predecessor, John Walters, who seems even more reactionary and less informed than McCaffrey, was all over the "smoking" argument soon after taking office. His medical advisor, Andrea Barthwell, went on a junket to condemn the absurdity of "smoked  medicine" just before being briefly hired away from federal service- first by commercial interests touting a different route of cannabinoid ingestion (and a different axe to grind)- and then an even briefer exploration of a Senate nomination.

Back to the smoking controversy: neither czar had apparently heard about the relatively new technique of "vaporizing" cannabinoids to permit their safer inhalation. I'm not surprised;  because before I began screening patients in 2001 I hadn't either. Despite a heightened awareness since then, I have yet to see any reference to vaporization in either the popular press or peer reviewed literature. I've also been quizzing applicants on what they knew about it and continue to find that nearly all first timers- including those who've been using pot for years- are still very ignorant. Even those who'd heard something are relatively uninformed: the most common guess of the few who had heard about it is that it's a "safer way to smoke."

One would think the drug czar's office would be on the same page as the DEA on pot issues- and that both would have heard of vaporization in the past nine years; especially since the DEA has been busy blocking a responsible request by a researcher to grow enough high grade cannabis for a credible study on vaporization. Of course, such hypocrisy is of little surprise to anyone familiar with the the way the feds do things; it's just that they  are usually a little less obviously hypocritical.

Which brings me, in roundabout fashion,  to my main point- not that 'reformers' wear white hats and the feds wear black- but that all humans seem to exhibit two major characteristics: a need to compete and a willingness to cheat when they think they can get away with it. Both the DEA and ONDCP rely on the ignorance of the mainstream media and their relative unwillingness to embarrass the drug war; thus their hypocrisy is both safe and deniable.  Even worse for 'reform' is that while it isn't clear whether Walters' ignorance of vaporization is real or feigned, neither possibility is very hopeful for their political cause.

From my better informed (and even more ignored) vantage point, I realize that 'reform's' behavior confronts me with exactly the same dilemma: are they that cynical, or do they really believe; that s__t?

The subject of vaporization-- and of the critical role played the varying ways pot can be ingested-- will be explored in considerably more detail in the near future.

Tom O'Connell MD

Posted by tjeffo at 11:30 PM | Comments (0)

The Retchin-Magbie Fallacy: practicing Medicine without an education.

 
Although hardly as familiar as 'driving under the influence," the phrase. "practicing medicine without a license" has a comfortingly familiar ring which is also misleading in most instances.  Sometimes the alleged miscreant had been educated as a physician,  but for some reason, hadn't been able to obtain,a license. Far more often however, it's someone without any medical training who is simply impersonating a physician. In other words, the real offense is practicing Medicine without the requisite education and training.

The tragic 2004 death of Jonathan Magbie in a DC jail illustrates that difference very well; it also serves as a near-perfect example of what may be the most egregious- and least recognized- consequence of American drug prohibition. Although the faux "physician" in Magbie's case was medically uneducated; she does have a law degree and was legally empowered by our federal government to order the shockingly misguided "treatment" which led directly to an avoidable death. She will also probably escape any significant punishment; In fact, she has already been re-appointed to the same bench from which she imposed her judgement.

What the Magbie case illustrates so clearly is an historic error incorporated into our drug laws by two ill-advised SCOTUS decisions shortly after passage of the Harrison Act in 1914. They essentially empowered the nameless functionaries of a Treasury 'Tax Unit,' specifically created to enforce the untried new law with sweeping legal powers which  not only allowed them to make medical judgements they weren't trained for,  but also to enforce them on real physicians through the  harsh penalties which Harrison added to the federal criminal code.

The same ludicrous 'principle' was followed in the 1937 MTA which banned cannabis ("marijuana"); the critical difference between Harrison and the MTA-  one directly responsible for the current political flap over "medical" marijuana- was that the 'medical exception' allowed under Harrison- for some opiates  (
not heroin) and cocaine- which was continued by the CSA's schedule 2- was not allowed for cannabis. Speculation about what might have transpired had cannabis been placed on Schedule 2 rather than  being completely abandoned to the illegal market is one of the many  reasonable "what if?" questions that history will never get to answer. The parallel anomaly is that heroin- originally an effective and safe opiate patented by Bayer in 1898- was treated the same way when Congress officially banned it in 1924.  We all know how that turned out.

What the Magbie case does illustrate- in a particularly poignant way-is  what can happen when judges are authorized to make medical decisions for which they aren't qualified, and for which they have neither liability nor malpractice insurance. When I first read about it, I wondered how a partially ventilator dependent quadriplegic could possibly have been sent to a facility so lacking in the necessary expertise and equipment. Now that the details have been released, it seems the ineptitude and irresponsibility were even worse than I'd suspected; but the medically unqualified judge may have no liability whatsoever for her lethal misjudgment.

As if to underscore the arrogance and ignorance still rampant in our system of  "justice,"  a trial is scheduled to begin next month in California in which another young quadriplegic, will be  tried by his local DA on charges eerily similar to the ones that did Jonathan Magbie in. The major difference is that Aaron Paradiso has been successfully managed without a ventilator; however, he is also a very high quad and totally dependent on a dedicated team of family and friends who provide him with a remarkable level of around-the-clock care; one which could never be replicated in California's notoriously troubled prison medical system.

A particularly mindless touch is that this will be the second attempt to try Paradiso; the first was thrown out on a technicality before the Magbie tragedy.

If these two cases, both ironically occurring in venues where  voters have already approved medical use of cannabis, can't convince the American public that its criminal prohibition- and, indeed, that of all drugs- is an inhumane fraud; then perhaps nothing will.
 

Tom O'Connell MD

Posted by tjeffo at 11:15 PM | Comments (0)