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February 19, 2010

Good News, Bad News

I was pleasantly surprised by a headline above the fold of this morning’s print edition of the SF Chronicle (how long can it survive? I’m always forced to wonder) reporting that “Clinical trials show medical benefits of pot.” That news wasn’t news to me, but the long-delayed recognition of pot’s efficacy in MS was gratifying, particularly because I have painful memories of sitting through two Larry King specials devoted to new developments in MS during which neither the words “marijuana” nor “cannabis” were even mentioned. I found the denial infuriating because I knew how rigorously the producers would have had to either screen or censor their not-quite celebrity guests to maintain such drug war purity.

So much for the good news; the bad news was that most of the money made available way back in 1999 has been spent and a program that is finally producing results is in danger of being starved financially.

Of course, it would never occur to the “bona fide” researchers in Academia or the wannabe scientific experts from ASA and NORML that a lot of non-criminals have been breaking America’s stupid drug laws for decades to treat not only multiple sclerosis, but a lot of other conditions as well. As a matter of fact, the people who have been applying for medical legitimacy under the provisions of California's Proposition 215 for over thirteen years are a valuable resource that's been shamefully neglected by self-appointed experts in both Academia and “reform” for far too long.

What might have opened their eyes a bit sooner could have been a few more pot docs willing to take decent medical histories and publish their results.

Doctor Tom

Posted by tjeffo at 03:28 AM | Comments (0)

February 15, 2010

Edibles and the “Body High”

That there are considerable differences between smoked and orally ingested cannabis is emphasized by use of the term “body high” to describe the effects of “edibles.” That federal policy makers still don’t understand either those differences or their physiologic bases is made clear from their failure to discuss them and from their subsidization of Marinol.

Whatever its basis, the general silence on those issues adds up to an indictment of both American drug policy and the intellectual honesty of our species as well as a suggestion that our tendency to deny unpleasant reality may be a serious human weakness.

To start with basic anatomy and physiology: taking "drugs" into the body (ingestion) is possible through a variety of mechanisms. When they can be volatilized by heating and then inhaled as vapor (“smoked”) the lung becomes an organ of ingestion. Since pulmonary venous blood drains directly into the heart, there's no faster way for cannabinoids to reach the brain. That’s also true of the nicotine in cigarettes and cocaine when it was processed into “crack” after ether extraction proved so unsafe.

Unlike drugs ingested by smoking, those we swallow must be digested in the gut and absorbed into the hepatic portal circulation thus delaying their arrival at the brain and exposing them to modification by the liver before they get there. It's slowest of all when the stomach is full and also explains why the effects of edible pot can’t be readily titrated.

There are other differences, all added by the liver, which not only receives the lion's share of pot’s pharmacologically active ingredients after an edible is consumed, but also adds three of its own, presumably by the same process of molecular deconstruction that characterizes its major function in other animals.

1) Pot’s duration of action is extended to three hours or longer after oral ingestion.

2) A degree of muscle relaxation that seems significantly greater than after smoking is noted by nearly all. Intense enough to interfere with most physical activity, it's the most common reason cited for avoiding edibles.

3) The nocioceptive (pain relieving) properties of smoked pot are intensified; an observation made most commonly by those with neuropathic pain (pain of nerve origin).

That these differences have not been addressed by either Big Pharma or Academia becomes readily understandable within the current setting of criminalization in which all “legal” cannabis intended for research must first be approved by the DEA and can then only be obtained from the federal marijuana farm in Mississippi.

Doctor Tom

Posted by tjeffo at 06:47 PM | Comments (0)

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 intoxication

As 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 may 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 아메리칸룰렛06:03 PM | Comments (0)

February 13, 2010

The High Cost of Imposed Ignorance

In March, 1972, when President Richard Nixon summarily rejected the reasonable, but timid recommendation of the Shafer Commission to decriminalize marijuana add investigate its potential medical benefits, the federal government still lacked the agencies he would later create to carry out his “war on drugs.” Thus passed the last slim chance to restrain the wave of arrests already under way as the nation’s police forces struggled to suppress the criminal market that had been created thirty-five years earlier by Harry Anslinger’s baseless Marijuana Tax Act.

Instead, that illegal market has continued growing steadily to its present enormous, but difficult-to-measure size, protected by the same ignorance and denial that has characterized “marijuana” law enforcement since 1937. Added to the current cost of the violence on our border with Mexico must be the lives destroyed by criminal prosecution of people for the “crime” of self-medicating with a safe, effective medicine; to say nothing of the mortality and morbidity incurred by those driven use its legal, but deadly alternatives: alcohol and tobacco. In retrospect, such costs are attributable to both Nixon’s rejection of the Shafer Commission’s plea and the compliant American media that allowed him to get away with it. Ironically, it would be the same media that would later drive Nixon from office for the relatively trivial Watergate affair, and is still in denial about both the size of the marijuana market and the enormous human cost of their own denial.

Indeed, the efforts of our species to implement a drug policy the UN adopted well before Nixon’s first term amply qualify as “insanity,” as 아메리칸룰렛defined by no less authority than Albert Einstein. In retrospect, what has been missed by those insisting on the necessity of marijuana suppression since the CSA became law has been any recognition of the sudden increase in the popularity of inhaled cannabis in the mid-Sixties, let alone questions about why "marijuana" became so popular when it did and is now the most sought-after illegal commodity on the planet.

Even more disturbing than the present grotesque failure of government, the media, or Academia to raise such questions is the world-wide denial that sustains our ignorance. When I first began blogging about what I've learned from the opportunity Proposition 215 offered for studying the behavior of pot smokers, I didn't realize the degree to which it would confirm the eminently sensible suspicions of Paul Maclean, which suggest there is an evolutionary basis for our paradoxical behavior as a species.

If he's right, our prognosis for a rational recovery is grave indeed, because it would have to be a first; our best hope may be that the non-violence of Ghandi, as encouraged by Einstein, might continue to find root as it did with MLK.

Doctor Tom

Posted by tjeffo at 12:52 PM | Comments (0)

February 11, 2010

More Background

In the last entry I referred to a temporal connection between Adolph Hitler’s consolidation of power in Germany and the passage of Harry Anslinger’s Marijuana Tax Act in 1937. Such connections were what talented science historian James Burke converted into books, a series of Scientific American columns and TV series on both sides of he Atlantic. With appropriate apologies to him, the following will mention similar links between Hitler’s and Anslinger’s two permanent legacies: World War Two and the War on Drugs.

Neither war was the exclusive contribution of either culprit to world history. What they did share, other than being born just three years apart, was a rise from obscurity through combinations of luck, chutzpah, and intellectual dishonesty, plus the ability to seize unexpected opportunities to make a mark on history. Unfortunately for us, both succeeded.

Born in 1889, Hitler had an unhappy adversarial relationship with an elderly, strict father who died suddenly when he was ten. Orphaned four years later by his mother’s death from breast cancer, he was then a bohemian art student; also homeless for a while. Lucky to even survive daring service in World War One, his rhetorical gifts propelled him into a position of leadership in the Nazi party. Ten years after a hare-brained putsch in 1923, that he was also lucky to survive, he suddenly found himself positioned to assert complete control over a nation that shared his resentments and would follow his assertive leadership while also tolerating his virulent antisemitism.

Born on this side of the Atlantic just three years after Hitler, Harry Anslinger, had also learned fluent German (from Swiss-German immigrant parents). Towards the end of World War One, his language ability landed him a job with the Armistice Commission in Europe; he would not leave federal service until retiring on his seventieth birthday and then served as the First UN Commissioner of "Narcotics," a position from which he promoted America's drug policy into its global clone.

His big career break came in 1930 when his wife’s uncle, Andrew Mellon, then Secretary of the Treasury, elevated him from a mid level job in the Treasury's Prohibition unit (doomed to elimination following Reform) to serve as the first Director of the newly formed Federal Bureau of Narcotics, a position from which he quickly arrogated the same degree of control of American drug policy as Hitler had the seized over the German nation.

From 1937 on, the comparison becomes less immediate, primarily because Hitler’s 1939 gamble of World War Two entailed far greater personal risk than Anslinger’s Marijuana Tax Act. Thus the delayed metaphorical war Anslinger enabled required help from yet another insecure wannabe warrior named Richard Milhous Nixon. The biographers of both men make clear that they each shared Hitler’s instinct for racial prejudice, if not its virulence.

The Asnlinger-Nixon drug war is still being fought. Despite medical marijuana’s implicit threat to its existence, it shows no sign of ending soon. Often overlooked is that it's waged by the whole world through national police forces against “enemies” who are simply trying to self-medicate. Because illegal drugs are, by and large, safer and more effective than their legal alternatives, the damage being inflicted is both enormous and almost impossible to quantify.

Finally, what seems to render global drug policy most impervious to rational criticism is humanity’s amazing tolerance for its obvious stupidity and failures through the phenomenon of denial. A cognitive species unable to face reality would seem to have limited prospects of solving its most pressing problems.

The smoking gun that could ultimately challenge that denial is the enormous success of illegal marijuana over the forty years that the world has been attempting to suppress its use. I plan to outline that success, and the reasons behind it, in the next entry.

Doctor Tom

Posted by tjeffo at 07:05 PM | Comments (0)

February 10, 2010

Essential Background

The Nazism that led Germany to almost destroy itself as a nation in twelve short years and the American drug war I compared it to in the last entry were both institutionalized repressions carried out by central governments. The speed at which they took place is the major difference between them; Hitler’s rapid acquisition of power between 1933 and 1935 allowed him to marshal the German people behind his impossible dream (lebensraum) of world conquest quickly enough to enable the invasion of Poland on September 1, 1939.

Constitutional restraints keep any American President from consolidating power nearly that quickly; however the CSA, Nixon’s radical enhancement of the power of America’s poorly conceived drug policy, has commanded unquestioning support from all three branches of our federal government since 1970, despite its well recognized role in the expansion of our prison population during that same interval.

The drug war’s particular impossible dream was soon defined as a “drug free” society. In both Germany and the US, the pursuit of officially designated national dreams led to the identification and punishment of internal enemies as scape-goats that would justify the use of extraordinary powers, allegedly to protect ordinary citizens from contamination. The American counterparts of Germany’s, Jews have been “druggies,” a concept clearly recognized by Richard Lawrence Miller in Drug Warriors and their Prey (1996) and emphasized in Nazi Justiz, his companion study of Hitler’s astute consolidation of power through Germany's vulnerable courts.

Bogus science also played a key role in both repressions; Nazi theory relied on the discredited ideas of Eugenics. In America, fear of addiction was a seed planted by the Harrison Act of 1914, nurtured by Harry Anslnger in 1937, and brought to unholy fruition by Nixon’s CSA in 1970. Ironically, the concept of “addiction” has remained stubbornly elusive, even as a behavior, and never been defined by Pathology as disease, despite the claims of drug war bureaucrats.

Not only is American drug policy burdened by its questionable biological assumptions, it clings stubbornly to the erroneous economic beliefs of prohibition that should have been decisively repudiated by Repeal in 1933. In brief, Prohibition (the Eighteenth Amendment) relied on respect for the law to prevent the criminal arbitrage that doomed it as policy. Within the relatively rapid span of 14 years, the Eighteenth Amendment had taken its place on the scrap heap of history, a process undoubtedly accelerated by the Great Depression. Unfortunately, survival of its belief that prohibition is reasonable public policy had already been guaranteed in 1930 when the FBN was created and placed under the control of a medically ignorant bureaucrat firmly committed to the idea that addiction is a police problem

Given Anslinger’s family connections, bureaucratic skills, and and intellectual dishonesty, things could only have become worse from there. Worse they became, in remarkably close parallel with Hitler’s success, when the MTA became law in 1937.

Doctor Tom

Posted by tjeffo at 05:00 PM | Comments (0)

February 08, 2010

Getting it Wrong

Both the American drug war and Nazism under Hitler between 1933 and 1945 are extreme examples of anomalous human thinking. What they also have in common is that they demonstrate what can happen when circumstances combine to empower an entire government, or in the case of the drug war, a large branch of government, with a dangerous degree of autonomy and the freedom to pursue mistaken ideas. In essence, i just compared America's war on drugs, to Nazism, a universally despised system widely recognized as the ultimate of evil. That notion, at first glance, might seem shocking to some.

Actually, the combination of essential elements exhibited by both phenomena isn't all that rare. Once one is able to consider them as straightforward examples of human behavior, similar situations can be see toabound. A convenient one, also American, is the system of chattel slavery that ultimately evolved in the Antebellum South. Over less than 3 centuries, slavery had become an inhumane system that gave ignorant overseers and slave traders almost complete authority over a group of humans defined solely by the color of their skin. Slaves were not recognized by federal or state law as human; almost no legal penalties were imposed on an owner who allowed his slaves to be punished excessively; even murdered.

Another characteristic often shared by such repressive systems is tolerance by the rest of society, a process often facilitated by circumstances that keep victims out of sight within institutions such as prisons or mental hospitals where ordinary rules do not apply and budget constraints and overcrowding can encourage a degree of callousness in the staff. Again, the most convenient example I can think of is the systematized barbarity of the modern American Prison system.

As it happens, I think I’ve also discovered the “smoking gun” needed to convince a majority of rational people that the drug war is as big a mistake as I’m claiming. What gives me some hope is that there are numerous examples in human history of critical insights that, almost by themselves, made sense out of what had actually been a random hodgepodge of mistaken ideas. Darwin’s intuition of a rational order driving what we now call Evolution (he didn’t call it that immediately) remains the best example I can think of. A smaller one, but one leading to dramatic reversal in a destructive practice was Silent Spring by Rachel Carson.

I’m painfully aware of how much I’m asking of readers who haven’t been conditioned, as I have, by years of realizing just how insane our drug policy had become without being able to articulate that conviction convincingly. The missing element was a concrete example that could pull enough grotesque drug war elements together into a convincing package. I now think I have such an example which, like so many other such phenomena, has been hiding in plain sight all along. All that was required was a proper focus.

That's enough for one day; the unveiling will come later.

Doctor Tom

Posted by tjeffo at 03:46 PM | Comments (0)

February 02, 2010

Annals of Supreme Hypocrisy

The first 'self-evident' truth asserted in America's revolutionary manifesto is that “all men are created equal;” yet when our founders, Jefferson among them, drafted a Constitution eleven years later in Philadelphia, that notion was cynically betrayed by their decision to embrace chattel slavery so seamlessly that neither word appeared in the document itself; nor was the institution of slavery addressed by the Bill of Rights appended before ratification. Instead, the onus of being a black slave was expanded judicially in 1857 when the Chief Justice of the Supreme Court 아메리칸룰렛explained that because they had been permanently excluded from citizenship by the Constitution, slaves could not sue for rights they didn't possess.

That reasoning so enraged abolitionist John Brown that his attack on a federal arsenal became the proximate cause of a bloody Civil War, one of the results of which was emancipation of all slaves. However, even that benefit was soon reduced by another terrible Supreme Court decision, namely that "separate" is the equivalent of "equal;" a notion that would allow a policy of Segregation supported by domestic terrorism to endure in the postwar South for almost sixty years before a Court presided over by an unlikely "maverick" finally agreed to uphold both the Thirteenth and Fourteenth Amendments.

In that context, I don't think it either unreasonable or impolite for a nominally black President to publicly rebuke the Court’s current 5-4 Catholic male majority for putting his Office on auction to American Corporations. He's certainly read enough history to know it's not that long since other Americans were bidding on his father's ancestors or hanging them from trees; both activities cleared at the federal level by this Court’s predecessors.

For any who think I also hold the Court responsible for their uninformed meddling in the practice of Medicine and subsequent foolish endorsement of the war on drugs, the answer is a resounding YES!

I see Justice Alito's response as remarkably uncool and revealing; I also doubt that any of his trial judge colleagues would allow it in their court rooms.

Doctor Tom

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