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April 29, 2012

A Politically Incorrect Study; Challenging a President

When I realized, relatively early in the course of screening Cannabis applicants in 2001, that all were chronic users to one degree or another, I saw the examinations required by Proposition 215 as an opportunity to learn about what had impelled them to become "heads." At the time I was actually embarrassed at how slowly I'd tumbled to that opportunity, but thinking about it almost ten years later, I realize that although the basic intuition had been correct; I'd been laughably naive to think an objective study would please either side of the "legalization" debate because it turns out that, even now, neither has the requisite objectivity to recognize the glaring errors embedded in their own positions.

Beyond that, their mistakes have not been identical; the federal error, more profound and longer in the making, has been their attempt to enforce a policy of criminal prohibition that can only fail. Thus they have become progressively adept at rationalizing the expensive failures they can neither recognize nor admit.

The errors and false assumptions of "reform" are more recent and easier to understand; for one thing, most reformers were not alive when Anslinger retired, or even when his MTA was overturned by the Warren Court in 1969. Thus the Mitchell-Nixon Controlled Substances Act of 1970. was their powerful ruling paradigm. Their goal was correspondingly timid: carving out a limited medical exception for "medical" marijuana while continuing to agree that "recreational" use should be punished as before. They were so unprepared for any possibility that youthful pot use could be effective self-medication for common emotional problems that they rejected it out of hand and sadly, have not looked further at the evidence; a position that appears vindicated by the absence of similar studies and the obvious interest of most "pot docs" in revenue.

Thus I've spent nearly 10 years simply unraveling the intertwined errors afflicting both sides in the legalization debate: although the federal position is weaker and must ultimately fail, it can probably hold out for quite a while because it's supported by the law, fear, tax dollars, and a host of powerful vested interests.

Last night, I was heartened by a rare breath of fresh air when Jimmy Kimmel twitted the President about DEA raids and reminded him that pot smokers also vote.

However the early media response has been disappointing: the usual unfocused confusion and denial. With each passing month I see a last-minute Obama epiphany as progressively less likely; it's even possible enough pot smokers will either sit out the election or vote against him to elect a clueless religious fundamentalist as his successor. It's happened before.

Doctor Tom

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April 24, 2012

How the Drug War Evolved from imposed "Public Health" to an International Conundrum

The "war on drugs" is a major American conundrum: how does a nation that imposed a seriously mistaken policy on the rest of the world admit it made a mistake? The obverse is even more troubling: why has the only species blessed with our complex cognitive skills, continued to endorse that policy through the UN?

That question becomes even more pertinent when one remembers that the US promptly canceled alcohol prohibition, the drug war's conceptual twin, by passing an ad-hoc "Repeal" Amendment in 1933, an event that might have warned of a similar fate following any attempt at rigorous enforcement of then-extant drug policy or sudden increase in drug markets it was focused on (precisely what happened in the Sixties). Thus the continued acceptance of a failing drug prohibition policy by the nations of the world becomes an issue for serious consideration: are human governments unable to think very clearly? Or do the various organization now benefiting from criminal drug markets have the political power to keep them in existence despite the harm they cause? I suspect it's a bit of both.

However, any idea that the various disparate groups profiting from the drug war are conspiring is nonsense. Drug criminals profit from breaking the law; they are also essential job security for police, as well as a source of bribes and other favors. Modern "Treatment," "Prevention,"and "Rehab" industries are also beneficiaries of drug prohibition, as are those who advocate (and promise) "drug free" schools and workplaces. Then there is the dubious moral imperative that "legalization" would be irresponsible because it "condones" use. What none of those "anti-drug" arguments recognize is that the ignorance imposed on all concerned parties by drug illegality eliminated the best opportunity to have understood what made them popular, the basis for their appeal to users, or how their use might be related to other factors just as their markets began flourish in the Sixties. Instead, a robust criminal drug culture based on youthful initiation of new agents was fanned by the CSA, a repressive omnibus prohibition law. The same markets, plus several new ones, have since been expanding uncontrollably for four decades; materially assisted by the ignorance and official myopia imposed by the CSA's two supporting agencies.

A major disadvantage of having a mistaken policy imbedded in criminal law has been the automatic support commanded by Law Enforcement Agencies and the Judiciary. In that respect, early supporters of drug prohibition were more aggressive than their opponents; they passed off the deceptive Harrison Act as a way to track problematic prescriptions, but began arresting physicians who were writing them on the notion that they were fueling "addiction." The Supreme Court's agreement expanded the law's intent and allowed the federal bureaucrats to prescribe specific treatment, a right they have yet to relinquish.

Medicine defines disease based on its pathological anatomy; legal precedents, are established by case law, in which outcomes (and precedents) are determined largely by rhetoric. That disconnect between objectivity and opinion remains at the heart of the drug policy controversy; it has allowed the drug war's claim to be a form of Public Health to be taken seriously. Unfortunately, it was based entirely on the medically incompetent rhetoric of John Mitchell, as protected by Richard Nixon.

Thus the drug war remains an incoherent policy without grounding in objective clinical studies, which have been literally impossible from the time Harrison was approved by the Supreme Court in 1920 until the first medical marijuana initiatives finally created the possibility of clinical access to "drug criminals" in 1996.

Although interval clinical research on cannabis users has been discouraged, enough recognized therapeutic benefits have been documented to render continued federal claims that "marijuana" has "no recognized use" in American Medical practice both embarrassing and stupid; yet that argument seems to the DEA's sole excuse continuing its raids in California.

If Obama would reign them in and make some positive noises about cannabis well before November, he'd probably be re-elected. But, given his recent clueless behavior, I'm not betting on the outcome.

Doctor Tom

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April 14, 2012

Annals of Federal Delusion

A common delusion of several US federal agencies has been slowly, albeit erratically, exposed since California voters defied conventional wisdom by approving Proposition 215 in 1996: namely that arresting enough violators of the Controlled Substances Act should “control” the illegal markets it has produced and thus make us all safer and healthier. In other words, the CSA is simply tough Public Health, as practiced by Law Enforcement. What makes that belief delusional is the failure of those who support it to recognize that it's simply Prohibition by another name. Those of us capable of critical thinking know how spectacularly the "Noble Experiment" flamed out; that there are so many humans apparently incapable of critical thinking comes as a bit of a surprise, but should be obvious to anyone paying even a modicum of attention to the Republican Presidential "debate."

The concept of how to redefine drug prohibition as the CSA was born in the fertile brain of John Mitchell in 1969; it soon earned the approval of Richard Nixon and was promptly passed as the Controlled Substances Act of 1970. Next, it was successfully defended against any modification when Nixon summarily buried the Shafer Commission report in March 1972. The next steps on the road to policy disaster were critical: creation of two entirely new agencies by Executive Order. The first, in 1993, created the DEA as a dedicated federal police force to enforce what amounted to a new prohibition. The second Executive Order in 1994 was truly diabolical it created NIDA as another dedicated agency charged with articulating and protecting the policy's (non-existent) "scientific" theory, a move that has had debilitating consequences for Psychiatry and the Behavioral Sciences for over four decades.

Given its provenance, the CSA’s failure as legislation should not surprise us; on the other hand, its continued ardent support by a substantial minority of Americans is critically important to understand; as is its acceptance as reasonable global drug policy (via UN Treaty) by the an overwhelming majority of nations on our troubled planet. Tangible proof of that acceptance: even a small personal “stash” of cannabis will result in a traveler’s arrest in virtually every international port of entry.

Narrowing the balance of this essay to the US, my systematic questioning of cannabis applicants reveals some important contradictions in the basic assumptions made by federal policy. One of the more cherished is that any drug that has to be “smoked” can’t possibly be medicine, an idea specifically articulated by the FDA on April 20, 2006.

That it was simply a press release, suggests it was pure propaganda; beyond that, its release on an April 20th, suggests a not-so-subtle dig that went over the head of the mainstream media that dutifully reported it as “news.”

However, a consideration that has become important to me, one revealed only by my questioning of users, is that there are significant differences between smoked "marijuana" and "edibles." Also that those differences are both clinically important and have not been adequately addressed by either side in the largely rhetorical "debate" that's been in progress since 1996.

I now think I've differentiated both the important therapeutic differences and the physiologic reasons behind them sufficiently to describe them in some detail and speculate about the reasons they haven't been addressed by either side in the "debate."

Doctor Tom

Posted by tjeffo at 10:56 PM | Comments (0)

April 08, 2012

Epistemology & Common Sense

Anyone interested in how we know what we think we know should also realize that to be consistent, the concept of culture should have been upgraded to accommodate the then brand new concept of evolution shortly after publication of Darwin’s landmark On the Origin of Species in 1859. Unfortunately, the many serious implications of Darwin's work have still not received the attention they deserve; probably because the most troubling of all were so contrary to the widely held (and comforting) religious beliefs of the mid-Nineteenth Century.

Ironically, the first solid confirmation was work by Mendel, a Roman Catholic cleric whose inspired insights almost certainly didn’t extend to rejection of an omnipotent Creator. Mendel and Darwin probably didn't read each others' work, and Mendel would certainly have disagreed vigorously if they had. The first decisive confirmation that an evolutionary process had been operating for billions of years was disclosure of the molecular structure of DNA (1953). The fall-out from that discovery has already been enormous and is just beginning.

Even given the relatively brief interval since Evolution was first proposed as a hypothesis, the rich context it has established within Biology renders the percentage of modern skeptics and naysayers surprising. Beyond that, the degree of denial our species is obviously so capable of is disquieting: that we are clever enough to create technology that poses serious dangers to the planetary environment while blindly pursuing it to excess is now painfully evident; but still not widely acknowledged.

The term “culture” almost certainly predated “evolution,” but once the former acquired its specific biological connotation, both terms have acquired new meanings. We can now think of culture as evolving, a concept that modifies the idea of "history." Further, if “evolution” is “true,” (an accurate theory) that circumstance necessarily casts great doubt on the concept that had dominated Cosmology (then known as Metaphysics) towards the end of the Eighteenth Century about the time the US Constitution was being debated in Philadelphia (en era still known as the Enlightenment to Philosophers and Historians). Before this short essay becomes too complicated, I just want to point out that we live in a changing world; one in which the rate of change has itself been accelerated, and that it would be unreasonable to expect that the underlying phenomena could not be having important, but so far unrecognized consequences. In other words, our IT capabilities are not necessarily a guarantee we won’t be blindsided by some new reality the same way mid-18th Century Victorians were by the most obvious implications of evolutionary theory.

The Universe may not have been planned and created by an omniscient god after all. Indeed, what we have been able to learn about what we now call the Cosmos is that it’s more likely a random, self-adjusting system infinitely older and bigger than we are yet able to measure. While our species certainly seems unique and has unquestionably had an important impact on events on our planet and within our solar system, we are comparatively insignificant on a cosmic scale.

At the same time, we can also recognize that other factors related to human thinking and behavior have been evolving in dangerous directions: there are more humans now alive than ever, and our accelerating acquisition of knowledge has unquestionably made us uniquely dangerous to both ourselves and other life forms. For one thing, we recently learned that Yellowstone National Park, in addition to being a "national treasure," represents an existential threat to all humans for reasons we are, thus far, unable to “control.”

Speaking of “control,” our species seems to have succumbed to that comforting euphemism as it has been applied to the lunatic American policy known as the “War” on Drugs. The idea that handing designated criminals a monopoly on the production of a commodity many people are willing to pay high prices for and risk arrest to possess deserves more than a quick stamp stamp of approval by politicians, academics and others who aspire to be taken seriously as policy mavens. Just what is it about Al Capone, Chicago, and bathtub gin that those smug idiots don’t understand?

On the other hand, a species so incapable of learning from its past mistakes may just have to reinvent itself. Unfortunately, and thanks largely to Harry Anslinger, John Mitchell, and Richard Nixon, hominids may have to start over from the cognitive level reached by Miocene Apes about nine million years ago. Even then, there’s no guarantee the conditions that ultimately produced Homo sapiens could be replicated.

It would be far better to learn from our mistakes before it’s too late.

Doctor Tom

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