Marijuana Triple Play

Politico does a twofer and the New York Times remembers an academic titan who well chronicled drug use and ensuing government policies to thwart it–a largely unsuccessful endeavor.

With unmistakable juxtaposition, Politico’s printed tabloid available in Washington, D.C. featured two informative items married together. First, a column from constitutional scholar and salon.com contributor Glenn Greenwald underscoring the political significance, public health benefits and taxpayer savings if Prop 19 is passed by California voters in a few weeks based on his recent research paper for the Cato Institute examining the benefits of Portugal decriminalizing all drugs in 2000.

Additionally, Politico wickedly notes that 28-years-ago today President Ronald Reagan declared a ‘war on drugs’, yet these days, the current drug czar is uncomfortable employing the now broadly derided term, deeming it “counter-productive”.

RIP David Musto, MD

Today’s New York Times does justice in honoring the recent death of Dr. David Musto, a well respected professor at Yale Medical School, an author of many notable books and expert in the history of drug control policy.

Before there was an Internet…from 1991 to 1993, David and I frequently corresponded about cannabis use, policy making and law enforcement via letters and faxes. His books (notably for me, The American Disease: Origins of Narcotics Control, along with other very important scholarly works researched and penned by Drs. Lester Grinspoon, Norman Zinberg, Andrew Weil and Consumer Union’s Edward Brecher; along with the writings of law professors Charles Whitebread and Richard Bonnie) quite definitely helped form my political and sociological views about cannabis.

I note from the Times’ obituary that David passed away in China whilst visiting to deliver his academic papers to Shanghai University. I trust somewhere in what must be an immense collection of papers and correspondences will be our exchanges, and a rare conceit from David in a correspondence to me, replying to my frustration that he was not more of an advocate for reforms rather than a genuine ‘Ivy League’ academician, he noted, I recall, something like: I seem best equipped to point out the history of drug use and government’s efforts to control for such…and let the public and elected policymakers make of my work what they will…I’m not an activist or a solutions person  per se.

As noted by NYT book reviewer James Markham correctly predicted that The American Disease would “probably become mandatory reading for anyone who wants to understand how we got into this mess”.

True then. True now. You can purchase a copy @ Amazon, or you can get the flavor of David’s writing from his 1972 essay, The History of the Marihuana Act of 1937 at druglibrary.org.

Why Isn’t There More Medical Marijuana Research? Because The Feds Won’t Allow It, That’s Why!

It’s the ‘Catch-22’ that has plagued medical marijuana advocates and patients for decades. Lawmakers and health regulators demand clinical studies on the safety and efficacy of medical cannabis, but the federal agency in charge of such research bars these investigations from ever taking place.

But it took until now for the federal government to finally admit it.

A spokesperson for the U.S. National Institute on Drug Abuse (NIDA) told The New York Times last week that the agency does “not fund research focused on the potential medical benefits of marijuana.”

Why is this admission so significant? Here’s why.

Under federal law, NIDA (along with the U.S. Drug Enforcement Administration) must approve all clinical and preclinical research involving marijuana. NIDA strictly controls which investigators are allowed access to the federal government’s lone research supply of pot – which is authorized via a NIDA contract and cultivated and stored at the University of Mississippi.

In short, no NIDA approval = no marijuana = no scientific studies. And that is, and always has been, the problem.

But to the folks over at NIDA, there’s no problem at all.

Speaking to The New York Times in a January 19, 2010 article entitled, “Researchers Find Medical Study of Marijuana Discouraged,” NIDA spokeswoman Shirley Simson said: “As the National Institute on Drug Abuse, our focus is primarily on the negative consequences of marijuana use. We generally do not fund research focused on the potential beneficial medical effects of marijuana.”

Since NIDA presently oversees an estimated 85 percent of the world’s research on controlled substances, the agency’s ban on medical marijuana research isn’t just limited to the United States’ borders; it extends throughout the planet.

Previous legal attempts to break NIDA’s bureaucratic logjam have failed to weaken the agency’s iron grip.

In 2007, U.S. DEA Administrative Law Judge Mary Ellen Bittner ruled that NIDA’s monopolization of marijuana research is not “in the public interest,” and ordered the federal government to allow private manufacturers to produce the drug for research purposes. But in January of last year, DEA Deputy Administrator Michele Leonhart set aside Judge Bittner’s ruling – stating that NIDA possesses “adequate” quantities of cannabis to meet the needs of clinical investigators, and that the agency monopoly on the distribution of marijuana for research is compliant with America’s international treaty obligations. (Notably, on January 26, 2010 President Barack Obama selected Leonhart to be the DEA’s full time Director.)

Most recently, in November 2009 the American Medical Association’s (AMA) Council on Science and Public Health declared, “Results of short term controlled trials indicate that smoked cannabis reduces neuropathic pain, improves appetite and caloric intake especially in patients with reduced muscle mass, and may relieve spasticity and pain in patients with multiple sclerosis.”

However, the Council lamented that despite these encouraging preliminary results, “[T]here is a contrast between the relatively small number of patients who have been studied over the past 30 years in controlled clinical trials involving smoked cannabis and survey data from patients with chronic pain, multiple sclerosis, and amyotrophic lateral sclerosis that indicates a significant use of cannabis for self management.”

And just what is the precise reason for this “contrast?” The AMA failed to specify, but to anyone who has followed this issue, the answer is painfully obvious.

Nevertheless, the AMA still resolved, “[The] AMA urges that marijuana’s status as a federal Schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines.”

But since any future clinical trials would still require NIDA approval — approval that the agency admits won’t be coming any time soon — it remains unclear what effect, if any, the AMA’s declaration will have on facilitating medical marijuana research. If history is any guide, it’s unlikely that the AMA request — much like the cries of tens of thousands of patients before it — will have any effect on NIDA at all.

[FYI... You can also comment on this essay on Alternet.org's newly launched SpeakEasy blog here or on the Huffington Post here.]

Mainstream Media Highlights Medical Marijuana

You can’t get more mainstream in the media than The New York Times and Wall Street Journal, who both highlight the growing medical acceptance of medical cannabis and the uber-political conditions placed on medical researchers who want to conduct rigorous scientific studies on cannabis’ medical efficacy and safety.

RESEARCHERS FIND STUDY OF MEDICAL MARIJUANA DISCOURAGED
by Gardiner Harris
January 19, 2010
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Despite the Obama administration’s tacit support of more liberal state medical marijuana laws, the federal government still discourages research into the medicinal uses of smoked marijuana.  That may be one reason that — even though some patients swear by it – — there is no good scientific evidence that legalizing marijuana’s use provides any benefits over current therapies.

Lyle E.  Craker, a professor of plant sciences at the University of Massachusetts, has been trying to get permission from federal authorities for nearly nine years to grow a supply of the plant that he could study and provide to researchers for clinical trials.

But the Drug Enforcement Administration — more concerned about abuse than potential benefits — has refused, even after the agency’s own administrative law judge ruled in 2007 that Dr.  Craker’s application should be approved, and even after Attorney General Eric H.  Holder Jr.  in March ended the Bush administration’s policy of raiding dispensers of medical marijuana that comply with state laws.

“All I want to be able to do is grow it so that it can be tested,” Dr.  Craker said in comments echoed by other researchers.

Marijuana is the only major drug for which the federal government controls the only legal research supply and for which the government requires a special scientific review.

“The more it becomes clear to people that the federal government is blocking these studies, the more people are willing to defect by using politics instead of science to legalize medicinal uses at the state level,” said Rick Doblin, executive director of a nonprofit group dedicated to researching psychedelics for medical uses.

On Monday, his last full day in office, Gov.  Jon S.  Corzine of New Jersey signed a measure passed by the Legislature last week that made the state the 14th in the nation to legalize the use of marijuana to help with chronic illnesses.

The measure was pushed by a loose coalition of patients suffering from chronic illnesses like Lou Gehrig’s disease and multiple sclerosis who said marijuana eased their symptoms.

Studies have shown convincingly that marijuana can relieve nausea and improve appetite among cancer patients undergoing chemotherapy.  Studies also prove that marijuana can alleviate the aching and numbness that patients with H.I.V.  and AIDS suffer.

There are strong hints that marijuana may ameliorate some of the neurological problems associated with such degenerative diseases as multiple sclerosis, said Dr.  Igor Grant, director of the Center for Medicinal Cannabis Research at the University of California, San Diego.

But there is no good evidence that legalizing the smoking of marijuana is needed to provide these effects.  The Food and Drug Administration in 1985 approved Marinol, a prescription pill of marijuana’s active ingredient, T.H.C.  Although a few small-scale studies done decades ago suggest that smoked marijuana may prove effective when Marinol does not, no conclusive research has confirmed this finding.

And Marinol is no panacea.  There are at least three medicines that in most patients provide better relief from nausea and vomiting than Marinol, studies show.

Buddy Coolen, 31, of Warwick, R.I., said he tried or continued to use some of those medicines.  “Smoking for me is as good as any medicine I have,” he said.

Eight years ago, Mr.  Coolen contracted gastroparesis and cyclic vomiting syndrome.  He lost 50 pounds and, despite being 5 foot 11, weighed 120 pounds.

His doctors gave him myriad anti-emetics, many of which he still takes.  They also prescribed Marinol, but it did not work for him, Mr.  Coolen said.

“My stepdad is old school and was really against marijuana, but then he saw what it did for me and totally changed his way of thinking,” Mr.  Coolen said.

Some doctors and law enforcement officials say such anecdotes should not drive public policy.  Dr.  Eric Braverman, medical director of a multispecialty clinic in Manhattan, said legalizing marijuana was unnecessary and dangerous since Marinol provided the medicinal effects of the plant.  “Our society will deteriorate,” he said.

Patients who call Dr.  Braverman’s clinic are, when put on hold, told that the clinic may prescribe supplements and other alternative treatments that have even less scientific justification than marijuana.  Dr.  Braverman said such alternatives rendered marijuana unnecessary, but his embrace of alternatives is a reminder that medicine has long been driven by more than science.

About 20 percent of drug prescriptions are written for uses that are not approved by federal drug regulators; about half of the nation’s adults regularly take supplements; herbal and homeopathic remedies are popular.

The nation’s growing embrace of medical marijuana has stemmed from these alternative traditions.

The University of Mississippi has the nation’s only federally approved marijuana plantation.  If they wish to investigate marijuana, researchers must apply to the National Institute on Drug Abuse to use the Mississippi marijuana and must get approvals from a special Public Health Service panel, the Drug Enforcement Administration and the Food and Drug Administration.

But federal officials have repeatedly failed to act on marijuana research requests in a timely manner or have denied them, according to a 2007 ruling by an administrative law judge at the Drug Enforcement Administration.  While refusing to approve a second marijuana producer, the government allowed the University of Mississippi to supply Mallinckrodt, a drug maker, with enough marijuana to eventually produce a generic version of Marinol.

“As the National Institute on Drug Abuse, our focus is primarily on the negative consequences of marijuana use,” said Shirley Simson, a spokeswoman for the drug abuse institute, known as NIDA.  “We generally do not fund research focused on the potential beneficial medical effects of marijuana.”

The Drug Enforcement Administration said it was just following NIDA’s lead.  “D.E.A.  has never denied a research registration for marijuana and/or THC if NIDA approved the protocols for that individual entity,” a supervisory special agent, Gary Boggs, said by e-mail.

Researchers investigating LSD, Ecstasy and other illegal drugs can use any of a number of suppliers licensed by the Drug Enforcement Administration, Dr.  Doblin said.  And if a researcher wants to use a variety of marijuana that the University of Mississippi does not grow – — and there are many with differing medicinal properties — they are out of luck, Dr.  Doblin said.

Law enforcement tends to emphasize the abuse potential of medicines without regard to their positive effects.  Bureaucratic battles between the D.E.A.  and the F.D.A.  over the availability of narcotics – — highly effective but addictive medicines — have gone on for decades.

So medical marijuana may never have good science underlying its use.  But for patients in desperate need, the ethics of providing access to the drug are clear, said Dr.  Richard Payne, a professor of medicine and divinity and director of the Institute for Care on the End of Life at Duke Divinity School.

“It’s not a great drug,” he said, “but what’s the harm?”

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IS MARIJUANA A MEDICINE?
by Anna Wilde Mathews, (Source:Wall Street Journal)
19 Jan 2010
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United States
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Charlene DeGidio never smoked marijuana in the 1960s, or afterward.  But a year ago, after medications failed to relieve the pain in her legs and feet, a doctor suggested that the Adna, Wash., retiree try the drug.

Ms.  DeGidio, 69 years old, bought candy with marijuana mixed in.  It worked in easing her neuropathic pain, for which doctors haven’t been able to pinpoint a cause, she says.  Now, Ms.  DeGidio, who had previously tried without success other drugs including Neurontin and lidocaine patches, nibbles marijuana-laced peppermint bars before sleep, and keeps a bag in her refrigerator that she’s warned her grandchildren to avoid.

“It’s not like you’re out smoking pot for enjoyment or to get high,” says the former social worker, who won’t take the drug during the day because she doesn’t want to feel disoriented.  “It’s a medicine.”

For many patients like Ms.  DeGidio, it’s getting easier to access marijuana for medical use.  The U.S.  Department of Justice has said it will not generally prosecute ill people under doctors’ care whose use of the drug complies with state rules.  New Jersey will become the 14th state to allow therapeutic use of marijuana, and the number is likely to grow.  Illinois and New York, among others, are considering new laws.

As the legal landscape for patients clears somewhat, the medical one remains confusing, largely because of limited scientific studies.  A recent American Medical Association review found fewer than 20 randomized, controlled clinical trials of smoked marijuana for all possible uses.  These involved around 300 people in all–well short of the evidence typically required for a pharmaceutical to be marketed in the U.S.

Doctors say the studies that have been done suggest marijuana can benefit patients in the areas of managing neuropathic pain, which is caused by certain types of nerve injury, and in bolstering appetite and treating nausea, for instance in cancer patients undergoing chemotherapy.  “The evidence is mounting” for those uses, says Igor Grant, director of the Center for Medicinal Cannabis Research at the University of California, San Diego.

But in a range of other conditions for which marijuana has been considered, such as epilepsy and immune diseases like lupus, there’s scant and inconclusive research to show the drug’s effectiveness.  Marijuana also has been tied to side effects including a racing heart and short-term memory loss and, in at least a few cases, anxiety and psychotic experiences such as hallucinations.  The Food and Drug Administration doesn’t regulate marijuana, so the quality and potency of the product available in medical-marijuana dispensaries can vary.

Though states have been legalizing medical use of marijuana since 1996, when California passed a ballot initiative, the idea remains controversial.  Opponents say such laws can open a door to wider cultivation and use of the drug by people without serious medical conditions.  That concern is heightened, they say, when broadly written statutes, such as California’s, allow wide leeway for doctors to decide when to write marijuana recommendations.

But advocates of medical-marijuana laws say certain seriously ill patients can benefit from the drug and should be able to access it with a doctor’s permission.  They argue that some patients may get better results from marijuana than from available prescription drugs.

Glenn Osaki, 51, a technology consultant from Pleasanton, Calif., says he smokes marijuana to counter nausea and pain.  Diagnosed in 2005 with advanced colon cancer, he has had his entire colon removed, creating digestive problems, and suffers neuropathic pain in his hands and feet from a chemotherapy drug.  He says smoking marijuana was more effective and faster than prescription drugs he tried, including one that is a synthetic version of marijuana’s most active ingredient, known as THC.

The relatively limited research supporting medical marijuana poses practical challenges for doctors and patients who want to consider it as a therapeutic option.  It’s often unclear when, or whether, it might work better than traditional drugs for particular people.  Unlike prescription drugs it comes with no established dosing regimen.

“I don’t know what to recommend to patients about what to use, how much to use, where to get it,” says Scott Fishman, chief of pain medicine at the University of California, Davis medical school, who says he rarely writes marijuana recommendations, typically only at a patient’s request.

Researchers say it’s difficult to get funding and federal approval for marijuana research.  In November, the AMA urged the federal government to review marijuana’s position in the most-restricted category of drugs, so it could be studied more easily.

Gregory T.  Carter, a University of Washington professor of rehabilitation medicine, says he’s developed his own procedures for recommending marijuana, which he does for some patients with serious neuromuscular conditions such as amyotrophic lateral sclerosis, or Lou Gehrig’s disease, to treat pain and other symptoms.  He typically urges those who haven’t tried it before to start with a few puffs using a vaporizer, which heats the marijuana to release its active chemicals, then wait 10 minutes.  He warns them to have family nearby and to avoid driving, and he checks back with them after a few days.  Many are “surprised at how mild” the drug’s psychotropic effects are, he says.

States’ rules on growing and dispensing medical marijuana vary.  Some states license specialized dispensaries.  These can range from small storefronts to bigger operations that feel more like pharmacies.  Typically, they have security procedures to limit walk-in visitors.

At least a few dispensaries say they inspect their suppliers and use labs to check the potency of their product, though states don’t generally require such measures.  “It’s difficult to understand how we can call it medicine if we don’t know what’s in it,” says Stephen DeAngelo, executive director of the Harborside Health Center, a medical-marijuana dispensary in Oakland, Calif.

Some of the strongest research results support the idea of using marijuana to relieve neuropathic pain.  For example, a trial of 50 AIDS patients published in the journal Neurology in 2007 found that 52% of those who smoked marijuana reported a 30% or greater reduction in pain.  Just 24% of those who got placebo cigarettes reported the same lessening of pain.

Marijuana has also been shown to affect nausea and appetite.  The AMA review said three controlled studies with 43 total participants showed a “modest” anti-nausea effect of smoked marijuana in cancer patients undergoing chemotherapy.  Studies of HIV-positive patients have suggested that smoked marijuana can improve appetite and trigger weight gain.

Donald Abrams, a doctor and professor at the University of California, San Francisco who has studied marijuana, says he recommends it to some cancer patients, including those who haven’t found standard anti-nausea drugs effective and some with loss of appetite.

Side effects can be a problem for some people.  Thea Sagen, 62, an advanced neuroendocrine cancer patient in Seaside, Calif., says she expected something like a pharmacy when she went to a marijuana dispensary mentioned by her oncologist.  She says she was disappointed to find that the staffers couldn’t say which of the products, with names like Pot ‘o Gold and Blockbuster, might boost her flagging appetite or soothe her anxiety.  “They said, ‘it’s trial and error,’ “she says.  “I was in there flying blind, looking at all this stuff.”

Ms.  Sagen says she bought several items and tried one-eighth teaspoon of marijuana-infused honey.  After a few hours, she was hallucinating , too dizzy and confused to dress herself for a doctor’s appointment.  Then came vomiting far worse than her stomach upset before she took the drug.  When she reported the side effects to her oncologist’s nurse and her primary-care physician, she got no guidance.  She doesn’t take the drug now.  But with advice from a nutritionist, her appetite and food intake have improved, she says.

Other marijuana users may experience the well-known reduction in ability to concentrate.  At least a few users suffer troubling short-term psychiatric side effects, which can include anxiety and panic.  More controversially, an analysis published in the journal Lancet in 2007 tied marijuana use to a higher rate of psychotic conditions such as schizophrenia.  But the analysis noted that such a link doesn’t necessarily show marijuana is a cause of the conditions.

Long-term marijuana use can lead to physical dependence, though it is not as addictive as nicotine or alcohol, says Margaret Haney, a professor at Columbia University’s medical school.  Smoked marijuana may also risk lung irritation, but a large 2006 study, published in Cancer Epidemiology, Biomarkers & Prevention, found no tie to lung cancer.

New York Times: Mexico “Legalizes” Drug Possession — Well, Not Exactly

According to today’s New York Times the Mexican government has “legalized” drug possession. Really? Perhaps someone at the NYT ought to inform Mexican President Felipe Calderon.

First of all, let’s explore the various connotations evoked by the word “legal.” After all, without proper context this term can mean many different things to many different people.

Oranges are legal. So are alcohol and tobacco. Aspirin is legal, as are thousands of prescription medications — including highly dangerous drugs like oxycodone. Yet while all of these products are ‘legal’ — in the sense that they may be lawfully produced and purchased by certain consumers — their distribution and possession are governed by vastly different regulatory controls.

Oranges, for instance, are widely available to all consumers, regardless of age. People can even grow their own, if they so desire. Aspirin is also readily available to the general public as an ‘over-the-counter’ medication, whereas prescription drugs may only be purchased at a state-governed pharmacy by those who possess written authorization from a licensed physician.

The sale and possession of alcohol and tobacco are also legal, yet both substances are heavily taxed and tightly controlled. State-imposed age restrictions place limits on who can legally purchase and use both products, and federal laws also specify how and where these products may be advertised. Federal, state, and county laws also impose strict controls regarding where these products can be legally purchased. Adults may legally produce certain types of alcohol, like beer and wine, privately in their home — if their production is intended for their own personal consumption and not for sale to the public. By contrast, federal and state laws tightly regulate the commercial production of any type of alcohol.

So then, when the NYT‘s headline asserts that drug possession in Mexico is “legal,” do they mean that marijuana is now legal like oranges are legal? Or like alcohol? Or like prescription drugs?

Unfortunately, the answer is ‘none of the above.’ In fact, no definition of ‘legal’ that I’m aware of resembles Mexico’s new drug possession scheme. The Associated Press explains:

The new law [Editor's note: NORML initially reported on Mexico's impending legal change this past May.] sets out maximum “personal use” amounts for drugs, also including LSD and methamphetamine. People detained with those quantities no longer face criminal prosecution.

… The maximum amount of marijuana for “personal use” under the new law is 5 grams — the equivalent of about four joints. The limit is a half gram for cocaine, the equivalent of about 4 “lines.” For other drugs, the limits are 50 milligrams of heroin, 40 milligrams for methamphetamine and 0.015 milligrams for LSD.

Anyone caught with drug amounts under the new personal-use limit will be encouraged to seek treatment, and for those caught a third time treatment is mandatory.

… “This is not legalization, this is regulating the issue and giving citizens greater legal certainty,” said Bernardo Espino del Castillo of the attorney general’s office.

So let’s review, shall we? Under Mexico’s new law:

* The private production of cannabis will remain a criminal offense;

* The commercial production of cannabis will remain criminal offense (and this production will continue to be monopolized by criminal enterprises/drug cartels);

* The commercial distribution of cannabis to consumers will remain a criminal offense (and this distribution will continue to be monopolized by criminal enterprises/drug cartels);

* The private possession of cannabis in quantities greater than “four joints” will remain a criminal offense;

* The private possession of cannabis in quantities under “four joints” will no longer be a criminal offense, but the marijuana will continue to be classified as contraband (and therefore seized by police), and the user will be strongly urged to seek drug treatment (or coerced to do so if it is one’s third ‘offense.’)

Does any of this sound like “legalization” (or even “regulation,” to quote the Mexican attorney general’s office) to you? I didn’t think so. A small step in the right direction, perhaps — but legalization? Not a chance — no matter how you define it!

New York Times’ Blog: If Marijuana Is Legal, Will Addiction Rise?

[Editor's Note: This interesting and informative exchange of ideas, provided by experts on cannabis regarding the future of America's cannabis policy, was originally published July 19 on the 'Open for Debate' blog found at the New York Times' webpage.]

If Marijuana Is Legal, Will Addiction Rise?

By The Editors
July 19, 2009, 7:00 pm

A New York Times article on Sunday discussed the debate over whether more and more potent types of cannabis affect the levels of addiction to the drug. This particular issue has become part of the larger debate over whether marijuana should be legalized or decriminalized.

Antidrug activists say that if the drug is legalized, more people will use it and addiction levels, made worse by the increased potency, will rise too. Legalization advocates note that pot addiction is not nearly as destructive as, say, abuse of alcohol. What would be the effect of legalization or decriminalization on marijuana abuse and addiction?

*Roger Roffman, professor of social work

*Wayne Hall, professor of public health policy

*Mark A.R. Kleiman, professor of public policy and author

*Peter Reuter, University of Maryland professor

*Norm Stamper, former Seattle police chief (more…)