September 1, 2004 - Alternatives (Eugene, OR) Political Insanity About Marijuana And Drug Use By Robert Volkman, MD, a doctor in private practice in Salem, Oregon

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Our national policy on drug use in general, and on marijuana use specifically, is simply insane.

This is an inescapable conclusion drawn from my nearly 20 years as a practicing physician, and from years as a citizen of my nation observing these policies in action.

Every day I see people who either struggle with or are resigned to cigarette and/or alcohol addiction, all of this being legal and socially "normal". Others of my patients use drugs of the illegal variety, including marijuana, heroin and, especially these days, methamphetamine.

As a practicing physician dealing with substance use/abuse, I focus most of my efforts on smoking cessation.

Alcoholism is also serious, but the more severe forms of alcoholism are much less common than smoking, which is dangerous even at minimal use. I have only disgust for methamphetamine, telling my patients who use it that I liken it to crank case oil. Cocaine use/abuse tends to be more an issue with a wealthier class of people than I normally see in my clientele.

With heroin patients I have observed firsthand how very addictive it is, and the limited effectiveness of current treatment options available under existing methadone maintenance programs.

Regarding heroin, it is interesting to note that there are programs in Switzerland and The Netherlands (of all places!) where heroin has been partially legalized, with notable success.

Under the drug policies of these nations, addicts, with access to clean needles and uncontaminated sources of the heroin, are able to lead normal lives with their families, hold down regular jobs and live without the physical complications generally associated with the drug. It is a cruel paradox that heroin in these countries is a far safer drug than either alcohol or cigarettes. Heroin is certainly much safer medically than other "hard drugs" like cocaine and methamphetamine, because these, like cigarettes, are not medically safe at any level of use.

But here is the interesting part in all this discussion. I have virtually no concern about marijuana use except for the rare individual who smokes it all of the time. (A pot-head is very much like a binge drinker, and there is always a problem with bingeing, quite apart from the substance being binged on.) I usually tell my pot-smoking patients to work to change the law that criminalizes its use. When people ask me about marijuana being a "gateway drug," I need to remind them that, on the contrary, it is cigarettes and alcohol that are the true gateway drugs, as they are far more addictive in their nature than marijuana is, and they are inevitably the first drugs used by young people, largely because they are legal and more commonly accessible than any other.

Additionally, the addictive tendencies are qualitatively different. For instance, I have yet to encounter a marijuana withdrawal syndrome and I seriously doubt that it even exists in any important way; certainly not like what I have had to deal with medically in the cases of the hard drugs -- methamphetamine, heroin, etc. Tobacco, interestingly, has withdrawal features quite similar to these hard drugs.

Leveling the Playing Field

Let's begin with the rational, non-controversial baseline assumption that a drug is a drug, whether legal or not. Tobacco, alcohol, marijuana, heroin, and methamphetamine -- all are drugs with psychological and physiological effects in the body. From this baseline, we can compare effects and come to conclusions. If you ask "why is the criminalization of marijuana so crazy?," one way to answer that question is to note that there are NO REPORTED DEATHS from marijuana use, ever. Compare this statistic to the other drugs on the list -- tobacco, alcohol, heroin, meth and the rest.

Death from drug use, whether cumulative over time or catastrophic overdose, is ugly. I have personally seen patients of mine dying from cigarettes since the time I was a medical student.

Some 440,000 die every year from cigarette use in this country alone, with an estimated 10,000,000 expected to die annually by the year 2030 (according to The Lancet in its recent July 13th issue). Add to this the health care costs of smokers, which run into the billions of dollars, and the health consequences from tobacco's non-lethal effects that hurt uncounted others, including millions of non-smokers as a result of second-hand smoke.

Yet, with all of this death and suffering, cigarettes are not only legal but the farming of tobacco has been subsidized by our government's farm policy for decades.

All deaths combined from heroin, cocaine and methamphetamine are a small fraction of those caused by cigarettes, but each one is tragic and avoidable.

With alcohol it's the same old story, though the numbers aren't so high as with tobacco.

Tens of thousands die every year from the cumulative effects of alcohol consumption, with thousands more dead from vehicle and work accidents related to addictive consumption of alcohol.

In addition, alcohol abuse is incredibly destructive to marriages and families.

I have seen alcohol kill in my immediate family, and destroy the lives of friends close to me. In the VA hospitals I trained in, the wards were crowded with those suffering from the medical complications of alcohol.

It is a troubling fact that, when we consider these substances and their effects on society in an evenhanded way, we see that the most dangerous among them are also the most legal.

Crime and Punishment?

Given the known dangers to real people and the costs to society, does it follow that we should criminalize the use of tobacco and alcohol, as we do the other drugs?

Hell no!! The "moral crusade" of alcohol prohibition during the 1920's & 30's proved the folly of that course of action and was rightfully repealed -- but not before crime syndicates like the Mafia had reaped enormous profits gained when alcohol was pushed underground. Prohibition does not work, plain and simple.

It didn't work for alcohol in the 1920's & 30's, and it doesn't work for drugs today.

It is the wrong way to deal with problems of personal choice and substance use/abuse.

Nobody disputes that these substances, legal and illegal, can be quite addictive and dangerous.

When considering the social costs (pain & suffering, ruined lives, neighborhood crime, billions of dollars spent making & distributing product or trying to dissuade use, police work, judicial & prison institutions, etc.) the distinction between legal and illegal may seem irrelevant, because all of these substances have a similar set of consequences. But the distinction is not irrelevant. Strange as it may seem, the illegality itself becomes one of the hardest things to deal with when it comes to "hard" drugs.

As stated earlier, I work very hard to help people stop smoking and abstain from excessive alcohol use, and I also work with people to stop using illegal drugs -- meth, heroin and cocaine.

I can say from experience that all of these efforts to promote health are impeded when the patient's drug of choice is classified as illegal.

It would be a nightmare to confront and deal with alcohol and smoking addiction if these two substances were illegal -- look how hard it is to deal with them as they are! With the illegal drugs, this nightmare is part of my day job as a physician dealing with public health issues.

And then there is marijuana.

Marijuana is illegal, with billions being spent as part of a "War On Drugs" against its use. For 70 years, the propaganda about its effects has been unsupported by the science and, indeed, has been the worst kind of hubris.

I have yet to see a family destroyed by use of marijuana, though I have seen great harm done to many people when legal actions have been taken against those who use it. There is virtually no medical basis for even scolding people about its use, except when they are bingeing on it, as described earlier.

I even occasionally recommend the use of marijuana, for its palliative effects on chronic disabling pain, muscle spasms of Multiple Sclerosis, nausea prevention, and such.

Marijuana, when used correctly, is highly effective for such palliative applications, but there is every indication that it has an even more profound future in medicine.

It is recently reported that endogenous cannabis-like compounds, "endocannabinoids," have been found in the human central nervous system (July 24th publication of The Lancet, page 315). These are similar in nature to the naturally occurring opiate-like compounds known as "endorphins" that have receptor sites in the human brain.

The development of a whole range of medicines came out of that earlier discovery, including drugs used routinely for pain mitigation by doctors throughout the world.

Now we know that marijuana mimics an endogenous neurotransmitter in our brains, which is a fancy way of saying that we can now pursue research that will inevitably open up a whole new field in medical knowledge and therapeutics. It certainly lends credence to the use of marijuana medicinally. In short, marijuana as medicine is real and not some fictitious rationalization for irresponsible drug use, as the federal government currently asserts.

Public Policy Criminalization and prohibition have obviously not worked.

As with the earlier prohibition of alcohol, our criminalizing of any of these drugs has been ineffective at best and, at worst, a mistake that has exacted a terrible cost to society for nearly a century, causing untold, unnecessary human suffering.

These are failed policies.

As legal scholars would affirm, the propagation and prolongation of failed, unenforceable laws has the detrimental effect of destroying respect for the law in general.

In a nation where we operate under the Rule of Law, this degrading effect is very significant, undermining the very foundations of this Republic.

The economic consequences of criminalizing these drugs is mind-boggling. Just try to wrap your mind around an insane distortion such as the street value of an ounce of marijuana exceeding the street value of a comparable weight in gold -- and this for a plant that can be grown anywhere for next to nothing by just about anybody.

Now that is a market incentive that any capitalist can understand! Many will risk the legal consequences for the financial rewards, and there are millions more who will figure out how to afford what they want to buy, even at prices that exceed gold itself. Property crime as a direct result of criminalization racks up extraordinary costs to business and private citizens (it is estimated that up to 80% of property crime is drug related, all brought on by our policy of criminalizing drug use). Add to this the diversion of law enforcement resources away from more important issues and the costs associated with clogging our court system with victimless crimes, and the insanity grows. Mirroring the good old days of Prohibition with Al Capone and his merry band of gangsters, whole new criminal organizations have formed and are being financed by the vast byzantine underground economy of the drug world.

But now, in this age of globalization, the problems caused by criminalization and prohibition know no boundaries, including national ones. These criminal organizations and the street gangs associated with them are a scourge to any society in which they work their dark deeds.

They could be put out of business in a heartbeat if we would repeal the crazy laws that keep them in business.

Let's face it; we are an addictive culture, as witnessed by our addictions to TV (see "Television Addiction" in the February, 2004 issue of Scientific American, page 74-80), computer gaming, sex, wealth acquisition, gambling, food and even sugar (try stopping sometime!).

The criminalization of drugs, especially that of marijuana, is bad medicine, bad law, bad business, and is moral hypocrisy at its worse.

This has to stop. How long will we fail to recognize and correct this mistake that is hurting so many people at such great expense?

As a nation, we can live and act with much more intelligence than this. It is time to act to change these very destructive laws, changes already being pioneered in Europe. It is time for those in the medical profession and in positions of authority to speak up on this matter.

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