Tidbits on Drug Policy

Another two cents thrown in

What are our laws based on?

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In a wonderfully informative primer, Why is Marijuana Illegal? A brief history of the criminalization of cannabis, Pete Guither writes:

Many people assume that marijuana was made illegal through some kind of process involving scientific, medical, and government hearings; that it was to protect the citizens from what was determined to be a dangerous drug.

The actual story shows a much different picture. Those who voted on the legal fate of this plant never had the facts, but were dependent on information supplied by those who had a specific agenda to deceive lawmakers.

Pete has touched upon a very important issue: way too often, our legislatures pass laws that are based on faulty data. The Drug War is just the most glaring manifestation of this phenomenon. Our elected representatives have no clue about many of the issues that they are called upon to regulate. As the result, we get a bunch of nonsensical laws – laws that we have to abide by, laws that govern our daily lives, laws that can send a person to prison for many years for doing something that likely doesn’t cause any major harm to himself or the society anyway.

Laws can be overturned if they are deemed unconstitutional; however, the Supreme Court exercises extreme deference to legislative opinion in most challenges. And, there is really no effective mechanism that would prevent legislatures from legislating on the basis of misinformation, hysteria or political agenda. As a result we are stuck with a plethora of laws and regulations that do more harm than good, and – most of these laws will be with us for a long, long time, simply because there is no mechanism that would evaluate them on the basis of effectiveness.

Well, you might ask, but what about the political leverage? If the society doesn’t like some law, its elected representatives will be forced to repeal or amend it, simply because they would like to get reelected. Ideally – yes, that’s how it should work. However, too often, the people simply don’t care or are just as misinformed about the issue as their legislators. The Drug War amply demonstrates that the society may welcome the most egregious and punitive laws even when credible information is available that proves that these laws do more harm than good.

The mere list of ideas on how to insure that we are governed by laws enacted on the basis of the most accurate information available can balloon this post to a barely readable length. I will try to outline a few of them in later posts and I encourage you to also think about how our system may be improved. Think about this: if Congress enacted laws based on the best available information the whole Drug War quagmire might have been avoided.

Refusing to See the Obvious: More on Medicinal Marijuana

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Two weeks after I wrote about studies demonstrating marijuana’s potential in treating cancer, the following article pops up on FoxNews.com:

A compound found in cannabis may stop breast cancer from spreading throughout the body, according to a new study by scientists at California Pacific Medical Center Research Institute. The researchers are hopeful that the compound called CBD, which is found in cannabis sativa, could be a non-toxic alternative to chemotherapy.

Source: Marijuana Compound May Stop Breast Cancer From Spreading, Study Says

Let me remind you, that marijuana remains a CSA Schedule I drug, which means, according to the Act that:

The drug or other substance has no currently accepted medical use in treatment in the United States. (Italics added)

That’s despite dozens of studies like the one above and that almost half of the nation’s oncologists recommend their patients obtain marijuana, despite its illegality, in order to alleviate their suffering. I mean, if that’s not currently accepted medical use, I don’t know what is. (By the way, speaking from a purely legal standpoint, this practice of recommending marijuana would fall under the Respectable Minority doctrine used in some states to refute malpractice claims! Or, if put otherwise, this would constitute a legitimate medical practice.) And yet – drug warriors continue to avoid finding medical utility of marijuana, despite pretty much overwhelming evidence to the contrary. One example of how they manage to do so comes from a decision in United States v. Oakland Cannabis Buyers Coop. (2001), where Justice Thomas writes:

In the case of the Controlled Substances Act, the statute reflects a determination that marijuana has no medical benefits worthy of an exception (outside the confines of a Government-approved research project). Whereas some other drugs can be dispensed and prescribed for medical use, […] the same is not true for marijuana. Indeed, for purposes of the Controlled Substances Act, marijuana has “no currently accepted medical use” at all. (Italics added)

Imagine Congress passing legislation that puts aspirin into Schedule I. Now, if this classification is challenged in the Supreme Court, the Court may do the sensible thing, analyze the evidence and address the issue on its merits – namely, should aspirin really remain in Schedule I – or, it could duck the issue by saying that “for purposes of the CSA, aspirin has no currently accepted medical use.”

So, what Justice Thomas was basically saying in that opinion is that “marijuana has no accepted medical use because the legislature says it has no accepted medical use.” He may have been staying within the currently accepted boundaries of judicial review; however, Thomas’ formalism steers far from common sense. No sane person would in all earnest claim that the Earth is flat simply because the legislature made such a determination.

On the changing nature of drug policy discourse

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“America needs to reconsider its punitive approach to “the so-called war on drugs,” presidential candidate John Edwards said here today.”

Source: DesMoinesRegister.com: Edwards: War on drugs too punitive

Something like this coming from a (somewhat) viable presidential candidate twenty years ago would be sufficient to bury his chances of being elected. It seems that we’ve come a long way since the “Casual drug users should be taken out and shot. Smoke a joint, lose your life.” pronouncement by the former Los Angeles Police Chief and the founder of the D.A.R.E. program Daryl Gates on September 5, 1990. Thankfully, today we don’t hear diatribes like this too often.

I hope that the changing nature of drug policy discourse is reflective of the changing social attitudes towards the punitive approach to the drug issues. Even, such admittedly obscurantist entity as the federal Office of National Drug Control Policy lists the “balanced drug control policy” as its main national priority – instead of stressing slash-and-burn tactics in the War on Drugs that it has continued to promote. It is good to see the menacing approach a la William Bennet or Daryl Gates go out of fashion – at least as far as the drug policy debate is concerned, albeit is still hasn’t translated into real action.

I wonder whether we are going to reach a tipping point where all these shy harbingers of common sense would saturate into a mass breaking of the flood gates that would allow the common sense voices to permeate drug policy discourse and, finally, result in real change.

Originally written on November 23, 2007

Marijuana useful in treating cancer?

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Jack Herer, the author of The Emperor Wears No Clothes writes:

In 1974, Virginia Medical College in Richmond, Virginia did research on tumors of the lung, brain, liver and kidney using mice and rats. Incredible things were done. The cancer stopped growing and in most cases even reversed itself 100 percent. Some of the mice who were given cancer and treated with cannabis actually lived longer than some of the controlmice who were not even given cancer! It was found that marijuana is the best thing to treat cancer of the lungs, brain, etc. After that they were stopped from doing anymore research at all by first Nixon and then Ford.

Source: Jack Herer’s Home Page

Well, I was sort of skeptical – but then, I found the link to the Virginia the study that he mentions. The synopsis indeed shows that

Lewis lung adenocarcinoma growth was retarded by the oral administration of delta9-tetrahydrocannabinol (delta9-THC), delta8-tetrahydrocannabinol (delta8-THC), and cannabinol (CBN), but not cannabidiol (CBD).

Upon a further search, a study done in Spain in 2000 turned up:

Here, we show that intratumoral administration of Delta9-tetrahydrocannabinol and the synthetic cannabinoid agonist WIN-55,212-2 induced a considerable regression of malignant gliomas in Wistar rats and in mice deficient in recombination activating gene 2. Cannabinoid treatment did not produce any substantial neurotoxic effect in the conditions used.

Finally, the pilot study involving nine patients suffering from glioblastoma – a type of brain cancer, concluded that

Delta(9)-Tetrahydrocannabinol inhibited tumour-cell proliferation in vitro and decreased tumour-cell Ki67 immunostaining when administered to two patients. The fair safety profile of THC, together with its possible antiproliferative action on tumour cells reported here and in other studies, may set the basis for future trials aimed at evaluating the potential antitumoral activity of cannabinoids.

Basically, that’s strong evidence that THC may indeed be effective in treating certain types of cancers. Something like that – I would think – would get plenty of media attention; however there wasn’t much apparently, since even myself, who actively looks for these types of news, wasn’t aware of this.

Suppressing the results of the Virginia study… ignoring credible results of European studies… obstructing studies into THC’s medicinal properties… the amazing consistency of government’s resistance to acknowledging the therapeutic value of marijuana really makes me wonder: it can’t be just about the desire of the anti-drug warriors to retain the lion’s share of their budget. There has to be some compelling reason behind this: a reason so sinister, that the government doesn’t want to disclose it out of concern for our feeble minds… But – I don’t usually subscribe to conspiracy theories – the ugly and banal truth is likely that it is all about the money. Apparently, the well-financed moral posturing is more important than a chance to save lives and alleviate suffering of thousands of people.

Taking Morality out of Drug Use

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Just got back from a month-long stint in Eastern and Western Europe(s). Of course, because of my interest in the field, I took some time to study the drug policy on the ground – talked with some people from both sides of the barricades and read some studies.

Of course, one cannot bundle together the drug policy approach of Eastern European countries such as Russia, Ukraine or Georgia and say, Netherlands. The law enforcement in Russia and Ukraine use the extremely punitive drug legislation as a tool in ensuring that they would be able to arrest anybody at any time simply by planting some “evidence” on the (un)desired person. The harm reduction approach is virtually dead. I will write a bit more about drugs and Russia/Ukraine sometime later.

Now, I mainly want to point out one thing that the drug policies of countries such as Great Britain, Italy, Spain, Portugal, Switzerland and Netherlands have in common: the absence of any moral component in decisions involving drug policy. The stress is made on harm reduction. That’s why Netherlands doesn’t persecute simple possession and its heroin addicts can safely shoot up in specially designated places (often located at or near police precincts).

If you, the reader, are from the United States, you might feel, if not indignation, but maybe, a certain discomfort, a feeling that there might be something wrong with that scenario. That’s your morality talking. We’ve been conditioned to believe that drug use is simply wrong – and, unfortunately, it largely colors the public discourse in this country concerning recreational drugs and recreational drug use. After all, when something is wrong, morally wrong, it is really beside the point whether or not it is good or bad for you. The objective reasons don’t matter.

The Dutch approach may have resulted in a marked decrease in overdoses and a general decrease in young hard drug addict population (the average age of a Dutch heroin addict has risen to 37!) – but it is morally wrong and thus, is completely unacceptable on our shores. Unfortunately, I am not being sarcastic. Until the public learns not to view drug use as one of the “vices,” we are bound to be hindered in our common sense judgments by our righteousness.

The Ethics of Heroin Maintenance

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Heroin maintenance programs have been used in some European countries (notably, Switzerland and Great Britain) with relative success for many years. The gist of these programs is providing an addict with a dose of pure heroin and a supervised setting in which to inject it. But this post is not about the relative merits or drawbacks of heroin maintenance, but rather about an ethical concern regarding heroin maintenance best expressed by Robert J. MacCoun and Peter Reuter in their wonderful RAND study, Drug War Heresies. I will quote the passage in full:

Feasibility [of heroin maintenance programs] is not desirability. Heroin maintenance has a contradiction at its heart. Having chosen to prohibit the drug, society then makes an exception for those who cause sufficient damage, to themselves and to society, as a consequence of their violation of the prohibition. Society’s decision is setting the damage level that entitles a user to access. It can require that an addict cause a lot of damage to gain access, which is expensive (in terms of crime and health risks) and inhumane. However, if it sets the barrier low, then access to heroin becomes too easy, and the basic prohibition is substantially weakened. That contradiction alone does not make maintenance bad public policy, but it does raise a fundamental ethical concern.

Obviously, this is not the only precedent when our society ultimately rewards an individual for a persistent violation of its laws. Take illegal immigration: migrants who are enterprising enough to overcome the obstacles (physical and otherwise) that the United States erects around its borders are often able to naturalize. Illegal immigration is a perfect example of an extra-legal status-quo: illegal aliens are tolerated because the U.S. is addicted to cheap labor.

Similarly, heroin maintenance programs involve a trade-off: despite general prohibition, some addicts who are “persistent in their addiction” are allowed access to heroin. In return, the society receives the aggregate benefits of lower health costs (no more diluted black-market heroin, no needle-sharing, not as much overdosing), lower crime-fighting costs (addict doesn’t have to resort to crime to finance his habit at black market prices) and a possibility of social re-integration of an addict back into the community.

But wait! Despite the benefits of the program, the ethical dilemma is still there! But only until one realizes that an exception to the rule does not always involve a compromise with ethics. This particular case involves a prohibition regime that is largely detrimental both to addicts and to the society at large. Any hole punched in this regime that moves it towards harm reduction and more sensible drug policy can be considered ethically suspect only on a purely logically-abstract level, insofar as it represents a contradiction with the existing policies.

Another, fairly straightforward way of removing the contradiction would be either shutting down heroin maintenance programs (not a correct choice, in my humble opinion) or legalizing heroin. Of course, the problem with that solution (in addition to the obvious political ones) is that nobody is really sure what’s going to happen: some say that if we legalize, we just might end up with a much greater number of addicts. It is a valid argument – there is no firm basis on which one could confidently argue that a spike in addiction won’t happen. On a theoretical level, one trick to avoiding mass heroin addiction in a legalization regime is a fine line between making access to heroin hard enough so that only the determined seekers of the drug would bother, but not making it so hard that it is easier or cheaper to obtain it in the black market. Drawing that fine line would not be easy; however, we did it with illegal immigration: the amalgam of border patrols, fences, regulations and penalties makes sure that we are not flooded with migrants; however the restrictions are not draconian enough to prevent our economy from getting its regular injection of cheap workforce.

How Does Prohibition Affect Drug Use?

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Our current Prohibition isn’t very successful at stopping drug use, for many obvious and not-so-obvious reasons. However, in order to sharpen our focus on this issue it is helpful to list the social effects that prohibitionist policies have on drug use. Here we go:

  • Deterrence or the fear of legal sanctions
    This mostly concerns expected legal risks (Example: the likelihood of the punishment for the prohibited activity in the eyes of a typical Joe Public.)

  • Informal self and social controls
    (a) Morality or legitimacy; (Example: Many people won’t try drugs if the society considers drug use to be something shameful and despicable.)
    (b) Forbidden fruit effects; (Example: Teens rebelling against the authority might be tempted to try drugs simply because the mainstream tells them not to.)
    (c) Community norms; (Example: Very religious rural communities create an environment that is less conducive to drug use than, say, a large cosmopolitan urban area.)
    (d) Informal or extra-legal social sanctions. (Example: The fear of being ostracized or being labeled a drug addict by friends and neighbors.)

While the economic laws of supply and demand make sure that the prohibitionist action-based policies are bound to fail, the prohibitionist propaganda (that was so prevalent during the Bill Bennett years) that tries to frame drug use as a social and moral taboo can be more successful. If the society believes that drug use is immoral, any rational argument for or against it becomes pretty irrelevant. Notice how in the list above, every type of social control mechanism (except the forbidden fruit effect) would work towards hampering activities associated with drug use in a drug-intolerant society.

(One of the reasons) why marijuana is still illegal

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This nation smokes far more pot than uses any other illicit drugs. For example, almost half (47.8%) of all high school seniors tried it, as compared with the next runner-up – all of hallucinogens, at 12%. Source: Monitoring the Future Study (2002). The numbers are similar for general population drug use – marijuana users represent an overwhelming share of drug users in general.

This information generally requires no specialized knowledge. Similarly, by now it has become apparent to the point of becoming common knowledge, that the dangers of marijuana smoking are seriously overstated, to say the least. Some even call marijuana “the safest therapeutic substance known to man.” Who?? None other than Administrative Judge Francis Young of the DEA in In The Matter Of MARIJUANA RESCHEDULING PETITION (Docket No. 86-22). It is very likely that even the most stalwart DEA officials don’t really believe in the dangerousness of marijuana.

So, how come it remains in Schedule I?

The answer lies in the first paragraph. Removing marijuana from the list of “evil” illicit drugs would substantially reduce this nation’s drug problem: without marijuana the number of drug users – other drug users – would drop significantly. A dramatically smaller drug problem wouldn’t justify tens of billions of dollars in funding that the DEA currently receives. Regardless of the objective pros and cons of marijuana use, the DEA will always oppose the rescheduling of marijuana simply because they want to retain their allowance.

In order to request an addition, deletion or a change in the schedule of the drug, one must petition the DEA. When a petition is received by the DEA, the agency begins its own investigation of the drug. Then, the investigation goes through some more motions, until the DEA Administrator reviews all available data and makes a final decision whether to propose that a drug be controlled and into which schedule it should be placed. I wonder how objective you would be in making a decision that has a potential to deprive you of a substantial majority of your budget?

On Legal Formalism

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Legal Formalism is a doctrine that reflects the wishful thinking of many legal theorists that judges should apply law in a sort of mathematical fashion without any regard to “real-life” normative or policy issues. (I think, in this country, Langdell was the originator of the formalistic school of thought in jurisprudence.)

Anyway. Under the doctrine, the judges should not concern themselves with whether the law is good or bad, just or biased, sound or nonsensical – all those issues are for the legislatures to decide. The idea is that a law should yield an unequivocal decision regardless of the substantive nature of the underlying fact pattern. There are many proponents of this doctrine, as well as many opponents (I, personally, happen to belong to the opposing camp) – but this post is really not about the merits of legal formalism, but rather about Supreme Court Justices hiding behind it, whenever they chicken out of truly addressing the issue before them on its merits.

For example, in Gonzales v. Raich (2005), observe Justice Stevens resorting to legal formalism in ruling upon an issue that is clearly about the right of gravely ill persons to, legally (under the state law) receive their medicinal marijuana without harassment by federal agencies:

“The case is made difficult by respondents’ strong arguments that they will suffer irreparable harm because, despite a congressional finding to the contrary, marijuana does have valid therapeutic purposes. The question before us, however, is not whether it is wise to enforce the statute in these circumstances; rather, it is whether Congress’ power to regulate interstate markets for medicinal substances encompasses the portions of those markets that are supplied with drugs produced and consumed locally. Well-settled law controls our answer. The CSA is a valid exercise of federal power, even as applied to the troubling facts of this case.”

Hey, it’s just about the blind application of the Congress’ power to regulate interstate commerce, right? As a legal formalist would put it, clearly the Controlled Substances Act legitimately has that power – and that’s all that matters – how that power is applied is beyond the scope of the judiciary. Notice how under Justice Stevens’ approach, the “case is made difficult by respondents’ strong arguments” – meaning, how strong real-life arguments of real-life respondents interfere with his structurally sound, aseptic interpretation of the issues. Well, lets consult the dissenting opinion by Justice Thomas:

“On this traditional understanding of “commerce,” the Controlled Substances Act (CSA), 21 U.S.C. ยง 801 et seq., regulates a great deal of marijuana trafficking that is interstate and commercial in character. The CSA does not, however, criminalize only the interstate buying and selling of marijuana. Instead, it bans the entire market — intrastate or interstate, noncommercial or commercial — for marijuana. Respondents are correct that the CSA exceeds Congress’ commerce power as applied to their conduct, which is purely intrastate and noncommercial.”

Hmmm… Now we have two eminent legal minds, one ruling that the CSA is within the commerce clause’ power to regulate interstate commerce; another saying that it isn’t. Under the perfect conditions envisioned by the formalistic doctrine, it isn’t supposed to happen. Seems like either the Controlled Substances Act is deficient, the Justices understanding of the formalistic approach is lacking or Legal Formalism itself is faulty. It could be all three are correct. It doesn’t really matter – after all, hiding behind a questionable doctrine to duck important issues is a dubious tactic all in itself.

The drawbacks of treatment with medicinal marijuana

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Here is an interesting argument against medicinal marijuana, mainly on the grounds that smoking a therapeutic substance isn’t a safe and uniform method of administration:

“If marijuana has therapeutic potential, it should be required to pass muster with the F.D.A. like any other medicine. We have considerable experience with making drugs from plant material, including the opium poppy. We don’t authorize patients to smoke ( or vaporize ) opium for medical purposes; rather, we require that opiate products, including morphine for pain relief and paregoric for diarrhea, be standardized, controlled for quality, fully tested, delivered in an appropriate manner and shown to be safe and effective. Why should marijuana be any different?”

Source:: NYT OPED: Crackpot Legislation

The author’s reasoning is medically sound; however, as far as I understand, the problem is that no marijuana derivative (i.e.: Marinol) in existence has been found just as effective as smoking marijuana. Smoking pot definitely has all the drawbacks that are described in Henry I. Miller’s article – but it still remains the only truly effective method of alleviating symptoms of many debilitating conditions. So far, there hasn’t been a single recorded death attributed to marijuana. Thus, it is no wonder that many patients choose an admittedly imperfect, but a relatively safe treatment over no treatment at all. Legalizing marijuana would certainly allow more research into its therapeutic effects and will allow development of medications that will better address Henry Miller’s concerns.

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