Friday, May 09, 2008

Medical Marijuana in California -- Questions

I am intellectually satisfied that marijuana has a wide range of medical values. I have been reading medical reports since 1976 when I met Robert Randall. I worked for a Congressman who co-sponsored medical marijuana legislation over 25 years ago. I followed the DEA administrative law judge's hearings in the 1980s, and read his findings of fact in 1988. In 1999 I read the report of the Institute of Medicine.

Therefore I believe marijuana should be available to patients who need it. So how do I understand what is happening in California?

Today, Joel Stein writes in the LA Times about his experience getting a physician's medical recommendation and buying marijuana at a dispensary. He implies that his medical complaint is , if not bogus, a commonplace complaint that few would consider a serious medical condition.

Bottom line, he satisfied the letter of California law to obtain marijuana which he is now essentially free to use socially, which seems contrary to the spirit of the law. He concludes,

I always wondered what would happen if marijuana were legalized for anyone over 18. It seems it already has been, and nothing happened.
I presume that doctors generally examine and treat their patients in good faith. I recognize that there are some doctors who are lazy, incompetent, dishonest or greedy, or all of the above. Is the California situation simply one that has created an opportunity for a class of unambitious physician to prosper?

Being in Washington, D.C., I think about all this playing out on the international stage. Yesterday I met with 7 top officials of Afghanistan's counter-narcotics police for a private conversation about drug policy, especially in Afghanistan. Of course, as guests of the United States I knew they had previously met with ONDCP.

In February, the White House issued the National Drug Control Strategy 2008 Annual Report . Brushing up on the government line, I saw that Afghanistan which supplies more than 90% of the heroin to Europe merits a page, and a map, on the next to last page of the report.

Thumbing through the report yesterday before my meeting, I came across the expose, "The Medical Marijuana Movement: Manipulation, Not Medicine." This White House gives medical marijuana in California priority coverage over the number one global source of heroin -- a country in which we are in a real war against the forces that attacked the Pentagon and destroyed the World Trade Center in New York; an enemy financed by the sale of ...that heroin.

Thinking about Joel Stein's column, today I went back to ONDCP expose. The White House reports on page 19 that "an analysis" of the patient records seized at "several dispensaries in San Diego" showed that half the customers were between the ages of 17 and 30. Only 2.05 percent of customers had recommendations for medical conditions such as glaucoma or cancer.

Given Joel Stein's report and others, this is not shocking.

But as one who believed that legal medical marijuana laws would primarily benefit and be taken advantage of by seriously ill people, I am confused and upset.

On one hand, I don't like scams and pretense. and the way this law is being "followed" looks like a scam. The scams of drug prohibition are a feature of our current drug policy that I abhor, so it troubles me that a reform I have worked for seems to have evolved into a scam.

To digress briefly, the economic premise of drug prohibition is a scam (as it drives up the price, it increases profits and attracts more suppliers). The moral basis of drug prohibition is a scam (there is no moral authority for the state to punish drug users for the act of using a drug because drug use is not wrongful -- by itself it does not hurt another nor negate a duty such as paying taxes). The scientific basis of drug prohibition is a scam (the harms from drug use are exaggerated, are not greater than numerous legal activities, and do not justify a prohibition on use). The fundamental tool of drug enforcement is a scam (create a false persona and earn the trust of someone in order to betray them by getting them to provide you with drugs that you have no interest in using for the purposes you claimed, use them only as evidence to send them to jail).

Because I see drug prohibition as a cruel scam, I think that it ought to be legal to buy and use drugs. But recognizing that drug use is risky behavior -- like skiing, mountaineering, white water rafting, sky diving, etc. -- a wide variety of harm reduction practices (which include legal controls) are appropriate. So, on one level I should be pleased with the situation that Joel Stein's observed,
I always wondered what would happen if marijuana were legalized for anyone over 18. It seems it already has been, and nothing happened.
But The White House Drug Strategy 2008 Annual Report says on p. 18 that, typical of the California medical marijuana situation, the San Diego police have
"received numerous citizen complaints regarding every dispensary operating in San Diego County. Typical complaints include:
* High levels of traffic to and from the dispensaries.
* People loitering in the parking lot of the dispensaries.
* People smoking marijuana in the parking lot of the dispensaries.
* Vandalism near the dispensaries.
* Threats made by dispensary employees to employees of other businesses."
This does not comport with Joel Stein's brief foray into the world of dispensaries.

The first four complaints are probably made by neighbors about the majority of convenience stores (except that the smoking complained of is typically juveniles smoking tobacco). No doubt aware of the perception of such problems at convenience stores, the 7-Eleven chain has an anti-crime and community relations program.

This type of neighborhood disorder is a legitimate challenge and responsibility for local government regulation.

Ironically, the DEA's wasteful interference in state medical marijuana laws has obstructed what could be effective local policing. Local police lured perhaps, by DEA money, Byrne Grant money or a share of federal asset forfeitures, or encouraged by DEA ideology, are taking the traditional enforcement approach to the dispensaries of raiding them to close them.

This has engendered a backlash. The California Assembly Committee on Public Safety recently approved AB 2743 to
make it the policy of state and local law enforcement agencies not to cooperate with the DEA or other federal law enforcement agencies in their attacks on sick and dying medical marijuana patients and their providers,
according to the Drug Policy Alliance California update.

Don't most of us want reasonable, effective, and humane oversight of the dispensaries?

There is a large experiment underway in California yet there probably is no consensus on what the experiment actually is about. Is it an experiment in medical marijuana? Or is it an experiment as Joel Stein says, in legalized marijuana for adults over 18. Certainly it will be hard to evaluate because the experiment is not being controlled or designed.

There are important questions: What is the actual role of the physicians who are issuing the recommendations? Are they facilitating the proper treatment of serious medical conditions that have been resistant to conventional medical treatment? Are they serving to block improper juvenile use of marijuana? Does their "gatekeeper" role help mitigate the abuse of marijuana?

It is time to ask the academic world to step forward to begin to seriously evaluate this experiment.

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Anonymous said...

I think if you look at the statistics since 1996, juvenile use of cannabis has declined precipitously in California. If the only argument is that it is too easy for patients to get medical recommendations, the solution is for the federal government to authorize physicians to write prescriptions which can be controlled as for other scheduled drugs. It is not likely that very many people are going to seek medical recommendations that would not otherwise be using marijuana, in any case.

In short, I think the disadvantages are largely theoretical but if it needs to be better regulated then it should be.

jackl said...

Some legitimate peer-reviewed research along the lines you are thinking of has recently been done by Thomas J O'Connell and Ché B Bou-Matar. This research was derived from Dr. O'Connell's clinical work in writing Prop. 215 "recommendations". Dr. O'Connell realized the medical histories of the over 4,000 people who were self-prescribing cannabis for their conditions offered a unique perspective in studying the beneficial medical use of cannabis under the California experiment.

However, as you might expect, research institiutions were not lining up to give Dr. O'Connell money to do the intense research and writing to make the 4,000 histories into a publishable scientific paper (based on personal conversation). I was delighted to see the paper published as I had not expected to see it ever done.

The paper is entitled "Long term marijuana users seeking medical cannabis in California (2001–2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants" and is available in the online Harm Reduction Journal at

Anonymous said...

I'm so happy to have found your blog, and I appreciate you bringing these questions about medical cannabis to light.

Until there is greater legal and governmental acceptance of medical cannabis, it will be hard to resolve the scams some physicians and dispensaries are running. Since the issue is still so politicized, both sides - the drug warriors and the medical cannabis proponents - probably feel forced to defend bad things because to do otherwise would be to seemingly admit that their position is wrong. It's an adversarial situation.

Both sides exploit the mistakes and accidents of the other. I'm not saying we shouldn't be held to account. But it would be nice to see everyone approach the issue with understanding and forgiveness.

When I lived in California and worked with the medical cannabis community, I saw many dispensaries take an honest approach. There was self-regulation that was fair, but tough, and dispensaries that didn't match up didn't enjoy the strength that comes with numbers.

Even so, the image of all medical cannabis patients being extremely ill and dying that organizations like NORML and MPP portray doesn't match the reality. The fact that not all patients are that stereotype in and of itself isn't bad, as Stein suggests, but I agree we're not doing ourselves any favors by perpetuating the stereotype.

Anonymous said...

Suffering from an addiction. This website has a lot of great resources and treatment centers.

Anonymous said...

Nice blog with good information. I think that medical staff can only access Electronic Patient Records once they have been thoroughly vetted. This will allow them to use a Smartcard which, depending on their job title, will give them access to the patient data they need.