Pubdate: Wed, 01 Sep 2004
Source: Alternatives (Eugene, OR)
Copyright: 2004 Get Real Inc.
Author: Robert Volkman, MD
Note: Robert Volkmann, MD, is a doctor in private practice in Salem, Oregon.
Bookmark: (Cannabis - Medicinal)
Bookmark: (Chronic Pain)
Bookmark: (Cocaine)
Bookmark: (Decrim/Legalization)
Bookmark: (Heroin)
Bookmark: (Methadone)
Bookmark: (Methamphetamine)


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,

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

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

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

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

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

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

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

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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MAP posted-by: Richard Lake