A Bus Named FURTHUR

I sometimes cannot prevent myself from committing poetry.  This time I'm going to inflict it on you:

A Bus Named FURTHUR

In memory of Aldous Huxley, the trailblazer and guide who has led the way, opening the

Doors of Perception for many to take the trip to

Furthur.

1939 International Harvester

1960s sound and film

Day-Glo paints,

Mandalas smeared and loppy.

Destination sign reads “Furthur”.

Are you on the bus –

-- or off the bus?

Neal Cassady’s driving:

Dean Moriarity On The Road again.

Foot down hard, going fast;

Hands in air – he steers by mental force.

Non-stop monolog – Beat rap now decades long enchanting all around but the traffic cop who gets confused and slinks away silently

– not on the bus.



Merry Pranksters careering thru deserts and down to Houston;

Stop at McMurtry’s door:

Larry dazed and enraged

At Blanket Girl naked on his lawn.

You’re either on the bus –

-- or off the bus.

On to Gotham: McMurphy’s on the stage

And foiling Ratched – who missed the bus long ago.



Sometimes a Great Notion: on to Millbrook

And enlightened Guru Tim.

But Tibet chants and Book of Dead are just a killing bore.

Tim’s dropped out --

– and off the bus.



Back on the bus – and furthur west:

The Fillmore waits; Garcia has the band.

Light show flicker/flows and Owsley spikes the brew:

Orange Sunshine for the trip.



If you pass the Acid Test, no need to use the bus.

Your mind’s enough:

The trip is always FURTHUR.

Legalizing Marijuana -- But How?

Legalizing Marijuana – But How?

Many now advocate legalizing marijuana – several surveys indicate that a majority of the population does. The idea is so vaguely worded that it presents two questions: what does legalization mean and how can it be done? The first can be clarified rather easily, but the second presents a tangle of complication.

Those advocating marijuana reform fall into three camps: decriminalization, medical use, and legalization. Decriminalization means removal of criminal penalties from possession for personal use while maintaining criminal laws against growth, distribution and sale. About twelve states have taken this approach (with most retaining small civil fines for possession), as have The Netherlands, Portugal, Germany, Mexico, and Brazil. Other European nations have simply quit enforcing laws against possession. Fourteen states and the District of Columbia allow possession for medical use by those with a doctor’s recommendation, several of these also establishing approved production and distribution systems. The federal government has announced that it will respect these programs. Canada and most of Western Europe also allow medical marijuana. In most respects, recognition of medical use is a form of decriminalization.

The most comprehensive reform being advocated is legalization, or removal of all criminal penalties for growing, processing, distributing, or possession. This would be accompanied by laws regulating places and methods of sale, age of users, and liability rules for misuse or abuse. Taxation would probably follow. Legalization would result in a system much like that used for alcohol today.

Current nation-wide polls show that over sixty per cent, and possibly eighty per cent, of adults favor recognition of medical marijuana, while about forty-five per cent favor legalization. These surveys usually do not distinguish between legalization and decriminalization. Some kind of national reform looks likely, but the methods are problematic.

The major problem comes from the federal structure of the American government. Both the national government and the state governments (all fifty of them!) have independent jurisdictions to make and enforce laws against marijuana. If the federal law is reformed, a person would still be restrained by the law of whichever state she was in; and if a state reformed its law, its residents would still be in jeopardy from federal enforcement. The current efforts of states to allow medical use of marijuana illustrate this problem. Even though today’s national administration has pledged to respect the state laws, the effect of the federal laws on banking, marketing of medicines, education, employment, and other areas of life prevent full implementation of those laws. Federal and state laws must both be changed if reform is to be effective.

Under these circumstances, three approaches are possible. Reform in the states may be pursued first before challenging the federal law; federal law can be confronted first, followed by the states; or the two can be assailed simultaneously.

Groups are currently active on both the state and federal level, but with little coordination between them. The major defect in this approach is that it dilutes resources, scattering people and money among dozens of groups with minimal cooperation between them. The major advantage is that these many groups can create widespread public attention and enthusiasm.

Federal reform could be pursued first, allowing the states to follow at their own rates. This approach was the one followed in the repeal of alcohol prohibition, with some states still retaining prohibitory laws some eighty-five years later. The result is a confusing patchwork of laws across the country, but it does allow localities to control their own destinies.

The third approach is to concentrate on the states first. Pending referenda in California and Washington are examples of this approach. If enough states reform their laws, the federal government will be forced to follow. Federal law, even during alcohol prohibition, was forced to rely on state and local agencies for enforcement. A national police force large enough to enforce drug laws would be prohibitively expensive and most people would refuse to allow that level of federal policing in everyday life.

Even if marijuana were legalized, federal law would need changing to allow medical use. Ending prohibition under the Controlled Substances Act would still have medicinal marketing banned by the Federal Drug Administration. The FDA’s administrative approval for marketing as a drug is practically prohibitive. Normally, approval of a new drug costs several hundred million dollars and takes many years. However, the safety requirements for approval of marijuana can be met from current information, and at least one new study showing the effectiveness of marijuana for pain relief claims to satisfy FDA requirements for a Phase III study (a number of Phase III clinical studies are required for approval), possibly making approval more likely. If marijuana is approved for even one use, the doctrine of off-label prescription means that physicians can prescribe it for any therapeutic purpose and pharmacists may fill those prescriptions.

The question remains about whether to attack DEA scheduling of marijuana as having no medical use, which would allow sales subject to FDA regulation, or to first seek FDA approval, which would force DEA rescheduling. Currently both are being pursued in parallel.

However, a third approach is possible. In the 1990s Congress established a separate method for regulating herbal remedies and dietary supplements. This system allows products to be sold without prior approval but subject to FDA after-market supervision for both safety and misleading claims. Marijuana clearly fits into the definition of many products now subject to that law and is safer than many of them that are also psychoactive like St. John’s Wort and Kava. Congress could easily move marijuana from the CSA to coverage under this system without facing the stigma of legalizing drugs.

Some kind of reform of marijuana laws is probable. However, the route to that reform is more complex than most people assume. More thinking about the best path to reform is necessary.

Screening Children

Screening Children

The American Academy of Pediatricians (AAP) has recommended that doctors screen all of their young patients for alcohol use starting in middle school, the Wausau Daily Herald reported May 15. The AAP Committee on Substance Abuse released a revised policy statement on youth alcohol use on May 1. "A remarkable amount of brain development is still occurring for young people through their 20s," said report lead author Patricia Kokotailo of the University of Wisconsin School of Medicine and Public Health. "This policy statement provides better evidence about how alcohol affects the brains of young people and why it is important to screen children."

Those worried about problems of drug abuse and dependency should approve of this policy. So should those who know that the most effective public health programs focus on prevention and detection, not simply on developing after-the-fact cures.

Alcohol is, without a doubt, the most dangerous drug in society. Long-term alcohol-related diseases cause over 100,000 deaths a year in addition to several thousand acute intoxication deaths, most of these in young people. Over 15,000 die each year in car wrecks involving drivers who have been drinking. Alcohol is the only drug the consumption of which has been causally connected to violent crimes. Domestic violence is the most prominent of these, but homicides and aggravated assaults are also common. Alcohol abuse is also responsible for a significant part of lost productivity (including absenteeism) and workplace injuries.

What should screening accomplish? About two-thirds of the population consumes some alcohol and around ten to fifteen per cent of those develop a dependency on it. Those with alcohol dependencies display most of the abusive behavior, causing the problems described.

Early alcohol use is one of the factors with the highest correlation with later dependencies and abusive behavior. Screening will provide opportunities for intervention and possibly prevent later abuse and dependency. It will also allow long-term longitudinal studies of alcohol use for the first time, creating the data to determine the ways in which alcohol use develops in the individual.

One side effect of this screening may prove almost as worthwhile as the direct benefits. It should also provide a means for studying, predicting, and intervening in the abusive and dependent use of other drugs.

Early use of alcohol has been shown to be antecedent to excessive use of other drugs. Virtually all of those who use other drugs in a destructive fashion first began using alcohol by the age of ten or twelve. Although marijuana is often accused of being a gateway drug – a claim thoroughly rebutted in the 1995 Institute of Medicine report on medical marijuana -- the correlation of early use of alcohol with later abuse of other drugs is much higher than is that of any other activity, significantly higher than that of marijuana use for instance. Identifying, and intervening with, those children using alcohol by their middle-school years should greatly decrease the number of those abusing other drugs as these children mature.

While the number of users of other drugs is miniscule compared to alcohol, it is high enough to raise legitimate social concerns. Excluding tobacco and marijuana, less than ten per cent of the population uses drugs other than alcohol. Of those users, like alcohol users, only around ten per cent develop dependencies or use abusively.

Tobacco use has decreased from a majority of the adult population in the 1950s to around twenty per cent today. However, a much higher percentage – possibly as high as twenty per cent – of the tobacco users become dependent, and diseases causally related to tobacco result in over 400,000 deaths annually.

Many more people use marijuana than use any other illegal drug. Among the young, rates of marijuana use may approach those of tobacco. However, marijuana users develop dependencies at a much lower rate than the rates for other drugs, and those dependencies are much weaker and easily broken. The best estimate is that only about three per cent of marijuana users ever show any signs of dependent or habitual use. Marijuana use has few, if any, health consequences for the user and marijuana has not been shown to have a causal relation to any consequential social harm.

Surprisingly little is known about drug dependency from a medical standpoint. So far debate still rages about whether it is a disease, a disorder, or merely a cluster of symptoms that may evidence other underlying diseases or disorders. Only a few rules of thumb have been agreed on. As already mentioned, early alcohol use is an almost universal precursor. Most of those dependent on drugs, including alcohol, experienced physical or sexual abuse as children. A large majority come from broken or dysfunctional families. Some genetic component or components are probably involved. Attempts at rehabilitation (except in the case of marijuana) are unsuccessful, with the best ones failing at a rate of over eighty percent, a rate that has not changed measurably since first determined among heroin addicts at the Federal Narcotics Farms in the 1930s.

Wide-spread screening of middle school children for alcohol use becomes important for several reasons. It identifies those likely to develop problems with all drugs (including alcohol) before dependencies and patterns of abusive use develop. It provides opportunities to intervene and prevent those dependencies from developing in the first place and to develop effective means for that intervention. But the most important benefit is that it will provide the data from large numbers of longitudinal studies that will eventually provide the scientific and medical knowledge necessary to prevent dependency and abuse problems in the first place.

The Way it Is Sold

The Way it Is Sold

On May 4, Washington, D.C., Assistant Police Chief Peter Newsham was quoted

in the Washington Post as saying, “People don’t feel marijuana is dangerous,

but it is because of the way it is sold.”

A doctor prescribes Desoxyn for a ten-year old patient diagnosed with ADHD. The prescription is filled routinely at a large chain drugstore like Walgreens or CVS at the chain’s standard price of $4.00 for a month’s supply of a generic drug. No one worries about the strength or purity of the drug because it was manufactured and distributed by a factory certified as following Best Manufacturing Processes and inspected by the FDA. Some of the pills will be turned over to the school nurse who will see that the child takes them when scheduled during school hours.

On the same day in the same city, a teenager tried to buy some crystal meth from a street dealer. When a police officer approached, the seller drew a gun and tried to run. The shoot-out ended with both the dealer and his young customer dead. When the police lab analyzed the drugs, they were found to be contaminated with several toxic substances. A search of the dealer’s motel room found a portable meth lab and some of the dangerous substances used in its manufacture.

The first of these stories is the outline of events occurring in the United States each week. The second is a composite of factors common in episodes also occurring daily in this country. The factor they have in common is that they both feature the same drug: methamphetamine.

Methamphetamine was invented almost a century ago, and from about 1940 until the mid 1960s was one of the leading prescription drugs. The amphetamine-like stimulants (amphetamine, methamphetamine, and Ritalin) as a group were the drugs most often prescribed during this period. They are grouped together not only because they are chemically similar, but because users cannot normally tell them apart. Today these drugs are primarily prescribed for attention spectrum disorders, extreme obesity, and some sleep disorders. Some doctors also prescribe them for the off-label use of increased mental functioning, or “brain-boosting”. Professor Rasmussen estimates that, counting these three drugs together and combining legal and illegal users, the percentage of the population using them today is roughly the same as in their heyday of the 1960s.

Meth for illegal use comes from three sources. A large amount, although only a small part of the total, is diverted from legal sources. Some of that comes from pharmacies, either through fake prescriptions or through burglaries. Holders of legitimate prescriptions provide a larger share by giving or selling some of their drugs to friends or through children rifling their families’ medicine cabinets.

By far the largest part of illegal meth is smuggled into the country. Most of that comes from small, unregulated factories in Mexico, but a portion comes from South and Southeast Asia. Mexican meth is a smaller trade than is the marijuana, cocaine, and heroin from that country, but it still contributes to the overheated competition between the drug cartels now causing so much damage in that country.

A very small part of the illegal meth in this country is produced in small “cookers” for local use. Many of these are set up in temporary locations like motel rooms and produce less than a pound of the drug. However, these cause damage greatly disproportionate to the amount of meth they produce. The people operating them are usually untrained in chemistry, trying to follow unreliable recipes they have gotten from the Internet or from other cookers. Their attempts often catch fire or explode, and the dangerous chemicals used and produced are thrown away so that intense local environmental damage results. Cleaning up these small disasters is tedious and expensive and exposes the responders doing the cleaning to great personal danger. If all of these small meth cookers were to disappear, the drug supply would not be appreciably diminished except in a few small isolated localities, but the dangers and harms to the surrounding communities would disappear with them.

Nothing about this portrait of a drug market should surprise anyone. It could also apply in detail to the market for alcohol during Prohibition.

Just as with Desoxyn, a legal market for potable alcohol existed. Doctors (including dentists and veterinarians) could prescribe up to a pint a week, and many drugstores became nothing but outlets for medicinal brand name whiskeys. Walgreens went from 20 stores to 525 during the decade. A family could have up to ten gallons a year of sacramental wines, and priests and rabbis were vested with authority to procure and distribute it. Since no official registry for rabbis existed, Jewish congregations sprang up in surprising neighborhoods with unexpected ethnicities. Farmers (meaning any householder) could “preserve” up to 100 gallons of their fruit crop by fermenting it. The market for grapes exploded, with California vineyards making more money shipping grapes than they had ever made selling wine.

Most of the market for alcohol was met by imports, although the primary source was Europe, not Mexico. While some of this liquor was the reliable brands people had long purchased, most of it was counterfeit: flavored grain alcohol with fake labels pasted on. One German company even marketed Black and White Horse Scotch.

And local cookers poisoned and polluted their neighborhoods as well. The South had a long tradition – dating back to the eighteenth century – of making moonshine. Their bootleggers stepped up production to meet the demand with sub-standard product, burning down the forests for fuel for their stills and dumping their wastes in the streams.

In the cities small distilleries presented the same kinds of problems that meth cookers create in rural areas eighty years later. Bootlegging gangs would pay tenement dwellers to operate small stills in their apartments. The five to fifteen dollars a week those stills brought in was a major incentive to these amateur operators, but these operations caused real problems to the neighbors in these crowded dwellings. The constant odors and heat and the continuing foot traffic were bad enough, but the frequent fires and explosions in the firetrap buildings became a serious public safety concern.

The sad fact is that the same stories can also be found two hundred years earlier when the British Gin Acts of the 1730s tried to impose prohibition on London. Einstein defined insanity as repeating the same experiment but expecting different results. Our current attempts to prohibit sales of drugs can only be seen as insane.

Federalism and Fiscal Policy

Federalism and Fiscal Policy

One objection to modifying state marijuana laws is that the state cannot act contrary to federal law. While that proposition may be correct as a general rule, the principles of federalism, or the allocation of power between the federal government and the states, are more nuanced than that broad statement would indicate. One part of the problem is what effect the enactment of a federal criminal statute has on a state’s ability to legislate on the same subject.

On the most fundamental level, the Supremacy clause of the Constitution requires that when congress enacts a criminal statute, all people in the country must obey it, including state officials and agents. A governor cannot have his own private stash of cocaine and a professor in a state university may not experiment on marijuana without a federal license to do so.

One major consequence of this principle is that state law may not overrule federal law and make it inapplicable within the state. Therefore, a state law legalizing marijuana would not nullify the application of the Federal Controlled Substances Act within the state. A state resident, even if in conformity with a valid state statute could still be convicted in federal court for possession or delivery of marijuana.

State laws may not hamper the execution of any federal project. When I was young, I was amused to find out the truck I drove for the Post Office had no state license plate and I could not be required to have a state driver’s license to operate it. (We were required to obey most local traffic laws because the Post Office ordered us to, but the local police could not give us tickets.) Likewise, local law cannot require federal law enforcement officers to get warrants from state courts before conducting searches or making arrests and the state cannot require federal officers to wear uniforms.

The states ordinarily are not obligated to enforce federal laws. Local police do not pursue counterfeiters nor screen people on the streets for illegal aliens. Likewise, federal officers are not in the business of catching murderers or pursuing speeders.

In some areas, state and federal responsibility may overlap. Robbing a bank is a state crime, and robbing a bank with a federal charter is a federal crime. Kidnapping is local, but if it crosses a state line it becomes a federal crime as well. In these cases, both sets of police agencies are active and usually cooperate with each other.

A major part of this separation of policing is fiscal. If the federal government were able to co-opt local police agencies, then the national government would, in effect, be determining how state and local governments allocate their tax dollars. This control would have the potential to allow the federal government to control all aspects of local government.

(When the federal government does need local assistance, they reverse this equation. It uses federal dollars to make grants to states and cities that fulfill the conditions imposed on those grants. This approach has mandated things like uniform national speed limits and drinking ages.)

While a state may follow the federal government by criminalizing the same conduct, making it a state offense as well as a federal one, the states do not have to do so. The Texas Court of Criminal Appeals once ruled that it was unconstitutional under the state constitution for the legislature to delegate its authority by enacting a statute that would automatically make illegal possession of any drug declared illegal by the federal government. The state was required to exercise its own judgment on the issue.

The most famous example of a state’s refusal to copy the federal law occurred in 1923 when New York rescinded its own alcohol prohibition law and directed its law enforcement personnel not to enforce federal prohibition. The result was widespread drinking and a flourishing entertainment industry in spite of the actions of the federal revenue agents.

Many states are considering a similar action today. They are examining legalization of marijuana under state laws. While this legalization would not nullify federal law, it would remove state law enforcement and courts from acting against marijuana users or suppliers, saving those states very large sums and allowing the closure of some prisons. Those states would only be following the trail blazed by New York over eighty years ago.

If populous states like California, Texas, or New York were to change their laws in this way, national marijuana prohibition would probably end as well. The federal government has never been able to enforce its prohibition laws –alcohol or drugs – but has relied on the states for enforcement efforts. The DEA and FBI together do not have as many officers as some of the large municipal police forces. Any large city processes more criminal cases each year than do the federal courts, and the federal prison system holds fewer inmates than do several of the large states. The federal government would have to increase the size of the Department of Justice to a size comparable to the Department of Defense, and with a similar budget, to maintain the current level of drug law enforcement. A major question would be whether the citizens would accept a federal police force as large as their local police in their cities. That presence would be a revolutionary change in American politics.

If the states want to change their drug laws to be less comprehensive than the federal law, they have the right and ability to do so. The ultimate effect of those changes could be far-reaching and beyond what most of us can predict.

APA: Drug Test Results Often Flawed

This is the first time I have posted an article from somewhere else, but this one is so important that it needs the widest exposure possible (i.e., show it to your school board, your boss, and your congresscritters)

APA: Drug Test Results Often Flawed




By Kristina Fiore, Staff Writer, MedPage Today



Published: May 23, 2010



http://www.medpagetoday.com/MeetingCoverage/APA/20253



Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM,

CDE, Nurse Planner



NEW ORLEANS -- That poppy seeds can lead to false-positive results on tests

for opioid abuse is not just an urban legend, researchers said here.



Amounts as small as a teaspoon -- at least the amount on a poppy seed bagel

-- can trigger a positive finding, and can last for two to three days after

consumption, according to Dwight Smith, MD, of Boston Medical Center, and

colleagues.



The example is one of many suggesting that drug-abuse tests often give

inaccurate results, according Smith's presentation here at the American

Psychiatric Association's annual meeting.



Another example is that most standard drug tests don't screen for the opioid

drug oxycodone, as well as a handful of other opioids including methadone

and fentanyl, Smith noted. Physicians must specifically order these assays.



"There are gaps in our understanding of the science behind drug tests, and

how that leads to our interpretation of testing results," Smith said. That's

one of the reasons he and colleagues conducted a review of the literature on

drug tests, their scientific background, and potential clinical concerns.



The latter are particularly important because drug screens are so common,

Smith said. Last year, about 150 million drug tests were conducted in the

United States.



"We drug test everyone in the states nowadays -- our students, our

athletes," he said. "It's a condition for employment in many federal and

private agencies."



Still, many physicians may not be aware that ordering a general "drug test"

won't cover all their bases, or that half of patients who are abusing

substances will be missed.



One study in the review found 88% of physicians were unaware of the need to

request the specific oxycodone assay, and half did not know about the

false-positives associated with poppy seeds.



Opioid tests screen for morphine and codeine, which are two of the most

common metabolites of many -- but not all -- opioids. They're not

metabolites of oxycodone, methadone, fentanyl, tramadol (Ultram), and

buprenorphine (Subutex, Suboxone), Smith said.



"You need to order the specific assays in order to accurately interpret

those," he added.



Similarly, only certain metabolites of benzodiazepines are detected on most

assays. That means diazepam, nordiazepam, and oxazepam (Serax) will be

detected, but alprazolam (Xanax), lorazepam (Ativan), and clonazepam

(Klonopin) aren't frequently screened.



Part of the problem is that there are no federal guidelines for minimum

negative threshold levels for a positive test, Smith said. Plus, each

laboratory has its own guidelines and procedures for dealing with test

sensitivity and specificity.



In their review, the researchers found that drug tests generally have a

sensitivity of 90% to 95%, and a specificity of 85% to 90%. These numbers

are a "pretty good basis" for making clinical decisions, Smith said, but

that means "one in 20 [tested patients] are going to have inaccurate

results, and those are more likely to be false positive than false

negative."



By comparison, confirmatory tests such as gas-chromatography

mass-spectrometry have a sensitivity of 99% and a similar specificity, but

they are more expensive.



Physicians "trust in science, and we believe [sensitivity and specificity]

are going to be higher than that when they're not," he said. "We really need

to get tests confirmed."



Many substances aside from poppy seeds cause these false-positives. Cold

medications can give a positive read on amphetamines, as can bupropion

(Wellbutrin) and tricyclic antidepressants.



Sertraline (Zoloft) and oxaprozin (Daypro) can alert physicians to a

benzodiazepine problem when there is none.



The HIV medication efavirenz (Sustiva) can come up as a positive for

marijuana use, and dextromethorphan, rifampin, and quinolones could show as

an opioid problem.



"If a patient does test positive, you need to take a careful medical

history," Smith said.



Smith also did some myth-busting, finding that there's no possibility of a

false positive resulting from passive inhalation of marijuana or cocaine --

unless they are exposed to an excessively concentrated amount of smoke.



"If a patient comes in and blames it on any of these scenarios, you can say,

'Unless you were in the van with Cheech and Chong, that's not what

happened,'" Smith said.



As far as false-negatives go, Smith said physicians should be wary of the

methods for diluting samples used in drug tests -- an issue he calls "the

elephant in the room."



On average, such strategies appear to work 50% of the time. These include

bleaching urine or adding the household cleaner Drano or the eye lubricant

Visine to it.



Others have gone to great lengths to design battery-powered devices that

keep urine warm, and offer a prosthetic device "in three or four skin tones"

for the most cunning of drug test cheaters, Smith said.



A fail-safe would be to screen the urine for its standard specific gravity

of <1.003, or standard creatinine under 20 mg/dL.



Yet no studies have been done to show exactly how prevalent drug test

cheating is, Smith said, adding that the area urgently needs research.



His advice to physicians who want to know the quality and the specifics of

the drug test reports they receive: "Become friends with the toxicologist in

charge of the lab. It's particularly helpful if the results of the test are

unexpected."



The review was based on studies found via a PubMed search between Jan. 1,

1980 and Sept. 1, 2009.



Ronald Bugaoan, MD, medical director of High Point Treatment Center in

Brockton, Mass., who assisted in the study, said urine tests do indeed have

the longest window of detection for most substances.



However, gas-chromatography mass-spectrometry is the "gold standard" for

drug testing, and added that patients enrolled in the Massachusetts health

plan can get tests using it for only $12 apiece.



The researchers reported no conflicts of interest.



--

Primary source: American Psychiatric Association

Source reference:

Smith D, et al "An update on testing for drugs of abuse: Scientific

background and practical clinical concerns" APA 2010; Abstract NR7-05.



http://www.medpagetoday.com/MeetingCoverage/APA/20253

Alcohol and Marijuana

Alcohol and Marijuana

When Prohibitionists argue that we don’t need another legal intoxicant or when legalizers claim that pot is not as bad as alcohol they are both building on the public’s idea that all intoxicants are alike. The fact is that alcohol and marijuana have nothing in common except for their both being used in social situations.

Marijuana is not alcohol. This statement looks obvious, but both sides of the marijuana legalization debate regularly conflate the two. The result is debates that are heated and emotional but that do little to clarify the social issues at stake.

One of the more common arguments advanced by the anti-marijuana advocates is based on the problems with alcohol. They point out deaths among alcohol users – both acute poisoning and long-term illnesses caused by alcohol – and deaths caused by alcohol users in car wrecks and domestic violence. From there, they may go on to workplace problems: absenteeism, decreased productivity, and increased injuries and deaths. They then make the (unwarranted) assertion that marijuana is an intoxicant like alcohol. The next step is to combine the two to support the assertion that legalizing marijuana would create a second legal intoxicant – another alcohol as it were – and greatly increase the incidence of the social evils enumerated.

Both of these arguments share two faults. The most fundamental one is that alcohol and marijuana have almost nothing in common except for their use in social situations. The other is that they prey on the public’s ignorance of any altered conscience than that caused by alcohol.

The second problem is what makes the first one so vicious. Most people today have seen or dealt with someone who has had too much to drink. The local news highlights a drunk driver almost every night. If anyone has not had to deal with an alcoholic in the family, they will probably have coped with one at work. On the other hand, few have had encounters (at least that they knew about) with someone impaired with any other drug. The exception might be those who have experienced a slight high from nitrous oxide (laughing gas) at the dentist’s office or seen someone groggy after a night on sleeping pills. When the majority tries to imagine the effects of any drug used socially, the only experience they can call on is the one that they have derived from drinkers. The result is that when most people hear “legal marijuana” they see hordes of drunken – or at least tipsy – pot-winos staggering around. And this vision points out the major problem with these arguments.

The first difference between them is that alcohol is a deadly poison and marijuana is virtually harmless. Drinking leads to over 100,000 deaths a year from consequences of alcohol-related diseases and several thousand deaths from acute intoxication. Marijuana has never been identified as the cause of a single death resulting from consumption. Long-term studies, some covering over forty years, involving thousands of patients, show no measurable health differences between marijuana users – even heavy daily users – and those who do not consume it.

The second major difference is in their relations to violence. Alcohol-related car wrecks kill over fifteen thousand people a year in the United States. Studies by four national governments, including the National Transportation Safety Board of the U’s., show that drivers who have consumed marijuana are a safe as unimpaired drivers. While marijuana does impair scores on laboratory reaction tests, since it does not impair judgment, drivers are conscious of that impairment and adjust for their slower reactions.

Alcohol is the only drug the consumption of which has been linked to violent crime. While many criminals are high on stimulants when arrested, the drug use itself was not a direct cause of their criminal behavior. Those crimes committed for the purpose of obtaining drugs result from the economics of the drug laws, not from the action of the drugs themselves. Alcohol is a factor in a significant number of domestic violence cases, and entertainment venues serving alcoholic beverages are centers of many assaults, fights, and shootings. Marijuana, if it has any effect at all in these situations, tends to reduce aggression.

Alcohol has marked effects as a cause of workplace injury and decreased productivity from both absences and from lowered efficiency. None of these factors have been associated with marijuana.

Alcohol is also highly addicting. Around ten per cent of all drinkers become addicts, for whom withdrawal can even lead to death. Marijuana is not addictive, although a few users, around three per cent, develop habitual use that may require some slight help in stopping.

All of these differences stem from the differences in the way the two drugs effect the brain.

Alcohol is a sedative that decreases the functioning of all parts of the brain. It first lessens the activities of the pre-frontal and frontal cortexes, which are responsible for judgment and higher mental functions. One consequence is that one who has had a few drinks will think that he is a skilled race driver, not one too impaired to drive. Alcohol then hampers the motor centers of the brain, leading to slurred speech and uncoordinated movement. Ultimately, it will suppress consciousness and even respiration, leading to death.

Marijuana, on the other hand, affects only specialized cannabinoid receptors in the nervous system. This results in its effectiveness in treating pain, spasms, and nausea. Its other major effect is as a mood elevator, making the user more relaxed and more cheerful.

Both those wanting to legalize marijuana and those opposed to the idea can find some data to support their positions. But if they truly want to convince people that they are correct, their arguments should be based on fact and evidence. The most basic fact they must both deal with is that alcohol and marijuana are different and have almost nothing in common.