Wednesday, April 15, 2009

Medical Marijuana

Cannabis Sativa

Many of the greatest gifts to the western world came from Mexico and points south: chocolate, Tequila, Mariachi music, maize (viz., corn), Tex-Mex food, potatoes, tobacco, and marijuana. All of them provide joy, every one of them is thoroughly and delightfully addictive, but only one is deadly, and the deadly one isn't the marijuana. (Well, you could count Tequila shooters as deadly, I suppose, if you tried to match me one-for-one.)

Marijuana, in addition to its recreational pleasures, is a godsend for chemotherapy patients and those who suffer from HIV-wasting or other diseases where nausea, vomiting, sleeplessness, and general lack of interest in eating are common. Marijuana greatly stimulates the appetite, giving the munchies to those who otherwise can't bring themselves to eat. It also reduces chemotherapeutic nausea, which is necessary if having the munchies is to do any good.

The medical claims for marijuana are growing for other conditions, but I'll leave their rehearsal to others. For me, it's enough that marijuana makes chemotherapy more bearable (see Occam's Razor). For those who want more information, this report of the AMA is dated but thorough.

In California, regulating marijuana may soon bring up to 1.3B much-needed dollars into state coffers, as discussed in the Washington Post. Eric Holder, the new Attorney General, has recently announced he and the dreaded Drug Enforcement Agency (DEA) will no long raid the store-front collectives ("dispensaries") that supply marijuana to patients. Thirteen states have legalized marijuana for medical purposes — so another of our long, dark wars is finally coming to an end. More on that, and what it might mean for poor Mexico, later.

The California ballot initiative that legalized medical marijuana has a serious flaw: it legalizes patient possession of marijuana without providing a legal way of obtaining it. You have to do business with the underworld to get it. Organized crime is involved on many levels, not just at the cash-for-crop dispensaries.

The attention of a state Medical Association scares the hell out of doctors. State MAs can make life a living hell for those who step out of line. In California, the medical association has decided to leave the decision to the doctor and patient concerning the medical use of marijuana. You can read their position here. On the other hand, not one of the dozen courageous doctors I see will write a "recommendation" for medical marijuana for me or for any of their other patients.

Therefore, yesterday I drove from San Diego to Dana Point to see a doctor who works in an outfit called Medical Marijuana of San Diego. There are similar, related facilities in Hawaii, Los Angeles, Santa Barbara and Dana Point (in Orange County). Now, this is only my opinion, and I may be wrong, but perhaps one look may suggest to you that they are supported by more than just the stream of youngsters with pasty, diseased skin who flood the waiting room with wads of $100 and medical records in their sweaty hands that suggest they have vague neurological disorders. I, insofar as I could tell, was the only truly ill person there.

What they do is accept and document patients, write recommendations for marijuana, and maintain a system whereby dispensaries can verify in real time that a patient has been examined, recommended, and documented. Oh, and you get a legally meaningless ID card that wouldn't impress a DEA agent for one second.

I left with a certificate (the card will come later in the mail), which you can see here, and was met in the parking lot by a thoroughly unrelated twenty-something girl with diseased, pasty skin who gave me a map to a nearby dispensary. The good folks at the clinic are not allowed to recommend dispensaries, or so the flamboyantly gay male nurse told me. The facility makes every effort to abide by a set of rules (the law) that allow them to operate without law-enforcement interference. No one involved is guilty of so much as a parking ticket, and the California Medical Association can't find fault either, much as they would like to.

Afterward I took a long, hot shower to wash off the dirty feeling I get when I think I've had something to do with vice. This despite the gratitude I have that at least someone is making an effort to address the supply-side problem.

There is an alternative, the officially equivalent drug, Marinol, which contains synthesized THC (tetrahydrocannabinol), the so-called "active" ingredient in the natural, organic plant. The Drug Enforcement Agency wants you to use Marinol. Here's a link to their propaganda.

There are many problems with Marinol, not the least of which is that it's a pill you have to swallow. Imagine, if you will, a chemo patient who can't keep food down: how does he keep a pill down? Smoked (or vaporized) marijuana doesn't have that problem.

Also, Marinol is subject to the vagaries of the digestive system. How soon it starts to work as well as its peak serum concentration depends in part upon whether the GI tract is empty or heavy with Chicago pizza. From my experience, the pill can take from ninety minutes to two hours to work and the effectiveness of the same dose can vary from barely noticeable to intense.

A good, useful drug would not behave in this way.

Smoked marijuana, on the other hand, is rapidly effective, which is hardly an insignificant benefit to someone closely examining the toilet bowl. Because the smoker can feel the effects almost immediately, the dose/effect can be easily controlled. No overdosing or underdosing.

Logic is a wonder made even more glorious by its lack of use. Marijuana is at the moment classified as a Schedule I drug, meaning, it has a high potential for abuse (whatever that is) and no medical use (a false assertion). Yet how can synthetic marijuana have a medical use but marijuana itself have none? Also, the government, in its wisdom, created Marinol so that they could claim to have provided an adequate, legal, and readily-available substitute, but has also put it on Schedule III, making it both difficult to get and expensive. Many insurance companies refuse to cover it, including Medicare. Lack of logic seems not to trouble our drug warriors.

I was in Tijuana a few weeks ago (The Happiest Place on Earth), one of the foci of the drug war currently being waged between the various cartels over control of drug distribution, mostly marijuana, to Americans. There were no bodies piled up on the main street, the Avenida de Revolution. There were no tourists, either, except for me. Between the recession and the fear of getting involved in the drug war (only rarely and by accident has the mayhem in Mexico involved innocent civilians), the safest street in Tijuana was deserted. I got a lot of unwanted attention. (Hey Mister....)

Here's what rankles. Mexico is tearing itself apart in a war that is entirely our fault. Mexicans are killing each other for the right to distribute marijuana to their major client, your average American citizen. They weild assault weapons bought mainly in three border states, then trucked to Mexico. The marijuana trade is enormous, in the many billions of dollars annually. See this article in the New York Times. Recently, the violence has spilled over into the US as well.

So we build walls and double the guards, as if the problem were there instead of here. We hammer the supply side and do nothing to reduce demand. Only recently, when Secretary Clinton spoke in Mexico, have we acknowledged that we are fueling this deadly, paranoid, loony war.

Well, not exactly nothing. California once again seems to be leading the nation, not from an excess of compassion, but because it needs the tax revenue. California is looking for a way to fix the flaw the medical marijuana law so that there is a safe, legal, and taxable way to obtain what is safe and legal for patients to use. Marijuana is the biggest cash crop in California. If you thought it was still oranges, see CNBC.

In my opinion, I think we owe it to those we have wronged (the Mexicans and countless of our fellow citizens rotting in jail for non-violent drug offenses) to declare victory and end the War on Drugs. Supply-side interdiction operations (not to mention supply-side economics) have done nothing but raise the cost in dollars and lives on both sides of the border. Punishing and interdicting has been about as successful as Cuchulain fighting the sea.

Instead, we should acknowledge that there can be no supply without demand and decriminalize marijuana, either permitting its use like we do alcohol (that is, with regulation and taxation), or declaring it to be a proper medical drug and stocking our pharmacies accordingly. Either way, our war ends, Mexico's cartels go back to distilling Tequila, those of us who can benefit from marijuana can safely obtain it, and we can relinquish the comforting but neurotic notion that this mess is somehow someone else's fault.


  1. Your views are well reasoned. Next time around on chemo, I intend to check out Oregon's medical marijuana policy. I'm glad you could obtain what you need.

    1. Not recently. Not only is our opportunist and Bush holdover, Bonnie Dumanis, is raiding every dispensary in San DIego, and breaking various laws to do it while running for mayor, but because of the evolving nature of marijuana itself. It isn't like your garden-variety garden-section vegetable. It has evolved considerably given the freedom growers have to engineer it.

      It is so strong now that one or two tokes of it can keep me stoned for more than two days, which is not to me desirable nor productive. Reluctantly, we need the FDA to grow it, measure its levels (and not just the THC), and label it as to strength. Then put it in pharmacies for prescriptions. Best for us, best for Mexico in the long term.

  2. You write well, Lon! You and BoogieBarb are the two most articulate members on the List!
    I only smoked ONE MJ cig in my life (at the age of 65) when nothing else worked to stop the awful nausea of high-dose chemo. It was a miracle: worked within seconds. My docs still tease me: "Growing anything interesting in your garden this year, Bob?"

  3. Today the New York Times ran a long article in part addressing medical marijuana:

  4. A well-put thesis, Lon, and if it were up to me, I'd make it happen. If you haven't read "Economic Hitman" by Jack Parker, I'd recommend it. It goes along way to explain why, no matter whether it is "grass" roots or any other kind of uprising, we are essentially out of the loop to have any effect of changing the commercial enterprise currently in motion.
    But for your sake, I am glad you were at least able to find relief.


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