Dutch Voters Leave Fate of “Weed Pass” Hanging

Clock Continues Ticking For Pot Tourists in The Netherlands.

AMSTERDAM—Voters in The Netherlands may have lost their final chance to block the nationwide imposition of the wietpas, or so-called "weed pass," as the law of the land in The Netherlands next year. On Wednesday, a crucial election in Holland determined the outline of a new coalition government under the narrowest of leads for the anti-immigration, anti-marijuana PVV party of Prime Minister Mark Rutte. The election featured a virtual tie with the center-left Labour Party (PvdA) upstart Diederik Samsom, who opposed the idea of closing marijuana shops to foreigners. 

 

But with 150 seats in the Dutch Parliament, experts say at least six parties will be involved in building a new coalition government. Cannabis advocates were hoping for a clear victory by the Labour Party and strong showings by other liberal parties.

Under legislation that came into effect in the south of the country in May, coffee shops effectively became private clubs, selling cannabis only to registered members, who must be Dutch, and able to prove it. The conservative government maintained that foreign drug criminals were replenishing inventory through the border shops, leading to violence and arrests.

As AP reported last week: “The center-left Labor Party [PvdA], which is surging in pre-election polls thanks to strong performances by its leader Diederik Samsom in televised debates, also advocates scrapping the pass and replacing it with legislation that would further enshrine tolerance of marijuana in Dutch law and regulate not only coffee shops but also growers. However, the coffee shops still have a fight on their hands – the conservative VVD party of outgoing Prime Minister Mark Rutte is topping polls and looks set to become the biggest single party.”

And that, more or less, is how it turned out. With a one-seat margin in various exit polls late Wednesday night in The Netherlands, the sitting VVD Prime Minister will want to stay the course and take marijuana out of the hands of foreigners, starting in January, 2013.

Dutch poll watchers had predicted a tight race between the conservative VVD and the liberal PvdA, with an additional dozen parties likely to land seats in a new coalition government. The VVD's election manifesto specifically supported the weed pass, as did other right-leaning parties in The Netherlands. 

"I don't want to apply for a pass because then everybody could see your personal information," one coffee shop owner told AP. "You don't have to do it in a bar to get alcohol, so why in a coffee shop?"

The only silver lining for pot tourists is a possible scenario in which a VVD-led coalition, having originally introduced the concept of the weed pass, winds up negotiating a centrist mashup in which all parties might be likely to barter away the weed pass in return for other policy favors. Moreover, the far-right PVV party led by Geert Wilders suffered heavy losses.

 

The Financieele Dagblad writes that in any case, voters will not be happy, "because any coalition is going to cause pain. The jigsaw that is a new cabinet will consist of many pieces. The results will be complex, just as in 2010."

Photo Credit: http://www.rnw.nl

Dawn or Dusk for Marijuana in the Emerald Triangle?

New book chronicles Mendocino’s “ganjapreneurs”

Every morning in California, thousands of marijuana growers wake up believing they are one day closer to becoming legitimate operators, like the state’s wine makers. Three generations ago, Northern California’s dope farmers dreamed the same dream—but it had nothing to do with “medical” marijuana. It had to do with a hilly, forested, secluded terrain with enough rain and sunshine to make it perfect for marijuana growing and utterly inhospitable to law enforcement without 4WD vehicles.

There are presently only a few disorders for which marijuana is clinically indicated (although that number is bound to go up.) These include glaucoma, HIV/AIDS-related nausea, certain forms of neuropathic pain, lack of appetite associated with chemotherapy, and some promising research having to do with the spasticity associated with Parkinson’s Disease and MS. But Doug Fine’s book, Too High to Fail: Cannabis and the New Green Economic Revolution, isn’t really about the medical specifics. It’s a paean by a true believer. “One tries not to sound like one of those ‘cannabis can do anything including bring about world peace and an end to Ring Around the Collar people,” he writes. But he does. Oh, how he does.  If you believe in cannabis legalization as the Higher Calling, this is the book for you.

Fine moves to Mendocino County to dwell among the ganjapreneurs and tell the tale of “horticultural civil disobedience” that is the hallmark of the Emerald Triangle of Mendocino, Humboldt, and Trinity counties in Northern California—a mythical adult Disneyland where juries tend to believe the assertion that “all 169 pounds of the marijuana on his property was medicinal in nature.” It is a land where the local sheriff acknowledges that “maybe five per cent” of medical cannabis claims are legit, but goes on to declare that “I’ve never seen a stoned man beat his wife.”

As a supporter of limited decriminalization, I tried hard to like Fine’s book. He has a breezy, colloquial style that makes for easy reading. And after all, the latest public opinion polls show American citizens poised 50-50 on the subject of cannabis legalization. The book has no source list, no back-of-the-book notes, and only the occasional footnote, but Fine does his journalistic part, following Lucille, his designated medical marijuana plant, from birth as a clone to death in the dope pipe of a cancer patient. But as his growing source, Fine picks a greenhorn grower whose poor planning and general lack of local knowledge give a Keystone Kops feel to the growing season. “Murphy’s Law rope-a-dope” is Fine’s description of his grower’s business strategy.  Fine’s Mendocino sometimes takes on aspects of a hip Lake Wobegon, where everybody is late for everything, and everybody thinks that’s fine.

In “Mendo,” organic cannabis growers envision a future in which arthritis-wracked senior citizens will go to their local pharmacy for insulin and amoxicillin, and to their local dispensary for an oh zee of Matanuska Valley Thunderfuck. Of course, Fine is correct to note that the vast majority of marijuana users do so without damage to their health and well-being. “What is the glass of red wine enjoyed by the fellow on his deck after a hard day of investment banking? I think that’s documented to be health maintenance. A long-term cost saver. An evening cannabis pipe… is the same thing for some people.”

If billions of dollars are poised to fall on our heads with the flick of a presidential pen, who would want to oppose legalization? The author has plenty of answers: Big Pharma, the private prison industry, law enforcement lobbies, and the banking industry (just too much profit laundering all that money from all those cartels).

Fine isn’t bothered by the menacing “Turn Around Now” signs, or the occasional shotgun volley over the tops of cars with an out-of-county look to them.  He doesn’t have much to say about booby-trapped fences, the county snitch line, the rampant foreclosures, or the stolen power from Pacific Gas & Electric. We don’t get many accounts of subpoenas for cannabis patient medical records, or opposition from the Mendocino County Board of Supervisors. To be fair, he does make note of all the young punks and career criminals drawn to tax-free grey markets like this one—“Real providers next to total thugs,” as one activist put it. There is no substantive discussion of other approaches, like Michigan’s medical cannabis model where there are no dispensaries, and cannabis patients either grow their own, or get it from a licensed grower. The in-your-face activism of growers and dispensary owners in California has led to a complete dispensary closure in Los Angeles (see below).

And there is the continuing “wet” and “dry” aspect to the California trade, reminiscent of the bootlegger era in the hills of Appalachia. To get their medicine to market, growers in the Emerald Triangle must run “The Gauntlet” south to San Francisco and Los Angeles, and the first hurdle—Sonoma County—has been the end of many “compassionate cannabis” deliveries. The situation is clearly untenable. Mendocino should have been a safe bet—all the arguments are settled, all the sheriffs are friendly, and the fix is generally in.

Except when it isn’t. Local constabulary may be green, and Fine delights in describing instances where growers called deputies to their aid when “rippers” show up at harvest time—but try going all green on the California Highway Patrol when they stop you on your merry way across Mendocino County with 50 pounds of pot in the trunk. Or even a pair of terpene-laced bud trimmer gloves in the back seat. Two words describe Fine’s book: bad timing. The “eye of Sauron,” as one grower described the federal presence in the Emerald Triangle, means that there are times when the habit of ignoring that pesky little federal cannabis scheduling problem can still land you in jail, official Mendocino yellow zip-tie program or not.

 On July 22, 2011, President Obama brought the Mendocino bubble in for a wobbly landing: “Am I willing to pursue a decriminalization strategy as an approach? No.” Federal authorities in the county seized a total of 725,000 plants in 2011. The Feds swooped down with “Operation Full Court Press” to clear growers out of Mendocino National Forest. Even the perennially optimistic Ethan Nadelman of the Drug Policy Alliance told Fine that “there’s only so much even a second-term Obama can do if the Republicans still control Congress.” This game, despite how it may look on the ground in Mendo, is still very much in the hands of the Feds. As an official for NORML admits, there could be “twenty years of this” yet to go.

To the DEA, local ordinances mean nothing. Shortly after Fine’s book ends, in early 2012, the cannabis market in the Emerald Triangle crashed after a series of raids and dispensary closures drastically limited medical outlets for their product.  By the end of the book, several of the growers have spent time in handcuffs—including the author himself, who didn’t care for the experience at all. It remains unclear whether he has written a celebratory book about the cannabis tipping point, or a eulogy for the death of the medical marijuana movement.

At this writing, cannabis activists appear to be genuinely baffled that Obama has not willingly adopted the mantle of “herb candidate” they wish to thrust upon him. But I do think Fine has at least a betting chance of being correct when he writes: “Like alcohol prohibition before it, commons sense, human desire, and economic inevitability will eventually prevail and the Drug War will end.”

Graphics Credit: http://humboldtherald.wordpress.com/

Addiction Books For the Beach

When 50 Shades of Grey doesn’t cut it.


The Science of Addiction: From Neurobiology to Treatment

Carlton K. Erickson
312 pages
Publisher: W. W. Norton and Company (2007)

Amazon Overview: Neuroscience is clarifying the causes of compulsive alcohol and drug use––while also shedding light on what addiction is, what it is not, and how it can best be treated––in exciting and innovative ways. Current neurobiological research complements and enhances the approaches to addiction traditionally taken in social work and psychology. However, this important research is generally not presented in a forthright, jargon-free way that clearly illustrates its relevance to addiction professionals. In The Science of Addiction, Carlton K. Erickson presents a comprehensive overview of the roles that brain function and genetics play in addiction.


The Addiction Solution: Unraveling the Mysteries of Addiction through Cutting-Edge Brain Science

David Kipper and Steven Whitney
304 pages
Publisher: Rodale Books (2010)

For decades addiction has been viewed and treated as a social and behavioral illness, afflicting people of “weak” character and “bad” moral fiber. However, recent breakthroughs in genetic technology have enabled doctors, for the first time, to correctly diagnose the disease and prove that addiction is an inherited, neuro-chemical disease originating in brain chemistry, determined by genetics, and triggered by stress. In their groundbreaking Addiction Breakthrough, David Kipper, MD, and Steven Whitney distill these exciting findings into a guide for the millions of adults who want to be free from the cycle of addiction, and for their loved ones who want to better understand it and to help.


In the Realm of Hungry Ghosts: Close Encounters with Addiction

Gabor Maté
520 pages
Publisher: North Atlantic Books (2010)

Based on Gabor Maté’s two decades of experience as a medical doctor and his groundbreaking work with the severely addicted on Vancouver’s skid row, In the Realm of Hungry Ghosts radically reenvisions this much misunderstood field by taking a holistic approach. Dr. Maté presents addiction not as a discrete phenomenon confined to an unfortunate or weak-willed few, but as a continuum that runs throughout (and perhaps underpins) our society; not a medical "condition" distinct from the lives it affects, rather the result of a complex interplay among personal history, emotional, and neurological development, brain chemistry, and the drugs (and behaviors) of addiction. Simplifying a wide array of brain and addiction research findings from around the globe, the book avoids glib self-help remedies, instead promoting a thorough and compassionate self-understanding as the first key to healing and wellness.


Memoirs of an Addicted Brain: A Neuroscientist Examines his Former Life on Drugs

Marc Lewis
336 pages
Publisher: PublicAffairs (2012)

Marc Lewis’s relationship with drugs began in a New England boarding school where, as a bullied and homesick fifteen-year-old, he made brief escapes from reality by way of cough medicine, alcohol, and marijuana. In Berkeley, California, in its hippie heyday, he found methamphetamine and LSD and heroin. He sniffed nitrous oxide in Malaysia and frequented Calcutta’s opium dens. Ultimately, though, his journey took him where it takes most addicts: into a life of addiction, desperation, deception, and crime. But unlike most addicts, Lewis recovered and became a developmental psychologist and researcher in neuroscience. In Memoirs of an Addicted Brain, he applies his professional expertise to a study of his former self, using the story of his own journey through addiction to tell the universal story of addictions of every kind.


The Chemical Carousel: What Science Tells Us About Beating Addiction

Dirk Hanson
472 pages
Publisher: BookSurge (2009)

A book for anyone concerned with the care and healing of addiction, substance abuse, and the latest advances in the area of addiction science. In The Chemical Carousel, science writer Hanson takes the reader on a voyage through the heady world of addiction science, from the lab to the clinic to the junky on the street. Hanson explains the workings of common neurotransmitters and documents the direct effect drugs and alcohol produce on the reward pathways of the brain. He shows how scientists and treatment professionals have finally given us an answer to the perennial question about addiction: Why can't those people just say no?


An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug, Cocaine

Howard Markel
336 pages
Publisher: Vintage (2012)

Acclaimed medical historian Howard Markel traces the careers of two brilliant young doctors--Sigmund Freud, neurologist, and William Halsted, surgeon--showing how their powerful addictions to cocaine shaped their enormous contributions to psychology and medicine. When Freud and Halsted began their experiments with cocaine in the 1880s, neither they, nor their colleagues, had any idea of the drug's potential to dominate and endanger their lives. An Anatomy of Addiction tells the tragic and heroic story of each man, accidentally struck down in his prime by an insidious malady: tragic because of the time, relationships, and health cocaine forced each to squander; heroic in the intense battle each man waged to overcome his affliction.


How to Change Your Drinking: a Harm Reduction Guide to Alcohol

Kenneth Anderson
86 pages
Publisher: CreateSpace (2010)

This book is the first comprehensive compilation of harm reduction strategies aimed specifically at people who drink alcohol. Whether your goal is safer drinking, reduced drinking, or quitting alcohol altogether, this is the book for you. It contains a large and detailed selection of harm reduction tools and strategies which you can choose from to build your own individualized alcohol harm reduction program. There are many practical exercises to help people change their behaviors, including risk-ranking worksheets, drinking charts, goal choice worksheets, and many more. There are also innumerable practical tips from folks who "have been there" and have turned their drinking habits around for the better.


Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It

William R. Miller and Kathleen M. Carroll
320 pages
Publisher: Guilford Press (2010)

While knowledge on substance abuse and addictions is expanding rapidly, clinical practice still lags behind. This state-of-the-art book brings together leading experts to describe what treatment and prevention would look like if it were based on the best science available. The volume incorporates developmental, neurobiological, genetic, behavioral, and social–environmental perspectives. Tightly edited chapters summarize current thinking on the nature and causes of alcohol and other drug problems; discuss what works at the individual, family, and societal levels; and offer robust principles for developing more effective treatments and services.

Writers On The Edge: 22 Writers Speak About Addiction and Dependency

Diana Raab and James Brown
204 pages
Publisher: Modern History Press (2012)

Writers On The Edge offers a range of essays, memoirs and poetry written by major contemporary authors who bring fresh insight into the dark world of addiction, from drugs and alcohol, to sex, gambling and food. Editors Diana M. Raab and James Brown have assembled an array of talented and courageous writers who share their stories with heartbreaking honesty as they share their obsessions as well as the awe-inspiring power of hope and redemption. Frederick & Steven Barthelme, Kera Bolonik, Margaret Bullitt-Jonas, Maud Casey, Anna David, Denise Duhamel, B.H. Fairchild, Ruth Fowler, David Huddle Perie Longo, Gregory Orr, Victoria Patterson, Molly Peacock, Scott Russell Sanders, Stephen Jay Schwartz, Linda Gray Sexton, Sue William Silverman, Chase Twichell, and Rachel Yoder

Photo Credit: http://www.readingkingdom.com/

Praising Marijuana Prohibition

The view from the White House.

As regular readers of Addiction Inbox will know, I am on record as favoring some form of decriminalization for marijuana. But I also write regularly about the difficulties of marijuana addiction and withdrawal. And I have been critical of the operational strategies employed by the medical marijuana movement in the several states in which it now operates. What I have not done, to date, is offer up the official view of a drug policy analyst from the Obama administration who straightforwardly favors a continuation of the legal prohibition against marijuana. 

One of the architects of the current federal resistance to marijuana legalization is Kevin Sabet, an assistant professor and the director of the Drug Policy Institute at the University of Florida College of Medicine. Sabet served from 2009 to 2011 in the Obama Administration as Senior Advisor for the White House Office of National Drug Control Policy (ONDCP) under Drug Czar Gil Kerlikowske, and was influential in shaping federal marijuana policy. Sabet consults with governments and NGOs on a wide range of drug policy prevention issues, and recently debated legalization advocate Ethan Nadelmann on CNN. He is also a regular columnist for thefix.com  and Huffington Post. He agreed to participate in a frank and lengthy 5-question interview with Addiction Inbox. (Be sure to check out the comments below).

1. In his new book, Too High to Fail, journalist Doug Fine argues that "the Drug War is as unconscionably wrong for America as segregation or DDT." Would you comment on this sweeping condemnation?

First, I think it is interesting to note that only people who want to condemn all of our current drug policies use the term "drug war." No one in serious policy circles uses that term anymore, and that is because it is woefully inadequate and vague as a way to describe a whole slew of policies designed to both reduce drug prevalence and drug consequences. I think his comparison is clumsy and unfair. Do some drug policies hurt disadvantaged groups? Of course they do. Is it a moral imperative to fix those policies, learn from our past mistakes and make our policies better? Of course it is. There's no reason to think that those policies can't be changed—in the White House in 2009, for example, we drastically reduced the penalty for crack cocaine. But what makes Mr. Fine's comparison even more wrong-headed and backwards is that we know that if we scale-up—not eliminate, as he would—the policies we know do work in reducing drug use and its consequences, all communities in America would benefit. A handful include:

(a) community-based prevention that not only focuses on stopping drug use among school kids, but in changing bad local laws and ordinances that promote underage drinking, smoking, and marijuana use (so-called "environmental policies");

(b) early intervention and detection of drug use in health settings;

(c) evidence-based treatment, including methadone and buprenorphine, as well as 12-step programs;

(d) recovery-based policies that don't penalize people for past drug use and instead facilitate recovery;

(e) law enforcement based on credible threats and modest sanctions.

2. The Drug War is an industry—the DEA alone has a budget of 2 1/2 billion and employs almost 10,000 people. If we add in profits from the private prison industry, and the money-laundering banks, the money is staggering. Wouldn't it make sense to recoup those historical costs by legalizing and taxing marijuana?

That phrase assumes two things: (a) criminal justice and regulation costs would be drastically reduced, or eliminated, with marijuana legalization; and (b) the underground market would be eliminated with marijuana legalization. Both of those assumptions are huge leaps that don't stand up to our experience with our already two legal drugs—alcohol and tobacco.

First, we know that legalization means more consumption. More consumption means more regulation. Today we have liquor laws, laws against drinking and driving, laws against public drunkenness, etc. With regards to legal alcohol, we make 2.6 million arrests every year for the violation of those laws. Meanwhile, we arrest a million fewer times for illegal drugs (1.6 million/year). Legal alcohol costs us money with regards to crime and regulation. I think that is a big consideration in this whole debate that we rarely hear about. So that means we'd have to have more prisons, more police, and more regulation costs under legalization—especially since few people are in prison or jail solely for marijuana use.

And I'm not so sure the underground market would be eliminated with marijuana legalization. Especially if it is taxed heavily, the incentive for the underground market—having been painstakingly established for decades by multinational corporate structures (cartels)—is very little. We'll still need a black market for underage marijuana, for marijuana to be sold to repeat offenders, etc. I just don't see the cartels throwing up their hands and saying "OK, it's legalized. We're out of the game now. Let's get into the ice cream business."

3. A "Pax Cannabis" would require rescheduling marijuana at the federal level, with an overt recognition that marijuana has some redeeming medical value. What's the argument for maintaining cannabis as a Schedule 1 drug along with heroin, a drug with which it has almost nothing in common? Could you comment on the upcoming U.S. Appeals Court consideration of medical marijuana?

Rescheduling marijuana is one of the biggest red herrings I can think of in this debate. If rescheduled tomorrow, it would do nothing to allow marijuana to be sold legally. Rather, it would be a huge symbolic victory for marijuana advocates -- but it would be wholly wrong on the science. Placing a drug in schedule 1 simply means the drug has no medical use and a high potential for abuse. It has nothing to do with the other drugs in that category (e.g. heroin). If it were a drug, a telephone would also need to be in Schedule 1 - I'm addicted to my cell phone and I know it has no medical use. That doesn't mean a phone is as dangerous as a syringe of heroin.  Today, cocaine is Schedule 2 because it has some very limited hospital use. Can a 21-year-old kid with no medical knowledge sell cocaine from a "dispensary" called "Happy Clinic" legally? Of course not, though that is what is happening [with marijuana] in California.

In order to be used for medical use, a specific product needs to be approved by FDA. Marijuana's specific product, so far, is Marinol, a Schedule 3 drug which has been approved by FDA and is used by people throughout the world. Crude, raw marijuana is not a specific product. The best way I can put it is this: We don't smoke opium to get the effects of morphine, so why do we think we need to smoke marijuana to get its potential medical effects? We have non-inhaled medications that are approved and we have others on the way. For a lot more on this, you can check out an article I wrote for Join Together. I think the District court opinion will rest on the science and agree with the Department of Health and Human Services that raw, crude marijuana is not medicine.

4. Alaska decriminalized marijuana in 1975, and only recriminalized after lengthy pressure from the Reagan administration. Isn't cultivation of this flowering weed for personal use the most obvious and straightforward solution?

The Reagan Administration could have cared less about Alaska, frankly. Alaska recriminalized because voters there wanted that to happen. They didn't like the effect of decriminalization on their state. That said, I don't think many people are in favor—and I am not—of locking up people smoking small amounts of marijuana. That isn't happening anywhere. One notable exception is New York City where they impose 24-hour detentions for public use and selling as part of their broken windows approach to crime control.

Indeed, in the 1970s, twelve states formally decriminalized marijuana. This meant that persons found to have a small amount of marijuana were not subject to jail time, but rather they would receive a civil penalty, such as a fine. The discussion in the United States is highly complex because even in jurisdictions without a formal decriminalization law, persons are rarely jailed for possessing small amounts of cannabis. A rigorous government analyses of who is in jail or prison for marijuana found that less than 0.7% of all state inmates were behind bars for marijuana possession only (with many of them pleading down from more serious crimes).[1] Other independent research has shown that the risk of arrest for each “joint,” or cannabis cigarette, smoked is about 1 arrest for every 12,000 joints.[2] This probably explains the fact that the literature on early decriminalization effects on use has been mixed. Some studies found no increase in use in the so-called “depenalization” states, whereas others found a positive relationship between greater use and formal changes in the law.[3]

The more recent discussion about state-level legalization may provide more insights. Two RAND Corporation reports concluded that legalization would result in lower cannabis prices, and thus increases in use (though by how much is highly uncertain), and that “legalizing cannabis in California would not dramatically reduce the drug revenues collected by Mexican drug trafficking organizations from sales to the United States.”[4]

5. Marijuana advocates don't like to hear it, but pot is addictive for some users. Where do you stand on this controversial issue?

Science tells us that marijuana is addictive—about 1 in 11 people who ever smoke marijuana are addicted; but if you start in adolescence that number climbs to 1 in 6. That's not anyone's opinion but rather the result of rigorous scientific research done by the National Institutes of Health and confirmed by other international scientific bodies. Is marijuana as addictive as tobacco cigarettes? No. The addiction rate for tobacco is about 1 in 3; for heroin it is lower, about 1 in 4. Users who try to quit experience withdrawal symptoms that include irritability, anxiety, insomnia, appetite disturbance, and depression.

A United States study that dissected the National Longitudinal Alcohol Epidemiologic Survey (conducted from 1991 to 1992 with 42,862 participants) and the National Epidemiologic Survey on Alcohol and Related Conditions (conducted from 2001 through 2002 with more than 43,000 participants) found that the number of cannabis users stayed the same while the number dependent on the drug rose 20 percent ­ from 2.2 million to 3 million.[5]Authors speculated that higher potency marijuana may have been to blame for this increase. As I've heard said many times by experienced tokers, "this isn't your Grandfather's Woodstock Weed."

[1] “Substance Abuse and Treatment, State and Federal Prisoners, 1997.” BJS Special Report, January 1999, NCJ 172871. http://www.ojp.usdoj.gov/bjs/pub/pdf/satsfp97.pdf

[2] Beau Kilmer, Jonathan P. Caulkins, Rosalie Liccardo Pacula, Robert J. MacCoun, Peter H. Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010.

[3] For a discussion see MacCoun, R., Pacula, R. L., Reuter, P., Chriqui, J., Harris, K. (2009). Do citizens know whether they live in a decriminalization state? State cannabis laws and perceptions. Review of Law & Economics, 5(1), 347-371.

[4] Beau Kilmer, Jonathan P. Caulkins, Rosalie Liccardo Pacula, Robert J. MacCoun, Peter H. Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010. And see Kilmer, Beau , Jonathan P. Caulkins, Brittany M. Bond and Peter H. Reuter. Reducing Drug Trafficking Revenues and Violence in Mexico: Would Legalizing Cannabis in California Help?.Santa Monica, CA: RAND Corporation, 2010. http://www.rand.org/pubs/occasional_papers/OP325. Also available in print form.

[5] ]Compton, W., Grant, B., Colliver, J., Glantz, M., Stinson, F. Prevalence of Cannabis Use Disorders in the United States: 1991-1992 and 2001-2002Journal of the American Medical Association.. 291:2114-2121.

Photo Credit:http://article.wn.com/

Synthetic Drugs: Collected Posts

Catching up with bath salts and spice.


The Low Down on the New Highs: Not all bath salts are alike.

“You’re 16 hours into your 24-hour shift on the medic unit, and you find yourself responding to an “unknown problem” call.... Walking up to the patient, you note a slender male sitting wide-eyed on the sidewalk. His skin is noticeably flushed and diaphoretic, and he appears extremely tense. You notice slight tremors in his upper body, a clenched jaw and a vacant look in his eyes.... As you begin to apply the blood pressure cuff, the patient begins violently resisting and thrashing about on the sidewalk—still handcuffed. Nothing seems to calm him, and he simultaneously bangs his head on the sidewalk and tries to kick you...” [Go here]


The New Highs: Are Bath Salts Addictive? What we know and don’t know about synthetic speed.

Call bath salts a new trend, if you insist. Do they cause psychosis? Are they “super-LSD?” The truth is, they are a continuation of a 70-year old trend: speed. Lately, we’ve been fretting about the Adderall Generation, but every population cohort has had its own confrontation with the pleasures and perils of speed: Ritalin, ice, Methedrine, crystal meth, IV meth, amphetamine, Dexedrine, Benzedrine… and so it goes. For addicts: Speed kills. Those two words were found all over posters in the Haight Ashbury district of San Francisco, a few years too late to do the residents much good…. [Go here]


“Bath Salts” and Ecstasy Implicated in Kidney Injuries: “A potentially life-threatening situation.”

Earlier this month, state officials became alarmed by a cluster of puzzling health problems that had suddenly popped up in Casper, Wyoming, population 55,000. Three young people had been hospitalized with kidney injuries, and dozens of others were allegedly suffering from vomiting and back pain after smoking or snorting an herbal product sold as “blueberry spice.” The Poison Review reported that the outbreak was presently under investigation by state medical officials.  “At this point we are viewing use of this drug as a potentially life-threatening situation,” said Tracy Murphy, Wyoming state epidemiologist…. [Go here]


The Triumph of Synthetics: Designer stimulants surpass heroin and cocaine.

A troubling report by the United Nations Office on Drugs and Crime (UNODC) shows that amphetamine-type stimulants (ATS) have, for the first time, become more popular around the world than heroin and cocaine. Marijuana remains the most popular illegal drug in the world, and the use of amphetamines has fallen sharply in the U.S., but the world trend represents the worldwide triumph of synthetic drug design over the plant-based “hard drugs” of the past…. [Go here]

Marijuana: The New Generation: What’s in that “Spice” packet?

They first turned up in Europe and the U.K.; those neon-colored foil packets labeled “Spice,” sold in small stores and novelty shops, next to the 2 oz. power drinks and the caffeine pills. Unlike the stimulants known as mephedrone or M-Cat, or the several variations on the formula for MDMA—both of which have also been marketed as Spice and “bath salts”—the bulk of the new products in the Spice line were synthetic versions of cannabis…. [Go here]


An Interview with Pharmacologist David Kroll: On synthetic marijuana, organic medicines, and drugs of the future.

Herewith, a 5-question interview with pharmacologist David Kroll, Ph.D., Professor and Chair of Pharmaceutical Science at North Carolina Central University in Durham, and a well-known blogger in the online science community. A cancer pharmacologist whose field is natural products—he’s currently involved in a project to explore the potential anticancer action of chemicals found in milk thistle and various sorts of fungi—Dr. Kroll received his Ph.D. from the University of Florida, and completed his postdoctoral fellowship in Medical Oncology and Molecular Endocrinology at the University of Colorado School of Medicine. He went on to spend the first nine years of his independent research and teaching career at the University of Colorado School of Pharmacy, where he taught all aspects of pharmacology, from central nervous system-active drugs, to anticancer and antiviral medications…. [Go here]


Mephedrone, the New Drug in Town: Bull market for quasi-legal designer highs.

Most people in the United States have never heard of it. Very few have ever tried it. But if Europe is any kind of leading indicator for synthetic drugs (and it is), then America will shortly have a chance to get acquainted with mephedrone, a.k.a. Drone, MCAT, 4-methylmethcathinone (4-MMC), and Meow Meow--the latter nickname presumably in honor of its membership in the cathinone family, making it chemically similar in some ways to amphetamine and ephedrine. But its users often refer to effects more commonly associated with Ecstasy (MDMA), both the good (euphoria, empathy, talkativeness) and the bad (blood pressure spikes, delusions, drastic changes in body temperature)…. [Go here]


Tracking Synthetic Highs: UN office monitors designer drug trade.

Produced by the United Nations Office on Drugs and Crime (UNODC), the Global SMART Update  (PDF) for October provides interim reports of emerging trends in synthetic drug use. The report does not concern itself with cocaine, heroin, marijuana, alcohol, or tobacco. “Unlike plant-based drugs,” says the report, “synthetic drugs are quickly evolving with new designer drugs appearing on the market each year.” The update deals primarily with amphetamine-type stimulants, but also includes newer designer drugs such as mephedrone, atypical synthetics like ketamine, synthetic opioids like fentanyl, and old standbys like LSD…. [Go here]


The New Cannabinoids: Army fears influx of synthetic marijuana.

It’s a common rumor: Spice, as the new synthetic cannabis-like products are usually called, will get you high--but will allow you to pass a drug urinalysis. And for this reason, rumor has it, Spice is becoming very popular in exactly the places it might be least welcomed: Police stations, fire departments—and army bases. What the hell is this stuff? [Go here]

Photo credit: http://gizmodo.com/

photo credit 2: http://www.clemson.edu/

Books By Addicts: A Collection

The Up and the Down.
 
(Click titles for full review)

Steve Earle and the Ghost of Hank Williams: I’ll Never Get Out of This World Alive

Musician Steve Earle made a solo name for himself with "Guitar Town" and "Copperhead Road" after playing in legendary country and bluegrass bands as a young prodigy. He was nominated for a Grammy, his reputations soared, he added rock and roll to his range—until 1991, when Earle put out the aptly named live album, Shut Up and Die Like An Aviator. Shortly thereafter, he was dropped by his record label for long-standing drug problems, and landed in prison with a heavy sentence for possession of heroin….






When Did I Become the Junkie Auntie Mame? Courtney Love tells her tangled tale in a new e-book.

Maer Roshan, author of Courtney Comes Clean: The High Life and Dark Depths of Music’s Most Controversial Icon, logged a dozen “exhilarating and exhausting” sessions with the widow of Nirvana’s Kurt Cobain over the course of a year, pulling together a definitive look at Love’s drug addictions and other demons. Roshan taped countless hours of interviews, and received additional written material from the “Tolstoy of texting,” as Love refers to herself. The book is highly readable, almost, one is tempted to say, addictively so. Sure, it’s tabloid stuff—let he or she who has never peeked at Gawker or Jezebel cast the first stone….





Mike Doughty Talks About The Book of Drugs: Former Soul Coughing front man on sobriety and life as a solo artist.

Over the phone, Mike Doughty doesn’t have much to say about his former band, Soul Coughing. When I mention it, he gives out a low growl as a warning. He said it all in The Book of Drugs, and it doesn’t sound like he had much fun. Although the avant-garde rock band created music that was spiky and sneaky and immensely popular, topped off by Doughty’s monotonic but strangely penetrating vocal delivery on such classics as “Super Bon Bon,” “True Dreams of Wichita,” and “Circles,” Doughty was drug-dependent and miserable….






Writers On The Edge: A compendium of tough prose and poetry about addiction

Here’s a book I’m delighted to promote unabashedly. I even wrote a jacket blurb for it. I called it an “honest, unflinching book about addiction from a tough group of talented writers. These hard-hitters know whereof they speak, and the language in which they speak can be shocking to the uninitiated—naked prose and poetry about potentially fatal cravings the flesh is heir to—drugs, booze, cutting, overeating, depression, suicide. Not everybody makes it through. Writers On The Edge is about dependency, and the toll it takes, on the guilty and the innocent alike.”






Book Review of Drunken Angel: A hipster gets his shit straight—sort of.

Addiction memoirs remain one of the most popular forms of autobiography on the shelves. But now, when considering a new addition to the genre, it’s impossible not to wonder whether the claims being made by the author are genuine. Since serious drunks often end up visiting the lower circles of hell during the course of their disease, hair-raising and improbable scenes are lamentably common—that is part of the genre’s charm, if that is the right word for it. But how are we to react now? The answer is, you can’t know, and you never really could, that bastard James Frey notwithstanding....






Addiction Fiction: Coming-of-Age Drug Novels

Call it “addiction fiction.” In the past few years we have seen a blossoming of this genre, where the private eye goes to 12-Step meetings, and one day your sponsor may just save your life by gunning down a rival in the street. Or, where the wise-beyond-their-years prep school drug addicts engage in Brett Easton Ellis-style sex and ennui….








Addiction Noir: The Next Right Thing

To date, I’ve only reviewed one novel here at Addiction Inbox—Steve Earle’s I’ll Never Get Out of This World Alive, featuring the ghost of Hank Williams standing in for the addictive pleasures that musicians are heir to. Now comes The Next Right Thing by Dan Barden, an exemplar of a new literary genre I am going to call addiction noir….








John Berryman and the Poetry of “Irresistible Descent”: The penal colony’s prime scribe

A year before he committed suicide by jumping off a Minneapolis bridge in 1972, Pulitzer Prize-winning poet John Berryman had been in alcohol rehab three times, and had published a rambling, curious, unfinished book about his treatment experiences. Recovery is a time capsule. If you think we have little to offer addicts by way of treatment these days, consider the picture in the 60s and 70s. In Recovery, treatment consists almost entirely of Freudian group analysis, and while there is regular talk of alcoholism as a disease, AA style, there is no evidence that it was actually dealt with in this way, after detoxification....

Weight Loss Redux

Why diet pills are problematic.

"Physicians who treat obesity hailed the Food and Drug Administration's recent approval of two new diet drugs—the first in 13 years—as a new era in weight-loss management."
--Wall Street Journal, July 30, 2012

 (The following post was originally published on September 20, 2011)

It took many years to bring depression and its treatment into the rational light of day. Addiction in the mid-1990s was in the process of undergoing a similar medical transformation. Even so, scientists were wary of pronouncing that overeating was in some cases a treatable chemical disorder.

Obesity, in any form other than pituitary cases, was not typically considered a medical disorder at all. In a 1998 interview with MIT’s student newspaper, The Tech, neurology professor Richard Wurtman recalled that ten years earlier, the major drug companies had shown little interest in a drug treatment for obesity: “They thought that if you were obese, it was your fault.” It was the same view that had prevailed concerning depression, alcoholism, and other drug addictions. Bulimia and carbohydrate craving were no different: a simple failure of will was once thought to explain them all. But everything changed when the serotonin-boosting diet pill called Redux (dexfenfluramine) won full FDA approval in 1996. Redux was the first drug ever approved in the U.S. for the long-term treatment of obesity.

In truth, Ely Lilly and Company did move forward with earlier efforts to win approval of high-dose Prozac for weight loss. That petition had been languishing in the FDA pipeline for years under the trade name Lovan. Back in the late 1980s, when Eli Lilly scientists were investigating rats that consumed fewer calories on fluoxetine, the company called upon Dr. Richard Wurtman, the MIT brain scientist who specialized in the connection between serotonin levels and carbohydrate intake. Scientists at Lilly had become increasingly concerned that the weight loss from Prozac was short-lived, and the mechanism of action remained maddeningly imprecise. For more than a decade, Eli Lilly had pursued Prozac along three separate but related lines of development: depression, weight control, and alcoholism. If you took it for depression, and it worked, you might also lose a few pounds, and drink less. If you took it for bulimia or weight loss, you might also feel better emotionally, and drink less. When the FDA made encouraging noises about Prozac as a new front-line treatment for bulimia in 1994, Eli Lilly followed that indication to market, and again chose not to follow up on weight loss or alcoholism.

Eli Lilly was no longer interested, but Richard and Judith Wurtman were undeterred. As it happened, the couple had already patented a serotonin-active drug of their own—dexfenfluramine—which French laboratories had been testing as a weight loss pill. The Wurtmans went public with a new company, Interneuron Pharmaceuticals, and filed with the FDA to market their weight-loss remedy. The Wurtmans became instant millionaires on paper.

“Diet pills” had always had a somewhat unsavory reputation. Typically, they were amphetamines, or the near-beer equivalent, ephedrine—and neither compound was anything like a healthy long-term answer to chronic overeating. The serotonin-active drugs were a new class of medications altogether. Dexfenfluramine wasn’t addictive, any more than Prozac was addictive. Moreover, fenfluramine was specifically intended for use by people suffering from carbohydrate-craving obesity. But would doctors be able to resist the demands of other patients who just wanted to trim off a few pounds?

Initially, the Wurtmans licensed the serotonin-active weight loss drug to several marketers in Europe, where it met with initial success. After a few small-scale studies, Rochester University in New York published a report showing that the weight loss effect was enhanced when fenfluramine was combined with a drug called phentermine. The resulting combination was widely known as “phen-fen.” As with Prozac, dexfenfluramine was tested as an anti-obesity medication at dosages several times higher than the amount typically prescribed for depression.

Early red flags were raised when Johns Hopkins researchers reported some cases of neurological toxicity in monkeys on dexfenfluramine, but MIT, which shared patent rights with the Wurtmans, was understandably enthusiastic when Redux, as dexfenfluramine became known, won full FDA approval in 1996.

And for many people, Redux worked. In the first six months after its approval, physicians wrote at least two million prescriptions for Redux. The phen-fen combination swept the weight loss industry. Estimates of total users of phen-fen ran as high as six million in the U.S. alone. Doctors and weight loss clinics sometimes prescribed Redux, sometimes the phen-fen combination. Initial earnings estimates were running as high as $600 million a year for the Redux portion of phen-fen, netting MIT between one and five per cent of the royalties.

The euphoria didn’t last long. By the time Redux made the cover of Time, researchers were already rumbling about continued reports of high toxicity and hypertension in rat studies. In addition, the serotonin surge associated with the use of dexfenfluramine caused concerns about pulmonary hypertension. In August of 1997, doctors at the Mayo Clinic in Minnesota reported serious heart valve abnormalities in 24 women taking the phen-fen combination.

A month later, at the FDA’s request, phen-fen and Redux were permanently pulled off the market.  In 2002, American Home Products settled a class action suit on behalf of almost 300,000 phen-fen users for $3.75 billion. As class action suits go, this put it right between the $2.4 billion Dalkon Shield settlement and the $4.5 billion breast implant accords.

What went wrong? Researchers now believe that the two drugs, which were never offered for sale as a single pill, should never have been combined in the first place. Somehow the fact that the phen part of the combination allegedly acted as an MAO inhibitor, and hence should not have been combined with yet another serotonin-enhancing medication, escaped notice. The combination of the two drugs apparently raised blood plasma levels of serotonin to abnormal levels. Too much serotonin in the bloodstream can damage blood vessels in the heart and lungs. Other suspected MAO inhibitors, like St. John’s Wort, or the Chinese herbal remedy ma huang, would not have combined well with Redux or phen-fen, either. Referring to the casual use of Ecstasy, Dr. Rick Doblin drew a parallel with phen-fen in the autumn 1995 issue of the Multidisciplinary Association for Psychedelic Studies (MAPS):

This use of MDMA, though not conducted in the context of a scientifically controlled experiment, does provide an opportunity for a very large epidemiological study. Similarly, over fifty million people have tried a prescription drug called fenfluramine, a diet aid prescribed for daily use for months or years at a time that causes the same kind of neurotoxicity in animals as does MDMA.

The phen-fen disaster highlighted the need to investigate drug synergies thoroughly before combining them as a pharmacotherapy. The phen-fen heart and lung damage may have been related to a potentially toxic condition known as “serotonin syndrome.”

And the Wurtmans? Ironically, Richard and Judith Wurtman had patented the use of Prozac for severe PMS years earlier, and ultimately sublicensed the rights back to Eli Lilly for several million dollars. Eli Lilly disguised the fact that their PMS drug was a case of old wine in new bottles. As Wellbutrin had become Zyban, so Prozac metamorphosed into Serafem, when prescribed for premenstrual syndrome.

Photo Credit: http://www.drugnet.net/