Alternatively, the federal drug warriors might give in on medical marijuana, moving it to Schedule II or III so doctors could prescribe it, and thereby put a "friendly face" on prohibition, exactly as Thomas Szasz fears. The multi-state initiative strategy is designed, in part, to force or facilitate the rescheduling of marijuana, with the underlying risk of relieving pressure for reform. If federal officials choose to build a firewall behind medical marijuana, but in front of legalization, hopes for repeal of prohibition would dim.
But is it really plausible that the guardians of prohibition would make that move? The ban on medical use of marijuana is rooted in the restrictions established by the 1937 law that banned recreational use, a mistake Congress failed to fix when it rewrote the drug laws in 1970. Compelling studies of marijuana's therapeutic potential in the late 1970s and early '80s did not affect federal policy, so it is difficult to believe today's proclamations that science will resolve this issue. The evidence suggests that the drug warriors believe prohibiting medical use is crucial to the overall policy of intolerance toward marijuana.
If the problem is ideological, it may be impossible to get a concession. The never-ending frustration of medical marijuana advocates is that the drug war can't seem to accommodate a modest reform like making cannabis available by prescription. By the same token, such a reform could be devastating to the war on the drugs. That, at least, seems to be the understanding of hard-core drug warriors.
Whatever the federal reaction, the fight for medical marijuana offers benefits that abolitionist critics often overlook. In addition to being a compassionate step in itself, changing state laws on medical marijuana tends to put the right issues into play and the right people on the defensive. It raises questions about the nature of drug prohibition and the rationality of its enforcers. It enhances the credibility of reformers and attracts allies who may ultimately be persuaded to support more radical change.
With those benefits in mind, medical marijuana initiatives should neither stoke nor calm fears about the medicalization of drug policy. Permitting the medical use of marijuana does not, as Thomas Szasz has written in Liberty, endorse the "fiction that self-medication is a disease" or declare "punishing it a treatment." The mechanism for allowing medical use is to carve exemptions into existing criminal laws. That seems to reduce the power of the state, especially since it forces those charged with implementation to change their tactics, sometimes fundamentally. Police in California, for example, are learning that marijuana they seize may be someone's medicine, in which case they have to give it back.
If opponents of the drug war want to have an impact, rather than focusing on the perfect policy or waiting for revolutions in the public's thinking, we have to reach out to new people, find working compromises, and advance concrete proposals. Proposals rooted in medicalization concepts currently have the greatest public appeal, notwithstanding the recent vote in Washington state. The more moderate and sensible our proposals seem, the better our chances of success. At the same time, if it is true that any successful challenge to the drug war, even on a relatively narrow issue, threatens an overly rigid paradigm, so much the better. We can't count on overthrowing the generals with modest peace offerings. But in the very strange world of U.S. drug policy, it just might happen.
Dave Fratello, previously with the Drug Policy Foundation, is communications director for Americans for Medical Rights, a Los Angeles-based group that ran California's Proposition 215 campaign and is sponsoring medical marijuana initiatives in several states.
Medicalization and Scientism
By John P. Morgan
Medicalization--the idea that drug consumption can be understood by a scientific assessment of what drugs do in the body and brain--is not new. Many physicians in the late 19th century tried to explain heroin or morphine addiction as a kind of allergic reaction: The repeated injection of opiates permanently changed the user's physiology, creating an illness requiring lifelong use of the drug.
Today, medicalization relies on apparently scientific explanations of the neurobiological mechanisms underlying addiction. Research in this area is increasingly complex, if not abstruse, and journalists look to the investigators themselves to explain how important and revealing it is. These scientists take a pharmacocentric approach, focusing on the drug as the cause of behavior and ignoring other factors. Their reports are scientistic, using the neutral language of neurobiology to disguise value judgments. Investigators usually assert that results from animal or cell-culture experiments are clearly relevant to humans. Indeed, they often claim that a given study "proves" the existence of a human drug reaction that cannot be found among humans.
Two highly publicized studies reported in the June 27, 1997, issue of Science illustrate these tendencies. In one, Fernando Rodriguez de Fonseca and other investigators at the Scripps Research Institute in La Jolla gave rats daily injections of a synthetic drug resembling delta-9 tetrahydrocannabinol (THC), the main active ingredient in marijuana, for two weeks. Then they gave the rats a cannabinoid antagonist, which stripped the THC-like drug from its receptor sites. This provoked a withdrawal syndrome lasting an hour or so, featuring tremors, hyperactivity, and defensive posturing. The researchers also measured increases in brain concentrations of corticotropin-releasing factor (CRF), a neural hormone. Such increases have been seen in rodents undergoing alcohol and heroin withdrawal.
The study and an accompanying editorial said these findings confirmed cannabinoid withdrawal in humans and provided evidence that increases in CRF create anxiety that drives marijuana users to ingest other drugs. De Fonseca et al. claimed their study therefore offered support for the "gateway" theory, which says smoking marijuana leads to the use of cocaine and heroin.
In the second study, Gianluigi Tanda and other researchers at the University of Cagliari in Italy measured the release of dopamine in the mesolimbic area of the rodent brain following injection of THC, a THC-like synthetic, and heroin. Neurobiologists have long wondered if cannabinoids raise extracellular dopamine in this brain area because such increases are triggered by many drugs that humans use for pleasure, including heroin, alcohol, amphetamine, nicotine, and cocaine. Prior to the Tanda study, evidence of dopamine release caused by injection of cannabinoids was equivocal.
In their report, Tanda and his colleagues unhesitatingly compared marijuana to heroin and, like de Fonseca et al., invoked their rodent findings as evidence for the much-discussed gateway theory. They speculated that marijuana use, by increasing dopamine, "primes" the brain, so the dissatisfied cannabis smoker will be drawn to heroin for the familiar dopamine rush.
Both studies were widely covered in American newspapers, framed in just the way suggested by the researchers. Their extrapolations to humans were reported without qualification, and their results were described as "new evidence" of marijuana addiction and a gateway effect.
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