This unscientific interpretation ignored the findings of prior research involving both animals and humans. Rodents and primates will not self-administer THC or other cannabinoids even when they have been primed with repeated injections and abrupt withdrawal. Simply put, these animals do not like pot; they find small doses unappealing and large doses aversive. Hence the de Fonseca study, in which the researchers went to great lengths to precipitate a short-lived cannabinoid withdrawal reaction in rats, has no obvious relevance to animal behavior, let alone human use, which typically involves smoking small amounts of cannabis episodically, with THC declining slowly after each session.
De Fonseca et al.'s most egregious extrapolation was their speculation that cannabis smokers move to other drugs because of the "anxiety" seen in withdrawal. It is difficult to show any marijuana withdrawal phenomenon in humans, and I know of no study that links cessation of cannabis use with the use of other drugs. Yet somehow the release of a neural hormone in rats signaled to the researchers that human cannabis users suffer abstinence anxiety that they try to alleviate with cocaine or heroin.
Similarly, it's hard to know what to make of the dopamine increases found in the Tanda study, since rats do not actually like cannabinoids. Earlier research in this area was based on the theory that reinforcing drugs raise dopamine levels. Now we have an experiment linking increased extracellular dopamine with a compound that is not reinforcing in rodents and has not been shown to be an important drug of dependence in humans. There are many drugs that increase extracellular dopamine which humans do not find attractive, including levodopa, tricyclic antidepressants (Elavil, Tofranil), and anticholinergics (atropine, Artane).
These attempts to scare people about marijuana through animal studies, because actual human experience with the drug is not alarming enough, suggest the pitfalls of the biological reductionism on which medicalization depends. Where medicalization is the practice, scientism is the theory.
John P. Morgan, a physician and professor of pharmacology at the City University of New York Medical School, is co-author of Marijuana Myths, Marijuana Facts (Lindesmith Center).
Show Me the Data
By George D. Lundberg
My personal activities in the field of substance abuse go back about 30 years to my time as a faculty member at the University of Southern California in Los Angeles. I am, by training and experience, a forensic pathologist and a toxicologist. The 1960s in Los Angeles were the early heyday of our modern drug abuse epidemic and provided a natural laboratory for studying voluntary human street drug experimentation, informing the academic and clinical fields, albeit with great pain and sadness.
I define drug as any chemical which, when administered to a living thing, produces an effect. I define drug abuse as the use of a drug in a manner that is likely to cause harm. This definition deliberately ignores law and medical practice because most drug abuse is legal (alcohol and tobacco) or within the bounds of medical practice (e.g., prescription sedatives). For practical purposes, drug abuse is confined to psychoactive drugs, which are chemicals that affect the way a person thinks, feels, or behaves. Drug use is not necessarily a problem; harm from drug use is the problem. Of course, you cannot have drug harm without drug use, but you can have drug use without drug harm.
We in the new group called Physician Leadership on National Drug Policy (PLNDP) believe that scientific evidence should drive American drug policy and that up to this point it has not. The PLNDP is a group of leading physician activists and pragmatists who intend to work with the public and with policy makers to improve the lives of our patients and our communities by reducing drug harm.
Chronic psychoactive drug use can lead to addiction, which is a chronic illness. Addiction does not go away. Physicians don't always strive for cures. We generally don't cure hypertension, arthritis, diabetes, or asthma, for example, but we can medically manage them quite well. The same is true with chronic chemical addiction. We cannot cure it, but we can manage it, often successfully, at a reasonable cost to society.
We in the PLNDP believe that when one considers the tens of billions that our federal and state governments spend each year on drug control, we should be getting better results. We should be applying principles of scientific evidence to the various methods available to intervene in the drug field--for primary prevention, secondary prevention, treatment, and rehabilitation. Available evidence strongly suggests that emphasizing source control, interdiction, and domestic enforcement--methods that account for 75 percent of drug control spending--is a very inefficient strategy. It is clear that the government is throwing large amounts of taxpayer money away each year. We don't have all the answers yet, but we do know that proven treatment methods offer a more cost-effective alternative.
Drug law enforcement has a place, but not necessarily the premier place, because the evidence does not support that approach. Now that the U.S. military (of which I was a loyal full-time member for 11 years) has run out of real wars to fight, it is getting involved in phony wars on marijuana fields in Mexico and coca fields in Bolivia. Let's stop playing drug war games. They are no longer entertaining, and they don't work.
George D. Lundberg is editor of The Journal of the American Medical Association.
Defending the Public Health Trademark
By Ernest Drucker
Public health is concerned with the well-being of populations and therefore shares with medicine the goal of reducing suffering due to disease. But its "patient" is the community and its measure of successful "treatment" is the reduction of collective morbidity and mortality, usually measured in terms of prevention. Indeed, clinical medicine exists as a function of public health's failure: It treats the casualties of unhealthy social policy and poor public health practice.
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