Letters

From the June 1998 issue

Drug Medicalization

Your symposium about national drug policy ("Drug Trial," March) does a service in arguing for more stress on harm reduction and treatment. I agree. Without legalizing any illicit drug, a great deal can be done to achieve demand reduction by prevention and treatment, and by decriminalizing the small-time user.

Voter initiatives to effectively legalize illicit drugs under the pretext of unproved medical benefits are dangerous. Which drugs should be available for medical purposes is a technical question that voters are not qualified to decide.

To allow that would undercut our system of consumer protection through the Food and Drug Administration. This system, of which America can truly be proud, sets scientific--not ideological--standards to ensure that only safe and efficacious medications can be marketed. Drugs like cocaine and morphine, illicit on the street, are nevertheless classified in Schedule II and are available by prescription for legitimate medical purposes.

If convincing evidence shows a real medical value for marijuana (or its active principle, THC), it will certainly pass FDA scrutiny and will then be reclassified and become part of normal pharmacotherapy. My opposition to these medical marijuana initiatives has nothing to do with marijuana per se, but with a concern for not bypassing the FDA procedure.

Avram Goldstein, M.D.
Professor Emeritus of Pharmacology
Stanford University
Stanford, CA

When discussing whether or not "medicalization" is an appropriate way out of the drug war quagmire, it is helpful to agree first on what the word means. "Medicalization" is defined by many as the approach which treats drug use--or abuse--as a public health problem, rather than a criminal justice concern. This seems like a good starting definition. Consequently, I have trouble referring to both November 1996 initiative victories --Propositions 200 and 215 in Arizona and California, respectively--as "medicalization" initiatives.

In Arizona, voters changed the law to remove jail time as an option for people arrested for using illicit drugs. The voters saw the use of cocaine, heroin, LSD, and other drugs as a "problem" where treatment, as opposed to prison, is the more appropriate governmental response.

In California, however, voters didn't see the use of marijuana as the problem. Rather, they saw medicinal marijuana use as the solution to health problems such as cancer, AIDS, glaucoma, and multiple sclerosis.

As we continue to pass good state legislation and win state initiatives, it will be increasingly important for us to develop a more nuanced drug war vocabulary. We are already having problems with this, as evidenced by the confusion over Initiative 685 in Washington state, which was defeated by the voters in November 1997. Advocates, opponents, and the media still refer to that initiative as a "medical marijuana" initiative. In truth, the "medical marijuana" provision was a subset of the "medical marijuana, heroin, and LSD" section--which included all Schedule I drugs--and this was only a small subset of the entire initiative, which was nearly identical to the Arizona initiative.

This confusion has very real policy consequences. Testifying in favor of medicinal marijuana legislation before the Washington state legislature on January 20, I explained that they should pass the bill because, among other things, the voters strongly support it. The chair of the committee responded by asking why the voters had just rejected Initiative 685. I raised my hands in frustration, explaining that they were two entirely different animals. That bill is now dead.

Let us hope that the public discourse is more informative in the months to come, as Washington state voters will have another opportunity to vote on an initiative--this one a pure medicinal marijuana initiative--in November.

Robert D. Kampia
Executive Director
Marijuana Policy Project
Washington, DC

I read with interest your roundtable in the March REASON. My graduate thesis concerns the use of suspicionless drug testing as a "prevention" and "addict identification" tool. (See www.nevada.edu/home/3/gladd/EPS/thesis.html.)

It remains an article of faith among drug war proponents that illicit drug use equals "abuse" and that users are by definition addicts in need of treatment. Under the Americans With Disabilities Act, if you test positive at work and allow yourself to be labeled an addict and remanded to treatment, you are among a protected minority with respect to "employment discrimination." Should you claim to not have a drug problem, on the other hand, your very dissent likewise "proves" you to be an addict "in denial," and your refusal to submit to treatment renders you summarily terminable.

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