“Legalize pot!” What was once hippie heresy has become a bandwagon. This past weekend's “Emerald Cup” in Sonoma County has just been covered by the San Francisco Chronicle and other media as if the holy herb were already legal and on display like prize pigs. The nation’s largest state medical association, the California Medical Association, adopted a policy paper urging decriminalization, regulation, and taxation” (DRT) of cannabis in 2010 (disclosure: I helped prepare it) – the CMA’s board vote was unanimous and caused little backlash in the medical world (although the ever-more conservative AMA voted against adopting the CMA’s position). A poll of readers of the New England Journal of Medicine regarding medical use of cannabis drew three-quarters support such use. Colorado and Washington have legalized “recreational” use and are struggling to figure out how to implement that policy — with a good chance they will make few completely happy. Of course the anti-drug “warriors' will be among the least happy of all — one such group just reached a new level of crassness by issuing a press releasing stating “Nelson Mandela was Against Marijuana Legalization!”
Beyond hysteria, the legalization debate focuses on at least three central questions: (1) Will legalization increase cannabis use? (2) Will it decrease crime? (3) Will it cost or benefit “society” in economic terms? And the answers are… debatable. The answer to #1 depends on who you ask, but is mostly focused on “the children” — and it is true that, the earlier one starts getting 'high' on anything, the more likely one will have longer-term problems of varying types. The best guess is that yes, some kids will be more likely to try pot if it is legal, but as so many do now, that effect is likely to be not so large. As for #2, DRT by definition will reduce “crime,” as it won't be illegal to partake, but the real question is if the more open markets and presumably reduced prices will decrease other types of pot-related thuggery — robberies and such. That positive effect seems likely. As for costs (#3), the significant drop in arrests and incarcerations for pot would undoubtedly yield substantial savings. That's likely a big, or even the main, reason law enforcement and prison lobbies are opposed to such infringements on their “full employment” bread-and-butter. And regarding taxes, who knows — certainly some revenue would result, as it has already in some places, but it's also very likely that a black or grey market in cannabis and its proceeds will continue even after legalization. Businessmen who are accustomed to paying no taxes tend to very good at avoiding or at least minimizing them when the rules change, and it is likely that much of the trade will remain “off the books.”
Much of the outcome of DRT will of course depend on how it is regulated — most health advocates would favor a fairly restrictive policy at least as strict as that controlling tobacco — stricter, in fact, with no advertising, significant taxes, age limits, much health education, and the like. Likewise, public polls consistently and increasingly support some form of DRT, with consistent pluralities endorsing legalization if marijuana is still off-limits for minors and some type of tax is levied on production or consumption with the proceeds earmarked for a “good” cause. In California, the first to legalize “medical” use in 1996 but now behind the curve, DRT advocates are wielding possibly competing ballot initiatives for 2014 – perhaps not having learned lessons from previous such bumbled “turf” battles — and, failing that, 2016. The savvy people at the ACLU, favoring a careful slower approach and putting this to vote in a presidential election year with theoretically higher voter turnout, cite a recent poll showing ¾ of democrats and independents, half of republicans, and substantial majorities of minority voters of whatever party affiliation in support. One problem for the “single-issue” crowd, however, is that such support seems mostly shallow — this is a tangential issue for most voters, who don't really care much about it, and can be persuaded to change their mind by the kind of last-minute barrage of scare ads that tend to surface in such campaigns. In any event, the ACLU has set up a panel chaired by Lt. Governor Gavin Newsom to advise on how to get DRT passed, with little in the way of surprises expected from yet another such report.
The issue is packed tighter than a bong with ironies. Few Californians could not get pot, if they really wanted to, before legalization of “medical” use. Many if not most lawbreakers in the business of producing and selling pot, “medical” or otherwise, don’t want it legalized, so such proposals tend to lose votes just where one might think support would be highest — namely, Humboldt and Mendocino. Cannabis was once the “devil weed” that drove people to insanity and murder but now it seems to cure or at least alleviate just about every ailment, if one listens to the most enthusiastic adherents. Some have argued that “all use is medical” but such inane statements lead to suspicion that the speaker has himself “medicated” too much – and that it hasn’t helped. The long-rumored “antimotivational syndrome cannabis supposedly causes seems disproven by the single-minded dedication of many stoners and pot advocates to their herb. I've had admitted growers and dealers tell me they are “freedom fighters' — for profit, they don't add — and once read of one cannabis-obsessed young woman from Humboldt who compared herself to double-Nobelist Marie Curie. Grandiosity and delusion are hallmarks of the cannabis-dependent, as many have observed.
And what of the cannabis club or dispensary system set up after Prop. 215? It provides jobs, at a minimum. Some legitimate patients who might not otherwise have access to their “medicine” even use dispensaries, but I've known more cancer and HIV patients who want nothing to do with “that scene” and stick to old-fashioned “street” sales. Even many knowledgeable medical folks who support legalized cannabis often think the system set up in California to provide access to the herb is corrupt. The “medical cannabis” system seems largely to be a wink-wink way to launder both product and profit. Thus many of those who have decried the undeniable hypocrisy of the “war on drugs” have also chosen to participate in a hypocritical capitalistic industry, as producer, distributor, consumer – or all three. Some employment is provided, and a few medical and legal professionals also benefit from the drug war, but most citizens do not. The side-effects of environmental destruction, a harder criminalized and often-armed sleazeball shadow on the “industry,” and so forth does not seem to bother many in that industry very much — at least not enough to try to do much about it. And we shouldn't hold our breath waiting for them to do it — the money's too good.
Lee Leer MD is a board-certified family practitioner and geriatrician in Eureka, active in the Humboldt-Del Norte County Medical Society. The July 2013 issue of their fine, solid-yet homey journal North Coast Physician contained an opinion piece by him titled “From Hepatitis to Cannabis.” His candor is refreshing, and thus quoted at length here:
“I’ve chosen to provide my own ongoing patients with cannabis recommendations when they ask and when their needs sound reasonable (e.g., insomnia, chronic pain, medication related nausea: sure; depression, glaucoma, “because I want to make sure I’m safe:” not gonna happen). Surprisingly, I’ve had more than one patient inquire as to how they should pay me for said recommendation: would I like a check right now, or should they pay at the front desk on their way out? As part of me sees a small fortune trickle through my fingers, I explain to them that I think it’s obscene to require extra cash payment for providing what is, after all, a routine medical service. Another part of me, admittedly, is thrilled to thumb its nose at a Federal law that makes absolutely no sense.”
In the similar county medical journal of the San Francisco Medical Society, I once reported that educated opinion among many doctors fielding a high number of requests for cannabis recommendations estimated the “validity’ of those, as they judged them, to be no more than 10%, and likely much less. A Kaiser MD told me that it was more like 5% of such requests there, and likely even less then that. Many have remarked upon how striking the huge reservoir of previously undiagnosed, untreated, otherwise healthy people, many of them young and otherwise vibrant — it's a cliche now to make that observation, but like many cliches, too true — now officially self-“medicate” with cannabis. A real test of this issue may come when truly non-psychoactive cannabis alternatives – say, CBD with no THC and thus no “high” – come truly online. How many of the “medical” users will switch to those? Time will tell.
Dr. Leer forcefully calls out a few of his colleagues for jumping into the hypocritical, profiteering world of “medical cannabis”:
“We all know, of course, that there are physicians out there who do little else but take cash from people who want legal cover to grow and or smoke weed. We have them in our community. I wonder why we physicians, who claim to be able to police ourselves, have just sat by and allowed people in our profession to get away with setting up these ‘medical marijuana’ prescription mills. Of course, on a grand scale, hardly any of the nearly 18% of our GDP that goes towards health care is falling into the pockets of marijuana doctors, but every dollar that does is a dollar wasted.
Yes, I do believe that most of us truly want to do what’s best. But there are exceptions, right? Doctors who do nothing but prescribe marijuana may be very nice people, may be very well-intended… may be all sorts of good things. But they are not physicians. Why we continue to allow them to pretend to be is truly beyond me.”
Strong words, those. But from my own unscientific survey, I think they are shared to some degree by most physicians who have not made “pot cards” their primary practice — even, again, those who otherwise support freedom of choice when it comes to using cannabis. They just don't want to take part, or be associated with, what they see as a transparently hypocritical system of cannabis access. And again, besides the CMA policy, I was one who help convince the San Francisco Medical Society to endorse Proposition 215 in 1996 — the only such group to do so. I doubt I could or would do that again now.
Also regarding the medical aspect, what happens if California legalizes cannabis but it remains under the DEA/FDA's Schedule 1 of the Controlled Substances Act, keeping research difficult unto impossible? Moving cannabis out of Schedule 1 to facilitate more research was a primary impetus of our adopted CMA paper. The powers-that-be still ignore that reasonable recommendation. In fact, perhaps the biggest irony of all is that all the states laws in the nation don't change the fact that the evil weed remains illegal in the eyes and guns of the Feds — and they trump all, if they want to. True to form, the Obama Administration has issued conflicting and confusing statements on this topic. But no cannabis industrialist, no matter how big or small, should doubt for a minute that if they want you, they can come and get you. And make no (fatal) mistake — even if you are a committed gun “enthusiast,” you'll be outgunned.
Uruguay just legalized cannabis. Legalization advocates here have jumped on this as a big deal, and it likely is – in Uruguay. Most Americans, including or maybe especially politicians, could not find Uruguay on a map if you bribed them with a kilo of Humboldt’s finest. That nation could be a ‘mouse that roared’ or more likely just a mouse, with little to no impact here – one might as well point out the cannabis has been legalized on the moon.
Legalization or DRT is not a panacea, but it sure seems preferable to what we have now. But one primary funder of the movement towards DRT, billionaire Peter Lewis, has just died, leaving what might be a big funding gap for drug reform efforts – he donated up to $60 million through the years. Newer rich folks, such as the vaunted techies, have been relatively absent in this realm. After all, what’s in it for them? Being affluent and rarely black or Latino, they don’t get busted for pot, and if they do, very unlikely to experience real trouble, and certainly not incarceration. In any event, at least $2 million is needed just to get any cannabis DRT initiative on the 2014 ballot. If it, or some other legalization vehicle eventually passes, we'll see hordes of politicos and advocates stepping forward to claim some glory from their putative pioneering roles, as already occurs.
On the other hand, of course, if a solid bipartisan posse of brave and honest politicians holding high offices would step forward and co-sponsor cannabis DRT legislation and make a real push to pass it, such a costly initiative would not be needed, the nation would save millions if not billions on law enforcement and incarceration, we'd have more revenue for good health and education programs, the crooks and profiteers in the “medical pot” industry would be out of business, and many more happy outcomes.
But I wouldn't wait to exhale on that scenario.