HRC talks to CNN about MJ

A CNN interviewer asked Hillary Clinton about cannabis policy.

On medical use, she replied that we need more resarch, including research about drug interactions, but in the meantime people with serious medical conditions where there’s “anecdotal evidence” of efficacy ought to have access.

On non-medical (“recreational”) use, she said that the states are the laboratories of democracy, that two states are trying legalization, and that we should wait and see how that goes.

Perfectly reasonable answers, as far as they went, and perhaps a little bit more pro-cannabis than I might have expected from such a cautious candidate.

But they cried out for follow-up questions:

1. As President, what would you do to promote medical research on cannabis and cannabinoids? Would you tear down the barriers to research now created by federal policy: in particular, the UMiss monopoly on cannabis for research purposes and the requirement that every study receive a “grant” of cannabis from a special committee within HHS?

2. While the states are doing their experiments, to what extent should the federal government help, or at least get out of the way? Colorado and Washington are now issuing state licenses to commit federal felonies. Current banking regulations make it difficult-to-impossible for cannabis stores to have bank accounts or to take credit cards, creating a huge all-cash business that is therefore an attractive robbery target. A state that wanted to experiment with state-monopoly retailing (arguably the best approach) would currently be barred from doing so by federal law. As President, would you propose changes in the Controlled Substances Act to make state-level experiments legal?

Instead, of course, the CNN interviewer asked her whether she intended to inhale. Arrrgggghhhhhh!

How long is it going to take for the press corps to stop giggling about cannabis policy and start reporting on it? https://www.youtube.com/watch?v=RuslmzjIeO4

A dispensary operator speaks out on “medical marijuana” and Americans for Safe Access

My post about Americans for Safe Access drew the expected outraged response from its target, but it also drew an unexpected note from someone I hadn’t met before, Muraco Kyashna-tocha, who runs the Green Buddha Patient Co-Op in Seattle. With her permission, I’m posting it here.

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I am the anthropologist who runs the state of Washington’s oldest medical cannabis collective. I loved your wonderful blog post on ASA. Actually, I have really enjoyed all your writings for the last year plus. You hit the nail on the head!

I made sure to pass your recent blog to Senator Jeanne Kohl-Welles who I expect to write a bill for submission early next year which will regulate medical cannabis and align the two systems into the I502 system. I have been a strong supporter of this, as well as an open strong supporter of I502.

Odd position, you might think, for a dispensary, but we’ve been trying to hold the line and deal with only authentic patients, the ones the media sees – the ones with cancer, MS etc. They aren’t easy to find among all the riff-raff.  Half my clients are cancer patients who have found the “medical marijuana” explosion frightening, and they don’t tend to find themselves nor the products they really need in the current medical cannabis scene.Sincere patients are few and far between.

ASA has been a nightmare for my state. They rally “patients” – collecting their funds from those selling the medicine to those patients. Early this year they worked against all reasonable attempts to get mmj regulated. They spoke constantly to the media about “safe access” which is a euphemism and rallying cry for “Save the dispensaries.”

Dispensaries do not need saving in Washington State (as I have said frequently at hearings in Olympia) – even as patients’ rights do need securing – affirmative defense, arrest protection, small home grow allowance, etc.

I see ASA willing to throw out patients’ rights in order to secure legal dispensaries for the real folks they speak for. I feel like I bang my head against the wall all the time, so I loved this line:

accuses ASA of “relentlessly talk(ing) about the interests of patients while single-mindedly serving the interests of the sellers.

You are correct – this is what ASA does. Green Buddha looks forward to closing very shortly. (Gawd, please will the stores open and can we get serious about licensing producers? We’re at 50 as of last Tuesday)

Green Buddha is the last of the original collectives. We have no paid employees. We’re all volunteer. Average age of our patients is my age, 56.

I view ASA as one of the major impediments to my state rewriting its mmj laws and regulating the system – align it with I502. Stay the course and keep pounding on them.

 

How is legalized pot doing in Colorado?

Vox tries to cut through the clutter of conflicting claims about the outcomes, so far, of commrcial cannabis availability in Colorado.

So far, the only thing I see that counts as a downside surprise is the problem of misuse of edibles: little children getting into Mommy’s cannabis-laced candies and winding up in the emergency room, older kids bringing those same candies to school, and grown-ups (plus, of course, aging juveniles like Maureen Dowd) getting way, way too stoned and experiencing a very unpleasant few hours.

The problem wasn’t unexpected, in that it’s obvious that sweets are attractive to children and it’s been known for years that the “overdose” risk is higher when the latency between ingestion and feeling the effects is very long. The surprise is that edibles seem to be grabbing a very large market share, and that – for reasons unknown to me – the promised rules about dosage labeling (which could make edibles actually safer than inhaled versions once consumers learn to manage their intoxication levels) weren’t in place when the stores opened.

There has been one undoubted disaster: Levy Thomba, a 19-year-old Congolese student at a college in Wyoming, came to Denver on spring break, bought a high-dose cookie, and (apparently despite a warning issued by the retail clerk) ate the whole thing. He then jumped or fell from a balcony to his death.

That ought to – but of course won’t – silence the pot advocates who argue that “No one has ever died from taking cannabis.” Accidents are a statistically predictable consequence of any sort of intoxication, and inevitably some of those accidents will be fatal. So one identified death doesn’t count as a surprise.

In response to a reporter’s query, I looked up the comparable statistics for our primary legal intoxicant, alcohol. CDCR reports 7500 deaths per year due to alcohol-related falls (out of a total of almost 50,000 acute alcohol deaths per year, in addition to another 40,000 alcohol-related deaths from chronic disease).

Now, Colorado has 1.6% of the population of the U.S. So, assuming the rate of alcohol-induced fatal falls in Colorado is typical, in the five months since Colorado legalized commercial cannabis sales something like .016 x 7500 x 5/12 = 50 Coloradans have died from falling while drunk. So if Levy Thomba is the worst the advocates of legal availability have to show, I’d advise them to pack up their traps and go home.

On the other hand, very few of the likely bad results from cannabis legalization – all of which come down to an increasing number of adolescent and adult problem users – were ever likely to show up immediately after commercial availability began, especially in a state such as Colorado which has had virtual legalization under the “medical marijuana” mask for years. The problems to look out for will show up – if they show up – slowly, not quickly. We’ll get some indications within the first couple of years on the key question whether cannabis substitutes for alcohol or instead complements it, but even that result might not be the same in the long run as it is in the short run.

So while I laugh at the drug warriors’ desperate attempts to portray Colorado as a disaster area, the pot advocates’ blithe assurances that everything is fine remind me of the guy who jumped off the observation deck of Empire State Building. As he passed the 42nd floor on his way down, someone yelled out to him, “How’s it going?” to which he replied, “So far, so good.”

How bad is stoned driving, and what should we do about it?

Dishonest advocacy aside, what are the actual risks of stoned driving? The answer, from what seems to be a well-done case-control study, is that driving stoned is hazardous, but much less hazardous than driving drunk. (A relative risk of 1.83 – meaning that driving a mile stoned is about as risky as driving two miles sober – strongly suggests that cannabis-impaired driving is a problem, but also that it isn’t much of a problem; the relative-risk number for alcohol is over 13.) On the other hand, the same study shows that adding cannabis or other drugs to alcohol substantially worsens the odds: alcohol-and-something-else has a relative risk of 23.

Given those numbers, and the technical difficulty of identifying cannabis-impaired driving (because impairment doesn’t track cannabinoid levels in blood nearly as well as it tracks alcohol levels) I’d propose the following rule: anyone who tests positive for cannabis on a mouth swab (which detects use within the past few hours) should be considered guilty of impaired driving if that person’s BAC is detectably different from zero. All that means is that, if you’ve been toking and drinking, you need to wait as many hours as you’ve had drinks before getting behind the wheel.

Of course, if I were advising someone personally, I’d be much more cautious: driving within six hours of using cannabis is pretty damned stupid. But the same is true of driving after a sleepless night. The question isn’t what’s imprudent; the question is what’s hazardous enough to make a serious criminal offense. So far, the numbers I see about stoned driving (in the absence of alcohol) don’t bring it across that very high threshold.

Given the long latency of THC, the “zero-tolerance” rules now being passed in some states, which making driving with any detectable cannabis on board drugged driving per se, without evidence of actual impairment, are simply a backdoor way of recriminalizing cannabis use.

Footnote A case-control study – comparing a group of drivers responsible for accidents with a random sample of all drivers – is the only way to figure out what’s really going on. The observation that, as cannabis use spreads, more crash-responsible drivers have cannabis on board tells you precisely nothing. After all, if consumption of blintzes were to increase, more responsible drivers would test positive for ricotta. You neeed a denominator, not just a numerator.

Washington State Court of Appeals bans medical marijuana stores

I completely failed to see this one coming.

A brief history lesson:

Washington State has had a medical marijuana law since 1998. In 2011, the legislature passed a bill allowing the creation of “collective gardens” (aka stores) to grow cannabis for patients registered with the state, and regulating those outlets in various ways: all members of the collectives would have had to register with the state. The governor used her line-item veto to take out major provisions of that bill, including the part that would have created the patient registry.

Until now, the prevailing view has been that the permission to open stores was valid law even though the regulations designed to control them had been zapped, leaving Washington with a booming, and virtually unregulated and untaxed, medical cannabis industry; as everyone says, Seattle has more “medical outlets” than it does Starbucks locations. Some players in that industry were among the strongest opponents of the I-502 initiative that legalized non-medical sales.

Once I-502 had passed, its proponents and administrators started to worry about how a regulated and taxed commercial market could compete with a wide-open, but untaxed and unregulated, quasi-medical system. There were efforts in the legislature this year to rein in the “gardens,” but the industry (speaking, of course, in the name of “the patients”) and a partisan split in the legislature made it impossible to pass anything. Battle was expected to be joined again in January, with the threat of federal intervention lurking in the background.

In the meantime, the town of Kent had passed a local ordinance banning medical outlets. Various industry players sued, citing what was left of the 2011 law. But now the Washington State Court of Appeals (the second-tier court) has ruled that the governor’s partial veto makes all the collective gardens illegal, because a legal collective garden must serve registered patients and there is no patient registry. Therefore, Kent is at liberty to ban what was – according to the court – an illegal activity in the first place. All that’s left of the medical marijuana law is permission for individuals with medical recommendations to grow their own: if charged with a violation of state law for production or possession (but not, apparently, sale), a medical recommendation creates an affirmative defense.

Presumably most of the localities that have collective gardens, including Seattle, will continue to let them operate, especially since the commercial outlets won’t even start to open until sometime around the end of June or early July.

There may be an additional layer of complexity: the Liquor Board planned to allow newly-licensed growers to bring some of their existing cannabis plants into the legal system, since otherwise there would be nothing for the new stores to sell. If newly-licensed growers have to grow new product from seed starting late this spring, the shelves will be bare until fall at the earliest.  Whether the new ruling puts a monkey-wrench in that machinery remains to be seen, as does the effect of the ruling on the bargaining over a new law next year. (Or will the governor call the legislature into special session to give it another try this year?)

Never a dull moment.

 

Cannabis, Bill Bennett, and the technique of selective reading

A friend emails, “Bill Bennett read your book … or, at least, every other page of it.”

Well, yes. Bennett and his sidekick Christopher Beach, in using the Caulkins et al. Marijuana Legalization book to support their argument against legalization, illustrate the point made here yesterday about the contrast between analysis and mere advocacy. To an analyst, every course of action* has advantages and disadvantages, which ought to be carefully weighed against the advantages and disadvantags of its alternatives. To a mere advocate, the course of action he perfers has only benefits, while the courses of action he deplores have only costs.

Since Beach and Bennett chose to base their argument on our book, (albeit without providing a link to it), it’s easy to see their principles of selection in action. They start out by mis-stating the book’s viewpoint and purpose:

In their book Marijuana Legalization: What Everyone Needs to Know, Mark Kleiman, Jonathan Caulkins, Angela Hawken, and Beau Kilmer—all of whom support the legalization of marijuana in some fashion—report …

This account suggests that the authors of the Weekly Standard essay never quite finished the book. While the first fifteen chapters, in Q&A format, are entirely collective products (I suppose in this context I can’t say “joint products”), the final chapter consists of four individually-authored essays. Of the four authors, only Angela Hawken is a straight-up advocate of legalization on the alcohol model. I’m clearly for legalization, but just as clearly against commercialization, concluding “So my first choice—not what I think will happen, but what I would like to see happen—is permission for production and use through small not-for-profit cooperatives, with a ban on commerce.”

Beau Kilmer points out how uncertain the whole proposition is, and devotes his essay to arguing that, if legalization is to be tried, it ought to be tried in an experimental mood, with, for example, sunset clauses. He adds:

Given the dearth of evidence we have about legalizing any of these activities, I am not convinced that jumping from one end of the continuum (prohibition) to the other (commercial production with advertising) is a good idea. Indeed, given the concerns about marijuana companies working hard to promote use, nurture heavy users, and keep taxes low, implementing the most extreme alternative to prohibition could be a really bad idea.

And Jonathan Caulkins – in fact the lead author of the book, though  Beach and Bennett list my name first – is more or less in the Beach-and-Bennett camp, starting his essay with  ”I would vote against legalizing marijuana … ” (though he lists a grow-your-own approach as a possible “middle ground”). Jon concludes:

About half of all days of marijuana use come from people who self-report enough use-related problems to meet criteria for substance abuse or dependence with respect to marijuana or another substance. Does the happiness a controlled user derives from using marijuana on a typical day offset the unhappiness of someone else spending a day harmed by and/or struggling to control problem drug use? In my opinion, the answer is no. In a free society there are plenty of other ways to have fun without insisting on a right to use something that becomes a stumbling block for others.

Why should Beach and Bennett want their readers to believe that the authors of Marijuana Legalization are all legalization advocates? Continue Reading…

The very political neuroscience of cannabis

If you were a neuroscientist and discovered that there were, on average, measurable anatomical differences between (1) the brains of 20 young right-handed people who smoke an average of a little more than 11 joints per week and had been consuming cannabis for a little more than 6 years and (2) the brains of an age-sex-chirality-matched group, and that those differences persisted even after controlling for alcohol consumption and were accentuated among those who use more cannabis, you’d probably say, “Hmmm … that’s interesting. I wonder what it means.”

After all, it might mean:

1. That using cannabis at that level causes changes in the brain.
2. That something else correlated with cannabis use – for example, use of other illicit drugs – causes changes in the brain.
3. That something about having that kind of brain makes cannabis use more attractive to people to have it than it is to people who don’t.
4. That the brain differences and the cannabis-use differences between the two groups are the product of some unknown third factor.

If, on further study, it were to turn out that the differences were the result of cannabis use, then you might ask, “What are the consequences – if any – of those differences?” After all, various learning tasks are known to change brain anatomy: London cabbies, who are required to learn London in astonishing detail, have larger-than-normal anterior and posterior hippocampi, and visual artists also have brains that are structurally different from non-artists.

Now, if you’d started out with already-known measured deficits in cannabis users and found brain changes independently known to lead to such deficits, that last question wouldn’t be so hard to answer. Of course, that’s hard, because the most recent meta-analysis found “no evidence for enduring negative effects of cannabis use” on neurcognitive function. (The Dunedin 8-IQ-point finding is about people with chronic substance use disorder.)

Overall then, if you were that neuroscientist, you’d write a paper saying “We studied cannabis users and non-users and found the following brain differences. Here’s the next study we plan to do, addressing the questions of causation and possible impact.”

That’s assuming that your goal was informing your readers about the content of your findings. If instead you wanted to score points in the culture wars, push your political agenda, and perhaps please your sponsors at the National Institute on Drug Abuse and the Office of National Drug Control policy, you’d behave differently. Continue Reading…

Bureaucratic politics 101: the U.S. adjusts its position on the drug treaties

Historically, the United States was the chief architect of the prohibition-oriented international drug control regime, and among the most “hawkish” of the signatories (along with Sweden, France, Russia, Japan, and Singapore, and much of the Arab world). The U.S. did a bunch of finger-wagging at the Dutch for their relatively liberal policies. And the Bureau of International Narcotics and Law Enforcement in the State Department (“INL” in Alphabet-speak, informally “Drugs and Thugs”) has long been one of the more hawkish players in internal drug-policy debates.

The treaties, on their face, require the criminalization of not only drug dealing but drug use. One of the arguments made against the tax-and-regulation approaches adopted by initiative in Colorado and Washington State was that their adoption would put the country out of compliance with its treaty obligations. There are legal loopholes: the treaties acknowledge that their obligations apply to each signatory only insofar as consistent with its domestic institutional arrangements. Since the U.S. federal government, the party bound by the treaties, lacks the constitutional power to require criminalization at the state level, it’s not clear that the actions by Colorado and Washington State voters can be said to have been illegal under international law.

Uruguay has gone further, legalizing at the national level. The Uruguayan government argues that even that is allowed by the treaties, because the treaties recite the reduction of illegal drug trafficking and the protection of public health among their stated goals, and the Uruguayan law is designed to accomplish those goals. Whatever the merits of that argument legally – personally, I don’t think it passes the giggle test, though as a policy matter I’m glad Uruguay is making the experiment and hope it succeeds – it is one that the United States could once have been counted on to scorn.

And yet, when the U.N. Commission on Narcotic drugs met in Vienna last month, and some member countries got up to criticize the Uruguayan move (which the International Narcotics Control Board, the referee set up by the treaties, promptly denounced) the U.S. had no comment on that issue.

In part that reflects changing U.S. public opinion about cannabis, and the more liberal stance of the Obama Administration compared to its predecessors. But in part it reflects the fact that INCB also blasted Colorado and Washington State, putting INL in the position of having to defend the permissibility under international law of those regimes and of the accommodating stance toward them adopted by the Justice Department. So the voters in those two states in effect forced a change in our national stance in international fora.

Here’s Ambassador William Brownfield, the Assistant Secretary of State in charge of INL, explaining the new stance: the treaties, we are now told, are “living documents,” allowing “flexibility” in how different nations choose to meet their obligations, and we should seek a new consensus about what that means.

Obvious, once it’s happened. (It might not have happened in, say, the Romney Administration.) But, as far as I know, not predicted in advance by anyone, least of all by me.

Footnote It would be easier to take more seriously the self-appointed “Global Commission on Drug Policy” if spokespeople such as Michel Kazaktchine didn’t insist on making nonsensical claims, such as that minor drug offenses account for half of U.S. incarceration (the actual figure is more like 20% for all drug offenses) and that prohibition has failed to reduce consumption (compared to what?) and that alcohol and tobacco control via taxation and regulation have been more successful (by what measure).

How not to make a hash of marijuana legalization

The cover package in the current issue of Washington Monthly includes articles on cannabis legalization by Jonathan Caulkins, Jonathan Rauch, and me, under the heading “Saving Marijuana Legalization.” Mine has the wonderful title (which I think Paul Glastris gets credit for) “How Not to Make a Hash of Marijuana Legalization.”

All three pieces consider how to legalize cannabis rather than whether to legalize it. Caulkins and I both distrust the trend toward a commercial system on the alcohol model, and I’m also unhappy both about a pure states’-rights approach and about legislation by initiative. I also float the idea of user-set monthly purchase quotas, a “nudge” strategy that I claim might do some good and couldn’t hurt.

Michael Hilzik gives the whole thing a very nice write-up on the LA Times business page.

Footnote Depressingly, none of the LA Times commmenters makes a point that is either original or cogent. It’s like hearing from the Romneybots in the fall of 2012.

Cannabis law and policy

Bloomberg just posted my essay about  the federal response to cannabis legalization in Colorado and Washington State and about the “rescheduling” issue, both of which have been the subject of rather confused debate.

Short version: No, the law doesn’t require the feds to shut down the Colorado and Washington State initiatives, and “rescheduling” cannabis would be a mostly pointless exercise; it’s much more important to remove bureaucratic barriers to medical research.

That essay doesn’t include one item on which the discussion has been especially confused: the claim that the President, by himself, has the power to reschedule. In fact, the Controlled Substances Act gives that power to the Attorney General, and requires that the AG get medical advice from the Secretary of HHS and take that advice as authoritative.  The AG has delegated his responsibility to the DEA Administrator, and the HHS secretary has delegated hers to the Assitant Secretary for Health.

Those powers are not arbitrary:  the law says that rescheduling requires an “accepted medical use,” and the courts have held that to mean the satisfaction of each of five criteria:

                        a.    the drug’s chemistry is known and reproducible;

                        b.    there are adequate safety studies;

                        c.    there are adequate and well-controlled studies proving efficacy;

                        d.    the drug is accepted by qualified experts; and

                        e.    the scientific evidence is widely available.

[Alliance for Cannabis Therapeutics v. DEA, 15 F.3d 1131, 1135 (D.C. Cir. 1994)]

Arguably, the AG and HHS Secretary could decide to change that legal standard; the courts, having deferred to administrative discretion in the earlier case, might do so again. But it’s not as simple as someone saying, “Gee, I’d like to reschedule cannabis this morning.” And though the President appoints the officials in question and can fire them, the power under the law does not belong to the President.

Moreover, the law explicitly requires that any substance covered by the international drug conventions – which marijuana is – be controlled, regardless of any other factors. Thus the Executive Branch as a whole lacks the power to remove cannabis from the CSA entirely.

Since Jacob Sullum and his friends get their feelings terribly hurt when I point out that he’s talking through his hat, and since I purely hate hurting people’s feelings, I won’t mention him here. That will save him the effort of once again misrepresenting not only the law but what I said about the law, and about his misunderstanding of it.   But the next time he decides to accuse the President – who in real life was a law professor – of not having read the law, perhaps Sullum will consider … reading the law.

Footnote Eighteen members of Congress seem to share this misundestanding, which Americans for Safe Access – the lobby for the medical-marijuana industry – is doing its best to promote.