Going to Pot

I would have expected CNN doc Sanjay Gupta’s very public recantation of his former (but equally public) pontifications on the evils of marijuana to have prompted a flood of pieces on pot. Surely this is an opportunity for in-depth investigations on a great many topics that the eventual widespread availability of Cannabis will affect.

marijuana plants
Attention, science writers. A partial list: health care, the medical profession, the pharmaceutical industry, research on chronic pain and on synthetic cannabinoids, genetic research on people and plants, crop research and the practice of agriculture, the constabulary, criminal justice and the prison system, economics, accident statistics, and, of course, local and national politics. But it hasn’t happened. Not yet anyway.

Yet here we are, undeniably at a watershed moment for marijuana in the US. Newly legal outright in two states. Legal for medical purposes in 17 others. And counting.

And there’s public opinion. At Wonkblog, Lydia DePillis points out that Gupta is just voting with the public, more than half of which has recently come to believe legality is OK. Pot, she says, is the new gay marriage.

And she quotes Gupta: “We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that,” he wrote. “I hope this article and upcoming documentary will help set the record straight.”

Not everybody has embraced the Gupta turnaround. Deborah Kotz, the Boston Globe‘s careful reporter on science and medicine, notes that the Gupta mea culpa was timed for maximum impact on viewer numbers for his CNN documentary on marijuana. She also points out, at her Daily Dose blog, that the pain-relief data Gupta cites are not persuasive. “He links to a single study involving 50 patients that was conducted over five days. How do we know whether there’s any long-lasting relief?” she says. “Yes, medical marijuana could be an effective treatment—and yes, it might very well be safer than controlled opiates used to treat chronic pain—but we just don’t know at this point because rigorous research hasn’t been conducted.”

Since one of the chief uses for medical pot is pain relief, trustworthy pain studies are obviously of the highest priority. But they are very hard to do. That’s because Cannabis and its derivatives are Schedule 1 drugs, and therefore illegal under Federal law and international conventions too. At The Finch and The Pea, Sarah Naylor discusses a recent Nature Neuroscience article urging neuroscientists to push harder for the right to research Schedule 1 drugs and for restrictions that are less restrictive. She points out that researchers who want to keep their jobs may opt out of that uphill battle. (An interesting question: Is Cannabis research legal in Colorado and Washington State?)

Uruguay: pot paradise?

A potentially instructive national experiment is going on to our south. Daniel Politi reports in the New York Times blog Latitude that Uruguay is on the verge of becoming “the first country in the world to fully regulate the production, sale and distribution of marijuana.” (An aside: Politi enumerates various policies that make Uruguay sound also like the best country in the world. Why don’t we hear more about Uruguay?)

Oddly, this is going on despite the fact that more than 63% of Uruguayans are against this law, he says. They fear it will lead to other drug use and that the country will become a drug tourist destination. Violence has also been increasing. I suppose that might have something to do with the drug trade, but I can’t imagine stoners fomenting violence.

At the BMJ Group Blogs, Alejandro Madrazo Lajous takes a more relaxed view, citing Uruguay’s splendid record of controlling and reducing tobacco use as evidence that the government knows how to do this with marijuana and will do it well.  If you want to know more about plans for Uruguay’s government monopoly on marijuana, see Park MacDougald’s post at Foreign Policy‘s Passport.

Pot dispensary in aptly named hotel. San Francisco 2012. Credit: Victorgrigas

Pot dispensary in aptly named hotel. San Francisco 2012. Credit: Victorgrigas

The BMJ blogger also makes a point I hadn’t thought of: “When the government monopolizes a single market, it creates an unparalleled source of information about how much product is out there, where it’s coming from, and who is buying it.” (Hmmmm. So that means we’ve got the wrong federal government agency in charge of US drug regulation. It should, obviously, be turned over to the agency with the most potent incentive for monitoring yet another personal data stream. Get rid of the DEA and bequeath drug regulation to the NSA.)

Neurobabble

I cheered Knight Science Journalism Tracker Paul Raeburn’s recent takedown of the turgid and semi-incoherent neuroscience-bashing in a recent Times Opinionator post by Benjamin Fong.   I had also been baffled when I tried to read the piece.   OK, the guy is unhappy with neuroscience research, but getting at exactly why was a frustrating job, and I abandoned the project pretty quickly.

It appears that Paul and I were not the only bewildered readers, because Fong returned a few days later with a “clarification.”  So called. Not, I would say, a huge improvement on the original, but he did manage to disgorge one clear sentence that made an intelligible point. He was complaining, Fong said, “. . . that the idea of changing human physiology — transforming the human being itself — is, at least in some circles, both more ‘scientific’ and more ‘realistic’ than changing human society.”

I don’t agree that changing physiology is the goal of neuroscience, if that’s what he means. But he is certainly correct (if I understand him) that we need to know more about the societal causes of bad behavior. Well, no, here’s my clarification: I guess I mean that since we already know a great deal about some of the societal causes of bad behavior–poverty, joblessness, lousy education, etc., etc.–what we really need is research aimed at finding practical policies to change those things.

More on marijuana and the placebo effect

The absence (so far) of definitive evidence about whether or not pot works for pain control, absence at least in part because it has been next to impossible to do the research, raises the question of how much placebo effect is involved in the zillions of anecdotal reports of pain relief from marijuana.

A lot of people are certain it works. I have a friend with terrible neuropathic pain related to her long-standing Type 1 diabetes who swears by it. You may know someone too.

Chemical structure of THC, pot's main psychoactive ingredient. Credit: Yikrazuul

Chemical structure of THC, pot’s main psychoactive ingredient. Credit: Yikrazuul

It’s pretty clear that pot is not terribly harmful. It now has official sanction in several states and will soon be contributing to state budgets and to the economy. All those factors will increase pot’s acceptability. It’s easy to see that people for whom no officially promulgated form of pain relief has been effective may well try weed and believe that it helps. As many already have.

Danielle Ofri’s recent piece for the Times blog Well defends placebos, sorta, as simply another medical tool.  She would probably deny it’s a defense, because to give patients placebos is to lie to them. But the way she writes about placebos is at the very least ambivalent. Hard to argue with something that works. Whatever.

One interesting question is what happens when the effectiveness research on pot finally gets done, as doubtless will occur eventually. One result may be to reveal that it was a huge mistake to prevent this research.

For one thing, by the time we have a firm answer, the machinery of several states, perhaps the whole nation, will be partly dependent on marijuana. Pot will be contributing to the economy. It will, with luck, have diluted the power of drug lords, lightened the burden on the criminal justice system, prevented a lot of people from going to prison, and maybe even reduced crime. It will have created jobs and consumer satisfaction. What if the research shows that pot is not as effective for pain as, say, opiates or even NSAIDs? Can we expect a rush to dismantle the now-established marijuana infrastructure?

Ha ha ha ha ha.

UPDATE: No post on Friday August 30. Labor Day weekend, so no labor.

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2 Responses to Going to Pot

  1. Jen Beck says:

    You shared even some techincal stuff about marijuana- very good read- thanks!

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  2. Erica says:

    “I guess I mean that since we already know a great deal about some of the societal causes of bad behavior–poverty, joblessness, lousy education, etc., etc.–what we really need is research aimed at finding practical policies to change those things.”

    Neuroscience has been a boon to the study of behavior and behavior modification across all species. In fact, it has dragged the study of behavior from a soft humanities subject into “real science”. Neuroscience provides a crucial backbone for research and practice of social behavior mod. Thank you, neuroscience!

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