Going To Pot: The Marijuana Sequel

In my last post, also on marijuana, I wondered why science writers hadn’t used Sanjay Gupta’s announcement of his apostasy from the anti-Cannabis contingent as a reason for examining the marijuana steamroller we are about to experience. I had been hoping for takeouts on what our present trajectory toward marijuana legalization is likely to mean for many aspects of US life, ranging from medical practice, to genetic research on people and plants, to its effects on politics–and more. But I hadn’t seen any.

Baby marijuana plants.  Credit: A7nubis

Baby marijuana plants. Credit: A7nubis

The pot post appeared August 23, prompting immediate indignation from my science-writing colleagues. On an NASW listserv they protested (correctly) that, dammit, they had too written about marijuana. I see on rereading my post that their charge was understandable. I was not, of course, saying that none of them had ever written marijuana stories. That would have been featherbrained. But I was ambiguous.

What I was trying to say is that this is a pivotal moment in our nation’s weird history with Cannabis. A great many things are going to change as a result. Whatever you think of Sanjay Gupta, his about-face on marijuana was a kind of bellwether. That high-profile apology was, I thought then (and still think), a missed opportunity to examine those changes.

More marijuana revolution from (gasp!) the Justice Department

A few days after my post, on August 29, came another such opportunity, and a few writers seized  it. The opportunity was the Justice Department’s decision to allow the places where pot is legal for recreation (at the moment Colorado and Washington state) to sell and regulate it even though that is against federal law.

Of the pieces on this event I’ve seen, most noteworthy was Maia Szalavitz’s at Time’s Healthland. Maia’s forthright lede sums it up: “The war on drugs may have ended today.”  Maia has written far more about illegal drugs, and for far longer, than most of us. Which makes her observations noteworthy, and not just because she agrees with me that something radical is going on.

There was a predictable response to the Justice decision on marijuana from those whose oxen were gored by it. Ryan Grim tells us all about law enforcement’s protests at HuffPo. He also notes: “Local law enforcement agencies rely heavily on the drug war for funding. Police departments are often able to keep a large portion of the assets they seize during drug raids, even if charges are never brought. And federal grants for drug war operations make up a sizable portion of local law enforcement funding.”

‘Nuff said.

A couple of writers foresee that the Justice decision on marijuana could hasten pot legalization in other states that have been held back by fear that the feds would come down on them. At Reason.com, Ed Krayewski lists five he thinks could be next to legalize marijuana: Oregon, Alaska, California, Maine, and Rhode Island.  At HuffPo, Nick Wing agrees with that list and adds 4 more states: Arizona, Nevada, Montana, and Vermont.

The plural of anecdote IS data!

States where medical marijuana is legal–an astonishing 20 now, and counting–will be seeing increased use, and at least some of it will actually be for medical purposes. Pot prescriptions are nearly all written for pain. So in my previous post I was uneasy about the relative lack of data on marijuana’s efficacy against pain.

My fellow writers slammed me for that, too. But I’m not taking it back.

Working on this follow-up pot post, I was thinking that medical marijuana was the quintessential example illustrating the cautionary quip well known to science writers: the plural of anecdote is not data. I dug around looking for the origin of that quote and discovered, by golly, blessed be Google, that the original comment was in fact exactly the reverse. Political scientist Ray Wolfinger has claimed that the version we all know and love was actually a twist on what he told a graduate seminar during the 1969-70 school year. Which was, he said, “the plural of anecdote is data.”

Which is even more apropos for Cannabis. Because that’s what we have here: a zillion anecdotes praising medical marijuana that serve as proxies for data on its power to heal. As I observed last time, that’s not scientists’ fault. Politics has made research on real medical applications, including pain, next to impossible, as neuroscientist David Nutt and his colleagues complained last June.   I don’t think that paper is open access, but you can read Maia’s piece about it, which is.

I have looked, mostly in vain, for studies that provide backup for declaring pot works on pain (or any of the other medical uses claimed for it.) I am comforted to find that I’m not alone in coming up near-empty. So august a body as the American Medical Association ran into the same absence of evidence, even though the search process they describe was far more thorough than mine.

In a 2009 report, its most recent, an AMA committee cited just 3 pain studies on marijuana, involving a total of 119 patients. One study (38 subjects) was on induced pain. The two others involved HIV-associated neuropathic pain. About half the patients reported at least 30% pain reduction from smoking weed. But the study lasted only 5 days. The AMA committee found nothing, it appears, about pot’s effects on chronic pain, although that’s the chief use for medical marijuana. Find a link to the report PDF here. Thanks to Maia for the ref.

The rest of the AMA report’s discussion on pain efficacy involved surveys.

Surveys. In short, anecdotes.

Here we have the American Medical Association declaring that yes, the plural of anecdote IS data.

Being descriptive about marijuana, and normative too

You will say this lack of data is true of other drugs in use, and I’m sure you’re right. But failure to study other drugs adequately doesn’t seem to me a justification for shrugging off the need for data on medical uses for marijuana. Why add one more oversight deficiency to the sorry list?

It’s also the case that these other ill-established drugs are not nearly as widely used as marijuana–not to mention the consumption explosion to come. This is a huge experiment we’re running here, folks. And so far as I know, no one’s keeping track of it.

Please don’t pretend I am arguing that pot doesn’t work on pain and/or that I’m hand-wringing about the march toward legalization. Nope, neither. As my philosopher colleagues used to say back in my bioethics days, my comments about the lack of marijuana research are descriptive statements, not normative ones.

If you insist on normative, I will say this: The positive anecdotes on pot appear to make it worth trying for chronic pain. The alternatives, even when they work, pose far more serious problems. Just last week The Lancet published a study claiming that opioid dependence causes the greatest health burden–meaning death as well as illness–of all the illicit drugs.

If you insist further on normative, I would also say that making pot legal (with restrictions and regulation and tax revenue) would be far better for the country than what we have now, with hundreds of thousands of people (most of them black) imprisoned for small drug offenses combined with a top-heavy and often ineffective–and extremely expensive–drug law enforcement establishment.

Not that legal marijuana doesn’t come with its own massive set of pitfalls. For a brief overview, consult “Seven Questions about Marijuana Legalization” at Dirk Hanson’s Addiction Inbox. There are, as you will see, many more than 7 questions. And they are very tough questions indeed.

Hanson says, “Moving a popular drug across the legal/illegal line is a bit like getting molecules through the blood-brain barrier: It can be done, but it had better be done with sufficient care and forethought.”  Alas, it is too late for sufficient care and forethought, although I suppose we can pray that other states will absorb and take advantage of the painful lessons Colorado and Washington state are about to learn.

Will there ever be research on medical marijuana?

Even though we are way beyond the stage of sufficient care and foresight, I am still arguing that the various uses for medical marijuana should be more firmly grounded in data than they are.

I also know perfectly well that research of this kind, including clinical trials, takes time, lots of time–and that it would have to be preceded by time-consuming policy decisions in the White House, and possibly in Congress and the courts, before it ended up in another time-consuming process for making funding decisions at the National Institutes of Health and other government agencies.

In short, we will not, cannot, have this knowledge in time to inform local policy decisions and educate medical professionals before the cavalcade of Cannabis is well away. Not to mention informing patients, who are understandably impatient for the straight scoop on how best to deal with their intractable neuropathic pain and other health burdens.

Yet here we are, having launched a radical revision in official attitudes and citizen behavior toward marijuana, in the process creating an unstoppable social and legal trend. Even though these transformations are, and will be for several years at least, backed up mostly with . . . hope.

To Scientific American Bloggers, Food Matters

There are, according to Saveur magazine, which puts together annual “best” lists of them, tens of thousands of food blogs.  One of the list categories is Best Culinary Science Blog. These blogs turn out to be more about technology than science. They are of course temples of sous-vide cookery  (and include $75 plans for putting together a DIY sous-vide machine.)  But they also feature other devices, for example using your pasta machine to concoct giant (black!) rigatoni using cocoa, cayenne, and baking soda.   Not to mention making cotton candy with a milk frother.

What you will find at the Scientific American Blog Network is not that. SciAm has added to its impressive stable of existing science blogs a new group blog devoted entirely to food. Find the Food Matters blog here.  And meet the bloggers here.

Food Matters bloggers are a mix of scientists and journalists. There will also be the occasional guest blogger. The range of topics is expected to be broad, although I’m hoping it doesn’t encompass making cotton candy with a milk frother.  In his email announcing Food Matters, SciAm’s blog czar Bora Zivkovic said the subjects would include “food chemistry, evolution and ecology of food crops and animals, the GMO controversy, biochemistry/physiology of digestion, nutrition, obesity, medicine, food poisoning, policy, politics, global food issues, anthropology of food, environmental and public health aspects of agriculture, food marketing and communication, science of cooking, and even recipes.”

The debut of Food Matters got some very high-level attention from other bloggers. At DotEarth, Andy Revkin did a video interview with most of the food bloggers.  And at CENtral Science, Carmen Drahl talked to the SciAm bloggers who will be doing food chemistry.

Bon appétit.

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14 Responses to Going To Pot: The Marijuana Sequel

  1. Byron says:

    It’s easy to find medical cannabis clinical trials. Sativex is a simple cannabis extract that contains THC, CBD, and the plethora of additional cannabinoids that are listed/categorized as essential oils. Aside from that, there’s another easy way for any adult to test the painkilling properties of medical cannabis. Try some. But keep in minds that there are relatively great differences between different cannabis strains, and potency varies greatly as well. For painkilling, perhaps sample bubba kush. Various websites describe the medicinal properties of different strains. Sativa-dominant strains may be much less likely to serve as painkillers.

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    • the messenger says:

      Indeed! This website offers much anecdotal evidence, and info on efficacy of many varieties of Cannabis:
      Leafly.com/

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  2. Silverado says:

    “Alas, it is too late for sufficient care and forethought, although I suppose we can pray that other states will absorb and take advantage of the painful lessons Colorado and Washington state are about to learn”.

    I don’t know where you’ve been or where you live but “painful lessons” is what we just emerged from, with most of the pain being liberally applied compliments of the federal, state & local govts. The govts consisting of both Democrats & Republicans. After what, 50 some years of….”painful lessons” that is about over, it’s almost funny because now all I (and many others) see is….opportunity. So, from pain there’s going to be MUCH gain here in Washington and Colorado and I plan on being on that side of the equation, along with many like-minded others. So maybe YOU should quit with the coming pain predictions and instead of trying to figure out your “painful lessons” of where we’ve been & where we’re going, how about writing about those opportunities (not yet missed) not all of us are apparently seeing….yet?? Let’s save the criticism about the anecdotal “painful lessons” that could be coming for awhile until after they arrive, if they arrive. My bet is that the one’s who indulge won’t be nearly as offended about any cannabis (non) issues as someone who doesn’t indulge. After all, those people didn’t win that last election basically legalizing cannabis in Washington or Colorado either, did they?? Painful lessons?? That must be what I/we see when I/we look in the rear view mirror….

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  3. John Thomas says:

    “Medical marijuana is yesterday’s issue. Today’s is recreational marijuana. The “Seven Questions” were not really tough ones. Primarily because we have been through them all with an addictive, much more harmful drug – alcohol. We resolved them satisfactorily. If not, we would have returned to its prohibition.

    How much easier then, will it be to transition non-addictive, near harmless marijuana? You act like it’s a brand new idea, when it was legal for thousands of years up until the great fraud of 1937. There was NEVER a good reason for prohibiting marijuana. It was all based on lies.

    The counter-productive, fraudulent marijuana prohibition has never accomplished even one positive thing. It has ONLY caused vast amounts of crime, violence, corruption, death, and the severe diminishment of everyone’s freedom.

    Every major government commission on marijuana, including President Nixon’s Shafer Commission of 1972, concluded it is FAR less harmful than alcohol, and should be regulated as is alcohol. The reports of all these major commissions can be read here:

    http://www.druglibrary.org/schaffer/Library/studies/studies.htm

    It’s now clear that every person who switches from Budweiser to buds, improves their health and life tremendously – as well as that of their family and community.

    It’s WAY past time to end what is, essentially, the American Inquisition!

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  4. Miles Monroe says:

    “… the consumption explosion to come [from cannabis law reform].”

    California has had de facto legalization at the personal use level for over a decade now, and that “explosion”, along with all the other Reefer Madness predictions, have yet to occur; so it’s a safe bet that whatever “painful lessons Colorado and Washington state are about to learn” will likely result from neocon and law enforcement obstruction together with federal prosecutorial abuses, as has also been the case in California.

    As for a lack of “data” regarding efficacy for pain management, this assertion rather conveniently fails to consider that prior to its prohibition in 1937 cannabis was routinely prescribed for that purpose, and the medical establishment’s arguments against the Marihuana Stamp Act–completely disregarded–were based on the fact it would leave physicians with no other alternatives to opioids, which were known even then to be vastly more dangerous and addictive.

    Salicylic acid (that we know today as aspirin) was in use for thousands of years before double-blind Phase III clinical trials purely on the basis of what would now be dismissed as “anecdotal” evidence; inoculations for smallpox originated in exactly the same way, as did every other medical remedy or practice prior to the modern era. Yes, the scientific method has refined our understanding and laid many misconceptions to rest, but it was “anecdotes” that prompted the research in the first place.

    The real issue regarding cannabis, medicinal or otherwise, has nothing to do its possible uses or harmful effects; it’s why, and by whom, it has been singled out for utter suppression for any reason whatsoever, an issue which this article, like most others like it, all but completely avoids.

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    • Miles Monroe says:

      do *with* its

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    • the messenger says:

      Well said! At it’s core, this is a war of ignorance about a flower. Few stop to ponder WHY they consider it so dangerous… Oh, I remember! It’s because the US Federal Government owns a patent on Cannabinoids as medicine:
      https://www.google.com/patents/US6630507

      “Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease and HIV dementia.”

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  5. Duncan20903 says:

    It is simply not true that most recommendations in States with medicinal cannabis patient protection laws are issued solely for “pain.” I mean no disrespect, but you might benefit from reading a book called “How to Lie with Statistics” by Darrell Huff. But let me explain the instant statistical fraud perpetrated by the prohibitionist parasites:

    http://public.health.oregon.gov/diseasesconditions/chronicdisease/medicalmarijuanaprogram/pages/data.aspx

    There are 55,937 registered medicinal cannabis patients in Oregon.

    There are 54,322, or 97.113% that list “severe pain” as a qualifying condition. But that statistic doesn’t prove the assertion that most recommendations are written as a palliative for chronic pain. That’s because there’s a reason the bailiff says “tell the truth, the ***whole truth*** and nothing but the truth.”

    There are 14,990, or 26.978% that list “Persistent muscle spasms, including but not limited to those caused by Multiple Sclerosis” as a qualifying condition.”

    There are 8,328, or 14.888% that list “nausea” as a qualifying condition.

    The remaining 6,414, or 11.466% that list a melange of qualifying conditions.

    14990 + 8,328 + 6,414 = 29,732 or 53.153% list qualifying conditions other than “severe pain.”

    Doesn’t anyone else wonder why the prohibitionist parasites chose to perpetrate a fraud if the situation were as cut and dried as they claim? Don’t let these people play you for the fool that they think you are. Their propaganda consists of nothing other than bald faced lies, half truths and hysterical rhetoric

    “Never let the facts get in the way of disseminating an effective piece of hysterical rhetoric” ~~ The motto of the Know Nothing prohibitionist

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  6. FYI, Sanjay Gupta referenced that collection of Major Studies of Drugs and Drug Policy in his article. Just to be clear on why he said what he did, you will want to read the references that convinced him. The one he mentioned specifically was the La Guardia Committee Report, published in 1944, seven years after marijuana was outlawed, at http://druglibrary.org/schaffer/Library/studies/lag/lagmenu.htm

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  7. “In short, we will not, cannot, have this knowledge in time to inform local policy decisions and educate medical professionals before the cavalcade of Cannabis is well away. ”

    Uuuuuuh, yeah — but not really. Just FYI, there have been numerous major commissions over the last 100 years that have studied the marijuana problem and made recommendations for policy. In short, they all found that marijuana prohibition does more harm than good — no matter what you assume about the effects of marijuana. In short, there is no rational reason to punish anyone who has done nothing more than to try to relieve their own suffering — even if you disagree with their choice of medicine, and even if they aren’t “sick enough” to suit your own vague, undefined standards.

    You want science? OK, let’s go. I have asked every US Drug Czar since William Bennett (1989) if they can name any significant study of the drug laws that supports our current policy on marijuana.

    I refer them to the list of major commission reports that I have already found at http://druglibrary.org/schaffer under Major Studies of Drugs and Drug Policy.

    I have gotten a personal reply from each of them. Not one of them could name any significant study of the DRUG LAWS that supports our current policy. In fact, it was apparent that none of them had even read any of the research that is already there.

    Note what I am asking for here — a study of the effects of the drug laws, not effects of the drugs. The best example is alcohol. We know that alcohol is dangerous for both individuals and society. That doesn’t mean that alcohol prohibition is the best solution to the problem. In fact, prohibition only made the problems worse. What we need are studies that show our approaches to these problems work — studies of the effects of the drug laws.

    You can find the full text of every major commission on the subject from around the world over the last 100 years. They all had surprisingly similar conclusions.

    If you are new to the collection, start with the following resources:

    The short history of the marijuana laws at http://druglibrary.org/schaffer/History/whiteb1.htm This is funny, fascinating, and not what you expected. You want research? One “expert” testified in court, under oath, that marijuana would make your fangs grow six inches long and drip with blood. He also said that, when he tried it, it turned him into a bat. He was the only expert in the US who thought mj should be illegal so they appointed him US Official Expert on the subject, where he guided policy for 25 years.

    Then read the Drug Hang-Up at http://druglibrary.org/special/king/dhu/dhumenu.htm This is an excellent history of the subject, written by a former president of the American Bar Association who once formed a committee with the American Medical Association to find better approaches to the drug problem. What he found out is a real lesson in what the drug war is all about in the US.

    Then read Licit and Illicit Drugs at http://druglibrary.org/schaffer/Library/studies/cu/cumenu.htm This the best overall review of the drug problem ever written. It explains how we got into this mess, and says a lot about modern research. If you ever take a college class in the subject, this will probably be required reading.

    Then read Marihuana, A Signal of Misunderstanding, the report of President Nixon’s US National Commission on Marihuana and Drug Abuse at http://druglibrary.org/schaffer/Library/studies/nc/ncmenu.htm This is the largest and most comprehensive report on the marijuana problem ever done.

    If you want to know the scientific reasons behind the marijuana laws in the first place, you can find the full transcripts of the hearings for the Marihuana Tax Act of 1937 at http://druglibrary.org/schaffer/hemp/taxact/taxact.htm Among other things, it has a terrible effect on the “degenerate races who are low mentally because of social and racial conditions” and it makes young lovers go crazy and elope to get married.

    There are no real remaining questions about what to do about marijuana from a public policy standpoint. The research has been clear for more than 100 years. If you want to understand the current state of the research then read about how we got to this point.

    The marijuana laws were absolute lunacy, passed by lunatics, with no real awareness by Congress and every major commission that has studied the subject has concluded that, of all possible policies, this was the worst. I await anyone who can find any major commission that reached a different conclusion.

    As for strictly “medical marijuana”, the following is true:

    1) Neither the author, nor anyone else, can define the difference between “medical” marijuana use and “recreational” marijuana use. The law is that use becomes “medical” whenever the doctor recommends it. If the doctor signs off, then the issue is settled. If the author disagrees with that idea, then the author should explain their own terms for who is “sick enough” that their use becomes medical.

    2) As far the use of it for medicine goes, every drug listed in the Physician’s Desk Reference comes with a long list of warnings and contraindications. There simply isn’t any drug that works well for everyone, and patients make a decision on risks versus benefits every time they pop a pill. Overall, the risks of marijuana are remarkably small. About 3,000 people per year die from overdoses of Tylenol and similar drugs. About 100 people die every year simply from drinking too much water. None have ever died from overdose of marijuana. According to the US DEA’s own Chief Administrative Law Judge, marijuana is probably the safest therapeutically active substance known to man. That was decided as long ago as 1989, and you can find the full text of his statement under Major Studies of Drugs and Drug Policy.

    So what were you saying about not having enough science to know what to sensibly do? For all the people I have met, who have read this research, there isn’t more than ten cents difference in their opinions on what to do about it.

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  8. Maia Szalavitz says:

    P.S. You also didn’t mention that it *has* the equivalent of FDA approval for pain treatment in MS in the UK, Canada and several other countries— so again, why the higher standard for a drug that would have been grandfathered into approval like aspirin and morphine if it had been commercialized when those drugs were?

    You write as though marijuana is actually as dangerous as drugs like opioids and alcohol. It simply isn’t. The risks are there, but they are like playing badminton compared to football— in other words, significantly lower such that if there were substitution of use instead of alcohol or opioids, a massive increase would *reduce* harm.

    But as far an “explosion of use” to come, where’s your data on that? Countries with more liberal laws have *less* use than we do.

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  9. Maia Szalavitz says:

    Thanks so much for the links and update, Tammy!!!

    But “lack of sufficient care and forethought” in Colorado and Washington?????’

    There has been over 50 years worth of thinking on this question and Washington actually hired as a “pot czar” to design the regulations a consultancy headed by Mark Kleiman, the head of drug policy analysis at UCLA, who is generally a leading *critic* of legalization. The people who put together the initiatives and designed the regulations have taken great care about critical issues— and they are guided by successful liberalization of marijuana laws in multiple countries, particularly Holland (where it is not officially legal, but some sales are tolerated). Kleiman worked specifically to design regulations that could be tweaked to deal with real world issues that arise.

    Regarding the data on medical marijuana, there is as much data as for many already-approved drugs: we simply hold this drug to an absurdly high standard even though it is abundantly clear that it is safer than alternatives like opioids (though not a substitute: opioids are still clearly more effective for most people). In 20 years, people will look back and wonder why there was such a fuss.

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  10. This is false. The AMA report did review double blind, randomized, placebo-controllled trials. how is that anecdote?

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  11. Pingback: Washington State issues how-to regs on growing, selling marijuana - Christian Science Monitor | Durango Chronic