NERVES NEED MARIJUANA-LIKE SUBSTANCE
TO STAY IN TOUCH, STUDIES FIND
Brain's Self-Made "Cannabis" Essential To Normal Thought
Even if you have never smoked a joint in your life, a cannabis-like substance occupies a special niche in your brain, fine-tuning the nerve connections that control memory and most other thought processes.
New research into how these so-called "endogenous cannabinoids" work may help scientists understand what goes on inside the heads of those who smoke pot -- which floods the nervous system with far more of the active ingredient than the brain can supply on its own. Last week's U.S. Supreme Court ruling against the medicinal use of marijuana came as brain scientists were celebrating profound new discoveries about how cannabis works in our heads.
The landmark studies, published recently in the journals Nature and Neuron by scientists at the University of California at San Francisco, Harvard Medical School and Kanazawa Medical University in Japan, suggest the brain cooks up its own marijuana-like ingredients in order to tweak the all-important connections that link nerve cells. Two of these marijuana-like substances have been discovered so far, docking in the very same nerve-cell receptors used by THC, the active ingredient in pot.
It's as if the brain has its own secret stash. But despite years of research, scientists had no clear idea until now what its purpose might be.
"Were we built to smoke marijuana?" wondered Jeff Isaacson, an assistant professor at the University of California at San Diego, who contributed to the latest findings by UC San Francisco graduate student Rachel Wilson and neuroscientist Roger Nicoll.
They set out to discover how nerve cells "talk back" to one another in a brain region called the hippocampus, which is crucial in memory and learning -- but not, coincidentally, one of the principal areas affected by smoking pot.
The back talk involved is actually a feedback loop that allows a nerve cell, or neuron, receiving an impulse from another neuron to fire back its own signal, thus modifying critical neurochemical activity at the source.
This so-called "retrograde signaling" is one key way neurons can dial into one another, allowing effective communication to take place at the cellular level.
There are essentially two kinds of brain cells, according to Stanford University neuroscientist Dan Madison. There are the principal cells that make up what he likened to a superhighway system of long-range information movement, and there are "interneurons," which are like traffic signals along that highway.
"Cannabinoids are a way for the principal cells to regulate the traffic lights," Madison said.
After two years of laboratory study and frustrating dead ends, Wilson and Nicoll found that the role of the brain's cannabis is to make the feedback system work. Harvard researchers, working independently, found an essentially identical role for endogenous cannabinoids in another part of the brain, called the cerebellum, which helps to control motor function.
"It's a way for a nerve cell to adjust the gain or intensity of the information coming into it," Nicoll said. "It turns up the amplifier, in a way, and allows more input to get through."
These adjustments seem to have an important role in the brain's uncanny ability to synchronize the firing of nerve cells scattered throughout the brain, linking behavior with mood and memory with vision or hearing. Thousands of signals thus become molded into vast oscillations, helping the brain bind together different aspects of perception into something we can experience as a coherent state of mind -- a feeling of being in love, perhaps, when we look at someone. If that's the case, the implications for marijuana smokers seem rather profound.
Marijuana receptors are just about everywhere inside our skulls, but the brain's natural cannabis is present in minute amounts, and its effects are subtle: a fleeting and localized shift in brain chemistry in particular areas of the nervous system.
When you smoke a joint, researchers said, you essentially swamp that whole system for however long the buzz lasts by flooding the brain with THC. This may help to explain why marijuana users report the drug has such diverse and often idiosyncratic effects on mood, memory, appetite, vision, pain and motor control. Some users report an odd stretching of their sense of time. Others make connections -- humorous, sometimes -- between things that normally don't seem related. And memory is clearly impaired, as is motor function.
Such effects start to make sense, researcher Wilson said, in light of the new insights into how natural cannabinoids function. "We suspect that marijuana is sort of hijacking the system, doing what the brain normally does but in overdrive," she said.
Marijuana researchers have found no reliable evidence of permanent damage arising from this hijacking, and the latest experiments are said to be essentially neutral as to the merits of allowing medicinal use of pot.
The new brain findings may help drug researchers find ways to mimic pot's effects, perhaps leading to development of drugs that similarly modify synaptic connections but in a more controlled way.
The research also gives scientists a topic with which they can liven up their social lives when they venture outside the lab.
Nicoll, for one, likes to look audiences right in the eye, wag his finger and insist that during the entire two-year research project he "never once inhaled."
"Marijuana and the brain is a fun field to be in," Isaacson, Nicoll's former graduate student, said. "You talk about this with people at parties, and they're actually interested."
MARIJUANA UNDER THE MICROSCOPE
Some would say using marijuana in a medical setting is, ahem, a half-baked idea with no possible benefits to society or suffering patients.
Others might disagree, including the McGill research group that recently received $235,000 from Health Canada in partnership with the CIHR ( Canadian Institute for Health Research ) to scientifically prove the medical worth of this popular plant.
Since the 1960s, scientists having been trying to ascertain the medical benefits of one of North America's most common recreational drugs. Consequently, there is a slew of anecdotal evidence attesting to its use in alleviating suffering resulting from Crohn's disease, partial spinal cord injuries and glaucoma.
Recent research has focused on the effects of marijuana on the immune system and discomfort associated with cancer and AIDS chemotherapy. Still, perhaps the most promising work has been done in the basic science analysis of the mechanism of action that marijuana has in the body.
The active component thought to provide much of the analgesic ( pain modulation ) and cognitive effects of marijuana is called THC ( tetrahydrocannabinol ). While many scientists believe there are other psychoactive compounds in cannabis, THC is the most studied and best understood. Basically, when one smokes a joint or uses some other ingestion device, the heat from the burning marijuana leaves causes the THC to become aromatic ( airborne ) and enter your lungs. Once inside, the THC enters the blood stream at the same exchange point as oxygen. As any cigarette smoker or asthma inhaler user will tell you, the alveoli are very efficient at allowing chemicals to enter the blood. Less than two minutes after ingestion, the blood flow will have distributed the tiny molecules of THC throughout the body.
In healthy people, who are not in the process of being strangled, the brain uses only 20 per cent of the oxygen available in the blood cells. Hence, a lot of blood needs to get to your noggin in order to meet the demand. And, like white on rice, the THC rides the chariot of blood cells upward at a rapid clip. Once it reaches the brain, a set of receptors are activated, causing the effects that have become so familiar to pot-heads and invulnerable undergraduates, among other sectors of our community.
In much the same way as a key fits into a lock, THC finds a home in what have been dubbed the cannibinoid receptors. Commonly referred to in scientific literature as CB1 and CB2 ( cannibinoid receptors 1 and 2 ), these receptors are abundant in the brain. They are especially common in areas responsible for memory, cognition and motor co-ordination. These regions are centred in the cerebellum, hippocampus, hypothalamus and basal ganglia. For scientists curious as to THC's effects, these receptors are crucial to ongoing research and their presence is a cornerstone to explaining marijuana's therapeutic effects.
Now, it might seem odd that we would have receptors for THC in our brain. Why would evolution, or God, have placed these intricate protein-carbohydrate structures up there just to get high?
Well, along with identifying the receptors for THC, researchers have also elucidated the endogenous ligand ( in English: the "key" for the receptor "locks" made naturally in the body ). This chemical is called anandamide and is derived from fatty acids ( the stuff in butter ).
Ananamide is involved in numerous physiological processes including pain modulation, control of movement, co-ordination, balance, pleasure sensation, learning, cognition and memory. The current basic science research is trying to resolve what impacts this receptor-ligand ( lock and key ) mechanism, hormones or neurotransmitters being the primary targets. Figuring out this mechanism would mean being able to further our knowledge of these incredibly complex systems, with the aim of eventually devising treatments to aid in treating problems in these areas.
Those working in the area of cannibinoids are excited about future prospects in this line of work. "Certainly not all the kinds of pathways are worked out, and probably not all of the involved molecules have been identified yet," commented Billy Martin at the pharmacology and toxicology department of the Commonwealth University in Richmond, Virginia. "But we're on the right track, characterising the normal physiological pathways used by the cannibinoids to affect pain modulation, control of movement, control of visceral sensation and other processes."
Anyone who has smoked pot has stories of their experiences that are both glorious and ignoble. Scientifically speaking, however, the short-term effects were summed up very nicely in 1996 in a paper by Dr. I.B. Adams and R. Martin titled Cannabis: Pharmacology and Toxicology in Animals and Humans.
"Usually the mental and behavioural effects of marijuana consist of a sense of well-being ( often termed euphoria or a high ), feelings of relaxation, altered perception of time and distance, intensified sensory experiences, laughter, talkativeness, and increased sociability when taken in social settings. Impaired memory for recent events, difficulty concentrating, dreamlike states, impaired motor co-ordination, impaired driving and other psychomotor skills, slowed reaction time, impaired goal-directed mental activity and altered peripheral vision are common associated effects."
Perhaps the most convincing evidence for a medical use of marijuana comes when one considers this common vision impairment. Essentially, glaucoma causes one's vision to blur due to a film or cataract that covers the eye. The cause is IOP ( intraocular pressure ) which is an increased blood pressure in the optical region.
Recent research has found that, in a three-to-four-hour period after administration of inhaled marijuana, the subjects' IOP was markedly decreased. These results were seen in both patients with glaucoma and those with normal IOPs. Also interesting to note was the fact that a topically applied ( cream form ) of THC had no effect. The exact mechanism of all other IOP inhibitory drugs is known but research in the area of marijuana has been remarkably slow.
Despite lingering concerns regarding the administration of a drug which had to be smoked, the American Academy of Ophthalmology had this to say about using pot in the treatment of glaucoma ( 1992 ), "There is clear evidence that marijuana ( or its components ) taken orally or by inhalation can lower intra-ocular pressure."
AIDS and Cancer Chemotherapy
Many of the strongest drugs used to treat various cancers and AIDS boast long lists of uncomfortable side effects. The most critical of these is "wasting," a term that describes rapid weight loss caused by nausea and vomiting that adversely affect many patients. The ravages of the disease are, in many cases, not as uncomfortable as the toxic soup of medications that are enlisted to aid in the body's defense efforts.
This is where marijuana comes to the rescue. With not a single negative drug interaction reported, and hundreds if not thousands of patients reporting miraculous alleviation of medication-related suffering, marijuana may be the drug of choice to prevent wasting.
Indeed, AIDS patients serviced by the Compassion Clubs ( marijuana pharmacies ) in Montreal and Vancouver have consistently toted the benefits in terms of allowing them to eat and carry on their daily routines. The medical establishment has taken these claims seriously and is currently investigating the possibility of using cannabis in a widespread manner to combat these side-effects.
THC also appears to have some immunosuppresent properties. This may seem alarming, but in terms of making you susceptible to that nasty cold, passing the joint and sharing your buddy's saliva is likely to be much worse for you. Still, some cell-mediated and humoral immune system responses may be slightly impaired by heavy marijuana use. The data in this area is not entirely clear or conclusive; some research actually points to an enhancement of other parts of the immune system.
Scientifically speaking, marijuana's effect on the immune system is an intriguing area of study. The auto-immune disorder multiple sclerosis has shown some anecdotal evidence of being ameliorated by weed. Also of note are results of experiments involving EAE ( experimental allergic encephalomyelitis ). This is a disease that is inducible in rats, which in many ways mimics the effects of MS. Here, marijuana has been shown to modify the immune response and decrease the severity of the disorder. This is certainly fascinating, as the more we begin to understand the action of THC in the body, the better we can apply its powers to the healing effort.
Science meets Politics and the Law
While the Canadian government has been more open to allowing marijuana to be studied and used in a medical setting, our neighbour to the south has not been so forthcoming. The DEA has not relented on marijuana's classification as a Schedule-1 drug, insisting it has a high potential for abuse and no medical uses. Many have pushed for downshifting of its status to Schedule-2, where it would sit alongside other tightly controlled prescription drugs such as morphine. These are drugs that have a high potential for abuse but also some possible therapeutic effects.
On May 14, 2001 Justice Clarence Thomas had this to say about changing the status of weed: "Marijuana has no medical benefits worthy of an exception." The 8-0 U.S. Supreme Court ruling that the manufacture and distribution of marijuana are illegal under all circumstances has been a blow to hopeful investigators and the substance's proponents in the scientific and medical communities.
On the other hand, a mere two months later, Canada relaxed its laws regarding the availability of marijuana to severely and terminally ill patients. As well, Health Canada has opened up the door to research endeavours with its ambitious multi-million dollar marijuana-growing facility in an abandoned mine under a northern Manitoba lake.
With high-profile science publications like the Proceedings of the National Academy of Science exhibiting work like Oxford's Leslie Iverson's piece titled, "High Times for Cannabis Research," it seems the tides may be changing regarding the uses of this banned substance. It remains to be seen, however, what the current research both McGill University and other universities here and abroad will uncover with regards to this tantalising scientific discipline.
Nursing Association Journal
Backs Access to Medical Marijuana
New York, NY: Marijuana is a safe and effective medication and nurses should support legal access to it, asserts a commentary in the April issue of the American Journal of Nursing, the official journal of the American Nursing Association (ANA).
"Patients need professional guidance about the safe administration of cannabis, and they need access to a legal and unadulterated supply," concludes the article, entitled "Therapeutic Cannabis: A patient advocacy issue." An estimated 2.5 million nurses nationwide receive the publication.
"If you were to listen to patients' reports of the benefits of cannabis or observe patients' responses to it, you would see its therapeutic value," author and registered nurse Mary Lynn Mathre writes (ed. note: Mary Lynn also authored the Foreword to the Oregon Medical Marijuana Guide.) "If you were to review the drug's history, you'd see that it is widely used therapeutically throughout the world and that it has been banned in the United States for political, not medical, reasons. If you were to review the current literature about its safety and potential health benefits, you'd see that there's no basis for the continued prohibition of this treatment."
In recent years, the nursing community has become more outspoken in its support for medical marijuana-law reform. Since 1994, the state nursing associations of Alaska, California, Colorado, Hawaii, Mississippi, New Mexico, New York, North Carolina, Virginia and Wisconsin have all passed resolutions in support of legalizing patient access to medical marijuana.
Pubdate: 17 Mar 1999
Source: Reuters
Copyright: 1999 Reuters Limited
Note: For an easy-to-read copy of the IOM report, go to:
http://www.nap.edu/catalog/6376.html
OFFICIAL U.S. REPORT BACKS
MEDICAL USE OF MARIJUANA
WASHINGTON, March 17 (Reuters) - A U.S.-commissioned report released on Wednesday strongly backed the medical use of marijuana, declaring that for some people with serious diseases such as AIDS it may be one of the most effective treatments available.
The widely-anticipated report by the Institute of Medicine (IOM) was commissioned by the White House Office of National Drug Control Policy and looked likely to prompt a thorough review of U.S. efforts to ban almost all marijuana use as dangerous drug abuse.
IOM investigators declared that marijuana was not particularly addictive and did not appear to be a "gateway" to the use of harder drugs such as heroin. They also said there was no evidence to indicate that approved medical use of marijuana would increase public abuse of the drug.
The IOM report, the product of more than 18 months of research, highlighted continued concerns over marijuana, noting that the common practice of smoking the drug was medically dangerous and asking for more studies on how the drug really works on the human body.
But on almost every front the independent medical review of scientific research and patient experience found "substantial consensus" to indicate that, for some people, the potential medical benefits of marijuana outweigh its risks.
"Smoked marijuana should not generally be recommended for long-term medical use," the report said.
"Nonetheless, for certain patients such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern."
The focus of the report was on "cannabinoid" drugs such as THC, the main active element in marijuana.
Research over the last 16 years has provided new insight into how these drugs work on both the brain and the body, where they can help to modulate pain, and alleviate other symptoms of serious illness such as anxiety, lack of appetite, and nausea.
The report said one focus of new medical and pharmaceutical research should be to design a "non-smoked, rapid onset" delivery system for the drug which could mimic the speedy action of a smoked marijuana cigarette.
But the report's authors also noted that some desperately ill patients may not want to wait.
"We acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana such as pain or AIDS wasting," they said.
To help these patients, the report suggested that doctors be allowed to launch one-by-one clinical studies of marijuana, informing each test subject of the potential risks and rewards of smoking the drug.
The IOM report lands amid an increasingly bitter U.S. debate over medical marijuana, launched in 1996 when California became the first state to pass a local initiative aimed at allowing patients with AIDS, cancer, and other serious diseases to use the drug.
While federal authorities have used their power to block implementation of the California measure, voters in six more states passed similar initiatives in 1998 - boosting pressure on the Clinton Administration to consider removing marijuana from the "Schedule I" list of dangerous narcotics.
Barry McCaffrey, Clinton's anti-drug "czar" and long an outspoken opponent of relaxing anti-marijuana law, ordered the IOM report in 1997 to give a scientific basis to the discussion, and his office Wednesday responded to the IOM findings with a call for more research.
"We will carefully study the recommendations and conclusions contained in this report," the Office of National Drug Control Policy said in a statement.
"We look forward to the considered responses from our nation's public health officials to the interim solutions recommended by the report."
Supporters of the medical marijuana movement declared the IOM report an unequivocal victory.
Bill Zimmerman, director of Americans for Medical Rights, the sponsor of six 1998 state marijuana initiatives, said the IOM's findings would radically rework the public image of what has long been one of the United States' most demonised drugs.
"They are in effect saying that most of what the government has told us about marijuana is false ... it's not addictive, it's not a gateway to heroin and cocaine, it has legitimate medical use, and its not as dangerous as common drugs like Prozac and Viagra," he said.
"This is about as positive as you can get."
Long-Term Marijuana Smoking
Doesn't Impact Cognition, Study Says
Long-term use of marijuana does not lead to a decline in mental
function,according to the results of a large-scale
John Hopkins University study.
"There is no convincing evidence that (even) heavy long-term marijuana use impairs memory or other cognitive functions," said NORML (National Organization for the Reform of Marijuana Laws) board member Dr. John P. Morgan of City University of New York (CUNY) Medical School. "During the past 30 years, researchers have found, at most, minor cognitive differences between chronic marijuana users and nonusers, and the results differ substantially from one study to another."
The most recent John Hopkins study examined marijuana's effects on cognition on 1,318 participants over a 15 year period. Researchers gave subjects specialized tests, called Mini-Mental State Examinations (MMSE), in 1981 and 1982. Subjects took follow-up MMSE tests 12 to 15 years later and scientists measured rates of cognitive decline among marijuana smokers and nonsmokers.
Researchers reported "no significant differences in cognitive decline between heavy users, light users, and nonusers of cannabis." They also found "no male-female differences in cognitive decline in relation to cannabis.
"These results seem to provide strong evidence of the absence of a long-term residual effect of cannabis use on cognition," they concluded. The study is the first to investigate the long term effects of marijuana on cognition in a large epidemiological sample.
Researchers did conclude that cognition declines over long time periods in all age groups, but found this decline "closely associated with aging and educational level, (and) not associated with cannabis use."
The study appears in the May 1, 1999, issue of the American Journal of Epidemiology.
For more information, please contact John P. Morgan of CUNY Medical School
(212) 650-8255 or Allen St. Pierre at (202) 483-8751.
To read an abstract of this study online, CLICK HERE
US: Pot Chemicals Might Inhibit Breast Tumors, Stroke Damage
Date: Tue, 14 Jul 1998
Source: Dallas Morning News
Contact: letterstoeditor@dallasnews.com
Website: http://www.dallasnews.com
Pubdate: Mon, 13 Jul 1998
POT CHEMICALS MIGHT INHIBIT
BREAST TUMORS, STROKE DAMAGE
There may be a silver lining to a cloud of marijuana smoke.
While most medical researchers don't condone recreational marijuana use, marijuana derivatives may prevent brain cell damage in strokes and slow the growth of breast tumors.
Researchers at the National Institutes of Health, led by A.J. Hampson, found that cannabidiol, one of a class of marijuana constituents called cannabinoids, is a powerful antioxidant. When tested on rat neurons in a lab dish (no smoking was involved), the substance prevented the death of brain cells during conditions simulating a stroke.
A stroke unleashes a torrent of glutamate, a chemical messenger in the brain, which leads to the formation of toxic oxidizing molecules. Other antioxidants, such as vitamins A and E, already are known to block the damaging effects of excess glutamate, but the researchers found that cannabidiol was even more effective.
Another cannabinoid, commonly known as THC, proved to be an equally effective antioxidant and neuron protector. However, the researchers said, THC's euphoric side effects would not allow doctors to administer it in high doses.
The study was reported last week in the Proceedings of the National Academy of Sciences.
In a separate study in the same journal, researchers - led by Luciano De Petrocellis of the National Institute for the Chemistry of Biological Systems in Naples, Italy - found that a third cannabinoid called anandamide can inhibit the growth of breast cancer cells by interfering with their DNA production cycle. Non-mammary tumor cells were not affected by anandamide.
CANNABIS NOT CAUSE OF AUTOMOBILE ACCIDENTS
The largest study ever done linking road accidents with drugs and alcohol has found drivers with cannabis in their blood were no more at risk than those who were drug-free. In fact, the findings by a pharmacology team from the University of Adelaide and Transport SA showed drivers who had smoked marijuana were marginally less likely to have an accident than those who were drug-free.
A study spokesman, Dr Jason White, said the difference was not great enough to be statistically significant but could be explained by anecdotal evidence that marijuana smokers were more cautious and drove more slowly because of altered time perception. The study of 2,500 accidents, which matched the blood alcohol levels of injured drivers with details from police reports, found drug-free drivers caused the accidents in 53.5 per cent of cases.
Injured drivers with a blood-alcohol concentration of more than 0.05 per cent were culpable in nearly 90 per cent of accidents they were involved in. Drivers with cannabis in their blood were less likely to cause an accident, with a culpability rate of 50.6 per cent. The study has policy implications for those who argue drug detection should be a new focus for road safety. Dr White said the study showed the importance of concentrating efforts on alcohol rather than other drugs.
Subj: Substance Use, Including Tobacco
Pub. Date: March 2000
Source: American Journal of Public Health
Read this online at: http://www.apha.org/journal/editorials/editdjar.htm
Prospects for a Public Health Perspective
on Psychoactive Drug Use
During the first half of the 20th century, illicit narcotic use was sufficiently localized that it was considered "the American disease."1 During this time, half of the estimated number of narcotic addicts in the United States lived in New York City,2 which may still be the city with the largest psychoactive drug problem in the world. A 1996 study of psychoactive drug use in New York City estimated that combined licit and illicit psychoactive drug use led to $5.1 billion per year in health care expenses (not including law enforcement expenses or the cost of lost employment) and that more than 20% of deaths in the city were associated with psychoactive drug use.3 (Not surprisingly, nicotine was the psychoactive drug responsible for the greatest mortality, accounting for slightly more than half of the deaths.)
If New York City and the United States still lead the world in the problem of psychoactive drug use, the rest of the world is catching up rapidly. The use of legal nonmedical drugs such as nicotine and alcohol has increased substantially in many countries over the last several decades.4, 6 These increases have been particularly dramatic in many developing countries.7 The injection of illicit psychoactive drugs has now been reported in 129 countries, and HIV infection, one of the newer and most dramatic adverse health consequences of drug use, has been reported among injection drug users in 103 countries.7
The "Benefits" of Illicit Drug Use
Consideration of the costs attributable to psychoactive drug use must be coupled with consideration of the potential benefits (contributions to well-being) of the use of these drugs. Estimation of the potential benefits of medical use of psychoactive drugs would be relatively straightforward - for example, days of hospitalization averted or improvements in quality of life. Estimation of the "benefits" of nonmedical psychoactive drug use would be more difficult.
Within a traditional economic framework, the value of nonmedical psychoactive drug use would be measured by what consumers are willing to pay, and this would lead to very high estimates of the value of nonmedical psychoactive drug use. This economic valuation, however, is based on the assumption that consumers make "free" choices among competing alternatives. In the case of compulsive drug use (dependence, addiction), the consumer clearly is not making a free choice. A couple deciding whether to go to a movie or out for drinks are likely to be making a free choice; a person going out on a cold, rainy night because he has no more cigarettes is not. Any estimation of the potential benefits of nonmedical psychoactive drug use would need to adjust for compulsive drug use, and such an adjustment would dramatically reduce the estimated value. The reduction would vary greatly for different drugs, with particularly large reductions for drugs such as nicotine, heroin, and cocaine.
Even though they have potential benefits, psychoactive drugs are clearly capable of causing much individual and societal harm, and societies need to regulate their use. Methods of regulation can include societal mores, incorporation of approved forms of nonmedical drug use into social rituals, medical supervision of some forms of psychoactive drug use, and civil and criminal laws. The present system for regulating psychoactive drug use in the United States clearly has many deficiencies, which is not surprising, given that the system originated prior to scientific understanding of the effects of drugs and often within contexts of intergroup cultural conflicts (i.e., racist stereotyping of certain forms of drug use within certain racial/ethnic groups).1
A Public Health Perspective: Regulating Drug Use
It should be possible to reduce many serious adverse health consequences of current drug use patterns by adopting a public health perspective on drug use. A public health perspective on regulating psychoactive drug use would at least include the following components:
1. Incorporation of scientific knowledge about different psychoactive drugs into policy-making. This would include knowledge of drug use as an extremely common (if not universal) human behavior, knowledge of drug addiction as a disease rather than a lack of willpower,8 and knowledge of the similarities in the effects of many drugs despite differences in their legal status. A wide variety of scientific disciplines, including pharmacology, neuroscience, behavioral science, ethnography, and epidemiology, produce information relevant to public health policies on psychoactive drug use. Political science may also provide useful insights into ways of incorporating scientific findings into public health policies.
2. Emphasis on effective primary and secondary prevention of particularly harmful forms of drug use. Currently, cigarette smoking is clearly the largest problem requiring increased prevention efforts. Ironically, prevention programs for illicit drug use are often continued despite research that shows they are not effective.9
3. Use of drug abuse treatment rather than arrest and incarceration for persons who have problems with illicit drug use.10
4. Reduction of the serious adverse consequences that are modifiable, even among persons who continue to use drugs. For example, alcohol-related fatalities can be reduced by anti-drunk driving programs,11 and HIV transmission can be reduced by syringe exchange programs.12
5. Inclusion in policy formulation of a consideration of the potential benefits of some forms of psychoactive drug use. Policies that ignore the potential benefits of some forms of drug use are likely to be impossible to implement effectively and may often be counterproductive. The prohibition of alcohol was not effectively implemented, and it had important counterproductive aspects.
Obstacles
Although the potential benefits of adopting a public health perspective on psychoactive drug use would seem obvious and compelling in a society that values health, there are serious obstacles to adopting such an approach in the United States (and in many other countries). Four such obstacles are worth mentioning here:
1. Euphoriphobia - fear of pleasure. In many cultures, intensely pleasurable states are considered morally suspect, particularly if these states are "artificially" induced. The Puritan tradition in American culture may epitomize the equation of externally induced pleasure with immorality. An important component of this fear is the belief that the pleasure will be so intense that the individual will not be able to control the desire to repeat the sensation and will become enslaved to it. While this tradition does not seem to keep Americans from seeking drug-induced euphoria, it does lead to policies that punish drug users, and it undermines policies that would provide treatment to persons with drug problems. This tradition also makes it difficult for health officials to publicly acknowledge that there might be real benefits from some forms of nonmedical psychoactive drug use.
There is also a countervailing American tradition that individuals have inalienable rights to "life, liberty, and the pursuit of happiness" (as stated in the Declaration of Independence).
It is important to distinguish between a puritanical perspective on psychoactive drug use (all use is immoral and should be prohibited), a libertarian perspective (all adults should be free to use any and all drugs), and a public health perspective. A public health perspective differs from a puritanical perspective in that it acknowledges that many people use some psychoactive drugs in a controlled manner, with at least a perceived improvement in their sense of well-being and with no objective indication of harm either to themselves or to society. A public health perspective differs from a libertarian perspective in two important ways. First, a public health approach challenges the idea that harm to the individual can be confined to the individual. If an individual becomes dysfunctional because of excessive drug use, this dysfunctional state is likely to result in harm at least to family members as well as to the individual. Infectious diseases such as HIV infection, hepatitis B, and hepatitis C are also transmitted from individual drug users to others. Second, a public health perspective rejects the idea that there should be unlimited commercial exploitation of psychoactive drugs. Many psychoactive drugs are sufficiently dangerous that their unregulated commercial exploitation would lead to unacceptable levels of social and individual harm.
2. Xenophobia - fear of the strange or the different. Integration of a specific drug into a culture may serve to reduce harmful use, but it may also lead to underestimation of the potential harmfulness of the drug, as in the case of nicotine. Conversely, the association of a drug with a "different" and stigmatized group may lead to exaggeration of the potential dangers of the drug. This happened with opium, which was used by Chinese immigrants in the United States during the early 20th century,1 and more recently with crack cocaine, which has become associated with inner-city minority youth. The linkages between the fear of specific drugs and stigmatization of racial/ethnic minorities make adopting effective, nonpunitive drug policies much more difficult in the United States. Ironically, a similar dynamic occurs in much of the developing world, where most illicit drug use is considered a feared and despised American custom.
3. Misplaced moralism - Some programs that protect the health of drug users have been strongly opposed because the programs appear to "condone" drug use. Syringe exchange programs are a notable example of programs that draw this type of opposition.13 Within Western culture, healing the sick and protecting health are primary moral values. The protection of health involves protecting the health of everyone in the community, regardless of their social or economic status. Thus, protecting the health of drug users is a fundamentally moral activity.
Public health leaders have a responsibility to advocate programs that would reduce the adverse health consequences of psychoactive drug use. Such advocacy, however, needs to be scientifically grounded. It should not include supporting programs that are politically popular but ineffective, as are some current forms of "drug education." Public health advocacy should also address the scale of effective programs. Token programs that are effective but reach only small numbers of persons in need do not protect the health of the public.
4. Economics of the status quo - Both licit drug production and law enforcement attempts to control illicit drug use are multibillion-dollar industries in the United States. Policies that would substantially reduce the use of licit drugs, such as nicotine, or that would substitute treatment for law enforcement and incarceration of illicit drug users, would entail large financial losses for these industries.
These 4 obstacles have important implications for efforts to change drug-related policies through American political processes. First, to the extent that current drug-related policies embody culturally conditioned fears, simple factual information on the lack of effectiveness of current policies is unlikely to lead to different policies. Indeed, data showing that current policies are not effective in controlling drug use and its adverse consequences may provoke a fear arousal situation in which the most likely response is intensification of the present policies (i.e., if a policy is not working, apply it more intensely.) Second, new policies that might endanger monies for the current nonmedical drug industries or for the illegal drug control/law enforcement industry will provoke strong resistance. This resistance may include the giving of large financial contributions to influence the political decision-making process.
Conclusion
The one social force that is most likely to change the present situation is the continually advancing scientific understanding of drug use and its effects on individuals and within social systems. There are now much better tools than in the past for studying psychoactive drug use, from the cloning of genes to brain imaging to sophisticated statistical computer programs that permit closer examination of the complex relationships between drug use and social environmental factors.
While continuing advances in scientific knowledge will undoubtedly provide many opportunities for improving public policies with regard to psychoactive drug use, it is important to remember that translating scientific knowledge into policy is not a simple task. The continuing debate over the teaching of evolution and creationism in US public schools clearly illustrates the limits of science when confronting strongly held beliefs among groups with political power.14,15
Psychoactive drug use is strongly related to a large number of important health problems, including overdoses, psychoses, interpersonal violence, cardiovascular disease, and infectious diseases. Psychoactive drug use can also alleviate symptoms of many psychological disorders, contribute to physical health, and, undoubtedly contribute to a sense of well-being for the very large numbers of drug users who control their drug use. One of the major challenges for public health in the next century will be to incorporate the rapidly developing scientific understanding of drug use into public policies that reduce the adverse individual and social consequences of psychoactive drug use, while not denying the potential benefits of some forms of psychoactive drug use.
Don C. Des Jarlais, PhD
Associate Editor, American Journal of Public Health
- The author is with the Beth Israel Medical Center, New York, NY, and National Development and Research Institutes, Inc, New York, NY.
Requests for reprints should be sent to Don C. Des Jarlais, PhD, Beth Israel Medical Center, 1st Avenue and 16th Street, New York, NY 10003 (e-mail: dcdesjarla@aol.com).
Acknowledgments:
I would like to acknowledge the very helpful comments of S. Deren, D. Vlahov, and M. Northridge on drafts of the manuscript, as well as the useful conversations with S. Friedman.
-- References --
1. Musto D. The American Disease: Origins of Narcotic Control. New Haven, Conn: Yale University Press; 1973.
2. Courtwright DT. Dark Paradise: Opiate Addiction in America Before 1940. Cambridge, Mass: Harvard University Press; 1982.
3. Richardson H, Califano JA, Tapper D, Demers J. Substance abuse and public health in urban America: analysis of costs in New York City. Curr Issues Public Health. 1996;2(3):91-100.
4. Peto R. Smoking and death: the past 40 years and the next 40. BMJ. 1994;309:937-939.
5. Edwards G, Anderson P, Babor T. Alcohol Policy and the Public Good. Oxford, England: Oxford University Press; 1994.
6. Jernigan D. Thirsting for Markets: The Global Impact of Corporate Alcohol. San Raphael, Calif: The Marin Institute for the Prevention of Alcohol and Other Drug Problems; 1997.
7. Ball AL, Rana S, Dehne K. HIV prevention among injecting drug users: responses in developing and transitional countries. Public Health Rep. 1998;113(suppl 1):170-181.
8. Leschner AI. Addiction is a brain disease, and it matters. Science. 1997;287:45-47.
9. Lynam DR, Milich R, Zimmerman R, et al. Project DARE: no effects at 10-year follow-up. J Consult Clin Psychol. 1999;67:590-593.
10. Wren CS. Top U.S. drug official proposes shift in criminal justice policy. New York Times. December 8, 1999:A23.
11. Centers for Disease Control and Prevention. Alcohol involvement in fatal motor-vehicle crashes--United States, 1997-1998. MMWR Morb Mortal Wkly Rep. 1999;48:1086.
12. Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 1996;348:987-991.
13. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995.
14. Pennock RT. Tower of Babel: The Evidence Against the New Creationism. Cambridge, Mass: MIT Press; 1999.
15. Glanz J. Science vs. the Bible: debate moves to the cosmos. New York Times. October 10, 1999:A1, A40.
.
marijuana, cannabis, pot, mary jane, medical, medicinal, AIDS, aids, HIV, hiv, pain, MS, spasm, marijuana, cannabis, sex, chat, xxx, sexual dysfunctions, seeds, pot seeds, XXX, growing, garden, hydroponic, Holland, Amsterdam, drug war, drug information, drugs, epilepsy, warts, wasting syndrome, cachexia, playboy, pain, muscle, netscape, software, nude, porno, games, porn, weather, penthouse, pornography, pussy, persian kitty, maps, marijuana, cannabis, music, adult, chat rooms, erotica, microsoft, jokes, shareware, magazines, pictures, employment, jobs, marijuana, cannabis, erotic, gay, netscape, bondage, lingerie, hardcore, hustler, espn, supermodels, disney, star wars, girls, Marijuana, Cannabis, movies, star trek, mirc, genealogy, screen savers, japan, soccer, tits, nude celebrities, nudity, mpeg, nudes, mtv, las vegas, nasa, travel, metallica, real estate, stock quotes, golf, sex stories, lesbian, cnn, sports, quake, hewlett packard, irc, simpsons, gay sex, nirvana, x-files, madonna, sex pictures, horoscope, football, map, java, midi, anal sex, cars, usa today, recipes, education, mexico, airlines, html, free sex, days of our lives, australia, nfl, india, babes, wrestling, history
