Below is an unedited transcript of a recent debate between Dr. David Murray, Special Assistant to the Director the Office of National Drug Control Policy and two drug policy reformers: Rob Kampia, the Executive Director and co-founder Marijuana Policy Project and Ethan Nadelmann, Founder and Executive Director of the Drug Policy Alliance. I recieved the transcript by e-mail from Bruce Mirken of MPP and am cutting and pasting it unedited below the fold. Enjoy!
Medical Marijuana Debate
Following screening of “Waiting to Inhale”
Produced and Directed by Jed Riffe
E Street Cinema, Washington, DC
September 13, 2006
CLARENCE PAGE (Moderator): Thank you ladies and gentleman for being here tonight. We are”¦ I am really honored to have a chance to be your emcee. Um, I am going to forego my usual array of clever remarks because I want to get right into this discussion. My job as one of my editors once said is kind of like the one-eyed javelin thrower, I may not score many points but I’ll keep the crowd alert.
PAGE: Thank you. They’re a little slow but they’re good. I want to introduce our panel: We have to my right David Murray whom you saw on tonight’s program, uh, in tonight’s movie. How’s it coming? Okay? Can you hear me now? Good! Thank you.
Dr. David Murray, Special Assistant to the Director the Office of National Drug Control Policy. Or as we say in the media, aka, the Drug Czar. He earned his M.A. and Ph.D. from the University of Chicago, a fine institution and a great American city, I might add and subsequently taught at Connecticut College, Brown University and Brandeis University before coming to Washington where he served as an adjunct professor at the University, I’m sorry, um adjunct professor at the Graduate School of Public Policy at Georgetown.
He’s been the Executive Director of the Statistical Assessment Service, uh, a Science, Media and Public Policy Think Tank and most important he is author most recently of the Penguin Press book It Ain’t Necessarily So: How Media Remake the Scientific Picture of Reality. Dr. David Murray.
PAGE: I’m sorry Dr. Andrea Barthwell can’t be with us tonight because of a last minute complication, so Dr. Murray you get to handle to, well, you get all the time tonight on that side of the debate. How about that? Thank you very much.
Just to immediate left, we have Bob Kampia. I’m sorry, I need a new prescription. you’re right, thank you Rob, I’ve only known him for about 5 years now. Rob Kampia, Executive Director of the Marijuana Policy Project. Co-founder. Oh, you’ve got some fans here tonight, man. Co-founder and Executive Director of the Marijuana Policy Project the largest marijuana policy reform organization in the U.S. Without going into Rob’s entire list of Rob’s many accolades and the many television programs and various journal in which he has been quoted, uh, let me say that he lead the campaigns for passage of America’s 3 newest medical marijuana laws in Vermont, Montana and Rhode Island and he tells me more to go So thank you for being with us tonight, Rob.
PAGE: Also to my left, Ethan Nadelmann, Founder and Executive Director of the Drug Policy Alliance, the leading organization in the US promoting alternatives to the War on Drugs. Also has a new book co-authored with Peter Andreas and entitled “Policing the Globe: Criminalization and Crime Control in International Relations”, which will be published by Oxford University Press in 2006. Is it out yet?
NADELMANN: Its out.
PAGE: Its out. We have a whole body of them out here. I’m glad they have the late news.
NADELMANN: Two weeks ago.
PAGE: Two weeks ago, okay. In 1994 Nadelmann founded the Lindesmith Center, a drug policy institute created with the philanthropic support of George Souros and is described by Rolling Stone as the “point man for drug policy reform efforts.” Did you know that? Appropriately labeled.
PAGE: I am going to, I am going to, uh, present a few questions, propositions which will be put forth and each side will have, um, about 3 minutes to respond. But first I am gong to open up by giving each side 4 minutes to, um, I’m sorry, each side 6 minutes. Try that again, lets see”¦ [inaudible] I do need, I just need a little more light here is what it is. That’s right. My panelists know the rules better than I do. One person on each side since gets one and a half minutes, so that is a total normally of 6 minutes and as I said before, you get 3, you lucky guy. I’m going to let you start.
MURRAY: Alright, thank you sir.
PAGE: So, please give your opening statement
MURRAY: Thank you. I appreciate being here and I acknowledge the presence of our other panelists who have a long investment in this issue and I appreciate their presence as well and obviously Clarence Paige, a man whose material I’ve actually read for quite a few years. And I lived in Chicago for a while, and I”˜ve actually met you on a couple of occasions. Not always in this context or with this theme but it’s a pleasure to be part of this.
Its seems to me”¦.the”¦ I enjoyed parts of the films and not just the ones with me in it, but didn’t enjoy some of the look at one age of that’s there”¦ But I was also kind of disappointed. I thought to some extent, they came across more as a bit of a cartoon, I was hoping it would be more of a medical engagement with this evidence and the science and the law which is a complicated issue… it’s not clear exactly what is the best course of action when you have claims about medical efficacy and patient suffering and the rest.
To have on the table what I think is important to have, uh, as a formal”¦ I’m going to defend some policies here. We clearly have federal government policies, the Controlled Substances Act and an understanding of the role of marijuana in American life and also the medical potential of the development of cannabinoid type medications. They are in an intricate balance here. These are the policies and I think is the clearest statement of where we are at the moment.
This was issued just this year by the Food and Drug Administration as a health advisory. I think it addresses almost everything that’s centrally on the table here. And here is the formal statement that was cleared through the Food and Drug Administration and also the HHS as well as DEA, White House Office and seems to express the dominant the medical opinion within those charged with approving medications:
“Claims have been advanced asserting smoked marijuana has value in treating various medical conditions. Some have argued that herbal marijuana is a safe and effective medication and that it should be made available to people who suffer from a number of ailments upon a doctor’s recommendation. even though it is not an approved drug Marijuana is elicited in Schedule I of the Controlled Substances Act, the most restricted Schedule of the Drug Enforcement Administration which administers the CSA continues to support that placement and FDA concurs, because there is currently sound evidence that smoked marijuana is harmful.
“A past evaluation by the Food and Drug Administration concluded that no sound scientific studies supported medical use of marijuana for treatment in the United States and no animal or human data supported the safety of efficacy of marijuana for general medical use. There are alternative FDA approved medications in existence for treatment of many of the proposed uses of smoked marijuana.
“FDA is the sole federal agency that approves drug products as safe and effective for intended indications. The federal Food Drug and Cosmetic Act requires that new drugs to shown to be safe and effective for their intended use before being marketed in this country. FDA’s drug approval process requires well-controlled clinical trials that provide the necessary scientific data, upon which FDA makes its approval on labeling decisions. If a drug product is to be marketed, disciplined, systematic, scientifically conducted trials are the best means to obtain data to ensure that drug is safe and effective when used as indicated.
“Efforts that seek to bypass the FDA drug approval process do not serve the interest of public health because they might expose patients to unsafe and ineffective drug products. FDA has not approved smoked marijuana for any indication or condition. A growing number of states,” ““ this is the end here ““ “have passed voter referendum or legislative actions making smoked marijuana available for a variety of medical conditions upon a doctor’s recommendation. These measures are inconsistent with efforts to ensure that medications undergo the rigorous scientific scrutiny of the FDA approval process and are”¦ before they are proven safe and effective under the standards of this Act. Since there has been no determination of safety and efficacy under the standards the Office of Drug Control Policy, DEA, HHS do not support the use of smoked marijuana for medical purposes.”
There are two things at stake. The approval process and the integrity thereof which has largely kept us safe and provided us with a pretty effective medical synthesis can be undermined by political pressure that goes outside its venue and probably would lead to a weakening and vulnerability with regard to a drug approval process.
There’s also the question as to what are the risks and harms to society as well as to patients from the continued consumption of the raw, crude smoked weed that has not been regulated, purified, distilled kept in terms of constant dosage. There is actual genuine harm. The medical community itself is not the principal proponent of the drive to call smoked marijuana a medicine. It is driven by other agendas and other interests.
There may very well be very powerful medications contained within cannabinoids. Cannabinoids may be very valuable at some point in the medical armamentarium. When it goes through the drug approval process it will be well received and accepted by our Office of Human Policy Acceptance. If they have not gone through that process, we must hold the door against them. Thank you.
PAGE: Thank you. Rob and Ethan do you want to split your time here?
Are you ready yet?
KAMPIA: Is this on? Thank you. Okay, so when I was in my office on Capitol Hill earlier today, I sent an email to the staff list asking if anyone had any handcuffs on them because I left mine at home. And interestingly someone actually did have handcuffs so here they are and I hold these up so that we can stay focused on what the real issue is. [holds up handcuffs]
Our side of the debate believes that patients that have their doctors’ approval to use medical marijuana should not be arrested and put in prison for using the medicine that is best for them. It’s important to keep that in mind as to us the issue is arrests and prison, arrests and prison.
We can talk about FDA regulatory process and that’s fine, but ultimately we’re concerned about prison for sick people. Uh, what are the penalties? Well, penalties vary from state to state for sure. In eleven states medical marijuana is legal. But on the federal level you can get up to one year in prison for just one marijuana cigarette whether you’re a sick person or a healthy person. And if you’re growing one marijuana, plant you can get up to 5 years in prison, on the federal level whether you’re sick or healthy. Those penalties are completely unacceptable in a civilized society, so we seek to change those laws.
What does it mean to have the threat of arrest hanging over people who are sick. Well, one year ago”¦ this is in a n AP article that came out of Seattle”¦ I’m going to read the first couple of sentences to you.
“An army veteran who fled to Canada to avoid prosecution for growing marijuana to treat his chronic pain, was taken from a hospital, driven to the border with a catheter still attached and turned over to U.S. officials. Stephen Tuck, the patient, then went 5 days with no medical treatment and only ibuprofen for the pain. Tuck, 38, was still fitted with the urinary catheter when he shuffled into federal court Wednesday for a detention hearing.
Quote: “˜This is totally inhumane. He’s been tortured for days for no reason’, his attorney said. And the article goes on and on including explaining that Tuck, an army veteran suffered debilitating injuries in the 1980’s when his parachute failed to open during a jump. This is how we treat our veterans apparently. A doctor recommends medical marijuana. He’s growing and using it legally in the state of California. He’s policed to California because he’s in trouble with the Feds. The Feds bring him back with a catheter still in him and drag him into federal court. Its completely unacceptable and we seek to change the Federal laws that treat patients this way.
Dave Murray”¦ I’ll say one last thing before I give the microphone to Ethan. Dave Murray notes that the medical establishments aren’t really behind in this. I just want to list some medical organizations that actually do support a changing in laws so that patients have medical access to marijuana.
The American Academy of Family Physicians, The American Society of Addiction Medicine, The National Association for Public Health Policy, The American Academy of HIV Medicine, The American Nurses Association, The National Nurses Society on Addictions, The American Public Health Association, Lymphoma Foundation of America The American Medical Students Association, The British Medical Association. And The America BAR association. Not to mention dozens of other state and local groups. There’s a lot of medical support behind this, it’s not just advocates like Ethan and me.
PAGE: You have one minute left.
NADELMANN: One Minute”¦ Let me stand up and talk fast.
Drug Policy Alliance like Marijuana Policy Project, we ultimately believe that, that marijuana should be more treated, taxed, controlled and regulated like alcohol. So we’re talking making it legal not just to people who are sick but really for all adults, and ending incarceration. And in fact the single best way to make this medicine available for people who really need it as a medicine as opposed to those just like to use it would make it legal for everybody.
What we also believe is that the persecution and the prosecution of people who use this only for medicine, who really are patients, is the most egregious, is the most horrific aspect of the war on marijuana. That’s clear. These are basically issues about freedom, compassion, medicine and human rights. That’s what we’re talking about here. Does a doctor have the right to recommend it without having the federal police in his office? Does a patient, does an individual, does a human being have the right to use this medication in whatever form including smoking it if that’s what alleviates pain suffering? I think the answers on both questions are yes and yes, and the federal government should get out of the doctor’s office and out of our lives. Thank you.
PAGE: Thank you. The first question goes first to the pro-medical marijuana side. Uh, most of the state laws and initiatives have been passed because the public perceives that patients are used cannabis for medical purposes are at risk for prosecution. How has this public concern for legitimate patients improved patients ability to access cannabis for medical use?
ROB: Well, yeah, when we talk about changing state medical marijuana laws, and as I mentioned there are eleven states where medical marijuana is currently legal. Uh, it’s quite effective because under the way our laws work, of all the marijuana arrests in the country, according to the FBI, 99 percent of all marijuana arrests are made by state and local police under state law. And only 1 percent of all marijuana arrests are made by the feds under federal law. So if you are changing the state law, you’re solving 99% of the problem.
And so in that sense, it’s quite effective changing state laws in terms of protecting patients. And just to give you some quick numbers, of the number of patients who are using in these states, um, in Alaska, these are just as of a couple months ago, in Alaska there were 62 registered patients. Um, in California it’s going to be in the many thousands, uh the p-program is still getting up and running. There’s been a change in the law recently. Um, let’s see where else here”¦ uh, Hawaii 2,596; Colorado 742; Montana 202; Nevada 610; Oregon 10, 775 patient; Vermont 29; and, Washington and Maine, it’s just too tough to tell because there isn’t actually an official registry program in those two states. So, these laws are protecting patients and we actually have real numbers to, to back it up.
PAGE: Dr. Murray?
MURRAY: Ah, Thank you. The um, state ““ I, I can challenge the premise of the, of the question that most of the state initiatives have been passed because the public perceives that the patients are at risk. I, I have no idea what they had in mind. Those are not the way the initiatives are written, about “the public perceives it that way”. That may be the case that may not be the case.
The reality is, however, you learn a great deal about the organizations and the nature of the argument in, uh, a debate by listening to the tactics they ploy. When you have the medical science, the facts and the evidence on your side, you want to argue the medical science, the facts and the evidence. When you don’t, you want to do something else. You either want to do an end run around the medical approval process, because you know you can’t win in that court, because you don’t have the evidence and the research, you don’t have the results and the findings.
So you go to the political process and you try to bring initiatives, confusing the public very often with very misleading advertising in many instances, and then try to bypass the drug approval process and create medicines by political plebicite. That’s not how you create a medicine. The second thing you’ll do is rather than arguing the evidence, the research and the status of the potential medical value, you’ll resort to the use of suffering individuals, to the emotionality and to the appeal to compassion.
Very moving, and very real, but nevertheless a sign that they know they can’t win on the basis of the science, the evidence, the policy, the law and the actual results of clinical trials. So at some point, we moved away off medical marijuana into talking about claims about the law, about persecution and about compassion. That’s no longer in the court of science whatsoever.
By the way, in state prisons today, of people who are actually incarcerated for marijuana offenses, they’re there for dealing and trafficking large amount of multiple repeat offences, in many cases involving violent offences. Less than 1 half of one percent of state prisoners who are there for possession and use of marijuana, less than one half and one percent of all drug offenders fit that profile, and they’ve overwhelmingly pled down from far more serious consequences.
People are not in fact getting routinely arrested and locked away for simple possessions. Because they are dealing and trafficking. And unfortunately the marijuana dispensaries as they have now become evolved in California have become incredibly high risk areas of high criminality, with the unregulated distribution of large amounts of marijuana to individuals who do not qualify by any of these vectors, for tens of thousands of dollars a day. They’ve become very often, criminal enterprises. They’re very risky.
PAGE: Time. I’ll give you the next question first. Is there research demonstrating that herbal marijuana has medical value?
MURRAY: I think it is absolutely clear that there is some enormous potential, with what become — within the medical community, we can I think have some hopes for, because of the compounds found in marijuana, the cannabinoids, that do seem to have a relationship with the endogenous cannabinoid system that we know is involved in pain, in memory, in appetite, in immune system, there is all kind of receptors in the system that’s endogenous.
So the prospect that there could be a powerful medicine developed out of the chemical compounds that are active in marijuana — there are 12 cannabinoids at least, we don’t know which of them exactly have which effect, THC’s been talked about. There are several others, cannabidiol and others, that might become valuable medicines that could supplement pain management neuropathy and those kinds of issues.
The other thing that needs to be recognized, however, is if you can interfere with this rather delicately calibrate endogenous cannabinoid receptors that are internally designed to respond to your own production of endogenous cannabinoids or anandamides, if you can interfere with that and actually disrupt the calibration by the introduction of external cannabinoids to which your system will adapt, it can actually lead into long-range difficulty for cannabinoid receptors in regulation. So we need to be very careful about developments and medicines. That’s why it should be handled in the court of science and medicine, with careful clinical trials. The potential is certainly there.
PAGE: The gentlemen on the pro-legalization side.
NADELMANN: Yeah, uh, is the research demonstrating that herbal medicine has medical value? I mean, duh. You saw the movie. Um, there’s evidence up the gazoo, and there is evidence up the gazoo not withstanding the fact that the federal government has done almost everything in its power to try, to try to prevent there being more research.
It reminds me a little bit of the “˜needle exchange’ some years ago. For years congress tried to block any research on needle exchange, even as it was becoming the standard operating procedure throughout the rest of the world. Finally the pressure became too great, Congress said okay we’ll allow the studies, we’ll pay for the studies, you know, the National Academy of Science says that it re”” that it reduces AIDS without inducing drug use, okay. The studies happen, they’re conclusive, everybody agrees, needle exchange reduces AIDS without inducing drug use, and congress comes back and goes, “Aah, we were just kidding, we don’t wanna do what the evidence says.”
That’s the story of medical marijuana as well. I mean, on the one hand you have the DEA years ago holding administration law hearings, coming to a conclusion the DEA’s owns administration law judge saying that marijuana should be rescheduled to Schedule II, to allow it to be made to be prescribed by doctors. He even says that it may be the safest psychoactive substance known in human history. The head of the DEA, does he respect that judgment? No. Congress has given him the power to say “absolutely not,” without any reason whatsoever. That’s what he does.
Now there’s the study– you know how most studies you do, the pharmaceutical companies to be able to produce the drugs? Well, we’re, if somebody wants to do research on marijuana in America, where do you have to go? Only one source: the federal’s marijuana farm in Mississippi. There’s now a lawsuit against the federal government to say “open it up and let us get more stuff.” You saw Don Abrams, the researcher in San Francisco? Same thing! He says they don’t want research on this. They will do everything possible to block it.
That being said, if you go to the National Institute of Health website and type in “therapeutic cannabis”, you will see hundreds if not thousands of reports indicating the positive outweighs the negative medical potential. Meanwhile, GW, the stuff that Andrea Barthwell was supposed to talk about, the uh, the s-Sativex, Tevex, you know, Marinol? Of course, as even David admits, there is medical value. Is there also medical value when you take it in the form of a joint? Of course! How could there not be? It’s the same substance, it’s the same drug!
So is there a reason not to take the net form? Well maybe smoking it is so harmful that we shouldn’t do it. But in point in fact, smoking marijuana is not that harmful. Never been a lung cancer death, never been an emphysema case associated just with smoking marijuana.
You can titrate the dose, it’s a lot safer that way, you can minimize your use. So, as Lester Grinspoon said in the movie with N-of-1 studies, with anecdotal evidence, when you can smoke something, and you realize that your symptoms have moderated, we’re not ta”” talking about some, you know, make-believe drug, some laetrile thing. We’re talking about an instant effect. The stuff works.
PAGE: Thank you. Okay, Robert, your chance. Should medical doctors have the right to recommend marijuana or other herbal products that are not approved by the FDA?
KAMPIA: Well, you know, our, our position is that we want the maximum number of treatment options for patients. We’ve heard about Marinol, which is the THC pill, it was approved by the FDA in 1985. Sativex we’ve heard was approved by Canada a year ago as a prescription medicine.
Let’s talk a little about what Sativex is. Sativex is liquid Marijuana. It’s liquid marijuana that is sprayed under the tongue. It’s a legal prescription medicine in Canada, it’s going to be prescribed shortly in, um, in the U.K. and clinical trials are about to begin in the U.S. Uh, my attitude is, if liquid marijuana is a medicine, then why isn’t solid marijuana a medicine? I mean, that’s like saying that uh, you should be able to, uh, drink a coffee but if you have coffee beans you should go to jail. That’s currently what our policy is. It’s absurd.
Um, I think ultimately, uh, our iss”” our con”” our position is Marinol, great, Sativex, great. If we want to have tinctures, food, vaporization that’s great. Smoked marijuana from the joint, that’s fine too. That should be legally available for patients. Uh, ultimately, the key question is who should be making these decisions in our society? Should it be between a physician and patient, or should it be local cops who have no medical expertise and federal bureaucrats who are completely out of touch with the people? I want to give the power to the doctors and the patients.
PAGE: Dr. Murray, uh, why”” why is the FDA approval important?
MURRAY: Um, are we”” we’re still on this, uh”” physicians””
PAGE: Same question, right. I’m just phrasing it in a different way””
MURRAY: Thanks, no, indeed. Just for clarification, I, I believe Rob misspoke. I mean, if, if the idea is that Sativex is just marijuana in its full 450 chemical entities that’s been liquefied, uh, I don’t think that is accurate. G.W. Pharma, I believe, uh, carefully controls the chemical balance, does not in fact include that full set of compounds, and it stays an extract so that they can keep a balance of cannabidiole and THC, and that it’s actually fairly, uh, carefully done. It’s not a synthetic, it is an extract, but I don’t think it’s simply””uh, um, Rob, is that not correct?
KAMPIA: I don’t think that is correct, what you’re saying.
MURRAY: You think that it is the full compound of all the plants in marijuana is what GW Pharma is presenting in Sativex?
Audience Member: Dr. Murray is correct.
PAGE: Who is that?
MURRAY: “¦whoever you are. I feel a little lonely, so”¦
PAGE: Someone just backed Dr. Murray, for the record.
PAGE: Anyway ““
MURRAY: ““ So, may-may-maybe get to the other issues here ““
PAGE: ““ About, back to our issue”¦
MURRAY: Should, should the doctor have a right to recommend? I mean, this has been the subject of a court case, uh, the court has made the determination that recommendations may be made by physicians. We don’t, and the White House, weigh in on court cases for, for that issue. But, uh, the issue is not that, not that troubling to us.
I mean, there’s a doctor-patient relationship, federal government does not intrude into that doctor-patient relationship. We preserve sanctity of that, it’s not actually a prescription, which would fall under DEA’s controlled substances prescribing capacity and DEA licensure, it’s presumably a recommendation.
Um, I do think that there are some concerns, however, about what are the medical implications of a patient using marijuana. Doctors have concerns, I think very widely, that it may or may not be efficacious based on anecdotal reports people felt better after they took it. Yeah, but what about the other compounds you were taking at the same time, and the mode of administration ““ the smoking, yeah? Well, what about the safety concerns for what you may be doing to your overall health and system?
Many doctors are deeply concerned that immuno-compromised patients should not in fact be smoking marijuana, because there are animal studies showing immuno-suppression in the presence of cannabis. Based on the sense that you are already immuno-compromised, are you in fact harming your patient or making your patient more vulnerable? Those are open questions.
PAGE: 30 seconds.
MURRAY: What do you do if a woman is pregnant, and she wishes to take marijuana? We have pretty good evidence now that there is an effect on the fetus, by virtue of the canna-uh, of the cannabis. We don’t know what the implications of all that will be, but they don’t look particularly healthful or helpful.
What about those who are adolescent, who have developing brains, who we know now when the high-potency THC is available at the younger age, has profound implications for increased risk of psychotic episode, schizophrenia, depression ““ particularly in those who are already susceptible, vulnerable because of their own previous histories.
PAGE: 10 seconds.
MURRAY: It’s a trigger here that we’re not sure what it is exactly we’re recommending in terms of the total health of the patient. That’s why these clinical trials are important as the gauntlet through which proper medicine should go, so we know what we’re handing when we recommend it.
PAGE: What potential liability does a physician have if he or she recommends herbal cannabis, or as we say in Southern Ohio “cann-ah-bis”, for medical purposes, and a patient ““ home of Hawken Valley Gold, by the way ““ uh, and a patient suffers harm from using it? What potential liability does a physician have?
NADELMANN: Let me stand for this, ah, Y’know, it’s actually good to answer this question and at the same time respond to what David said. If you listen carefully to what David just said, you realize no physician would ever prescribe anything to anybody”¦ because, all these substances are dangerous, they’re all risky! It’s that marijuana is dramatically less risky for adults and for young people than most of the other substance that doctors are prescribing. You know, something like fifty, 100,000 people die each year from pharmaceutical substances approved by the FDA, either through the proper use or misuse of these drugs.
So, by the criteria David’s using, we wouldn’t be allowed to have anything! Lester Grinspoon said it beautifully in the film. He said, “Every doctor essentially engages in a basically cost-ben, cost-benefit safety-benefit analysis. You make the judgement”¦ is this person, do the benefits of smoking”¦ are the benefits of smoking this marijuana exceed the negative side?
Now the question is”¦Who’s gonna make that choice?
[brief interruption and conversation to deal with technical malfunction of microphone]
NADELMANN: The question is, every medication has a risk. Who’s gonna make the decision? I say, and Rob says, and most Americans say it should be up to the patient and the doctor in their consultation, based on their own judgement. David’s saying “It’s the state, it’s the government who makes that decision.” We don’t agree.
Now, specifically to this question, after we won the medical marijuana initiative in 1996 and I and my organization were totally involved in the legalizing marijuana initiatives in California, Alaska, Oregon, Washington, Colorado, Nevada, and Maine, putting all those through, right after we won the California initiative, in December ““ right around Christmas of ’96, Barry McCaffrey the old Drug Czar, Donna Shalala former head of HHS, Alan Leshner former head of National Drug Abuse, and a few others stood at a national press conference and they said “If any doctor tries to recommend this stuff, we’re gonna go after him, we’re gonna ah-try to take away his license, we’re gonna try to get him.”
And my organization, Drug Policy Alliance, then called Lindesmith Center, we hooked up with the ACLU and some patients and others, and we sued their ass! And we said “What you are doing is violating the First Amendment rights of doctors and patients. And we fought them for seven years in federal court, we won temporary restraining orders, preliminary injunctions, we won in a district court, we won in federal appeals court, and finally the government gave up. We won and we confirmed the constitutional right of doctors and patients to talk about marijuana in the pruh-privacy of a doctors office, and for a doctor or nurse to recommend that.
And th — a little bonus sign I have to tell you personally, is shortly thereafter the Drug Policy Alliance and the ACLU each received checks of $350,000 from the Drug Czar’s office for attorney’s fees, thank you very much.
PAGE: Dr. Howard? Dr. Howard, what about the question of liability?
MURRAY: Yeah, um”¦ th-th-that was the answer to a question “Do physicians have a potential liability if they recommend.” Um, I, I think that may have missed the target. But the answer I would give is, that has not actually been adjudicated. Make a very interesting set of cases. My se”¦impression is, uh, there is the prospect of, uh, some degree of, of some degree of liability. Uh, it has not been cleanly worked out in the law. Uh, but yeah, there is a prospect I think of, of lawsuit. Uh, there may be prospects about licensure, I really have no idea, because it really has not been brought forward to a clarified dispositive position within the law.
But one can understand that we are a litigious society, and people who have perceived harms, uh, often times do resort to such activities. I-It is also I think important to keep in mind, uh, i-it’s very difficult to have simultaneously the argument that this is such a powerful medication, that has these extraordinary effects on muscular dystrophy, on neuropathy, on tremors and spasms of all sorts, on AIDS wasting disorder, it has that kind of potency and capacity, and yet somehow none of it could ever be bad, and that it is the safest-safest possible thing, it could never n-never possibly be as dangerous as other substances.
That’s a remarkable kind of claim to make, that simultaneously we see more and more death and profundity of the systems it purportedly can effect, at the same time they claim it’s just innocuous, it’s just harmless, it’s nowhere near as important as say a, an empty bottle of beer.
PAGE: Uh, stop. Many”¦many in the medical marijuana movement want to transfer to Schedule II of the Controlled Substances Act. How is that relevant in the controversy about whether herbal marijuana should be made available as a medicine. Rob?
KAMPIA: The quick answer is that it’s not too relevant. Uh, let’s review what Schedule I is.
PAGE: I like quick answers!
KAMPIA: Okay. This’ll be a little longer.
PAGE: Okay [laughs].
KAMPIA: Schedule I is, includes marijuana, uh, heroin, and LSD, and other drugs. And it’s defined under federal law as saying that the drug has a high potential for abuse, the drug or other substance has no currently accepted medical use, which is clearly not true, and that there’s a lack of accepted safety for use of the drug under medical supervision, which has obviously also been proven untrue. Schedule II, which is what some advocates want to move it to, is for drugs that have medical value, such as cocaine and morphine. And these drugs are considered to have more medical value for you than marijuana.
Now, if we were to move marijuana to Schedule II, it would certainly would, it would be a big PR coup, because that would show a little bit of a loosing of federal law, but in fact it wouldn’t provide any patients with immediate access to marijuana. Because you’d still have to go through the FDA approval process to get marijuana packaged and marketed and so forth like a prescription medicine.
So, rescheduling marijuana in and of itself is actually not the name of the game. The name of the game again is ““ [holds up handcuffs] we have to change federal law, we have to change state laws so that we’re removing criminal penalties for the possession, use, and cultivation of marijuana for medical purposes.
PAGE: I wish I’d brought a visual aid with me. Those, those are a good idea. Dr. Howard?
PAGE: Why isn’t it a Schedule II drug?
MURRAY: Um, the, uh, part of it’s definition. That which is medically accepted as being efficacious or therapeutic for some specified indication, and does not have high potential for abuse or risk associated with it, will be scheduled where it is appropriately found. Marijuana is a Schedule I drug because it satisfies neither of those criteria. It has not been demonstrated to be acceptable for current therapeutic value in, uh, medical conditions, by clinical trial, by the FDA, by those who certify and approve it, and it does have very high potential for abuse.
In fact, globally, cannabis is an enormous problem for the health and wellbeing of people all over the world. It is the most prevalent drug of abuse in the United States by far, it is also a very prevalent drug of abuse in places like Africa and Asia, where it is a major contributor to underdevelopment, poor health, and serious difficulty with HIV-AIDS and high-risk sexual behaviors.
It is a problematic drug. It’s got abuse potential for the society, it has risk for the person who takes it, and the medical evidence about its efficacy is no doubt going to be found in the particular chemicals that can be produced, synthesized, clarified, and given in proper dosage, not the raw, crude, smoked weed. We don’t chew Willow bark to get rid of a headache, we take aspirin, we is extracted from Willow bark. Something like that is going on with medical marijuana. It presents risks to the user that are greater than the benefits to the user of the drug or the medical community.
To think otherwise, by the way, to think that somehow we are keeping it in Schedule I in an unjustified fashion because the science actually shows otherwise, is a bit of a charicature. We have already approved and moved into Schedule II very potent, very powerful medications, like cocaine, like methamphetamine. We don’t fear them. We put them in Schedule II, which is tightly controlled and regulated and restricted, indeed, but because they have shown that they have actual medical efficacy for particular conditions. If marijuana crosses that bar, then the revisiting of scheduling would be altogether appropriate. But until it does, it is not.
PAGE: Many, uh”¦If herbal marijuana were legalized for medical use, what impact could this have on teenagers? And, I will put this back to, uh, Rob and Dr. Na..uh, uh, Ethan Nadelmann.
KAMPIA: It is Dr. Nadelmann, right?
NADELMANN: If he’s a doctor, I’m a doctor.
PAGE: It’s also Doctor Murray, not Howard as I said earlier, by the way.
MURRAY: I can only recommend, I can’t prescribe. (laughs)
KAMPIA: I have a bachelors in science, I have a b.s. after my name.
KAMPIA: So uh, interestingly, so what do we know medical marijuana to be? So in 1996 when uh, Ethan sort of put the Medical marijuana initiative on the California ballot, the bad guys essentially said two things. One is that it was going to basically make it legal for everyone, which hasn’t been found to be true. And two, and they said that teenage marijuana use was going to rise through the roof. And they said that in every state since.
And so now we have eleven states where medical marijuana is legal. In 10 states there’s been enough time since the laws have been passed that we can actually look at the data and find whether teenage marijuana usage rates have gone up or down. As an example of the hypocrisy and the dishonesty of the federal government, they choose not to release these numbers in a way so that the public can understand. The fact of the matter is that”” I just dropped my little light. [laughs] I’ll squint.
PAGE: Now you’ll be as blind as me.
KAMPIA: Yeah, now the two of us are in trouble. Uh, in the ten marijuana states where we have had time to do before and after data, the teenage marijuana usage in all ten of the states have gone down since the passage of the medical marijuana laws in each state. They’ve not gone up. And pretty dramatically, too.
As an example, in California, I’ll just read right from a report that we’ve issued because the Federal government wouldn’t. California, which has the longest term, most detailed data available because it was the first medical marijuana state, the number of ninth graders reporting marijuana use in the last 30 days declined by 47 percent from 1996 when the law was passed through 2004. An analysis commissioned by the California Department of Alcohol and Drug Programs found, quote, this is government, not MPP, “no evidence supporting that the passage of Provision 215 increased marijuana use during this period.”
So, the feds have a real hard time now explaining, um, how medical marijuana laws are supposedly bad for teenagers when in fact teenagers are smoking less marijuana after the laws are enacted.
Now we don’t know why this is. We can take guesses. Uh, one guess might be that with cancer patients and AIDS patients smoking marijuana legally, maybe teenagers look at these people and think, “Maybe marijuana smoking isn’t so cool. I don’t wanna be as cool as a cancer patient that’s on his or her deathbed.” It’s just a guess. We don’t really know what the reason is. What we do know is that the numbers are down, down, down every year.
PAGE: David Murray.
MURRAY: How long have I got?
PAGE: Uh, well you’ve got about two minutes here.
MURRAY: Two minutes, okay.
PAGE: When your up I’ll stop you, go ahead.
MURRAY: Yeah, I think there are a, a, very large number of things wrong with the characterization Rob just gave about the, uh, analyses of what we know on state-level data regarding marijuana use, and I don’t think his argument can be sustained. Unfortunately, it would take a fair amount of time to lay out what exactly he misrepresented or did not fully understand about what the data show. I, I’m sorry that that’s a cheap shot of sorts, but I’m, i-it is in fact quite contestable what he just said.
But I think there’s another important point. We have seen marijuana use amongst young people go down, go down very steeply. Principally, in the period 2001 to 2005, it’s been a roughly 20-percent drop in Monitoring the Future survey, it’s been a 17-percent drop in the National Household survey. And we’re seeing it across the horizon for young people in early drug use, particularly marijuana.
We believe that much of that is attributable to communication to young people about perceptions of risk in using marijuana, a rising sense of the social disapproval, the norms against marijuana use, and that they have been efficacious. We have seen this in other countries. The most interesting case of course is the Netherlands. The Netherlands, which did decriminalize in many regards, and saw little immediate effect from the cannabis cafes and the other presence of cannabis in their society upon the generation that was currently teenagers at the time this took place.
However, as marijuana use became normalized in the system, and as the cannabis cafes began to sell it, as the laws against it were so removed it became integrated into the normal expectation of a kid growing up, the generation that came forward under those regimes saw a tripling, from 15 to 44-percent, between 1986 and 1997, of their marijuana use rates.
There’s reason for believing that the normalization of marijuana does in fact increase. Alcohol use is normalized in American life, and there’s 120,000,000 are using it, and the toll on society is high. Marijuana use is not normalized in society, and the toll on society’s very high. It’s only around 14-and-a-half million current users. If it were to be at the level of alcohol, 120,000,000 users, the devastation would be quite remarkable. It is the leading cause of need for treatment for drug dependency in the United States.
Finally, I’ll just leave you with this notion. Marijuana normalization was seen in the film. There was a patient in the kitchen. They were making cupcakes. And what was the depiction? “When my son’s friends all came over, they were so fascinated, and they watched and said “˜I didn’t know that, you can eat this, you can do this, it’s good for you, it’s healthy, it cures cancer?’ Yeah, that’s what happens.
[NOTE: At this point director Jed Riffe announced that the program had exceeded the time limit the theater was available and that all needed to exit ASAP]