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Steve Heilig

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Cannabis and California's Physicians: A New Perspective

Posted: 12/12/11 04:30 PM ET

Co-authored by George Fouras, Donald Abrams, and David Pating

There has long been a "drug war" surrounding marijuana, not only in terms of the plant's legal status but also in words. As the California Society of Addiction Medicine observes, "Reasonable dialogue regarding marijuana use has historically proven extraordinarily difficult." The result is a longstanding stalemate and various symptoms of "reefer madness," but with a growing consensus that our nation's marijuana policy has not served us much better than the failed experiment with alcohol prohibition many decades ago.

Most recently, there was this headline: "California Medical Association calls for legalization of marijuana." It was a cover story in the Sunday Los Angeles Times in October. As the CMA is a large, mainstream medical society, this caused quite a stir.

The four authors of this article served as San Francisco's representatives on the CMA's "Technical Advisory Committee" (TAC) tasked with drafting "a comprehensive white paper recommending policy on marijuana legalization and appropriate regulation and taxation." The TAC was "selected to represent CMA in the areas of science, ethical affairs, public health, addiction medicine, and expertise in the use of cannabis." We met five times; the deliberations were sometimes contentious but each member agreed sufficiently to endorse a final report to the CMA board of trustees.

Our 14-page report, titled "Cannabis and the Regulatory Void", was submitted to the CMA's Board of Trustees and approved, unanimously, in October. Reactions from all sides were immediate. The CMA was called "irresponsible" and at least one opponent utilized the cliché "What are they smoking?" But there has also been much positive response as well, with editorials saying we took "a bold step" towards "a prescription for the medical pot mess" and that that the CMA's "traditionally conservative doctors" are "simply acknowledging the obvious: Our current laws and the resulting war on drugs aren't working. "

1. Impact on Cannabis use: The primary concern regarding "legalization" or any lessening of legal penalties regarding cannabis is that it might increase use, particularly among teens. We share such concerns, especially in light of growing evidence regarding negative effects on neurodevelopment. But there is no good evidence that laws have much effect on use; in fact, long evidence is that our punitive approaches have little deterrent effect. Thus we should seek approaches which maximize knowledge about the impacts of cannabis use, and which do not worsen the problem by criminalizing otherwise law-abiding people, kicking kids out of schools to no productive end, wasting resources, and hampering research. Evidence-based drug education is difficult but likely to be at least as effective as legal approaches -- and likely more so.

2. Resources and costs: Enforcing largely futile laws is expensive, especially when prison is involved. Appropriate treatment and education is far more cost-effective. While our report recommends an approach closer to that taken towards alcohol, at least for adults, we have no illusion that such an approach is easy or ideal, or that the taxation we endorse will be a simple matter or yield massive funding. But we are confident that it will be more cost-effective than longtime, failed "drug war" or prohibition-type policies. And very importantly, the funds saved and generated should be directed towards treatment of addiction.

3. Medical Marijuana: We join the many experts and organizations holding that cannabis be placed in a less restrictive category that would facilitate more research. And while we support some legal medical use of cannabis such as allowed since 1996 in California, we note that a decriminalization approach would have the salubrious effect of lessening or even eliminating the need for physicians to serve in the oft-uncomfortable "middle man" role of "gatekeeper" for medical use of cannabis - and also allow for more rigorous regulation of questionable practices at "cannabis dispensaries."

An ever-growing roster of medical, legal, political, and other authorities of all political stripes feel that the time has come for a serious change in our drug laws, especially with respect to cannabis. We have joined them, as has the CMA.

Interestingly enough, another new CMA policy was independently adopted this year, which could have served as a preamble to our own report:

MEDICAL VS. LEGAL SOLUTIONS TO DRUG ABUSE: CMA encourages the federal government to re-examine the enforcement-based approach to illicit drug issues ("war on drugs") and to prioritize and implement policies that treat drug abuse as a public health threat and drug addiction as a preventable and treatable disease.

We agree, and know that many others do as well. We hope our elected leaders will listen.

***

Steve Heilig is with the San Francisco Medical Society and editor of the Cambridge Quarterly of Healthcare Ethics. George Fouras is a child and adolescent psychiatrist and President of the San Francisco Medical Society; Donald Abrams is chief of Hematology-Oncology at San Francisco General Hospital and a leading medical cannabis researcher at the University of California, San Francisco; David Pating is an addiction psychiatrist and past-president of the California Society of Addiction Medicine. Their opinions here are their own and not necessarily representative of their affiliated organizations.

For more information:

The California Society of Addiction Medicine:

http://www.csam-asam.org/

The San Francisco Medical Society:

http://www.sfms.org/AM/Template.cfm?Section=SF_Medicine_Magazine&Template=/CM/HTMLDisplay.cfm&ContentID=2892

Los Angeles Times: "California Medical Association calls for Legalization of Marijuana":

http://articles.latimes.com/2011/oct/15/local/la-me-doctors-marijuana-20111016

This post originally appeared in the December edition of San Francisco Medicine, the journal of the San Francisco Medical Society.