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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.

 
 
 
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HUFFPOST SUPER USER
MalcolmKyle
11:38 AM on 12/14/2011
Nonsense!

We need to throw a few more trillion dollars at this, give the police even more extra powers and proper weapons like Death-Rays that work on large crowds. Take away forever what's left of everybody's rights and liberties and then indulge ourselves in even more wishful thinking or bizarre pseudo-science before even more hippies, or the ill & dying, get a chance to corrupt and endanger our truly pure and caring society with their evil plants.
11:35 AM on 12/14/2011
END THE WAR ON MARIJUANA

SUPPORT H.R. 2306

END THE MADNESS!!
10:10 PM on 12/14/2011
Likewise! Help us gather 50 million signatures before the 2012 elections to fight addiction and end the War on People.

http://www.change.org/petitions/fight-addiction-end-the-war-on-people
11:34 AM on 12/14/2011
SUPPORT H.R. 2306

END THE MADNESS!!
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gneep
if it wasn't always the same, it'd be different
04:03 PM on 12/13/2011
Why don't you address the Real Issue. Here it is pay close attention: in my hometown and just about any other place, When caught, you go home with your dope, or to jail, depending on who your parents are. There is no other issue except The Drug Laws are unconstitutional The drug laws allows the Gov. (local or otherwise) TO OWN YOU!!.
03:04 PM on 12/13/2011
my opinion. i smoke pot not saying its like eating an apple but i think its the safest or close to the safest recreational drug people can use, and it does have benefits.shown to reduce tumors in animal test. not saying its the cure for cancer but if it's showing premise that it could be or at least be a step to finding the cure thats a benefit that should be looked into more if the government wasn't restricting research. my opinion all drugs shouldn't be legal some drugs are to risky,don't get me wrong i think its a health issue but at the least they need fines, i think the cartels would shift there priorities to other crimes. there's people that say regulate pot the cartels would just go to other crime, they do already (if they focus on slave traffic there wont be a boost in people buying slaves), what im getting at if we legalize all drugs the US's pony out of the race of stopping these cartels it would be just mexico's problem and they'll have to deal with angry cartels who lost revenue which isn't fair because its the US's fault as well. put it simple decriminalize and regulate pot fine harder drugs so it will be harder for people to abuse them while reducing cartel power while not turning them hulk and focus a lot more on it being a health issue then a little further down the line take the cartels out.
10:26 PM on 12/12/2011
Right now with prohibition of MJ, we find that 1 in 5 of our 12th graders have smoked pot in the last month. We know that vicious drug cartels gain about 60% of their income from marijuana. We know that thousands of people die every year in Mexico at every level of society if they even dare speak against the cartels. We know that the prohibition of alcohol was a failure. We know our jails are filled with non-violent criminals busted for marijuana violations. We know that politicians want to appear tough on drugs and it is a dangerous move to stand up and support the dispensaries operating legally in California. I applaud any effort of law enforcement to remove those acting illegally with regard to California law. In some ways, it seems the federal government has found some low hanging fruit in attacking California dispensaries.

Recent Federal actions in CA have cost the state an estimated 5000 jobs and an estimated 50-100 million dollars in tax revenue. President Obama during his campaign specifically stated that the US Government wouldn't waste limited resources on the medical marijuana issue. He now seems quiet on the topic.

Attorney General Eric Holder on Thursday (12-8-11 I believe) reiterated the Justice Department's support for the Ogden memo, which in 2009 declared that the sale and use of medical marijuana in states where it's legal are a low priority for federal prosecutors. That seems inconsistent with recent actions in California.
09:13 PM on 12/12/2011
Oh great, now we're just going listen to a bunch of highly trained doctors. Don't they know how good it makes a man feel to bust down a door in the middle of the night with a bunch of heavily armed SWAT team members and arrest hippies at gun point for smoking weed? Marijuana is the most serious threat to all of human kind in all of history and with trillions of US tax dollars, we can arrest everyone in the country if we have to and put them all in privately owned jails. We must ignore the 100 million adults in the US over the last 70 years that have smoked it with little or no consequence other than jail time. We must ignore the fact that this evil weed has been enjoyed by millions of evil doers for over 5,000 years with no record of serious harm. Thank GOD that the DEA is saving us from this terrible weed by kicking down the doors of Pot smokers that prevent Freedom and Liberty!
10:17 PM on 12/12/2011
I'm against this failed, pointless drug war as much as the next guy, but you can't be serious. The DEA has no interest in hippies smoking marijuana in their homes. In an ever increasing number of states with decriminalization or medical policies, there's almost no chance of being arrested in your own home just for possession.

The only thing the controlled substances act accomplishes is the humiliation of law enforcement. You can't expect the public to respect a government that enforces laws they don't agree with or find outright stupid.

The current state of our government is disgraceful and is closer to fascism than democracy.
10:17 AM on 12/13/2011
I know several people personally that would disagree with you who have had their doors kicked in, in the middle of the night, and were only charged with possession. If they were charged at all.
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Nicon
07:30 PM on 12/13/2011
Yah, we only arrest a MILLION Marijuana smokers each year. 750,000 Of them for simple possession.

I suppose those 750,000 people don't really count a whole people, their pot smokers.
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dgmeansit
08:00 AM on 12/13/2011
Your rant seems to size up the view of the Feds quite nicely! Well done!
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Jeremy Echols
07:22 PM on 12/12/2011
Always nice to see people with influence taking a stand and telling the truth rather than hiding behind federal laws and pushing to keep the status quo.

Thanks!
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06:27 PM on 12/12/2011
Thanks you California's Physicians for lending your support to what has obviously been a health, rather than a criminal issue. Human beings put a lot of things in their bodies, for good and ill, but in the end,
it's the individual's choice. Selectively making that behavior 'illegal' simply creates crime and criminals out of what already exists. When one does harm to others, then the law should provide remedy, but otherwise we should be free, as adults, to make those choices..
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dgmeansit
06:25 PM on 12/12/2011
There is absolutely no doubt in my mind that the prohibition of marijuana does a great deal more harm to the individual user and to society at large than outright legalization ever could! I believe the correct answer is to regulate it in a manner similar to alcohol and have thought this for at least the last 30 years. It's about time our elected officials finally figure it out!
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Joey Ismail
05:56 PM on 12/12/2011
If you believe in prohibition, your just not that smart. We are passed the point of debate. The very fact that marijuana is still illegal is a slap in the face to anyone who can chew gum and walk.
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claygooding
05:31 PM on 12/12/2011
One has to wonder when common sense will kick in regarding medical marijuana,,how long is America going to take to realize that for some reason,they're government is failing to heed science,practical experience and more than substantial research on the medical efficacy of cannabis and they still refuse to end the prohibition.
Someone somewhere had better be making a lot of money to keep bending US over without kissing us.
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dgmeansit
08:04 AM on 12/13/2011
It seems that America has already realized the value of marijuana and it's lack of danger. The ones who haven't yet realized it are the damn politicians!

Beware - if Newt Gingrich gets elected as our next president you can be sure he will ratchet up the war against marijuana users tremendously! In spite of, like our current president, he used it himself when he was younger... Go figure!
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Sean Jennings
Gun loving hippie fireman
11:48 PM on 12/13/2011
I hear you about Newt but I don't think you have to worry. That guy is such a loose mouth cannon that he will sink himself. Besides as Rick Santorum said today of Newt, "At least Obama doesn't trade in his wife like used cars". Newt's past will prevent him from being elected.
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4PeasInMyPod
Aspie, Mom, Patriot
07:19 AM on 12/14/2011
" ...like our current president, he used it himself when he was younger... Go figure!"

You have to wonder how many lives have been ruined, how many people have been unable to realize their potential due to a drug charge on their record. Where would our president be right now had he been arrested for cannabis when he was younger? Certainly not the White House.
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Midnight Toker
05:26 PM on 12/12/2011
''Cannabis use for medicinal purposes dates back at least 3,000 years. It was introduced into Western medicine in the 1840s by W.B. O’Shaughnessy, a surgeon who learned of its medicinal properties while working in India for the British East Indies Company. Its use was promoted for reported analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant effects.''

http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page3
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dgmeansit
10:08 AM on 12/14/2011
There is a lot of evidence that there are medicinal uses for cannabis. It is really shameful that the Federal Govt only seems to recognize studies that they fund with the hidden agenda of proving that it has none. They disregard any and all evidence to the contrary. They pay the Drug Czar big bucks to continue the lies and propaganda. We really need, badly, new leadership that will stop this insanity.