Up in smoke

After years of denial, the government agrees that marijuana has medicinal value. Is legalization next? No way, dude.

by Jason Gay

Last week, your federal government finally acknowledged something that you, your friends, your friends' friends, and your freshman-year roommate with the skull bong and the Hot Tuna tapestry have all known for eons: marijuana isn't especially dangerous and, in certain cases, may actually be good for you.

Last Wednesday, March 17, after a two-year study, the National Academy of Sciences' Institute of Medicine (IOM) released a report concluding that marijuana has clear medicinal value for patients suffering from a variety of illnesses, including cancer and AIDS. "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 or wasting," the report states. It also declares that smoking marijuana isn't particularly addictive, and it rejects the contention that pot serves as a "gateway" to more-dangerous drugs such as cocaine and heroin.

In short, after decades of denial and demonization, the feds agreed that the evil weed isn't so evil after all. And in a flash, a linchpin of the government's anti-drug rhetoric evaporated faster than a tray of hot dogs at Mo Vaughn's birthday party. The country's drug "czar," General Barry McCaffrey -- who had in the past referred to marijuana's medical benefits as a "cruel hoax" and a "Cheech and Chong show" -- called the IOM report a "superb piece of work" and pledged further investigation into medical marijuana.

At first glance, the IOM report would seem like a big win for drug-policy-reform activists. After all, this study is the government's baby; McCaffrey himself lobbied for it, and Uncle Sam funded it to the tune of $900,000. Here it is, saying marijuana has benefits for sick people. How far off could medical legalization be? And after that, full legalization?

Pretty far off, apparently. Far from being a breakthrough document, the IOM report is a carefully worded package that, while acknowledging marijuana's medical value, delivers no new information and does little to rock the establishment. What's more, the report is unlikely to narrow the philosophical gulf between medical and full legalization: many people who endorse the former don't endorse the latter, and people who favor both don't always see the two issues as being intertwined.

Finally, activists say that the impact of the IOM report is likely to be negligible because the government's war on marijuana -- and the drug war in general -- has never really been based on scientific facts at all. That's why people like Scott Ehlers, a senior policy analyst at the Drug Policy Foundation in Washington, DC, weren't exactly celebrating last Wednesday.

"The government has a history of ignoring reports," Ehlers says. "Our feeling is that they are going to let this report sit on the shelf . . . and not do anything about it."

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Marijuana is still a big story in this country, however, and the Institute of Medicine report on the Class D drug was a Class A news event. It made the front page of the Boston Globe, the New York Times, and USA Today. FEDS GO TO POT, barked the New York Post. Katie Couric even hosted a medical-marijuana rap session on the Today show.

Despite the hype, the report, titled Marijuana and Medicine: Assessing the Science Base, shouldn't make people feel comfortable about sparking up a joint while strolling down Comm Ave. While it doesn't condemn medicinal marijuana use, the report doesn't wholly endorse it, either. It expresses worries about the health risks posed by smoking marijuana -- in joint or pipe form -- and advocates the creation of safer delivery systems, such as inhalers and pills, which will take years. It also casts doubt on the efficacy of marijuana to treat conditions it was previously thought to help, including glaucoma and Parkinson's disease.

Still, the report does make a delicate, narrow case for the medicinal value of marijuana, particularly its primary psychoactive ingredient, THC. And the 11-member IOM panel agrees that those in desperate need of marijuana should be allowed to smoke it, albeit in a carefully monitored medical program.

"The accumulated data indicate a therapeutic value for cannabinoid drugs, particularly for . . . pain relief, control of nausea and vomiting, and appetite stimulation," the report states. "[The evidence] suggests that cannabinoids would be moderately well-suited for certain conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting."

This careful conclusion is more pro-pot than most marijuana and drug-policy activists had expected. "We were actually expecting it to be worse," says Scott Ehlers. "So overall, we were happy with the result."

But it's hardly a revolutionary moment. Several groups quickly pointed out that the IOM report merely regurgitates previous studies showing marijuana's medical value (it's true; the IOM drew on old research and didn't perform any new clinical trials). In fact, much of the current report's findings echo two previous IOM studies that examined marijuana use in general. IOM reports in 1976 and 1982 found marijuana to be minimally addictive, and not a hazardous "gateway" drug.

That's why, for those who had hoped the IOM might break new ground, the report is a disappointment. "We felt their recommendations were tepid at best," says Allen St. Pierre, executive director of the NORML Foundation, the educational branch of the National Organization for the Reform of Marijuana Laws. "This is the third go-round we've had with the government."

St. Pierre dismisses the IOM report as "first and foremost a political document," and he's not alone. Michael Cutler, a Brookline attorney and coordinator of the Voluntary Committee of Lawyers -- a national organization of legal-trade drug-policy reformers that counts former attorney general Elliot Richardson among its members -- criticizes the report for being "framed in politically correct terms."

"It has something for everyone," says Cutler.

Thomas Clark, a researcher at the Boston nonprofit Health and Addictions Research, Inc., says the IOM likely found itself caught between the medical evidence and the hard-line anti-drug position of its government sponsors.

"I thought it [the report] clearly was a compromise where they had to tread a careful line between the perception of the government about sending a wrong message about marijuana and, on the other hand, that there is indeed a lot of evidence that marijuana can relieve certain [ailments]," Clark says.

Indeed, this report knows who its mama is. Activists say its many caveats -- especially its resistance to smoking of the drug -- offer just enough wiggle room to policymakers seeking to stall, or at least distance themselves from, the debate. In the aftermath of the report's release, McCaffrey said that smoked marijuana was unlikely ever to be sanctioned by the government. "You should not expect to go into an ICU in 15 years and find someone with prostate cancer with a `blunt' stuck in his face as a pain-management tool," the drug czar told the Washington Post.

While few deny that smoking presents health hazards, activists complain that McCaffrey's hard line ignores several basic points. For one, many of the people seeking therapeutic relief through marijuana are suffering from terminal illnesses, so it's highly unlikely that the risks of lung cancer and other smoking-related diseases outweigh the previously existing risk of, well, death. What's more, people who smoke marijuana for chronic conditions (such as glaucoma) tend to use less than one joint a day. And on the subject of risk, activists argue that many FDA-approved drugs and therapies have dangerous side effects -- some far worse than those of smoking marijuana. "By definition, there is toxicity to almost every medication that you take," says Adam Smith, associate director of the Drug Reform Coordination Network in Washington, DC.

It's not surprising that a government that has lectured the country on the dangers of cigarette smoking would oppose marijuana smoking, but Michael Cutler argues that smoking is a uniquely effective delivery system for medical marijuana. Compared to pills and other methods, he says, smoked marijuana is fast-acting and "self-titrating" -- that is, the patient can easily regulate how much enters his or her system. "You take one hit, wait five minutes, see how you feel," Cutler says.

In fact, Cutler and other drug-policy reformers contend that the real reasons for the government's objections to smoked marijuana are less scientific than they are economic and political. The economic motive, they suspect, is to preserve the undoubtedly lucrative delivery-system market for pharmaceutical companies. And such delivery-system development is likely to take a long time. "In essence, they have bought themselves years and years of doing nothing," says St. Pierre. "And they've kicked it to the pharmaceutical industry."

The political reason for condemning marijuana smoking, of course, is to avoid sanctioning behavior the government has long condemned. And here, the government is content to let the medical-marijuana debate segue into the larger, more controversial discussion of full decriminalization. Though scientists, physicians, and laypeople have long drawn distinctions between medical and recreational use, the feds continue to push the idea that supporting the former is tantamount to condoning the latter.

"I'm concerned about the message we're sending," Joyce Nalepka of the parents' anti-drug group America Cares told the New York Times after the IOM report's release. "Kids interpret things different than adults. What they are going to hear is, `Marijuana is good for something.' "

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No doubt there are some marijuana smokers who see the medical debate as a yellow brick road to legalized marijuana for everyone. Anti-drug activists are especially fond of ominous references to what they describe as the "real motives" of drug-policy reformers. McCaffrey told the Times last week that he worries about "mischievous agendas at work" in the medical-marijuana movement.

It's true that some people who favor legalized medical use favor decriminalization in general. It's also true that any scientific evidence showing the therapeutic benefits of marijuana destigmatizes the general use of the drug. But to those who support drug-law reform, "slippery slope" arguments are shaky at best.

Making a drug available pharmaceutically has never been a gateway to general legalization; both cocaine and heroin, activists point out, have been available in pharmaceutical form for ages, but neither is on the cusp of large-scale legalization. What's more, legalizing medical marijuana would be unlikely to make the drug any more prevalent than it is already. "The black market has done such a marvelous job of making marijuana universally available -- it's hard to imagine that making it medically available will enhance that delivery," says Michael Cutler.

What's really threatened by the legalization of medicinal marijuana, activists claim, is the multibillion-dollar drug-enforcement business. The war on drugs is a $20 billion-a-year federal industry; another $30 billion is spent among the states. Nearly 80 percent of that effort is dedicated to marijuana. In 1997, a record 695,200 people were arrested on marijuana charges; 87 percent were busted for simple possession.

And the war on marijuana isn't limited to recreational use. After California and Arizona passed laws approving medical marijuana, McCaffrey pledged to prosecute physicians who prescribed it to ailing patients. Some of California's biggest distribution clubs for medical-marijuana users have been closed. Some medical users have even been jailed.

"Should we be arresting thousands of people who are gaining legitimate relief through a plant?" asks Adam Smith. "Is that the message we want to send to our children?"

The tone of Smith's comment is telling. Historically, the drug-law reformers based their arguments on science, economics, and the inefficiencies of law enforcement. But the more that marijuana gains legitimacy as a medicine, the more the drug-policy-reform lobby is able to seize the moral high ground from the government. After all, stopping Deadheads and college kids from smoking marijuana is one thing. Stopping terminal cancer patients from using it is another.

Indeed, the activists now sound preachier than the politicians. "McCaffrey's response is, 'We've got to study more,' says Cutler. "That's complete bullshit. I hope nobody in his family gets cancer and is retching his guts out."

And activists are fond of pointing out that the public is already on their side. Surveys have shown that between 60 and 70 percent of Americans favor legalizing marijuana for medicinal purposes. Six states -- California, Washington, Oregon, Arizona, Alaska, and Nevada -- have passed ballot initiatives favoring medical use. Four more states -- Maine, Colorado, Michigan, and Ohio -- are being targeted this year and next. Bills are also pending in New Hampshire and Minnesota. ("Jesse Ventura is very supportive," says Chuck Thomas of Washington, DC's Marijuana Policy Project.)

"The people are ahead of the pols on this one," says Adam Smith. "There's going to be a gap between when the government catches up with the public on this one."

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But the government isn't in any particular rush on medical marijuana. Though the IOM report recommends a compassionate-use program for patients -- that is, allowing very sick people who need marijuana to smoke it until an alternative can be found -- McCaffrey and others have yet to retreat from their pledge to prosecute physicians who provide it to their patients. That outrages activists. "I don't want patients to go to jail," says Chuck Thomas.

But it seems that every time the government loses a battle in the drug war, it simply changes its argument to justify its policy of full prohibition. Now that it can no longer argue that marijuana has no medical value, it argues that smoking the drug is dangerous. Now that it cannot classify medical decriminalization as a hippie issue, it's warning of the "ulterior motives" of certain activists. "It's dig-in-your-heels time," says Thomas Clark of Health and Addictions Research. "And I'm afraid that it's driven by the law-enforcement trade, which still drives the [drug-policy] agenda."

Sure, it's tempting to see the government's case against medical marijuana as an ice floe that continues to shrink under the heat of examination. But rationality -- or admitting error -- has never been a critical element of the government's drug policy.

That's why some activists expect the war on marijuana to get worse before it gets better.

"The empire is striking back," says Michael Cutler. "The rebel forces are demonstrating the irrationality of the empire's primary vice -- the illegalization of marijuana -- so the empire must strike back. Once the rationality leaves that equation, all that is left is brute force."

Jason Gay can be reached at jgay[a]phx.com.