It is conventional wisdom that any substance use during drug treatment leads to lower rates of success. But a new study in the American Journal on Addictions suggests that's not always so.

The study looked at patients in treatment for opiate dependence using a drug called naltrexone – a treatment whose effectiveness, the researchers write, "has been severely limited by poor adherence." As part of a study designed to test two different support protocols intended to help patients stay on naltrexone treatment, researchers also looked at use of other substances by means of regular urine tests conducted during clinic visits.

Contrary to conventional wisdom, patients with "intermittent" marijuana use (defined as between 1% and 79% of urine tests coming back positive) stayed on treatment for nearly four times as long as those who abstained completely. Treatment adherence by "consistent" marijuana users (80% or more positive urine tests) was almost identical to that of the abstainers.

The researchers note that the beneficial effect was most apparent early in treatment, that marijuana use was not only associated with staying in treatment longer but also with more consistent pill-taking, and that during the study the patients tended to maintain or even increase their marijuana use. This, they write, is "consistent with a process of self-medication. These findings are of interest because they suggest the hypothesis that moderate cannabis use may be exerting a beneficial pharmacological effect improving the tolerability of naltrexone in the early weeks after induction."

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The long, sad story of Charles C. Lynch should take a major turn this Thursday, June 11, when Judge George Wu is expected to finally determine a sentence for the federally-prosecuted but state-legal medical marijuana provider. MPP has joined Charlie's defense team and many supporters in calling for as lenient a sentence as possible in this tragic case of federal interference with California's voter-approved state law.

Our friends over at Reason TV released this new video, aptly set to the tune of "Whipping Boy" by Chris Darrow, to help raise awareness of Charlie's plight.

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Today the Obama administration unveiled a new antidrug strategy for the Southwestern border, a region plagued by horrendous violence from Mexican drug cartels. Alas, the plan simply rearranges the proverbial deck chairs on the Titanic.

Lovely chairs they may be, but the boat's still going down.

The plan, as reported by the Associated Press based on an advance copy, includes lots of technological fixes like "visual shields near border-crossing points so that drug cartel spotters can't alert approaching motorists about inspections."

Yeah, that'll put the cartels out of business, just as sure as there's a Tooth Fairy.

As MPP director of government relations Aaron Houston said in a statement today, "The plan ignores the central problem, which is that our policy of marijuana prohibition has handed the Mexican cartels a massive market that keeps them rolling in cash, not just in Mexico, but according to the Department of Justice, in 230 American cities.

"Rather than trying to make America's 15 million monthly marijuana consumers go away, we need to gain control of this market by regulating marijuana like we do beer, wine and liquor," Houston continued. "Any anti-drug effort that leaves the marijuana trade in the hands of the cartels is nothing but a full-employment plan for professional drug warriors and cartel bosses alike, not a serious proposal to address the problem."

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I've recently been corresponding with a medical marijuana patient and Navy veteran, Eugene Davidovich, who was recently arrested in a particularly slimy undercover sting operation. Eugene, a member of a San Diego medical marijuana collective, was contacted by an undercover cop posing as a registered, licensed medical marijuana patient who asked for his help obtaining his medicine.

You can probably guess the rest, but here's a link to a good comprehensive story on his arrest.

Prosecutors argue that Eugene violated the law in providing medical marijuana to the undercover cop – even though the cop presented him with documentation verifying his status as a licensed medical marijuana patient. They even insinuate that Eugene's motive was profit and not compassion.

It appears that what's really happening is that prosecutors are taking advantage of vagaries in California's medical marijuana law to persecute patients and caregivers who are doing their best to take care of themselves and stay within the law.

Here's how Eugene put it:

Every attempt made to date by collectives and coops to follow the law in San Diego has resulted in prosecutions or collectives having to operate so deeply underground and under such intense daily fear and pressure, that the potential public benefit they could be bringing to the community and to patients is stifled by this environment of fear.

Eugene has a fight on his hands now. Please visit his Web site and help him out if you can.

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The surprising finding that THC might help at least a small percentage of schizophrenia patients for whom conventional treatments have failed was reported in the June issue of the Journal of Clinical Psychopharmacology. 

This is surprising because, as the British government's Advisory Council on the Misuse of Drugs reported last year, "there is clear evidence that the use of cannabis may worsen the symptoms of schizophrenia and lead to relapse." The ACMD -- a far more objective body than any U.S. government outfit remotely connected to drug policy -- did not consider marijuana to be a significant cause of psychosis in otherwise healthy people; its report reflects a broad consensus that marijuana (and specifically THC) can worsen the prognosis of schizophrenics or those with a genetic vulnerability to schizophrenia.

But doctors at the Rockland Psychiatric Center in Orangeburg, New York, reviewing the records of one severely ill patient -- a man who was "grossly psychotic, assaultive, disorganized" and not responding to conventional treatment -- noticed that he had a history of "calm behavior when he was using marijuana." So as an experiment, they prescribed THC capsules (dronabinol, brand name Marinol). "Remarkably," they write, "he became calm, logical, nonviolent, and cooperative within days and was discharged within weeks." 

They then tried the same thing with five other patients with a similar history -- unresponsive to conventional treatments but showing some signs of improvement when they smoked marijuana. Three of these "improved to a clinically significant extent," one showed no significant change, and one got somewhat worse. That's a remarkable level of success in chronically ill patients for whom conventional antipsychotic drugs had failed, "in which success with any intervention might be unlikely."

The article goes on to lay out some possible explanations, but at this point no one knows for sure why this small group of psychotic patients had an anomalous and positive reaction to THC. What is clear is that the relationship of cannabinoids to schizophrenia is more complex and variable than even many experts -- much less anti-marijuana propagandists -- have acknowledged.

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There was good news on medical marijuana from two statehouses late today:

In Rhode Island, the news hasn't hit the wires yet, but a statement from the Rhode Island Patient Advocacy Coalition reports: "Tonight, Wednesday, June 3, the Rhode Island House of Representatives voted 64-4 for a bill to allow the Health Department to license a non-profit compassion center to grow medical marijuana for state-approved patients." Having already passed the Senate, the bill now goes to Gov. Donald Carcieri.

The bill would make Rhode Island the first state to ever to expand an existing medical marijuana law to permit state-licensed dispensaries. Rhode Island's original medical marijuana law was enacted over Carcieri's veto in 2006, and observers think a similar outcome is likely this time.

Meanwhile, Delaware's medical marijuana bill passed its first committee hurdle, the Senate Health and Social Services Committee, after a 90-minute hearing at which MPP legislative analyst Noah Mamber spoke. No one testified against the measure.

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In the May issue of Current Opinion in Psychiatry, two noted researchers weigh in on the marijuana debate with an article titled, "The Challenges in Developing a Rational Cannabis Policy."

Australian Wayne Hall and American Michael Lynskey urge that international treaties be rewritten to allow nations more freedom to experiment with policy changes, and more research aimed at weighing the costs and benefits of prohibition. Along the way, they make a number of noteworthy observations, including this:

The public health impact of contemporary patterns of cannabis use is modest by comparison with those of other illicit drugs (such as the opioids) or with tobacco or alcohol. In the case of illicit drugs, this reflects the absence of fatal overdose risk from cannabis. In the case of alcohol, it reflects the much lower risks of death from cannabis-impaired than alcohol-impaired driving, fewer adverse effects on health and lower rates of regular cannabis use to intoxication.

 Would that U.S. policies were based on such a calm, rational assessment of the facts  

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Apparently, the Iowa Board of Pharmacy's standard of proof for the efficacy and safety of medical marijuana is pretty high. Much higher, than that of, say, the National Academy of Science's Institute of Medicine, which in 1999 concluded, "Nausea, appetite loss, pain, and anxiety are all afflictions of wasting and all can be mitigated by marijuana."

The board was required by a court order to evaluate the scientific evidence surrounding medical marijuana Monday to determine whether it ought to be reclassified under the state's controlled substances list.

But the board's justification for rejecting the evidence presented said much more about the board's condescending attitude toward medial marijuana and its advocates than it did about the evidence itself.

Seizing on one small point made by advocates – that 13 states had already passed medical marijuana laws – here's what Guthrie County pharmacist DeeAnn Wedemeyer-Oleson had to say:

I liken this a lot to when I was a junior in high school and I pleaded to my dad that the time I should be allowed to stay out at night should be extended to one o'clock in the morning.

I said, I was a junior in high school and all my other friends got to stay out until one o'clock in the morning. And he said, 'well if all of your friends jumped off the bridge, does that mean you should jump off the bridge?'

That's cool. I liken Wedemeyer-Oleson's logic to when I was in kindergarten and would stick my fingers in my ears and sing loudly whenever a grownup would try to tell me something I didn't want to hear.

[update: Carl Olsen, whose group won the court order that led to the pharm board's review, makes an important point in comment #3 that I missed in my original post. The argument that 13 states already accept medical marijuana's safety and efficacy is by no means small. It should have been crucial to the board's decision if they'd applied the Iowa legal standard of whether marijuana has any accepted medical use in the United States. Thanks for clarifying that, Carl.]

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Let's deal with the bad news up front: Bogged down in a major fight over budget and tax issues, the Illinois House of Representatives finished its spring session and left town without acting on the medical marijuana bill. Legislators generally don't return to session until a November "veto session."

The good news is that we made historic progress this year. The bill passed the state Senate for the first time ever, and cleared all the necessary House committees. That leaves the measure well positioned for a vote either during the veto session this fall or when they reconvene for the next full session in January.

In a statement issued earlier today, House sponsor Rep. Lou Lang (D-Skokie) said, “This bill gained more and more momentum at every stage of the legislative process, and I think the pace at which it moved is testament to the support it enjoys.”

We'd all prefer to see the process happen faster, but neither MPP, the bill's sponsors, nor the dozens of courageous patients who've come forward to speak about their own personal experiences with medical marijuana have any intention of giving up.

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In mid-May, spurred by a press release from the drug czar's office, the American news media reported with varying levels of hysteria that average marijuana potency had soared past the 10% THC level for the first time. Clearly the sky was falling, or at least was about to.

Small problem: According to the actual report, from the Marijuana Potency Monitoring Project at the University of Mississippi, average marijuana potency is only 8.52% -- a fact easily determined by doing something most journalists apparently didn't bother to attempt: reading the report, which is based on tests of samples seized by police. The way they got to the claimed rate of 10.1% was by including samples of hashish (average potency 20.76%) and hash oil (15.64%).

There's more. While the potency of marijuana samples did increase a bit from the comparable period a year ago, the overall proportion of samples represented by hash and hash oil also increased. That is, a greater percentage of the cannabis products seized and sent in for testing was the high-strength stuff.

But are these police seizure samples tested representative of what's actually available to marijuana consumers? There is absolutely no way to be sure, but every indication is that they aren't.

First, the number of samples tested dropped markedly, from 1290 a year ago to 818 in the current period. Why such a big drop? The MPMP report doesn't say.

Second, as with prior years, the domestically produced marijuana tested tended to be significantly weaker than the imported stuff, but domestic cannabis only represented 29.7% of the samples tested. No one seriously believes that less than a third of the marijuana consumed in the U.S. is produced here. Indeed, a 2005 State Department report suggests that the real proportion is almost the exact reverse: "More than 10,000 metric tons of domestic marijuana and more than 5,000 metric tons of marijuana cultivated and harvested in Mexico and Canada is marketed to more than 20 million users in the United States. Colombia, Jamaica, and Paraguay also export marijuana to the U.S.” Those last three countries, though, represent a tiny fraction of what comes here from Mexico and Canada.

Is the average potency of marijuana inching upward? Probably, though there isn't the slightest evidence that this makes it more dangerous. Is the real average potency over 10%? Only if you believe in the tooth fairy.

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