Monday, January 6, 2014

"Do You Think Marijuana Should Be Legalized?"

     This is a question I was asked a lot when I had my clinic.
     The answer is, yes, I think marijuana should be legalized, not just state by state, but across the country, at the federal level.  I'm not so sure all drugs shouldn't be legalized, and heavily taxed, and the taxes used to pay for rehab centers that offer free services to anyone who walks in and wants to quit.
     I believe in whatever gives us more free choice, and I don't think the government has a right to regulate a drug like marijuana when other drugs, like tobacco and alcohol, are not regulated in the same way.  Giving states jurisdiction over marijuana legalization would be fine, except for the schizoid condition of making a behavior legal at the state level and illegal at the federal.  Moreover, using marijuana as a pretext for incarcerating people is silly and wasteful:  our prisons are filed to capacity with non-criminals.  Prisons function as an industry in this country, with their prime motive being to make profits, and they've become an economic necessity for many towns whose entire citizenry rely on jobs at the local prison for their survival.  If we legalized drugs we'd have to stop jailing people for them, and we'd be forced to close all those prisons.
     I believe in less government, especially when a law hasn't been shown to effect the change it intended, or has had the opposite effect, of increasing the prohibited behavior.  In countries where marijuana is either legal (Holland, Canada, Pakistan, Peru, Argentina, Russia, Jamaica and Uruguay) or has been decriminalized (Switzerland, Belgium, Portugal, Spain, and Bangladesh) there is no evidence that national tolerance for marijuana possession and use has led to increased use.  There is evidence, in fact, to the contrary.
     There's another argument which recalls, for forcefulness, the economic condition of China in the mid-1800s when, according to some estimates, one-third of that country's male population was opium-addicted.   Won't we have a nation of lazy, no-good, non-taxpaying, lollygagging, weed-smoking derelicts on our hands, if marijuana is legalized?  And after marijuana, what?  Should we legalize opium?  Cocaine?  Meth?
     Opium addiction in China was first recognized in the seventeenth century.  After it was prohibited by law in 1729, according to Wikipedia, "there followed two centuries of increasing use."  Tight governmental regulation of any substance doesn't necessarily correlate with reduced use of that substance.
     The United States is the biggest consumer of prescription opioids--morphine and codeine being the most common, substances derived from the poppy plant, from whose seed pod a rubbery paste can be extracted and dried into opium.  Opium is the base ingredient for most pain-killing medicines in the world, including morphine and codeine, which, therefore, are "natural" and "organic" products, though they are standardized in the laboratory.  A variety of synthetic opioids is now available, imitation-opium, products manufactured by pharmaceutical companies and touted for their purity;  these include methadone and fentanyl.
     All of the opioids are extremely addictive, but morphine also happen to be the most effective pain medicine in the world and its availability is essential for physicians if they are to ease suffering in a civilized world.  As a physician, I can confirm that there is nothing like morphine for patients who would otherwise be in agony.  It has been an essential tool and, in the physician's armamentarium, the main means of exercising compassion, probably going as far back as 4000 BC.  Poppy seed capsules have been found in neolithic burial sites like the "Bat Cave" in Spain, and evidence of poppy cultivation has been found among ancient Sumerian ruins from Mesopotamia (3400 BC) as well as in Babylonian and Ancient Egyptian settlements.  
     These substances have been around for all of recorded human history.  Most of us can regulate ourselves so that we aren't victimized by the substances we use, and don't use substances we don't need.  But if we do fall into addiction, we need government-supported help.  We need fewer police, fewer laws, fewer jails, fewer costumed role-players in SWAT gear, and more assistance where it really matters.  Managing addiction is like managing a pack of devils;  the more allies you have, the more likely you are to prevail.
     But the American government has been like one more devil, when it comes to drug issues.  It's not an ally in the "war on drugs."  Detoxification and rehabilitation centers are too few and too expensive.  One of the biggest problems I experienced as a physician was finding help in the community for addicts.  AA, NA and the emergency room provide minimal assistance for people who say they're ready to confront an addiction problem.  The local inpatient facilities are often full to overflowing, whenever doctors call them. Most of the time they wouldn't even consider taking my patients because the patients didn't have insurance.
      The best way to control drug trafficking is to reduce the number of drug users.  Therefore, we need to address socioeconomic factors that make addiction in some sectors of our population more likely than in others, and we have to get rid of the stigma associated with addiction.  Much of the money our government spends on apprehending people for marijuana possession and drug use is wasted, because addiction and rehabilitation aren't addressed in prison.  Ninety percent of those who are incarcerated for drugs come out of jail no better--they're worse, in fact, because they have prison records and can't get jobs--so they return to their old lifestyles.
     Yes, I'm in favor of legalizing marijuana, maybe even all "drugs of abuse."  People must be given the opportunity to choose how they live, so long as they don't harm others, without an overbearing, finger-wagging, gun-toting government to contend with when they're at the bottom of their game.  

1 comment:

  1. I agree with this post. I was shocked to learn that in most cities there are long waiting lists for programs designed for people who want to break a drug habit. Why can't we tax the drugs that are addictive and harmful, whether legal, like tobacco, alcohol, or illegal, like meth, heroine, etc. and use the tax money to ensure treatment for all who want to quit?

    Not all addicts acknowledge their addiction, and even if you want to stop your addition you may fail. It's hard. But you have no chance of quitting unless you want to quit. So we ought at least to make sure we offer help to those who want to change.