After listening to the stories of thousands of San Francisco Cannabis Buyers' Club members in the early 1990s, Dennis Peron concluded, "In a system that prescribes Prozac for shy teenagers, all marijuana use is medical." Dennis's detractors within the movement never quoted his observation in full. They shortened it to "All use is medical," which they ridiculed as an absurd generalization. And Dennis, understanding that overstatement has its uses, decided not to correct them.
In recent years Tom O'Connell, MD, has come to a conclusion similar to Dennis's. "All chronic, long-term users are self-medicating," according to O'Connell, whose "Notes re Patterns of Use" appears in the Spring '04 O'Shaughnessy's, and is reprinted here.
Since the Fall of 2001 I have conducted interviews of patients seeking a 'medical' designation in the San Francisco Bay Area.
Over the first seven months the interviews became more focused and I developed a standardized set of questions that was asked of all candidates. Recently I began analyzing data provided by 625 patients, who were all seen between July 1 and Dec. 31, 2002.
* 80% were men (average age 33); 20% women (average age 39).
* 70% (of all) were Caucasian; 15% were African-American; 7.5% Hispanic and the rest split between Asian and "Other."
My patients typically made appointments to be seen at cannabis clubs. While they range in age from 18 to 91, there were very few over the age of 56 -- perhaps reflecting that most people who will ever use cannabis try it before the age of 21. Many did not have health insurance. Others (generally members of Kaiser Permanente) reported that their doctors would not discuss cannabis with them.
While most cited 'somatic' symptoms/conditions -- especially chronic pain -- as their reason for using cannabis, the intensity (and validity) were quite variable. A careful chronology almost invariably reveals that cannabis use was chronic before the painful condition existed.
More than 90%, when asked directly, acknowledged "stress," "anxiety," "insomnia" "agorophobia," " anorexia," and other indications of emotional distress.
An inescapable conclusion is that much initial use is motivated by psychic rather than -- or as well as -- physical pain.
Patterns of use
* 95% were using five or six days per week and had been for years -- or decades.
* The average amount used varied from 1/16 to more than an ounce per week, but the great majority admit to between 1/8 and 1/4 oz per week.
* Marijuana is smoked or otherwise ingested in multiple small doses with an emphasis on avoiding becoming "stoned."
* Some always smoke in the morning. Others never smoke in the morning; Many will smoke in the morning -- but only on days off. In other words, work schedule -- and fear of exposure -- play a big role in usage. There also seems to be an avoidance of daytime use for other reasons.
* Although all age groups are represented, the great majority -- 92.9% - -- were under the age of 56.
* The vast majority -- 84% -- had first sampled ("initiated") cannabis in either high school or junior high.
* The average age of initiation has been declining steadily -- from older than 16 in the late 1960s to under 15 in the late '90s.
* Essentially all had initiated alcohol and most (93%) had also tried tobacco at average ages remaining more or less constant at about 15.
* The rate of addiction to tobacco was extraordinarily high; 70 % became "every day smokers." All had quit or were trying to quit, but only about half had succeeded by the time of the interview. The rest remain unwilling "inveterate" smokers.
* Aggressive drinking -- manifested by binge drinking in high school or college, black-outs, and DUI citations -- had also been exceptionally high. Those who became daily cannabis smokers moderated their drinking spontaneously, whether they thought about it or not. The "substitution" effect of cannabis for alcohol is dramatically demonstrated in this population. One almost never sees simultaneous problem drinking in this group of daily pot smokers -- even though two-thirds of them had been problem drinkers in their youth.
* Lifetime initiation rates for other drugs were unexpectedly high:
MDMA (ecstasy) 49%
Looking for environmental factors that might explain such high rates of illicit drug use, I began taking increasingly detailed family histories. It soon emerged that there was a common pattern: the biologic father had not played a positive, supportive role in their lives between pre-school and the sixth grade -- roughly ages four through 12.
The most common reasons were:
- - an unknown father
- - early (before 7) death or divorce
- - an alcoholic/workaholic father
- - a stern, punitive father.
There are other, less common scenarios involving an invalid or an elderly father, or a recent immigrant who cannot communicate in English.
Many of my patients reported early self-esteem problems which were made worse by the following:
- - any learning or reading disability
- - being in a racial minority
- - being teased (for any reason)
- - frequent moves and attendant school changes.
Quite a few of the younger ones were evaluated for/identified with ADD; many of the older ones would probably have qualified.
The bottom line is that most of the people who use cannabis regularly and were forced to come to buyers' clubs for their "recommendations" - -- either because they don't have a doctor, or their own doctor wouldn't discuss it with them -- were/are using seeking to control an emotional "disorder" rooted in low self-esteem.
Cannabis was clearly only one of several agents they'd tried -- along with alcohol and tobacco. Any of these agents may be able to control the underlying emotional disorder for a while, but pot is -- for them, at least -- the safest and least harmful, especially over the long haul.
"Initiating" heroin seems an unquestionable indicator that the underlying emotional disturbance is severe. Those who tried heroin also tried cocaine and mushrooms at rates over 90%, and had the highest rates of problem drinking... There's some preliminary data that access to cannabis predisposes against addiction to heroin.
It appears that most adolescent drug use may be motivated by the same basic causative factor: low self-esteem in its many guises.
About a year ago Rosie, who was raised on a farm and knows her produce, started complaining about the quality of store-bought asparagus -- even the Berkeley Bowl's. She says that only asparagus from the local farmer's market -- grown in Kettleman City and available about for about five months -- has been consistently free of soft spots and vines emerging from the tabs on the side of the stalk. Now, thanks to a New York Times piece by Timothy Egan, we know why: the store-bought asparagus matures in refrigerated cars en route from Peru, where farmers are paid by the US government to grow asparagus (instead of cocaine, theoretically). Peruvians subsidized by US taxpayers can charge less than farmers in California and Washington state, many of whom -- along with their packers -- are being driven out of the asparagus business.
Millions of pounds of US-grown asparagus have gone to waste in recent years as the major packing plants closed or moved to Peru. Ed McKay, 73, who once had 225 acres in asparagus in central Washington, has given up on the crop "after growing it for 50 years and employing more than 100 people at the height of the season."
In Washington there has been a 55 percent decline in acreage planted to asparagus since since the Andean Trade Preference Act was signed in 1991. "During the same period," Egan writes, "Peruvian asparagus exports to the United States have grown to 110 million pounds from 4 million pounds."
Asparagus acreage in California is down by a third. "The crop has nearly disappeared from the Imperial Valley," according to Egan. In Michigan "the value of the asparagus industry has dropped by 35 percent since the Andean trade agreement."
Egan quotes the director of the Washington Asparagus Commission: "We've created this booming asparagus industry in Peru, resulting in the demise of a century-old industry in America. And I've yet to hear anyone from the government tell me with a straight face that it has reduced the amount of cocaine coming into this country."
It is unlikely that many Peruvian asparagus growers are actually former coca producers. The US government's Foreign Agricultural Service, according to a 2001 General Accounting Office report, "does not believe that Peruvian asparagus production provides an alternative economic opportunity for coca producers and workers -- the stated purpose of the act."
According to John Bakker, executive director of the Michigan Asparagus Advisory Board. "They didn't plow under the coke to plant asparagus in Peru. If you look at that industry in Peru and where it's growing... Coca leaf is grown in the highlands. The asparagus is near sea level."
But the Peruvian government has got the rap down perfectly. As stated in a recent letter to the US State Department: "It is important to understand that the war against drugs is another face of the battle against terrorism and will be successful only if new legal jobs are created as an alternative to illegal activities."
The US asparagus growers know that they're being done in by the so-called war on drugs, but their representatives don't have the nerve to challenge the basic premise. "It's not like Michigan farmers are against the war on drugs," John Bakker told Egan of the Times. "There are certainly social benefits from trying to curb cocaine production, but why should one industry take it on the chin?"
In fact, many US industries are taking it on the chin. Fresh-cut flower producers around Half Moon Bay have been devastated financially by imports of subsidized Colombia roses and carnations. The environment takes it on the chin, too, as enormous inputs of fuel are required to ship plants, under refrigeration, from South to North America.
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