The solution to today’s cannabis problem, this book concludes, is to legalise it ‘for all uses’ and remove it ‘entirely from the medical and criminal control systems’. The authors, respectively a professor of psychiatry and a lecturer in law at Harvard Medical School, believe legalisation is desirable for all the reasons now widely adduced in the UK, not least by some senior police officers and by last year’s Lib Dem Party Conference: that the criminalisation of cannabis is absurd given the promotion of tobacco and alcohol; that it creates black markets, police corruption and crime; that the law against it is impossible to enforce, and, manifestly lacking the endorsement of millions of otherwise law-abiding citizens – there may be twelve million users in the USA – compromises respect for the law and the police. Lester Grinspoon and James Bakalar’s argument, however, is that marijuana should be legalised because of its medicinal properties. Its benefits as a general ‘feel-good’ drug, preferable to certain anti depressants and tranquillisers manufactured by the pharmaceutical industry, have been widely touted by legalisation groups: Grinspoon and Bakalar seek to publicise its more specific therapeutic applications.
One lies in cancer treatment. Among the worst side-effects of chemotherapy are severe vomiting and appetite loss; damaging consequences for morale often follow. Many patients have found that smoking a joint before chemotherapy sessions can circumvent these side-effects far more successfully than drugs prescribed for that purpose, which often bring further side-effects. Another use lies in the control of glaucoma, an eye disease involving increased intra-ocular pressure that leads to severe loss of vision and often blindness. Standard prescription drugs (e.g. beta blockers administered in the form of eye-drops) are widely found unsatisfactory, their side-effects including depression, asthma and risk of heart failure. It was discovered by chance some years ago that cannabis effectively reduces intra-ocular pressure, and many glaucoma sufferers attest that smoking it has proved the sole effective treatment.
Grinspoon and Bakalar go through a succession of conditions, from epilepsy and multiple sclerosis to menstrual cramps, in which it is claimed that relief is better obtained through cannabis than with officially-prescribed medications. Some of their evidence stems from papers published in regular medical journals, but most is from first-hand accounts written by (American) sufferers.
These testimonies are moving and often angry. They tell of great pain suffered while undergoing surgery or a series of ineffective prescription medications, followed by the discovery of a treatment that actually works. The irony is that the one effective therapy is illegal. Hence marijuana generally has to be used against medical advice – or at best under the blind-eye of an unusually sympathetic physician Obtaining the weed often proved costly and risky. Not least, it went against the grain with Middle Americans, who in principle supported the ‘war on drugs’ but grew exasperated by the hypocrisy of a system that obstinately denied them palliation. ‘As a parent I was strongly opposed to marijuana,’ writes one contributor, whose cancer-stricken son could tolerate chemotherapy only with the aid of pot: ‘if marijuana had medical value, we thought that the Government would know and would make it legally available by prescription.’ She was to discover how innocent she had been.
Some of the stories are horrific. A 53-year old Minnesota farmer who suffered badly from epilepsy discovered that cannabis markedly reduced his seizures and began to grow a few plants in his backyard. In 1989 he and his family were arrested at gunpoint in a police raid; he wrote his account while serving a six-month prison sentence, and virtually without medical support. Again, a Florida man, Robert Randall, who had contracted Aids following a blood transfusion, had, with great difficulty, obtained legal authorisation to use cannabis to reduce the nausea he suffered. He, too, was arrested at gunpoint, tried and convicted on a charge of growing marijuana.
Some of Grinspoon and Bakalar’s evidence comes from impeccable professional sources. The Harvard biologist, Stephen Jay Gould, is a rare survivor from a generally lethal form of cancer. Chemotherapy induced in him ‘long periods of intense and uncontrollable nausea’ which only smoking joints alleviated. Gould notes that he had never personally approved of recreational drugs.
The authors are fully aware that such anecdotal evidence may not appear copper-bottomed. ‘I tried it and it worked’ stories have always been the staple of quackery and the bane of therapeutic evaluation – hence the modern insistence on rigorous double-blind clinical trials. The problem is that no such trials have been conducted with cannabis. As an illegal substance with unsavoury associations, it is the last thing any smart, careerist researcher would dream of testing, even were permission granted. Nor would it hold attractions for pharmaceutical companies since, as a plant growing freely worldwide, it would be impossible to patent.
Hence, Grinspoon and Bakalar conclude, medicine today is largely ignorant of cannabis’s therapeutic potential and may remain so. They are broadly right. Take the entry in The Oxford Companion to Medicine (1986): ‘Cannabis is a general term for products of the hemp plants Cannabis indica and Cannabis sativa which contain the active principle tetrahydrocannabinol and compounds closely related to it. There is a variety of synonyms: marihuana, hashish, bhang, ganja, pot. See ADDICTION.’ Last year’s updated edition makes one alteration – the cross-reference has become ‘See SUBSTANCEABUSE’ In other words, the assumption is that the sole medical reference-point lies in terms of dependency (itself, it should be said, a deeply problematic category): no mention is made of any therapeutic uses.
Things were not always so. There is abundant evidence that cannabis was used in the past not just as a ceremonial drug but medicinally, alongside opium, alcohol and other psychoactive substances. It routinely turns up in early herbals: Culpeper believed it was good for colic and gout. In his Anatomy of Melancholy (1621), Robert Burton recommended it against depression, and it was widely endorsed by Renaissanee physicians for its pain-relieving properties. Eighteenth and 19th-century pharmacopoeias called it an anti-spasmodic, good for convulsions, childbirth pain and chronic bronchitis; its fans included Queen Victoria’s physician, J.R. Reynolds, who in 1890 published an article in the Lancet ‘On the Therapeutic Uses and Toxic Effects of Cannabis Indica’. Over the last century, however, the medical profession has ‘forgotten’ what it once knew about its therapeutic powers.
This is not hard to explain. In studies of traditional contraception and abortion practices, John Riddle has demonstrated how often knowledge of therapeutic agents formerly possessed by the folk memory and by medical practitioners has been lost. Urbanisation obliterates hand-me-down lore. Medicine’s growing claims to scientific status result in dismissiveness towards traditional treatments. Above all, the pharmaceutical industry’s triumphs – morphine, codeine etc were isolated soon after 1800 – implanted the conviction that laboratory-made drugs like barbiturates would always be more effective than the fruits of the field.
A further element in this ‘forgetting’ process has been the ‘war on drugs’ (including alcohol) declared by zealots in the 19th century and taken up by governments, led by the United States. Earlier, the laws of supply and demand had governed the sale of all substances, including poisons, stimulants and sedatives. The great 17th-century physician, Thomas Sydenham, proclaimed that ‘among the remedies which it has pleased the Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium’ – a panacea that was freely available over the counter. Alcohol was legal but heavily taxed, and the British Government found it easy to slap stiff duties on coffee, tea and tobacco because all had to be imported (the home-grown tobacco indusiry, sprouting in the 17th century, had first to be wiped out and native tobacco-growing criminalised). Free trade held sway to the extent that Britain twice went to war in the 1840s when China banned opium imports from British India.
In Britain, restrictions on the sale of drugs began in 1868 with the first of a series of Pharmacy Acts (ostensibly for public protection, though implicitly to protect the medical profession from competition): an initial step on the road to the category of prescription-only drugs. Thereafter, opiates were to be legally obtained only through a physician. After the Report of the 1926 Committee on Morphine and Heroin Addiction, the understanding was that addicts could routinely be supplied through a doctor. The system worked, in that the number of narcotics-users remained small.
An identical situation initially held in the USA: up until 1903 Coca-Cola contained cocaine and as late as 1920 the Department of Agriculture was urging cultivation of cannabis crops as a profitable undertaking. But vociferous lobbies were emerging, calling for curbs on ‘harmful substances’. Campaigners claimed that the Republic was being subverted by a narcotics menace – the public hysteria had a racist basis, since the opium habit was linked to Chinese immigration and ganja use to the black and Hispanic communities. The Pure Food and Drug Act of 1906 required the labelling of patent medicines containing morphine, cocaine etc. Three years later, importation of smoking-opium was proscribed. Then, in 1914, the Harrison Act made opiates and other narcotics legally available only on prescription and for the treatment of disease. The Supreme Court ruled that supplying addicts with prescriptions for narcotics was illegal under the Act – contraventions led to some 25,000 physicians being arraigned and 3000 serving prison terms.
Penalisation bred panic, drugs were dubbed ‘mankind’s deadliest foe’, and in 1930 the Federal Bureau of Narcotics was formed. ‘How many murders, suicides, robberies, criminal as saults, hold-ups, burglaries, and deeds of maniacal insanity [marijuana] causes each year, especially among the young, can only be conjectured,’ thundered its chief commissioner, Harry Anslinger. He ‘created’ the cannabis problem in the USA by securing the passing of the Marijuana Tax Act 1937, which, by imposing huge taxes, bureaucratic restrictions and penalties, effectively put an end to its legal use.
The spirit of the Thirties carried over into the ‘war on drugs’ launched by President Nixon and waged ever since, backed by escalating Federal funds, powers and manpower. In 1971, Nixon declared that ‘America’s Public Enemy No 1 is drug abuse.’ Soft and hard drugs got demonised together, the consequence being that in the Eighties some 300,000 Americans were being arrested every year on cannabis charges.
With the triumph of psychopharmacological McCarthyism, the medical profession changed its tune. Doctors had traditionally thought rather well of cannabis. Set up in 1893 by the British Government to investigate the use of bhang, the Indian Hemp Drugs Commission concluded in its 3000-page Report that moderate use had no appreciable physical, psychological or moral effect. Banning it might, the Commission feared, drive the Indian poor ‘to have recourse to alcohol or to stimulants or narcotics which may be more deleterious’. Prohibition or even ‘repressive measures of a stringent nature’ would create ‘the army of blackmail’. Moreover, depriving natives of a habitual narcotic would be politically unwise. The Commission’s findings may have been skewed by the fact that cannabis was a key source of revenue to the Raj, but they also reflected sound medical opinion.
With the drive against cannabis in America, medical thinking shifted, however. In 1934, ‘drug addiction’ appeared for the first time in the American Psychiatric Association’s diagnostic handbook, and four years after the 1937 Marijuana Act, cannabis disappeared from the US Pharmacopoeia. When a Commission of the New York Academy of Medicine concluded in 1944 that there was little evidence that marijuana harmed health, the American Psychiatric Association prudently if cravenly advised its members to disregard those findings because they would do ‘great damage to the cause of law enforcement’. The Association knew which side its bread was buttered.
Following the criminalisation of narcotics, the American medical profession fell into line. As funds became available for those developing anti-addiction drugs like methadone and setting up detox programmes, doctors could easily believe that they were helping addicts and society, while also doing their careers a favour.
The Sixties brought a volte face in Britain, too. With governments feeling obliged to be seen as responding to a growing drugs problem – or sensing that capital might be made out of victimising friendless scapegoats – new restrictions were imposed. No longer could GPs routinely supply addicts: now they had to register at special clinics and undergo treatment. In Britain as in America, the upshot of tougher laws and policing was quite predictable: the traffic went underground, achieved a new allure and became enmeshed with criminality and corruption. As early as 1925, Robert Schless had observed that ‘most drug addiction today is due directly to the Harrison Anti-Narcotic Act ... The Harrison Act made the drug peddler and the drug peddler makes drug addicts.’ Schless’s analysis still holds good.
It can make no medical sense that Marlboro Man is still billboarded as a hero while Marijuana Man is busted and jailed. Claims regarding cannabis’s medical perils remain unproven, and its alleged tendency to lead on to hard drugs is essentially a product of the illicit circumstances of its use. All of which suggests that in large measure the legal status of substances may have less to do with any scientific measure of danger than with their ‘ceremonial’ connotations. Thomas Szasz has argued that public anathematisation of drugs can be explained only in terms of the demonising of scapegoats, mirroring earlier persecution of heretics or witches. It is also a function of economics and vested interests. Who doubts that if liquor were mainly made in illicit stills and tobacco grown in back gardens, powerful lobbies would quickly ensure such practices were outlawed?
What is to be done is less clear. It is easy to adopt some principled stance, be it therapeutic paternalism (people need protecting from harmful substances no less than from firearms), or a Szaszian libertarianism (substances are not dangerous per se; it is not for government to protect individuals from their own folly). Things are less easy in practice. We rejoice that the anti-smoking campaign is biting, since that will reduce disease. But will marginalising and even criminalising tobacco merely generate yet another underground culture full of seductive ‘smokeasies’? Mightn’t government sanction for anti-smoking campaigns be a subtle case of victim-blaming, hitting the individual smoker while barely penalising tobacco companies and diverting attention from the environmental and public health hazards politicians choose to ignore? Not least, will anti-smoking campaigns not lead to new healthist witch-hunts?
We need clear minds on these topics because we’re surely standing on the threshold of a new explosion of mind-influencing ‘smart drugs’, ever more potent Prozacs. Should these be encouraged or banned? Sold over the counter or only on prescription? The irony is that it is almost certain that cannabis will in retrospect look like a basically benign drug, and the time will come when the powers-that-be will rue the day they criminalised it in the first place.