Repost: Attitudes on Drug Risk: A lesson from the Len Bias fatality

Jun 21 2012 Published by under Drug Abuse Science, Drug Fatality

A discussion on the Twitts today returned me to this old post. I can't believe I've never reposted it.

This was originally published on the ScienceBlogs.com version of the blog on 2/292008.

___
I have a tendency to refer to data from the Monitoring the Future study with some frequency. Unfortunately I've been too lazy to post the critical data figures for your entertainment. Until today DearReader.
One example of which I am particularly fond, is what I call the "Len Bias effect" on the public perception of "risk" associated with casual use of cocaine. I refer to this so often because of the casual sneering response I (and others of my approximate generation) retain for the "Just Say No" program championed by Nancy Reagan in the mid-80s. The MtF data suggest to me at any rate that our "gut feeling" that these types of programs are stupid should be more nuanced.


One of my uses of the MtF data can be found on the old site in which I wrote:

Is attitude everything? Does a "scared straight" approach really work best? Examine the data in the MtF 2005 full report and you will find that, in general, attitudes toward health risks of a given recreational drug are remarkably stable, even across decades. (You will also find that drug use follows broad trends unlikely to be explained by specific events. This is a caveat to my main thesis.) There is one other notable case in which the perceived risk for a drug (e.g., for "trying it once or twice") was initially low in comparison with most other drugs and underwent a rapid increase in the proportion of people thinking it "risky". For cocaine between 1986 and 1987. Unsurprisingly, the shift in attitudes led to a drop from about 20% of 20-somethings endorsing annual use in the early-mid eighties to about 7-8% in the early nineties. The "why" is material. Two words, Len Bias.

These data are also related, for example, to a comment I wrote in response to a post from Uncertain Chad which appeared to express a not-uncommon skepticism that intervention programs such as "D.A.R.E" and "Just Say No" actually work to prevent or minimize recreational drug use.
The data I'll be presenting today are re-drawn from the tables provided in the MtF publications. The appropriate cites for the current versions (Volume I; Volume II) are

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume I: Secondary school students (NIH Publication No. 07-6205). Bethesda, MD: National Institute on Drug Abuse, 699 pp.

and

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume II: College students and adults ages 19-45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse, 307 pp.

The annual monographs are incremental and a given publication year covers data on the US population up to the prior calendar year; my graphs are about a year out of date so they go up through 2005. This long-running study has made some changes over the years, most prominently the introduction of new survey items. So some drugs have more historical data than others. There have been some minor methodological changes which in some cases affect the data to a noticeable extent. Read the footnotes on the full reports if you are interested but I'm fairly confident I've scrutinized the appropriate places to make sure the major points I'm making are not contaminated by this problem.
First up we have the answers to questions about the relative riskiness of using a particular drug. Here I've pulled out selected data for the fraction of individuals who endorse "great risk" in response to "Q. How much do you think people risk harming themselves (physically or in other ways), if they. . .". These numbers are for "try it once or twice".

And to show that this trend for cocaine generalized across a broader range of adult ages.

Certainly, one can hypothesize until the cows come home about the source of this rather obvious trend in which cocaine was suddenly believed by considerably more people to be risky. One might point to Nancy Reagan's championing of "Just Say No", or the founding of D.A.R.E. in 1983, for example. One might scrutinize popular media. One might hypothesize some larger social or political trends in society. These types of data encourage debate because they are not, of course, anything like a controlled study. Nevertheless, the comparison with trends for other drugs of abuse suggests to me that this situation is specific to cocaine. And it is difficult for those of us who lived through that event to ignore the attention that was garnered by the death of a promising young basketball player on June 19, 1986.
Now, the critical figure for the larger point at hand, I've just pulled from the Volume II monograph itself. This is the corresponding trend in people who endorse at least annual use of cocaine for various age groups.

I won't really belabor this point except to note that we have no similar alterations in the trends for use of marijuana, hallucinogens, inhalants, amphetamines or heroin locked to this timepoint in the mid 80s. Some of these were in long gradual slides that began in the late 70s and some were in level patterns. Many reasonably popular drugs of abuse have much lower prevalence than does cocaine at any single timepoint however amphetamine rates are quite similar and marijuana, of course, is more popular. So it looks like a very drug-specific effect.
I won't go too far into my usual applications of this observation. Mostly since I have before and likely will again in more targeted contexts. My belief is, however, that this reminds us that "scared straight" approaches to preventing (at least casual) drug use work. It is just that the target audience must actually be scared in the sense that they think bad consequences could actually happen to them. Second, this points out that, embarrassingly, highly accurate reflections of the state of scientific knowledge may be beside the point when dealing with public policy goals; the fact that cocaine could cause acute cardiac arrest was no mystery to science at the time.

102 responses so far

  • AcademicLurker says:

    I sort of agree and sort of don't. Certainly there was a change, but as I recall it was a much wider cultural change and you're a bit too quick to give credit to Nancy Reagan and DARE.

    The whole pop culture image of cocaine went from "glamorous" to "skeevy" over the course of the mid 80s. But I associate this with things like Less than Zero, Bright Lights, Big City, the whole "yuppy/preppy meltdown" genre that was big at the time, combined with the increasing association of cocaine with violence (because it was mentally lumped in to the same category with crack, which was starting to make headlines after 1985 at least). And of course stories like the basketball player you mentioned.

    I'm not saying that programs like Just Say No and DARE did nothing (although my friends and I certainly mocked them a fair bit), but I wouldn't be too quick give them too much credit.

  • drugmonkey says:

    You aren't convinced by the timing?

  • AcademicLurker says:

    The correlation is clear enough, I'm just not sure about the causation.

  • Isabel says:

    I think DM needs a little "stop and frisking" and a little time in a jail cell, perhaps a couple of decades separated from his children, where he can have a little quiet time without the distraction of his smart phone or NIDA buddies. Maybe that would scare some sense into him.

    Why does a medical PhD want to throw people in jail and deny them student loans because of their plant consumption patterns? What kind of sicko even thinks that way.

    Sorry DM, your recent tweets are hugely disappointing. Why or why did I ever take on this seemingly hopeless task? Well it looks like reason may soon prevail against incredible odds.* Sadly, DM here, who has never even tried the stuff because he is too chicken, will come down on the wrong side of history.

    * from ballot initiatives in numerous states to a rebellion in latin america. Go Uruguay!

    ps what's this woman on??

  • Isabel says:

    The real wacko on the tweets is PalMD- wtf is his problem????? Let's see those lung cancer STATISTICS, Pal.

    ALL the studies are contaminated by the inability to control for cigarette smoking among other glaring problems.

    Another chicken, obviously. Sorry you and DM were such pathetic squares growing up. Now you are getting your revenge I guess.

  • Isabel says:

    She's like a robot on crack. Marijuana is Schedule1 drug. Schedule 1 drugs are addictive and have no medical use. Therefore marijuana has no medical use and is very dangerous. Cannabis is an illegal drug. All illegal drugs are bad bad bad. Therefore cannabis is bad bad bad. Blah blah blah.

    http://www.huffingtonpost.com/2012/06/21/michele-leonhart-dea-crack-heroin-marijuana_n_1615270.html?utm_hp_ref=fb&src=sp&comm_ref=false#sb=1441036,b=facebook

  • Drugmonkey says:

    And should I be erroneously convicted of murder and put on death row to "convince" me of the evils of anti-murder laws Isabel?

  • Genomic Repairman says:

    I was a child of the 80's and remember them trotting out the drug addict to come speak to us in school during our D.A.R.E. Seeing how fucked up that dude was and how his life had changed (he was previously a physician before swapping vocations to burglarize houses to support his coke addiction) made me never want to do drugs.

  • DrugMonkey says:

    Anyone who deals in facts will never "come down on the wrong side of history" Isabel.

  • I'm not sure if scaring people is the way to get them to not use drugs. Comparing the rates of cannabis use in The Netherlands where it's decriminalized to that in other countries shows that less people use cannabis in the Netherlands (both past month and lifetime prevalence) (refs for example here: http://www.drugwarfacts.org/cms/Netherlands_v_US#Data)
    Just because it's there makes it a lot less tempting to use.

  • zap says:

    Our DARE "drug addicts" were burly convicts with lots of tattoos. The kids thought they were cool.

    My "scared straight" was at age 10, when a visiting friend of my dad flipped out in the middle of the night, screaming about how he wanted more pills.

  • AcademicLurker says:

    Our DARE "drug addicts" were burly convicts with lots of tattoos. The kids thought they were cool.

    This matches my recollections of the "scared straight"-style programs we were exposed to in middle school.

  • drugmonkey says:

    IBAM- facile inter-national comparison have only minimal value. Dutch use went up across successive de-crim steps. Portugal started with very low base rate of use. The US had a significant bump up in the early 90s that is not obviously connected with policy changes (dope rap, yes).

  • Isabel says:

    "And should I be erroneously convicted of murder and put on death row to "convince" me of the evils of anti-murder laws Isabel?"

    I have been trying to convince you of the evils of *prohibition* of popular, commonly used substances. The effects on society are devastating far beyond anything the drug will do (to a person who chooses that fate yet).

    Trying to jar you into realizing how twisted it is to lock people in cages for personal use of a common plant that people have used for millenia.

    And how hypocritical it is for medical people who have vowed "first do no harm" to agree with this sadistic practice.

    Well while you PalMD and weirdo zombie Leonhart go about your cushy lives the people in latin America are sick of all the beheadings and other horrific results of this never-justified-in-the-first-place policy and are finally standing up to the US.

    You and Leonhart are just flailing at this point.

  • Isabel says:

    "I was a child of the 80's and remember them trotting out the drug addict to come speak to us in school during our D.A.R.E. Seeing how fucked up that dude was and how his life had changed (he was previously a physician before swapping vocations to burglarize houses to support his coke addiction) made me never want to do dru"

    Wow, what a good little student you were GR. The story never seemed suspect to you, that a physician couldn't afford his own cocaine so he had to quit to burglarize houses? What a joke.

    "IBAM- facile inter-national comparison have only minimal value. Dutch use went up across successive de-crim steps."

    In other words, IBAM, Drugmonkey will win every argument with his obscure N=9 addiction studies. He is a zombie robot like Leonhart.

    Thanks largely to the drug war against the American people (especially people of color) the incarceration rate in the US is 730/100,000 and in the Netherlands it is 87 (wikipedia).

  • drugmonkey says:

    1) I am not a "medical people" and I made no vow about "first do no harm" in my profession or personal life.

    2) I have never once suggested the "evils" that so concern you are anything but. You are trying to "convince" me of something about which you have very little evidence regarding my beliefs. or, at least, little evidence that you've chosen to heed.

    GR/zap/AL: this speaks to my point that in order for "scared straight" to work, people have to actually think it is something that might happen to them. Perhaps seeing an intelligent, educated professional brought low is most effective for some demographics (i.e., the ones that habituate this blog).

  • Genomic Repairman says:

    DM,
    you are right, I saw a successful pillar of the community with the flashy cars and vacation homes rendered to some skeevy little fuck because coke ruined his life. Scared my ass straight, I put down the pipe that day in 3rd grade.

  • Isabel says:

    "2) I have never once suggested the "evils" that so concern you are anything but."

    Nice try, but we are all on to you. You have repeatedly said that "leegaleezit types" need to consider this or that study. What else can this mean except that you support the status quo unless cannabis can be proven to completely harmless? Why else would you be so fixated on "leegaleeze it types"?

    You also blamed these evils on cannabis users themselves in a recent comment, responding to horrific news stories from Mexico.

    Say it then. Say you think PROHIBITION of cannabis is wrong.

  • Isabel says:

    "1) I am not a "medical people" and I made no vow about "first do no harm" in my profession or personal life. "

    Well your twitter Pal did, and he's spreading total bullshit about cannabis causing lung cancer. Probably another alcoholic. And nice to know the people doing research in the medical field don't have to worry about doing no harm, that explains a lot.

  • drugmonkey says:

    Why else would you be so fixated on "leegaleeze it types"?

    because they amuse me? and their tactics offend me?

    What else can this mean except that you support the status quo unless cannabis can be proven to completely harmless?

    It could mean that I support the recognition of science rather than the denial of science.

    You also blamed these evils on cannabis users themselves in a recent comment

    It is indubitably the case that if all the US cannabis smokers stopped using tomorrow there would no longer be any economic incentive for the horrific stuff that attends the illicit cannabis trade. Are you denying this?

  • drugmonkey says:

    he's spreading total bullshit about cannabis causing lung cancer.

    Pal referenced a peer reviewed study. There is also this one. and this one. at least one skeptical review concludes only that there is insufficient basis for conclusions, hardly a rejection of the hypothesis.

    The point here is that your representation of Pal as spreading "total bullshit" is, itself, total bullshit. There is a clear basis at present for concluding that cannabis smoking (particularly as the density increases to daily or nearly daily smoking) increases the risk of lung cancer. It may not be overwhelmingly proven but it is something that has scientific support.

  • Michael Tomasson (@MTomasson) says:

    It's kinda scary in here, so I'll leave my thoughts and then run away....
    The problem with establishing a cannabis-lung cancer connection is that cannabis use is very tightly associated with tobacco use. In one of the studies you cited in fact, all (100%) of the cannabis users also smoked tobacco. Other studies talk about "adjusting for tobacco use," but the real gold would be to lay hands on a group of cannabis-only smokers. These are hard to come by, and the studies that have looked at them have not been positive. I even found one study that claimed that cannabis might protect against cancer. The positive Tunisia study notes that they found no dose-response, which is worrisome for a positive connection. Bottom line, if you want to follow the science, it seems not "total bullshit," because it remains a valid hypothesis that cannabis causes cancer. But also the data to me are not nearly strong enough to say that "cannabis smoking...increases the risk of lung cancer."

    I apologize if I am not appropriately foaming at the mouth for top-tier internet flame-a-thon. I'm new at this.

  • Michael Tomasson (@MTomasson) says:

    One additional out-of-left-field thing. Just because I'm am famous on our hospital unit for this pet peeve, and it feels like I should spread the cheer....

    I have a major issue with Dilaudid. Dilaudid is a "good drug." Schedule II. We use it gang-busters on our oncology floor because it makes the pain go away and the nurses happy. Every single time I am on service, I have to deal with addiction/complications of over-use of this drug. Physicians are told over and over that we are under-treating cancer pain and that we should not be so heartless as to slow the opioid flow. Now increasing data are emerging on the opioid overuse consequences to society. Generally, I think it is true that cancer patients in pain will not become addicted to opioids if used properly. But IV dilaudid is different. It is highly, highly addicting. One day, I set an open challenge to our very well educated pharmacist--"what is the pharmacodynamic difference between Dilaudid and heroin?" Heroin, we all know is an "evil drug." Dilaudid is a good drug. Well, the challenge stands. No data I can find on why/how Dilaudid is functionally any different than heroin. I'm all ears if someone can find any data.

  • Isabel says:

    If you keep looking for something, you will keep finding evidence.

    "Using the prevalence of the highest tertile of cannabis smoking of the controls, it was estimated that ∼5% of lung cancer in those aged ≤55 yrs in New Zealand may be attributable to cannabis smoking. "

    This, with a diagnosis that is very rare to begin with. And as you say, only relevant to heavy users. No association was found with average users. Others that found an association were done in the UK and North Africa where people mix tobacco in with their joints (who still smokes joints anyway? Maybe the paper is contributing). Like I said- the more you look for something the more evidence you will imagine you find. This is true of any substance.

    Yet tobacco is legal and you and pal want to lock casual users of cannabis away in cages and deny them loans and apartment rentals based on a study that is 95% bullshit (better?).

    "because they amuse me? and their tactics offend me? "

    What tactics offend you? For one thing you might start listening. For example, you repeatedly accuse me of saying cannabis use is "harmless" and cannabis is "totes awesome" while I have never said anything of the kind. You just said it again at Sci's place. You will only find such comments occasionally on comment threads, never with actual activists in my long experience.

    "What else can this mean except that you support the status quo unless cannabis can be proven to completely harmless?

    It could mean that I support the recognition of science rather than the denial of science. "

    You are painting yourself into a corner, DM. Now you are saying that the science supports prohibition! Yet every commission that examines all the evidence finds that prohibition is not warranted. Why are you and Leonhart such science deniers?

    "It is indubitably the case that if all the US cannabis smokers stopped using tomorrow there would no longer be any economic incentive for the horrific stuff that attends the illicit cannabis trade. Are you denying this?"

    This is just too stupid to respond to. It could never be coordinated. You hate and blame half of American adults because they have tried cannabis. You want to make half of adults in the US criminals until the science proves cannabis is totally 100% harmless, just like all the other legal substances around. If you can catch them you want to lock them in cages.

  • Isabel says:

    Furthermore, I take some comfort in the fact that all those billions of dollars have been poured into research and such weak associations are found when they are found at all.

    The research is fine, yes, we want to know the risks, and it is fine that you want to help addicts. None of this supports prohibition, however. This is where you are extremely deluded. Groups of experts have looked at the total evidence time and time again and have come to this same conclusion. Are the members of these commissions "legaleeze it types" in your view?

  • Isabel says:

    Well DM, I am still waiting for an answer to my questions. Why do you always disappear just after I make my best points? So you can pretend you didn't see them when you next decide to spew lies about what I have been saying?

    Again:

    What tactics offend you? I remember you once saying that the medical weed people were not pure enough in their motivations. Is that it? Really?

    Next:

    Are the members of the governmental commissions "legaleeze it types" in your view?

  • Loonabel, there's a brand spanking new post about drugs at the toppe of the blogge!!!!!!!! GO LOOK NOW!!!!!!!!!!!!

  • Drugmonkey says:

    Lying about the scientifically established harms of pot smoking Isabel. It's not like this is news to you. Or have you somehow failed to encode this into long term memory each and every time it comes up? I wonder why that might be? Hmmm.....

  • Drugmonkey says:

    None of this supports prohibition, however. This is where you are extremely deluded.

    There you go tilting at straw figures again Isabel. Never have I made any comment whatsoever with respect to my views on what supports or does not support a specific policy goal. I simply maintain that I think policy goals should not be supported on false assertions. I also remind people that, like it or not, our current public policy often diverges from the available evidence. This does not, however, justify running roughshod over evidence to create new policy.

  • Drugmonkey says:

    Btw, did you see the latest paper on cannabis use disorders and social anxiety disorder? Very interesting!

    http://www.ncbi.nlm.nih.gov/m/pubmed/22266089/?i=7&from=Cannabis%20use%20social%20anxiety

  • Isabel says:

    "Lying about the scientifically established harms of pot smoking Isabel. It's not like this is news to you."

    It is news to me that anyone has done this. I swear I have not witnessed this lying. Can you give an example? Again, from a valid activist at least, not some crazy commenter that swung by your blog.

    "Or have you somehow failed to encode this into long term memory each and every time it comes up? "

    When did you actually provide an example in the past? I have asked you to do so many times.

    You didn't answer my second question. or are you implying that the governmental commission members lied?? Again actual example please.

    As far as your stupid anti-cannabis joke, I am the only one that can even keep track of a thread around here. Do you have any real evidence that I have memory problems? So because someone wants to end the drug war against the American people (and the rest of the world, especially latin America) they have long term memory problems (i.e. they are a pothead with hazy memory)? I think cannabis affects short term memory anyway. Nice try.

    PP is drunk out of his mind. This drags down the whole society. We should lock him up in a cage for everyone's benefit. Also take away his home and eligibility for grants. It's only fair.

    Oh that reminds me, another question: please respond to the fact that the FAFSA screens for drug offensives (including mere possession) but not for violent or other serious crimes.

    And question #4:

    If you were to advocate for cannabis legalization on your blog, do you think it would affect your career success?

    See? Every time you do not answer my questions I will add two more 🙂

  • Isabel says:

    "Btw, did you see the latest paper on cannabis use disorders and social anxiety disorder? Very interesting!"

    Looks interesting, and I promise to look it over, but I would rather stay on topic. I can see what you are doing here. Please just answer the questions.

  • Drugmonkey says:

    Q4: no.

    Read the text of the ballot initiative for legalization in CA carefully. The initiative *itself*, not even mere argumentation in favor.

  • Isabel says:

    "I simply maintain that I think policy goals should not be supported on false assertions."

    Finally we agree about something.

  • Drugmonkey says:

    Oh and example? It's you. Take for example your false description of a lung cancer/pot smoking link as "complete bullshit". Case in point.

  • Isabel says:

    Please post a link, there are a million current initiatives, and refer to *particular statements*. I am a busy grad student!

  • Isabel says:

    That is just a crazy person ranting on your blog! 🙂

  • Drugmonkey says:

    If we agree than why do you make false assertions about the established harms of pot, Isabel?

  • Isabel says:

    It was wrong of PalMD to make those blanket statements on twitter and I was super-pissed off. I commented more specifically as well: It was a small effect on a rare disease in one study, while many other studies had opposite results. Hardly justifies his statement. Agreed? Again, please reference major organizations advocating legalization, the commissions that have looked at all the evidence, etc. You know, the legaleeze it folks. Not me!

  • Isabel says:

    "If we agree than why do you make false assertions"

    WHAT false assertions? I'm not the one who says pot is as bad as meth and will ruin your life and cause cancer.

  • LOONABEL: Look at the toppe of the blogge!!! More drugs are now illegal!!!!!!!!

  • Isabel says:

    Flailing hostile drunks like you are seriously pathetic. You should seriously consider switching to weed.

    http://jezebel.com/5905455/im-a-mom-and-im-stoned-right-now

  • Isabel says:

    "It was a small effect on a rare disease in one study, while many other studies had opposite results. "

    AND the small effect did not even apply to most users!

  • PalMD says:

    It's odd that my citation of the current data should so inflame someone. It's not like I put down some redneck's pitbull or something. It's just data. It's not only the best data we have to date (I explained in my very detailed blog post why the data are imperfect) but it's also plausible probable based on the pathophysiology.

    There is no reason to think that inhaled tobacco products are the only plants that injure lung tissue. Any particulate plant matter should be able to raise an inflammatory reaction, blocking bronchioles, causing destruction of aveolar architecture, and causing enough hits to DNA to allow for the growth of carcinomas.

    Some things in medicine, while still needing data, are not too remarkable. Casting a broken arm makes it feel better and helps it heal properly. Smoking weeds fucks up the lungs.

  • Isabel says:

    "It's odd that my citation of the current data should so inflame someone. "

    It wasn't a citation. You just tweeted that it caused lung cancer and was a bad dangerous drug or some shit like that.

    We are talking about legalization here. Why do you support denying blacks and hispanics student loans and housing for something that is undeniably no worse that drinking a glass of wine?

    "There is no reason to think that inhaled tobacco products are the only plants that injure lung tissue. "

    But you can read ALL the evidence (cannabis has protective effects as well and your study clears average users anyway!) AND it doesn't mean you need to throw people in cages.

    "Smoking weeds fucks up the lungs."

    Liar. Why do you hate cannabis users so much?

  • Isabel says:

    "put down some redneck's pitbull "

    "redneck"??? So you're a racist too. Nice guy.

    Did you tweet and blog about how alcohol causes cancer? Do you advise your patients to all avoid it completely for that reason? I hope you do.

    You're supposed to care about first doing no harm. People have decided they want an alternative to alcohol and cannabis is a great one as it is less harmful. Yet you are spreading scare stories. There was no effect on average users in your study.

    I wonder how many headless bodies were found in Mexico last week?

  • lee says:

    "Smoking weeds fucks up the lungs."

    "Liar. Why do you hate cannabis users so much?"

    Isabel, you have grossly mischaracterized PalMD's statements. We know from decades of research that inhalation of particles vapors or gases from pyrolysis of carbon sources in any form is bad for the lung. This is true for lung function measurements, or infectivity rates, or cancer. These data come from studies of ambient concentrations that are ~1000 times lower than that of mainstream cigarette smoke or weed. Hence, any inhalation of the particles, vapors or gases from weed will in fact alter the normal physiology of the lung in such a way that may eventually lead to pathogensis.

  • BikeMonkey says:

    Redneck is not a "race" Isabel, but rather a set of voluntary cultural affectations and affiliation behavior. So it cannot be "racist" to use to this term.

  • drugmonkey says:

    Here's a question for you, Isabel. In your wonderful Utopia of legalized pot, will cannabis addiction, cannabis induced car crashes and vocational productivity change? For the better or for the worse?

  • Isabel says:

    "Isabel, you have grossly mischaracterized PalMD's statements"

    How? It doesn't "fuck up" the lungs. Most people today smoke very little amounts of good bud and it has protective effects. I can't imagine Pal responding to an admission from one of his patients that they had a glass or two of wine every night with an alarmed "Alcohol is a bad drug! It causes cancer!" Can you? Yet studies show even that amount has more effect on breast cancer risk for women than the study he cited increases lung cancer risk for average users (not at all).

    "In your wonderful Utopia"

    Fuck you. Why can't you ever just respond to what I actually SAID? I just want to get law enforcement out of ordinary peoples lives!

    "cannabis addiction, cannabis induced car crashes and vocational productivity change? "

    The last two don't even exist! Drivers drive more carefully to compensate, and our president, along with countless other ex-heavy users had no such problems. You really have to stop getting your bogus info from the stupid NIDA website.

    As far as addiction? It may even improve, as it becomes more accepted and people are not hiding it, and in any case you can help the addicts. It will be much easier for you to study and find ways to help, as it will all be out in the open. There will also be a transition from alcohol to cannabis for many which will be a benefit for the health of those people and for society.

    Okay you still haven't answered my questions so here's another one: you keep avoiding answering my question of whether you ever tried cannabis. If you did answer that you were a user or ex user, would it harm your career? And would it make you a hypocrite, like ex-pothead Obama?

  • drugmonkey says:

    Hey it turns out the Miami cannibal dude was on marijuana and nothing else! wow.

  • drugmonkey says:

    Drivers drive more carefully to compensate,

    http://www.ncbi.nlm.nih.gov/pubmed/22369479

    http://www.ncbi.nlm.nih.gov/pubmed/22323502.1

    http://www.ncbi.nlm.nih.gov/pubmed/21976636

    http://www.ncbi.nlm.nih.gov/pubmed/21376919

    http://www.ncbi.nlm.nih.gov/pubmed/21071390

    http://www.ncbi.nlm.nih.gov/pubmed/20373229

    In other words, Isabel, you are quite wrong. The evidence of compensation is based on driving simulator studies, perhaps? If so, then all we can conclude is that such studies are tapping only a limited subset of the demands of real-world driving. or perhaps in the focal setting of a laboratory study the subjects apply special attention and resources and manage to drive in a compensatory way. Clearly, when it comes to population level, real-world situations, being intoxicated with marijuana is not a good thing and leads to increased numbers of accidents.

    I am willing to entertain the notion, if you like, that the extended window of detection for cannabis in the body leads to the inclusion of folks who are not acutely intoxicated at the time of the accident. This, however, simply points the finger at lasting cognitive effects in the smokers of marijuana.

  • drugmonkey says:

    If you did answer that you were a user or ex user, would it harm your career?

    Nope.

  • drugmonkey says:

    And would it make you a hypocrite, like ex-pothead Obama?

    Can you explain why being interested in the science of what marijuana does to the brain and the rest of the body would make anyone a "hypocrite" based on whether they themselves smoke marijuana (or ever have)?

  • Hey it turns out the Miami cannibal dude was on marijuana and nothing else! wow.

    That must have been some seriously schitty ditchweede!!!

  • Isabel says:

    "Can you explain why being interested in the science of what marijuana does to the brain and the rest of the body would make anyone a "hypocrite" based on whether they themselves smoke marijuana (or ever have)?"

    You are pro-prohibition, that is now clear. There is no other reason why you could think the question is still up for discussion, and that before "deciding" we should "look at the science". If you were or still are a user, your support for prohibition would certainly be hypocritical, like Obama's is.

    Why are you being so obtuse? And why are you so afraid to say whether you tried it or not?

    "being intoxicated with marijuana is not a good thing and leads to increased numbers of accidents. "

    No, it does not. And alcohol does.

    When people post a link, they should indicate something about each link. You are going to make me hunt for info after downloading all these papers? I have seen the literature. Again, if you obsessively look for something you will find it, or imagine you did. Typically the studies that show an increase in actual accidents are flawed, because they don't indicate whether the person was actually under the influence (smoked 2 hrs or less before the accident) and had no other drugs in their system.

    "I am willing to entertain the notion, if you like, that the extended window of detection for cannabis in the body leads to the inclusion of folks who are not acutely intoxicated at the time of the accident. This, however, simply points the finger at lasting cognitive effects in the smokers of marijuana."

    wtf? Lasting cognitive effects are either non-existent or at least way less than from alcohol.

    Why does this have anything to do with law enforcement anyway? Get them the fuck out of peoples' lives. I say disband the NIDA, the DEA, and throw in the TSA as well. It's so sick to use taxpayer's own money to control and harass ordinary people. What would the founding father's think?

  • Isabel says:

    "Hey it turns out the Miami cannibal dude was on marijuana and nothing else! wow."

    Gee willikers, I guess that Reefer Madness film was right after all!

  • Isabel says:

    Also, if there is a transition by many to cannabis instead of alcohol, this could lead to a reduction in car accidents also (as well as other horrors like domestic abuse).

  • drugmonkey says:

    So in other words, you have no intention of reading the studies because your mind is already made up that there is no traffic risk and any paper which says otherwise must surely be "flawed"? Do I have that about right, Isabel?

    I didn't "obsessively look", I went to pubmed and started down through the results. You can easily do the same. It only requires "obsession" if you are trying to figure out how to justify your pre-existing (and erroneous) position and must work out how to deny every finding that supports a different conclusion than your (pre-existing) conclusion.

  • drugmonkey says:

    Why does this have anything to do with law enforcement anyway?

    My post had nothing much to do with "law enforcement" until you insisted on trolling it up. Just like most of the time around here.

  • Isabel says:

    "Do I have that about right, Isabel? "

    Dude, you can barely manage to read my comments, yet you want me to download and read half a dozen papers before responding to your comments?

    I told you I've read them and they are flawed for the reasons I have stated. By obsessively look I mean in doing the studies themselves. Eventually you will find what you were looking for or think you did. It's one of those logic flaws/cognitive biases.

    "It only requires "obsession" if you are trying to figure out how to justify your pre-existing (and erroneous) position and must work out how to deny every finding that supports a different conclusion than your (pre-existing) conclusion."

    Exactly.

  • Isabel says:

    "My post had nothing much to do with "law enforcement" until you insisted on trolling it up. Just like most of the time around here."

    You just referred again to the legaleeze it types on twitter which is what brought me over here as I already explained.

    You continually complain that legaleeze it types are ignoring this-or-that study. What else can this mean except than that you support the status quo? What does this-or-that study have to do with being against law enforcement dragging our society into a police state?

  • drugmonkey says:

    What else can this mean except than that you support the status quo?

    Your lack of imagination is hardly my fault.

  • Isabel says:

    You are the one who cannot imagine not living in a police state.

    You can call me a troll all you want, but anyone reviewing this thread will see a pattern of me answering questions sincerely and you trying to be clever. Just answer the damn question for once.

  • Isabel says:

    "You just referred again to the legaleeze it types on twitter which is what brought me over here as I already explained. "

    In fact, I think it was in a link to this post (though I could be wrong, but I think it was). So my comments are justified. You cannot separate the two issues, and when I complain you accuse me of not being able to separate them. wtf?

  • PalMD says:

    Lemme get this straight: smoking pot is "protective"? Against what? The bankruptcy of Frito-Lay?

  • Isabel says:

    Get lost, Pal. We are having a serious discussion here, and you obviously have nothing to contribute with your lame attempt at sarcasm. Your hypocrisy is depressing and your ignorance is shameful.

  • south says:

    How about you guys actually start answering her questions?

    You cite all the studies that are against cannabis. But in the end if you good hearted scientists actually gave a damn about cancer or health you would be fighting against alcohol and tobacco with the same passion as all the other drugs.

  • DrugMonkey says:

    What questions haven't been answered? She's been led to the water of peer reviewed studies and refuses to drink. She just keeps parroting the same falsehoods without providing evidence, nor is she swayed by any answer that is given. Did you have a point relevant to the topic or do you also favor the "look squirrel" misdirection towards alcohol that is favored by the pot fans?

    Nobody, least of all PalMD or I, has suggested for a second that alcohol or tobacco aren't harmful...they clearly are. But this is orthogonal to the question of whether pot is harmful.

  • Isabel says:

    That response to south is almost scary, DM, in the extent to which it completely misrepresents my point of view. I am tempted to give up, unfortunately I vowed not to, so...

    "What questions haven't been answered? "
    Well here's one. I have repeatedly pointed out that multiple commissions have looked at the prohibition issue over the years and have unanimously recommended lifting the prohibition. It's simply not warranted. Why should I have to provide NEW evidence before you are convinced?

    Meanwhile I have provided a TON of evidence that the prohibition is devastatingly harmful to individuals and society.

    Therefore I have repeatedly asked: Why do you demand more evidence from me? Why do you repeatedly insist that the individuals like me who want to end the harmful prohibition need to look at more evidence, especially when that evidence is not particularly compelling?

    If you are unhappy with the work of the many professionals who have already made their recommendations you really need to stop beating around the bush and explain why.

  • DrugMonkey says:

    "convinced" of what? Again, you continue to tilt at imaginary windmills.

    I do not "demand evidence of you", I say you should acknowledge, accet and integrate the evidence that exists. When you refuse to do so, I point it out. Simple.

    "many professionals" have also come to the conclusion that our current state of legal control is appropriate and necessary, btw. So arguing about "professionals" and their opinions about policy implications is kind of dumb. Far more productive to stick to facts instead of appeals to authority.

  • lee says:

    Isabel, what’s with all the vitriol? Your approach to sway DM and PalMD with arguments against the prohibition of pot is not very convincing. Trotting out tobacco and alcohol as evil while portraying pot as angelic, is laughable. Why not start with some facts, here I’ll help. Prohibition of marijuana costs the US 9 billion dollars per year, which would largely be alleviated with legalization. Or even better, a recent meta analysis has revealed that cognitive deficits following cannabis use are limited to the first 25 days post-withdraw, suggesting that the cognitive effects are temporary.
    http://www.ncbi.nlm.nih.gov/pubmed/22731735
    *Note: I am in now way in support of legalization of pot.

  • Isabel says:

    "Trotting out tobacco and alcohol as evil while portraying pot as angelic"

    Who did this? it all happened in your imagination.

    "Prohibition of marijuana costs the US 9 billion dollars per year, which would largely be alleviated with legalization"

    Wow, we've gotta real genius here. And you wildly underestimate the cost btw. Ignoramus. We've been all over all this. have you been following the conversation? have you followed my links?

    "*Note: I am in now way in support of legalization of pot."

    So, why do you want to lock people in cages because they prefer a less harmful way to relax than alcohol?

    Another asshole.

  • Isabel says:

    "I say you should acknowledge, accet and integrate the evidence that exists. "

    INTEGRATE IT INTO WHAT????????

    ""many professionals" have also come to the conclusion that our current state of legal control is appropriate and necessary, btw."

    No they haven't - NO ONE from any independent or government commission has ever said this. I know for a fact that you cannot give me a single example because it is a lie. only freaks like you and Zombie Leonhart think it.

    DM, I cannot believe you are a scientist at this point. I have never seen such pig-headed illogic thinking in my life.

  • Isabel says:

    "How about you guys actually start answering her questions?"

    Because they are terrified. They cannot imagine challenging the status quo. They tried cannabis once and it revealed to them what losers they are and they now think it is evil. Like Richard Nixon, they hate hippies. They are sadistic control freaks who really love locking people up in cages. They are closet racists want to keep blacks back by the drug war. Just a few guesses.

    "You cite all the studies that are against cannabis. But in the end if you good hearted scientists actually gave a damn about cancer or health you would be fighting against alcohol and tobacco with the same passion as all the other drugs."

    Exactly! Instead they trade cocktail recipes and brag about their beer drinking and Jamesons. Thanks for the support. Most of the self-congratulatory anti-racists and ethicists and other supposedly progressive types around here either don't give a shit or don't want to rock the boat, or both.

  • south says:

    Cannabis is not a magical plant. It is not harmless. However, there are a lot of studies that show its usefulness as medicine. That and the fact that it is less harmful than alcohol and tobacco makes it worthy of legalization.

    "Pot fans" do not try to portray tobacco and alcohol as "evil". The thing there is really no evidence that shows tobacco and alcohol are safer that cannabis.

    Sure, the somke damages your lungs (so does tobacco smoke and its legal).

    Sure, if you will try to drive under its influence you could crash (so with alcohol and its legal).

    Sure, you could get cancer even if some studies say the opposite (tobacco and alcohol related cancers are MUCH more common yet alcohol and tobacco are still legal).

    If you say you can go crazy killing frenzy on cannabis you clearly havent tried it. Anyone saying otherwise is lying. Yet alcohol and violence are directly related and its still legal.

    You can treat cancer and other diseases with cannabis. Can you do this with tobacco or alcohol?

    So, since alcohol or tabacco are not safer nor do they cause less problems. Why not lift the prohibition on cannabis? Or why not prohibit alcohol and tobacco too since you people are so concerned with our health?

    Plus, legalizing cannabis opens the door for cultivation of industrial hemp which has thousands of uses.

    Cannabis being illegal and the other two being legal is plain nonsense.

  • south says:

    "Thanks for the support"

    No problem, I'm sick of these people also. They dont get the fact that if you moderate your cannabis use it is not likely to cause you problems (probably true with any drug). Anything in excess is bad and people should be taught this instead of prohibiting and shutting out all other possiblities when it comes to drugs.

    They blame the plant, but its not its fault! Its just a plant! Its people's fault. And its the government's fault because regardless of the drug, all of these deaths are because of the lack of education. Scare tactics are not education.

  • Isabel says:

    The thing is, cloud, these people are obsessed with evidence based medicine etc, but prohibition as a policy is the opposite of evidence based science. There is NO evidence anywhere that prohibition of popular substances has ever worked! Yet they cling to the fantasy as the drug cartels take over Mexico and the incarceration rate climbs.

  • PalMD says:

    You can treat cancer and other diseases with cannabis. Can you do this with tobacco or alcohol?

    Sorry, while most of what you say is unarguably true, this part is completely unsupported by evidence, and is implausible to boot.

  • MonkeyPox says:

    I'm not worried about Isabel's pot problem..i worried about whatthefuckever other problem makes her an entertaining nut bag.

  • Isabel says:

    "Sorry, while most of what you say is unarguably true, this part is completely unsupported by evidence, and is implausible to boot."

    Let's not get distracted here into one of these drawn out, derailing discussions of the evidence. There is nothing to discuss. The point is that none of it matters anymore in terms of prohibition. You can keep discussing it after legalization, just like you do with other drugs. Like the dangerous prescription drugs that the DEA now considers its highest priority, for good reason. Later poor Pal here can try to catch up with the literature.

    It is clear that cannabis is a great alternative to more dangerous drugs. It is extremely popular and safer than alcohol. The majority of Americans agree that there is no justification for its prohibition. None.

  • Lee says:

    "You can treat cancer and other diseases with cannabis. Can you do this with tobacco or alcohol?"

    Pal is correct above but I wanted to add:

    Actually, though with some debate, tobacco use has been shown to have a negative effect on ulcerative colitis.
    http://www.ncbi.nlm.nih.gov/pubmed/19170191
    And Parkinsons disease:
    http://www.ncbi.nlm.nih.gov/pubmed/20461808

    Both are likely through nicotine
    http://www.ncbi.nlm.nih.gov/pubmed/22693036
    http://www.ncbi.nlm.nih.gov/pubmed/10583016

  • Isabel says:

    Lee,

    Please answer my question before you continue derailing the conversation by telling us what a magical substance tobacco is.

    "*Note: I am in now way in support of legalization of pot."

    So, why do you want to lock people in cages because they prefer a less harmful way to relax than alcohol?

    Or perhaps you meant to say:

    "*Note: I am now way in support of legalization of pot."

    "now" or "no"?

    The other reason we know DM supports this disastrous prohibition is, like Pal, he spreads scare stories rather than supporting efforts to overturn prohibition. We know it doesn't take much.

    Do you believe in evidence-based policy, DM?

  • lee says:

    The point of the post was not to derail the discussion by espousing the virtues of tobacco, it was to point out that the medicinal value of say marijuana can be boiled down to a few active ingredients. THC, for example, is available by prescription (Marinol) in certain cases.

    Secondly, “now” was a typo on my part and I didn't mean to confuse the issue. I am not in support of locking away individuals who have not committed a crime; however, given that pot is illegal, individuals caught buying, selling or using an illicit substance should be prosecuted based on the laws of state or federal government.

    Furthermore, you have not proven at any point that pot is less harmful that alcohol.

  • drugmonkey says:

    The peer reviewed literature is now "scare stories", Isabel? Because that is what I "spread". You, otoh, are the one that spreads evidence free and often factually incorrect assertions.

    Here's a question for you. What fraction of people "locked up in cages" are there *only* because they had simply been holding a personal use amount of marijuana? And were otherwise totes law abiding citizens, just minding their own beeswax?

  • Isabel says:

    "Furthermore, you have not proven at any point that pot is less harmful that alcohol."

    That isn't my goal nor has it ever been on this blog. It has already been proven. Where the heck have you been? Really, you don't know this?

  • Isabel says:

    DM, please go back and READ my posts and follow the very specific links I have provided re law enforcement issues.

    You don't read my arguments and then you complain that I haven't made any!

    I am sick of repeating myself.

    When you reply, please quote or link to an actual comment.

    Thanks.

  • Isabel says:

    "are there *only* because they had simply been holding a personal use amount of marijuana?"

    "no one is incarcerated for possession" is a myth.

    Educate yourself. I am trying to help, but you need to stop being a stubborn child and to participate in the process.

  • drugmonkey says:

    I posted an analysis some time back which showed that "arrests" for possession were not all equal and the alleged costs were multiplying all such arrests against the costs for full booking arrests. Turns out to be a way to hugely overestimate serious, booking arrests for simple possession raps.

    When I follow your links to pro-pot advocacy sites I notice this issue is always intentionally conflated which is why I ask the question of you. It is also fresh in my mind because the most data-driven, science-fluent drug Czar I have heard of the past three was just this past CPDD meeting repeating the notion that people in jail for pot were not "just smokers". You suspect his motivations (he's no longer the drug Czar, btw)? Fine, but all you can do is pit those with motivation to exaggerate the number so "just smokers" behind bars in reply.

    Are there some poor unfortunate people who get thrown in jail for long periods of time *merely* for holding a joint? maybe. But where's your evidence that this represents a major fraction? You claim to have posted a link to that and perhaps I have missed it....but somehow I doubt that very much. I do review your "evidence", I just usually find it wanting.

  • drugmonkey says:

    I may have my problems with Walters as a Drug Czar but he didn't personally compile this report:

    http://www.prisonpolicy.org/scans/whos_in_prison_for_marij.pdf

    I encourage anyone to read this as a starting point.

    I encourage Isabel to apply the appropriate caveats to her continued attempts to portray the *entire* prison population which is in on anything related to marijuana as if they were in on mere first time, personal possession charges.

  • drugmonkey says:

    The majority of Americans agree that there is no justification for its prohibition.

    The "majority of Americans" have agreed, at times, that gays can't marry each other, that blacks and whites can't marry each other, that there is no reason for the state to control how industry chooses to pay and treat its workers, that women can't vote, that black people can't vote, that companies should be free to flood watersheds with chemicals and all sorts of other crapola.

    You appeal to majority opinion is valueless.

    Which you undoubtedly know....or do you agree with the decision of California voters to retain the restriction on marijuana use when it was up for ballot initiative a few years ago? Do you agree with the decision of these expert citizens who considered the pros and cons of legalization (in one of our most liberal states, mind. a state saturated with Humbolt kinde budde on one end and Jeff Spicoli's as far as the eye can see on the other) and said "No thanks"?

    Yeah, I thought not.

  • Budde says:

    No wonder these grad students and postdocs are taking longer to finish and are whining about the job market! Stop getting stoned out of your gourds all the time. It makes you lazy and stupid.

  • Isabel says:

    Unfuckinging believable. You guys are true anti-American, ignorant, racist scum.

    Hey Pal, when one of your patients announces that they drink a glass of wine every night do you recommend that they stop immediately because it's a bad drug? You never answered the question.

    And you really thought Budde's stupid joke was funny? Here's the formula: someone mentions cannabis. Jokester says something, anything at all, about pot making you stupid or lazy. Everybody laughs up uproariously. Fucking drunks.

    DM, you are lying. I haven't linked to ANY "pro-pot" sites. You are living in some kind of alternate universe. Damnit, I told you I want quotes! WHAT do you disagree with SPECIFICALLY? Quote it and link please. Don't give me any more bullshit government links. At least you are finally coming out of the closet as a prohibitionist.

    Every decade or two, a commission is put together to look at this question. Inevitably, after they look at all the affects on individuals and society, they come to the same conclusion: prohibition of cannabis is not justified. Even if the members are hand-picked hippie-hating conservatives, they come to this same conclusion. Also inevitable is the immediate burial of their recommendations. Then the debates starts all over again, until it builds up to the next commission. This has a name: insanity.

    Drugmonkey, Budde, Lee, and PalMD are all racist control freaks who prefer living in a police state to using their brains.

  • Isabel says:

    "up uproariously." uproariously, sorry.

    "I encourage Isabel to apply the appropriate caveats to her continued attempts to portray the *entire* prison population which is in on anything related to marijuana as if they were in on mere first time, personal possession charges."

    Liar liar pants on fire. Never said it.

    "the most data-driven, science-fluent drug Czar "

    "drug czar" needs to be eliminated along with the TSA, NIDA, and DEA. All worthless. You need to find some new friends and associates, DM. You are truly scraping the bottom of the barrel here.

  • Isabel says:

    I said I want law enforcement out of regular, hard-working law abiding peoples' lives. Arrests count. Getting arrested sucks, and has serious consequences, privileged assholes. Most cannabis arrests are for possession only.

  • Budde says:

    Oh I do prefer to use my brain. That's why I don't fuck it up with marijuana. Can you say the same, Isabel?

  • Isabel says:

    You're just fucked up. And no one says "marijuana". Grow up.

    "Can you say the same, Isabel?"

    We are talking about public policy here, and nothing else, especially not your imaginary "superior" habits (that you learned while watching government propaganda PSAs). Go away.

  • Isabel says:

    I just want to apologize to readers for the excessive abusive language. I do need to take a break for now, but not for good. DM just makes me so angry when he intentionally mis-characterizes my overall message, makes fun of victimized cannabis users, and refuses to directly answer questions or back up his assertions.

    At first it actually seems to lower my blood pressure to be able to yell directly at NIDA status quo folks, but after a while it seems to have the opposite effect.

    Have a nice Fourth of July everyone.

  • PalMD says:

    As to your question, I don't "tell" my patients to do anything. I give them the facts, make a suggestion, and then it's in their court. If one drink of wine is perilous to a particular patient's health, I tell them so. If I have a patient with chronic liver disease, I tell them that any amount of alcohol is dangerous. I also tell them that more than 3g of acetaminophen a day is dangerous. EtOH can also be habit forming, so stopping even one drink a day can be hard.

    If I have an asthmatic whose disease is not controlled and they are smoking marijuana every day, I tell them it's likely making their asthma worse and asthma can be deadly. Marijuana can be habit forming, so stopping even one bowl a day can be hard.

    What I do isn't really all that hard, I guess.

  • PalMD says:

    OH, and some of my best friends are rednecks.

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