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UK: Book Review: Smoke Without Fire
London Review of Books
Thursday 02 Nov 2000 Website: http://www.lrb.co.uk/index.html Author: Richard Davenport-Hines SMOKE WITHOUT FIRE In this exclusive essay from the London Review of Books, Richard Davenport-Hines considers three books which explode some of the myths surrounding marijuana The Science of Marijuana by Leslie Iversen. Oxford, 278 pp., £18.99, 6 April, 0 19 513123 1 Drug Diplomacy in the 20th Century: An International History by William McAllister. Routledge, 344 pp., £16.99, 9 September 1999, 0 415 17989 0 Drugs and the Law: Report of the Independent Inquiry into the Misuse of Drugs Act 1971 Police Foundation, 148 pp., £20, 28 March, 0 947692 47 9 "Marijuana has no therapeutic value, and its use is therefore always an abuse and a vice," trumpeted Harry Anslinger, the implacable Commissioner of the US Bureau of Narcotics in 1953: While opium can be a blessing or a curse, depending on its use, marijuana is only and always a scourge which undermines its victims and degrades them mentally, morally and physically . . . In the earliest stages of intoxication, the will power is destroyed and inhibitions and restraints are released; the moral barricades are broken down and often debauchery and sexuality result. Where mental instability is inherent, the behaviour is generally violent. An egotist will enjoy delusions of grandeur, the timid individual will suffer anxiety, and the aggressive one often will resort to acts of violence and crime. Dormant tendencies are released . . . Constant use produces an incapacity for work and a disorientation . . . often leading to insanity after prolonged use. Anslinger's claims have been endorsed by high officials ever since. "There is not a shred of scientific evidence that shows that smoked marijuana is useful or needed," declared the former US drugs czar General Barry McCaffrey in 1996. "This is not a medicine. This is a cruel hoax." Our own home secretary endorsed this line after his son's arrest for a drug offence in 1997. Ann 'zero-tolerance' Widdecombe is even more opposed to it (except, it seems, when used by shadow cabinet colleagues and other supposedly 'educated, articulate people'). Anslinger was lying. In The Science of Marijuana, Leslie Iversen has produced the most authoritative and up-to-date scientific assessment of the medical uses of cannabis now available. He recalls that cannabis was recommended for the treatment of constipation, gout, malaria, rheumatism and menstrual problems in a Chinese compendium of herbal medicines published around 2800 BC. It was a medicament in many subsequent cultures. Difficulties in standardising cannabis preparations meant, however, that it was not widely used in 19th-century western medicine. Even so, in 1937, when its medical use was suppressed in the US, there were 28 different medicines in which it was an ingredient. In 1964 came confirmation that virtually all the pharmacological activity in hashish extracts is attributable to one compound, delta-9-tetrahydrocannabinol (THC). Later, the existence of specific receptors for cannabinoids in the brain and other tissues was established. Early in the 1970s the US Drugs Enforcement Agency was petitioned to reclassify marijuana as a Schedule II drug which could be prescribed by physicians. Finally, in 1986, after prolonged legal tussles, the DEA agreed to public hearings on the petition. The hearings lasted for more than two years. Despite the DEA's legal expert recommending the rescheduling, and his conclusion that cannabis is "one of the safest therapeutically active substances known to man", the DEA denied the petition. Iversen refers to a 1990 finding that 44 per cent of US oncologists had suggested that a patient smoke marijuana for relief of the nausea induced by chemotherapy. If the drug were really unsafe for use even under medical supervision, as its Schedule I status affirms, this recommendation would have been unthinkable. Despite the DEA's obstruction, the discovery of the cannabinoid control system in the body has revitalised scientific research. Two synthetic cannabinoids have become available on prescription to patients in Europe and the US. The annual sales of dronabil (soldunder the trade name of Marinol) in the US are estimated to be worth about $20 million: some 80 per cent of prescriptions are as an appetite stimulant for people with Aids or HIV, 10 per cent to counteract the nausea associated with chemotherapy and 10 per cent for other purposes. The Eli Lilly Company has developed nabilone: under the trade name of Cesamet it, too, is used to treat nausea in patients undergoing chemotherapy, although it also gave promising results in clinical trials in the treatment of anxiety. In addition, many patients with multiple sclerosis have reported benefiting from smoking cannabis. The possibility of its use in the treatment of glaucoma and epilepsy is being looked into. During 1997, the American Medical Association recommended controlled clinical trials on the medical uses of smoked marijuana, and the BMA recommended trials of synthetic cannabinoids The House of Lords Science and Technology Committeereported in 1998 that more clinical research was needed, but recommended the drug's rescheduling to permit its medical use. A year later, the National Academy of Sciences, Institute of Medicine urged that its therapeutic use in pain relief, control of nausea and appetite stimulation be further investigated. New clinical trials will probably soon be underway in Europe and the US, and I don't doubt from the evidence laid out by Iversen that they will yield positive data. It will then be hard for governments to refuse approval for the medical use of cannabis or cannabinoids. "The argument that approval of the medical use of cannabis would be tantamount to encouraging the legalisation of the drug for all purposes is clearly specious," Iversen concludes, "and is no justification for withholding an effective medicine from patients who need it." Such ideas were anathema to the egregious McCaffrey. "There could be no worse message to young people," he insisted. "Just when the nation is trying its hardest to educate teenagers not to use psychoactive drugs . . . they are being told that marijuana is a medicine." Many other psychoactive drugs have a recognised place in European medicine notwithstanding the dangers of misuse. Heroin is the foremost example. Despite Congressman Stephen Porter's disastrous Act of 1924 prohibiting its medical use in the US, European countries resisted postwar American pressure (directed through the United Nations) to impose this ban globally. An attempt under the Eden Government in 1955 to prohibit its medical use in Britain was defeated by a House of Lords rebellion led by the former Lord Chancellor, Lord Jowitt, supported by a number of medical peers. One of the virtues of William McAllister's meticulously researched history of 20th-century drugs diplomacy is to highlight the source of most national drug regulatory systems in the series of international conferences on the subject held since 1912. Summaries of diplomatic proceedings, or of the Conventions they produce, can make dry reading, but McAllister brings a wry humour to his subject. The book is indispensable to world in 2000; among many rich details, it gives disturbing insights into the influence of pharmaceutical companies on global policy. At the crucial Conference on Psychotropic Substances held in Vienna in 1971, several key delegations, including the US delegation, were infiltrated by company executives defending their freedom to sell amphetamines and barbiturates with minimal regulation. The mystery as to why the spokesman for six Latin American countries opposing tight regulations spoke only broken Spanish was solved when he was discovered to be a Swiss employee of Hoffman-LaRoche. McAllister's is an international history, drawing on diplomatic archives: he does not go into detail on the home office's troubled relations with cannabis. The home office first took notice of what was then known as Indian hemp in 1922, when it was sent a substance found in the coalshed of an Egyptian coffee-house keeper in South Shields. The home office confirmed to the chief constable that on analysis the substance proved to be 'hasheesh', which was not covered by the Dangerous Drugs Act (DDA) of 1920. Next, in1923, ten tons of cannabis resin en route from Bombay to Djibouti were detained: the shipper was Henri de Monfreid, whose memoir La Croisiere du Hachich (1935) - in English translation, Hashish: A Traveller's Tale (1994) - is a splendid introduction to the subject of trafficking and drugs regulations. The home office was consulted before Monfreid's shipment was allowed to proceed. Shortly afterwards, two waiters, one Italian and the other Sudanese, were arrested in Old Compton Street and accused of offering to supply raw opium. In fact, the brown substance in their possession was hashish, which it was then legal to possess, and the case was abandoned. But it provided the excuse for an alarmist series of cheap newspaper articles in the silly season - including a supposed interview in the Daily Mail with a home office official - in the relevant file in the Public Record Office the official in question has written the word 'Liar!' in the margin. On the strength of the hoo-ha metropolitan police recommended the incorporation of cannabis in the Dangerous Drugs Act, one CID officer advising that cannabis "has practically the same effect as cocaine and morphine upon its victims". Even the Met was not optimistic about the success of prohibition: the "only result" of prohibiting the drug in Egypt had been "an increase of price to its consumers". The home office did not want to legislate, but foresaw that "the prevalence of the vice in Egypt" - despite prohibition there - might result in 'international regulation of the drug'. This was prescient. A month later, the Egyptian ministry of the interior concluded that as it was "practically impossible to keep hashish out of Egypt . . . the League of Nations should consider hashish as an international affair and should try to persuade its members to make dealing in or consuming the drug a crime punishable by severe penalties." Consequently, at the Geneva Conference on Opium of1924-25, Egypt's delegate proposed bringing hashish within the Hague Convention of 1912. His memorandum, circulated to support this proposal, represented it as "a dangerous narcotic . . . more harmful than opium", and stated that "about 70 per cent of insane people in lunatic asylums in Egypt are haschiche eaters or smokers." Congressman Porter, the monomaniacal leader of the US delegation, was keen on this initiative. "We are asking them to help us to destroy the vice of opium, coca leaves and their derivatives," he declared of the Egyptians. "This is a good time to practise a little reciprocity. They have their troubles and we have ours." The contracting powers at the Geneva Conference accordingly agreed in 1925 to prohibit the import and export of Indian hemp except for certified medical or scientific purposes. In Britain, cannabis was immediately rescheduled as a poison, with effect from April 1925. A few months later, a new DDA brought Britain into line for the ratification of the Geneva Convention. The House of Commons debate on the Bill lasted less than five minutes: Indian hemp, or cannabis, was not mentioned once. The House of Lords debate was slightly longer. Peers followed the advice of Lord Haldane that, as it was "impossible to form any judgment on the details of the Bill", it should "be taken by the House to a large extent on trust". It was on this slipshod basis that cannabis was criminalised. This might not have mattered much had it not been for the enduring effects of Prohibition in the US. Cannabis was listed in the US Pharmacopoeia as a recognised medicine from 1850 until 1942. It was sold cheaply by drugstores in the form of fluid extracts, and was smoked in cigarette form by asthmatics. Between1900 and 1920 it began to be used on a limited scale as a recreational drug by immigrant labourers from Mexico and the Caribbean. Its consumption was enormously increased after the 18th Amendment - prohibiting alcohol - came into force in 1920. Alcohol became more difficult to obtain, more expensive and often of poor quality. In urban centres 'tea pads' operating like speakeasies provided cheap marijuana. In 1944, Mayor La Guardia's Committee on Marijuana estimated that there had been five hundred 'tea pads' in New York City by the 1930s. The mass marketing of marijuana for recreational use was the result of bad law-making. Congressman Porter's response to the Egyptians at Geneva showed that cannabis was not then regarded as a problem by anti- drugs propagandists in the US. It first received public attention in a series of sensationalised and false reports in the New Orleans press in 1926 involving drug-crazed black marijuana users and corrupted schoolchildren. By 1931, all but two stateswest of the Mississippi and several others in the East had made a criminal offence of the possession or use of cannabis. By 1937, every state had outlawed the drug under legislation allowing no distinction between physiologically addictive narcotics such as heroin, habit-forming stimulants like cocaine, and hallucinogens. Anslinger felt that his agents at the Bureau of Narcotics were overstretched coping with opiates without having to suppress a drug that could be easily grown in many states of the Union. He accepted then that "the marijuana addict" did not "graduate into a heroin, an opium or a cocaine user". Once he'd decided that he would have to submit to political pressure for a Federal law to be passed against marijuana, he did so in a manner calculated, not untypically, to strengthen his own position and that of the Bureau. He strenuously supported the Marijuana Tax Bill. "How many murders, suicides, robberies, criminal assaults, hold-ups, burglaries and deeds of maniacal insanity it causes each year, especially among the young, can only be conjectured," he said, assuring the House of Representatives that under the influence of the drug, "people will fly into a delirious rage and many will commit violent crimes." His corrupt rhetoric was contaminating. It produced such an atmosphere than when the official representative of the American Medical Association came to testify against the Bill, he was bullied and insulted. (An editorial in the Journal of the American Medical Association of 1 May 1937 advised that "the proposed Federal venture into the interstate control of cannabis hardly seems to be justified by experience . . After more than twenty years of Federal effort and the expenditure of millions of dollars, the opium and cocaine habits are still widespread.") Like Lord Haldane 12 years earlier in the House of Lords, Congressman Sam Rayburn assured Congress that "this Bill has a unanimous report from the committee and there is no controversy about it." When asked what the Bill was about, he added, vaguely: "it has something to do with something that is called marijuana. I believe it is a narcotic of some kind." The Bill passed after less than half an hour's debate. If a good law is one that reduces misconduct, while a bad law results in increased infractions, then the Marijuana Tax Act was calamitous. It raises the question that is too seldom addressed when considering policy on drugs: does social deviance lead to social controls, or do such controls result in deviance? In the five years after 1937, about sixty thousand tons of marijuana were destroyed in the US and about a thousand people arrested annually for violating the law. The number of arrests in California rose from 1156 in 1954 to 50,327 in 1968. By 1998, there were 695,000 arrests annually in the US: 86,086 was the comparable figure for Britain in 1997. The policing of cannabis accounted for nearly 80 per cent of police time spent on drug offences in both countries. The DEA has grown into a second international intelligence agency, with a global network of agents rivalling that of the CIA. The total spent on the War on Drugs rose from $537m in 1980 to $1.2bn in 1984. By 1991, the Government was spending $7.7bn on action against illegal intoxicants. Despite the deployment of all these repressive instruments, the US has failed to disrupt the dynamics of prohibition and illegal supply. As the late Jan-Willem Gerritsen writes in his perceptive study of prohibition policies, "the high 'business risks' keep prices high and guarantee good profit margins for successful entrepreneurs, so that the market continues to exercise tremendous magnetic appeal." Although "increasingly stiff sentences imposed under the criminal law aggravate the risks on the supply side, they also boost the market position of those able to evade prosecution. The harsher the repressive measures, the greater the reward for successful entrepreneurs, who have every reason to expand their market and increase the volume of their supply." Such reasonable observations are anathema to the prohibitionists. Anslinger moved ruthlessly and mendaciously to discredit the authoritative medical and scientific report commissioned by La Guardia. His agents would have been equally hostile to Iversen, who in his temperate and understated book regrets that cannabis "has rarely been regarded simply as a substance with effects and side effects". Instead, it "has been equated with morality and the debate about its use portrayed as one of good versus evil. Marijuana has been linked with the pursuit of pleasure and with idleness rather than the work ethic." Most scientists believe that the grave short-term risks attributed to cannabis "were grossly exaggerated", but neither scientists nor anyone else can prove the effect of a substance to be non-existent; it is therefore impossible to prove that any substance is harmless. Most mental effects of cannabis are potential rather than inherent; the potential physical effects cannot be assessed without much more data on long-term consumption. While it is less habit-forming than heroin, nicotine and cocaine, Iversen postulates that "as many as 10% of regular users will become dependent on the drug." Current recreational use of cannabis has less adverse effect on public health than either tobacco or alcohol, but it is likely "that an increased use of cannabis would bring an increased public health impact". The profits from trafficking in illegal intoxicants are always 'black': they fall outside the supervision and authority of governments. As Gerritsen argues, 'since a country's sovereignty stands or falls with its monopoly on taxation and the obligation of its citizens to pay taxes, the illegal drugs trade forms a fundamental threat to the system of national states.' Since 1985, under the insistent leadership of the US, there has been a concerted campaign to control the international laundering of black-market money derived from drugs. This aspect of the war on drugs, he writes, is leading 'to something that was never intended: a uniform global regulatory regime, which will be applicable to all types of financial service'. Gerritsen's sociological history charts the way 20th-century controls on drugs were used to defend social norms. Men like Anslinger, who was obsessed with Red China, and Richard Nixon, who revived the widespread use of cocaine by his maladroit War on Drugs, regarded their sale and use as a collective threat from outsiders. The 'silent majority' (a phrase Nixon borrowed from Homer, who was referring to thedead) refused to acknowledge that prohibitionist legislation and its enforcement are indispensable preconditions for the growth of illicit supply. "In a repressive climate of this kind, more informal modes of regulation - which certainly exist among users - are by definition confined to a twilight subculture that is a natural breeding ground for crime and other expressions of counter-culture," Gerritsen writes. This is one of the quandaries addressed by the Police Foundation inquiry into the Misuse of Drugs Act 1971. The members of this committee (chaired by Lady Runciman) are essentially pragmatic: It has become inescapably clear to us that the eradication of drug use is not achievable and it is not therefore either a realistic or a sensible goal of public policy. The main aim of the law must be to control and limit the demand for and the supply of illicit drugs in order to minimise the serious individual and social harms caused by their use. Rather than react to the bullying of journalists, drugs laws should reflect the latest scientific understanding; they should also "be accepted by the public as fair, consistent, enforceable, consistent and just". As to social attitudes, the Mori survey commissioned by Runciman showed that tobacco and alcohol were considered more harmful than cannabis by every age group. Illegal drug use remained a minority pursuit well after the 1960s. But by the late 1990s, the majority of people aged between 16 and 29 admitted to having tried illegal drugs; the estimate is that up to one third of this group may have used cannabis or other drugs within the last year. Cannabis accounted for between 70 and 85 per cent of all offences under the MDA, of which there were more than 110,000 in 1997. The best chance of formulating a workable policy lies in viewing drugs as commodities within a hugely lucrative, dynamic and expanding illicit economy. Forty years ago, before the reform of gambling laws, bookies' runners presented a major challenge to a bad law: they convinced the authorities that they would not go away, could not be suppressed and had better be regulated. The cannabis users of 2000 are in the same position as the off-course gamblers of 1960.
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