11/02/14 Doug McVay

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Doug McVay Reports: New research finds more than 39 million American adults suffer persistent pain, and Mark Kleiman talks about legal marijuana.

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TRANSCRIPT

CENTURY OF LIES

NOVEMBER 2, 2014

TRANSCRIPT

DOUG MCVAY: Hello and welcome to Century of Lies. I'm your guest host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network, which comes to you through the Pacifica Foundation Radio Network and is supported by the generosity of the James A. Baker III Institute for Public Policy and of listeners like you.

Find us on the web at drug truth dot net, where you can find past programs and subscribe to our podcasts. You can follow me on twitter, where I'm @drugpolicyfacts, and also @dougmcvay. The Drug Truth Network is on Facebook, be sure to give its page a Like. Drug War Facts on facebook as well, please give it a like and share it with friends.

Now, on with the show.

Newly published research shows that there are more than thirty nine million American adults who suffer with persistent pain. In an article titled “Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey,” researchers from the state of Washington reviewed data from the federal National Health Interview Survey.

The article is published in the October 2014 issue of the Journal of Pain. The full text is available for free from the journal's website. They researchers found, quote:
“about 19.0% of adults in the United States report persistent pain. Rates of persistent pain are
higher among women, adults aged 60 to 69, adults who rate their health as fair or poor, adults
who are overweight or obese, and those who were hospitalized one or more times in the preceding
year. Most adults who report conditions such as arthritis, carpal tunnel syndrome, or back or joint
pain do not describe their pain as 'persistent.' Of the estimated 39.4 million adults who report persistent pain, 67.2% say their pain is 'constantly present,' and 50.5% say their pain is sometimes
'unbearable and excruciating.'” End quote.

The federal Institute of Medicine in its 2011 book Relieving Pain in America came up with a much higher figure for those suffering with pain in the US, estimating that 100 million Americans suffer from chronic pain conditions. The key here is in what's being looked at: chronic pain is a broader term, of which persistent pain is a subgroup. The authors of this new study even note that distinction, writing quote:
“In the 2010 NHIS, an estimated 59.5 million adults reported lower back pain in the past 3 months, and all of these would be described in the IOM report as having chronic pain. However, only 42% of respondents described their lower back pain as frequent or daily, and lasting 3 or more months.” End quote.

Numbers like these are why so many people in the US use opioid pain medications. And they use more than just opiates. The authors note, quote:
“adults with persistent lower back pain are also more likely to take medications for anxiety or depression and to say that pain medications do not take away their pain completely. This persistent pain subgroup is also likely to be at higher risk of long-term exposure to, and dependency on, prescription pain medications.” End quote.

Loyal listeners will recall that research shows increasing rates of opioid overdose mortality across the US, and that many of these so-called opioid overdoses also involve other drugs including anti-depressants and benzodiazepines, as well as alcohol. Other research has shown that states which allow access to medical marijuana have lower rates of opioid overdose. There are several ways in which this occurs. The most obvious reason is that medical marijuana is used in conjunction with or possibly as a substitute for opiates. Additionally, marijuana is widely used as a replacement for pharmaceutical anti-depressants and tranquilizers, and also as a substitute for alcohol.

The bottom line is, when we hear some in government and the media talk about an epidemic of painkiller use, we need to bear in mind that there is also a widespread problem of persistent and often untreated chronic pain in the US. This is a serious public health problem. The researchers even contend that, quote:
“From a public health planning perspective, persistent pain can be thought of as an indicator of unmet need for pain management in the general population, as well as an obvious risk factor for disability, depression, and dependency.” End quote.

Again that article is titled “Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey ,” and appears in the October issue of the Journal of Pain.

Now, get ready to mark your calendars. December 17th is the 100th anniversary of the Harrison Narcotics Act, the day the US began its 100 year long drug war – its century of lies. On that day, people in towns and cities around the nation will hold rallies at local courthouses to call for an end to prohibition. You can get involved. Email the Drug Truth Network's executive producer Dean Becker, he's dean at drug truth dot net. Several organizations are already on board including Law Enforcement Against Prohibition, Students for Sensible Drug Policy, Break The Chains, and the November Coalition. Get involved today. Find out more at endprohibition.org. Also check out the facebook page, it's facebook.com/100 Years Is Enough, that's facebook.com/100 years is enough.

We're going to take a short break now. You're listening to Century Of Lies, a production of the Drug Truth Network. I'm your guest host Doug McVay, editor of Drug War Facts dot org. Century Of Lies is heard on 420Radio.org on Mondays at 11 am and 11 pm, and Saturdays at 4 am, all times are pacific. We are heard on time4hemp.com on Wednesdays between 1 and 2pm pacific along with our sister program Cultural Baggage. And we're on The Detour Talk Network at TheDetour.us on Tuesdays at 8:30pm. A few of the stations out there which carry Century Of Lies include WERU 89.9 FM in Blue Hill, Maine; WPRR 1680 am 95.3 fm in Grand Rapids, Michigan; WIEC 102.7 FM in Eau Claire, WI; WGOT-LP 94.7 FM in Gainesville, FL; KRFP 90.3 FM in Moscow, Idaho; and Free Radio Santa Cruz 101.3 fm in Santa Cruz California.

Welcome back.

Now, let's turn to the politics of pot. Mark A.R. Kleiman is a Professor of Public Policy in the UCLA School of Public Affairs and a drug policy researcher. He is the voice of the centrists in the drug policy debate. He's not strictly speaking a prohibitionist, and he's also certainly not a legalizer. He falls somewhere in between. The drug policy debate has matured. Reformers have starting winning the minds as well as the hearts of the public. As support for prohibition wanes, the center shifts in the direction of reform. Thus, Mark's positions have also evolved.

Whatever else I may think of him Mark is a reflection of the center. He's become a voice of the moderate in the drug policy debate. That moderate position is probably the position of the majority of the American public. At least, a centrist position is probably the most broadly acceptable. Mark recently spoke about the upcoming 2014 elections and marijuana legalization measures on the Oregon, DC, and Alaska ballots. Let's hear some of what he had to say:

MARK KLEIMAN: So there's a story about Henry Kissinger and Chou En-Lai. Stop me if you've heard this one. So, so, uh, before they were mass murderers, Henry and Chou were both historians by trade, and the story, when Kissinger goes to uh, to Beijing to set up the first ping-pong diplomacy, he decides to break the ice with a little historian small-talk. So he says to Chou, in China, do you think that the French Revolution was a good thing or a bad thing? So that's the question you just asked me. And Chou is supposed to have replied, in China, we think it's too soon to tell.

Now that was sort of a joke, it's not a joke to say it's just too soon to tell what's going to happen in Washington or Oregon.* You know, ask me in ten years and I'll have some idea about what the results were. At the moment, both in Washington and Oregon, both of which had massive medical marijuana availability before they legalized for commercial sale, uh, the medical prices are half or less the commercial prices. So, the bulk of in-state buyers either have their own medical card or have a friend who has a medical card, and they aren't bothering to pay any extra price at the commercial shop.

So, the, the, commercial sales are a lot of out-of-staters, uh, and some people who are respectable or simply don't want to tell a lie to a doctor. But, the availability of cannabis for adults in those states has not changed very much, since legalization, so it's hard to tell what the effects were of not much policy yet. Give it three years and we're going to see the commercial prices collapse, unless the states act to restrict, uh, production or really increase their taxes.

When the commercial prices fall below the medical prices, then the experiment starts, and we can start looking for results. But in the meantime, everybody's running stories, you know, this good thing happened in Washington, that, uh, uh, a chicken that laid two eggs in, in Washington, that proves that pot legalization was a good idea. It's all just complete nonsense. And, there are people saying that well they legalized pot last year and youth consumption hasn't gone up yet. Well, that reminds me of the guy who jumped off the top of the Empire State Building. Goes past the 42nd floor, somebody yells out, how's it going? And he yells back, so far, so good!

Uh, I think there's been a lot of nonsense. Look, journalists need to write something, so, they're going to write something, but at the moment there's nothing to see, move along, folks.

BRAD ROWE: So, now we have four new states that could potentially be coming on line, of course, you know with Florida it's for medical marijuana. But I guess the question becomes, uh, the federal government so far has had this allow for now policy, but this is under the Obama administration. We're not sure what could happen with the next president and how they're going to react to it, so what are your opinions on that, and of course, to our viewers, we're going to get moving into the state by state part and we'll follow it up by Q & A, and just wanted to cover some of the national issues first. Uh, what do you think the federal government could be doing that they're not doing now, to maybe stave off some of the issues that might be problematic, for the state-by-state legalization trend.

MARK KLEIMAN: I think the federal guidance was reasonable, but I think it wasn't specific enough. It said, you've got to make sure that cannabis isn't getting to kids. That's a reasonable goal. It's not a goal you could accomplish perfectly. It's available for adults, kids are going to have access to it. Of course if it's illegal kids are also going to have access to it, question is how much does the access increase? Uh, and the main factor there it seems to me is price. Pot is so cheap as a way of getting altered, that casual users aren't going to be much influenced by price one way or another.

The amount of cannabis at California medical prices, maybe it would take an ordinary user, not somebody who's built up a big tolerance but an ordinary user, to get wrecked for three hours, it's probably two dollars worth. You know, it's half a joint, a joint is four tenths of a gram, a gram's about 10 dollars. Hard to see that somebody who wants to do that once a week is going to care whether it costs two dollars or two and a half dollars. In either case, the Doritos cost more than the pot.

The people who are going to care about the cost of cannabis are the heavy users, and especially the under-age heavy users because they don't have a lot of money. Jon Caulkins, our colleague, uh, and Maria Cuellar, uh, have been doing work which is looking at the Household Survey on Drug Use, which asks people among other things, you know, have you used pot ever? Have you used in the last year, have you used it in the last month? If so, how many days in the last month? The lifetime and past year numbers have not changed in twenty years.

The past month numbers have gone up some. The small fraction of users who say yeah, I used 21 or more days in the last month, the technical medical term is chronic zonker. Uh, that number is up a factor of seven since 1992. Now, 1992 was a trough, it's only up about 50 percent since 1979. Still, factor of seven's a big increase, and when you're dealing with juveniles, it's not a happy pattern. Whatever else you say, a 17 year old who's getting stoned most days is not doing the work of a 17 year old. I would really worry about that. So what I'd worry about is preventing heavy use among juveniles. The best way to do that is keep the price up.

Now at the moment, Washington and Colorado are doing fine. The restriction on production for commercial sale has created a shortage and therefore the prices are way high, so we don't have any of that problem yet, though in both states the medical prices are way low compared with the rest of the country, and you do see, in states with heavy medical marijuana penetration more use among the 12 to 17 crowd. So that's something to worry, now, that's Rosanna Smart has, has done those calculations. So if I were the federal government, I would say we will tolerate your state level whatever it is, as long as the price doesn't fall much below the current nation illicit price. And that they didn't say.

BRAD ROWE: So there's some big, there are still some big question marks out there, and you're, you're, you're, you're doing a lot of work through BOTEC Analysis and through your work at, at UCLA, and you talked about Jon Caulkins and about uh, Rosanna Smart and some other people doing some great thinking int his area. You were talking about access to minors as one of the big issues. What are some of the other things that these states that are maybe coming online, where should they have their antennae up for, and what should they be looking to try to figure out?

MARK KLEIMAN: Uh, well there's the big issue bout stoned driving, and, I think there's less to that issue than meets the eye. Uh, it looks like if you're just using cannabis, the additional risk of driving is not huge. It's not small, people should not get stoned and drive, but it's certainly less than the, than the uh, risk of using your cell phone while you're driving, even if you're using a cell, a hands-free cell phone. So I think we ought to regard that as a traffic problem and not as a drunk driving problem. That's, that view is not the currently dominant view, everybody wants a stoned driving law that looks just like a drunk driving law.

In general, there's a tendency to say well look, we already have a legal intoxicant, it's called alcohol, why don't we just apply those same policies to cannabis? And my answer to that is, because the policies toward alcohol are really bad, and that's just not a set of mistakes that we want to repeat. Alcohol kills a hundred thousand people a year, either they're own drinking or someone else's drinking. It's more drug abuse, more violence, more crime, more arrests, more incarceration, than all the illegal drugs combined.

Now, I don't think anything we can do to cannabis will lead to a problem that size just because cannabis is not as dangerous a drug on most dimensions as alcohol. But that policy of commercial availability with some taxes and not much regulation, it's a catastrophic failure. Let's not do it again.

BRAD ROWE: So maybe it's a fact that cannabis doesn't have as many heavy social impacts as alcohol, or other things like it. Uh, and, it was interesting for me to see this past week that US Senator Jeff Merkley in Oregon came out saying he was going to vote for the uh, the initiative in Oregon, and uh, do you think that that's a sign that some politicians are putting their toe in the water, maybe going to have a little courage about cannabis initiatives, or – not initiatives, about moving the issue forward through legislative means?

MARK KLEIMAN: Yeah, it's, it's interesting that you've now got cannabis legalization, just state it that baldly and do a poll on it, it now has majority support in most polls. And there really is no national politician who's taken the lead in saying, you know, I'm for cannabis legalization. So that's a sort of a strange political fact, probably not stable in the long run. As to voting for the Oregon initiative, I'd vote for the Oregon initiative, even though I don't much like it, on the grounds that the legislature can fix it. But, if I were a senator and I'm a big admirer of Senator Merkley, I'd be a little embarrassed to say that I'm going to vote as a US Senator to authorize people in my state to commit a federal felony. Right?

The right thing to do, the best thing to do, would be for the Congress to act and change the drug law to allow state experiments. Having state experiments happen when the stuff is still illegal at the federal level is really very much a second best, and having it done through the initiative process is a third best. It's way too complicated for initiatives. The problem is at the moment it's way too tough for politicians, and so the voters who want to change it can only change it through the initiative process.

Tom Lehrer once said that of folk music that the problem with folk music is that it's written by the people, who by and large have no musical talent whatever. They're not so great at legislation either, and you know, having your pollsters and your TV ad men debate about what the provisions of what your marijuana law is going to be is just way, way, short of optimal.

BRAD ROWE: Well let's, let's talk about Oregon for a minute then. They're thinking about coming on line, $35 of tax per ounce. Uh, what do you think about that price? You're talking about the people setting laws. I guess, what do you think about the price, and what do you think about taxing by weight versus how we do it with alcohol, by potency?

MIKE KLEIMAN: Right. So, second things first. Obviously, we should tax by potency, essentially measured by THC content, and not by weight. Uh, because otherwise you create an artificial tax incentive to make super pot. So one of the things that's happened over the last 30 years is that the THC content, and THC is the main intoxicant in cannabis, THC content of cannabis sold in the US is up a factor of three or four. Probably the stuff that people were using when I was in college was average 3 percent THC, uh, there's stuff at the California medical outlets that's 22 percent THC. Now that's not the average stuff.

Several things have happened. One is that, it used to be that what was called marijuana was mostly leaves. And now only the flowers are considered salable product. Uh, in addition people have started doing fancy agronomy, both in terms of how they grow it and how they breed it. And unfortunately, the breeding process that produces more THC, produces less cannabidiol. Cannabidiol is the, one of the other molecules that's in the cannabis plant, and it seems to have a buffering effect on THC. So it competes at the receptor site so you get a little less stoned just because the cannabidiol is occupying the same place. In addition, it seems to have an anti-anxiety, anti-psychotic effect, and so the really bad side effects that people do get with cannabis seem to be less common when there's more CBD in their product, or more common when there's less CBD in their product.

Unfortunately, at a biological level, the plant in manufacturing THC is using the same precursor chemicals that would otherwise manufacture CBD, so when you breed for high THC you're breeding for low cannabidiol. And so you get this skunk that's, I think actually, clearly more dangerous than the stuff that was being used thirty years ago. I mean the, you know, the slogan, this is not your grandfather's pot is used by the opponents of legalization, who I should point out were against legalizing it when it was your grandfather's pot, uh, but it really isn't the same, and I certainly don't want a set of tax laws that encourage people to make super weed. So yeah, we should tax by THC content.

But the other question is the level of the tax, and the problem with that is it's a dynamic problem. Let's think back to the goal. You want to take the cannabis business away from the criminals, which means you have to offer a legal product at a reasonably competitive price to the illicit product. It doesn't have to be lower, I think people would rather have the legal product, but it can't be grossly higher. On the other hand you don't want the price to go too low, because then you've got increased heavy use, increased heavy use by minors, and in any one state if the price goes too low have to worry about exports to other states.

So you're looking for a goldilocks price, that I claim is around the current illicit price. Well, that means your tax is going to have to change as the market price changes. The key fact about cannabis as a commodity is that it's dirt cheap to produce. Legally, right. They don't call it weed for nothing.

There are two products that Americans are used to that are a lot like a joint. There are the flowers and leaves of a plant, dried and wrapped in a little wrapping. All right? One's a tobacco cigarette. We know what the production cost of a tobacco cigarette is, roughly a penny. I mean, almost all the price is either profit or tax, but Jin Lings sell for a penny. Uh, and the other's a tea bag. Right? What's a tea bag cost, two, three cents. And that's what a joint's going to cost in the end, before tax. So eventually you're going to have to have a price that's almost all of the price. You know, something like ten dollars a gram.

BRAD ROWE: So, in the state of Oregon they've kind of left the door open for vertical integration, you can be a grower, a produ – you can package, you can market, you can sell all the way to market, all the way to retail. Do you worry that, uh, there could be monopoly and that could cause price issues that, uh, that would be out of the control of the state?

MIKE KLEIMAN: Remember, monopoly's a good thing in this case, if you want the price to be high. Uh, whether vertical integration's going to create more industrial power, what I'm mostly worried about is two things that the industry can do: Market and lobby. And it's not, it's not obvious whether an integrated or a dis-integrated industry is going to be more powerful in either of those things. It may well make a difference, I just don't know which difference it makes. So, Co – uh, Washington mandates separation of levels, you can be a grower or you can be a retailer, you can't be both. Colorado is indifferent, and, uh, or the Oregon proposition's indifferent. Not sure it's going to matter, but it might matter.

Again, these are probably carryovers from alcohol policy. People don't want brewers owning bars, and so there's a strong rule against that and Washington just copied that over. I'm mostly worried about price and marketing effort. I'd like to see a tax that moves against the market price, rather than with it, right? So, the, Washington and Oregon, or Washington and Colorado, sorry, tax a percentage of the market price, which means that the tax falls as the price falls. That's exactly the opposite of what you want, you want the tax to rise as the price falls.

The way I'd do it if I got to write the law, but I wouldn't put this on the ballot because you could never explain it in a thirty second spot, not have a tax at all. Decide how much cannabis you're going to sell, based on your last year's surveys, uh, license the production of that much THC, say we're going to allow so many, so many grams of THC to be produced in the state, and have an auction, and let the producers bid for the quota rights. That means the state captures all of the surplus.

But if you have a limited number of producers and you hand out licenses for free to whoever seems to be a deserving applicant, you're giving them a license to print money. Why should that windfall go to the industry rather than the taxpayer? So I think there's a clean way to do it, and it's much too complicated to put through as an initiative.

BRAD ROWE: Well, uh, with all the states except for Florida, they, the legislatures have the right to alter these, uh, laws afterward so maybe they'll take into account some of these ideas.

MIKE KLEIMAN: It's possible. Uh, in fact it gets back to our lobbying problem. Once you've got an industry established, the legislature's not very likely to do anything that's damaging to the financial interests of that industry. Now, we see that in the alcohol case, know what I mean. The most obvious drug policy move to make in the country, the one with the biggest benefits and the smallest costs and essentially no risks at all would be tripling the average alcohol tax. Current average tax on a drink is about a dime. The current damage done to non-drinkers by the average drink is a dollar and a half. Again, most drinks don't do any harm, but the drink the guy just, took just before he pulled out a gun and shot somebody was a pretty expensive drink.

If we tripled the tax from a dime to thirty cents, about a twenty cent increase, twenty percent increase in the price of a drink. Average drink is a beer, and a beer in a grocery store costs about a dollar. That twenty percent increase in price is a 6 percent decrease in fatal auto accidents and in homicides, and we can do that without crashing through anybody's door, without setting up any illegal enterprises, without anything, just a change in a number in the tax code. And we'd get huge benefits out of it.

DOUG MCVAY: Our thanks to BOTEC Analysis for that audio. You were just listening to Mark Kleiman from BOTEC Analysis. Mark is also a professor of public policy at the UCLA School of Public Affairs.

And well, that's it for this week. Thank you for listening. I'm Doug McVay and this was Century of Lies. You can find a recording of this show and past shows at the website drugtruth.net, where you can check out our other programs and subscribe to our podcasts. Follow me on Twitter, where I'm @DrugPolicyFacts and @DougMcVay. The Drug Truth Network is on Facebook, be sure to give its page a Like. Find Drug War Facts on facebook as well, please give it a like and share it with friends. Spread the word. Remember: Knowledge is power.

We'll be back next week with more news and commentary on the drug war and this Century Of Lies. For now, for the drug truth network, this is Doug McVay saying so long. So long!

* Mike Kleiman seems to be getting Oregon mixed up with Colorado in this first part of the segment. Oregon was considering a ballot measure to legalize for adult use in 2014, while Colorado passed its legalization measure in 2012 at the same time as Washington state. Colorado had a sizable medical cannabis program at the time, and still does. Oregon's medical marijuana initiative was approved in 1998 however its dispensary system was only established by the state legislature in 2013 and became operational in 2014.

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