CULTURAL BAGGAGE

JUNE 5, 2019

TRANSCRIPT

DEAN BECKER: I am Dean Becker, your host. Our goal for this program is to expose the fraud, misdirection, and the liars whose support for drug war empowers our terrorist enemies, enriches barbarous cartels, and gives reason for existence to tens of thousands of violent US gangs who profit by selling contaminated drugs to our children. This is Cultural Baggage.

Hi folks, I am Dean Becker, the Reverend Most High. You are listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network.

A little bit later we'll hear some thoughts of Doctor Carl Hart, perhaps a little editorial from yours truly, and some great news out of Illinois, but first up, we'll hear from Doctor Ethan Russo.

ETHAN RUSSO, MD: Currently, the director of research and development for the International Cannabis and Cannabinoids Institute. That's based in Prague, but I still live in Washington state.

DEAN BECKER: With that, we've begun the introduction of today's guest, Doctor Ethan Russo. He's an MD, he has a lot of credentials, a board certified neurologist, psychopharmocology researcher, and former senior medical adviser to GW Pharmaceuticals, which is perhaps the top dog of the medical marijuana industry.

With that, I want to welcome our guest, Doctor Ethan Russo. How are you, sir?

ETHAN RUSSO, MD: I'm fine, thank you.

DEAN BECKER: Doctor Russo, I wanted to put forward your credentials because you have worked with, and I hate to use the phrase, but the top dog of the industry, GW Pharmaceuticals. They've been headlong at this for over a decade now, have they not?

ETHAN RUSSO, MD: Well, yeah, actually, the company started in 1998, and I was a scientific adviser with them, starting that year, and came on full time in 2003 for the next eleven years.

DEAN BECKER: And they have put forward, I always try to pronounce this, Epidiolex?

ETHAN RUSSO, MD: Close. Epidiolex. So that was actually their second product. The first, called Sativex, was a spray in the mouth combining extracts of a high THC chemovar, chemical variety of cannabis, and a high CBD chemovar of cannabis.

Sativex is approved in thirty countries outside the US for treatment of spasticity in multiple sclerosis. Epidiolex is almost a pure cannabidiol product, and in 2018 it was approved by the Food and Drug Administration for treatment of two severe kinds of epilepsy, Lennox-Gastaut syndrom and Dravet syndrome.

DEAN BECKER: Well, you know, Doctor Russo, I think I knew that, that Sativex was the precursor, if you will, and had been available. I was lucky enough, and gosh, it's been fourteen, fifteen years ago, I interviewed Doctor Geoffrey Guy, who I think was then the chairman or head scientist or something at GW, and they put him on the airways back then, and we talked about Sativex, and how it's a two-pronged approach. Right?

ETHAN RUSSO, MD: Correct. Sure. So, again, GW was really instrumental in bringing cannabidiol back to the fore. Most people around the world had sort of forgotten about it since it was positively identified in 1963. It really lacked the excitement, if you will, of THC, which is obviously the main psychoactive ingredient in cannabis.

Along the way there were individuals, particular Raphael Mechoulam in Israel and the team headed by Elisaldo Carlini in Brazil that continued to look at cannabidiol for its anti-inflammatory and anti-convulsant properties. An anti-convulsant is a drug for seizures.

DEAN BECKER: Well, Doctor Russo, I, again, I wanted to bring you on today's show because there's an important issue that really needs addressed, it's kind of multi-faceted, and I'm going to try to jump into it here, but I was wanting to bring forward your credentials, your, you know, expertise, if you will, for the listeners out there, because there's a lot of discussion and a lot of, I don't know, opinions being put forward, but some of them I don't think are to be trusted.

Doctor Russo is author of Handbook of Psychotropic Herbs, he's co-editor of Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. He's a man with those credentials, and with that, I want to jump right into it.

There is, even in Texas now, an approval or a forthcoming approval for CBD medicines, the federal government has been talking of, you know, allowing for CBD medicine, or the use of CBD, I'm not sure, they talk about, you can't say it's good for medicine, that kind of thing, and I just wanted to ask you, Doctor Russo, there's so many types of CBD, they're selling it in head shops and at gas stations and all kinds of places. Are they to be trusted, I guess is the first question?

ETHAN RUSSO, MD: Well, I think that consumers are probably going to be pretty confused by this situation, and for good reason, because this is a highly unregulated industry at this point.

I think that it's clear we're going to always have three echelons of products. There are going to be the rare pharmaceuticals, prescription medicines, like Sativex and Epidiolex, that have gone through the FDA approval process.

Then we're going to have supplements that are made by reputable companies that have some level of quality control that they can identify and provide to consumers.

And then there's just going to be the other products, which could be herbal cannabis, or something that your neighbor makes. Right now, with all the online commerce and everything else, we've got a lot of products that don't necessarily have the quality control behind them.

They may or may not have the CBD concentration that they purport to have. Some of them are going to have THC in them, even though they claim that they may not. A lot of these products are going to be produced abroad and they're going to be made from hemp refuse. What I mean by that is, the stuff that's left over once they've used the other materials, say for building or whatever else, and they're left with this mass of stuff that either would have gone to landfill or gotten composted, but they'll chemically extract it to get the CBD as a value added product.

But in the course of that, in order to concentrate the material to get the CBD, they're also concentrating pesticides, heavy metals, or anything else that might be contaminating that material.

But, you know, I personally would like to see some regulation of the industry so that the consumer can, number one, know exactly what they're getting, in other words have access to a certification of analysis to accompany the product that also would include safety data, something that would indicate that this material is free of pesticides, heavy metals, or bacteria for that matter that would pose a public health risk.

DEAN BECKER: Okeh. I appreciate that thought. It brings to mind that, you know, you talk about this refuse, the leftovers, being used. It seems like the less effective way to do it, and I guess my first question, or next question, would be, is the best CBD extract to come from the flowers, the leaves, -

ETHAN RUSSO, MD: Absolutely.

DEAN BECKER: - the seeds, are the seeds of use? How do those come in -

ETHAN RUSSO, MD: Well, yeah, let's look at the plant. The highest concentration of cannabinoids, including cannabidiol, is absolutely going to come from the unfertilized female flowering tops. That's the quality area for this kind of material.

The amounts in the fan leaves below the flowers are going to have about one percent. The trichomes - the place where these are made have about one percent of the content as compared to the trichomes that come from the flowers.

So, immediately, you've got a lower quality product, and it's not the same kind of profile, either. If we're talking stems, you get this down to a minute amount, and the seeds, if they're washed, although they can produce a high quality protein and essential fatty acids that are good in the diet, they have no cannabinoids at all.

Similarly the roots are devoid of cannabinoids, but have other products that have medicinal value. So there are many parts of the plants, and they have uses of their own, but, best medicine is going to come from the flowering tops.

While we're at it, we have to make a distinction between what's called a cannabidiol or CBD isolate, that would be some kind of concentrated form of CBD that supposedly excludes the other material, versus what's called a whole-plant extract.

An extract, medically, is almost always going to be more effective in that it would contain other ingredients, at least trace amounts of other cannabinoids and also the terpinoids, the essential oil components that contribute to the medical effect of cannabis.

DEAN BECKER: That brings to mind, we have had over the years the Marinol, which was a synthetic THC, which I guess -

ETHAN RUSSO, MD: Right.

DEAN BECKER: - had no CBD contained therein, and it didn't work because, as you're talking about, it's compounding, the multiplicity of the molecules, enhances its effectiveness. Right?

ETHAN RUSSO, MD: Quite true. Yeah. THC as a synthetic isolated drug has had very little uptake in the medical field because it's been poorly tolerated, it tends to produce dysphoria, an unhappy mood rather than euphoria. It's poorly tolerated even by people who may have been accustomed to using cannabis in the past.

So it's had limited use in treating vomiting associated with chemotherapy and previously in patients with AIDS wasting syndrome, but it's had very small sales in the industry because of these problems. So it's very different to THC that would come from a whole plant extract, directly from cannabis, which is a much more versatile and better tolerated medicine.

DEAN BECKER: All right, my friends, once again we are speaking with Doctor Ethan Russo, a very learned man, very learned doctor, and we're seeking his opinions about marijuana products.

Doctor Russo, I'm not going to ask you for a legal opinion, there are different laws. Texas is saying they're going to legalize hemp, they're saying they're going to legalize CBD, and yet it is the dispensary, the Texas dispensary, only makes CBD oils, they can't even sell the flowers here, and I guess what I'm leading up to is that, we have to be demanding, I guess, there are these stores even here in Houston that are selling CBD, but there's nobody who's really knowing what is going on.

And I guess what I'm really going to point to is that they're selling a one eighth ounce of CBD flowers, hemp flowers, for fifty bucks, whereas if you go on the web you can buy a full ounce for thirty bucks. It's - there's a lot of shenanigans going on. Your thought there, Doctor Russo.

ETHAN RUSSO, MD: Well, I have to agree. Again, I will go out on a limb and say I think that we have to have a descheduling of cannabis so that research can proceed unencumbered, and that patients in need can have access.

By the same token, I'd like to see regulatory oversight on all these products so the consumer doesn't have to regard it as a crap shoot when they go to a make a purchase of a cannabis product.

So I'd like to see those two things happen. But it's a big ask, because there's a tremendous amount of ignorance out there, and a tremendous amount of prejudice attached to this medicinal plant.

DEAN BECKER: No, I agree with you. There's even a different extreme, if I can explain it properly, and that deals with folks, and again, I love marijuana, I smoke it every day, I think it's the best thing, you know, medicine there is, but there are those who, you know, go a little too far, I think, calling it a sacred plant, it's not a medicine, it's, leave us well enough alone, et cetera.

There's a middle ground there where rationality comes in. Your thought there, Doctor Russo.

ETHAN RUSSO, MD: Yeah, I agree. I think anytime you go to extremes, one way or another, it's not necessarily going to be the best policy.

But, prohibition has never worked, it certainly hasn't with respect to cannabis, and we need a situation where people can have access to the medicine they need and have confidence in its quality and safety.

DEAN BECKER: Okeh. One more point hinging on that thought about the sacred plant and everything. We have to also maybe back the truck up a bit. Take a look at this. I smoked Marlboro's for fifty years. I have COPD, I regret every damn cigarette I smoked.

But the point I'm looking at now is I see these kids with these rigs they've got, and the anvil and a blowtorch, and they're doing these dabs and they're taking these massive choking hits. Maybe that's good for youngsters, maybe that's good for a little while. Is it good for a lifetime? Your thought, Doctor Russo.

ETHAN RUSSO, MD: Well, I don't think it's good, even on a temporary basis. Quite frankly, a lot of this behavior is a byproduct of prohibition. What I mean is, in prohibition, yeah, there was some beer, but the prevalent item was bathtub gin. And that was a high potency material.

If you're going to have to lug around a product that you've got to hide from the police, it's better if it's high potency, and the same applies to cannabis.

So what we had the last several decades is selective breeding for high THC cannabis to the exclusion of cannabidiol or other components. So the popularity currently of these concentrates and dabs is just running that kind of trend to an extreme.

So you've got materials now, some of these concentrates can have seventy-five to ninety percent THC, to the exclusion of CBD. Generally they're devoid or have minimal terpinoid content.

What's going to happen with that is, you'll have all of the possible side effects attached to THC without benefit of the other components that will temper the experience and increase the safety factor.

So, when someone uses this kind of material, there is a risk that they're going to have a condition called orthostatic hypotension. This basically is a faint. The sudden release of high content of THC slows down the heart enough, what's called vasovagal reaction, that it causes the person to faint. They basically have inadequate blood flow to the brain and they pass out.

In the meantime, they may fall, hit their head, end up in the emergency room at the hospital, having incurred huge expense, and scared a bunch of people. The condition will pass, but it's totally unnecessary.

The other problem with these concentrates is they provoke the rapid development of tolerance. Tolerance means that, if somebody uses this kind of material regularly they're going to have to use more and more to attain their desired level of high.

In use of cannabis, whether it's recreational or for medical purposes, the smallest dose that does the job is the correct dose. And that is best achieved with a whole cannabis product, preferably in a small dose.

With that, particularly if CBD is aboard, there's little risk of developing tolerance and these other side effects. That would be the proper way to use cannabis.

DEAN BECKER: All right, thank you, Doctor Russo. I've got one more question for you, sir. I see the ads, people trying to sell the vape cartridges, the little, you know, for your pen vaporizer. And, I see the warnings, there's a lot of them that are found to contain high levels of lead and other toxins. We - you talked about it, prohibition is just not the way to control or prevent these problems.

ETHAN RUSSO, MD: That's true.

DEAN BECKER: Go ahead, sir.

ETHAN RUSSO, MD: Sure. So, yeah, it is true to say that these vape pens can't be beat in terms of convenience and how rapidly somebody can get high and how easy it is to hide.

So, it's very attractive, particularly to young people. But, it just is not necessarily the best way to use cannabis, and certainly isn't recommended for medical use.

Most medical conditions are going to be chronic, where cannabis is used, and under those conditions it's best to use an oral preparation that's going to have a longer onset of activity, and is less likely to produce an overt high. The idea is to treat the symptoms, not to alter one's consciousness in medical applications.

So, in order to have best practices, we have to buck this trend of higher potency THC to the exclusion of other things, and this particularly attractive and simple delivery device is a very insidious proposition. So, again, improvements are going to come through education, but also regulation.

So that is what I'd like to see happen.

DEAN BECKER: I'm with you, sir. You know, I talk about it's time for us to finally control our supposed controlled substances. Would you agree with that thought?

ETHAN RUSSO, MD: Right. Prohibition is the worst method of control.

DEAN BECKER: Well, it certainly is. Well friends, once again we've been speaking with Doctor Ethan Russo, a medical doctor, written several great books. Doctor Russo, some closing thoughts, a website you might want to share.

ETHAN RUSSO, MD: Well, further information would be available on the International Cannabis and Cannabinoids Institute website, which is ICCI.science.

DEAN BECKER: It's time to play Name That Drug By Its Side Effects! Rash, hives, difficulty breathing, tightness in the chest, yellow eyes, swelling of the tongue, hoarseness, dark urine, fainting,, fever, irregular heart beat, mental or mood changes, seizure, and death. Time's up! The answer, from the UCB Group: Xyzal, for asthma.

DAN LINN: My name is Dan Linn, and I'm the executive director of the Illinois chapter of NORML, which is the National Organization to [sic: for the] Reform [of] Marijuana Laws.

DEAN BECKER: Well, the news is that Illinois is to become the eleventh state to legalize marijuana. Tell us what that means for your state.

DAN LINN: Well, we will be taking this market that already exists in the illegal sector and bringing it above the table to the legal sector. We will be able to create jobs with this, increase tax revenues, as well as expunge a lot of criminal records for folks who were caught with low level amounts of cannabis.

We're talking about 800,000 people with those arrests records in Illinois that will be getting wiped clean.

DEAN BECKER: Now, when will this take effect? And who will be able to buy?

DAN LINN: Adults over 21 will be able to purchase up to about an ounce of cannabis on January First, 2020.

DEAN BECKER: Will folks be able to grow their own at home or not?

DAN LINN: Only patients that are registered in the medical cannabis program will be able to grow up to five plants, but out of state residents would be able to purchase about half of the amount that an instate resident would be able to buy, so you're looking at about a half ounce with a little bit smaller amounts of edibles and concentrates that out of state residents could buy in Illinois.

DEAN BECKER: Now, I'm aware that in several of the states that have legalized there's big discussion, brouhaha if you will, to make allowances for legal places where people could smoke, in essence like a bar, so to speak. How is that going to align in Illinois?

DAN LINN: Yeah, the state didn't carve out a specific license for those types of social consumption facilities, but they do allow local municipalities and regulating bodies to create, well, it would be kind of like a hookah lounge or a cigar shop or a private club where you're, at least in theory right now, people could publicly consume cannabis at those facilities.

DEAN BECKER: Now, this will allow for growth of marijuana flowers then to be sold, but will it also allow for extracts and any of these other derivatives?

DAN LINN: Absolutely, and it does have a specific license for the processing or production of those products.

DEAN BECKER: Okeh. Now, I know the law enforcement community is striving desperately to find a means to determine those who are incapacitated while out driving on the roads. What is that situation in Illinois?

DAN LINN: There's some language in the law about a validated sobriety test. Right now, what we're advocating for is a standardized field sobriety test, similar to the one that most people are familiar with, with walking the line, standing on one foot for thirty seconds, saying the ABCs backwards. We feel that that, coupled with a dashcam video, will be able to keep our roads safe and still allow prosecutors to prosecute somebody who's impaired behind the wheel.

DEAN BECKER: Let's talk about what it took to get to this point for Illinois. You know, I share my show with stations around the country, heck, up into Canada, and I'm in Texas, but we're - we're F'd. We can't do a thing here until these politicians get off their butts.

But what did it take to get this done in Illinois?

DAN LINN: We were in a similar situation. We couldn't put it to the ballot and the voters, we had to go through the legislature. This was the product of close to twenty years of lobbying at the capitol, holding educational and informational meetings, seminars throughout the state.

But really it was about having lobby days at the capitol, getting voters and constituents to meet with their elected officials, talking to them about the need for change. We were able to get a medical cannabis law passed, after that we were able to get a decriminalization law passed so that people would no longer be arrested for these low level possession amounts but just be issued a ticket.

And then ultimately we were able to make it where people were able to purchase this at a legal storefront, and consume it in certain places.

DEAN BECKER: All right. Well, Dan, I want to thank you. Once again folks, we've been speaking with Mister Dan Linn, he's the executive director of Illinois NORML, that's NORML, out there on the web. Thank you, Dan.

DAN LINN: No problems, it's a pleasure talking with you.

DEAN BECKER: Major media does not treat the drug war fairly. Doctor Carl Hart doesn't like that attitude, and the way it tries to dismiss the credentials or credibility of drug reform. The following is part of a recent interview he did with Global Health.

INTERVIEWER: He has a different and what some would say radical and controversial approach to drug policy. He is joining us now to explain what that is. Carl, thank you so much for joining us.

CARL HART, PHD: Thank you for having me.

INTERVIEWER: Yeah. We've been chatting during commercial break about some of your views, but to include everyone else in on the conversation, what are some of the myths, the commonly held myths that people have about drugs and drug addiction?

CARL HART, PHD: Before dealing with the myths, I'd just like to say something about the introduction. So, like, when people introduce me as radical or controversial, that kind of sets the frame for the audience to see me in a certain light, and we must understand that I'm the chair of my department at Columbia University. I'm a scientist who's published hundreds of papers in the scientific literature.

So, that's not radical. My perspective is evidence driven.

INTERVIEWER: Okeh.

CARL HART, PHD: And so, because the perspective is not held by most people doesn't mean that it's radical. It means that those people are ignorant.

INTERVIEWER: Okeh. Fair enough.

DEAN BECKER: Just a few seconds left for this Drug Truth Network editorial.

These politicians, nearly all of them, know the truth about the drug war. They made their bones through this policy. It's hard for them to back down now. But I know if you, their constituents, go before them with the evidence, the truth, the scientific papers, and the ability to show they are immoral, they are off base, they are allies of terrorists, cartels, and gangs, and they are ensuring more overdose deaths of our children, eventually they will come around.

I remind you, once again, because of prohibition you don't know what's in that bag. Please, be careful.

To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network. Archives are permanently stored at the James A. Baker III Institute for Public Policy. And we are all still tap dancing on the edge of an abyss.

CULTURAL BAGGAGE

MAY 29, 2019

TRANSCRIPT

DEAN BECKER: I am Dean Becker, your host. Our goal for this program is to expose the fraud, misdirection, and the liars whose support for drug war empowers our terrorist enemies, enriches barbarous cartels, and gives reason for existence to tens of thousands of violent US gangs who profit by selling contaminated drugs to our children. This is Cultural Baggage.

Hello, my friends, I am Dean Becker, the Reverend Most High. This is Cultural Baggage, and I think it's very important to recap what I learned last year in Switzerland, where they have had twenty-seven million injections of pure heroin with zero overdose deaths.

CHRISTOPH BUERKI, MD: Christoph Buerki, I'm a psychiatrist in Bern, and I've been with heroin prescription from the very beginning, which is, if I recall it right, 1993, we started with that. And, I think you should, if we talk about prescribing heroin in Switzerland, we should also mention the time before, before that.

DEAN BECKER: Oh yes.

CHRISTOPH BUERKI, MD: Because, there was a very, very big open drug scene here. We'll walk past the park where the drug scene was. We really had an epidemic of heroin overdose, for a small country, six million people, it was extraordinary, some -- up to five hundred persons a year died of heroin overdose.

Now, I know in the US you have a bigger epidemic right now, but, sizewise, it was still very significant.

DEAN BECKER: And, approximate population of Switzerland at that time?

CHRISTOPH BUERKI, MD: Six million.

DEAN BECKER: Six million. Yeah that's --

CHRISTOPH BUERKI, MD: Six and a half million, it was, yeah. Yeah. And so, we just needed to have new ways, and that was one of the new ways. There was different, new ways and initiatives. One was a safe consumption room, that exists also until today in Bern, as well as in many other cities, where people can go consume their own drugs.

DEAN BECKER: Right. With supervision.

CHRISTOPH BUERKI, MD: That they bring with. Under supervision, yeah.

DEAN BECKER: I've been to Insite in Vancouver, which is probably similar.

CHRISTOPH BUERKI, MD: Yeah. Yeah, very much. I visited, like, a week after it was opened, and it's very similar to our injection room.

So, that was really a major initiative from big cities in the mid-'90s to find ways to close down those huge open drug scenes.

DEAN BECKER: Sure. Sure.

CHRISTOPH BUERKI, MD: And, an important element was this -- was the heroin prescription. Of course, we couldn't just do it like that, we needed a legal basis for it, and we did this within a research frame.

So this was a huge, multi-center study, as we call it. It's called PROVE, P-R-O-V-E, where, sort of, we did it under that research -- research umbrella. So, it was --

DEAN BECKER: How large of an undertaking, a project, was that, the PROVE?

CHRISTOPH BUERKI, MD: In the beginning, it was like some 800 patients, and some -- some 16 or 18 centers, all around Switzerland.

DEAN BECKER: Good.

CHRISTOPH BUERKI, MD: And, the reason it was important to -- it wasn't a gold standard research in the sense, as you would do it in medical science, for to prove something, like, in the sense of a gold standard where you have two groups --

DEAN BECKER: Oh yes.

CHRISTOPH BUERKI, MD: -- that you directly compare with each other.

DEAN BECKER: One placebo group, maybe.

CHRISTOPH BUERKI, MD: Even placebo, which is difficult to prescribe a placebo, if you're heroin dependent you'd immediately realize that it's placebo.

DEAN BECKER: Where's my heroin?

CHRISTOPH BUERKI, MD: Right. So, that sort of methodological -- it's not a flaw, but it's, it can be proved methodologically.

DEAN BECKER: Well, sure. It was the best --

CHRISTOPH BUERKI, MD: At the time --

DEAN BECKER: -- possible, right?

CHRISTOPH BUERKI, MD: At the time, it was what we could do. What we did basically was, we started taking people in. We couldn't take in everyone.

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: We could only take in people who had a certain history of addiction, who had certain -- more than one, several -- several attempts of quitting, with the heroin addiction. Mostly methadone, but also inpatient detox. They'd have to prove, or we would have to prove together with them, that they really tried to stop in other ways.

They needed to have certain social or psychological, somatic complications of their addiction.

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: So, in the end, we -- we could only take them off and -- take them in and get permission if we could prove all those things.

DEAN BECKER: Yes, sir.

CHRISTOPH BUERKI, MD: And, then we -- we started, and you will find -- you will find how it works in detail.

DEAN BECKER: Well, Christoph, what you're saying about, you know, these, the patients, more or less having to prove the need, or the mental framework, that would allow them to go ahead and use the heroin.

Doctor Goulão there in Portugal was talking about, they have the dissuasion committees that try to convince people to quit using drugs, but some people say, no, I'm a heroin user, I will keep using it, and therefore they're allowed to continue, you know, without interference.

CHRISTOPH BUERKI, MD: It's nicely put, the dissuasion committee. Actually this is just part, of course, of everyday -- of our everyday work, it was at the time. And that's, I think, is the most important aspect of heroin prescription.

You treat the patients, of course you give them out heroin, and that's why they come to you. But, it provides a whole opportunity to treat, to talk, to provide social -- social support, housing, finance, and so on, to provide medical support, to provide psychiatric support.

Many of those people have a dual diagnosis, in the psychiatric sense. They have maybe psychosis or depression, or anxiety disorders.

DEAN BECKER: May I ask you a question?

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: I would surmise, I have no proof of this, but I would surmise that many of these people who use drugs, and wind up on heroin, have suffered a penalty, or ostracized by either law enforcement or family, or whomever, for their drug use, which may lead them even further in that direction. Is there -- ?

CHRISTOPH BUERKI, MD: Of course. Many, many of the people who entered the program had a previous history of -- of court problems, of prison stays, of delinquency of some sort, of course.

DEAN BECKER: Yes sir.

CHRISTOPH BUERKI, MD: And that was also one of the findings, one of the most important findings, also, besides, that people simply survive their addiction, another important finding was that rates of criminalization, of delinquent behavior, decreased massively once patients have entered the program.

DEAN BECKER: Now, is that -- I would guestimate a couple of reasons why, one is, they're no longer having to devote time looking for heroin, and perhaps no longer having to scrape up money with which to buy it.

CHRISTOPH BUERKI, MD: Of course. Of course, yeah. That's a very important thing, to have a structure during the day.

They get up and they go to bed, at some time, two times when they need to appear in the distribution center, in the clinic, and they get their heroin, and they don't need to run around, they don't need to prostitute themselves, or rob old ladies of their handbags, or do worse things, or, by the way, deal with drugs. They don't need to do that, as well.

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: So, that's a massive, massive improvement over the life of an addict before he or she enters a program.

DEAN BECKER: Hi, this is Dean Becker, I wanted to remind you, you're listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network. This interview was recorded in Bern, Switzerland, in the office of Doctor Christoph Buerki. He's the designer of the long-term, very successful, Swiss heroin injection program.

We talked briefly out there on the street about the US having a major problem.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: Sixty thousand dead last year, they say, and I close my radio program with this thought, okeh? Because of prohibition, you don't know what's in that bag, please be careful.

And it's -- I think that's, at its worst in the United States, best I understand it, with the fentanyl, carfentanyl, the mixture, that's being sold, and people just don't know what they're taking. I wonder how often it even contains heroin. Your response, please.

CHRISTOPH BUERKI, MD: Of course, that's one of the major issues, if you're a drug addict on the street, you just have to consume or take whatever your dealer sells you as being heroin, and that can be, especially -- we also do street surveys of street drugs, up to today in the canton of Bern, regular samples are taken in the low-threshold street agency, and it's really a problem, because it contains between two or three percent of heroin, up to forty or sixty percent of heroin.

DEAN BECKER: Oh, my.

CHRISTOPH BUERKI, MD: That's a very, very dangerous situation. Many people might -- can overdose in those situations. If you're used to heroin of five percent and then you suddenly get heroin, street heroin, of sixty percent, it can be a death penalty.

DEAN BECKER: There you go.

CHRISTOPH BUERKI, MD: It could be really, really dangerous. So, of course, that's one of the things that, even up to today, where we've done it twenty-five years now, almost. I'm not aware of a single patient who has died of an overdose in a heroin injection -- of a heroin injection in a heroin prescription clinic. Not a single overdose death.

DEAN BECKER: That's wonderful. The best outcome you could hope for, right?

CHRISTOPH BUERKI, MD: I think it's, for the individual patient, it's the best outcome one can hope for. Yeah, it is. And, also many people, they -- I mean, one big criticism of heroin prescription is that you keep patients forever, sort of, for the rest of their life.

Which, for some patients, it's true, one has to say, it's true, they are so heavily addicted, and they can't, despite all the motivational efforts by staff and psychotherapists, doctors, social workers, they cannot be motivated, they cannot be pushed into trying to quit or doing something different, which is one of the issues, of course.

But then again, those people, would they find a way out if they lived just on the street, on street heroin? Probably not. Most of them would be dead by now.

DEAN BECKER: Yeah. Well, right, because of the impurities, the -- and again --

CHRISTOPH BUERKI, MD: Yeah. Lifestyle.

DEAN BECKER: -- and not knowing what is in that bag.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: Like I say. There was a gentleman, one of the founding members of Johns Hopkins University, very prestigious outfit over there in the US.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: He was known as a lifelong morphine addict. He was, and I'm trying to remember his name [sic: Dr. William Stewart Halsted], but he was declared to be the father of modern surgery, he was that good.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: And, I often like to ask folks, if he were your surgeon, would you want him to have his fix before or after he cut you open? And my thought is, I think he should have it before he cuts me open, but, he had a very productive life just the same, and do you find some of your patients nonetheless have very productive lives despite -- ?

CHRISTOPH BUERKI, MD: Of course. That's, I mean, that's the ultimate goal of the program, to have, yeah, a fulfilling or productive life, somehow. That meant -- might mean totally different things for different people.

It might mean that you have a job, that you have a family, for others it might mean that you don't die of suicide or you don't die of a major mental illness. So that's a -- that's an individual thing, what is a fulfilling life.

But that's the ultimate goal, of course, in all the treatments that we do as doctors, as institutions.

DEAN BECKER: Right. Well, and, that's very admirable, I, that's why I'm here, you know, to learn about it.

We'll be back shortly after this quick break.

It's time to play Name That Drug By Its Side Effects! Blistering or peeling skin, swelling of eyelids, throat, and lips, blurred vision and yellowing of eyes, black tarry stools, vomit that looks like coffee grounds. Time's up! The answer: Celebrex.

Again, we're speaking with Doctor Christoph Buerki, the inventor of the Swiss heroin injection program.

My hope, my goal, and again, I'm a former cop, I want to legalize all drugs.

CHRISTOPH BUERKI, MD: Yeah. Yeah.

DEAN BECKER: I want them to be made by Merck and Pfizer.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: Not some Mexican farmer who's mixing cartel --

CHRISTOPH BUERKI, MD: Yeah. Yeah. Yeah.

DEAN BECKER: -- fentanyl all together.

CHRISTOPH BUERKI, MD: Yeah. And, may I say something?

DEAN BECKER: Please.

CHRISTOPH BUERKI, MD: Because I have been to the US as well, like, last year, and I, with a big smile, I drove through Colorado and listened to the radio ads of marijuana.

DEAN BECKER: How good this one is, that [unintelligible] the other, yes.

CHRISTOPH BUERKI, MD: I think it's great, that tendency, that marijuana is taken out of, I mean, to punish somebody because he consumes marijuana, it's frankly quite a stupid thing to do.

And, however, I think it's a bit problematic, as a psychiatrist, I'm of course aware that marijuana is not without risks.

DEAN BECKER: No, no.

CHRISTOPH BUERKI, MD: And, if we talk about legalization, I would very strongly think we should prohibit commercial advertising --

DEAN BECKER: Well --

CHRISTOPH BUERKI, MD: -- for those [unintelligible]

DEAN BECKER: I'm with you. I'm with you.

CHRISTOPH BUERKI, MD: Basically, same with cigarettes and alcohol, it shouldn't be advertised, on TV and cinemas, on billboards somewhere. It shouldn't --

DEAN BECKER: That's just glamorizing it.

CHRISTOPH BUERKI, MD: Yeah. And the same thing, we shouldn't do with drugs, be it marijuana, be it whatever psychoactive substance.

DEAN BECKER: The --

CHRISTOPH BUERKI, MD: Bit of a criticism to the legalization movement in the US. It goes like from one extreme, the total demonization of relatively, a relatively harmless substance called marijuana, to a consumer product that even needs advertising and --

DEAN BECKER: It doesn't need much advertising at all.

CHRISTOPH BUERKI, MD: It's a bit extreme, those pendulum swings.

DEAN BECKER: I like to look back, the United States had a 1906 Pure Food and Drug Act --

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: -- which said -- up til then, it had been snake oil salesmen, and, you know, buy this, it will --

CHRISTOPH BUERKI, MD: Yeah, yeah.

DEAN BECKER: -- give you a [unintelligible], or whatever, but, the truth was, the 1906 Act required that the manufacturer label very specifically what was in the product.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: And I think that's -- we could stop right there, because, like I told Doctor Goulão, that, you know, if somebody, if there's kerosene and foot fungus in the cocaine, which there is, coming out of Colombia, because of the manufacturing process, maybe small amounts, but if somebody likes kerosene and foot fungus and they're willing to buy it, seeing it there on the label, then we ought to let them buy it.

And, I guess the point I'm getting at is, you know, people are going to do brave things. I think that's a lot of what drug use is, is bravado, thinking I can face down this lion. I can do it on a daily basis.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: I don't know. I'm drifting off here, but I think the point I'm getting at is that there are a lot of factors that lead people to take drugs. I'm not saying that kerosene and foot fungus is one, but I'm just saying, through labeling the product, people would know exactly what they're buying, and they would be liable for that.

Then, we could judge people by their actions, like we used to, rather than the baggy in their pocket. Your response to that, please.

CHRISTOPH BUERKI, MD: Well, it's a philosophical question, because we're in both our societies very far away from such things, and our compromise in Switzerland, and I think it's not a bad compromise, is --

DEAN BECKER: Oh, no, I admire it.

CHRISTOPH BUERKI, MD: -- is starting prescribing it through doctors, the heroin. Yeah, I mean, heroin is strong stuff, one must admit, and it is, you can get over it, of course, but it doesn't go easily. It does have side effects, it also restricts your life at the moment, the way you -- the way it's prescribed in the clinic. There's no take home doses of heroin. It's no fun to be a patient in a heroin prescription clinic.

But it's a compromise, it's medicalized through that, it's made sure that what patients get and take is clean and pure. And maybe also one aspect, I think it's important to realize, it's also, the heroin prescription, giving out the heroin every day, is only a means to get into touch with people.

DEAN BECKER: Sure.

CHRISTOPH BUERKI, MD: And to really get them into treatment. I think that's the biggest value of this type of program, that you can get in touch with people. You see them every day twice, you can intervene, when they have a pneumonia, when they -- many of them are HIV positive. I mean, we started at a time when we didn't have anti-retroviral substances yet.

DEAN BECKER: And, the -- it was taking off, the --

CHRISTOPH BUERKI, MD: And it was exploding. The numbers were exploding. And, or they have hepatitis C, or all those things. And you can, you see them, you can intervene, you can -- when, when somebody gets psychotic because of their underlying psychoses, you can medicalize them with an anti-psychotic medication.

You can give them out anti-depressants if they're depressed, and so on, you can do psychotherapy for certain situations, in order for them to find -- find a way to be with their problems in life.

So, there's a lot of things you can do in that accompanying --

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: -- treatment, and they're only possible because your patients come to you.

DEAN BECKER: Once again, a reminder, you're listening to Cultural Baggage on Pacifica Radio. This interview was recorded in the office of Doctor Christoph Buerki in Bern, Switzerland. Got a lot smarter.

Now, in the US, we've, there's talk of legalizing marijuana at the federal level.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: But then there's this roadblock that's always put up, that, oh, we can't do that, we're party to the UN treaties and it wouldn't allow for, and it brings me to my next question to you. How did you get through, or work around, that situation?

CHRISTOPH BUERKI, MD: You're asking me something that you should ask somebody from the federal government. I'm sorry, I'm not quite aware -- if I remember it right, the -- what's clear is that members of the United Nations Narcotics Control Bureau [sic: Board], they have been here several times, have visited, and overall, were absolutely impressed, and -- impressed by the quality of the treatment, by the seriousity -- how it was done.

They didn't have to complain about anything with the -- in that regard. So, it is possible, within UN framework, to do something like that, there's no doubt.

DEAN BECKER: Hard to chastise you for success and keeping people alive, right?

CHRISTOPH BUERKI, MD: It is, it is.

DEAN BECKER: All right. Well, I was just going to say, Doctor Buerki, if you would, tell me what I'm leaving out. What should be let my listeners know about the success of your project?

CHRISTOPH BUERKI, MD: Basically, walk around Bern. Have a look around. You can -- there's no corner in Bern that you cannot walk around.

DEAN BECKER: The criminality is down.

CHRISTOPH BUERKI, MD: Criminality is so much down. Drug related crime, delinquency, petty crimes, stealing, all those things, so much better nowadays than it was 25 years ago. That alone is a huge success for it.

And, on the individual level, you have many, many lives who are saved. You have --

DEAN BECKER: Prolonged.

CHRISTOPH BUERKI, MD: Many people who are still dependent on drugs, somehow, some of them, for some of them it's a phase in their life, for some of them it's a phase that never ends, or for some of them, still it is a phase that ends their life. But, overall, many, many people have survived or even survived in good health, basically, unfortunate addiction.

DEAN BECKER: Right. Well, you know, I -- I grew up in the '60s. I tried heroin, I never did like downers, it just didn't appeal to me. Got into speed for a while, and, you know, and noticed that I was going to have a son, kind of caused that to end, you know, that affection for the speed.

CHRISTOPH BUERKI, MD: Yeah. Yeah.

DEAN BECKER: And, I think, in many cases, that tends to be the case, that a job or a wife or a kid, or some other happening to your life, tends to help many people, you know, walk away from the dangerous part of their habit, at least.

CHRISTOPH BUERKI, MD: Yeah, yeah.

DEAN BECKER: Has that proven to be true for many of these addicts, or is -- or were you dealing more with the more serious, committed addicts, I guess is what I'm --

CHRISTOPH BUERKI, MD: Basically, from epidemiological research we know that this is very true, that a lot of people use drugs, maybe even have an addiction over a certain time in their late teens, in their twenties, and once in their thirties they start thinking about families, about career, and so on, and they stop.

DEAN BECKER: Yeah.

CHRISTOPH BUERKI, MD: It's the same with cigarettes, it's the same with excessive alcohol drinking. It's the same with drugs, generally. And, however in the heroin prescription program, as I lined out before --

DEAN BECKER: These were serious people.

CHRISTOPH BUERKI, MD: -- we have that, we have serious people, with serious addictions, with a lot of co-morbidities, of a psychological nature. So, they tend not to be that easy --

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: -- a population that can sort of, at the blink of an eye, quit their habit and go on with their lives.

DEAN BECKER: Time's up, I'm done.

CHRISTOPH BUERKI, MD: Yes. This is more something I do nowadays, I have a lot of, still a lot of patients in, with some sort of drug problem. For example, nowadays, young people, they tend to take more MDMA.

DEAN BECKER: Doctor Buerki, I want to thank you for your candid -- for being so candid with us, and for sharing your thoughts. The last question I want to present here is that, our president is talking about people who sell drugs, they need to be killed.

That's what he's been saying, consistently, for the last few weeks, that their lives are just not worth prolonging another moment. We're not talking -- you were not talking about selling drugs, but it just seems such a, I don't know how to phrase this without trying to drag you into something political.

CHRISTOPH BUERKI, MD: Don't worry about it. I have my opinions. It's a war on drug -- it's a typical statement of a war on drugs person. I mean, we as a society, we have tried war on drugs for countless years. I think the war on drugs was formally declared by Richard Nixon, if I recall it right.

It has not proven to work. It has not proven to work. Let's look at the situation in the US. It's worse than ever, despite all the law enforcement efforts going into, into combating drugs, into having that war on drugs, so, all we can say is, more of the same, or even inhumane approaches to that war on drugs.

DEAN BECKER: He says we have to get tough, as if we haven't been.

CHRISTOPH BUERKI, MD: I can't understand it. It's just not understandable, how somebody can say something like that, and how, I mean, there is -- he's also supported by many religious people, in your country, I know. How can somebody support a person who says such crazy things? With such disrespect for life? It's incredible.

DEAN BECKER: Again, that was Doctor Christoph Buerki, the inventor of the Swiss heroin injection program. Just enough time to remind you that because of prohibition you don't know what's in that bag. Please, be careful.

To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network. Archives are permanently stored at the James A. Baker III Institute for Public Policy. And we are all still tap dancing on the edge of an abyss.

TRANSCRIPT

CENTURY OF LIES

JUNE 24, 2018

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Welcome to Century Of Lies. I'm your host Doug McVay.

Well, on today's show, we're going to hear from Doctor Dustin Sulak about medical cannabis, we're also going to hear from Doctor Staci Gruber about medical cannabis. But first, Philip Alston is the Special Rapporteur on Extreme Poverty for the United Nations Human Rights Council. On Friday June 22, he reported on conditions in the United States. Let's hear what he had to say.

PHILIP ALSTON: In relation to the USA, I note with regret that United States Ambassador Nikki Haley has characterized this Council as a cesspool and has chosen to withdraw from it just days before my presentation.

Speaking of cesspools, my report draws attention to those that I witnessed in Alabama as raw sewage poured into the gardens of people who could never afford to pay $30,000 for their own septic systems in an area remarkably close to the State capital. I concluded that cesspools need to be cleaned up and governments need to act. Walking away from them in despair, as in Alabama, only compounds the problems.

Ambassador Haley complained that the Council has done nothing about countries like Venezuela. In fact I and several other special rapporteurs reported earlier this year that, and I quote, "vast numbers of Venezuelans are starving, deprived of essential medicines, and trying to survive in a situation that is spiraling downward with no end in sight.". We warned of an unfolding tragedy of immense proportions.

Mr President, I turn now to my report on the United States. My starting point is the combination of extreme inequality and extreme poverty, which generally create ideal conditions for small elites to trample on the human rights of minorities.

The United States has the highest income inequality in the Western world, and this can only be made worse by the massive new tax cuts overwhelmingly benefiting the wealthy.

At the other end of the spectrum, 40 million Americans live in poverty and 18.5 million of those live in extreme poverty.

In response, the Trump administration has pursued a welfare policy that consists primarily of, one, steadily diminishing the number of Americans with health insurance. Two, stigmatizing those receiving government benefits by arguing that most of them could and should work, despite evidence to the contrary. And three, adding ever more restrictive conditions to social safety net protections such as food stamps, Medicaid, housing subsidies, and cash transfers.

For example, a farm bill approved yesterday by Republicans in the House of Representatives would impose a stricter work requirement on up to 7 million food stamp recipients. Presumably this would also affect the tens of thousands of serving military personnel whose families need to depend on food stamps, and the 1.5 million low-income veterans who receive them.

The US health care system already spends eight times as much to achieve the same life expectancy as in Chile and Costa Rica, and African-American maternal mortality rates are almost double those in Thailand.

Babies born in China today will live longer healthy lives than babies born in America.

In an exclusive Fox News story yesterday Ambassador Haley called my report misleading and politically motivated. She didn’t spell out what was misleading but other stories from the same media outlet emphasized two issues.

The first is that my report uses official data from 2016, before President Trump came to office. That's true, for the simple reason that there will be no Census Bureau data on the Trump era until September. But these data do provide the best available official baseline, and my report then factors in the effects of combining massive tax cuts for the wealthy and systematic slashing of benefits for the less well-off.

The second criticism, as noted by Sean Hannity, is that the US economy continues to roar to life under President Trump. Indeed, the US economy is currently booming, but the question is who is benefiting.

Last week’s official statistics show that hourly wages for workers in production and nonsupervisory positions, who make up 80 percent of the private workforce, actually fell in 2017.

Expanding employment has created many jobs with no security, no health care, and often with below-subsistence wages. The benefits of economic growth are going overwhelmingly to the wealthy.

The American dream of mobility is turning into the American illusion, in which the rich get ever richer, and the middle classes don’t move.

My report demonstrates that growing inequality, and widespread poverty which afflicts almost one child out of every five, has deeply negative implications for the enjoyment of civil and political rights by many millions of Americans.

I document the ways in which democracy is being undermined, the poor and homeless are being criminalized for being poor, and the criminal justice system is being privatized in ways that work well for the rich but that seriously disadvantage the poor.

Underlying all of these developments is persistent and chronic racial bias. That bias also helps to explain the abysmal situation in which the people of Puerto Rico find themselves. It's the poorest non-state in the Union, without a vote in Congress, at the mercy of an unelected and omnipotent oversight board, and suffering from record poverty levels in the aftermath of Hurricane Maria.

In her statement on my report, Ambassador Haley says that it is patently ridiculous for the United Nations to examine poverty in America, and claims that I should instead be looking at the human rights situations in two war-torn African countries, Burundi and the DRC [Democratic Republic of Congo].

Leaving aside the fact that this Council has published many report detailing the situations in those two countries, my view is that when one of the world’s wealthiest countries does very little about the fact that 40 million of its citizens live in poverty, it's entirely appropriate for the reasons to be scrutinized.

If this Council stands for anything, it's the principle of accountability, which is the preparedness of States to respond in constructive and meaningful ways to allegations that they have not honored their human rights commitment.

The US position, expressed by Ambassador Haley, seems to be that this Council should do far more to hold certain states to account, but that it should exempt the United States and its key allies from such accountability.

DOUG MCVAY: That was Philip Alston, Special Rapporteur on Extreme Poverty, reporting to the United Nations Human Rights Council on conditions in the United States. I weep for my country.

Now, let's get on with the rest of the show. First, let's hear from Doctor Staci Gruber from Harvard University.

STACI GRUBER, MD: I am Doctor Staci Gruber, I am the director of the Marijuana Investigations for Neuroscientific Discovery program at MacLean Hospital, Harvard Medical School.

DOUG MCVAY: Tell me about the MIND Project, very quickly.

STACI GRUBER, MD: The MIND Program was started just under four years ago, specifically to look at the impact of medical marijuana treatment on measures of brain structure, function, cognitive performance, clinical state, quality of life, and conventional medication use.

So that's what we're doing, we look at patients before they begin using cannabis, and we test the hell out of them, and we follow them over time. We see them again at three months, six months, one year, and now eighteen months and twenty-four months, and so far we're seeing extraordinary, extraordinary results.

DOUG MCVAY: You just spoke here at the Patients Out of Time conference, what do you hope are the takeaways that people take away. I hate that.

STACI GRUBER, MD: What do -- what's the take away that people can take away? I think the biggest take away message is that sort of in the words of the immortal Karen Carpenter, we've only just begun. Right? There's an awful lot that we have to do, but so far, what we know is pretty exciting.

It's pretty extraordinary, and we have some really unbelievable evidence, I would say, that, from a neurobiologic perspective, cannabis does change the way that you process information, and may even be changing brain function and structure. I think that's a big take away. We don't see decrements in medical cannabis patients after using. We see improvements in a number of areas, typically -- typically, that show decrements in recreational consumers. That's important.

DOUG MCVAY: Where can people learn about -- learn more about your work, obviously you're publishing, but is there a website for the project, how's that go.

STACI GRUBER, MD: Sure. DoctorStaciGruber.com, like www.doctorstacigruber.com, has a pretty comprehensive look at all of our work, not just in cannabis, but primarily these days that's what we do.

The MIND Program has its own page there, and you can see the latest publications which report a 47 percent reduction in opioid use in the medical cannabis patients after only three months of treatment. So, pretty exciting.

DOUG MCVAY: Terrific. Doctor Gruber, thank you so much.

STACI GRUBER, MD: Of course, my pleasure.

DOUG MCVAY: That was Doctor Staci Gruber from Harvard University. I caught up with her at the Patients Out of Time Twelfth National Clinical Conference on Cannabis Therapeutics, which was held in Jersey City in mid-May. Full disclosure: I work with Patients Out of Time doing website and social media management.

You're listening to Century of Lies. I'm your host Doug McVay.

Also speaking at that conference was Doctor Dustin Sulak. Dustin is a doctor of osteopathy based in Maine, he's done quite a lot of work on pain and opioids, and substitution of cannabis for opiate treatment. He spoke at that conference. Let's give a listen to part of his talk.

DUSTIN SULAK, DO: I love Patients Out of Time. There's something so special about the way that Patients Out of Time has maintained the heart and roots of the cannabis liberation movement that's been around for decades, and even in this time of great change in cannabis, there's something so integral about this community and this conference, and I just love to be a part of it. Thank you.

And so we have some new material today, quite a lot of it, even though, and I really appreciate the full hour to share it with you, we're going to move fast through some of it so we can get to the great content at the end.

So, here are my potential confluences -- conflicts and confluences of interest, and I put it that way because I'm always working to do what's best for my patients and what's best for patients elsewhere, and sometimes for a lot of us in the field, whether we're clinicians or in cannabis business, we have to deal with some of these things in order to best serve our patients, create a sustainable infrastructure for high quality, safe medicine that's used in the right way, and the best way, to help the most number of people.

So I'm the owner of Integr8 Health, which are my medical practices that my wife, Doctor Danielle Saad, who's here, helps me run, she's also the medical director. I'm an equity owner of a company called Healer, that does free patient education, all of our stuff is -- all the patient education we use in the clinic, it's all for free online. Programs for people that are new to cannabis, that are experienced with cannabis, that have specific goals using cannabis medically, it's all there.

We also do industry consulting, extraction and formulation. I was the owner of a testing analytic laboratory, no longer, but that's something that provides services to patients, and it helped me learn a lot about cannabis dosing because people were bringing in artisanal preparations from thousands of different producers in Maine, and we were getting to look inside of them and see what are the active constituents, and what dosages are people using, people who are getting results, people who aren't getting results, and that really informed our practice.

And then I've done consulting work and speaking for some cannabis dispensaries and producers, and I'm also a course director for a CME program, and I'm on the board of directors for the Society of Cannabis Clinicians. If there's any clinicians here that are looking for a professional membership organization that they can be a part of that has access to colleagues who have been doing this for years or decades, and we provide support, please check out the Society of Cannabis Clinicians.

So here's the learning objectives for today. I was asked to kind of review the research from the last year, because last year, we also focused a little bit on this topic, more than a little bit, of cannabis and the opioid problem and what we can do, and there was a lot of need for more research, and actually quite a bit has come out since the last Patients Out of Time, so we're going to review all of that, or, just about all of it, and I'm going to give you my thoughts on those things.

We're then going to do a quick review of the role of the endocannabinoid system in reward and relapse, not nearly as deep as you received yesterday with Doctor Gerdeman, and describe a practical, clinical approach to using cannabis to help reduce and replace opioid medication. So I want to leave you with some really applicable, where the rubber meets the road, practical tips for making this a reality.

So, here's kind of the overview of how the talk is laid out.

Let's start where we left off last year. We had the father-daughter team, Bradford and Bradford, at Patients Out of Time in Berkeley, and they presented this data on medical cannabis laws and the associated decreases in prescribing, in the Medicaid system, of various classes of drugs. And you can see the decrease that was significant in nausea drugs, pain drugs, antipsychotics, seizure drugs, and so forth.

But what they didn't do here in the pain drug is divide this up into opioids and non-opioid analgesics. What they did do, that I really liked, is they showed, wow, if there was, you know, based on this decreased prescribing and dispensing, here's how much the states are saving each year. And if you look at New Jersey for example, about nine hundred thousand dollars for the state, and another nine hundred thousand for the federal government.

And so this is a pretty substantial savings, and this is just having a medical cannabis law, right, not intending to use it to substitute pharmaceuticals, just an association with having the law.

But if we look at a more populous state, like New York, the numbers are a little bit more impressive. Right? Seven and a half million dollars saved per year, just in Medicaid, not Medicare, not private insurance. So a huge amount of cost savings come from sparing prescriptions, and using cannabis instead.

Well, two authors in the Journal of the American Medical Association Internal Medicine, just the beginning of April, published another study that looked at some of this data and took a more indepth look at the pain drugs and opioid prescribing.

And so what they found, well, what they looked at was the time period between 2011 and 2016, and so that included these eight medical cannabis states that implemented their program during that time frame, so states like Maine and California, that had been doing this for a long time, weren't included. They wanted to kind of capture what happens when a state implements the law.

And then they did the same thing for the four adult use states, does that impact Medicaid prescribing of opioid medications? And they found out the answer was yes. And so if you look starting over on the left here, all opioids, here's the bar for medical marijuana laws, medical cannabis laws. About a six percent decrease that was significant, and just a little bit more for the adult use medical cannabis laws.

So just by having these medical or adult use laws, less overall opioids being prescribed.

They broke it down into schedule two opioids and then schedule three through five opioids, and you can see there were some different signals based on medical and adult use, but the -- the take home message is that this was something associated with decreased opioid prescribing.

Now if you look a little more closely at the data, I think it would have been more robust data, except that there were some confounders. What were the confounders? Well, the authors said that Illinois and New Hampshire were not precisely estimated, and these were two of the non-significant decreases, and then also Connecticut, even though it has a functional program, chronic pain is not one of their qualifying conditions.

So, if you're not going to be treating chronic pain, it's hard to really spare opioids, and that's where Connecticut fell on the chart. And then Maryland, they included the data from Maryland, even though the program was so-called active, the dispensaries weren't open and providing medicine to patients during the time frame here. So they had a program but it wasn't functional, and so that data didn't look good.

If you look at the states like Delaware, Massachusetts, Minnesota, and New York, those are even stronger signals, and again, if we look at the states that had legal adult use cannabis, you can see decreases in their opioid prescribing.

Now, the -- so the adult use marijuana laws overall were associated with nearly ten percent lower spending on opioids, and they calculated that this is eighteen hundred dollars per a thousand enrollees being saved on opioid prescriptions being dispensed, and of course the data would change a little bit, but if we extrapolated this to the giant Medicaid system across the country, that has 67 million participants, we're talking about a savings of around 122 million dollars, potentially.

So this is starting to be big numbers, and this is just opioids alone, not all these other classes of drugs that cannabis is saving.

What are my thoughts? Well, one of the things about this study is that they're looking at number of prescriptions, they're not looking at morphine equivalents. So basically, if I'm prescribing someone 80 milligrams of morphine three times a day, and I get them down to ten milligrams of morphine three times a day, that's a huge improvement in the patient's health, in the potential for harm at the public health level, but that's not going to change this data, because it's the same number of prescriptions being dispensed.

So in my mind, what this data is actually looking at more is people who are getting off of opioids, when there's less prescriptions altogether it's not so much showing a taper, it's more showing the discontinuation, and I think that that's -- that's huge, that's a great ultimate goal, but not always what we can do.

The other thought is that adult use is often medical use, and this was revealed by a Forbes study in Colorado, where they found the number one reason that people were using adult use cannabis was to help them sleep. Right, there's a continuum, and it's so healthy for us to think in a continuum, a gradient, not medical or adult, it's always both.

And so many people that are using it for adult use, they get sick, whether it's acute or whether it's chronic, and they start using it medically, or maybe in their adult so-called adult recreational use, what they're doing is using it to enhance the quality of their life, because they feel better, and maybe less likely to use some of these other drugs, and to me that's certainly medical.

So these authors concluded, these findings suggest that medical and adult use marijuana laws have the potential to reduce opioid prescribing for Medicaid enrollees, a segment of the population with disproportionately high risk for chronic pain, opioid use disorder, and opioid overdose. This is a big point, right, these are people who are low income, have very challenging social and economic situations.

Nonetheless, marijuana liberalization alone cannot solve the opioid epidemic. As with other policies evaluated in the previous literature, marijuana liberalization is but one potential aspect of a comprehensive package to tackle the epidemic, and I completely agree with this. It's one aspect, and I think that we need to take this data and the rest of what I'm going to show you today and see how can we use this one aspect and make it as powerful and safe as possible, and then build the rest of the strategy, because not one thing is going to do it all.

In the same article -- excuse me, the same issue, there was another article by the Bradford and Bradford team and some of their colleagues that looked at Medicare Part D prescribing associated with state level medical cannabis laws, and looked specifically at the opioid prescribing.

They found that there was an eight and a half percent reduction in opioid prescribing overall associated the a state medical cannabis law. It was fourteen point four percent reduction in states that had dispensaries, and six point nine percent reduction in states that allowed home cultivation only.

So a bit of a difference there, and both are absolutely important.

If you look specifically at some of the data there were significant decreases in hydrocodone, morphine, those were the two that showed up the strongest. Again, this was only looking at prescribing by drug name, and did not convert the doses into intensity measures like morphine equivalents, so we're not looking at people who are reducing their dose, we're looking at less number of overall prescriptions.

So again, very powerful, but I think the dosage reduction data, which is hard to get at this big data level, that would reveal a lot also, because I'm sure people are decreasing their dose. That's what I'm seeing in the clinic, and these authors had a similar conclusion, combined with previously published studies, suggesting cannabis laws are associated with opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids. I absolutely agree.

What are my thoughts on that study? Medical cannabis laws are associated with people getting off opioids, even when there's no specific program. No education. Often, opioid use disorder is not even a qualifying condition in the state where they have these laws, but it's still taking a big bite out of the problem.

What if we had programs and education? Could we make it stronger? States with no medical cannabis laws can likely make a significant improvement in the opioid epidemic simply by legalizing medicinal use, even home grow only. We don't -- these states that still -- there's lots of states that don't even have laws, so many of us in this audience are spoiled and a lot of us aren't.

All they have to do is make it legal for people to grow their own medicine in their own back yards, and use it, and they can take a big chunk out of the opioid problem. They don't need a big regulatory system, just basic human rights.

Imagine what we could -- [applause] -- imagine what we could do using medical cannabis with intention, and with collaboration. What if we had a collaboration of all these different programs that are funded and working hard to find solutions to the opioid problem? What if we were working together with them? What if we were really figuring this out, oh my gosh.

Now, Patients Out of Time -- if there's even been patients out of time, it's now. There are over a hundred and fifteen people dying of opioid overdose in the country every day, and we could take six, seven, eight, fourteen maybe percent chunk out of that every day, ten fewer deaths, just by admitting that people have a right to grow their own medicine in their own back yard and use it as they wish.

Now is the time, we can't wait around for this. This has to happen now, and there's too many states that still don't have laws.

We've had a lot of success, right, but let's -- we can't sit back and relax, there's still a lot of work to do.

Some more data that came out of recreational cannabis legalization in Colorado, looking at the opioid deaths from years 2000 through 2015, and what they found was after they legalized adult use, they already had medical for a long time, they found that there's less opioid related deaths per month, about point seven per month, and I think the picture says a lot, because you can see this increasing trend in opioid related deaths, right up until the time that they legalized adult use and that that became available to people, and now we're starting to see a decline.

That's pretty impressive. It will be nice to follow that out a few more years and make sure that that's a strong trend. I think it will be. Right? And that's just one state. Again, imagine what if we had descheduling, federal legalization, what would we do to that 115 people dying a day, can we chip away at that number just by changing the laws? Even without collaboration and education and thoughtful programs around this, I think that we can, just by changing the laws.

Now, how is this possible? Why are we able to just change a law and suddenly see opioid use, opioid related deaths, hospitalizations, and so forth, decrease? Because the cannabinoids and the opioids work together. Here's a review article that came out in the last year, that looks at 19 pre-clinical studies that basically gave an opioid and a cannabinoid to rodents and pain models, and what they found was that, when you add THC to morphine, the effective dose of morphine is three point six times lower than the effective dose of morphine when it's used by itself.

When you add THC to codeine, the effective dose is nine point five times lower than the effective dose of codeine on its own. If we saw even a fraction of that drug potentiation in our patients, this would be a major win, and we are seeing it. This is happening, and for the first time we have some really high quality human data that came out of Ziva Cooper's group, just a few months ago, from New York, that looked at an experimental model of pain and the combined effects of various doses of oxycodone with either placebo THC and real THC.

So there were six sessions, people received different combinations of either zero milligrams oxycodone, two and a half, or five, and either zero percent cannabis -- zero percent THC cannabis, or NIDA five point six percent THC cannabis. In joints. And these were already cannabis users in New York, so -- but anyways, they were exposed to the cold pressor test, which is dunking their hand in ice water, letting it sit there until they first feel pain, keeping it there as long as they possibly can then withdrawing it, rating the pain.

They rated how much they liked the cannabis, how much they liked the pills they were given, and all that was put together. They were also given a chance to buy more puffs of cannabis at the end of the day, using some of their study money. More puffs of the NIDA five point seven percent cannabis. Not too many took them up on that offer though.

DOUG MCVAY: That was Doctor Dustin Sulak, speaking at the Patients Out of Time Twelfth National Clinical Conference on Cannabis Therapeutics in Jersey City back in mid-May.

And that's it for this week. Thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about drug policy reform and the drug war. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

DOUG MCVAY: For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.

CULTURAL BAGGAGE

APRIL 26, 2018

TRANSCRIPT

DEAN BECKER: Broadcasting on the Drug Truth Network, this is Cultural Baggage.

Hi folks, this is the Reverend Dean Becker. I'm glad you can be with us this week. Last week, we had Major Neill Franklin. He was the executive director of Law Enforcement Action Partnership, talking about our alignment, the Drug Truth Network and their outfit.

And today, I want to talk about another outfit, more local, here in Houston, that deems to grant me the -- as a contributing expert to their efforts. They're based at Rice University, the James A. Baker III Institute, and I want to welcome the director of that drug policy group, Professor William Martin. Hello, sir.

WILLIAM MARTIN, PHD: Hi Dean, good to talk with you again.

DEAN BECKER: Professor, you know, the truth about the drug war is slowly being recognized. I think it's been available to people if they just wanted to absorb it, but it's beginning to be recognized as valid, and needing, or creating need for change. Your thought there, sir.

WILLIAM MARTIN, PHD: Oh, that's absolutely true, and the media picked up on this now for -- for the last three, four or five years, and people are -- people can't help but see it, they can't help but be exposed to it. When they are exposed to it, it's so clear that it's been such a mistake that I've run into people, it doesn't matter whether it's at a church, or at a gathering of soft Republicans, and they'll just say, you know, we've got to change this, this doesn't work. We've got to try something else.

So, yes. The drug war is on the run.

DEAN BECKER: And, you know, I mean, I've been preaching this for, you know, nearly 20 years, we're empowering terrorists, enriching barbarous cartels, we give reasons for these gangs to exist, and we have created this situation where we're leading the world in overdose rates of our children because nobody knows what in the hell they're buying. Am I right, sir?

WILLIAM MARTIN, PHD: That's true, and when you're -- when you buy an unregulated product, sold to you by a criminal with no incentive whatever to be concerned about purity or quality or strength, then you are taking much more of a risk than if it were in the hands of a regulated industry that had to follow rules regarding quality and strength and purity.

DEAN BECKER: Now, Bill, we've had a couple of events within the last month at Rice University, two events looking at cannabis, cannabis laws, the future of cannabis, if you will. It's become a very mainstream topic, has it not?

WILLIAM MARTIN, PHD: Oh, it has, and there it was -- my colleague Katie Neill, who you know, attended a conference last week, I'm attend -- may attend one tomorrow, I haven't yet decided. I'm going to attend a harm reduction meeting in San Antonio that's going to have some high level leaders of that at that, to talk about syringe exchange and other harm reduction measures, that's recognizing that we've got to do -- we've got to do things differently.

DEAN BECKER: Yes, sir, and you know, I just returned from Switzerland and Portugal, and over there, I was able to talk to, and I'll just be, you know, rough with it, the top dogs, the drug czar, the guy who designed the heroin injection program, the head of the European Monitoring Centre, the top scientist there.

They're willing to talk to me, and here in the US, for twenty years, I've tried to get the drug czar, you know, the head of the ONDCP, the DEA, all of these guys whose opinion matters, if you will, it certainly matters in the legislators' opinions, in forming or continuing these laws, and I guess I want to get your thought there, sir. It's time for everybody to face down this lion. Every official. Am I right?

WILLIAM MARTIN, PHD: Well, that is true, and I appreciate so much the way you have gone after this for so many years, and although you haven't gotten all the people that you wanted to get, you have gotten a tremendous number of people of substance, and you're the -- I'm happy to have a new audience for you to reach. I'm sure there will be a lot of people following you from your old time, but I'm happy that you'll also pick up some new people to see what a unique contribution you have made.

What's the number now, is it above 1,500 people you have interviewed?

DEAN BECKER: Oh, I haven't actually tallied it. Once I got above a thousand I kind of quit, and that was about six years ago. So ---

WILLIAM MARTIN, PHD: It's way on up there, but, and we at the Baker Institute, we are so pleased now for several years to have, to serve as an archive for that resource, and just as, you know, your book, To End The War On Drugs, which we helped to -- helped to publish and also to distribute, helped with financing of that to some extent.

DEAN BECKER: Yes sir.

WILLIAM MARTIN, PHD: And, which is in itself, which you did, based on the interviews that you've done over the years, sort of topic by topic of the drug war, and then much more even really quite currently, we have on the first page of our website, you can go to -- you can google Baker Institute Drug Policy, and you'll come up on the front page, and there's an article there that I put together about law enforcement in Houston favoring drug policy reform.

Even though I put it together, it came from your interviews with the past and present chiefs of police, the sheriff, the DA, and with other people who have minor roles in that article, but not minor roles in -- all of these people agree that the drug war has been a failure, and we need to do something else besides lock people up.

DEAN BECKER: Well, Bill, I appreciate that endorsement, and you know I send it right back to you guys for standing so tall and so honest in this regard. Please point them to that website one more time, Bill.

WILLIAM MARTIN, PHD: Okeh, you can just go to drug -- Baker Institute Drug Policy, and it will pop up.
https://www.bakerinstitute.org/drug-policy-program/

DEAN BECKER: The following segment comes to us courtesy of MIC.com.

ASHA BANDALE: On the anniversary of Prince's death, what I want people to think about, more than anything, is that we don't have to lose another life. We don't have to have people dying of overdose. My name is Asha Bandale, I'm a senior director at the Drug Policy Alliance.

Prince meant so much to me, because he was black excellence and because he was free. Gave me the ability to claim my own freedom, and be who I was. I'm here talking about addiction and talking about drug use, because I loved Prince.

When I think about Prince, I think about a man who probably felt a lot of stigma because he was in pain, and because he didn't feel like he could ask for help. And so when we use terms like crackhead, junkie, addict, and we just dismiss the humanity of people, they don't feel like they can come to us and ask for help, they feel shame.

Each year in America, somewhere around 64,000 people die needlessly of drug overdoses, about 42,000 of those deaths are driven by opioid use. From marijuana to heroin, 75 to 90 percent of the people who use them never become addicted.

So we need to begin to look at what are those things that are present in the lives of people who do become addicted, and often what you find are things like lack of access to healthcare, loss of hope, loss of jobs, loss of family structures, and so we have to not think about addiction as this isolated sort of craziness that some person who's a freak lives in. We have to think about our social responsibility and what we're not providing people.

There are nations like Portugal that once had an overdose epidemic, much like the one we're having here in the United States. Portugal took drugs to the maximum extent possible out of the criminal justice system, and put it inside their public health system, and so when they've done that, what they've actually seen is a reduction in young people who use drugs. They've ended their overdose epidemic. They've almost exclusively curtailed, almost entirely, the transmission of HIV through shared needles.

So Trump's approach about killing the drug dealer is his lazy, scientifically unsound, and morally unethical approach to, actually, what we need to have a leader of this nation do, which is figure out how to save lives.

donald trump: If we don't get tough on the drug dealers who are wasting our time, and that toughness includes the death penalty.

ASHA BANDALE: The war on drugs has been an abject failure and we've known it. People are going to use drugs. Our job as a society should be to save lives, but we're more concerned about morality than we are with saving lives, and my plea to anybody who's within reach of my voice, is choose life first. Wouldn't we want Prince still here? Wouldn't we want Whitney Houston still here? Wouldn't we want our own loved ones, who we've buried to drug use, still here?

They could be, if we actually let go of our morality and chose their lives first. That is the true morality, to me.

DEAN BECKER: All right, folks, that was Asha Bandale from the Drug Policy Alliance. I toured Portugal with her, Lisbon, we interviewed the drug czar over there, each of us.

I want to say this. I have a local minister, he's here in studio with me, he's going to be anonymous for today, but he just wants to see what's going on. He's thinking of joining forces with us, and I'm hoping he's the first of many local officials, ministers, you know, county commissioners, and whomever, police chiefs maybe. It's time to challenge the logic of the drug war. It has no reason to exist.

You know, after I left Lisbon, I went to Bern, Switzerland. There, I got a chance to interview Doctor Buerki, Christoph Buerki. He's the inventor of the, how do you call it, the heroin injection program, which has saved a lot of lives. We're going to hear half of that discussion today. This is Doctor Christoph Buerki.

It's time to play Name That Drug By Its Side Effects! Agitation, paranoia, hallucinations, face chomping, lip eating, heart devouring, brain slurping, ecstasy, suicidality, zombie-ism. Time's up! The answer, according to law enforcement, from some crazy-ass chemist somewhere: mephedrone, otherwise known as bath salts.

CHRISTOPH BUERKI, MD: Christoph Buerki, I'm a psychiatrist in Bern, and I've been with heroin prescription from the very beginning, which is, if I recall it right, 1993, we started with that. And, I think you should, if we talk about prescribing heroin in Switzerland, we should also mention the time before, before that.

DEAN BECKER: Oh yes.

CHRISTOPH BUERKI, MD: Because, there was a very, very big open drug scene here. We'll walk past the park where the drug scene was. We really had an epidemic of heroin overdose, for a small country, six million people, it was extraordinary, some -- up to five hundred persons a year died of heroin overdose. Now, I know in the US you have a bigger epidemic right now, but, sizewise, it was still very significant.

DEAN BECKER: And, approximate population of Switzerland at that time?

CHRISTOPH BUERKI, MD: Six million.

DEAN BECKER: Six million. Yeah that's --

CHRISTOPH BUERKI, MD: Six and a half million, it was, yeah. Yeah. And so, we just needed to have new ways, and that was one of the new ways. There was different, new ways and initiatives. One was a safe consumption room, that exists also until today in Bern, as well as in many other cities, where people can go consume their own drugs.

DEAN BECKER: Right. With supervision.

CHRISTOPH BUERKI, MD: That they bring with. Under supervision, yeah.

DEAN BECKER: I've been to Insite in Vancouver, which is probably similar.

CHRISTOPH BUERKI, MD: Yeah. Yeah, very much. I visited, like, a week after it was opened, and it's very similar to our injection room.

So, that was really a major initiative from big cities in the mid-'90s to find ways to close down those huge open drug scenes.

DEAN BECKER: Sure. Sure.

CHRISTOPH BUERKI, MD: And, an important element was this -- was the heroin prescription. Of course, we couldn't just do it like that, we needed a legal basis for it, and we did this within a research frame.

So this was a huge, multi-center study, as we call it. It's called PROVE, P-R-O-V-E, where, sort of, we did it under that research -- research umbrella. So, it was --

DEAN BECKER: How large of an undertaking, a project, was that, the PROVE?

CHRISTOPH BUERKI, MD: In the beginning, it was like some 800 patients, and some -- some 16 or 18 centers, all around Switzerland.

DEAN BECKER: Good.

CHRISTOPH BUERKI, MD: And, the reason it was important to -- it wasn't a gold standard research in the sense, as you would do it in medical science, for to prove something, like, in the sense of a gold standard where you have two groups --

DEAN BECKER: Oh yes.

CHRISTOPH BUERKI, MD: -- that you directly compare with each other.

DEAN BECKER: One placebo group, maybe.

CHRISTOPH BUERKI, MD: Even placebo, which is difficult to prescribe a placebo, if you're heroin dependent you'd immediately realize that it's placebo.

DEAN BECKER: Where's my heroin?

CHRISTOPH BUERKI, MD: Right. So, that sort of methodological -- it's not a flaw, but it's, it can be proved methodologically.

DEAN BECKER: Well, sure. It was the best --

CHRISTOPH BUERKI, MD: At the time --

DEAN BECKER: -- possible, right?

CHRISTOPH BUERKI, MD: At the time, it was what we could do. What we did basically was, we started taking people in. We couldn't take in everyone.

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: We could only take in people who had a certain history of addiction, who had certain -- more than one, several -- several attempts of quitting, with the heroin addiction. Mostly methadone, but also inpatient detox. They'd have to prove, or we would have to prove together with them, that they really tried to stop in other ways. They needed to have certain social or psychological, somatic complications of their addiction.

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: So, in the end, we -- we could only take them off and -- take them in and get permission if we could prove all those things.

DEAN BECKER: Yes, sir.

CHRISTOPH BUERKI, MD: And, then we -- we started, and you will find -- you will find how it works in detail.

DEAN BECKER: Well, Christoph, what you're saying about, you know, these, the patients, more or less having to prove the need, or the mental framework, that would allow them to go ahead and use the heroin. Dr. Goul?├║o there in Portugal was talking about, they have the dissuasion committees that try to convince people to quit using drugs, but some people say, no, I'm a heroin user, I will keep using it, and therefore they're allowed to continue, you know, without interference.

CHRISTOPH BUERKI, MD: It's nicely put, the dissuasion committee. Actually this is just part, of course, of everyday -- of our everyday work, it was at the time. And that's, I think, is the most important aspect of heroin prescription.

You treat the patients, of course you give them out heroin, and that's why they come to you. But, it provides a whole opportunity to treat, to talk, to provide social -- social support, housing, finance, and so on, to provide medical support, to provide psychiatric support. Many of those people have dual diagnosis, in the psychiatric sense. They have maybe psychosis or depression, or anxiety disorders.

DEAN BECKER: May I ask you a question?

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: I would surmise, I have no proof of this, but I would surmise that many of these people who use drugs, and wind up on heroin, have suffered a penalty, or ostracized by either law enforcement or family, or whomever, for their drug use, which may lead them even further in that direction. Is there -- ?

CHRISTOPH BUERKI, MD: Of course. Many, many of the people who entered the program had a previous history of -- of court problems, of prison stays, of delinquency of some sort, of course.

DEAN BECKER: Yes sir.

CHRISTOPH BUERKI, MD: And that was also one of the findings, one of the most important findings, also, besides, that people simply survive their addiction, another important finding was that rates of criminalization, of delinquent behavior, decreased massively once patients have entered the program.

DEAN BECKER: Now, is that -- I would guestimate a couple of reasons why, one is, they're no longer having to devote time looking for heroin, and perhaps no longer having to scrape up money with which to buy it.

CHRISTOPH BUERKI, MD: Of course. Of course, yeah. That's a very important thing, to have a structure during the day. They get up and they go to bed, at some time, two times when they need to appear in the distribution center, in the clinic, and they get their heroin, and they don't need to run around, they don't need to prostitute themselves, or rob old ladies of their handbags, or do worse things, or, by the way, deal with drugs. They don't need to do that, as well.

DEAN BECKER: Right.

CHRISTOPH BUERKI, MD: So, that's a massive, massive improvement over their life of an addict before he or she enters a program.

DEAN BECKER: Hi, this is Dean Becker, I wanted to remind you, you're listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network. This interview was recorded in Bern, Switzerland, in the office of Doctor Christoph Buerki. He's the designer of the long-term, very successful, Swiss heroin injection program.

We talked briefly out there on the street about the US having a major problem.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: Sixty thousand dead last year, they say [sic: that's all drug overdose deaths], and I close my radio program with this thought, okeh? Because of prohibition, you don't know what's in that bag, please be careful. And it's -- I think that's, at its worst in the United States, best I understand it, with the fentanyl, carfentanyl, the mixture, that's being sold, and people just don't know what they're taking. I wonder how often it even contains heroin. Your response, please.

CHRISTOPH BUERKI, MD: Of course, that's one of the major issues, if you're a drug addict on the street, you just have to consume or take whatever your dealer sells you as being heroin, and that can be, especially -- we also do street surveys of street drugs, up to today in the canton of Bern, regular samples are taken in the low-threshold street agency, and it's really a problem, because it contains between two or three percent of heroin, up to forty or sixty percent of heroin.

DEAN BECKER: Oh, my.

CHRISTOPH BUERKI, MD: That's a very, very dangerous situation. Many people might -- can overdose in those situations. If you're used to heroin of five percent and then you suddenly get heroin, street heroin, of sixty percent, it can be a death penalty.

DEAN BECKER: There you go.

CHRISTOPH BUERKI, MD: It could be really, really dangerous. So, of course, that's one of the things that, even up to today, where we've done it twenty-five years now, almost. I'm not aware of a single patient who has died of an overdose in a heroin injection -- of a heroin injection in a heroin prescription clinic. Not a single overdose death.

DEAN BECKER: That's wonderful. The best outcome you could hope for, right?

CHRISTOPH BUERKI, MD: I think it's, for the individual patient, it's the best outcome one can hope for. Yeah, it is. And, also many people pay -- I mean, one big criticism of heroin prescription is that you keep patients forever, sort of for the rest of their life. Which, for some patients, it's true, one has to say, it's true, they are so heavily addicted, and they can't, despite all the motivational efforts by staff and psychotherapists, doctors, social workers, they cannot be motivated, they cannot be pushed into trying to quit or doing something different, which is one of the issues, of course.

But then again, those people, would they find a way out if they lived just on the street, on street heroin? Probably not. Most of them would be dead by now.

DEAN BECKER: Yeah. Well, right, because of the impurities, the -- and again --

CHRISTOPH BUERKI, MD: Yeah. Lifestyle.

DEAN BECKER: -- and not knowing what is in that bag.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: Like I say. There was a gentleman, one of the founding members of Johns Hopkins University, very prestigious outfit over there in the US.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: He was known as a lifelong morphine addict. He was, and I'm trying to remember his name [sic: Dr. William Stewart Halsted], but he was declared to be the father of modern surgery, he was that good.

CHRISTOPH BUERKI, MD: Yeah.

DEAN BECKER: And, I often like to ask folks, if he were your surgeon, would you want him to have his fix before or after he cut you open? And my thought is, I think he should have it before he cuts me open, but, he had a very productive life just the same, and do you find some of your patients nonetheless have very productive lives despite -- ?

CHRISTOPH BUERKI, MD: Of course. That's, I mean, that's the ultimate goal of the program, to have, yeah, a fulfilling or productive life, somehow. That meant -- might mean totally different things for different people. It might mean that you have a job, that you have a family, for others it might mean that you don't die of suicide or you don't die of a major mental illness. So that's a -- that's an individual thing, what is a fulfilling life.

But that's the ultimate goal, of course, in all the treatments that we do as doctors, as institutions.

DEAN BECKER: All right. Once again, that was Doctor Christoph Buerki, the Swiss scientist who came up with the Swiss heroin injection program, as he says, almost 25 years in existence now. Nobody's ever died of heroin there in Bern, Switzerland, since they came up with that program. I got to tour the facility, a six story building. I got to see how they store the heroin, how they dispense it, how they control, you know, who gets what.

Twice a day, people come in, get their heroin fix, then they go back to work or tending their children or whatever it might be. But, it is a much better way than we have, where people are buying crap on the street, they've got no idea what's in that bag. And yet, you know, they keep buying it just the same, because, well, that's the way America likes their drug war, deadly and dangerous, I suppose.

I've got a track I want to share with you about something that's fixing to happen, and I hope you will tune in, because I'm certainly going to.

donald trump: We're going to work with the people who are so addicted, and we're going to try like hell to get them off that addiction.

SANJAY GUPTA, MD: A national epidemic. Trump campaigned to end it. As president, he promised to fix it.

donald trump: The scourge of drug addiction in America will stop. It will stop.

SANJAY GUPTA, MD: But one year later, it hasn't stopped. People are still dying. A hundred and fifteen Americans die every day from an opioid overdose. More than car accidents, breast cancer, or guns.

VOICE ONE: Literally everyone we know knows somebody who has died of an overdose.

SANJAY GUPTA, MD: And two and a half million Americans are currently struggling with opioid addiction.

VOICE TWO: I was completely helpless, where I just was like suicide is a constant thought.

jefferson beauregard sessions III: People need to take some aspirin sometimes, and tough it out.

SANJAY GUPTA, MD: A solution some believe is this: cannabis. It's controversial to many. Is cannabis a gateway drug? But a gateway to recovery for others.

Did it help you get off of the opiates?

VOICE TWO: Absolutely.

VOICE THREE: Cannabis has given me a reason to live.

SANJAY GUPTA, MD: Join us as we investigate, search for answers, and meet potential pioneers and outspoken critics. Whether you struggle with opioids, or know one of the millions who do, decide for yourself.

DEAN BECKER: It shall air Sunday, April 29, at 8pm eastern on CNN.

I hope you tune in. It's going to be, I think, very instrumental in changing America's perspectives on this. It was Doctor Sanjay Gupta about four or five years ago who came forward, talking about the benefits of medical marijuana, for all those little kids with epilepsy, and how it made them able to have a fairly normal life, how a small dose of cannabis was able to twerk or tweak their brain to where they were able to, you know, lead a more productive life, go to school, learn to walk, talk, all those good things we want our children to do.

I got to wrap it up. Once again though friends, I want to invite you to contact me, especially if you're a minister, a commissioner, or whoever out there. Our number, our email is Dean@drugtruth.net, and again I remind because of prohibition you don't know what's in that bag. I urge you to please be careful.

To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network. Archives are permanently stored at the James A. Baker III Institute for Public Policy. And we are all still tap dancing on the edge an abyss.