05/06/18 Bill De Blasio
Century of Lies
Bill De Blasio
This week on Century, we hear about drug consumer safety from Mark Miller, former director of the University of Oregon Drug Information Center, and Jennifer Burbank Roch, member of the board of directors for Mothers Against Misuse and Abuse. Plus, New York City Mayor Bill De Blasio announces his support for establishment of supervised injection facilities in NYC.
CENTURY OF LIES
MAY 6, 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: Hello, and welcome to Century Of Lies. I'm your host Doug McVay.
Well, this week we're going to hear about drug consumer safety. It's a very simple idea, it's like, well, harm reduction. Reducing the harms, minimizing and managing the risks. People use drugs. That's just a fact of life. Whether it's the caffeine in the coffee that you drink in the morning, or the aspirin that you take with your coffee to get rid of the hangover from the night before from the alcohol, which is a drug, that you were drinking.
Or maybe it's the tobacco. Maybe it's the marijuana, or cannabis if you prefer. Ma, I like to call it. Maybe it's the cocaine, maybe it's the opiate that you took. Maybe it's something else. Maybe it's one of those herbs that you got from the drug store or from the convenient grocer.
People take drugs. The smart thing to do is to learn how to do what we do without hurting ourselves. Drug consumer safety.
Simple things like knowing that if you are healing from surgery, whether it's dental or something else, if you're taking a blood thinning agent, which makes it more difficult to coagulate, that means you will bleed, and you'll have trouble healing. So if you're popping those aspirin to take care of yourself after dental surgery, that could be problematic, because you may end up bleeding because NSAIDS do not promote coagulation.
It's a simple thing, but believe it or not, there are even dentists and doctors out there that get these things wrong. These prescription drug monitoring programs that you've got in various states, doctors are supposed to look at that not just to find out if you've been going to too many doctors to try and get your prescription, they should be looking at this thing to find out what else you've been prescribed.
Your psychiatrist is prescribing you two different medications. Your medical doctor prescribes you an opioid, but the opioid interacts with those other two prescriptions and sometimes in a bad way. You need to know what you're doing. You need to know about those interactions. What if you decide you want to have a glass of wine along with your benzo? And then you take your opioid. That's dangerous. Did you know that? You need to.
The problem is, the onus, the burden, is on you, the patient, to know this stuff, because frankly, you just can't rely on most of your medical doctors to give you this advice. Why? Because they're not looking at the whole picture. They're looking at what they're prescribing for you, and even then, they may not be thinking about it.
It's up to you. It's your health. It's your safety.
Many years ago, some friends of mine came up with this idea, the drug consumer safety rules. It was radical at the time, in the 1980s, the idea that anyone would talk about taking drugs safely.
Even if we're talking about legal drugs, the idea of drug consumer safety was considered so radical, so taboo. Well, it's not. It's a good idea, and we're going to listen to a discussion about that now, in fact.
One of the people who put together those drug consumer safety rules was a man named Mark Miller. He worked at the Drug Information Center at the University of Oregon, and he collaborated with an organization called Mothers Against Misuse and Abuse, which was founded by my good friend Sandee Burbank.
Sandee's daughter, Jennifer Roch, is now the director of MAMA, and she's carrying on for Sandee. She and Mark Miller presented a while back about these drug consumer safety rules. We're going to listen to them right now. First up is Jennifer Burbank Roch.
JENNIFER BURBANK ROCH: Hello, everyone, I'm very happy to be here with all of you today. I've been participating in Patients Out of Time conferences since 2002. My name is Jennifer Roch, and I'm on the board of Mothers Against Misuse and Abuse.
My mother, Sandee Burbank, and a few other women, founded MAMA in 1982, when I was but a wee babe, like Hannah, who I think many of you have probably come across, is today.
MAMA has always focused on reducing the harm from all drug use, but it became apparent that some of the harm was being caused by drug policy.
Although cannabis was illegal, after meeting some of the federally legal patients in 1991, MAMA was compelled to advocate for the patients' access to cannabis.
When it comes to cannabis, because of its illegality, it was difficult to offer advice. We couldn't tell people to read the label. It was hard to get scientific information, but we knew many people were using cannabis regularly without negative health effects.
Thankfully, here in Oregon, our medical marijuana program started in 1998. There are currently more than 60,000 patients registered. The Oregon Medical Marijuana Program is a registry program and does not provide information on the aspects of the use of cannabis.
We opened a clinic here in Portland in 2005, because we were hearing from patients whose doctors were either not willing to sign for their qualifying conditions, or who were willing to sign but didn't know how to direct patients to access, use, or preparation of cannabis.
Today, MAMA's three clinics provide certification and educational services to thousands of patients in the Oregon Medical Marijuana Program. We have clinics in Portland, The Dalles, and Bend. This provides MAMA with a unique opportunity to provide drug consumer safety rules, and how to apply them.
MAMA clinics provide patients with a personal orientation and a booklet that provides drug safety information, rules on the Oregon program, growing and possession limits, and provides additional information resources. MAMA's comprehensive procedure and education have led to a reputation of professionalism and respect.
MAMA works with doctors, paid staff, and externs. We provide college externs training for -- to familiarize them with cannabis therapeutics, drug safety information, and clinical intake procedures. In addition, many supporters and volunteers have provided their services and donations for more than 30 years.
Medical use is now allowed in 22 states [sic: this was in 2014], but access to cannabis is hazy in most of them. Education to reduce harm is almost nonexistent.
Patients need to know the different forms of cannabis medicine, the onset and duration of the effects of the different forms, whether or not cannabis may interact with other medicines they're using, and where to get the information they need.
While rated significantly less toxic than many other substances, cannabis still requires responsible use to avoid safety issues. Here are the five drug consumer safety rules. Because of many of the faculty here, and others, we are beginning to get the information we need to apply these rules to cannabis.
We didn't know he'd be available, but we have with us Mark Miller, whose the former director of the University of Oregon Drug Information Center, where the drug consumer safety rules were developed. Who better to apply them to cannabis for the first time than Mark? So I'm going to ask Mark to step up here and do just that.
MARK MILLER: I may wish to pull a little rank today. How many people in this room have been active in this movement since 1990? Let me see a show of hands. How many of you have been active since the 1980s? How many since the 1970s? Take a look around the room. I've been at this since 1972, when we first started.
The drug safety rules are:
What is the chemical?
Where is it working in the body?
What is the dosage?
What are the drug interactions?
Is there a potential for tolerance or addiction?
These five rules are critical in any type of drug, whether you go to the doctor, the drug store, the supermarket, or off the illegal market. And things have changed dramatically in this drug technology, even in our science. How many of you have heard the joke about the lawyer who's sitting in his office, a client walks in, completely naked except he's wrapped in cellophane. The lawyer takes on look at him and says, you know, obviously I can see you're nuts.
If you had told me ten years ago that we would have the science available today that we do, the research that's ongoing, the incredible social changes we have seen, to now where most of the country supports medical use, and even a majority is supporting legaliziation, if you had told me this ten years ago, I would have said clearly I can see you're nuts.
There's another reason for these rules today in Oregon, that we'll be going through. We do have, of course, medical access through dispensaries. How many of you don't have dispensaries in your state? This is an example of what is in an Oregon dispensary. Makes your eyes red just thinking about it.
I'd like to point out that we have an outstanding medical service in this state, that's Emerald City Medicinal Services. David Evans, are you here, would you stand? He's in back. We also have the staff, this is Tobias Smith, and we also have Ann Sunshine Delaney. I think this is an example of responsibility. David brought his staff here today to be educated, to make sure that when they give information out to patients walking in, it is accurate, timely, and reduces hazards.
Most of you have never seen how this comes out. There's a warning that it should not be used by children. There's a listing of the percentages of THC, percentages of CBD, and percentages of CBN. This is going to be important because of the psychoactive effects, the pain relieving effects, and perhaps some sedative effects. It's also been tested for mold, herbicides, and mildew. This is all required in the state.
What is not required is that patient education be given out. David's staff is here today to learn that, and we'll be helping put out information to this effect, probably from MAMA, in the new pamphlet we're making available.
Let's go ahead and take a look at some of these rules. The first rule, what is the drug? Of course today, the science, we can elucidate this, THC, delta-tetrahydrocannabinol. We're also well aware of the fact that there are a number of other cannabinoids that will produce effects.
We also can say definitively now, which we couldn't say a few years ago, that these drugs will effect the human cannabinoid system.
Now, we have to define the endocannabinoid system because people haven't heard of this before. Now, it is true that, you know, back in the 1970s, they didn't realize we had natural opiates in our body, but ever since the research on endorphins and enkephalins came out, you can almost make a joke that we're walking opiates. As the public gets to know more about this endocannabinoid system, and how pervasive it is through the body, we'll probably start seeing the comedians making jokes that we're all walking pot plants.
But this will be an acknowledgement of the understanding that we have a chemical in our body, or a series of chemicals, that are very responsive to the cannabinoids. They are found throughout the central nervous system in a number of body organs. They regulate a number of important functions that we can now give information to patients on.
We can describe CB1 and CB2 receptors, where they're working in the body, the chemicals that will be important. We can say where they're found so we can tell people what these effects might be.
We've also been able to elucidate the CB2 receptors, where they're working, what they do to a large degree, certainly enough to provide essential patient safety information.
We know that what these CB receptors do, what they're mostly responsible for, and we're describing this in simple terms. When you have to go in front of the public and teach them essential pharmacology rules so they can be safer, and follow the doctrine of informed consent, you don't need to complicate things immensely, but you do have to make sure that they understand the essential concepts.
So, that was answering the first question, what is the chemical? Where is it working in the body?
Now, we know that there is a strong affinity for the cannabinoids to these CB receptors, and they will produce effects. And we can also tell what the anticipated therapeutic effects will be when marijuana is used, or cannabis is used, by patients who have qualifying medical conditions in Oregon.
We know that if it's cancer, it's going to be reducing nausea and vomiting. Glaucoma will be reducing intra-ocular pressure. Severe pain, two effects here, it's reducing actual pain, and also perception of pain in the brain. Cachexia, it will increase appetite and we see this also with HIV and AIDS, it's going to reduce nausea, anxiety, sleeplessness, nerve pain.
DOUG MCVAY: You're 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.
We're listening to Jennifer Roch and Mark Miller speaking about drug consumer safety education, a very vital topic, an essential part of harm reduction, and a thing that all of us could be doing, and should be doing. If you're a healthcare consumer or if you are simply a person who lives in the world, this is important information. Now let's get back to that. This presentation was delivered at the Patients Out of Time conference in Portland, Oregon, in 2014.
MARK MILLER: Once again, we can go through the list of what the basic therapeutic effects are, but we're trying to explain why the medicine is going to be effective.
Now, we also run into a number of patients, quite frankly, who don't have experience with marijuana. There's a lot of misperceptions about the program in this state, and the state agency's not required to do anything about it. A lot of people in this state think that this is a wide open program that anybody can get into. It's not. You have to have qualifying conditions. There's only about 60,000 patients. That's less than two percent of the state population.
There's also a belief amongst the public that the category that's most used for qualifying, pain relief, is an abused category, that many people are sliding under in here without a real qualifying condition. But there have been studies done in this state of the potential numbers of people suffering from severe chronic pain. It's about 1.2 million.
Even if 95 percent of the patients are coming in on a pain qualification, that is still well below, only about 20 percent, of the total number of patients suffering severe pain in this state. In other words, the category is not being abused.
There's also the perception that a lot of young people are just using this as an excuse to get marijuana. That's not the case. The program's stats show that the majority of them are over the age of 50. Quite frankly, most of our patients are sick, elderly, and proportionately large number of vets. Vets make up only about eight to ten percent of our state population, but they make up about 25 percent of the patient population.
So there's a lot of misimpressions. People even think that the dispensaries are going to be places where kids can hang around and get drugs. Nothing could be further from the truth. There are so many strict laws on this dispensary that most of you would consider it a colostomy of, you know, business practices, the way the government looks at everything.
There are security cameras in every room. There are security doors. Nothing goes unseen. No one is allowed in these facilities without a patient card. No one. No sightseers, no civilians, no one period. This is a very controlled program, but our public doesn't know about this.
So, we have patients who come in, sometimes who have never used marijuana. They don't know what the effects are going to be, oh, but they've seen what's on the television. Gee, am I going to start having, you know, weird visions and plasticity and will I, you know, wake up in the dog -- you know, dog in the bed in the morning or something, you know, it's just weird stuff. They don't know what to expect. They've only heard the government exaggerations.
So we have to, you know, advise them that yes, there will be effects from the drug, in many cases they will not be very disorienting. There may be some closed eye visuals, some misperception of time, but we do have to perform some education. Many of our patients are walking in, they've never used the drug before. Keep in mind, many of the patients are the sick and the elderly.
We also have to differentiate between low dose and high dose, and we remind that, at least with smoking, you can tend to titrate the dosage and feel the effects, but we also caution them that if the drug is used orally, that's not going to be the case. You have full absorption when it's being taken orally, takes about twenty to forty minutes, and we caution people that if they want to learn just how strong a drug marijuana is, or cannabis, eat it.
We also have to mention side effects, but we are careful to differentiate between side effects and adverse reactions. Let's just see a show of hands here. When you go to the doctor, how many have ever explained the difference between a side effect and an adverse reaction? How many of you have ever had that done? Well, they're supposed to do it, by the doctrine of informed consent. Do you ever see this information in the PDR? No.
You might think about getting the essential guide to prescription drugs. This is a book that does clearly show the difference between side effects and adverse reactions, which you'll need to know. Side effects are the routine effects that we expect from the drug, may be unpleasant, but adverse effects indicate the drug might not be working properly.
There may be a problem, and in those conditions, you should be calling a medical professional, reducing dosage, something to alleviate this problem. You know, sometimes the adverse reactions are mild, in very rare conditions they can be severe.
Now, the way they take it is going to be important. Inhalation will be very rapid, a lot of the drug will be exhaled, and when it's taken orally once again we remind them the effects will be much longer, much more intense. Be very, very careful with edibles.
We also warn them about the drug interactions that are possible here. Luckily, marijuana is not an extraordinarily toxic drug. We do not expect life threatening reactions in the vast majority of cases. But, cannabis is a medication. It is a drug. It follows the drug safety rules. Caution needs to be exercised.
Now, there are contraindications. We have to err on the side of safety. We put that it's probably advisable to avoid driving. We're well aware of what the research indicates, but we don't know if we have a novice user or an experienced user here, so caution is indicated.
Yes, we're aware of the research that shows in some cases it might even be advisable in pregnancy. But we err on the side of caution, we say be sure to check with a doctor. If you have a history of cardiac history, very strong caution should be exercised in using this medication. Severe mental illness, once again, the research parses it out in a very interesting way, but for the most part in severe psychoses, probably not recommended.
The addiction potential. Certainly, this drug cannot be compared to most of the major CNS depressants, which in many cases would produce life threatened withdrawals. It can't even be compared to, let's say, the opiates, which can produce severe flu-like reactions. In fact, if we're going to say that after long-term high dose use there is a potential physical addiction, the symptoms of withdrawal are certainly much, much less severe than just about with any other pharmacological agent we see.
Long term health problems - we're aware of the latest research showing that it does not appear to cause lung cancer nor COPD, but that doesn't change the fact there can be respiratory irritations, especially with heavy use.
It's difficult to say what the long term risks are. Yes, we have research on where it's working. Yes, we have research on activity right now. But we don't have long term longitudinal studies. We do know that of course anecdotally marijuana has been used for thousands of years, at least for the last 40 years in this society. It has been used extensively, and if we were going to see high casualty rates, they would have been showing up, they would have been ballyhooed in the press on a scale that would be unbelievable.
Now, I've mentioned the informed consent procedures. This is a medical ethic that dictates when you go to to the doctor and you get a drug, surgery, or medical device, they're obligated to explain all the benefits and all the risks. You, the consumer, then have a decision to make. This is the only book, right here, that lists specifically marijuana contraindications and interactions. Every household should have this book for the prescription drugs and the over the counter drugs they're taking, and even for cannabis.
There's also websites you can go to. I need to point out something here, for all of us who have been in this for a long time. We are finally getting to a place that many of us thought would not be possible, and it's time to swing out the ax. We can't afford to blow it here.
I'll use alcohol as an example. After they re-legalized alcohol in 1937 [sic: 1933], there was no attempt at public education. There was no attempt to establish societal norms. There was no education on the effects of the drug. There was no teaching of one drink per hour is what you should be doing if you want recreational effects, instead this society developed an ethos that you drink to get drunk.
We have the corresponding statistics to show for it. Half the fatal traffic accidents, half the violent crime, half the domestic abuse, half the loss of productivity. Now, luckily, marijuana, or cannabis, is not alcohol.
But if you honestly think for one minute that with millions of people using this drug in the near future if it's legalized, or the tens and hundreds of thousands of patients who are using it right now, if you honestly think that we can get by without drug education on this, I merely point out the most recent press releases on Colorado.
Kid eat more than he should of a cookie, decides to take a flight off the fourth floor balcony, according to the press. Another individual eats marijuana laced candy, wife calls 911, shot to death on the phone. We don't know the full story yet, maybe other drugs were involved, but I guarantee one thing: if the press starts latching on, as they're starting to, to lurid stories of misuse of marijuana or cannabis, I guarantee you, you will never see the light of day again.
I have been at this 43 years. You are on the verge of greatness. Be sure to get the education out, or we will pay the price.
DOUG MCVAY: All right. You've just heard Jennifer Burbank Roch and Mark Miller talking about the drug consumer safety rules. They were speaking at a Patients Out of Time conference in Portland, Oregon, in 2014. Full disclosure: I work with Patients Out of Time, doing website and social media.
May Ten through Twelve, Patients Out of Time holds its Twelfth National Clinical Conference on Cannabis Therapeutics in Jersey City. Plenty of information about that at PatientsOutofTime.org, and some terrific presentations there, too.
Now, before we go, while we have a few minutes, in New York City, Mayor Bill De Blasio has backed the idea of having a supervised injection facility in the city of Manhattan. Actually, several sites. Details are still coming out. These plans are all very tentative. They're going to need a lot of support to make it all happen, but the health department of New York City has finally released its report on supervised injection. They're finding that a program could prevent well over a hundred overdose deaths each year.
Now, a hundred people, with all these thousands dying, you may think, oh, but that's so few. But you know, if it's your brother, or your sister, or your mother, or your child, your spouse, your dear friend, then by god, it's worth the effort. It's worth the cost.
Again, De Blasio's plan still has some hurdles to go through. It's going to take a while before this works. What they're looking at is the possibility of a one year pilot program in Brooklyn, midtown, Washington Heights, and in the Bronx. There are needle exchanges at each proposed site, and there's already a nonprofit doing these, so, in a way, we're simply expanding the service offerings that are already being provided.
It would be private funding through nonprofits, so there's no tax dollars going to it, which is sad, really, because, you know, if there's a kind of program out there that deserves public support, it's harm reduction and supervised injection. So New York City has now entered the race to see which city, which county in the United States will be the first to have its own supervised injection facility.
The federal government has already spoken through various US attorneys, saying that that would be against the law and we won't have that. And you know what? They said the same thing about medical marijuana in the 1990s. The thing about harm reduction is that sometimes you have to get ahead of the law. When it comes to the choice of either blindly obeying a stupid, outdated, and completely wrongheaded rule and letting people die, or doing something that breaks the law that saves a life. There's not really a choice there, is there?
I didn't think so either. So New York City, thank you. And to all the people who worked so hard to make this happen, bless you, thank you so much.
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.