When it Comes to Good Drug Policy, Science Should Trump Law

Marijuana makes people say the craziest things. Not the people using the drug — though, of course, those people spout plenty of cloud-brained iotas of wisdom in the moment. No, it’s the people looking to make marijuana seem like a lethal toxin, however sober they may be in their attempts at reason, who are responsible for a dizzyingly contradictory litany of statements about the ill effects of the drug.

Marijuana is, all at once: a highly lethal drug that kills in seconds (see the image below), a laziness-inducing plant that will turn a generation of people into lethargic automatons, a fire-stoking drug that will lead to people being killed by those high on it, a drug so addictive that one can’t help but toke up at any given second, and a drug that isn’t that “hard” but does lead to use of other drugs. Marijuana makes people go insane, and it makes people lazy. It’s unavoidably addictive, and not that bad (but even though it’s not that bad, it’s nonetheless a dangerous gateway). Surely, a drug that inspires such a cornucopia of symptoms must be the kind of substance that merits Schedule I status, the legal category in the United States reserved for the most lethal drugs. But when you look to the five schedules of the Controlled Substances Act of 1970 (CSA), a surprising classification scheme reveals itself.

The CSA orders the five “Schedules” of drugs based on four criteria (note that the CSA scheduling applies to drugs and “other substances,” but for the purposes of this article drugs will be the focus):

  1. Potential for Abuse: Does the drug act in human bodies in such a way as to encourage users to abuse the drug for purposes other than is intended?
  2. Safety: Is the drug safe for human beings to ingest?
  3. Addiction: How likely is it that users will get addicted to this drug?
  4. Legitimate Medical Use: Even if the drug has some harm (and, of course, all drugs have side effects), is there a medical purpose for it that outweighs any externalities?

The layout of the five CSA schedules, based on the principles above, looks like this:

  • Schedule I: Reserved for drugs/substances that have a high potential for abuse, have no legitimate medical use, and no safe conditions under which to be taken.
  • Schedule II: Reserved for drugs/substances that have a high potential for abuse, have some legitimate medical use in a tightly controlled series of circumstances, and a high potential for addiction.
  • Schedule III: Reserved for drugs/substances that have lower potential for abuse than Schedule I and II, an understood medical usage, and a lower likelihood of addiction than Schedule I and II drugs.
  • Schedule IV: Reserved for drugs/substances whose potential for abuse is lower than Schedule III drugs, an understood medical usage, and lower potentiality for addiction than Schedule III drugs.
  • Schedule V: Reserved for drugs/substance with a low potential for abuse, currently accepted medical purposes, and limited potentiality for addiction.

Those unfamiliar with this scheduling might guess that marijuana ends up on the upper register — Schedule III at the very least. But what surprise those people will have when they find out that marijuana is listed as a Schedule I drug, which means that it has no accepted medical usage, odd given that medical marijuana establishments are becoming more common across the United States. Moreover, even those adamantly opposed to marijuana’s legalization would be hard pressed to say that marijuana is the most addictive drug.

The absurdity of marijuana’s place on the CSA schedules becomes more apparent when one looks at how other drugs fit into the classification scheme. The drug categorizations below are not comprehensive, but instead consist of a sampling of some popular legal and illegal drugs:

  • Schedule I: Diacetylmorphine (heroin), Lysergic acid diethylamide (LSD), marijuana, MDMA (Ecstasy)
  • Schedule II: Adderall, demerol, cocaine, methadone, fentanyl, ritalin
  • Schedule III: Drugs with <15mg of hydrocodone per dose (Vicodin), ketamine, drugs with <90mg of codeine per dose (codeine)
  • Schedule IV: Ambien, valium, Xanax
  • Schedule V: Cough medicines with <200mg of codeine, Lyrica, motofen

That’s right: according the United States federal government, cocaine and methamphetamine are less dangerous and more medically useful than marijuana. It turns out Walter White should have taken to growing a marijuana farm on Breaking Bad, rather than devising his signature blue methamphetamine: weed is the real danger.

Walt thought he was the danger… but it was actually marijuana all along (Source: AMC)

Now, some clarification: yes, cocaine and methamphetamine have or continue to serve medical purposes. Medically prescribed varieties of methamphetamine, such as Adderall and Ritalin, help those with mental disorders like Attention Deficit Disorder (ADD) and Attention Hyper-Deficit Disorder (ADHD). Small amounts of cocaine are used in topical anesthetics, where the drug also exhibits its vasoconstrictive (blood flow shrinking) benefits. Back when Coca-Cola was first introduced in the 20th century, the coca plant from which cocaine is derived counted itself among the ingredient list of the now world-famous soda. As is the case with many drugs, cocaine conjures up specific images that belie its wide and sometimes, however insane it may seem, acceptable medical use.

The CSA ushered in the age of America’s “War on Drugs,” a government-sponsored crackdown on certain types of drugs with the five schedules as its regulatory mechanism. As such, many of our present-day stereotypes about drugs derive not from scientific and medical facts, but rather the particular view of the US government in regulating those drugs. (These common misconceptions were recently the subject of an episode of the popular TV “comedy debunking” series Adam Ruins Everything.) No drug better represents the oddities of the CSA better than marijuana, a drug that has some undeniable side effects but kills far fewer people than other substances that are either on lower CSA schedules or are completely legal. Tobacco, a legal but highly regulated substance, can be bought at gas stations and grocery stores across, yet it has no proven medical benefits and kills nearly a half a million people per year in the US, according to the Centers for Disease Control (CDC). Ironically enough, upon scrutiny the only way to justify current US drug law is to be in an altered mental state of some kind.

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Drug and Substance Deaths in the United States by Type

The CDC attributes 88,000 deaths and 2.5 million years of life lost to overconsumption of alcohol, based on statistics from 2006-2010. 1 in 10 deaths can be linked to excessive alcohol consumption.
The CDC reports 480,000 deaths caused by tobacco per annum, a number that includes 41,000 secondhand smoke-caused deaths. Globally, tobacco smoking leads to around six million deaths.
In 2014, a study performed by German researchers for the journal Forensic Science International claims to have identified the first two deaths from marijuana use, caused ostensibly by cardiovascular issues. Other German doctors were quick to criticize the study, with the opposing consensus taking the view that “Deaths due to cannabis use are usually accidents that are not caused by the substance, but to the circumstances of use.” Whichever side of this debate is correct hardly matters, however, for the broad claim that marijuana has better safety numbers than most other drugs. If it took until 2014 to find the first two deaths by marijuana, when other drugs kill into the thousands each year, it’s clear that marijuana poses less of a medical risk. Marijuana overdose — a term whose validity remains suspect — has been the cause of zero reported deaths per CDC numbers.
A CDC study of drug overdoses from 2010-2014 cites cocaine as always in the top three causes of overdoses per year. The study also reports a steady increase in age-adjusted deaths by cocaine overdose, and that one in five drug overdoses involving heroin also involved cocaine.
A CDC study charts a rise in methamphetamine-caused overdose deaths, which doubled from 2010 (1,388) to 2014 (3,728).
Once marketed as a pain reliever much like prescription opioids such as Vicodin, heroin has become an increasing problem in the United States, reflected by the ongoing notion of an “opioid epidemic.” The CDC reports a quadrupling of heroin-related overdoses since 2010, with 13,000 individuals losing their lives to the drug in 2013. Crucially, three in four heroin users confess to having come to opioid addiction from medically prescribed pain medicines.
A doctor’s prescription pad does not come with a guarantee of life, particularly when it comes to highly addictive substances like opioids. In a piece for The Washington Post, Keith Humphreys notes that “medical use” and “dangerousness” do not exist on a single continuum, where more medically safe drugs are not dangerous, and more dangerous drugs have less medical usage. “Prescription opioids are highly effective for easing the pain of cancer patients, yet also kill more Americans each year than all Schedule I drugs combined,” Humphreys writes. 183,000 deaths have occurred from 1999-2015 due to prescription opioid overdose, according to the CDC, which also lists the striking statistic that almost half of all drug overdoses come from prescribed pain pills.

(Mis)conceptions about drugs like these make the fundamental task of good drug law extremely difficult: thinking about these things as substances, with chemical compositions, interactions, and effects. The marijuana plant and the poppy plant (from which we derive opioids) do not exist in nature as “drugs”; that term is bestowed upon them by humans when they discover that those plants can make them feel good. And while the notion of a “drug” has merit, and accurately describes the range of effects brought about by the ingestion of things like marijuana buds, the term evolved into being its own category, as seemingly natural as “plant” or “seed.”

In public consciousness, marijuana and cocaine get treated as “bad drugs” but pills given to a patient by a doctor must inherently be “good drugs.” Chemically, however, the distinction between crystal meth — i.e. the stuff people get thrown into jail for — and prescription drugs like Adderall is quite small, if nonexistent in some cases. You can manufacture speed (as methamphetamine is sometimes called) into small pills, put those pills into bottles, and have a licensed doctor give that bottle to a patient, but nowhere in that process does the speed stop being speed. The scientific and colloquial names for drugs should not be the first thing people think of when discussing drug policy; the terms of science, not the War on Drugs, should set the debates.

When you switch to thinking about marijuana from the perspective of a Richard Linklater movie to a scientist, the deep misunderstandings about the drug caused by US government, it’s not long before you see that priorities need to be seriously reordered. Marijuana does have side effects, as any drug does, but its destructive powers pale in comparison to the body-destroying harm caused by heroin and tobacco — which is to say, it doesn’t have much by way of destructive power. The popular claim about marijuana being a “gateway drug” makes even less sense, for the chemical composition of marijuana differs from opioids like heroin and hydrocodone. Cannabis and opiates are not substitutes; their effects on the human body are not the same, and even though someone who smokes a pot (marijuana) joint and someone who injects heroin into his veins would both say they are “getting high,” the highs come from contrasting places, due to contrasting mechanisms of interaction with the body. Anyone with an ailment that causes chronic pain will find a more accessible gateway through their state-approved doctor, who with a few scribbles of a pen can prescribe an opioid painkiller that, as mentioned in the death statistics above, three out of four heroin users became dependent upon before taking up heroin.

This graph shows an increasing mortality from opioid drugs both legal and illegal. The National Institutes of Health has no such graph for marijuana related overdose deaths, as none have ever happened in the United States. (Source: National Institute on Drug Abuse, USA)

To be sure, marijuana’s relative harmlessness and lower risk for dependency compared to opioids does not necessarily mean that it should be available right next to the Slurpee machine at the local 7-11. Plenty of scientific research needs to take place before sound policy is made, though it should be stressed that whatever policy comes to pass, it can’t be the ones in place in the status quo, which lock people up for decades for either possessing or consuming a drug which medically speaking does less harm to them and others than tobacco. However, in the United States such research proves near impossible to do at the massive scale required to get a robust sample size for a study, all thanks to the CSA’s five schedules. According to the dictates of the CSA, anyone wanting to research a Schedule I drug can only use a small amount of the drug, and the drug must be procured and delivered by the federal government. Predictably, the US federal government is a stingy dealer when it comes to Schedule I drugs. Until the US either seriously overhauls or completely rewrites the CSA, marijuana remains locked in the Schedule I category, and thus out of reach for US researchers. And before anyone suggests that US scientists could present the findings of foreign research on marijuana, studied in countries where the drug is legal in some capacity, let’s remember that a thing called American exceptionalism exists.

For anyone who believes in doing good research, presenting that research to the public, and then trying to follow up on that research, the CSA drug schedules represent pure madness. The scientific rationales for why some drugs pass the “accepted medical use” test while other’s don’t remain unclear, yet the law is codified and has been enforced for over 40 years. It’s not going anywhere. The more we find out about the layout of the CSA schedules, the more we realize they are wrong, and yet little can be done about it. Years of lobbying and policy change at the state level — such as those new laws in Oregon, Washington, California, and Colorado, which have legalized marijuana to some extent — should build up momentum to help convince the US federal government that the CSA relies on outdated and unsophisticated notions of what makes a drug dangerous and/or “medically useful.”

But if the US government is slow to change on drug policy, the rest of us need not live with the five schedule mentality. The rising opiate epidemic in the United States should wake everyone up to the dangers of the pills they sometimes get from a nice pharmacy tech at a local Walgreens. S/he doesn’t look anything like what people think of when the use the phrase “drug dealer,” but the substance s/he’s giving you can veer close to something that you’d be arrested and locked up for trying to buy in a dark alley. Where policy remains obstinately fixed, people must take on the task of knowing the dangers of all drugs and substances on their own terms, not on the terms of a piece of federal legislation so outdated scientifically as to be laughable.

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