Cannabinomics: The Marijuana Policy Tipping Point (BOOK REVIEW)

Drug War Chronicle Book Review: "Cannabinomics: The Marijuana Policy Tipping Point," by Christopher Glenn Fichtner, MD (2010, Well Mind Press, 345 pp., $29.95 HB)

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Cannabinomics? That is simply Chris Fichtner's eye-grabbing term for managing our relationship with cannabis. Or it is cannabis science, cannabis policy, and cannabis economics. Or, more broadly, it is the development of the vocabulary that will allow us to move from pot prohibition to regulation.


I read lots and lots of books about marijuana policy -- it's part of my job -- and I have to say that Cannabinomics is one of the most gratifying I've seen in a long time. While Fichtner covers a lot of familiar territory -- the increasing acceptance of medical marijuana, the amazing stupidity of and harms derived from pot prohibition, the economic potential of marijuana -- he does so in a manner that is both fresh and exceedingly well thought out.

Fichtner is an MD, a psychiatrist, and public mental health specialist who has served, among other posts, as the Illinois state mental health director. As such, he brings a powerful professional focus to marijuana and health and marijuana and mental health. But equally as valuable, he brings with him a calm, considered, and compassionate approach to the Gordian Knot of issues that surround cannabis in our society.

In fact, I would have to say that if I had to choose a single title dealing with marijuana policy to give to  someone new to the conversation, I'd have to go with Cannabinomics. Fichtner is cautious and even-handed -- he is, after all, a psychiatrist, not a wild-eyed pamphleteer -- and that makes his carefully considered judgments all the more powerful.

As a practicing psychiatrist, Fichtner has had ample opportunity to see how medical marijuana (or, as he prefers, therapeutic cannabis) has worked for some of his patients. Cannabinomics includes several abbreviated case histories of patients who, on their own, turned to medical marijuana to relieve symptoms ranging from epileptic seizures to depression to PTSD. That provides him with an opportunity to tout "consumer-driven health care" -- in other words, listening to patients about what actually works for them.

That is at odds with the prevailing model of scientific research on medicines, which relies on rigorous, large sample, carefully-designed testing. As Fichtner notes, there is nothing wrong with such testing, but it should not be exclusively relied on at the expense of real world patient experience. If a patient reports that carefully titrated use of marijuana reduces the frequency of his seizures, it does no one any good to retort that such findings are not supported by the scientific data.

Of course, marijuana is funny that way. It's not a medicine in the eyes of Western medicine because it's not a synthesized and standardized concoction available in pill form from a major pharmaceutical company. In fact, Fichtner suggests that perhaps marijuana should not be treated as a medicine but as an herbal, or traditional medicine. He also wonders, quite convincingly, whether health care in the US is driven more by the needs of pharmaceutical companies than those of human beings.

But while Cannabinomics begins with medical marijuana, it isn't just about medical marijuana. Fichtner also discusses the history and results of marijuana prohibition in the US. Unsurprisingly, like every even-handed observer on the topic, he finds prohibition to be a disaster, both in terms of public policy and in terms of wasted opportunities. He doesn't cover a lot of new ground there, but he does calmly and dispassionately make the case that pot prohibition is one of the great policy failures of the 20th Century.

He doesn’t want it to be one of the great policy failures of the 21st Century, and the final section o Cannabinomics is devoted to getting us off the schneid when it comes to actually enacting real marijuana law reform. Fichtner has some concrete recommendations for that: a federal cannabis regulatory commission, the federal government to become a cannabis purchaser, a pilot program granting veterans access to medical marijuana through the VA, fast-track approval of Sativex, opening the cannabis trade to legal entrepreneurship, and allowing the states to experiment with new licensing processes for age-restricted substances, including alcohol and tobacco.

Cannabinomics is a humane, thoughtful, and powerful look at how we as a society can better deal with one of our most popular -- and least harmful -- substances. It should be especially useful in bringing those who are not pot advocates but who have a genuine concern about what the best marijuana policies might look like into the discussion. And that makes it a very important work indeed.

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Another reason pure marijuana isn't a medicine to big pharma

Is that it's so cheap to grow they can't make megabucks out of it and it threatens who knows how many of their toxic side effect ridden cash cows. When that association of California alcohol dealers was so bold as to openly give money to the no on 19 campaign in California, they gave the game away.

Can you imagine what Jesus would say about pharmaceutical companies that run from the cure because all they worship is the almighty $? Or drug (alcohol) dealers who suppress far safer competition for the same slimy reason?

A pilot program allowing VA patients to use medicinal marijuana is an interesting idea. Veterans who need to use MMJ have a lot more status in Washington DC than other folks who need to use it, who generally don't exist in Washington DC's eyes. But Obama is turning into a huge disappointment (why won't he reschedule cannabis when he knows damn well it has important medicinal uses!), he seems puzzlingly under the thumb of the drug warriors. And unless Gary Johnson can shake things up, the Repubs if they win in 2012 look set to march us backwards. 

I'd like to see veterans organizing to push the government to let them use cannabis when medically indicated. It would be a useful project to assemble the testimony of veterans (unlike us, people who exist to the pols in DC and state capitals) who found medicinal marijuana beneficial, especially those for whom it was vital. The reprobates could be challenged to read this, and properly rebuked when they refuse. Cold hearted bastards.

It sounds like the reviewer

It sounds like the reviewer was enraptured by this book, and its sappy title sounds like the gobbledygook one generally expects from psychiatrists, so accustomed to obfuscation that even when one trying to be sincere it still sounds suspect (in this case an unoriginal capitalizing on the blockbuster book Freakonomics). However, it is notable that the author is taking a civil libertarian view of cannabis use, and hails from Illinois, where medical cannabis is looming large (what action will he personally take on medical cannabis in his own state?) However, with only the most minuscule exceptions, psychiatrists are not the people to look to when thinking about social policy, since their own profession has been an unending barrage of human rights abuses and outright lies. One must therefore be chary when listening to them about issues of public health, since behind it all is their own agenda: to be "judge, jury and turnkey" of the individual's consciousness.

reply to dougey

"However, with only the most minuscule exceptions, psychiatrists are not the people to look to when thinking about social policy, since their own profession has been an unending barrage of human rights abuses and outright lies."

While I share your views about psychiatry in general, I see nothing in what you have written to indicate that Dr. Fishtner is not one of the "miniscule exceptions." Indeed, that he would author this book indicates that he is.

I have read nothing in the book that is obfuscatory. The interview I watched on YouTube presents a reasonable, articulate, and learned person stating why we are at a tipping point in marijuana policy in this country.

When a board certified physician like Dr. Fishtner takes a public stand, how does it further the reform movement to discount what he says on the basis of his medical specialty over what he actually says? He deserves our thanks and support. That is probably why the reviewer seemed "enraptured."

 

Cannabis Plant

First and foremost, Cannabis prohibition is an act of lunacy. The U.S.A. government is like Hermann Goering trying to convince Hitler that the allies will be defeated before they reach German airspace. This " drug free america " garbage is just that. Trash. How hard would it be for Pres. Obama to score some CIA LSD ? Some good LSD . Pres. Obama and his wife would have the best sex they`ve had in a long time , I assure you . To bad the cowards in congress live in a bubble and can`t see the reality that surrounds them.

Wondering about Sativex as a single-cannabinoid medication

My understanding of Sativex is that it only contains the cannabinoid CBD.  CBD is not at all that common in most cannabis samples.  However, it's also my understanding that CBD works best for pain managment when it's paired with a somewhat similar amount of THC, or something close to a 1:1 ratio of THC to CBD.

The currently available synthetic THC (drabinol or whatever it's called)  fails due the single molecule approach.  Will the single molecule approach of CBD (Sativex) really match or exceed the therapeutic effects of the whole herb?  Just wondering.

And, how about the cost of producing and packaging Sativex compared to say a cannabis tincture.  How do they compare in cost and efficacy?

Sativex is a whole plant

Sativex is a whole plant extract of cannabis.  It contains at least 60 different cannabinoids as naturally occur in the plant.

It is in fact a blend of two different strains, gently heated in alcohol to deliver an approx 1:1 ratio of THC to CBD.

Don't let Big Pharma fool you. It's just an old-fashioned tincture of cannabis

http://peterreynolds.wordpress.com/2010/10/19/the-truth-about-sativex/

Right Reverend Gregory Karl Davis's picture

Big Pharma is fooling us

It is my overstanding according to E.C. Danuel Quaintance (famous on the Internet and Court filings for being arrested with his wife Mary while transporting 172 pounds of marijuana in their car and making a religious use claim in defense), "I read the patent for Sativex. G W Pharma added ethyl glycol to the cannabis extracts to get their patent. You can't get a patent on a natural substance," an education was given during a telephone conversation before that fateful trip. "I don't get it," this commentator ignorantly responded.  "Ethyl glycol is anti freeze. They added a poison," that imprisoned prophet clued in this unrighteous steward one day. And now, the only legal grow in Great Britain is licensed by the Queen to the Germans for adding poison to medicine.

Let's not over-rate things please

@notspicoli I viewed the YouTube-posted interview with Dr. Fichtner you mentioned. He is indeed well informed on the issue of medical cannabis. Unfortunately, like a senator who sneaks in an inappropriate rider to a bill, he glibly interjected “mental illness” that old cash cow, and will-o’the-wisp into his discourse. Let’s be frank: “Mental Illness” is not a scientific concept, and, like water dowsing, exists in the realm of faith and willful imagination. There is no lab test for schizophrenia. No MRI scan for it. This is because “Mental Illness” has always been a social construction and will continue to be so as long as we empower men like Fichtner to preside over our own assessments of what is mental health. Sanctioning psychiatrists like Fichtner to intervene in social health matters can only lead to disaster. We don’t need Fichtner to explain to us the obvious failure of cannabis prohibition, and we should certainly not look to him for guidance on ancillary issues. The only use Fichtner can be is to change the opinions of his colleagues, who have shamefully maintained drug prohibition for decades to further their social standing despite the scientific evidence to the contrary, and, of course the pharmaceutical and insurance company kick-backs that furnish their delightful homes.

"Dougey"

This individual who calls himself Dougey only demonstrates that drug policy reformers may be as much characterized by ignorance and bigotry as the drug war perpetrators they work against.  I wish that were not the case.  Believe me, Dougey, I've read it all and can argue your own position better than you can (I just don't have time to do it here).  By the way, neither should you:  Your comments are a waste of energy, since I already know all your arguments (and they are fair enough, but really irrelevant to the much more important issues of civil rights and healthcare access).  In mental health, the issues with which you are preoccupied are just out of date; the more critical issue is not that "too many people are being locked up" (they actually are, but in prisons, not psychiatric hospitals), but that persons who seek access to mental health services often can't get them.  Come on, this is the 21st century (not the 19th)!

Reschedule, Regulate and Recreate

On the subject of Marijuana:

(1) Schedule I.—

(A) The drug or other substance has a high potential for abuse.

(B) The drug or other substance has no currently accepted medical use in treatment in the United States.

(C) There is a lack of accepted safety for use of the drug or other substance under medical supervision."

 No prescriptions may be written for Schedule I substances, and such substances are subject to production quotas by the DEA.

 Under the DEA's interpretation of the CSA, a drug does not necessarily have to have the same abuse potential as heroin or cocaine to merit placement in Schedule I (in fact, cocaine is currently a Schedule II drug due to limited medical use):

 When it comes to a drug that is currently listed in schedule I, if it is undisputed that such drug has no currently accepted medical use in treatment in the United States and a lack of accepted safety for use under medical supervision, and it is further undisputed that the drug has at least some potential for abuse sufficient to warrant control under the CSA, the drug must remain in schedule I. In such circumstances, placement of the drug in schedules II through V would conflict with the CSA since such drug would not meet the criterion of "a currently accepted medical use in treatment in the United States." 21 USC 812(b).[21]

As any well informed individual can readily see, Marijuana does not meet the requirements for placement on Schedule I's list.  It was done so purely at the whim of the Federal Government to eliminate competition in the Paper Industry and many other areas, Pharmaceuticals being one in particular.

mistake

The statement above, "No prescriptions may be written for Schedule I substances," is flat wrong.  You and anybody else can write such a prescription any time you want.  The statement could be corrected by replacing the word "written" with "filled". ",""

mistake

The statement above, "No prescriptions may be written for Schedule I substances," is untrue.  You and anybody else can write such a prescription any time you want.  The statement could be corrected by changing the word "written" to "filled".

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