Wednesday, November 26, 2008

Detecting cannabis intoxicated drivers

One of the important features of an effective drug control policy is the ability to detect drivers who are actually impaired by a drug. We can confidently distribute alcohol to the universe of adults because we can punish those who misuse alcohol by driving while impaired by alcohol.

Purdue University issued a press release in August 2008 that said that Purdue personnel and a business were forming a new business (Intelimmune LLC) to detect the actual presence of THC in the body. We all know that there is a very big space between a press release about the intent to do something that involves scientific research, peer review publication, product engineering, testing and approval of the scientific instrument, successful marketing, and actual use on the street. This is still a ways out.

But we should wish them Godspeed. An accurate measure of impairment linked directly to the neurologically active quantity of THC, and other relevant cannabinoids, would be an important feature in building public acceptance of legal, responsible cannabis use.

Accurate measures of alcohol ingestion correlated to measures of impairment means that our society is comfortable allowing Americans to consume alcohol, because we are a society that travels by car. We have an objective tool to discriminate between those whose drinking has not degraded their ability to drive a car below a minimum standard, and those whose drinking has done so. Implicit in this policy is the belief that there is a fairly standard correlation between quantity detectable in the blood and the degree of impairment. (Whether there is a similar curve for cannabis ingestion and the ability to operate an automobile is something we have yet to learn.)

The key point is that our society recognizes that many people drink modestly and then drive at some point thereafter, and we can sort out those whose drinking has been too great to permit them to be driving.

Effective drug policy requires accommodating this reality for other drugs too. The self-controlled social use of cannabis and other drugs will include mobility. It would be unrealistic to think that a legal cannabis policy would require that no one could drive for, let's say, twelve hours after ingesting cannabis.

A critical element of obtaining law enforcement buy-in, insurance company buy-in, auto safety advocate buy-in -- indeed buy-in by anyone who is not a cannabis user who also uses the roads, that is everybody -- is accurate impairment testing.

Impairment testing can either be performance based or based on a measure of drug quantity that has been tied experimentally to driver performance. Direct performance testing is the highest, most logical standard, as it applies to ability to drive regardless of the cause of impairment: tiredness, use of over-the-counter cough, cold or allergy medication, other legal medication, age, disease, etc. We use the much more subjective approach of the field test by the side of the road of performance impairment: reciting the alphabet backwards, and physical tests such as touching one's nose with a finger or testing balance by walking in an unusual manner (i.e., heel to toe).

Our society believes that there is a direct correlation between the blood alcohol concentration (BAC) and impairment. We believe that this is sufficiently true in order to impose criminal liability for driving while impaired based upon the evidence of the BAC. We believe that the instruments used to measure BAC -- such as the Breathalyzer that "estimates" the BAC based upon the alcohol concentration in exhaled air -- are sufficiently accurate that we consider this evidence to be "objective" and more reliable than the visual field test of a police officer.
Currently, there is a consensus in our society and the courts that the "objective" approach to detect alcohol-induced impairment the relies upon the blood alcohol concentration standard is satisfactory. It may be that lawyers and scientists will challenge this consensus.

To the extent our society remains committed to this kind of "objective" measure, the Intelimmune concept sounds like it is taking the science in the right direction.

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Peter R. Orszag to direct OMB

The selection of Peter R. Orszag to direct the Office of Management and Budget has very interesting implications for the effective drug policy movement. Orszag has been charged with finding real budgetary savings. Orszag is committed to evidence-based policy, which is the antithesis of the damn-the-evidence, full speed crusade that has driven drug enforcement for decades.

In particular, Orszag has a specialty in health care economics. Substance abuse -- tobacco addiction, alcohol misuse, and drug misuse -- has big costs, but we know that in many respects these costs are a consequence of prohibition: the society's failure to effectively control the quality of drugs, their distribution, the appropriate and necessary education in the use of drugs, and the costs of lost productivity from criminal justice intervention and incarceration.

Recently Orszag lectured at Harvard. In his blog, he characterized the theme of his talk

Greater emphasis on the psychological and sociological influences on human health could lead to improvements in many areas of health care and medicine.

OMB plays a major role in setting policy for all federal agencies. In domestic policy especially it helps keep the various agencies in sync. This appointment looks like good news for those of looking for a smarter drug control regime.

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Monday, November 17, 2008

Public health study shows addiction going down without arrests and jail; public employee unions should ask questions

Paul Armentano from NORML has noted on the prestigious Congress Blog at The Hill, one of the newspapers that specializes in covering Capitol Hill and politics, that a new CDC report shows that the prevalence of cigarette smoking has dropped below twenty percent!

Paul contrasts the dramatic decline in cigarette use since the 1960s with the increase in marijuana use, and concludes,

If federal lawmakers truly wished to address marijuana use, they would take a page from their successful campaign to reduce the use of cigarettes. This would include taxing and regulating cannabis with the drug’s sale and use restricted to specific markets and consumers.

One factor helping to reduce cigarette addiction has been increased tobacco taxes. Apropos of taxation, and the fiscal crisis facing states, counties and cities across the nation:

Before the nation's governors, mayors and county executives propose furloughing or laying off police officers, school teachers, sanitation workers, doctors, nurses, psychiatrists, social workers, and recreation aides who care for our family members and protect public safety, there is one question that the public employee unions should demand answered: How much revenue from marijuana taxation are they throwing away in order to sacrifice those jobs and the families of public employees?

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Friday, November 14, 2008

Physician sentenced to 1500 lashes and 14 years in prison

A physician who treated members of the Saudi royal family for over 20 years has been sentenced to 1500 lashes and 14 years imprisonment for causing a Saudi princess to become addicted. He is to be whipped 70 times per week every week for roughly half a year.

Raouf Amin el-Arabi is a physician from Egypt. He originally was sentenced to 750 lashes and a 7 year sentence by the trial court, but the appellate court doubled his sentence, punishing him for exercising his right to appeal.

If this were an ordinary medical malpractice case, this extraordinary punishment would never be considered. Dr. Amin is a victim of the hysteria around drugs.

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Wednesday, November 05, 2008

Morning-after Question: Who will be the Obama Administration's drug policy appointees?

In this morning's inbox:

I assume that you know the process by which the short lists for the new heads of ONDCP, DEA, NIDA, etc. will be formulated.
Do you know who will be compiling those lists, i.e. who has the task of planning for the formulation of drug policy in this administration?

This morning, few outside the campaign know yet the answers to these questions.

Drug policy and the drug policy chiefs are low priority. There is no urgency to fill these positions from the public or political realm.

A transition team will be appointed. There are likely to be two aspects of this.

First, there is likely to be a public transition process that may have some number of experts appointed to "study" the issue, and make recommendations. This is to give the concerned groups a focus for their concerns, and to demonstrate that no issue is being ignored. Clinton did this. Concerned groups of all kinds are completing their transition documents right now. A coalition of advocates of criminal justice reform is finishing their agenda catalogue and will post it here soon.

The second process is the real process which is likely to ignore the public process. The new White House personnel team will consult with political constituencies that are important to Obama, which will include appropriate key Members of Congress, and perhaps funders, and consider these appointments in a very large matrix that involves balancing paying back political debts, appeasing political pressure groups, finding a leadership team for the various agencies, and giving the best appearance of choosing "qualified" persons.

Selecting appointees is a higher priority than making any policy decisions. First, it is easier for the media to count up "unfilled" positions and blame the new Administration for being "slow" to fill vacancies. Second, because few policy changes are without political costs, most changes will require extensive preparation of the public. The possible exceptions might be medical marijuana and sterile syringe exchange which have large public support.

The three agencies and the agency chiefs are likely to be considered by three different teams: White House team, Justice department team, and a HHS team. For each of these teams, drug policy and drug agency heads are going to be lower profile, lower priority appointments.

For the Administration and the nation, the economic appointments and the national security appointments are going to be the top priority. Then there are a host of other issues and the agencies that deal with them that are much higher priority than drug policy.

Various groups in Washington and around the country will start trying to influence these decisions by assembling their own lists of suggested appointees and forwarding them to the press and to persons who know people close to or inside the new Administration.

I would not be looking for an announcement of a nominee to be the ONDCP director until the Spring. DEA can operate with an acting director, likely to be a career DEA manager, for a long time, as can NIDA. The decision of DEA Administrator won't come before a new Attorney General has time to orient himself or herself.

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