10/31/18 Lawrence Pasternack

Lawrence Pasternack, Prof at Okla State University re new medical marijuana laws, from Harm Reduction Conference Cory Escovedo of St Jamees Infirmary & Colin Dwyer of Opiate Crisis Response Fund.

Cultural Baggage Radio Show
Wednesday, October 31, 2018



OCTOBER 31, 2018


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, this is Dean Becker, the Reverend Most High. Thank you for being with us for this edition of Cultural Baggage. A little bit later we'll have more from New Orleans and the Twelfth National Harm Reduction Conference, but first up, I want to share with you how well things are going for medical marijuana in the state of Oklahoma.

LAWRENCE PASTERNAK: My name is Lawrence Pasternak. I'm a professor at Oklahoma State University, a professor of philosophy, and got involved in the medical marijuana movement around, close to a year ago. What I do with regards to medical marijuana issues in the state does not reflect on my -- on Oklahoma State University, I'm not representing the University in any regard.

I began just simply getting curious, you know, I don't have any professional background in these issues. Just started to read, and involve myself in discussions, wrote a number of editorials through state newspapers, the Oklahoman, the Tulsa World, and others, and that drew attention to me from various advocates, and they started to invite me to events.

Eventually, I got invited to meet with the Marijuana Working Group at the Department of Health, and spoke with them on a number of occasions as they were working through issues, and then was invited to be part of the drafting committee for a supplementary bill to expand on our state measure, and also was invited to present, provide testimony, before a state legislative [inaudible].

DEAN BECKER: Well, Lawrence, that's quite a lot of feathers in your cap for about a year's worth of knowledge or, you know, involvement.

I want to say this, you know, I live in Texas, and for, hell, decades, I guess, it was debated who would be first to go legal on either marijuana or medical marijuana, between Oklahoma and Texas, and Texas has a -- almost has a law, I don't know how to say it, that there's about a handful of kids that will get CBD medicine, but you've got to jump through so many hoops, go to two different doctors, try every pill in the world.

But what Oklahoma has done, insofar as medical, as best I understand it, beats what California did back in the day. It's a much better situation than they had before they went legal. Tell us what's going on in Oklahoma, what is the situation on medical marijuana?

LAWRENCE PASTERNAK: June 26, the state passed by 57 percent during our primary election, passed a medical marijuana measure. There are a few unique aspects to that measure, one of which, perhaps the most controversial of which, was that unlike most states, which have listed qualifying conditions that its patients are only eligible if they have certain conditions -- multiple sclerosis and so on -- we had no qualifying conditions.

Instead, it was left to the physician to make a determination. Now, on paper, that actually looks very different than many other medical states, but in practice it's not necessarily so. A number of medical states, including California, at least before they went recreational, California had in their language, in addition to qualifying conditions, they also had a statement, something to the effect of, or any other medical condition for which a physician regards marijuana as potentially beneficial.

A number of other states with qualifying conditions had that kind of language, and certainly there were states that had very lengthy lists of qualifying conditions in theory, you know, a physician could get a patient into one or another of those conditions.

Chronic pain, for instance. Roughly eighty percent of all medical marijuana patients around the state -- around the nation are registered for chronic pain, and sometimes, you know, there's an objective basis for it. You know, you might have an x-ray of somebody's spine and so on, sometimes there is no objective basis.

So in theory, any individual potentially could get a medical marijuana in just about any state where they have a program. Oklahoma, in a sense, understanding this to be kind of an artifice, in many instances, well, why create that additional burden? Allow the physician to make a responsible decision, based upon medical research.

So one way in which, like I said, on paper we're unique, is we don't have qualifying conditions, but in practice, well, my thought is that in just about any state, just about any patient could potentially get a medical marijuana card, so the same would be true here.

In other states, California for instance, and Maine, before they went recreational, they had about 3.5 percent enrollment in their medical marijuana programs. And so right now in Oklahoma, it's well below one percent, you know, the program is just starting out. So, my guess is that in a matter of a year to two years, Oklahoma will likely reach the numbers similar to what we saw in California and in Maine, three and a half percent, give or take.

Which would mean, in our population, that would be, oh let's ballpark it at 130,000 people in the state.


LAWRENCE PASTERNAK: Who could potentially have -- who would like to have these cards.

DEAN BECKER: Now, there are other liberties afforded through the Oklahoma laws, or situation, and a couple I want to address, one is that it's allowed to be smoked anywhere that tobacco cigarettes are smoked. Is that correct?

LAWRENCE PASTERNAK: That's right. Basically, usage tracks with the existing smoking law, and, with a few qualifications. One qualification is, even though this is not directly stated in statute, one takes it as implied that one can't consume it in one's vehicle.

And so, just as for instance there can't be an open container of alcohol, in the cabin portion of a vehicle, so likewise there can't be available marijuana in the cabin portion.

DEAN BECKER: Well, that seems fair enough, I would think. And then the other one is that it would allow for reciprocal acknowledgment, whatever you call it, if you have a doctor's recommendation in another state, that you could then use that same certificate as justification for being a medical patient in Oklahoma. Correct?

LAWRENCE PASTERNAK: Yes, sort of. It still requires the visitor to the state to apply for a temporary permit.

DEAN BECKER: They probably have restrictions on how many plants one can grow, but most anyone who has the recommendation can grow. Right?

LAWRENCE PASTERNAK: So, in Oklahoma, the permit is -- the permitted amount is six mature plants, and six seedlings. So, twelve plants, only six of which can be flowering.

DEAN BECKER: There is now a perspective in Oklahoma that no longer vilifies medical patients, that has taken a step back from hundred year prohibition to just take another snapshot. Right?

LAWRENCE PASTERNAK: Yeah, and, you know, during the campaign for State Question 788, our medical marijuana question, during that campaign, one saw basically the -- the executive board of the state medical association, I don't think it necessarily reflected rank and file physicians, but the executive board of the state medical association, the oil and gas industry, certain religiously conservative leaders in the state, opposing medical marijuana.

And, now, I think that there is a changing attitude, you know, very quickly, in fact. And part of my sense is that there's a -- there's a sense of a threat or an intimidation, a changing paradigm, that people were afraid of, because it's not simply just that it's marijuana. Marijuana symbolizes so much. Right? That, you know, we've had a political divide in this nation for decades, and marijuana all the way from the 1960s onwards reflected the left, opposition to marijuana reflected the right.

And so, Oklahoma being a conservative state, many of those on the right thought that it was a threat to their ideology. It wasn't necessarily that they would even oppose marijuana, well some might, but still, I think that a lot of the energy, a lot of the emotion there, had to do with its symbolic representation of a political divide in this nation. Sort of giving ground to the enemy, I think, was part of what fueled the opposition.

The OSMA, the state medical association, hosted an event last week. There were approximately four hundred physicians who attended. I attended as well, and there was a day of presentations, and overall the presentations were very favorable towards marijuana, looking at its pharmacology, looking at its history, looking at the law, and so on.

And the presenters overall, and this was hosted by, it was organized by one of the entities that during the campaign opposed, vehemently opposed it. Nonetheless, you know, the program itself was positive towards it, and the audience was very positive towards it.

Just as one example, state statute doesn't prohibit physicians who lack national certification for recommending marijuana. State statute has, requires, obviously, that physicians are licensed by a state board. It doesn't require that they have any national certification, that they're not a member of a national board.

For some reason, the Department of Health misunderstood, at least in my opinion misunderstood State Question 788, and required that any physician who recommends marijuana has to have a national certification, you know, whatever it is. Hematology or whatever, they have to have some kind of national board certification, in order to recommend marijuana. This is arbitrary, it doesn't reflect statute, but nonetheless, the Department of Health required it.

And when that issue was brought up during the meeting, there was an uproar among the audience, you know, all these physicians, roughly 400 physicians in the audience started to yell at the speaker, outraged. The speaker was from the department of health.

Outraged, at this arbitrary addition to the regulations, because it's preventing many of them, who don't have a national specialty, roughly 25, 30 percent of physicians, like a family physician, for instance, may not have a national specialty, preventing them from being a recommender.

And, you know, that reflects to me the perspective of the rank and file physician. They're interested in if it's an option for their patients. So, you know, already in a matter of just a few months after the election, I think we are seeing surprising levels of, not simply just tolerance or accepting from the standpoint of those who might have formerly opposed it, but enthusiasm.

DEAN BECKER: The knowledge is just being recognized, it has been kind of forbidden for decades now. Would you agree with that thought?

LAWRENCE PASTERNAK: The way I would put it is the following, that most of the research done with regards to marijuana in the 1970s and '80s, at least particularly in the United States, was funded by federal agencies whose goal was to show its harms. So they did everything they could, you know, tens of billions of dollars of financing, to try to establish a political truth that they wanted.

At the same time that the DEA was funding research on the harmful effects of marijuana, our own National Institute of Health was funding the medical benefits of marijuana in Israel. So the NIH actually funded the medical research in Israel that became the foundation for modern -- for the modern scientific understanding of marijuana.

Identifying its active ingredients, active compounds, how those compounds operate, it led Israel to be one of the first nations in the world, if not the first, you know, nation in the world to, in modern times, legalize it, so early 1990s, Israel legalized medical marijuana, at least in part because of US NIH funding establishing its medical benefits.

And then California followed suit roughly four years later, and then of course there's been a snowballing, a slow, you know, slow rate of growth, but snowballing effect across the nation. We have 31 states now, and in the late 1990s, there was a significant increase in medical research as we identified THC, as we identified CBD, as we identified the endocannabinoid system, our own natural -- our own body's natural cannabinoid system.

We produce cannabinoids in our bodies. Anandamine [sic: anandamide], 2-AG, it plays -- they both play a central role with regards to metabolic homeostasis. So, our body produces these natural cannabinoids that maintain homeostasis with regards to a whole array of systems in our body, and it's been discovered over time that a number of the medical conditions that marijuana treats are due to endocannabinoid deficiencies, are due to a lack of a homeostasis in our body, underlying, that is, deficiency with regards to our own body's production of an anandamine [sic: anandamide], for instance.

Multiple sclerosis, various inflammatory conditions, IBS, Crone's disease, even migraines, fibromyalgia, many of these have been identified as the consequence of a dysfunction within the endocannabinoid system, and marijuana is being recognized as basically like a replacement therapy.

Now, it works in a number of different ways for a number of different conditions, but, there has been this enormous increase in medical research from the late '90s onwards because of the discovery of the endocannabinoid system.

And so now we're looking at something in the order of 30,000 research articles on it. One of the physicians who presented before the legislature expressed frustration over the following circumstance.

She said that the problem that the medical community has is that all this literature is, as she puts it, a matter of apples and oranges and pears and grapes and carrots. That is, it was so eclectic that the medical establishment was having trouble getting their heads around it.

Well, understandably, those physicians here in Oklahoma and in other states where there is no medical program, who haven't read any of this research, to confront 30,000 research articles, how to start trying to figure out how to categorize it. And in this research there's a whole bunch of different study structures, and, you know, there are cohorts anywhere from just ten people all the way up to three thousand people, different products used, vape, smoke, different ratios of THC and CBD, and so sure, there's a whole array of very different types of studies out there.

But, you know, after you get beyond this intimidation factor, that here's a whole area of science that you don't know anything about, here's an essential structure to the human body that you've never been taught in medical school, and you just have to accept that, you know, it's overwhelmingly established that we have cannabinoid receptors in our body, and we are understanding what these receptors are doing.

Then, once the intimidation factor is over, a scientist should be excited to enter into this new vista. And I think that the meeting on Friday last week, from the OSMA, reflected that. Doctors now are seeing, wow, look at this aspect of the body that we were never taught about. Look at what it's -- what it could do. Look at the potential here of therapies for all these medical conditions that could be associated with the endocannabinoid system.

DEAN BECKER: Amazing stuff. Friends, we've been speaking with Lawrence Pasternak, he's a professor up there in Oklahoma.

Well, I want to thank you for your perspective, for your knowledge, and any closing thought there, Lawrence?

LAWRENCE PASTERNAK: Well, my understanding is that the Republican party of the state of Texas has added to their platform an endorsement of medical marijuana, and when you look across the nation, you look at successful programs and unsuccessful programs, and one of the things that demarcates the difference is whether or not chronic pain is included, and whether or not smokeable products are included, and personally I do not support smoking, there's no need to smoke in my opinion.

But, the same product that could be smoked could also be vaporized. And the harms with regard to vaporizing don't seem to be significant. Basically you're just inhaling gas, it's not combustion. Nothing's combusted, you're simply just gassifying the trichomes.

So as your state legislature moves forward, if you want your program to be successful right off the start, two recommendations are, be sure to include chronic pain as a condition, if you're going to have qualifying conditions, and don't exclude whole flower, so that patients who wish to can vaporize it, and use a public service campaign to recommend vaporizing over smoking. Those are my two [sic] key recommendations.

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COLIN DWYER: My name is Colin Dwyer, I'm at the Opioid Crisis Response Fund, which is a start-up nonprofit fund that I've started. I am a fiscal sponsee of the Harm Reduction Coalition, so that means I kind of operate as a subsidiary of theirs, a grantee of a number of philanthropic foundations and major donors. I'm basically a start-up fund, raising money for the sake of funding community based organizations that are engaged in naloxone distribution, where they can't get money, you know, in other ways

Like they can't get money from, you know, from the federal government, or their county health department, and if it wasn't -- yeah, I'm out there trying to basically get money for people who are trying to pay for naloxone with yard sales, or facebook fundraisers, or something like that.

DEAN BECKER: Well, and that's a great idea. The fact of the matter is, you know, it still has a stigma to many elected officials who are in control of that funds distribution, and I guess the whole point is that naloxone is really not that cheap. To my understanding, it's not pennies a dose, is it?

COLIN DWYER: Well, okeh, so there are a couple of things in what you just said. So, one is that, you know, there's a lot of money out in the world to buy naloxone, and that money, the people who decide who gets that money, are sometimes getting that money to people who can't really use the naloxone to get it to the places where it's going to be most likely to be used to actually do something about an overdose.

So there's millions of dollars out there to buy naloxone, but it's going to, you know, elementary schools, or maybe local law enforcement, or places where it's popular to fund naloxone distribution, but unfortunately, you know, getting money to, you know, community organizations that actually work with people who use drugs, who are actually the people who are most likely to die of an opiate related overdose, it's not as popular to give money to those kinds of organizations as it is to a school.

So, I'm trying to correct that problem, and going out to raise money to try to take care of that, yeah.

DEAN BECKER: But, am I right though, it's not that cheap per dose.

COLIN DWYER: It depends on what you are trying to buy. So, there's an auto-injector device, which is very expensive, right? The regular Narcan that most people know, if you're trying to buy it over the counter at the pharmacy, I think it would be a hundred and twenty-five bucks. Right?

But the actual generic intra-muscular naloxone, which is, you know, effective and appropriate to use and safe to use, it is not expensive enough that anybody should not be able to have it, to save -- I mean, there's probably, I mean, I'm not a public health researcher, but when I tell people, you know, how much it costs to save a human life in the United States with naloxone, people are like, I thought you could only save lives that cheaply in Africa. You know?

It, kind of it shows that we really actually don't value human lives equally in the United States, when, you know, Medicare spends thirty-four thousand dollars per capita for end of life care, you know, whereas, you know, somebody could be alive by Monday if we had naloxone in the right hands. And we're not willing to pay for it.

DEAN BECKER: How can folks learn more, is there a website?

COLIN DWYER: Yes. So, the website is www.OCRFund.org. Like, as in Opioid Crisis Response Fund. So OCRFund.org. There's a take action page where people can make direct donations with credit card or, you know, paypal, and we're already pretty active, so we just, I just publicly launched this month, but I was operating kind of without publicity for the past year or so, and so far we've gotten thirty-five thousand doses of naloxone out across the country into Ohio, Indiana, Wisconsin, Iowa, Louisiana, and Connecticut.

And by any conservative measure, those 35,000 doses will save thousands of lives. And so that's what we're doing.

DEAN BECKER: Well, Colin, I thank you for your time. I wish you great success in your efforts.

COLIN DWYER: Thanks a lot. Thank you very much for giving me a chance to talk about it.

DEAN BECKER: Opening up a can of worms and going fishing for truth, this is the Drug Truth Network. DrugTruth.net.

CARY ESCOVEDO: Hello, my name is Cary Escovedo. I'm with St. James Infirmary, based in San Francisco, which is already where I live. I'm a bay area native.

DEAN BECKER: Tell us the nature of St. James Infirmary.

CARY ESCOVEDO: So, St. James Infirmary was founded in 1999. We are the only peer run occupational safety and wellness clinic for sex workers in the United States. There are many peer run programs that have a very similar goal to us. The difference is that we also offer various amounts -- types of care, primary care, sexual health screening, a trans program, and various groups, syringe access, and so on.

DEAN BECKER: Now, as I understand it, tangential to the work you're doing, there was an effort this year to legitimize I guess the safe consumption facility in San Francisco. The governor kind of didn't go along, because he's afraid of federal interference, but, that's kind of the nature of these type things, they take some courage and some time, but they get done because they make sense. Right?

CARY ESCOVEDO: Agreed. St. -- I would venture to say, I would just say that St. James is in support of safe consumption sites. We have a robust syringe access program ourselves, and what our mission statement is really broadly is the decriminalization of sex work, of an end to the drug war, and decriminalization of drug use, and decriminalization of people, and I'll speak for myself on this one, as I'm manager of the HIV program, decriminalization of basically existing law, it should be positive.

DEAN BECKER: Right. And, that's, the heck of it is, we can't hide from these truths anymore, that it's here, it's with us, it's, you know, it's in the society, it's part of who we are, and to keep avoiding it or trying to look away, it's not going to help.

CARY ESCOVEDO: Yeah, I would say, I would agree, yeah. Totally.

DEAN BECKER: You know, the heck of it is, at this conference here in New Orleans, you know, there are so many diverse perspectives being presented. Every one of them has a nexus to humanity, do they not?

CARY ESCOVEDO: Yeah, agreed. One of our t-shirt slogans that are selling, shirts right now at this booth actually, is Sex Worker Rights Are Human Rights. So often our community is swept under the rug, figuratively and literally. Recent legislation in regards to, like, FOSTA and SESTA, bills that passed on the federal level, you know, the effects of which literally kill sex workers.

We need to stand up for ourselves because our, you know, sister communities have in some cases, but also have not been there for us, but we also understand that in order to meet all of our community's needs, we have to address the needs of everyone who exists in that community and the intersections of them all, not just limited to sex workers.

DEAN BECKER: Well, you know, this idea of prohibition, prohibiting sex or prohibiting drugs, you know prohibiting alcohol, you know, a buddy of mine talks about this. He says, in the beginning there were two people. They were instructed not to take from the tree of good and evil, and there was one cop at the time, his name was god, and yet, they bit into that apple, they went against that prohibition. It's just impossible to prohibit most human functions, is it not?

CARY ESCOVEDO: Yes, I will agree, without expanding, yeah.

DEAN BECKER: All right. Well, is there a website, some closing thought?

CARY ESCOVEDO: Absolutely. So, you can find out more about us, our mission statement, our programs, you can find me on there, my name's Cary. I'm the HIV Services Manager at St. James. And, at St. James Infirmary, that's StJamesInfirmary.org.

DEAN BECKER: Please visit our website, DrugTruth.net, and remember, 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.