Lost in the Weeds

According to the polls, Massachusetts voters are going to overwhelmingly approve a ballot initiative next month that legalizes medical marijuana. That should be good news for someone like me, who’s spent half his life smoking pot. So why am I feeling so uneasy?

The author, photographed in August. (Photos by Scott M. Lacey)

“Where’s the pipe?”

Bill Downing shouts as he removes a nugget of Hindu Kush, a crystal-covered bud of premium marijuana, from an orange prescription-pill bottle. There’s a group assembled around him, and some-one hands over a glass bowl that’s been darkened with resin. Downing pinches off a bit of herb, stuffs it into the pipe, lights up, and inhales deeply. As treasurer of the Massachusetts Cannabis Reform Coalition, Downing is here tonight with 20 other people for the organization’s monthly “civil disobedience” training session. They practice so that when the group holds a smoke-in at a police station or a courthouse—“to purposefully break the law,” Downing explains, “to show how stupid the law is”—everyone will feel comfortable smoking in public, and won’t cough, crack up, or generally look undignified. As the pipe works its way around the circle, Downing, who is 53, tells me about the first time he ever smoked, which is the pot-enthusiast version of small talk. He was 14 and at Boy Scout camp when his 16-year-old provisional troop leader led his charges into the woods, took out a pipe hewn from a deer antler, and handed it to little Bill. Downing goes a bit middle-distance on me as he relives the moment. Maybe it’s the pot.

I respond with my own story. I was 16, and it was summer, and I was sitting on the front step of my friend’s house. His parents weren’t home. My friend produced a cheap glass bowl and filled it with some brownish crumbs from a baggie. It was different than smoking cigarettes, he said. You could take it right into your lungs. A few hours and bags of Doritos later, we were still watching TV. I never felt anything.

Just before I smoked for the second time—standing on a tennis court in the middle of the night—I started thinking of my parents and how disappointed they’d be if they knew. I imagined them telling me I was ruining my future. Being a teenager, I got over that feeling pretty fast. But even now, after 16 years of smoking pot, I still feel a version of that nagging uncertainty. Why, I find myself asking, am I still doing this?

That sense of unease has always been a little vague, but now it’s suddenly become urgent. That’s because next month, if the current polling holds, Massachusetts voters are going to approve the Massachusetts Medical Marijuana Initiative by a landslide. A recent poll found 58 percent of respondents supporting the measure and just 27 percent against it, which would make ours the 18th state to legalize medical cannabis. We voted to decriminalize possession of up to one ounce of pot in 2008, and to guys like Downing (not to mention his ideological opponents), medical marijuana is just the next step toward full-scale legalization.

But even if that doesn’t happen, even if medical is as far as we ever go, it won’t really matter. You see, I know from personal experience that any state-sanctioned marijuana-distribution system leads to easier pot access for everyone. I lived in Colorado in 2010 when that state’s medical-marijuana dispensaries opened. I never got a doctor’s note and I never set foot in a pot shop—because I didn’t have to. The herb was everywhere, and it was cheap, potent, and easy to get. And everything I’d hated about marijuana—the variable quality, the prices, the street deals—was suddenly gone. Not coincidentally, I sunk into a level of pot use I hadn’t known since college. I was regularly lighting up a bowl after work.

When I moved back to Boston, the spell was broken, and that gave me some time to think about what was behind all that smoking in Colorado. Was it really just how easy it had become to score? Or was it something a little deeper, something inside of me? The truth is that I’ve never escaped the feeling that maybe the pot I’ve smoked over the years has eaten away at my potential. And every time I take another hit, I get that sinking feeling: I’ll be high for the rest of the night, cut off from the world.

I go a little middle-distance myself when I start thinking about all of this, which is probably why I was still working the whole thing out when I realized just how close Massachusetts is to authorizing medical weed. Before that happens, I suddenly understood, I needed to get some clarity. I needed to talk to the experts and figure out whether my future really is at stake, or whether I should just relax—because after all, it’s only pot. I don’t think marijuana is evil, and I definitely don’t think it’s the government’s place to help me control myself. But I do worry that there’s more to my smoking than mere ease of acquisition, and before I find myself awash in marijuana again, I need to figure out what it is.

“I am content that, ultimately, I have done more to relieve suffering than most of my colleagues.”—Lester Grinspoon, medical marijuana godfather and associate professor emeritus, Harvard Medical School

I’m sitting in the passenger seat of my friend’s car on Colfax Avenue, Denver’s neon-stripped main drag, and I’m freaking out. My friend has been inside the dispensary way too long, and I just know that something’s gone wrong. Maybe they figured out that he’s buying for someone else.

But then I see him walk out the door, with a brown paper lunch bag in his hand and a carefree look on his face. He gets into the car and tosses the bag to me. I look inside and see a couple of green pill bottles with a few grams of pot. Gray-market drug deals are as easy as that.

It took a few more trips to dispensaries before I unlearned the paranoia I’d picked up from a hundred or so street deals. It was 2010, and pot shops had become more numerous in Denver than coffee shops. Getting a Medical Marijuana Registry ID card was as simple as paying a doctor $200 and complaining of pain, so lots of healthy people, like my friend, ended up with access to legal pot. By 2012 nearly 100,000 Coloradans held the cards. I never applied for one—I was too afraid of ending up on a list that might come back to haunt me—but I didn’t have to, because my friend was willing to buy for me. So every few weeks, I’d hand over $30 and get an eighth of an ounce of top-shelf product. That was half of what I was used to paying, the quality was consistent, and I didn’t have to put up with any more shady dealers.

Buying from sketchy people is what I hated the most. In high school in Connecticut, when local dealers were dry, we’d head into the city. I once got caught in a messy brawl because one of the guys I was with owed the dealer’s friend some money. Fists flew, glass broke, and we ran out the door without our money or our weed. In college, a few guys I knew who were dealing pot got held up at gunpoint.

That violence undercut the reason I had started smoking pot in high school—it was an easy way to laugh and make friends. By college, marijuana had become an identity. I listened to jam bands, and my friends were my smoking buddies. But after I graduated, things changed. I had a girlfriend at the time, and though we didn’t get along that well, we stayed together. I’d say good night to her, go home and smoke a bowl, and the relationship would idle on. Pot became something I did to distract myself. We stayed together for an extra few months probably because I was high so often. That makes me wonder: Just how much time has marijuana cost me over the years?

It’s true that people at my stage of life tend to start asking themselves these kinds of questions. I’m 32 now, married and with a good job in the city, which means the stakes seem higher to me. And I’m not alone. Of people ages 30 to 34, 16 percent say they’ve smoked marijuana in the past year. Among those 35 to 39, it’s just 10 percent. But what happens when you suddenly have a card to buy marijuana anytime you want and can legally smoke weed? Massachusetts seems poised to find out.

Medical marijuana has been overwhelmingly popular with American voters since California put up the first citizens’ ballot, in 1996. In all, 17 states and the District of Columbia have legalized the drug for medicinal use, and only one, South Dakota, has voted down a medical-marijuana ballot initiative. Next month, people in Colorado, Oregon, and Washington will vote on whether to legalize (and tax) marijuana for any use—in direct violation of a federal ban that’s been in place since 1937. Polls in Colorado and Washington show support at more than 50 percent.

But just because medical-marijuana laws have been popular at the ballot box doesn’t mean there haven’t been problems enforcing them, or that there’s any kind of uniformity in how they’re written or applied. As I mentioned, you have all kinds of healthy people—like me—taking advantage of the system. Then you have the growers who use medical-marijuana laws as a cover to produce pot for illegal distribution. A two-year study in Colorado, for example, found 70 instances of state-regulated pot being diverted to drug traffickers in 23 states.

In California, meanwhile, the state has little to do with licenses or dispensaries, which has led to an unchecked proliferation of pot shops and to confusion among law enforcement officials when it comes to who is truly medicating and who is committing a crime. And then there’s the fact that in more than half of the states with medical-cannabis laws, marijuana has never been sold in a brick-and-mortar shop. In those places, the law doesn’t allow sick people to buy pot at a retail outlet. It simply protects them from arrest or prosecution for possession.

But here in Massachusetts, the medical-marijuana proponents believe they’ve found a better way to deliver the drug into the hands of those who need it, while keeping it away from those who don’t. I’m not sure that’s possible.

“When legalization happens in one state and the sky doesn’t fall, all the other states are going to say, ‘What are we, idiots?’ “—Bill Downing, treasurer, Massachusetts Cannabis Reform Coalition

The first guy I call for some insight on the ballot initiative is Downing, who’s been involved with pro-marijuana groups since the late 1980s. The Massachusetts Cannabis Reform Coalition (MassCann) is the local affiliate of the National Organization for the Reform of Marijuana Laws, and I figured they were behind the initiative. I was wrong. They support the legalization and regulation of marijuana for adult use, but MassCann had no part in drafting the medical-marijuana bill. That work was done by representatives from the ACLU and the Massachusetts Patient Advocacy Alliance. When I finally connect with the writers of the ballot measure, they stop talking to me after I broach the topic of legalization. They aren’t interested in discussing anything beyond giving physicians the right to prescribe pot to their suffering patients. To MassCann, on the other hand, legalization is the whole point of the movement.

In early July, I pull up to Downing’s house in Reading. He comes out to greet me dressed in loose khakis, his mini ponytail tucked into the collar of his shirt. We sit by his pool, which is alive with tadpoles—he says he hasn’t cleaned it for the season yet—and talk pot. He’s married and has two teenage boys, but few people in the state have a longer history of pushing a pro-marijuana agenda than he does. MassCann has made slow progress over the years, including increasing the size of its annual Freedom Rally in September—which features “civil disobedience” smoke-ins on the Common—but things are now picking up speed. Downing feels like his time is finally coming.

If Massachusetts voters approve Question 3 on the November ballot, the state will permit up to 35 nonprofit “medical marijuana treatment centers” around the state. Those centers will be allowed to sell a 60-day supply of pot to anyone with a doctor’s note that’s been approved by the Massachusetts Department of Public Health. (The ballot question leaves it to the Department of Public Health to define what constitutes a 60-day supply.) Patients with a financial hardship or without access to a dispensary may also be allowed to grow an equivalent amount of pot.

And to discourage doctors from running the kinds of prescription mills that popped up in Colorado, the would-be law requires that a physician and a patient have a “bona fide” relationship. The state would also be authorized to conduct criminal-background checks on all dispensary agents, and it would be a misdemeanor to defraud the system—a felony if such fraud is for trafficking, sale, or distribution. Finally, all marijuana would need to be grown in an enclosed, locked facility to prevent theft. These are the signature Massachusetts measures meant to keep legal herb from ending up on the street. I have my doubts.

Keeping an eye on home growers, especially if there are a lot of them, isn’t really feasible. Even quantifying the total amount of pot grown is likely to be difficult, since different plants and growing techniques yield different results.

To Downing, though, the real concern is the black market that exists under our current drug laws, which is why he’s so pleased with the medical initiative. It’s the money from illegal sales, he tells me, that “goes into all those evil, evil things that we associate with international crime syndicates. So by taking all that marijuana out of the black market, we’re starving the crime syndicate of that money.”

That may be true, but I suspect that the real reason Downing likes the initiative is its broader implications. He believes that the state-by-state adoption of medical-marijuana laws is pushing the country toward a tipping point. If eight more states approve the laws, a majority will have done so. The government, he believes, will have to remove the federal ban on medical pot or risk looking foolish. And that will set the stage for MassCann’s true objective: legalization—the stuff of reggae songs and T-shirts on college campuses. Downing brings up the full-scale legalization bills in Colorado, Oregon, and Washington, saying, “If a state gets legalization, you know, everybody recognizes that the emperor is naked. When legalization happens in one state and the sky doesn’t fall, all the other states are going to say, ‘What are we, idiots?’”

If marijuana were going to bring down society, it probably would have already. Humans started using hemp from pot plants to weave clothes during the Stone Age, while later generations adapted the strong and flexible fibers to make sails and rigging. The Chinese began ingesting it around 2,700 BC, and it quickly spread from there. It’s included in the world’s oldest pharmacopoeia—a reference book for medicines and their uses—from the first or second century, and in later editions is mentioned as a treatment for a variety of ailments, including diarrhea and rheumatism.

Marijuana’s popularity as a medicine comes from its painkilling powers, but the drug doesn’t work like opiates such as morphine or oxycodone, which block pain signals but are highly addictive and can repress the respiratory system. Pot’s 80 cannabinoids, a type of chemical compound, stimulate the parts of the brain that influence pleasure, motion control, and memory, which can offer relief to people suffering from severe pain and muscle spasticity, and can help prevent nausea, which makes it useful to chemotherapy patients.

Marijuana, of course, can also be fun. The mind-altering use of pot in America started near the end of the 19th century, at Asian opium dens on the West Coast. In 1911, as Prohibitionist sentiment was peaking, Massachusetts became the first state to outlaw the possession of opiates and cannabis, or even merely being in the same room as the stuff. In 1937 Congress passed the Marihuana Tax Act over the objection of the American Medical Association, which made it illegal for anyone, including doctors, to move cannabis without proper documentation. Out of fear that it could destabilize the social order, pot was criminalized.

In 1970 the Nixon administration rewrote the drug code, reclassifying drugs based on their potential to harm or to help. Judges and federal drug agents decided, against the wishes of a few physicians who testified, to classify marijuana as a “Schedule I” drug, placing it alongside heroin and LSD. An age-old medicine was suddenly categorized as having no medical benefits and a high potential for abuse.

Yet the change did not deter the steady climb in usage rates. In 1969 Gallup polling found that 4 percent of American adults had tried pot. Four years later, that had tripled to 12 percent, and it doubled again to 24 percent by 1977. For teenagers, pot use among 12th graders peaked in 1978, when half of those surveyed admitted to smoking grass in the past year. Usage began a fairly steady decline from there, dipping to its lowest point in 1992, but the percentage of high school seniors who have tried pot continues to hover between 30 and 40 percent. Today, about half of Americans between 18 and 60 have tried marijuana at one point or another.

Just because pot remains popular, though, doesn’t mean it’s necessarily helping anyone. To learn more about its medical uses for the sick and suffering, I head to the Wellesley home of Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard Medical School.

In 1967, Grinspoon was watching as his friends and contemporaries quickly adopted marijuana as their drug of choice. He feared that it “was a dangerous drug, no question about it.” Since he was an M.D., he took it upon himself to find definitive proof of marijuana’s harmful effects, then use what he’d discovered to convince young people to quit. Thus began an exhaustive review of the cannabis-related literature in the Harvard Medical School library. The more he looked, though, the more he became convinced that marijuana wasn’t dangerous. He published his results in Scientific American in December 1969, and two years later expanded his argument in a book called Marihuana Reconsidered. “At first I thought it was a terrible drug,” Grinspoon says. “But that first book was to reassure me and the rest of the world that we were all wrong about this, that this is a remarkably nontoxic drug. It’s the only drug I know of that you can’t…establish a death from it, from an overdose.”

Around the same time, Grinspoon’s young son, Danny, was diagnosed with acute lymphocytic leukemia. Grinspoon wouldn’t condone medical marijuana for his son, but his wife, Betsy, went behind his back and bought a little cannabis in the parking lot at Wellesley High School. She shared some with Danny before one of his chemo sessions. Gone was the anxious kid who vomited for hours after treatments. Instead, Danny asked for a sandwich on the ride home. “You have no idea what a relief it was for him,” Grinspoon tells me. “Not just for Danny, but all of us who saw the way he suffered.”

Danny passed away in 1973, but Grinspoon by then was personally and professionally invested in marijuana. He tried smoking it himself for the first time that same year, when he was 44. With President Nixon recently classifying it as a Schedule I drug, Grinspoon wanted to prove pot’s medical potential. He spoke with Emil Frei at Harvard Medical School about conducting a proper study on marijuana’s antiemetic effect—meaning its ability to curb nausea. Frei’s results, published in The New England Journal of Medicine in 1975, became the first American study proving pot’s effectiveness in reducing nausea. Grinspoon added to his own research with 1997’s Marihuana: The Forbidden Medicine, presenting hundreds of case studies that showed marijuana’s ability to ease the suffering of patients afflicted with conditions like multiple sclerosis, Crohn’s disease, cancer, AIDS, epilepsy, migraines, glaucoma, and arthritis. While there are synthetic marijuana tablets available by prescription, Grinspoon maintains that they don’t offer the full benefit of the whole marijuana flower.

Sit with Grinspoon long enough and you’ll believe what he does about the medical use of cannabis, that it “will be like penicillin seemed in the early ’40s—the wonder drug of our time.” I ask him whether he thinks the nature of his work affected the trajectory of his career. He suspects that he was never granted a full professorship at Harvard because of his research on marijuana, but says, “I am content that, ultimately, I have done more to relieve suffering than most of my colleagues.”

I leave Grinspoon’s basement office thinking that marijuana is clearly a valid medicine to help people who are suffering. But that doesn’t prove it’s not harmful to those who aren’t sick. Could weed be both beneficial to the ill and damaging to the future success of a guy like me? To find out, I call up Harrison Pope, a professor in the Harvard Medical School psychiatry department.

Pope, the director of McLean Hospital’s Biological Psychiatry Laboratory, conducted a number of marijuana studies between the late 1980s and 2000. I ask him if marijuana is dangerous over the long term. No, he tells me, but there are definitely short-term effects. “We had found from neuropsychological testing that chronic marijuana users exhibited difficulties, especially with verbal memory, for at least a week or two after they stopped smoking,” he says. So, the age-old stereotype that stoners have bad short-term memories is true. But thankfully, it doesn’t last. Pope tells me that in his studies, the memory problems disappeared within 28 days, and the adult pot smokers “were no longer distinguishable from the comparison group.”

Okay, so if the marijuana haze is a tax on mental output, temporarily skimming the top few percentage points of productivity and creativity and success, I guess I can live with that. What feels more serious is its effect on relationships. I won’t scapegoat pot for every little thing that hasn’t gone my way, but I’ll never know how many opportunities I had to make connections with people, but didn’t. It continues to seem plausible that pot has had a negative influence on my life.

It’s a dark July night as I pedal my bike toward 22 The Fenway, one of Berklee’s classroom buildings. There’s a Marijuana Anonymous meeting here tonight, like there is every Monday. A twitchy young guy stops me before I get to the door. “You here for the meeting?” he asks. “Yeah,” I reply. He fidgets and asks if he can use my phone to call his sponsor. He doesn’t care if I put it on speaker and hold it for him. He tells his sponsor that he’s not well and that he needs to meet right now. His sponsor says to just hang on.

The evidence suggests that marijuana is less addictive than caffeine: One 1992 study found that only about 9 percent of people who try it become dependent. Alcohol, according to the same study, turns 15 percent of users into problem drinkers. But as I enter the Marijuana Anonymous meeting, the truth is I have no idea what to expect. I find five people sitting at desks in a circle, chatting and waiting for the meeting to start. They greet me and ask if it’s my first time. I say it is and they welcome me. I have a sense that I’m about to be laid bare.

I’ve come here to do some reporting, but now I have a creeping fear that I’m going to see a version of myself in these guys. It’s all I can think about as they tell their stories and I identify with a snippet here, an anecdote there. The slide into addiction wasn’t anything terribly pronounced, everyone had just become aware of his slow undoing thanks to weed.

As I listen, I think back to a few weeks earlier, when I got an overview on pot addiction from John Knight, a Harvard Medical School professor who’s also the director of the Center for Adolescent Substance Abuse Research at Children’s Hospital. Marijuana, Knight told me, infiltrates the limbic system, the part of the brain that sends waves of happiness across the body when you have sex, eat good food, or sleep well. But with pot, he explained, “You do it again and again and pretty soon, you’ve saturated your reward pathway, so nothing else can get through. Nothing is rewarded except the drug.” Think of a marijuana smoker sitting, legs splayed on the couch, the light from the TV flickering off his face. He looks completely impassive, unaware of what time it is. That’s what a saturated reward system looks like. I know, because I’ve been that guy.

And now it’s my turn to talk to the group. “Hi, I’m Casey,” I say, following the format. But in the space where I’m supposed to say, “I’m an addict,” and everyone else is supposed to respond, “Hi, Casey,” I keep right on going. “I heard about this meeting and talked to a guy who comes and thought I should check it out,” I say. A few people nod in approval, another few say, “Hi, Casey.” I don’t talk anymore. Then the next guy goes, and attention turns to him.

I’m not sure whether refusing to self-identify as an addict was a failure or a success. The meeting winds down soon after, and I stick around afterward—to collect a few pamphlets and talk a little more, but mostly to prove to myself that I’m not one of them. We have things in common, but I haven’t slid quite so far. I’m married, I’m curious about the world, I’m good at my job, and I do my best to balance work and life, family and friends. This isn’t my tribe. So why do I still feel so uneasy?

I know plenty of well-adjusted people who relieve stress by turning to high-end wine, craft beer, or nice food. Others run marathons, or sit at the poker table, or kneel in prayer. I smoke pot. All of it, of course, can be done to excess. Only once you’ve smoked up, there’s no way to stop being high. When my wife, who doesn’t smoke pot, was out of town recently, I had a thought while stoned. What if she calls and I’m unable to hold up my half of the conversation and she thinks I don’t care? The thought pings around and around and around, along with that other one: Why am I still doing this?

At the MassCann civil-disobedience meeting, the pipe reaches my hands. I’ve been waiting. I take it, push it to my lips, flick the lighter, and breathe in real deep.

As far as a quick psychic escape, smoking marijuana is like being whisked away on a hot-air balloon. In seconds, you can rise above the mental clutter and see things for what they actually are. And heavy ideas—like whether I’m some kind of pot addict—fade into an abstract lightness. I relax.

I look over to Downing and he’s looking at me. I’m among strangers who are freely smoking marijuana in a more-or-less open lot in a fancy town outside Boston. I hand him the pipe and he hits it and sends it on its way, flitting from mouth to mouth like a bee pollinating flowers. My senses begin to feel overwhelmed. I’m listening to all the conversations, but not comprehending any of them enough to participate. All the activity is chasing my brain back into its snail shell, where it’s safe. Grinspoon had told me about three types of marijuana use: medicinal, recreational, and enhancing. The last one, he explained, is the state of feeling your mind open to new thoughts. And while I’ve definitely smoked pot for recreation and for enhancement, my mind opens to a fourth use for marijuana, escape.

Escape seems more useful than ever as a way to get some space from a carnivorous world of obligations and not enough time and friends becoming strangers and whatever else. Escape, whether achieved by smoking, drinking, or regular old running away, is fine now and again, but if you do it all the time, it becomes its own sort of trap. For me, the trap is having things not seem as bad as they are. Like around the time of college graduation, when I was about to face a big and abrupt change, and I had no plan. Instead of making one or asking for help, I smoked up and ran away and waited for the world to set itself right. It took me almost a year to figure out that it never would.

I tune back into Downing and notice he’s been talking. “I used to be on a bong team in college,” he says. They called themselves Bongardiers, and he went by Wild Bill. He seems delighted by this. I get the feeling that he still sees himself that way.

On some fundamental level, smoking marijuana is a longing for something simpler, something teenage and effortless that happens on a summer night with the crickets buzzing and the frogs singing, and the road is empty except for a circle of you and your friends, and the world is straightforward and easy to move through and just crackling with possibility. And then you purse your lips to the end of the pipe and suck in and you know the possibilities are real. You know because you can feel them. That is the real reason I’ve smoked pot. I thought it would help me. Which, of course, it couldn’t.

Source URL: http://www.bostonmagazine.com/2012/09/medical-marijuana-in-massachusetts/