Medical marijuana: How much is enough?

CHRIS JOSEPH TAYLOR / THE SEATTLE TIMES

Muraco Kyashna-Tocha, 48, of Seattle, has grown marijuana legally since 1999. Kyashna-Tocha has had five neck and back surgeries and said that using marijuana manages her pain enough so she can engage in daily life. Kyashna-Tocha's moluccan cockatoo Big Bird Bubba sits on her shoulder and travels with her almost everywhere.

A state Health Department proposal that medical-marijuana patients be allowed more than 2 pounds of pot every two months took law enforcement by surprise and prompted the governor to tell health officials to start over.

Faced with a legislative mandate to spell out what constitutes a "60-day supply" by July 1, the department in February briefed Gov. Christine Gregoire's office on its recommendation: Patients or caregivers could possess up to 35 ounces of cultivated marijuana and be allowed a plant-growing area of 100 square feet.

Gregoire promptly directed Department of Health Secretary Mary Selecky to solicit more comment from law enforcement and medical providers. "I wouldn't say she was upset" by the amount, said Gregoire's spokesman, Pearse Edwards, but she believed input had been one-sided.

The issue of how much marijuana a patient needs remains one of the most contentious parts of the law voters passed in 1998, which allows patients with certain chronic, fatal and debilitating diseases to possess a 60-day supply of marijuana with a doctor's authorization.

Last year, in an effort to help end conflict between law enforcement and patients or their pot-growing caregivers, the Legislature directed the state Health Department to define how much marijuana patients can possess under the law.

In four hearings around the state last fall, hundreds of patients and medical-marijuana advocates lined up to speak. But conspicuously absent from most hearings were the voices of two important "stakeholders": doctors and law-enforcement officials.

Doctors have a stake because under the law, they must authorize qualified patients to use marijuana.

And law-enforcement officers have a stake because they must decide whether to treat pot smokers and growers as patients or criminals.

Why the detour?

Now the Health Department says it can't meet the July 1 deadline for a final rule, though it hopes to have an official draft by then so it can gather public comment during the summer. Once it makes a decision, it isn't subject to a veto by the governor, although Selecky ultimately answers to Gregoire.

Medical-marijuana activists suspect the process got derailed by objections to the amount of marijuana the department planned to propose. Some worry that a process supposed to be guided by science has been hijacked by politics.

Officially, law-enforcement leaders say they just want a number — any number — for the amount of pot qualified users can possess. They say they're not doctors and they wouldn't presume to set an amount any more than they would tell a patient how much cholesterol medication to take.

But when pressed, they express discomfort with the amounts revealed to the governor in the briefing.

Don Pierce, executive director of the Washington Association of Sheriffs and Police Chiefs, said he's been invited to an upcoming "stakeholder" meeting by the Health Department. He said the amounts originally proposed by the department "fly in the face of reasonableness from our perspective."

At 35 ounces, the amount of usable marijuana the health department planned to recommend is nearly a kilogram — 2.2 pounds — Pierce said. "That's a lot."

Cowlitz County Sheriff Bill Mahoney says the whole issue is now "very, very difficult for law enforcement to deal with" because nobody knows what constitutes a 60-day supply.

"From my standpoint as a sheriff, I just need the state to step up and define it. I don't care what the number is."

But, he adds: "Most of our cops, if they were forced to come up with a number, they'd say 3 ounces."

Basis of calculation

How did the state Department of Health (DOH) calculate the amount? According to its briefing memo, obtained through a Public Disclosure Act request, the department began with the average dosages given to a handful of patients enrolled in a federal medical-marijuana program.

It doubled that amount, because some patients might eat the marijuana instead of smoking it.

Sunil Aggarwal, a University of Washington medical and doctoral degree student who studies "medical cannabis" there, says the department's calculation used an incorrect multiplier.

Because "oral administration" of medical marijuana is much less efficient than smoking, the limit should be about 71 ounces for 60-day supply, he has told health officials.

The 35-ounce amount is more than permitted in some places that allow medical marijuana use, but less than others. For example, Oregon allows 24 ounces of usable marijuana and six mature plants, while limits in California counties and cities range from 8 ounces to 3 pounds in Humboldt, Santa Cruz and Trinity counties, the Health Department's memo said.

The federal program, called "Compassionate Investigational New Drug"program, supplies a limited number of patients with 300 to 450 "joints" per month, or about 9 ounces, according to department research.

Karen Jensen, an acting assistant secretary for DOH, said the department is now conducting "informal conversations," with law-enforcement officials and medical providers.

"The rule needs to be something that works for law enforcement and the medical community and the advocacy community," Jensen said, although she and the governor's office deny that the current process is a "negotiation."

Aggarwal says he worries that there is political "backdoor dealing" going on, with law enforcement at the head of the table. "This was supposed to be a public process, and it was supposed to be based on the best available medical science. ... That's why it went to the DOH in the first place."

Jensen maintains "definitive science" is scarce. "We don't have some standard out there that we can go to. There are studies and reports, but no hard-core science out there for us to lean on."

Guidelines

The Legislature told the Health Department to base its decision on research, expert advice and public input. Public input, so far, has been overwhelmingly from patients and advocates.

Tom Curry, executive director of the Washington State Medical Association, says Selecky recently sought some names of doctors knowledgeable about medical marijuana or patients with conditions authorized under the law, such as cancer, HIV, or multiple sclerosis.

One is Dr. Bob Wood, director of the HIV/AIDS Program for Public Health — Seattle & King County.

Wood, who doesn't care for patients directly these days, says he doesn't authorize patients under the law, but he did march to Westlake Plaza during the recent "free marijuana" rally.

Watching a few rail-thin patients in wheelchairs "smoking up a storm," Wood said he thinks there's "a lot of variation" in what patients need. Some may just need the occasional hit to deal with pangs of nausea, but some with serious or fatal diseases may simply want to stay high all the time.

"I would say, if that person isn't driving a school bus or driving down the road in a wheelchair, I don't see how they're hurting anybody," Wood says.

Still, despite state laws allowing medical marijuana use — and the very limited federal program — it remains illegal under federal law.

And because "science has been effectively blocked by the feds," Wood says, it may be hard for the health department to settle on a hard-and-fast number.

Pierce, a former Bellingham police chief, says sheriffs and police chiefs have always maintained that setting a limit on a 60-day supply "is really a medical decision that should be determined by physicians."

His group, he says, has told the department: "You shouldn't be talking to the law-enforcement community to find out what the right number is, any more than you should be talking to the advocate community."

But on this issue, Pierce says, doctors aren't willing to step forward. "Most physicians are reluctant to identify what the appropriate supply is, because many of them don't feel there is an appropriate supply."

Law enforcement's interest is simple, he says. "We don't want folks who are involved in the sale of drugs to be able to hide behind the medical-marijuana law. Because we think that's not good for our community ... [or] for the people who have a legitimate use for medical marijuana."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

Copyright © 2008 The Seattle Times Company

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Is Alcoholics Anonymous A Cult

What comes to your mind when you hear the word cult? Jim Jones Kool Aid? David Koresh? Charles Manson? The Texas Polygamist Compound? Maybe even Scientology. Do the words Alcoholic’s Anonymous come to mind? I certainly have never thought of Alcoholics Anonymous as a cult and I am a member. As many people know from my recent blog post, I have been in AA for over a year.

I received many emails and comments in response to that post. Many of those commenting believed that AA was a cult. I frankly take them with a grain of salt. 100 percent of them were from former AA members. When you are at a low point in your life and counting on something to turn that life around and it does not work, what do you do? You don’t look to yourself. You blame everyone else. You blame the program. You dismiss , you denigrate, you destroy. Anything so you can relieve yourself of personal responsibility for your failure. I know this because I have been there. That does not make AA a cult. That makes you human.

Let us start with the premise that AA as an overall organization can not possibly qualify as a cult because it has no central authority structure. No one is handing down edicts from the top saying you must do this or that to stay in the group. This is because there is no top. To be a cult an organization as a whole must have a “top” in terms of its authority structure.

This leaves us with the question of whether the AA philosophy encourages “cult like behavior” in its thousands of chapters. I do not necessarily disagree that this can not happen depending on the personality makeup of the specific chapter. I do believe that it is the very rare exception rather than the rule.

The other day someone who read my blog, sent me an article about an AA chapter in Washington D.C that was accused of being a cult. The members of this chapter of AA basically encouraged younger females members to have sex with older males members and encouraged members in general to cut off all times with anyone who was not a member of this AA chapter. Does that ring the “cult bell” in your head? It certainly does in mine. You can read that article here.

Yes I agree that this particular chapter probably qualified as a cult but to say that the actions of a isolated group within a larger group classify that larger group as a cult is ludicrous. When these allegations were made public, this group was in fact disbanded as an AA sanctioned group.

What else would classify AA as a cult? The biggest book on this subject is AA Cult or Cure By Charles Bufe.
Bufe goes through a litany of things that qualify AA as a cult. I am not going to debate his criteria. Why? Words are like statistics. You form your opinion than you make them fit to make your point. I frankly could take Bufe’s points and make a good argument that the Boy Scouts are a cult using his criteria.

Anytime you have people coming to together in a group of any kind, you are going to have formal and informal criteria for membership even at the lowest level. You are going to have a common purpose. You are going to have strong personalities and weak personalities. You are going to have strong personalties that overwhelm and dominate weaker personalities. You are going to have weaker personalties who have to adopt the essence of the stronger ones to excel in the group. Does that happen in AA? Of course it does. Does that happen in the Boy Scouts? Of course it does. Did that happen in my law school study group? You bet. That happened in my weekly poker game. That is not a cult. That is group dynamics.

These personality issues can be much more pronounced in self help groups like AA. No one is walking into an AA meeting because they are at a high point in their life. They are defeated, they are weak, they have lost self, self respect, family, life etc. They are open to almost every and any suggestion that will put them on a new track of self respect and sobriety. This certainly lends itself to the danger of domination by strong personalities with amoral motives in the group without checks and balances. AA groups have checks and balances. These checks and balances are the members themselves who are different, diverse and look out for each other, not try to conform each other.

So, is AA a cult? I don’t think so but since each person has to make it work for them as an individual, I can see how some people who fail at it would take solace in viewing it that way. Of course those who think it is a cult would argue that I am a “cult member” and cult members never think they are in a cult. I have not read Catch-22 in many years but it sounds I am certainly not going out to fly that next mission so I can get out of the army.

I can also see how people with personalities that are just not compatible with a core philosophy would not do well and view it as a cult. Is there any group out there that does not have a core philosophy? These people however probably have issues in any group setting in which some conformity is an element of reaching a common goal. Is there any group out there where some level of conformity is not needed to reach a common goal?

AA does offer a program of conformity but AA is not about conformity. AA is not about submission to others in the group. I will not dispute that AA is about submitting to the fact that you have a problem and want help. How this makes it a cult I have no idea. I submitted to that exact same thing when I studied for the Texas Bar Exam. Is the legal profession a cult? I know some that would say yes.

AA is not about shunning those who do not conform or submit. AA is about people with a desire to stop drinking helping other people with a desire to stop drinking.

If that is a cult, pass me the Kool Aid……

UPDATED BLOG NOTE TO ALL: Please do not leave “11th tradition” comments on this post. They are off topic. I have written two other blogs about AA that you can find in my archives and for which 11th tradition comments are fine.

Below are two diametrically opposed videos on AA One is by Bill W., one of the founders of AA and the other is an interview with author James Stanton Peele who argues that AA is a cult. A fascinating comparison in viewpoints.

BILL W.

JAMES STANTON PEELE

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Growing buds in offices increase employee’s job satisfaction

If it wasn’t already something that we all have probably thought about or experienced on our own, plants have been proven to make office workers happier, more satisfied with their jobs, the work they do and job satisfaction. It seems that most people would probably admit that the absence of plant life can put a damper on living and the mood you have around that environment. A peculiar finding in the latest research seems to show that men reported more positive results due to plants, windows or greenery being around their working conditions.

Researchers at Texas State University in the Department of Agriculture have released the latest study on green living in the office environment. You can read the study abstract here that is titled, “The Effect of Live Plants and Window Views of Green Spaces on Employee Perceptions of Job Satisfaction.” The complete sample of this study was 450 participants in the Midwest. The study asked questions about whether there were live plants in the office or outside within view of a window, what the work environment was like, job satisfaction, demographics and the preferences of the general office. All participants completed their answers on an Internet survey.

One of the findings that really stood out from this specific study was the difference in gender and their reflections on job satisfaction when around plants. When singling out females from their demographic answers, they were not found having a notable difference in job satisfaction whether they had plants in the office or not. When singling out men from their demographic answers, they were found to rate job satisfaction statements higher when they had plants in the office, opposed to men without plants in the office.

Although there were gender differences found in the study, there were many demographic pieces that had no effect on the change in answers in the study. The demographic categories that provided no statistical difference were age, ethnicity, salary, education levels and position in the workplace. Whether you would find plants in the office or the office bare of plants, these demographic categories did not provide a statistical difference in the study.

When considering the overall findings of this particular study it was found that having plants or window views with greenery in sight provided quite a difference on employee outlook. Employees who worked in offices with plants and windows said they felt better about their job and the work they performed. When looking at overall quality-of-life ratings from the survey, employees with windows and plants scored higher.

It seems that the well-being of employees, happiness and job satisfaction isn’t the only thing that is improved when plants are around. The Society of American Florists covers a study done by Texas A&M University here revealing productivity increases when plants are around. This particular study involved 101 participants that had a duration of eight months to come to it’s conclusions.

This study took the participants and put them in random environmental office conditions, selected at random: fresh flowers and plants; with abstract sculptures; or with no embellishments at all. When placed in these specific environments participants were asked to perform a series of tasks while taking part in emotional, creative and attention demand protocols. The researchers took the data and measured the number of ideas participants generated, their ideas’ originality and flexibility, and other responses from the tests. As in the first study, these participants were found to be more creative and original when around plants, flowers and sculptures. Also similar to the first study, male participants were found to have more positive results do to the presence of plants, flowers or embellishments.

Basically, if the office is seeming a little dull it probably needs some sprucing up with some plants, a new view or some flowers. If there doesn’t seem to be a green thumb around to keep anything alive you can always put some art or inspiring pieces like sculptures that were found to have positive results in the second study. Whether you’re in a corporate office, cubicle or a home office, a plant would probably do you good in more ways than one. Your new-found office environment will be budding with happiness, positive outlooks and creativity.

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