DROP IN WITH DR DAVE

To find out what is happening on the front lines of marijuana addiction and
treatment, Jonathan Knight spoke with David Smith, founder and president of
the Haight Ashbury Free Clinics in San Francisco. When Smith opened his
first clinic in 1967, the Haight Ashbury district was at the epicentre of
American hippie counterculture and drug experimentation.

Today the Clinics treat 50,000 people a year at 22 sites in the Bay
Area.David Smith also holds a professorship in toxicology at the University
of California's San Francisco Medical Center and consults to the White
House office on drug abuse policy.

How do you know when someone is addicted to a drug, and is cannabis truly
addictive?

"Addiction used to be defined in terms of the severity of the withdrawal.
Then we started seeing people who used amphetamines compulsively. But their
withdrawal was just a mild crash. They'd fall asleep or perhaps get a
little depressed.

That's when I coined the idea of the three Cs: Compulsion, loss of Control,
and Continued use despite adverse consequences, as a definition of
addiction.

Similarly for cannabis, withdrawal was characterised by anxiety and
insomnia. It wasn't significant physical withdrawal, but that didn't mean
it wasn't addicting. We would see people use compulsively every day, stop
going to school, and spend all their money on marijuana. So the toxicity
was lower than for heroine, but it still fit in to our definition of
addiction.

Has the pot that's available on the streets become stronger?

The tobacco industry used DNA technology to increase the amount of nicotine
in tobacco plants, and the cannabis growers do the same thing. They market
it on the street as more potent and charge more for it. The legalisation
people say that's not happening. But then are the dealers fraudulent? That
seems illogical, cause the consumer thinks the stuff is more potent and is
willing to pay more money for it.

And is it more addictive?

Of course it's more addictive, it's pharmacological logic. If you increase
the power, it's going to be more addicting. But there's no way to know if a
higher percentage of users are becoming addicted, or if only those who are
addicted use stronger stuff. The people we see are smoking potent forms of
marijuana, they are spending a significant amount of their income on it,
they are suffering psychotic reactions, anxiety and depression. But if you
smoke a joint at the Filmore auditorium on a Friday night and have a
wonderful time, you don't go see the Haight Ashbury clinic. And we don't
know how many people like that are out there.

Should cannabis be made legal?

I'm an opponent of marijuana legalisation. I don't want people to go to
jail, I want them diverted to treatment, but I also don't want more
marijuana available in the street. If marijuana were legalised I believe
the tobacco companies would be the main distributors of it. And they would
target youth as they did for tobacco. You would have the equivalent of Joe
Camel for marijuana.

I prefer medicalisation: demand reduction through education and treatment.
For example, 80 per cent of the people in the criminal justice system have
drug abuse problems but only 5 per cent get any treatment now.
Medicalisation puts much greater emphasis on treatment. If you get busted
for smoking while driving, you get diverted to treatment, not jail. We've
gone about as far as we can go with the criminal justice approach.