AMERICA'S ALTERED STATES, PART 1

When Does Legal Relief Of Pain Become Illegal Pursuit Of Pleasure?

"My soul was a burden, bruised and bleeding. It was tired of the man
who carried it, hut I found no place to set it down to rest. Neither
the charm of the countryside nor the sweet scents of a garden could
soothe it. It found no peace in song or laughter, none in the company
of friends at table or in the pleasures of love none even in hooks or
poetry. Where could my heart find refuge from itself? Where could I
go yet leave myself behind?" -St. Augustine

To suffer and long for relief is a central experience of humanity. But
the absence of pain or discomfort or what Pablo Neruda called "the
infinite ache" is never enough. Relief is bound up with satisfaction,
pleasure, happiness - the pursuit of which is declared a right in the
manifesto of our republic. I sit here with two agents of that pursuit:
on my right, a bottle from Duane Reade pharmacy; on my left, a bag of
plant matter, bought last night for about the same sum in an East
Village bar from a group of men who would have sold me different kinds
of contraband if they hadn't sniffed cop in my curiosity and
eagerness. This being Rudy Giuliani's New York, I had feared they were
undercover. But my worst-case scenario was a night or two in jail and
theirs a fifteen-year minimum. As I exited the bar, I saw an empty
police van idling, waiting to be filled with people like me but,
mostly, people like them, who are there only because I am.

Fear and suspicion, secrecy and shame, the yearning for pleasure, and
the wish to avoid men in blue uniforms. This is (in rough, incomplete
terms) an emotional report from the front. The drug wars - which,
having spanned more than eight decades, require the plural - are
palpable in New York City. The mayor blends propaganda, brute force,
and guerrilla tactics, dispatching undercover cops to call "smoke,
smoke" and "bud, bud" - and to arrest those who answer. In Washington
Square Park, he erected ten video cameras that sweep the environs
twenty-four hours a day. Surveillance is a larger theme of these wars,
as is the notion that cherished freedoms are incidental. But it is
telling that such an extreme manifestation of these ideas appears in a
public park, one of the very few common spaces in this city not
controlled by, and an altar to, corporate commerce.

Several times a month, I walk through that park to the pharmacy, where
a doctor's slip is my passport to another world. Here, altering the
mind and body with powders and plants is not only legal but even
patriotic. Among the souls wandering these aisles, I feel I have kin.
But I am equally at home, and equally ill at ease, among the outlaws.
I cross back and forth with wide eyes.

What I see is this: From 1970 to 1998, the inflation-adjusted revenue
of major pharmaceutical companies more than quadrupled to $81 billion,
24 percent of that from drugs affecting the central nervous system and
sense organs. Sales of herbal medicines now exceed $4 billion a year.
Meanwhile, the war on Other drugs escalated dramatically. Since 1970
the federal anti-drug budget has risen 3,700 percent and now exceeds
$17 billion. More than one and a half million people are arrested on
drug charges each year, and 400,000 are now in prison. These numbers
are just a window onto an obvious truth: We take more drugs and reward
those who supply them.

We punish more people for taking drugs and especially punish those who
supply them. On the surface, there is no conflict. One kind of drugs
is medicine, righting wrongs, restoring the ill to a proper, natural
state. These drugs have the sheen of corporate logos and men in white
coats. They are kept in the room where we wash grime from our skin and
do the same with our souls. Our conception of illegal drugs is a
warped re-flection of this picture. Offered up from the dirty
underworld, they are hedonistic, not curative. They induce artificial
pleasure, not health. They harm rather than help, enslave rather than
liberate.

There is some truth in each of these extreme pictures. But with my
dual citizenship, consciousness split and altered many times over, I
come to say this: The drug wars and the drug boom are interrelated, of
the same body. The hostility and veneration, the punishment and
profits, these come from the same beliefs and the same mistakes.

I.

Before marijuana, Cocaine or "Ecstasy," before nitrous oxide or magic
mushrooms, before I had tried any of these, I poked through the foil
enclosing a single capsule of fluoxetine hydrochloride. My drug story
begins at this point, at the end of a devastating first year of
college. For years, I had wrapped myself in an illusion that my
lifelong troubles - intense despair, loneliness, anxiety, a relentless
inner soundtrack of self-criticism - would dissolve if I could only
please the gatekeepers of the Ivy League. By the spring of freshman
year, I had been skinned of this illusion and plunged into a deep
darkness. From a phone booth in a library basement, I resumed contact
with a psychiatrist I'd begun seeing in high school.

I told him how awful I felt, and, after a few sessions, he suggested I
consider medication. By now our exchange is a familiar one. This was
1990, three years after Prozac introduced the country to a new class
of antidepressants, called selective serotonin reuptake inhibitors.
SSRIs were an impressive innovation chemically but a stunning
innovation for the market, because, while no more effective than
previous generations of antidepressants, SSRIs had fewer side effects
and thus could be given to a much broader range of people. (At last
count, 22 million Americans have used Prozac alone.) When my doctor
suggested I take Prozac, it was with a casual tone. Although the idea
of "altering my brain chemistry" unsettled me at first, I soon
absorbed his attitude. When I returned home that summer, I asked him
how such drugs worked. He drew a crude map of a synapse, or the
junction between nerve cells. There is a neurotransmitter called
serotonin, he told me, that is ordinarily released at one end of the
synapse and, at the other end, absorbed by a sort of molecular pump.
Prozac inhibits this pumping process and therefore increases
serotonin's presence in the brain. "What we don't understand," he
said, looking up from his pad, "is why increased levels of serotonin
alleviate depression. But that's what seems to happen."

I didn't understand the importance of this moment until years later,
after I had noticed many more sentences in which the distance between
the name of a drug-Prozac, heroin, Ritalin, crack cocaine - and its
effects had collapsed. For example, the phrase "Prozac eases
depression," properly unpacked, actually represents this more
complicated thought: "Prozac influences the serotonin patterns in the
brain, which for some unknown reason is found to alleviate, more often
than would a placebo, a collection of symptoms referred to as
depression." What gets lost in abbreviation - Prozac cures! Heroin
kills! - is that drugs work because the human body works, and they
fail or hurt us because the body and spirit are vulnerable. When drugs
spark mira-cles prolonging the lives of those with HIV, say, or
dulling the edges of a potentially deadly manic depression - we should
be thankful.[1] But many of these processes are mysteries that might
never yield to science. The psychiatric establishment, for example,
still does not understand why serotonin affects mood. According to
Michael Montagne of the Massachusetts College of Pharmacy, 42 percent
of marketed drugs likewise have no proven mechanism of action. In
Listening to Prozac, Peter Kramer quotes a pharmacologist explaining
the problem this way: "If the human brain were simple enough for us to
understand, we would be too simple to understand it." Yet
pharmaceutical companies exude certainty. "Smooth and powerful
depression relief," reads an ad for Effexor in a recent issue of The
American Journal of Psychiatry. "Antidepressant efficacy that brings
your patients back." In case this message is too subtle, the ad shows
an ecstatic mother and child playing together, with a note written in
crayon: "I got my mommy back."

The irony is that our faith in pharmaceuticals is based on a model of
consciousness that science is slowly displacing. "Throughout history,"
chemist and religious scholar Daniel Perrine writes in The Chemistry
of Mind-Altering Drugs, "the power that many psychoactive drugs have
exerted over the behavior of human beings has been variously ascribed
to gods or demons." In a sense, that continues. "We ascribe magical
powers to substances," says Perrine, "as if the joy is inside the
bottle. Our culture has no sacred realm, so we've assigned a sacred
power to these drugs. This is what Alfred North Whitehead would call
the 'fallacy of misplaced concreteness.' We say, 'The good is in that
Prozac powder,' or 'The evil is in that cocaine powder.' But evil and
good are not attributes of molecules."

This is a hard lesson to learn. In my gut, where it matters, I still
haven't learned it. Back in 1990, I took the Prozac and, eventually,
more than two dozen other medications: antidepressants,
antipsychotics, antianxiety agents, and so on. The sample pills would
be elegantly wrapped. Handing them to me, the doctors would explain
the desired effect: this drug might quiet the voices in my head; this
one might make me less de-pressed and less anxious; this combination
might help my concentration and ease my repetitive, obsessive
thoughts. Each time I swelled with hope. I've spent many years in
therapy and have looked for redemption in literature, work, love. But
nothing quite matches the expectancy of putting a capsule on my tongue
and waiting to be remade.

But I was not remade. None of the promised benefits of the drugs came,
and I suffered still. In 1993, I went to see Donald Klein, one of the
top psychopharmacologists in the country. Klein's prestige,
underscored by his precipitous fees, again set me off into fantasies
of health. He peppered me with questions, listened thoughtfully. After
an hour, he pushed his reading glasses onto his forehead and said,
"Well, this is what I think you have." He opened the standard
psychiatric reference text to a chapter on "disassociative disorders"
and pointed to a sublisting called depersonalization disorder,
"characterized by a persistent or recurrent feeling of being detached
from one's mental processes or body."

I'm still not certain that this illness best describes my experience.
I can't even describe myself as "clinically ill," because clinicians
don't know what the hell to do with me. But Klein gave me an entirely
new way of thinking about my problems, and a grim message.
"Depersonalization is very difficult to treat," he said. So I was back
where I started, with one exception. During our session, Klein had
asked if I used marijuana. Once, I told him, but it didn't do much.
After he had given me his diagnosis, he told me the reason he had
asked: "A lot of people with depersonalization say they get relief
from marijuana." At that time, I happened, for the first time in my
life, to be surrounded by friends who liked to smoke pot. So in
addition to taking drugs alone and waiting for a miracle, I looked for
solace in my own small drug culture. And for a time, I got some. The
basic function of antidepressants is to help people with battered
inner lives participate in the world around them. This is what pot did
for me. It helped me spend time with others, something I have yearned
for but also feared; it sparked an eagerness to write and conjure
ideas - some of which I found the morning after to be dreamy or naive,
but some of which were the germ of something valuable. While high, I
could enjoy life's simple pleasures in a way that I hadn't ever been
able to and still find maddeningly difficult. Some might see this (and
people watching me surely did) as silly and immature. But it's also a
reason to keep living.

Sad to say, I quickly found pot's limitations. When my spirits are
lifted, pot can help punctuate that. If I smoke while on a downward
slope or while idling, I usually experience more depression or
anxiety. Salvation, for me at least, is not within that smoked plant,
or the granules of a pill, or any other substance. Like I said, it's a
hard lesson to learn.

To the more sober-minded among us, it is a source of much
consternation that drugs, alcohol, and cigarettes are so central to
our collective social lives. It is hard, in fact, to think of a single
social ritual that does not revolve around some consciousness-altering
substance. ("Should we get together for coffee or drinks?") But drugs
are much more than a social lubricant; they are also the centerpiece
of many individual lives. When it comes to alcohol, or cigarettes, or
any illicit substance, this is seen as a problem. With
pharmaceuticals, it is usually considered healthy. Yet the dynamic is
often the same.

It begins with a drug that satisfies a particular need or desire -
maybe known to us, maybe not. So we have drinks, or a smoke, or
swallow a few pills. And we get something from this, a whole lot or
maybe just a bit. But we often don't realize that the feeling is
inside, perhaps something that, with effort, could be experienced
without the drugs or perhaps, as in the psychiatric equivalent of
diabetes, something we will always need help with. Yet all too often
we project upon the drug a power that resides elsewhere. Many believe
this to be a failure of character. If so, it is a failure the whole
culture is implicated in. A recent example came with the phrase "pure
theatrical Viagra," widely used to describe a Broadway production
starring Nicole Kidman. Notice what's happening: Sildenafil citrate is
a substance that increases blood circulation and has the side effect
of producing erections in men. As a medicine, it is intended to be
used as an adjunct to sexual stimulation. As received by our culture,
though, the drug be-comes the desired effect, the "real thing" to
which a naked woman onstage is compared.

Such exaltation of drugs is reinforced by the torrent of
pharmaceutical ads that now stuff magazines and blanket the airwaves.
Since 1994, drug-makers have increased their direct-to-consumer
advertising budget sevenfold, to $1.2 billion last year. Take the ad
for Meridia, a weight-loss drug. Compared with other drug ads ("We're
going to change lives," says a doctor pitching ac-ne cream. "We're
going to make a lot of people happy"), it is the essence of restraint.
"You do your part," it says in an al-lusion to exercise and diet.
"We'll do ours." The specific intent here is to convince people who
are overweight (or believe themselves to be) that they should ask
their doctor for Meridia.[2] Like the pitch far Baby Gap that
announces "INSTANT KARMA" over a child wrapped in a $44 velvet jacket,
drug ads suggest - or explicitly say - that we can solve our problems
through magic-bullet consumption. As the old saying goes, "Better
living through chemistry."

It's the job of advertisers to try every trick to sell their products.
But that's the point: drugs are a commodity designed for profit and
not necessarily the best route to health and happiness. The "self
help" shelves at pharmacies, the "expert only" section behind the
counter, these are promised to contain remedies for all ills. But the
wizards behind the curtain are fallible human beings, just like us.
Professor Montagne says that despite obvious financial incentives,
"there really is an overwhelming belief among pharmacists that the
last thing you should do for many problems is take a drug. They'll
recommend something when you ask, but there's a good chance that when
you're walking out the door they'll be saying, 'Aw, that guy doesn't
need a laxative every day. He just needs to eat right. They don't need
Tagamet. They just need to cut back on the spicy food.'" It is hard to
get worked up about these examples, but they point to the broader
pattern of drug worship. With illegal drugs, we see the same pattern,
again through that warped mirror.

Not long after his second inauguration, President Clinton signed a
bill earmarking $195 million for an antidrug ad campaign - the first
installment of a $1 billion pledge. The ads, which began running last
summer, all end with the words "Partnership for a Drug Free America"
and "Office of National Drug Control Policy." It is fitting that the
two entities are officially joined. The Partnership emerged in 1986,
the year basketball star Len Bias died with cocaine in his system and
Presi-dent Reagan signed a bill creating, among many other new
penalties, mandatory federal prison terms for pos-session of an
illegal substance. This was the birth of the drug wars' latest phase,
in which any drug use at all - not abuse or addiction or "drug-related
crime" -became the enemy.[3] Soon the words "drug-free America" began
to show up regularly, in the name of a White House conference as well
as in legislation that declared it the "policy of the United States
Government to create a Drug-Free America by 1995."

Although the work of the Partnership is spread over hundreds of ad
firms, the driving farce behind the organization is a man named James
Burke - and he is a peculiar spokesman for a "drug free" philosophy.
Burke is the former CEO of Johnson & Johnson, the maker of Tylenol and
other pain-relief products; Nicotrol, a nicotine-delivery device;
Pepcid AC, an antacid; and various prescription medications. When he
came to the Partnership, he brought with him a crucial grant of $3
million from the Robert Wood Johnson Foundation, a philan-thropy tied
to Johnson & Johnson stock. Having granted $24 million over the last
ten years, RWJ is the Partnership's single largest funder, but the
philanthropic arms of Merck, Bristol-Myers Squibb, and Hoffman-La
Roche have also made sizable donations.

I resist the urge to use the word "hypocrisy," from the Greek
hypdkrisis, "acting of a part on the stage." I don't believe James
Burke is acting. Rather, he embodies a contradiction so common that
few people even notice it - the idea that altering the body and mind
is morally wrong when done with same substances and salutary when done
with others.

This contradiction, on close examination, resolves into coherence.
Before the Partner-ship, Burke was in the business of burnishing the
myth of the uberdrug, doing his best - as all marketers do - to make
some external object the center of existence, displacing the
complications of family, community, inner lives. Now, drawing on the
same admakers, he does the same in reverse. (These admakers are happy
to work pro bono, having been made rich by ads for pharmaceuticals,
cigarettes, and alcohol. Until a few years ago, the Partnership also
took money from these latter two industries.) The Partnership formula
is to present a problem - urban violence, date rape, juvenile
delinquency - and lay it at the feet of drugs. "Marijuana," says a
remorseful-looking kid, "cost me a lot of things. I used to be a
straight-A student, you know. I was liked by all the neighbors. Never
really caused any trouble. I was always a good kid growing up. Before
I knew it, I was getting thrown out of my house."

This kid looks to be around seventeen. The Partnership couldn't tell
me his real name or anything about him except that he was interviewed
through a New York drug-treatment facility. I wanted to talk to him,
because I wanted to ask: "Was it marijuana that cost you these things?
Or was it your behavior while using marijuana? Was that behavior
caused by, or did it merely coincide with, your marijuana use?"

These kinds of subtleties are crucial, but it isn't a mystery why they
are usually glossed over. In Texas, federal prosecutors are seeking
life sentences for dealers who supplied heroin to teenagers who
subsequently died of overdose. Parents praised the authorities. "We
just don't want other people to die," said one, who suggested drug
tests for fourth-graders on up. Another said, "I kind of wish all this
had happened a year ago so whoever was able to supply jay that night
was already in jail." The desire for justice, and to protect future
generations, is certainly understandable. But it is striking to note
how rarely, in a story of an overdose, the sur-vivors ask the most
important question. It is not: How do we rid illegal drugs from the
earth?[4] Despite eighty years of criminal sanctions, stiffened to the
point just short of summary executions, markets in this contraband
flourish because supply meets demand. Had Jay's dealer been in jail
that night, jay surely would have been able to find someone else-and
if not that night, then soon thereafter.

The real question - why do kids like Jay want to take heroin in the
first place ? - is consistently, aggressively avoided. Senator Orrin
Hatch recently declared that "people who are pushing drugs on our kids
... I think we ought to lock them up and throw away the keys."
Implicit in this re-mark is the idea that kids only alter their
con-sciousness because it is pushed upon them.

Blaming the alien invader - the dealer, the drug - provides some
structure to chaos. Let's say you are a teenager and, in the course of
establishing your own identity or quelling inner conflicts, you start
smoking a lot of pot. You start running around with a "bad crowd."
Your grades suffer. Friction with your parents crescendos, and they
throw you out of the house. Later, you regret what you've done - and
you're offered a magic button, a way to condense and displace all your
misdeeds. So, naturally, you blame everything on the drug. Something
maddeningly complicated now has a single name. Psychologist Bruce
Alexander points out that the same tendency exists among the seriously
addicted. "If your life is really fucked up, you can get into heroin,
and that's kind of a way of coping," he says. "You'll have friends to
share something with. You'll have an identity. You'll have an
explanation for all your troubles."

What works for individuals works for a society. ("Good People Go Bad
in Iowa," read a 1996 New York Times headline, "And a Drug Is Being
Blamed.") Why is the wealthiest society in history also one of the
most fearful and cynical? What root of unhappiness and discontent
spurs thousands of college students to join cults, millions of
Americans to seek therapists, gurus, and spiritual advisers? Why has
the rate of suicide for people fifteen to twenty-four tripled since
1960? Why would an eleven- and a thirteen-year-old take three rifles
and seven handguns to their school, trigger the fire alarm, and shower
gunfire on their schoolmates and teachers? Stop search-ing for an
answer. Drug Watch International, a drug "think tank" that regularly
consults with drug czar Barry McCaffrey and testifies before Congress,
answered the question in an April 1998 press release: "MARIJUANA USED
BY JONESBORO KILLERS." [5]

II.

In 1912, Merck Pharmaceuticals in Germany synthesized a type of
amphetamine, methylenedioxymethamphetamine, or MDMA. It remained
largely unused until 1976, when a biochemist at the University of
California namedAlexander Shulgin, curious about reports from his
students, produced and swallowed 120 milligrams of the compound. The
result, he wrote soon afterward, was "an easily controlled altered
state of consciousness with emotional and sensual overtones."

Shulgin's immediate thought was that the drug might be useful in
psychotherapy the way LSD had been. In the two decades after its
mind-altering properties were discovered in 1943 by a chemist for
Sandoz Laboratories, LSD was widely used as an experimental treatment
for alcoholism, depression, and various clinical neuroses. More than a
thousand clinical papers discussed the use of LSD among an estimated
40,000 people, and research studies of the drug led to some
extraordinary advances - including the discovery of the serotonin
system. When LSD experiments were restricted in 1962 and again in
1965, Senator Robert Kennedy held a congressional hearing. "If they
were worthwhile six months ago, why aren't they worthwhile now?" he
asked officials of the Food and Drug Administration and the National
Institute of Mental Health. "Perhaps to some extent we have lost sight
of the fact that [LSD] can be very, very helpful in our society if
used properly."

The answer to Kennedy's question was that LSD had leaked out of the
universities and clinics and into the hands of "recreational users."
It had crossed the line that separates good drugs from bad. LSD was
outlawed three years later. In 1970, when a new law devised five
categories, or "schedules," of controlled substances, LSD was placed
in Schedule I, along with heroin and marijuana. This is the
designation for drugs with no accepted medical use and a "high
potential for abuse." In 1986, MDMA would be added to that list of
demon drugs. The question is: How does a substance get assigned to
that category? What separates the good drugs from the bad?

In the nineteenth century, now-illegal substances were commonly used
in medicine, tonics, and consumer products. (The Illinois asylum that
housed Mary Todd Lincoln in the 1870s offered its patients morphine,
cannabis, whiskey, beer, and ale. Sigmund Freud treated himself with
cocaine - and, for a time at least, praised it effusively - as did
William McKinley and Thomas Edison.) A new era began with the federal
Pure Food and Drug Act of 1906, which required the listing of
ingredients in medical products. Then, the 1914 Harrison Narcotic Act,
ostensibly a tax measure, asserted legal control over distributors and
users of opium and cocaine.

On the surface, this might seem progressive, the story of a
still-young nation establishing commercial and medical standards. And
there was genuine uneasiness about drugs that were intoxicating or
that produced dependence; with the disclosure required by the 1906
act, sales of patent medicines containing opium dropped by a third.
But the movement for prohibition drew much of its power from a far
less savory motive. "Cocaine," warned Theodore Roosevelt's drug
adviser, "is often a direct incentive to the crime of rape by the
Negroes." [6] As David Musto reports in The American Disease, the
prohibitions of the early part of the century were all, in part, a
reaction to in-flamed fears of foreigners or minority groups. Opium
was associated with the Chinese. In 1937, the Marihuana Tax Act
targeted Mexican immigrants. "I wish I could show you what a small
marijuana cigarette can do to one of our degenerate Spanish-speaking
residents," a Colorado newspaper editor wrote to federal officials in
1936. Even the prohibition of alcohol was underlined by fears of
immigrants and exaggerations of the effects of drinking. On the eve of
its ban in 1919, a radio preacher told his audience, "The reign of
tears is over. The slums will soon be a memory. We will turn our
prisons into factories, our jails into storehouses and corncribs. Men
will walk upright now, women will smile and the children will laugh.
Hell will be forever for rent."

But the federal authorities, temperance advocates, and bigots had
reached too far. Whereas alcohol (like coffee and tobacco) has been a
demon drug in other cultures, in Western societies its use in
medicine, recreation, and religious ceremonies stretches back
thousands of years. Most Americans had personal experience with drink
and could measure the benefits of Prohibition against the violence (by
gangsters and by Prohibition agents, who, according to one estimate,
killed 1,000 Americans between 1920 and 1930) and the deaths by
"overdose."[7] After Franklin Roosevelt lifted Prohibition, subsequent
generations knew that the drug, though often abused and often
implicated in crimes, violence, and accidents, differs in its effects
depending on the person using it. With outlawed drugs, no such reality
check is available. People who use illegal drugs without great harm
generally stay quiet.

Alcohol also can be legally used in medicines, such as Nyquil, or used
medicinally in a casual way - say, to calm shattered nerves. Demon
drugs, on the other hand, are prohibited or seriously limited even in
cases of exceptional need. Forty percent of pain specialists admit
that they undermedicate patients to avoid the suspicion of the Drug
Enforcement Administration. Their fear is justified: every year about
100 doctors who prescribe narcotics lose their licenses, including, in
1996, Dr. William Hurwitz, a Virginia internist whose more than 200
patients were left with no one to treat them. One of these patients
committed suicide, saying in a videotaped message, "Dr. Hurwitz isn't
the only doctor that can help. He's the only doctor that will help."
Chronic pain, mind you, doesn't mean dull throbbing. "I can't shower,"
one patient explained to U.S. News & World Report, "because the water
feels like molten lava. Every time someone turns on a ceiling fan, it
feels like razor blades are cutting through my legs." To ease such
pain can require massive doses of narcotics. This is what Hurwitz
prescribed. This is why he lost his license.

But at least narcotics are acknowledged as a legitimate medical tool.
Marijuana is not despite overwhelming evidence that smoking the
cannabis plant is a powerful treat-ment for glaucoma and seizures,
mollifies the effects of AIDS or cancer chemotherapy, and eases
anxiety. The editors of The New England Journal of Medicine, the
American Bar Association, the Institute of Medicine of the National
Academy of Sciences, and the majority of voters in California and six
other states (plus the District of Co-lumbia) are among those who
believe that these uses of marijuana are legitimate. So does the
eminent geologist Stephen Jay Gould. He developed abdominal cancer in
the 1980s and suffered such intense nausea from intravenous
chemotherapy that he came to dread it with an "almost perverse
intensity." "The treatment," he remembers, "seem[edj worse than the
disease itself." Gould was reluctant to smoke marijuana, which, as
thousands of cancer patients have found, is a powerful antiemetic.
When he did, he faund it "the greatest boost I received in all my
years of treatment." "It is beyond my comprehension," Gould concluded,
"and I fancy myself able to comprehend a lot, including much nonsense
- - that any humane person would withhold such a beneficial substance
from people in such great need simply because others use it for
different purposes."

This distinction between "people in great need" and those with
"different purposes" is crucial to the argument for the medical use of
marijuana.[8] Like Gould, many who use marijuana for medical reasons
dislike the "high." Many others don't even feel it. But it is a
mistake to think that the reason these people can't legally use
marijuana is simply that other people use it for purposes other than
traditional medical need. Because the very idea of "medical need" is
constantly shifting beneath our feet.

I do not have cancer or epilepsy, or a disabling mental disorder such
as schizophrenia. The "other purposes" Gould refers to are, in many
ways, mine. The qualities of my suffering are (to simplify) anxiety,
numbness, and anhedonia. If these were relieved by a legal drug - in
other words, if a pharmaceutical helped me relax, feel more alive,
have fun - I would be fully in the mainstream of American medicine.
This is my strong preference. But when I returned to see Donald Klein
this past summer, hoping that new medications might have emerged in
the last five years, he told me that "there are lots of things to try
but there's only marginal evidence that any of them would do any
good." He also made it clear that I shouldn't get my hopes up. "What
you have," he said, "is not a common condition, and it's almost
impossible [for pharmaceutical companies] to do a systematic study,
let alone make money, on a condition that's not common." And so, yes,
I turn sometimes to marijuana and other illicit substances far the
(limited) relief they offer. I don't merely feel justified in doing
so; I feel entitled, particularly since, every year, the
pharmaceutical industry rolls out new products for pleasure, vanity,
convenience.

When Viagra emerged, it was not frowned upon by the authorities that
lead the drug wars. Instead, President Clinton ordered Medicaid to
cover the drug, and the Pentagon budgeted $50 million for fiscal 1999
to supply it to soldiers, veterans, and civilian employees. Pfizer
hired Bob Dole to instruct the nation that "it may take a little
courage" to use Viagra. This is a medicine whose sole purpose is to
allow far sexual pleasure; it was embraced by the black market and is
easily available from doctors, including some who perform
"examinations" via a three-question form on the Internet. But Viagra's
legitimacy was never questioned, because it treats a disease -
erectile dys-function. Before Viagra, when the only treatment options
were less-effective pills and awkward injection-based therapies, this
condition was referred to as impotence. The change in language is
interesting. The "dys" sits on the front of dysfunction like a streak
of dirt on a pane of glass. At a level more primal thati cognitive, we
want it removed. This is what we do with dysfunctions: we fix them.
Impotence, on the other hand, meaning "weakness" or "helplessness," is
something we all experience at one time or another. Applied to men
"incapable of sexual intercourse, often because of an inability to
achieve or sustain an erection," the word carries a sense of something
unfottunate but part of living, and particularly of growing older.