INTRODUCING O'SHAUGHNESSY'S

W.B. O'Shaughnessy, a British physician stationed in India, was 30 years
old in 1839 when he wrote the article that introduced cannabis to Western
medicine. Tod Mikuriya has written about him with admiration: "After
studying the literature on cannabis and conferring with contemporary Hindu
and Mohammedan scholars, O'Shaughnessy tested the effects of various hemp
preparations on animals, before attempting to use them to treat humans.
Satisfied that the drug was reasonably safe, he administered preparations
of cannabis extract to patients, and discovered that it had analgesic and
sedative properties.

"O'Shaughnessy successfully relieved the pain of rheumatism and stilled the
convulsions of an infant with this strange new drug. His most spectacular
success came, however, when he quelled the wrenching muscle spasms of
tetanus and rabies with the fragrant resin."

The "discovery" of cannabis wasn't O'Shaughnessy's only accomplishment,
according to Mikuriya. In 1832, when he was completing medical school in
Edinburgh, he had "invented intravenous fluid and electrolyte replacement
therapy during a cholera epidemic... In the years following the publication
of his cannabis article, he went on to publish a pharmacopoeia of Indian
medicines. He then changed careers, becoming an engineer, and brought the
telegraph to India, a service which led to his being knighted.

He then returned to England, changed his name, and was married thrice
before dying at the age of 81."

And that's why the California Cannabis Research Medical Group -organized by
Mikuriya for doctors taking a special interest in their patients' cannabis
use-is called O'Shaughnessy's. The first issue, a 20-page tabloid, went to
the printers June 17. Your correspondent served as managing editor and
contributed an article called "Which Conditions are Californians Actually
Treating With Cannabis?"

From O'Shaughnessy's statement of purpose: "Our primary goals are the same
as the stated goals of any reputable scientific publication: to bring out
findings that are accurate, duplicable, and useful to the community at
large. But in order to do this, we have to pursue parallel goals such as
removing the impediments to clinical research created by Prohibition, and
educating our colleagues, co-workers and patients as we educate ourselves
about the medical uses of cannabis.

"At least 50,000 Californians have obtained doctors' approvals to use
cannabis since Prop 215 made it legal in November, 1996. (This estimate is
based on records kept by cannabis clubs and an extrapolation with Oregon,
which has a state program that maintains a registry of patients authorized
by physicians to use cannabis.)

"...Doctors who have approved cannabis use by their patients fall into
three broad categories: 1) Willing specialists - mainly oncologists and
AIDS specialists who, having been educated by their patients over the
years, understood the utility of cannabis and felt confident about
approving its use; 2) Willing general practitioners who have written
approvals for a few of their patients who have grave illnesses or otherwise
undeniable needs; and 3) Cannabis specialists, who recognize its
versatility, are convinced of its relative benignity, and keep abreast of
the literature with respect to mechanism-of-action, clinical trials in
Europe, etc. CCRMG members are in this subset.

Collectively, they have issued approvals for more than 25,000 patients.

O'Shaughnessy's most conventional journal article is Mikuriya's "Cannabis
as a Substitute for Alcohol." It reports on 92 cases in which cannabis use
helped reduce alcohol consumption in part or entirely.

One of its key points is that "'drug of choice' is strongly influenced by
social and cultural factors, and, once determined, becomes a defining
element of individual self-image, i.e., possible but not easy to change in
adulthood. Prohibition of marijuana, the intense advertising of alcohol,
and its widespread availability encourage the adoption of alcohol as a drug
of choice among U.S. adolescents. It is likely that legal access to
cannabis would result in fewer young adults adopting alcohol as their drug
of choice, with positive consequences for the public health and countless
individuals."

This is a thesis around which California college students could organize
politically. A reasonable demand, on any given campus, would be that
Student Health Services arrange or promote access to cannabis.

In Chico -where the Cal State campus is famous for "partying," i.e., binge
drinking- a man named Joel Castle is right now trying to start a cannabis
club. According to the Enterprise Record, Castle naively hopes that Butte
County District Attorney Mike Ramsey will give him the green light... If
ever there was a community that would benefit from reading Mikuriya's
"Cannabis as a Substitute for Alcohol," it's Chico.

An overview article by Lester Grinspoon, MD, "The Marijuana Problem," warns
that corporate-produced cannabis medicines can only realize their full
profit potential if prohibition endures. "The commercial success of any
psychoactive cannabinoid product will depend on how vigorously the
prohibition against marijuana is enforced," Grinspoon observes. ".It is
safe to predict that new analogs and extracts will cost much more than
whole smoked or ingested marijuana even at the inflated prices imposed by
the prohibition tariff.

I doubt that pharmaceutical companies would be interested in developing
cannabinoid products if they had to compete with natural marijuana on a
level playing field."

The bravest contribution to the new journal is "Notes on What to Look For"
by Tom O'Connell, MD. O'Connell is a retired thoracic surgeon who spent
half his career in the U.S. Army. He resumed practicing two years ago,
intensely interested in who was using cannabis under Prop 215, and why. His
"Notes" describe the evolution of his patient interview and his methods of
collecting and analyzing data. O'Connell's informal and almost
self-critical tone is striking because the medical culture tends to be
macho and show-offy.

The "Which Conditions?" survey posed a few simple questions to 10
physicians who, between them, had approved use by more than 25,000
patients. Most responded with estimates.

One requested anonymity. Responses to the question "What percentage had
been self-medicating with cannabis prior to consulting you?" revealed a
somewhat surprising pattern:

Dr. A: More than 97 percent.

Alcalay: 99 percent.

Bearman: While most have used it before, many had stopped years ago before
starting again medically. I would estimate that 95% to 97% had been using
with benefit just prior to the visit.

Denney: 95%. Fry: All but approximately 20. Hadorn: I can only remember one
who wasn't already using it. Hergenrather: 99%. Lucido: 99% Mikuriya: 99.9%
O'Connell: Essentially all; most for years -or decades. Schoenfeld: Prior
to consulting me, all but one or two had been self-medicating with cannabis.

In other words, with very few exceptions, only people who had been
self-medicating with cannabis are availing themselves of it under
California law (at least from this subset of doctors). Apparently
legalization has not led to a wave of naive patients with various
conditions trying cannabis to see if it might help in some way, or doctors
recommending that they do so. "Approve" is a far more accurate term than
"recommend" to describe the physicians' role to date.

Several factors may explain the flat state of demand for a promising new
medicine. The highly publicized prosecutions of cultivators and
distributors by state and federal law enforcers has maintained an aura of
illegality around cannabis. No manufacturers have an interest in promoting
its use -in fact, they have a strong incentive to lobby for continued
prohibition. Cannabis remains hard to get and expensive ($400/ounce).
Insurers don't reimburse for it. Corporate employers test, humiliate and
fire cannabis users at will. Almost no doctors have been educated on any
aspect of cannabis -modes of delivery, efficacy, mechanism of action, etc.-
whereas all are aware that smoking involves an assault on the lungs.
Threats from the federal government, although ruled unconstitutional, have
had a chilling effect.

In subtle but significant ways, lingering Prohibition has also affected the
thousands of Californians who legally self-medicate with
cannabis. Mikuriya has observed that many problem drinkers, at their
initial exams, will emphasize conditions other than alcoholism; upon
learning that substituting cannabis for alcohol entitles them to a letter
of approval, they reveal the true severity of their drinking
problem. Similarly, O'Connell reports that many young men debilitated by
what he diagnoses as ADHD with low self-esteem will present with
physical-pain problems.

They are forthcoming about beneficial psychotropic effects only after the
doctor has acknowledged the possibility of such effects. It can be argued
that a signal from the physician would inevitably skew the interview; but
the impact of prohibition is such that it may take a signal of tolerance
from the physician to begin to un-skew it.

O'Shaughnessy's will be online at http://www.ccrmg.org. Address
correspondence to CCRMG p.o. box 9143, Berkeley CA 94709. Or email
journal@ccrmg.org.

SECOND ITEM Ring Lardner, Jr., on Cannabis as a Substitute for Alcohol

Screenwriter Ring Lardner, Jr. won an Oscar in 1938 for "Woman of the Year"
and another in 1970 for "M*A*S*H." His wonderful memoir "I'd Hate Myself
in the Morning" (which takes its title from his line to the House
Un-American Activities Committee) includes this description of his
colleagues Ian Hunter and Waldo Salt:

"Ian, too, had an alcohol problem -one that, unlike mine, increased in
severity to the point of debilitation. During the period when we had to
come up with an episode for a half-hour television program every week,
there were times when I had to perform the task by myself.

On occasion, he would pull himself together and make a big effort to match
what I had done single-handed. Eventually, though, he came to the
conclusion that he would have to give up drinking for good. And he
proceeded to do just that, first by enlisting in Alcoholics Anonymous, as
he went cold turkey, then, to fortify his abstinence, by substituting
marijuana for alcohol.

It happened that a friend of ours, the blacklisted writer Waldo Salt, had
made the same medicinal switchover. Since Ian and Waldo also shared a love
of drawing, they could pool the cost of a model and spend an evening
indulging in pot and art. Neither of them drank again, as far as I know.

"Some years earlier, when the film community was still disproportionately
Jewish, my good friend Paul Jarrico announced a discovery.

He had been wondering why a small grup of his fellow screenwriters -Ian,
Dalton Trumbo, Hugo Butler, Michael Wilson, and I- were such a close, cozy
group.

What bound us together, Paul reported, was the fact that we were all
gentiles. 'Nonsense,' Ian declared, 'It's that we're all drunks.'
Instantly, I knew he was right.

It was by far the stronger bond."