1995 Stanford Health Policy Forum

Opening remarks from Nonjohn (A.K.A. John Tennison) for a panel on "Alternative Drug Uses and Therapies," Kresge Auditorium, Stanford University, Palo Alto, California, April 22, 1995

    "Hello. My name is John Tennison. I'm a second year medical student at Stanford and I will be moderating today's workshop on Alternative Drug Uses and Therapies. Before describing the rationale for this workshop, I would like to introduce our three panelists. To my left is Rick Strassman, M.D., Associate Professor of Psychiatry, University of New Mexico School of Medicine. To Rick's left is Charles Grob, M.D., Associate Professor of Psychiatry, UCLA School of Medicine; Director, Division of Child and Adolescent Psychiatry, Harbor-UCLA Medical Center. And to Charles's left is Juan Sanchez-Ramos, M.D., Ph.D., Associate Professor of Neurology, University of Miami School of Medicine."

    "The idea for this workshop came about because of my having seen a talk here at Stanford last year by psychiatrist, Peter Kramer, author of the popular book, "Listening to Prozac." In his book, Kramer suggested that Prozac, although categorized as a anti-depressant, might in fact have other positive qualities that even someone who was not depressed could benefit from. For example, Kramer noted that after taking Prozac, some patients became "better than well" and "acquired extra energy and became socially attractive." Kramer's comments got me thinking about the possibility that drugs might have applications other than those recognized by conventional medicine. So I reviewed the literature to see what had been written regarding unconventional uses of psychoactive compounds. In doing so, I realized that some of the most interesting claims for alternative uses of drugs had been made for what the FDA calls Schedule 1 drugs. The FDA system classifies drugs into one of five categories or "schedules." Drugs placed in the Schedule 1 category are generally said to have a high potential for abuse, a lack of acceptable safety, as well as no acceptable medical use. However, my review of the literature revealed that some individuals believe that certain substances, despite being classified as Schedule 1, have a low potential for abuse, can be used safely, and have legitimate medical and even non-medical uses. So I made the decision at that point to establish a workshop at this year's forum that would examine the rational basis for the current public policy towards controversial uses of both licit and illicit psychoactive drugs, such as Prozac, and also marijuana and the hallucinogens. And in reviewing the most currently published literature, I learned that there were three individuals -- three researchers in the United States -- who were currently conducting FDA-approved studies with Schedule 1 substances in human beings. And I'm happy to report that we have all three of them here today. In turn, they're going to discuss their work and speak to the health policy issues related to their work."

    "For the sake of today's workshop, I've divided the possible drug uses into five categories. These are somewhat arbitrary and surely there's some overlap between them. And perhaps they're not inclusive of every possible use imaginable, but for the sake of the workshop, these are the five categories: (Certainly you gentlemen don't have to work within these bounds. If you want to add your own categories, you're welcome to.)"

    "The first category is one of traditional medical use, which I call "therapeutic." These are uses which fit into popular medical models, including psychotherapy, the treatment of depression, drug addiction, pain, nausea, glaucoma, anxiety, and so forth. For example, Harvard psychiatrist, Lester Grinspoon, noted that, "In AIDS patients, smoked marijuana has been reported to be more effective than the synthetic version of THC, in the oral pill, at relieving nausea. In fact, here in California, the National Organization for the Reform of Marijuana Laws is conducting an effort to place a medical marijuana initiative on the 1996 California ballot. Regarding psychotherapy, I might also mention that when it was still legal, the actor, Cary Grant went through one hundred LSD psychotherapy sessions. As a result of his treatment, he said, "All my life I've been searching for peace of mind. I had explored yoga and hypnotism, and made attempts at mysticism. Nothing really seemed to give me what I wanted until this treatment." So I thought that was a pretty thought-provoking statement to have been made. Not to say that Cary Grant is the end-all, but he's not your classic Dead Head, your tie-dyed type that you might expect to say such a thing. (But some of my best friends are Dead Heads, to use a classical expression.)"

    "The next category I use is "basic science." And this is something Stanford, of course, is very interested in -- that is, uses with human subjects to elucidate the workings of the central nervous system. For example, Johns Hopkins neuroscientist, Solomon Snyder, who himself ingested LSD when it was still legal to do so, noted that "Brain researchers want to know the molecular mechanisms that underlie the psychedelic experience, hoping thereby to discover the physiological principles behind such intangible yet ineluctable entities as our sense of religiousness, our striving for immortality, and our fundamental awareness of being human." That was also an interesting quote, I thought."

    "The third category is one of "psychological enhancement." This one falls neatly into Kramer's speaking of Prozac as a means of enhancing personality. Also, Lester Grinspoon wrote in 1994 that marijuana 'can help the user to penetrate conceptual boundaries, promote fluidity of associations, and enhance insight and creativity.'"

    "The next category is one of "religious/spiritual" uses. These are uses which could be regarded as exercising of one's religious freedom. When considering hallucinogenic substances, such as mescaline, psychoactive mushrooms, and ergot of barley, Joseph Campbell, noted scholar of religion and mythology, remarked, "There can be no doubt today that through the use of such sacramentals, revelations indistinguishable from some of those reported of yoga have been experienced." Another noted scholar of religion, Huston Smith, noted that, 'psychedelics seem on occasion to offer direct disclosures of the psychic and celestial planes, as well as in rare instances, the infinite itself.'"

    "The last category that I've put forth for today's workshop is one of an "aesthetic/sensual" nature, that is, uses to enhance the perception of pleasure or beauty, such as generating euphoria, promoting aphrodisia, and modulating sensory experiences, sometimes with the intent of creating what's known as synesthesia, that is, seeing a sound or hearing a color."

    "Now even if all of these or some of these uses were deemed undesirable, I think society would still be faced with potential public health concerns resulting from the continued use of licit and illicit psychoactive compounds. For example, if you've been following the O. J. Simpson trial on television, you might have been exposed to the sound bites from the Nobel laureate, Kary Mullis, who discovered the so-called "polymerase chain reaction." It was the intention of the defense to use Mullis as an expert witness on genetics to refute the DNA evidence gathered by the prosecutors. However, in relation to this workshop, the most interesting comments from Mullis regard his use of LSD. To paraphrase Mullis, he's claimed that LSD expands the mind, and that he intends to keep on using it, even it is illegal. And apparently he's not alone. For example, in a 1991 University of Michigan study, 9.6% of college students reported having tried LSD and 46.3% reported having tried marijuana. So it seems that everyone, especially those concerned with health policy, would benefit from learning the facts about these and other psychoactive compounds. So without further commentary, I'd like to hand the mike over to Rick Strassman as our first presenter, and we'll go down the line here to Juan."

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