Weed Land. Peter Hecht
The Drug Enforcement Administration refused to allow the marijuana for the study, then being cultivated in Amsterdam, to be imported into the United States unless the Dutch government would send the DEA a letter saying it was okay for the company to export it. The Dutch government wouldn’t send the letter unless the DEA said it was okay to import it. So the Food and Drug Administration told Abrams to get in touch with the National Institute on Drug Abuse, which had access to government-grown marijuana, cultivated since 1970 under a closely supervised program at the University of Mississippi. Since 1976, the five-acre government pot farm had produced monthly tins of three hundred marijuana cigarettes, which were sent to about a dozen patients in the little-known Compassionate Investigational New Drug program of the FDA. The program was created after a lawsuit by glaucoma patient Robert Randall, who sued the government after a raid on his pot garden in 1975. A U.S. District Court in Washington ruled Randall’s use of marijuana was a medical necessity—pot helped keep him from going blind—and ordered the government to provide Randall with the drug. A dozen more people were later added to the Compassionate IND program. Otherwise, getting weed out of Uncle Sam’s pot garden was all but impossible—especially so for medical research that might show the benefits of cannabis.
The fact that Donald Abrams was working on the front lines of the AIDS epidemic, in which people were starving and dying with wasting syndrome, wasn’t enough to force the hand of the National Institute on Drug Abuse or its director, Alan I. Leshner. NIDA rejected Abrams’s plan for a community-based, outpatient study. The agency contended the study protocol didn’t provide adequate supervision of patients’ diets. It also suggested that research subjects with AIDS wasting syndrome might deal the government’s pot to their friends.
Leshner told Abrams he needed to go to the National Institutes of Health to have his study peer reviewed. Abrams reworked the study as a supervised, inpatient clinical trial at San Francisco General Hospital, in which subjects admitted for two fifteen-day evaluation periods would smoke marijuana or placebo joints with the psychoactive THC removed. The National Institutes of Health reviewed the study but effectively killed it, because the agency didn’t bother to attach a research score, an action critical to ranking the trial for potential government funding. Two peer reviewers questioned why researchers wanted to test a “toxic” substance such as pot. Another suggested that wasting patients rediscovering their appetites might develop high cholesterol, clogged arteries, and reduced suppression of tumor cells. Abrams was incredulous. People with wasting syndrome didn’t live remotely long enough for any of that to occur. These people obviously don’t see the same patients I do, he thought.
In 1995, Leshner wrote Abrams, formally notifying him that the study idea was flawed and not worth the government’s resources. Rick Doblin and fellow board members of the Multidisciplinary Association for Psychedelic Studies went to the National Conference on Marijuana Use, Prevention, Treatment and Research in Washington, D.C. In a silent protest, they unfurled banners charging that NIDA was blocking critical medical marijuana studies. Abrams, a clinician perpetually calm and cerebral with a wry humor, went off on Leshner in a furious missive.
“To receive the first communication from your office nine months after we sent the initial submission is offensive and insulting,” Abrams wrote. His letter rose in intensity as he challenged the NIDA director’s purported concern for wasting patients. “Finally, the sincerity in which you share my ‘hope that new treatments will be found swiftly’ feels so hypocritical that it makes me cringe,” Abrams wrote. He went on: “You and your institution had an opportunity to do a service to the community of people living with AIDS. You and your institution failed. In the words of the AIDS activist community: SHAME!”
By November 1996, when California voters passed Proposition 215, the prospects for research still remained uncertain at best. Three months earlier, the National Institutes of Health had joined in rejecting Abrams’s wasting syndrome study. Yet there was new hope in San Francisco and its gay community. Improved protease inhibitor drugs and other new antiretroviral medications were ending the death sentence of AIDS. Far fewer people were afflicted with wasting syndrome. And, though it made no reference to medical research, California’s historic medical marijuana vote seemed to cry out for studies on pot’s effectiveness in conditions such as AIDS/HIV, cancer, anorexia, spasticity, and pain.
In January 1997, after attending President Bill Clinton’s inauguration for his second term, Abrams got an audience at the National Institute on Drug Abuse in Bethesda, Maryland, with Alan Leshner. Abrams wanted to know what it would take for the government to support cannabis studies. Their meeting was both cordial and revealing.
“You know, I have better things to do than to continue to write grants to study marijuana,” Abrams began. He argued to Leshner that people were still going to smoke pot if studies showed it was harmful. He also suggested it was unlikely that more people would use marijuana if it was proven beneficial and safe.
“That’s where you may be wrong,” Leshner answered.
It was a year before the United States government would file civil actions to close Jeff Jones’s Oakland Cannabis Buyers Cooperative, declaring that the facility, which purported to offer medicinal comfort for sufferers of AIDS, cancer, and other serious illnesses, was drug trafficking under federal law. And the director of the National Institute on Drug Abuse told Abrams that proving pot’s medical efficacy could be problematic. Leshner suggested that it might challenge the government to rethink marijuana’s legal status as a prohibited Schedule I drug deemed to have no medical benefits and a high potential for abuse. He informed him that NIDA’s congressional mandate was to study substances of abuse or addiction. Leshner said the agency wasn’t intent on blocking all medical cannabis studies, particularly those with favorable peer review. But he made it clear that research protocols designed to establish marijuana’s medical benefits were unlikely to get agency backing or funding.
“We are the National Institute on Drug Abuse, not for drug abuse,” Abrams reported Leshner told him. The director denied using the phrase.
After Proposition 215’s passage, Abrams attended meetings with the San Francisco Department of Public Health in 1997 to discuss how to make the law operational for people who needed cannabis. At one meeting, he met an ACT UP member worried about the recent death of an AIDS patient who had been taking Ecstasy. The drug had blocked the liver’s metabolism of protease inhibitor drugs, heightening the patient’s vulnerability to the disease. By then, an estimated eleven thousand gay men in San Francisco were using marijuana for AIDS or HIV. The ACT UP activist wanted to know whether pot, too, could interfere with lifesaving antiretroviral drugs. Abrams had an epiphany. He could study the risk of pot for patients on protease inhibitors. He wrote up a research protocol for a clinical trial on the potential interaction between marijuana and the AIDS-fighting medications, arguing the connection “is worrisome since many HIV-infected patients continue to smoke marijuana as an appetite stimulant or to decrease nausea.”
On April Fools Day in 1997, Abrams attended a planning conference for the Office of AIDS Research in Washington, D.C. During a morning break, a colleague told Abrams there was a man from the National Institute on Drug Abuse who wanted to talk with him. Abrams found himself discussing his research aspirations with Dr. Jag Khalsa, a program officer with NIDA’s Center on AIDS and Other Medical Consequences. Khalsa told Abrams he funded studies on health and medical effects of substances of abuse. He said a study into whether marijuana interfered with protease inhibitor drugs might fit the bill.
“Send it to me,” he said of Abrams’s research plan.
“Do you know who I am?” Abrams asked, convinced this must be an April Fools joke.
“I know who you are,” Khalsa replied. “Send it to me.”
In August 1997, after a peer review by specialists whom Abrams had suggested—in clinical pharmacology, immunology, virology, endocrinology, and HIV medicine—NIDA and other government agencies signed off on the project. With $1 million in funding awarded for the research, Abrams accepted delivery from NIDA of fourteen hundred government-rolled joints from the University of Mississippi, plus a research supply of the synthetic THC drug Marinol from the pharmaceutical manufacturer Roxane Laboratories, of Columbus, Ohio. The pot was stored at San