The mechanism by which tobacco smoke impairs endothelial function, and by extension, how marijuana smoke exerts similar effects, is incompletely understood. Chronic exposure to tobacco smoke results in changes in the serum that can directly lower the activity of endothelial nitric oxide synthase in cultured endothelial cells, thereby lowering the production of nitric oxide, in a manner involving increased oxidative stress. However, the mechanism by which smoke induces these changes, and the identity of the mediators of the effect, are unclear. Given the chemical similarity between marijuana and tobacco smoke,it is likely that the chemicals or the ultrafine particles leading to these changes in the endothelium are common to both kinds of smoke. The gaps in our knowledge about how tobacco smoke exerts its adverse cardiovascular effects have not prevented the findings that tobacco SHS is harmful from having a considerable impact on public health policy, smoke-free laws, physician advice to their patients, and individual behavior. As legal marijuana use increases, public exposure to marijuana SHS may also increase. This demonstration that marijuana SHS exerts adverse effects on endothelial function in rats that are similar to effects of tobacco SHS on both rats and humans should help to inform similar policy and behavioral discussions. Recent policy debates in municipalities such as Ontario, which initially proposed to allow people with prescriptions to smoke marijuana in enclosed locations including theaters and then reversed the policy,exemplify the risks of assuming that marijuana SHS is harmless,hydroponic drain table and illustrate the importance of evidence that marijuana SHS shares at least some adverse health physiological effects with tobacco SHS.
While the public health community has strongly advised people to avoid tobacco SHS for many years, it has not made comparable pronouncements about marijuana SHS, primarily because the evidence has not been available that it could elicit similar adverse effects. The public’s perception of risk from marijuana SHS has thus been limited to a few publicized studies. Marijuana SHS exposure was recently reported to lead to minor increases in heart rate and mild impairment of cognitive function in humans, but only under unventilated conditions with high smoke levels,presumably due to the THC. Mittleman et al reported that active marijuana use increased the risk of experiencing a heart attack roughly 5- fold within the next hour. Because THC has direct effects on heart rate and blood pressure, the authors focused on the potential link between the elevated heart attack risk and the THC. It is also possible that the increased heart attack risk was caused by the adverse effects of smoke on endothelial function. A limitation of the study is that the typical ambient levels of marijuana SHS have not been systematically measured in real world situations, in contrast to what is known about tobacco SHS. The exposure levels of tobacco SHS on which our conditions were based can reasonably be expected to exist for marijuana SHS at parties, rock concerts, and other situations in which multiple people are smoking marijuana at any given time, but this remains unconfirmed. Our understanding of the relative risks of exposure in different social situations would benefit greatly from a comprehensive study of particle levels under these circumstances. Nonetheless, the smoke concentrations in our study were low enough that the smoke was not visible during the exposures in the clear exposure chamber . Since this was a rodent model, specific parameters such as the exposure times and exact durations of impairment may not completely match the corresponding properties of exposure in humans.
However, the process of FMD in rats as we measured it shows great similarity to FMD in humans, as shown by extensive physiological and pharmacological validation as we have described previously.Moreover, rats and humans show comparable responses to similar tobacco smoke exposure conditions.Because our understanding of human cardiovascular consequences of marijuana use has been limited to retrospective association studies,our ability to perform prospective, controlled rodent experiments fills a crucial gap in our understanding of the rapid consequences of marijuana SHS exposure that can be extrapolated to humans. Increasing legalization of marijuana makes it more important than ever to understand the consequences of exposure to secondhand marijuana smoke. The similarity of the chemical composition of SHS from tobacco and marijuana, along with our observation that both kinds of smoke can impair endothelial function, indicate that marijuana SHS has adverse cardiovascular effects in rats and suggest that it may have similar adverse effects in humans. It is important that the public, medical personnel, and policymakers understand that exposure to secondhand marijuana smoke is not necessarily harmless. The four decades old drug policy reform movement is comprised of individuals and organizations working to liberalize drug policies and move away from the system of “punitive prohibition” that typifies current drug policy in the U.S. According to Blain this “campaign is a ‘movement’ in the sociological sense that it employs the conventional repertoire of contention .” Drug policy reform organizations have trained their efforts on a wide variety of policy arenas, including, marijuana decriminalization, needle exchange programs , medical marijuana, and decreasing the penalties for drug offenses.
Over the years, the number of organizations has increased and the specific concerns of various organizations have fragmented. The movement is made up of advocacy and membership-based organizations , a shifting mass base, and wealthy benefactors. Although the movement is ideologically powerful and well funded, successful campaigns in the political arena are few and far between. The drug policy reform movement has encountered opposition from both parent groups opposed to drug policy liberalization , and, uniquely, resistance from government agencies such as the Office of National Drug Control Policy and the Drug Enforcement Administration. The various organizations in the movement focus on a variety of campaigns of local, state,and national scope, yet the two most successful forms of drug policy reform have been medical marijuana and needle exchange programs Medical marijuana has been the most successful form of drug policy reform. In early 2012, sixteen states and the District of Columbia, have laws that allow qualified people to use marijuana for medicinal purposes. Individual medical marijuana dispensaries,rolling benches hydroponics storefront locations that sell cannabis to qualified patients, operate openly in California, Colorado, Montana and Washington. Clandestine medical cannabis dispensaries have been opened in several other states including Nevada, Michigan and Oregon. Along with needle exchanges and safe injection facilities, medical cannabis dispensaries represent specific modalities of drug policy reform. Modalities are different from changes in drug laws and sentencing policies because they have a physical location and present an active challenge to prohibitionist policies. The drug policy reform movement uses a combination of legal change to alter drug laws it finds unfavorable and direct action to put new policy modalities in place. While legislative change occurs comprehensively through ballot initiatives and the adoption of new legislation, activists, organizations and providers institute change on the ground slowly through protracted interactions with law enforcement agencies and state and local governments.Drug policy has been a central problematic in the social science literature for decades. In the 1930s, Alfred Linde smith became the first scholar to look critically at the harmful consequences of punitive drug policy. His work paved the way for later scholars who looked at the negative effects of a policy that some have characterized as “punitive prohibition” . In the 1940s, Mayor Fiorello LaGuardia of New York City organized a team of scientists to investigate the cannabis use and policy in the Big Apple in response to fantastic allegations put forth by the director of the Federal Bureau of Narcotics in the previous decade. In the 1960s and the early 1970s, sociologists Becker , Gusfield and Duster all looked at the symbolic content of drug prohibition and the role of social status in determining which types of drugs were prohibited. During the 1980s and 1990s, epidemiologists and other scholars concerned with the intersection of drug use and drug policy would develop the harm reduction approach in response to the AIDS epidemic . Beginning the 1990s, the racially discriminatory consequences of the war on drugs became a major area of inquiry for scholars of drug policy . While they have often been critical of drug policy, these scholars have rarely had the opportunity to analyze how drug policy becomes more liberal. The emergence and growth of medical cannabis in California presents a unique case of drug policy becoming less punitive. Consequently, it provides me with interesting questions as a scholar of drug policy change. Until the latter half of the 2000s, academics have not afforded medical marijuana the same amount of attention as harm reduction.
Studies of marijuana policy often focus on legislative and judicial arenas , but do not discuss the role of individual actors in initiating marijuana policy change. Blain provides the only scholarly analysis of the drug policy reform movement in a paper he presented at the World Congress of Sociology conference in 2002. He details the emergence of the “anti–drug war campaign” and looks at the strategies that the Linde smith Center and the Drug Policy Foundation put forward at their 2001 meeting. Blain’s work has been very helpful in providing me with background information and avenues of inquiry to guide my research, but I seek to provide more details about the evolution of drug policy reform and the success of medical marijuana. Three detailed analyses of medical marijuana in California introduce some of the issues that I seek to explore further. In Waiting to Inhale, Journalist Alan Bock provides extensive coverage of the campaign to pass Proposition 215 in California, from the initiative’s drafting, to making the ballot, to passage in November of 1996. After passage, Bock gives great details about the struggles of early activists to implement the initiative and the counter-attack of federal law enforcement. His emphasis on regional variations in the governance of medical marijuana provides me with a key insight to organize my analysis of local differences in chapter 5. Bock’s history ends in 2000, however, which leaves me with numerous subsequent events to systematically incorporate into my narrative. Historian, Kathleen Ferraiolo analyzes how drug policy reformers used the ballot initiative process and issue framing to circumvent Federal intransigence with regard to medical marijuana in California and other states. With co-author Richard Webb, sociologist Wendy Chapkis address many of the philosophical and political issues and debates that bound the idea and provision of medical marijuana. Ultimately, Chapkis and Webb, present an intimately detailed ethnography of the WoMen’s Alliance for Medical Marijuana, a medical marijuana collective in Santa Cruz, California. Although the work of Bock, Ferraiolo, and Chapkis and Webb provide me with rich background material, analyses, and concepts to build on, they leave me with plenty of questions about the growth of medical marijuana, the role of the wider movement for drug policy reform and future directions for reformers. Bock’s work is detailed but not systematic. I seek to build on his ideas by incorporating concepts and insights from social movement theory. I also seek to incorporate the ten years of medical marijuana in California that Bock does not cover. While Chapkis and Webb present an exquisitely detailed ethnography of a small-scale medical marijuana cooperative, they do little to contextualize the cooperative they study as but one form of medical marijuana provision in California. The narrowness of their focus does not address the role of the wider movement for medical marijuana, or the wider movement for drug policy reform. Ferraiolo’s scholarly work provides some interesting insights by using the concepts of direct democracy and issue framing, but like many treatments of the medical marijuana movement, she does not address the important role that activists and organizations play in instituting and defending medical marijuana “on the ground.” In addition to building on, and contributing to the field of drug policy studies and the growing literature on medical marijuana, I draw on social movement studies. Social movement scholars have focused on a variety of questions over the past century and a half. Classical works, including Marx’s class-based analysis of the Paris commune and LeBon’s The Crowd, have cast a long shadow on the field, defining central problems and providing fuel for debate. In North America, scholars used the social psychological lens of collective behavior until the 1960s , when resource mobilization theory and Olson’s rational actor approach displaced this orientation.