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Any evaluation of marijuana's real or potential for abuse
for scheduling purposes under the Controlled Substances Act
(CSA) must rely on the legally and scientifically significant
professional standards currently employed by the CPDD.
The CPDD's policy is that evaluation of dependence liability
should be based on markers that reflect biological actions
of the substance in question. The CPDD relies on animal models
to test for dependence liability. A 1984 review of CPDD's
animal testing procedures notes that:
"It is important, however, in testing drugs for physical
dependence liability, to ensure that the same test paradigm
is employed throughout, so that the behavioral influences
are kept constant for all drugs under comparison."(10)
Cicero described the College's work in a background paper
for the Office of Technology Assessment (OTA) of the U.S.
Congress. Cicero lists harmful, "compulsive drug self-administration"
as the first of five characteristics of a drug with significant
abuse potential. The second characteristic Cicero notes is
a "preoccupation with drug seeking behavior to the exclusion
of all other activities." Craving, tolerance, and withdrawal
symptoms are the other three markers of drug dependence."(11)
These criteria are "semi-quantitative" and are used to
evaluate "the degree to which a drug possesses dependence
liability."(12) Tolerance and withdrawal symptoms develop
for many compounds, but that does not qualify them as drugs
with a significant dependence liability. Cocaine use, for
example, lacks evidence of significant tolerance but satisfies
the first three criteria.
"Thus, it is essential that one look at the full spectrum
of the drug's effects and the degree to which it satisfies
the foregoing criteria before any conclusions regarding its
dependence potential are drawn. However, it should be clear
that the first three criteria mentioned above [harmful self-administration,
compulsive drug seeking behavior, and craving] must be satisfied
in all cases to classify a drug as having significant dependence
liability."(13)
Cicero explains that people self-administer many substances
because of perceived beneficial effects. It is when this behavior
results in adverse consequences that self-administration becomes
an indication of drug dependence.
"To summarize, self-administration of a drug to the point
where the behavior becomes obsessive and detrimental to the
individual is the primary criterion which must be met to classify
a drug as one with significant potential for dependence."(14)
The CPDD's conceptual framework for screening drugs for
abuse potential is the same for opiates, stimulants, depressants,
hallucinogens and inhalants. (15) Animal models are used to
evaluate self-administration, drug-discrimination, and tolerance
or other neuroadaptation.
Animal models are a powerful tool, and their use by CPDD
creates legal standards by which the dependence liability
of drugs is determined in comparison to other drugs. Cicero
concedes that animal models are not perfect.
"It must be clearly recognized that the ultimate answer
to the issue of whether a drug has significant abuse potential
is long-term experience once the drug has become available.
Specifically, when a drug is introduced into the general population,
either legally or illegally, the true incidence of its relative
abuse can be assessed with far greater precision than can
be achieved using animal models or limited clinical screening.
Nevertheless, animal models serve as the only practical means
of initially screening drugs for dependence liability and
have proven to be the most effective means of detecting whether
there is likely to be a problem in humans."(16)
On the basis of Cicero's and other reports, the Office
of Technology Assessment concluded that:
"The capacity to produce reinforcing effects is essential
to any drug with significant abuse potential, whereas tolerance
and physical dependence most commonly occur but are not absolutely
required to make such a determination . . . The predominant
feature of all drugs with significant abuse potential properties
is that they are self-administered . . . Animal models of
self-administration provide a powerful tool that can give
a good indication of the abuse liability of new or unknown
drugs."(17)
Brady succinctly summarizes the significance of reinforcement:
"If the abuse liability of a substance as defined by
the likelihood of it supporting drug-seeking and drug-taking,
is to be evaluated, an assessment of its reinforcing functions
by self-administration is clearly the method of choice."(18)
At CPDD's 1989 annual meeting, a presentation on reinforcing
characteristics of drugs also explains that this is the preeminent
criterion:
"If the abuse liability of a substance as defined by
the likelihood of it supporting drug-seeking and drug-taking,
is to be evaluated, an assessment of its reinforcing functions
by self-administration is clearly the method of choice."(19)
Cicero's defense of CPDD's testing paradigms rests on
a considerable foundation of published material, including
the work of noted researchers such as Brady, Griffiths, Schuster,
and Woods. Criticism of reliance on self-administration studies
will be addressed below.
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