From a memo to the student editors of Synapse May 1998

UCSF launched its new “Center for the Neurobiology of Addiction” —an accounting entity described by its founders, poetically, as “a building without walls”— with a symposium May 7-8 at Cole Hall.

The keynote speaker was Alan Leshner, PhD, the director of the National Institute on Drug Abuse. He began by promoting a book published by NIDA entitled Prevent Drug Use Among Children & Adolescents: A Research-based Guide.  He showed a slide of the cover and said modestly, “It’s becoming a bible.”

Leshner’s talk at UCSF and his support for the new “Center” was part of a long-range marketing campaign for a new generation of not-yet-perfected pharmaceuticals that will treat addiction. It’s the same playbook used in marketing Prozac and the other SSRIs. Leshner had taken charge of the National Institute for Mental Health (NIMH) in ‘88, just when it started pushing the concept of Clinical Depression to doctors and the general public.

Leshner is wiry, with a wolfish look. His clothes are expensive. He used pomade and light pancake make-up, and said crass things like “I grew up in the mental health business.” He said he had commandeered slides from some NIDA addiction experts because “after all, I’m the director of the Institute.”

Eight speakers described their addiction-related research to an almost full house of neuroscientsts, postdocs and graduate students. Two very rich men named Wheeler and Samuelson have pledged millions to underwrite addiction-related research at UCSF.

Haile Debas tried his rhetorical best to make it seem as if UCSF has done something other than join forces with the Drug Warriors. He said addiction is a brain disorder, not a character flaw, and doctors should treat it and scientists should seek to cure it. But even in separating the role of biomedical science from the role law enforcement, Debas accepted and repeated the basic political premise that addiction is a threat to society and eradicating it should take top priority as we allocate our time, energy and resources.

Alan Leshner is the federal bureaucrat who for years sabotaged Donald Abrams’s attempt to study the safety and efficacy of marijuana as a treatment for wasting syndrome in HIV patients. In December 1996, in response to the passage of Prop 215, he took part in the press conference (with Barry McCaffrey, Janet Reno, and Donna Shalala) at which they threatened to pull the licenses of California doctors who approved cannabis use by patients. In February ’97 Leshner organized a conference at the National Institutes of Health at which leading experts from all the major fields of medicine agreed that more research was needed before cannabis use could be sanctioned.

NIDA seems to occupy some middle turf between law enforcement and psychiatry combines a prosecutor’s perspective with a scientist’s vocabulary. He was quoted in the New Yorker recently, “My belief is that today, in 1998, you should be put in jail if you refuse to prescribe SSRIs for depression… I also believe that five years from now you should be in jail if you don’t give crack addicts the medications we’re working on now.”

This man has a PhD in psychology from Bucknell, yet he has the gall to say that some experienced physician who might have concerns about the side effects of Prozac belongs in jail… And he’s so sure of the drugs now being synthesized that doctors who won’t give them to crack addicts belong in jail… This was UCSF’s honored guest.

The experiments the Addiction Experts described in Cole Hall ranged from the self-evident to the bizarre. Most proudly showed photographs of their lab set-ups —the rat at the lever, microelectrodes inserted, ready to do some speed for science. Some of the slides showed really cute, content-looking Disney-style rodents. Dr. E. London, PhD, showed a photo of one of her test subjects and said, “You’ll see he’s wearing a little hat…” E. has made a specialty of brain imaging, the phrenology of our time. Depression makes this part of the amygdala blue, and Addiction makes this part of the CVR yellow, and Violence-Prone makes this part of the hippocampus green… I kid you not.

When the scientists give the test animals shocks or “uncomfortable heat” to signal disapproval of drug-seeking behavior, they are introducing an artificial element into the experiment. They are creating a situation that has nothing to do with rodents in the wild. They claim to be creating a situation analogous to that faced by the human drug user. The unpleasant heat applied to the animal in the lab is supposedly analogous to the prosecution of the “drug abuser” in society. (They too feel “the heat”). But why should health scientists replicate that factor in their experiments? Why shouldn’t they question the need for it on behalf of patients?

Most of the speakers discussed rats and addicts in the same terms and tone. Roy Wise, an NIMH researcher, described an experiment in which rats that had to work harder to get their fix did indeed work harder and remarked a “policy implication”: that “the addict would steal that many more hubcaps.”  He was not talking about human beings, he was talking about addicts. As in “hoodlum.” As in “inner city.” As in…

An area of research Leshner wants neuroscientists to pursue involves the genetic changes caused by chronic drug use. This is how he put it: ADD QUOTE

After the session I told Leshner I was a journalist covering the ongoing Prop 215 story and wanted to know his line on the addictiveness of marijuana. He told me in professorial cadences that I was asking two questions that had to be kept separate. (Immediate ranking) One, he said, was the question: “Is marijuana effective as a medicine?” and this, he said, was an open question, the science had yet to be done. The second was the addictiveness of marijuana, and on that the scientific verdict was unambiguous: marijuana is addictive. “Eight to 10 percent of experimental subjects become addicted.”

Addiction, according to NIDA’s new bible —and UCSF Magazine’s cover story released in conjunction with the Center’s inauguration— involves “behavior that becomes compulsive and persistent, despite the negative consequences that result from the drug’s continued use.” In the real world, the “negative consequences” are mainly those imposed by society —stigmatization unto incarceration. Leshner wants neurobiologists to identify the types of biochemical changes —”genetic alterations”— caused by the various “drugs of abuse.” Whatever the neuroscientists come up with will then be defined as “signs of addiction,” and “biology” will have established the “scientific basis” for the manufacture and sale of other drugs —good drugs, NIDA-approved drugs designed to “treat” addiction— for which there is a market of 30-40 million Americans.

And if you won’t prescribe ‘em… you belong in jail. And if you don’t want to take ‘em… you belong in jail.

The chancellor should reconsider his commitment to this Center and should refuse to allow federal bureaucrats and self-interested pharmaceutical companies set the agenda for our medical research. UCSF’s leaders should set their own agenda, deciding what studies need to be done to advance the public health. Neuroscientists should be encouraged to study all aspects of brain and nervous system function —memory, pain, mood, whatever they in their wisdom deem significant. We shouldn’t let the scientific agenda be set by federal bureaucrats and the drug companies into whose employ many will go the minute they leave “public service…” When Alan Leshner is telling UCSF faculty members, postdocs and graduate students how to focus their work, the tail is wagging the dog.

Where are the people with public health training? UCSF is supposed to be the institution where the clinicians and researchers are always interacting. How come nobody stood up for cannabis? Doesn’t anybody take seriously the existing evidence —in the pre-prohbition literature and in the anecdotal evidence provided by patients— that marijuana is safe, effective medicine for people with a wide range of conditions? Why isn’t there a movement of clinicians and researchers to approach this subject without bias? Is everybody so timid? Is it a matter of everyone in Cole Hall being addicted to a certain income level? I suppose we should console ourselves with the thought that honest investigators like Basbaum will get a little more support in the name of “understanding the neurobiology of addiction,” and maybe some of the basic mechanisms will be elucidated and applications developed that really do reduce human suffering.

But it’s not worth the intellectual compromise involved. It’s not worth lending the name of this institution to what is basically a political position. To study addiction from an unbiased medical perspective means questioning all —not accepting any— of the prevailing paradigms. That’s science, isn’t it? Questioning?

Alan Leshner is a drug marketer. He is marketing “anti-addiction medications.” He doesn’t quite know what they’ll consist of, or what their side-effects might be, but people should go to jail for not taking them… This is the voice of “science” talking?.

Many phrases in Leshner’s pitch for the coming Addiction medication (still a gleam in his very gleamy little eyes) echoed those used by his mentors who were pushing the drugs for Clinical Depression a decade ago: “A new generation of research based-medications…” “The ultimate answer lies in biology…” “Drug Addiction is a treatable disease” (and we happen to have the treatment in the pipeline and five years from now you better be prescribing it or, you know….)

Many of the slides Leshner showed were very simple, the first words in capital letters.

The actor Carol O’Connor and his wife attended the event in Cole Hall looking stunned and mournful.  Their son was an addict who committed suicide and now NIDA is exploiting them, poster children in old age…  I recalled a long-ago episode of Archie Bunker’s Place that exposed the effects of speed perfectly. It went something like this: A customer at the bar pays a small debt with some pills. Archie comes home from the bar at 3 a.m., calling for Edith. She hurries down the stairs tying her belt. “What’s the matter, Archie?” “Edith, I decided that tonight I’m going to do something for you that you’ve wanted me to do for a long, long time.” She goes “Ooh, Archie,” in a kittenish voice as if anticipating some longed-for pleasure.  “I’m going to paint the back porch.”