140 May 4, 1981 THE MARIJUANA EPIDEMIC I get a sick feeling in the pit of my stomach when I hear talk of marijuana being.safe. Marijuana is a very powerful agent which is affecting the body in many ways. What the full range of these consequences is going to be, we can only guess at this point. But from what we already know, I have no doubt that they are going to be h0rrendous.l Dr. Robert DuPont Former Director of the National Institute on Drug Abuse.

INTRODUCTION Marijuana smoking has reached epid emic proportions in the United States. Some sixteen million Americans are now regular users; and among high school seniors, about one in ten are daily smokers averaging 3% joints a day The extent of current marijuana consumption raises many important conc e rns. While use of the drug is widespread throughout the world, for instance, only in the United States is it so prevalent among young people of all classes that an entire genera tion is affected. In other countries, the smoking of marijuana is not usually found throughout the entire society generally use is confined to certain religious groups or classes this country does it involve the whole culture.

Only .in Washington Post, July 30, 1978 2 The most frightening aspect of the widespread use of the drug is that the overwhelming majority of smokers have no mowledge of the demonstrated medical effects of marijuana. Most regard it as completely harmless, or at least as no worse than alcohol or tobacco. During the 1960s, when the drug became common in America r elia6le scientific evidence was sparse. Marijuana seemed harmless enough to most people, and the-very expression of doubt by experts was all too often discounted as deriving from opposition to the political and social attitudes of the users This absence o f hard evidence regarding the consequences of the drug caused many scientists and legislators to take a liberal view of marijuana usage how could one condone alcohol and tobacco and then condemn marijuana? But in the last ten years the climate has changed. Many detailed studies have been published on the medical aspects of the drug, and a body of scientific literature has been assembled which was unavailable only ten years ago. The National Institute on Drug Abuse (NIDA a division of the Department of Healt h and Human Services, has taken the lead in sponsoring over a thousand tests, employing sophisticated procedures to control dosage strength, etc consistant with patterns of social usage. Other organizations have funded similar research projects.

It took sixty years of'studies to establish a strong correla tion between tobacco' smoking and a number of serious diseases.

Yet'the results of experiments carried out in the last decade already suggest a strong relationship between the use of drugs and several med ical disorders. Marijuana appears to Impair memory, learning performance, motivation and may permanently damage brain tissue. It would also seem to have damaging effects on the lung, reproductive organs and the immunity system.

The powerful evidence now available has caused many experts to revise their position from one of indifference to one of great concern. Dr. Robert DuPont, quoted above, is a case in point.

In various senior governmental positions, he did much to soften attitudes towards the use of marijuana indeed he was often cited in the literature of the decriminalization lobby. But now as president of the American Council on Marijuana, he is in the fore f ront of a campaign to end the consensus that marijuana is no worse than many other drugs taken for pleasure. That belief, he says is a disaster and I feel very badly to have contributed to it Ir2 Like so many of those who have changed their minds in light of the evidence, Dr. DuPont is particularlyranxious about the long-term consequences of marijuana smoking on the current school population 9 Reading, k'riting and Reefer NBC News Report, broadcast December 10 1978 3 This Backgrounder will review the scimt ific evidence which has led to the ciramacic change of heart by so many people It will then examine 'she policy options available to &ea1 with the situation TIE G2OWING USE OF WIJUA What is Marijuana?

Marijuana (also known as pot or grass) comes from the p lant Cannabis Satin (Indian hemp or hashish which has been culcivated for hundreds of years as a source of rope. The princigal psycho active, or mind-altering, inqredient of marijuana is a substance know scientifically as delta-9-tetrahydrocannabinol (or T XC although several hundred other chenicals with various effects are also present An 1ntak.e of between five and ten milligrams of T5C into the bloodstream is usually sufficient to induce intoxication a high In tlle 1960s, when the drug was becoming fashi o nable most of the marijuana smoked in this country vas of domestic origin At that time, most Amerlcan marijuana had a rather low THC content (0.2 percent to 1 percent and so a 1 gram joint might contain in the region of 2-10 milligrams of THC. By-1970, ho w ever Mexican marijuana with an average THC of between 1.5 percent and 2 percent, had begun to dominate the market. By the end of the 1970s, Jamaican and Colombian varieties, with concentrations of 3 percent to 4 percent THC began to enter t!he country in i ncreasing quantities. In addition, liquid hashish, with a concentration of 30 percent to 90 percent THC, began to appear. At a potency rate of 50 percent THC, an ounce of'this oil is sufficient to intoxicate one thousand people. In 1974 alone, 369 pounds were seized by federal agents.

The rise in potency of marijuana available in the United States is central to any discussion of the medical impact of the drug. The early, inconclusive studies carried out in this country were based on the low-potency marijua na then being consumed But now we are dealing with far stronger varieties, and the studies using these strains of marijuana are far from inconclusive.

Usaqe of Marijuana Twenty years ago, marijuana was hardly used in this country.

Only in the late 1960s did the drug become widely used, and not until the mid-1970s did it become commonplace. The increase in use has been drmatic by any measure study on usage was conducted by the National Institute on Drug The most recent major 3 J. N. Jenson, Testimony befo r e the Senate Subcommitt2e on Internal Security Hay 1975, ref. 81, pp 31-450. .Abus2, using a national sample carcfully brokzn dow by aqe and other characteriscics As Table I indica-ces, this study fcund that 68 percent of young adults in 1973 had tried in a rijuaca compared with only 4 percent in 1562. hong 12- t.o 17-gsar-olds the proportion had grown over the same period from just 1 gercent to 31 percenc. Even zmong 12- to 13-year-aids in 1979, the study showed 8 percent had besn introduced to the drug. Wh e n NIDX examined currenc users (those who had used tne drug within che lase month the pattern illustrated by Table I1 emerged. 4s the figures Indicate, widespread use now occurs among children of high school age and 40 percent of the college-aged populatio n are current users.

Among those who reported current use of the drug, the NiDA study found that about two-thirds of younq adults and one-half cf older adults and youths have used marijuana five or more times i11 the last month. Of our high school seniors, some 10 percent =ere found to be dailv users, consuming an averaqe of 2% marijuana joints even day. Not only has the proportion of daily users doubled among high school seniors since 1975, but it now exceeds the number who use alcohol on a daily basis (s t able at about 5 percent since 1975 When one renernbers that the potency of the average marijuana joint has increased many fold in the last ten years, it becomes clear that we are dealing with a staggering increase in the consumption of THC, particularly a mong the student population.

In the 1960s, the medical implications of marijuana use were of direct concern only to a small number of people, ana the dangers of heavy chronic use to an even smaller group. But today, the I drug is so widespread that the med ical evidence is important for the mtire population.

The volume and market value of the marijuana trade now rnakss it a major industry. According to the Wall Street Journal.even domestically produced marijuana rivals some leading farin crops.

In California, the value of production may soon pass the $1 billion grape industry the state's number one farin commodity.

In Hawaii, the level of marijuana production and sales may exceed the islands' largest business, the S300 million sugar industry.5 The Federal Drug Enforcement Administration (DEA) estimat2s that domestically produced marijuana now accounts for up to 20 percent of the value of the entire trade. The American growers have specialized in recent years on developing very high grade varie ties, by sel e ctive breeding. The most potent California strains G Yational Iastitutt for Grug Abuse, Yational Survey on Drug .Yous lain Findings 1979 (Rockville, Plaryland iIDA, ESOj. J h'all Street Journal August 4, 1980. d.[ 0 N J h Q c 4 m h m r U U a Q) 4 k CI 5 0 a S L 0 a 0 0 h m c hl (0 aa v 00 mz 7 can'contain as inuch as 6'percent pure TBC. A single plant, on a three-foot'diameter plot, can yield S1,OOO a moderate-sized garden will produce $100,000 worth of the drug.6 The size or' the total American trade, inc l uding imports, can only be deterinined roughly, buc it has been estimated that the amount of marijuana coming into this country every year is between ten and tve'nty thousand tons, with a street value in the region of S20 The 1970s also saw the rapid grow t h of what has now become.a multi-million dollar industry providing drug-related paraphenalia magazines and books. Publications such as gigh Times which boasts a readership of four million carry in-cepth articles on the use of drugs and legal issues, and a r e-full 02 glossy adver tisements for drug equipment. High Times even provides full listings of the prevailing market prices for many drugs, much as the Wall Street Journal carries the'latest stock market quotations While the commercial return available on marijuana has been a major contributor to its ready availability, there are other important factors behind the growth in usage. In the late 1960s and early 1970s, the drug was an integral part of the non conformist lifestyle in universities and elsewhere. The attempt by "authority" to stamp out marijuana consumption, or even discour age it, was seen as an attack on the alternative lifestyle, and the illegality of the. drug was quit2 probably a significant stimulus to its consumption. This mood of resistanc e was only encouraged by exaggerated claims (on the basis of then available evidence) regarding the health dangers connected with marijuana in use has been simple ignorance. If, as most people believe the drug is fairly harmless, then why not use it if it is pleasant?

As we shall see in this study, nothing could be fur+her from the truth, but survey after survey shows that while the dafigers of alcohol and tobacco are widely appreciated, those associated with marijuana are not.3 In all probability the most important cause of 'the explosion THE SCIENTIFIC EVIDENCE General Considerations Before we examine the evidence regarding the effects of marijuana on the body, it is important to put this ev1denc.e in its historical perspective. The early American studies on mari juana, such as they were, were unsatisfactory for several reasons 5 Vashington Post, February 15, 1981. 20,000 tons would be sufficient to make approximat2l-j 13 billion joints See, for instance, L. D. Johnston, J: G. Bachman, and P. Y. O'Plalley, Drug Use Among Kigh School Students, 1975-1977 (Rockvill Yaryland: NIDA, 19771 8 The strength of TXC in test samples was often not .Lr?own vitk srecision, and. so it was debat≤ in nany inscances what wps actuallJ being measurcd. in addition, as has been explained, the TEC strength of the average joint has ixreased dramatically ir recent years ie are dealing with a totally different lwei of consumpxion than was the case in the 1950s. Using typical test results from the 1950s and 1960s as a quide to the ef f xts of present-day use pattsrns is rather like trying to determine the consequences of a bottle of gin a day on the averase Ferson by testing the effects of a single daily martini that many were inconclusive, and this gave powe'rful ammunition to the pro- l egalization lobby. Even among the scientific esz&lish ment, a comparatively sanquine attitude seemed. justified Given the shortcomings of early tists, it Fs not suwrising The first deternined challenge to this consensus came from cians have often been the first people to warn the world of the clinical psychiatrists particularly from those associated with educational institutions where the drug was in heavy use. Clini unforeseen effects of a arug thalidomide being perhaps' che most well known case and the i m portance of their front-line role cannot be understated. Typical of such clinicians was Dr. FTa_r,-ey Powelson, head of the Psychiatric Division of the Student Health years of 'extensive exposure to Berkeley students during the period in which marijuana u s e accelerated greatly make him probab ly the most experienced campus psychiatrist in the country. Like so many of his associates in the 1960s, Powelson took a tolerant attitude to marijuana in his early days at the University of California; but as he watc hed individual users over an extended period of time his attitude changed completsly, to the point where he came to believe that it is the most dangerous drug with wnich the nation must contend.g Service at aerkeley between 1964 and 19

72. Powelson's eight It was the conclusions of observers such as Powelsorr that created the pressure for the very thorough testing which began in the early 1970s. This series of tests have been far superior to the research of the 1950s and 1960s: more carefully controlled TH C doses have been used, for instance, and strength levels I both human and animal tests reflsct current usage. it should Sz noted, however, that there are still some unavoidable obstacles to tssting. Marijuana is an illegal substance, and so it is not alwa y s easy to obtain statistically perfect volunteer groups. In addition, early studies showed that THC is highly toxic, and that it may pose significant dangers to certain individuals and co the fetus. So there are strong moral and legal irnpediinents to cer t ain imporcant t2Tss of study, necessitating the use of animals ratkr D. H. Powelson, Testimony before the Senate Subcommittee ,311 Internal Securicy, May .197 ref. SO, pp. 15-29; and "Y3rijuana lor2 Oanqec.~us Than You Knoc Reader's Digest, Decem-bsr L?iL . 9 than humans for test purposes. But in these cases, che aninals possess nedical characteristics that parallsl nunan functiok and dosages given to the scbjects have been equivalent to those taken by humans. Furthermore the results vith appropriatt animal s correspond closely with clinical. obsenations of human users. lo TEC and the Sodv Unlike water soluable drugs such as alcohol, whic,h is rnetabo lized and "washed outtf of the system within twelve hours TXC is fat soluble and remains in the body for a co nsiderzble tine. The THC in marijuana has a half-life of about three days; that is, it takes three days for nalf the TEC in a joint to leave the body.

It may take over three weeks for all the TBC to be broken down.

According to one expert, obserrations suggest that the younger the age of first use, the greater may be the long-tsrn effects resulting from the THC in the body.

This pattern of retention in the body means that even the occasional marijuana smoker may nev er be free of EX. Furthermore there is strong evidence from animal tests that the toxicitv is cumulative small amounts of Tic administered over a periGd seem to be far more harmful mar the sane total quantity in one dose The fat solubility of TEC, which i s exceeded only by substances such as DDT, affects the way in which the substance is distributed within the system. Intravenous injections of radioactive TIC confirm that it concentrates in the fatty tissue, and also that it lodges in the liver, lungs, rep roductive organs and the brain.

It was not until the early 1970s, with the work of Julius Axelrod and. others, that e pattern of THC &so-tion by the body, or the period for which it was retained, was known with any real certain ty.13 Until then it was assu med that TEC vas broken down and removed from the body as quickly as alcohol For excellent reviews of the scientific studies concerning marijuana see George K. Russell, Marijuana Today (New York: Yyrin.Institute, i?BO published in cooperation with the .Am e rican Council on ~arijuana Gabricl G. Nahas, Keep Off the Grass (New York: Pergamon Press, 1979 Twelve Things You Should Know About Marijuana Consumers Research Yagazine April 1980 I. Lantner, J. O'Brian and H. Voth Answering Questions bout Harijuana Use Patient Care, May 30, 1980.

Carlton Turner, Associate Director; Researcn InstituLe of Pharmaceutical Sciences, University of Mississippi, Address to Seminar sponsored by the J.X. Foundation, New York, September 9, 1980 unpublished transcrigt).

W. D. Patton, Testimony before the Senate Subcommittee on Icternal Security May 197 ref. 80, pp. 70-79.

Ibid Also D. S. Kreuz and J. Axelrod Delta-9-Tetrahydrocannabinol 15 l3 Localization in Body Fat Science, 179 (1973).

This discovery that TEc is retained for a c onsiderabls time in certain organs of the body is crucial to a proper understsnding of its effects. It ineans that the drug is quits uclike alc'ohol with vnich it is oftefi incorrectly compared. Afid the noaerztt user is runclng far greater risks than the moderzte user of alcohol ad many other dru5s Tolermce and A,dC!iction A discussion of the cumulative effects of a drug leads to the issue'of tolerance. One of the popular misconceptions rtgard ing marijuana is at the user develops a Ilreverss tolerance he needs gradually lzss and less THC to produce the same "high."

It is possible that this belief developed from an =xuninacian of the effects or' the low dosages commonly used in the 1950s. Therc may also be a "lsarning effect1' that develops with low doses that leads to a greater appreciation of the high by the user. In addition, it is possible that low doses of TEiC may cause the release of quantities of the drug stored in the body's organs.

But it has now been firmly established through careful studies wi th doses typical of current use that a 2rofound tolerance develops that is, steadily larger doses are nec,essary to produce the same effect.14 Tolerance means that the heavy chronic smoker must increase his TIC intake to obtain the sane psychoactive resul t s; which in turn means that ne must increase the coficentra tion of TBC in his brain, lungs and other organ's. Tolerance effects also encourage the ilser to try more potent drugs, such as LSD, and to combine marijuana with alcohol or other available drugs .

One reason why marijuana is considered as relatively safe by so many people is the belief that it is non-addictive. 5ut a misconception regarding the nature of addiction liss at the heart of this impression. if the sole criterion is phvsical addicticn me aning a physical dependence on the drug followed Sv severe physical withdrawal symptoms then the evidence woula indeed suggest that marijuana is only inildly addictive, even at high doses.15 Of much greater concern, however, is the degree of psvchological dependence that is associated xith marijuana my users aisiniss the notion of psychological dependence as synonqmous with "liking marijuana" in the sense that one might like chccolate ice-cream or tennis. But the term iinplies a inore subtle and dangerous effect on the user. As Gabriel Nahas of Columbia University has explained Iarij~zna and Health: Eizhth Annual Report to the U.S. Congrtss Rockville Yaryland: HTDA, 1?8Oj, p. 26 larijuana Today, p. 70.

R. T. Jones and

3. Sac-hnan Clinical Studies of Cannabis Tolerance and Dependence Annals or' the Yew York Acadernv o Science, 282:221 ii976.i.

Because of the slow 2limination of THC from the body, c*.ithdrawal cffecrs are not severe. The desire for instant gratification is a profound psychological. reinforc er adiction to a drug is not. a function of the drug to produce withd2a'rial s-ynptoms. Drug dependence results basically from the reproducibie interaccion betveen an individual ana a pleasure-inducing biologically active molecule. The ccmmon denominator o f all drug dependence is the psychological rein' Lorce ment resulting from reward asscciated with past (use) and the subseauent increasing desire for repeated performance. 16 It is this psychological dependence that.makes the marijuana habit difficult to b reak. It is clear from clinical evidence that it is very common for heavy users to continue smoking even when they concede that it severely impairs their health and motivation, and tbat professional help is regularly needed to enable d user to give up the drug. The plain fact is that in'the case of inarijuzna, the distinction between physical and psycholo gical addiction is senantic, not real.

Marijuana and Other Drugs Little could be further from the truth &than the idea that a daily joint is merely the eauivalent of a lunch-time martini.

There are crucial differences. In the first place, as has Seen pointed out, alcohol leaves e system far no re rapidly.than marijuana. Even when taken to excess, the effect of alcohol is short-lived. It takes very heavy drinking over a long period to cause irreversible damage to the liver, or to th2 proper function ing of the brain (and then it is due primarily to a protein deficiency resulting from liver deterioration The effects of TXC, on the other had, occur with only moderate dosage, and it appears to cause damage to more organs in a much shorter space of time.

There is also little evidence to suggest that alcohol and marijuana are in fact considered as alternatives by users. The usage of alcohol among school students, for example, has not fallen during the period in which marijuana smoking has rapidly increased. If anything, there appears to 'be a small ?o s itive correlation between marijuana use and the taking or' other drugs due in large part tdthe fact that a combination of THC with many other drugs leads to a greater effect than that achieved with either drug alone 17. Alcohol in combination with marijua n a for example, enhances the sedative result obtained with just the same aosage of alcohol. This is also the case with Valium, Librim antihistamines, barbiturates, and' narcotics such as opium, heroin 15 G. C. Nahas, Zarijuana Deceptive Geed (Yesj York: Ra ven Press, 1973).

A. J. Siemans Effects of Cannabis in Combination with Ethanol and ather Drugs in R. Peterson (ed Marijuana Research Findings, 19SO (Washington D.C.: U.S. Government Printing Office, 1980). 12 mcrphine .ana c3deize. with cther drugs the co mbinaticn it nasi juana ixreases the stirnulane effect, followed by a heavier depression. Such drugs woulc include coc=i.n-e, 322zaarlne zzc 3exadrine The reason for this enhancing effecc may be chat ehs czlia of the liver Derform as identifiers and dispo s crs of foreig chemicals in the body through the accion of enzymes. Xhen the TIlC is taken, however, the efficiency of this liver functior! is impaired and detoxification is reduced. Consepsntly, the power of the other drug to affect the body is increased. 1 3 With some therapeutic drugs, the combination xith TEC may have the opposite result, leading to a reduction in the er'ftctiyie ness of the prescribed drug. Taken wich anticonvulsants suck 3s DiLantin and Pegamone, for instance, THC antagcnizes the druq a n d lowers the seizure threshold. Similarly THC can inhibit the results of beta-blockers, used to treat hypertension ami some neart conditions. Ana when taken by a diabetic, marijuana c2n alttr the amount or' insulin necessary to maintain balance.13 The inc i dence of marijuana us2 in combination with other drugs is increasing. Not only is the enhanced effect sougnt of itself by the user, but it is also asmeans of obtaining better value for money from more expen.sive drugs. The availability or low-cost marijua na may therefore increase the use of harder drugs.

Psycho logical Effects Summary There is now a considerabls body of scientific dati regzrd ing the behavioral effects nad intellectual' impairmezt resulcing from marijuana us Roy Hart ana Gabriel Nahas have surveyed the extensive foreign literature As Harc points out, iinpairmenc sf menory, judgment, intellectual functions, orientation and motiva tion have been accepted as consequences of marijuana use for inany yezrs The evidence from this country leads to the same conclu sion Dr owelson has summarized the clinical evidence 5s follows Its earl17 use is beguiling. It gives the illusion of feeling good The user is not aware of the begi,n,ninq loss of mental functioning. I have never seen an excepticn to the o b servation thzt marijuana impairs the LS Yahas ee? Off the Grass, p. 02 Lsntner Answering Questions About 'larijuana p. 137 2. Hart A Psychiatric Classification of Cancabis Intoxicatiori Journal of th2 American Acadern of Psychiat.ric Yeurology 1! iv cL976 pp 33-97; Sanas, Yarijuana, and Kser, Qfi the Grass 3 5 13 user's ability to juage the loss of his own mental functioning.

After one to three years of continuous use the ability co think has become so impaired that pathological form of thinking begin to take over the entirs thcught process.

Chronic heavy use ltads to paranoid thinking c Chronic heavy use leads to deterioration in body and mental functioning which is difficult and perhaps impossible to reverse Its use leads to a delusional system of thinki ng which has inherent in it the strong need to seduce and prose lytize others. I have rarely seen a regClar marijuana user who wasn' t pushing. If As these people move into government, the professions, and the media it is not surprising that they continue as "pushers thus adding to the 'confusion that (the scientific community) is obliged to ameliorate. l Behavioral Effects Broadly, light marijuana smoking results in enhanced secsitl vity to sensory stimuli. Heavy smoking tends to result in apathy and with d rawal. Research conducted on moderate and hea77 smokers shows that a distortion of reality is common, together with confusion, memory loss, diminished concentration, reduced motiva tion, and hostility towards discipline and authority. Among relatively ine x perienced users, acute anxiety can develop as the smoker rows aware that reality is becoming distorted. The same anxiety can also occur when a joint of higher potmcy is snoked.22 ileavy usage of marijuana accentuates these effects. Marked memory impairmen t and confusion is common among such users, ad latent paranoia and schizophrenia.23 very damaging At precisely the time that difficult arrangenents need to be made, marijuana may distort both the reality that must be faced and the judgment needed to deal w i th it. The maturing process is inhibited, and.a concern with the moment overshadows any assessnent of the future. Dr. Mitchell Rosenthal, president of Phoenix House in New York, has summarized the consequences af marijuana use among adolescents as follows : there is evidence that heavy smoking can exacerbate mild and The consequences these effects have on adolescents may be Powelson, Testimony before the Senate, May 1974, quoted in Russell flarijuana Today, p 22 32 Yarijuana and Xealth, p. 21 33 Ibid pp. 21 -

22. A' 14 To grow, to develop to acklisve adulthood, adolescents must cope zith the enocicnai scorns and squalis of thq troubled ttenqe period. They turn t~ inarijuana ~r t alcohol to self-medicate 2nd. ca rtlievz the anxieties of the moment. They do not cope and they do not kzow how to cope. They blow away their troubles in clouds or' sinoke and they blow away their chance or' becoming mature and responsible adults.

Social Behavior Marijuana use does appear to foster alientation, towards both the family and society in gengral. In school ana colltge settings, the tendency of users to form subculturss hostila to prevailing social customs and atcituaes is well known. A large scale study of Boston schoolchildren for example, showed that eariy use of the dru g was closely correlated with truancy, alien tion from authority, 3oor academic achiwement and the earl Qse of alcohol and tobacco.2s a It renains to be seen what sort of society will emerge as a generation so heavily associated with marl juana attains the position of leadership.

Intellectual Functions Motivation It is all too common to hear of a marijuana user who appears to have lost all will to succeed. The decline in motivation among heavy ar?d moderate smokers and even some occasior,al users is probabl y the effect noticed most often by a user's friends. Chronic heavy use can lead to almost total withdrawal often rationalized in such terms as "getting out of the rsx race Clinicians dealing with high schools and colleges report constantly of gifted stude n ts who are marijuana users'md who lack the drive necessary to reach their full potential.25 user is often quite unaware of just how great a decline in notiva tion he is experiencing, ana increasingly, as fir. Franz h'inkler The H. Rosenthal tlarijuana and Effects on dolescents given at "l.larijuan3 Biomedical Effects and Social Implications Second Annual Conference 911 l'larijuana, Yew York University Post-Graduats ?ledicsl School and the American Council on Xarijuana Sew York, June 25-29, 1979 (unpublishe d transcript G. Smith and C. Foqg Psychological 2redicators of Early CS i3Le Cse and Yon-Use of Harijuana among Teenage Students in D. Kandell d LonTFtudinai Research on Drus-Use (Nerd York: iialstead Press, 1?73).

See, for example, H. Kolansky and Ti. T loore Effects or' Yarijuam on Xdolescsnts and Young Adults ,I' Journal of the .I?merican 'ledical ssorlstion 216 (1971 2p. 456-492; and "Toxic Effeccs of Chronic Yarijuana Lse,"

Journal of the .American ediccll Association, 222 (1972 pp. 20-35. has pointed activities out, the smoker loses all interesc in nornal studsnt The lasting effects of noderate amounts of inarijuana are minimal in contrast to the harmful effects or' even a couple of reefers a week A early effect of mari juana and hashish use is a pro g ressive loss of willpower already noticeable to the trained observer after about six weeks of moderate use Soon all ability for real joy disappears, to be replaced by the noisy pretense of fun. While healthy teenagers will eagerly participate in all kinds of actiTities, such as sporfs, hiking artistic endeavors, etc a marijuana user xi11 show an increasing tendency to talk aimlessly of great goals while doing nothing about A particularly disturb tion is that in some cases later that THC appears to h brain, and clinicians such of patients who gave up mar regain their normal level o year or more of abstinence ing aspect of this reduction in motiva it may be pemanent. It will be shown ave long-tern physical effects on the as Powelson have cited several instanc es ijuana and yet are still unable to f motivation and concentration after a 28 Learning and Skills The decline in motivation common amdng marijuana users is closely related to a general reduction in intellectual performance.

Chronic use or' the drug can s eriously inhibit powers of comprehen sion, judgment and learning and this effect is not confined to the period of intoxication. The most distinctive influence i's on short-term memory. THC appears to interfere with the transfer of learned information from the short-term menory, leading to diffi culty in recalling material learned when into~icated Given the widespread .daily use of marijuana among school chlldrtn, this effect has most serious educational implications.

The use of marijuana has also been shown to have detrimental effects on the smoker's ability to operate certain machinery such as an automobile or airplane. Several studies have denon strated a distinct impairnent of driving skills, and that users are ove r represented in accidents compared with non-users.20 It must be emphasized that this impairment does not only occur during a I'highll; it continues for many hours after the subjective intoxication. Since judgment itself is affected, a driver may be totally unaware that his skills have diminished and that his 27 F. E. Winkler, About Yarijuana (New York: Xyrin Institute, 19iO uoted 2s Powelson fHarijuana, pp. 95-99 in Russell, Yarijuana Todav, p. 40 23 Yarijuana and Health, p. 10.

Several of these studies are summarized in Harijuana and Health, p. 11. 16 reactiGns are slower. And since :he i.n-fluence of marijuana unlike that of alcohol, is nct easily detected by others assen gers travelling with the user nay be una-dare of their own danger.

Thers are certaih aspects of the effect of TEC on skills acd intellectual functioning which need to be Imderscood to ar;precizite the full inpacr of marijuana use, and the shortcomings cf some studies. in the first place, THC has a much greater ir,fliler?,ce on the perfor m ance of less familiar tasks than on yell learned activities. The impact on the student, i_n_ other words, is likely to be much greater than on the assembly line worker. Furthernore the effects are dose related the heavy smoker experiences markedly greattr impairment than the cccasional user (dthough frequent but light sinoking does have a cumulati-Je effect Thus studies hased on the relatively low doses generally as2d in the 1960s do not provide an accurate guide to the influence of hign potency marijuana c urrently used Another key feature of the drug is that its effect: an skills and performance appears to be correlated strongly with the intelli gence level of the user. Thus, the impairment seen ainong students and professionals is usually greater than tha t among people of average or low intelligence. More generally, the impact of the drug on middle-class smokers tends to be more significant than iil the case of manual or working class users. This is particularlL1 important when examining evidence from abro ad, since in countries such as Egypt, Morocco or the West Indies, the use of marijuana is a habit usually confined to the poorer, less educated classes.

Only,in the United States is marijuana widely used by better educated segments of society the very grou ps most prone to its damaging effects By appreciating these distinctions in the influence of the drug one can appreciate the aeficiencies of tests sych 2s the Jamaica Study, If which is widely cited by the pro-legalization lobby as a demonstration of the b enign effecrs of the drug In this study, the researchers selected a group of thirty ganja i.e marijuana) smokers and a control group of thirty non- smokers. The groups were given a battery of psychological ana other tests, and their brain wave patterns-we re examined. No significant differences jetvesn the groups were detected.

This study has been faulted on several grounds, some of them technical, and the finaings ran strongly against the clinical evidence available in Jamaica. But more importantly, che V. Rubia and L. Comitas, Ganjs in Jamaica 4 ?!edicJl Anthropo!oeicaL Studv of Chronic Yarijuana Use (The Hasue, The >ieLherldnds ouron Trcss 1975 j 32 See Russell, clarijuana Today! pp. 25-30 ianas, K~P? Oii chc Crass, pp Russell, Yarijuana TQda p. 28 101-! 02. 17 study ignored both the' relationship Setveen intellectual ckpacity and impairment, and the difference in the influence of TBC on skilled as opposed to simple ana familiar tasks.

Brain Damage The personality and learning impairinent associated with m arijuana use leads naturally to the question Does marijuana actually cause physical dmage to the brain There is now a strong body of evidence to suggest that it does in ways consis tent with clinical observations.

The most important work in this field has been conducted by Dr. Robert Heath of Tulane University Medical Schcol. In the most significant test undertaken by Heath, groups of rhesus monkeys were used to examine the physical effects on the brain resulting from marijuana use. This species or' monke y s has a central nervous system very close to that of man, and is widely used as an indicator of the consequences of therapeutic and other drug use on humans. By using monkeys, Heath was able to remove many problems associated with human volunteers such as legal issues and the difficulty of keeping a tight control on the level of drug use. He was also able to sacrifice the monkeys and conduct a close examination of the brain tissue of each animal.

In the test TElC was administered both by smoke i-nhalation and by injection the intake being equivalent to that normally found among human users. The monkeys were exposed to the drug for six months and studied for a further eight months after the drug was withdrawn, using deep and surface electroencephalograms (E EG after which they were sacrificed and examined Heath found distinct changes in the brain wave pattern in the "deep brain sitestt or' the limbic region the area associated with smell, taste, emotion, pleasure, and the control of drives.

This change was no ticeable after two to three month's use by monkeys subjected to the equivalent of heavy or moderate intake by humans. There was no such effect in the control group. The alteration in the deep brain pattern resembled that associated with conditions such as schizophrenia, and with the reduction of awareness. Eeath continued to monitor the deep brain throughout an eight-month period after THC intake was ceased, during which time AAe change in pattern continued suggesting long-.term and possibly permanellt bra in damage.

After the eight-aonth period the monkeys were sacrificed and their brain tissue carefully studied. Electron microscope analysis revealed distinct damage, parricuiarly at the synaptic junction where one neme cell connects with the next regions th at .re crucial to the operation of the central ne-rvous systen. This damage include6 a widening of the synaptic cleft (i.e the gap between the cells) by an average of 25 perc'ent; which is a condi tion seen in brain poisoning associated with substances su c h 3s carbon tetrachloride and in cases of severe vitamin B ceficimcy lsading to psychosis. Heath also noted that dense mterial was 18 deposittd in the clefts, and, anong other efz'tcts, there vere changes within the cells active in menory fuxtion.24 The c h anses in the brain observed by Esath correspond :iiti the behavioral and. learning function altzracions described zarlier His studies snow cleariy that TIC has a detectable 3nysical effecz on the brain, even though the inplications of the effect are Rot k n own. Most disturbing of all, his experiments suqqest that the changes in the brain tissue may be permanent en among moderate marijuana smokers While Heath's exgeriments have provoked consider=ble contro versy, both regarding the methodology ar,d the meani n g or' the results, there is supporting evidence. A 1971 study, for im'lance used air encephalography to examine the brains of a group of young smokers, each of whom had used marijuana consistsntly for many years and were experiencing severe personality ch a nges. The study, conducted at the Royal United Hospital 'in aristcl, England concluded that there was evidence of as much brain atrophy among the group as would be expected in very elderly people. None or the test group displayed clear evidence of any con d ition prior to smoking the drug that might have produced such a level of degene ration.35 More recent research, using CAT scanners to examine the brains of chronic users, has failed to confirin the Bristol results, however, and so further testing is clear l y necessary before any 'firm conclusions can be reached on the question of brain damage. 36 Nevertheless the weight of existing evidence does suggest that there is good reason to believe that gotentially serious physical effects on the brain do result fro m chronic marijuana' use Disease and Cell Division Recent research has shown that THC seems not only to nave very damaging effects on the cells of the brain, but also that it may have an impact on cells related to the immunity system. Vork by Gabriel Nahas , for example, showed that the cell division rate 34 R. G. Heath Yarijuana: Effects on Deep and Surface Electroencephalograms af Rhesus ?Ionkeys Yeuropharm, 12 (1973 pp. 1-4; Heath and rei. >lyers Cannabis Sativa: Ultrastructural Changes in Organelles of N e urons in Brain Septal Region of blonkeys ,It Journal of Xeurosiience Research. i 1979 pp. 9-17 35 A. Campbell 1. Evans, G. Thompson, and Y. Williams CSrebra1 Atrophy in Young Cannibis Smokers Lancet, 2 f.1?71 pp. 1?19-!22 86 B. Co, D. Goodwin, Y. Gado, Y. Mikhael, 3nd.S. Hill Absence of Cerebral Atrophy in Chronic Cannabis Users I Journal of the Americsn edLca'l ASSOCL ation, 237 (1977 pp. 1231-1232; J. Suehnle, J lendelson, K Ivis, and P. Yew Computed Tomographic Examination of Xeaw Varijuana Smokers Jour n al of the .herican 'ledical Association. 237 (19771, pp. 1229-1230 19 for the lymphocytts of a group of human users was over 4'0 percer,.c lower Llan for a cmcrol groug (lymphocytss are white blood cells that divide rapidly and attack viruses and foreign t issue This result would mean a drastic reduction in the ability of users to fight diseases a reduction comgarable with that r'ou~d ir cancer patients and kidney transplant Fatients receiving inununo suppressive drugs to prevegt rejection (these patients a r e highly prone to illness 37 The influence of THC on cell division seens to extend even further Llan the immunity system Research findings presented by twelve different medical groups at a 1978 international conference on marijuana indicated that use of t h e drug causss strong ir?ter ference with the syn'desis of proteins, DNA and ,WA (the basic building blocks" of cells) in a wide range of cell t-ypes. The substance was also snown to impair the rate of tissue growth, to lead to unnatural cell division, and to the production of cells with an abnormal number of chromosome Further work is needed in th'is area, but it should be noted that chromosome damage in certain cells does lead to leukemia and other conditions; and similar damage to gonadal tissue could af fect the physical'and mental characteristics of children conceived from the sperm or egg cells of a marijuana user.

Reproduction Several studies have been conducted recently to dete'rinine the effect of THC on the male reproductive system. Research by Dr.' Eiobert Kolodny, using a group of young males who were heavy users (averaging 9.4 joints per week found that the principal male hornone, testosterone, was reduced by 44 percent within the group (altnou h this was still within the noma1 range for the popul ation 32 The hormone plays an important role in sexual change during adolescence, and in sperin production. Whether this reduction has a significant effect, or if it is pemanent with chronic use, is not yet known.

Two other studies of smokers indicate that chronic heavy use does result in abnormalties in the sperm count, and that it affects the mobility and physical characteristics of s9,srin. 4 37 G. Nahas, N. Suciu-Foca, J. Armand, and A. Plarishima Inhibition 43f Cell-tledicated Immunity in Yarijuana Sm okers Science, 183 (19741, pp 419-420; Nahas, Keep Off the Grass, pp. 116-122 38 G. Nahas h Paton and J. Indanpaan-Heikkila (edit Yarijuana: Chemistry aiochenisty and Cellular Effects (Yew Sork: Sp.ringer Verlag, 1976j 39

8. Kolodny, G. Xastcrs and others Depression of Plasma Testosterone Levels in Chronic Intensive Yarijuana Us2 Yew Enqland Journal of Yedicice 290 (1975 pp. 872-874 Hembree, G. Nahas and H. Huang Changes in Human Spermatazoa. Associateti vi:h High Dose Xarijuana Smoking in G. Nahas and

5. Paton larijuana 8iolo2ical Effects (New York: Pergarnon Press, 1'279 j Y. Issidores Obser vations in Chronic Zashish Users: Xuclear Aberrations ih 31ood and Sperm and Abnormal Acrosomes in Spermatazoa in Yahas and Paton, Yarijuana Biological Effects 20 Regorts from Jamaica, IIIorocco, India, and this country zlso yet, there =re no publishec rqorts of a correlaticn bet.;eeh mari juma use and abnoraal offspring indicate a high level of ispotence arnong iong-turn us~rs A s Teschg the sffects of T9C on wcme n especizlly preqnanc women poses ethical ana legal probleins. Rhesus monksys have therefore been used for certain of these tests, both to overcome sach problem and to enable dosage to be tightly controlled. Sut there is also a good deal of clinical human evidence evailabls.

Research by Dr. Carol Smith on monkeys has shown that exrJosure to TXC ior just a few days during the inenstrual cycle can lead to the suppression of ovulation and the disruption of the cycle, due apparently to an interruption in the pr oduction of necessary hormones.42 The menstrual cycle returzls to norinal tyo to three months after use of the drug ceases. Dr. Joan Bauman of the asters and Johnson Clinic in St. Louis, studied the menstrual cycles of young volunteers who were frequent u sers of marijuana an average of 4 joints per week and had been so for at least six months: The group was then compared with a control. Dr.

Bauman found that 38 percent of the marijuana users experienced problems with their cycles, compared with 12.5 percent of the control group, and a substzntial number of them failed to ovulate.

The users were also prone to other irreglarities, such as hormone imbalance.4s Although it is not possible to monitor precisely the drug habits of such volunteers, the human resul ts compared sufficiently closely with more exact animal tests for the conclu sion to be reached that marijuana use results in definite irregu larities in the cycle.

More serious than the evidence on the menstrual cycl however, are the strong indications t hat THC may be very damaging to the unborn. Tests by Dr. Ethel Sassenrath of the University or California Primate Research Center, in which rhesus monkeys were exposed to moderately heavy doses of marijuana (the e2uivalent of between one and two joints pe r day resulted in a 42 percent loss of o-ffspring by the monkeys chrougn spontaneous abortion fetal death, stillbirths or death in early infancy four times the rate in the control group. Post morten examinaticns of the offspring, moreover, revealed a numbe r of abnormalties, such 5s fluid in the brain, together with vascular, liver and kidney J. Hall, Testimony before the Senate Subcommittee on Internal Security Play 197 r2f. 30, pp. 1&7-134; H. B. Jones ana H. C. Jones, Sensual Drugs Deprivation ana Rehabil itation of the Mind (Nerd York: Cambridge Lniyers it Press, 1977 C. Smith, M..Srnith 3. Besch 8. Smith and 3 Asch, EEfilc: of Delta-9-THC on Female Reproductive Function, in Hahas and Paton arijuuana cal Effects.

J. Bauman, Effect of Chronic Xarijuana Use on Endocrine Function i~f che Slologi 43 Human Female, in Nahas and Paton, Yarijuana: Sibloaic31 Effec~s. 21 disorders.44 Experiments using radioactive TEC (allowing its progress through the body to be traced) have shown that'the drug appears in the milk o f the mother and passes into the bodies of the infants being nursed. Furthemore, there is evidence that THC passes through the placental barrier, ana lodges in the fatty tissue and various organs of the fetus, including the brain.45 These results are very alarming. The consequences of mari juana use by pregnant women and mothers has yet to be fully dete-mined, but the evidence so far indicates that use of the drug may be extremely dangerous or even fatal to the unborn child.

The Heart and Lungs Marijuana u se tends to increase the heart rate, leading to a reduced capacity for exercise although this effect does diininisn as tolerance to the drug builds up. For young, healthy users this presents no particular danger, but in the case of smokers with pre-existi n g heart conditions, marijuana can accelerate the development of chest pains and heart irregularities.46 Results of test examining the effect of marijuana smoking on the lungs are more disturbing, indicating not only tnat the drug is connected with lung da m age, but also that this damage may be more severe an that associated with tobacco. The U.S. Army's drug program in Europe, between 1968 and 1972, for example revealed a high incidence of serious respiratory ailments among soldiers with access to the very p otent strains of marijuana then availablz in Europe. Bronchitis and emphysema were seen even among young smokers. Emphysema, in particular is a disease usually associated with later life, and to find it among young soldiers was most unusual. As Dr. Forres t Tennent, who headed the study, testified to the Senate Even though a person can get bronchitis and emphysema from cigarette smoking, one must usually smoke cigarettes for 10-20 years to get these complications. We became alarmed about this because we beg a n seeing these condi tions in 18 19 and 20-year-old E. Sassenrath, L. Chapman and G. Goo Reproduction in Rhesus onkeys Chronically Exposed to Delta-9-Tetrahydrocannabino1 in Nahas and Paton E1arijuana Biolozical Effects R. Vardis. D. Weisz. A. Faze1 and X . RaGitch Chronic Administration of Delta-3-Tetrahydrocannabinol to Pregnant Rats, I' eharrnco Logy, B iochcmis try and Behavior, 4 (1976 pp. 249-254 R. Prakash and h Aranow Effect of 'larijuana on Coronary Disease Clinical Pharmacology and Therapeutics, 1 9 , iv (19i6 pp. 94-99 47 F. Tennant, Jr., Testiinony before the Senate Subcommittee on Internal Security lay 197b, ref. 80, pp. 288-314 22 An examination by Dr. Earris Rosenkrantz or' the Mascr. 3esearch Institute in Massachusetts, found that the exposure o f labcratory rats to only moderate amouncs of marijuana smoke lsd to a d'?lstindt alteration in iung tissue. These effects included intense iEflzm mation, a breakdown of the air sacs, and the fornation of posits in the lung tissue. The air caDacity of the lung was also rtduced by 15-20 percent. CoEtrol experiments showei clearly that far mor2 damage occurred than xith the same degree of exposure to tobacco smoke Test conducted with humans have reached similar cocclusions.

A University of California study, for example, matched a grourJ of healthy users with a control group and found a 25 percent hiqher airway resiscance in.the lungs or' the marijuafia sinokers after just two mofiths. of heavy use.43 This level of rosistance rairsly occurs among tobacco smok e rs before fifteen or twenty pars of use Therapeutic Uses for Xarijuana Like many drugs that exhibit damaging effects usage, TEC does seen to have some useful propertie with certain conditions. It appears to be effecti in providing relief for certain glauc o ma sufferers non-psychoactive drugs can achieve the same result cases d S ve s ith chronic for patients for exarrple althougn in many Of much. greater importance is the possibility of using TEC as a treatment for severe nausea often associated with chemot h era py. The National Cancer Institute recently embarked on a Sl million program to distribute THC capsules to a large number of cancer patients undergoiRg chemotherapy. By using TEC in capsule form, rather than cigarettes, the possibility of lung damage i s avoided. Some critics of the program do, however, maintain that capsules are inferior to smoking the drug, and there is some evidence available to support such a claim in the case of certain patients. Further testing is necessary to determine the cases w here inhalation might be an appropriat? method of administering the drug until an effective synthetic version becomes available.

The use of TIC for therapeutic _curposes is not without its problem. Patients run the risk of the damaging resuits of marijuana discussed earlier, but these risks are much lower in medical programs. Most of the damaging effects associated with the drug appear to result from moderate to heavy use for a longer period than is usual in medical puqoses. And the drug can be H. Rosenkra n z and R. Fleischman Effects of Cannabis on Lun3s in 33h3s 45 D. Tashkin, E. Shapiro and others Subacute Effec:s of Heavy Iclarijuana and Paton, Flarijuana: Biological Effects Smoking on PuLmonary Function in Healthy !len Sew England Journal of Yledi cine, 244 (1976 pp. 125-139. 23 a Toided in the case of hish-risk Patients. 31 t if THC t as wi2ely distributsa, even under prescyiption, it would be difficult' to ensure such cmtrol. Another prcblern with the drug is that its psychoactive effects can be ve'ry d isturbing to some .patients particularly older ones. Again, carefully controlled use allows these side-effects to be detected at an early point. Csrtaln drugs that are chemically similar to THC (such as levo-nantradol are currently being tested to see if they may be superior in certain instances.30 inconsistent with the position that it is very harmful in general.

Sorne'highly dangerous drugs are very beneficial in certain circum stances, but this does not imply that they should be made freely available. O ccasional 'use of THC capsules by some carefully chosen patients is not the same as chronic heavy smokicg of marijuana Consideration of THC as a therapeutic drug is not in any way 1 PUBLIC POLICY CONSIDERATIONS Marijuana Use and the Law The inescapable co n clusion from the scientific evidence now available is that marijuana is a dangerous substance. The increase in potency in recent years means that we are now dealing with a very different problem than the one faced in the 1960s. The evidence also shows tha t THC is quite different from alcohol in the way that it loages in certain organs and causes damage to them in a short period of time Yet the question remains What, if anything, should be done There are many things that we do which are dangerous. Is the us e of marijuana any different than these?

There are really four aspects to this question, and each raises important philosophical and practical issues 1. To what extent should society interfere with the individual s decision to pursue a dangercus activity 2 . Is there harm, or a cost, to non-users 3. Does society have the right to enforce some collec tive lifestyle on the individual to pr- mserve some notion of I1culturetf or Ifway of life the other issues 4. Is an effective law possible, given a resolution of Washington Post, November 11, 1980.

Taking etch of these questiofis In turn a) Marijuma ar?d Individual Freedom It has always been a tenet of the idea of liberty that the individual has the rignt to pursue 2 dmgerous activity, or to knowingly damage his own health. If it were ocherwise, we snould ban everything from hang-gliding to eating candy On the other hand, it has usually been conceded that her2 may be another justifiable position in the case of certain seqnepts of society. When a person does not r calize the consequences of an action, it is reasonable to warn him, and perhaps to physically prevent him from undertaking it. Most smokers of inarijuana have very little understanding of the likely consequences of ttking the drug It would seem quits appr opriate to embark on a program of education, particularly in schools, to reduce this ignorance.

In addition, a policy aimed at making the drug less available, by presenting obstacles to supply, would reduce the 'liklihood of casual access by the ill-informed while the determined user would still be able to obtain supplies.

Drugs do of course, involve a complication when considering the ability of the user to judge the consequences of his actions We recognize that children should be prottcted from many things because inexperience and poor judgment can lead to unforeseen resu l ts. But some drugs actually cause reduction in the power of reasoning, or the ability to cease using the substance. This is one reason why. we ban heroin but not hang-gliding N'hether there is a sufficient obserJable effect on the processes of the brain f o r us to class marijuana with heroin rather than hang gliding is open to serious question. Yet there is probably sufficient evidence available to suggest that THC does affect motivation and the will to resist higher doses, and other drugs to justify a poli c y of active discouragement b Yam and Cost to Others When a drunk decides to drive his automobile, he poses a physical threat to other,s, and so it is reasonable for society to impose heavy penalties on such actions for the protection of ingocerit parties. There is plenty of evidence for us to conclu6.e that the use of marijuana interferes with the reactions and skills of people.who drive or fly, and that this is hazardous to other people. In addition, the effects of marijuana usually last longer than those due to alcohol. It is quite reasonable, therz fore, for society to punish marijuana users who drivs or fly under the influence of the drug. Sophisticated laboratory cxh niques are now availzble to enable the level .of THC in the body to be knowzl with rea s cnable accuracy, and roucine detection eauipment should soon be operational. So it will be posslbit %s provide clear guideiines and penalties, to deal with the smoker driver 25 The idea.of cost is not so simple. If the brilliant s-cholar becomes a heavy s m oker quits college, and goes on welfare, he is taking from society rather than contributing to it. Yet only a sinall minority of users could be said to impose costs such as this. Active discouragement would seem to be the most practical way of dealing wit h the situation c) The ImDosition of Societv's Standards and marks a clear difference of opinion between the libertarian and the conservative If one believes that "society" is simply a collection of individuals, it is difficult to argue L!at.the spreading u se of a drug is detrimental to society in any sense assuming individuals other than the users ars not harmed On the other hand, if one feels that the strength of a society, and the benefits that it can provide to its members, depends on the broad acceptan c e of certain obligations and customs and that the individual is hurt when these customs are eroded then it could be legitimate to discourage certain activities This is in many respects the most difficult issue of all It is at least arguable that the wides p read use of marijuana leading to a decline in motivation, educational achievement and health, may reduce the benefits of society for us all. If this is. so, then it would provide an additional reason for active discouragement. d Just and Effective Law Leg i slation It has been argued by many that we are in a form of "prohibi tion erat1 with respect to marijuana. The drug is illegal, but the law is openly and widely flouted, just as it was when alcohol was made illegal. The law is held in disrespect 'and the p unishment of marijuana users is deeply resented. According to this argument otherwise law-abiding people find themselves dealing with crimi nals, and only complete legalization will restore faith in the law and get the business of marijuana out of the han d s of crimi nals While this argument does have a surface plausibility to it it is fraught with dangerous implications. In the first place the almost universal public ignorance of the harmful consequences of marijuana use lies at the heart of the discontent with the law. If the drug were to be legalized, making it available at the corner drugstore, it would confirn the general belief that marijuana was fairly hamless. If the drug were freely available with the consent of government, it would be virtually inp o ssible to persuade users that they face real dangers. XOW could one justify a situation where marijuana was made legal vhen every attempt had been made to ban saccharine 26 Iilegality may not stop the use of sene to hold the 1i.n-e vnile people are To rtm o ve the legal r5stricticns on its chaxe of reversing the trend mari j uana but educated as to use could also it inay remove my its danqers ii) Decriininalizaticn There is, of course, a distinction legalization and decriminalization. In considering making t h e distribution and betweer! the issues of the one case we are consumption of a drug a legal activity; while on the other we are talking &out reducing the penalties for taking the drug It is a little difficult to justify putting someone in jail when they a r e probably ignorant of the consequences of tzkirig marijuana. Even if they are fully aware of the possible.darnaqe it does seem unreasonable to apply. harsh criminal penalties when no other person is affected While full legalization would undoubtedly lead to an explosior of use, non-criminal penalities for the possession or use of small quantities of marijuana together with criminal sanctions for the possession of large quantities or supplying marijuana to children, would be a more just and acceptable posi tion.

There are, however, many experts who feel that even decrimi nalization would be a grievous error. This view has been put forward very cogently by Dr. Robert DuPont, the forner NIDI director For many years, while I was in government, I supported decri minalization of marijuana and was actively publi cized by the marijuana lobbying organizations as one of their chief advocates or supporttrs. I was never this but I did for some years favor decriminalization of marijuana. I have cnanged my mind completsly on that point and I now strongly oppose decriminalization. I am persuaded that we, as a nation, are dealing wich a massive epidemic with grave consequences for our society and that decriminalization Fs a signal in this political debate tnat, however much o ne night feel that it is not a.good idea to put people in prison for possession of small amounts of marijuana, support for decriminalization is seen as support for marijuana. We all need to recognize that the battle lines are drawn and that decriminalizat i on is the major line that is drawn across the political landscape right now.51 The argument surrounding the decriminalization issue Is thus not so much one of principle as one or' practical poltics. If rtm0vi.n-g crininal penalties for the possession of s mall quantitiis ddress co .seminar sponsore!i by che J.

3. Foundation, see nocz 10. 27 of marijuana (while maintaining criminal sanctions for distribu tion) would not lead to a significant i~crease in use, or to overwhelming pressure for legalization, then &criminalization would have the support of many people who nevertheless consid2r the drug as very damaging ACCESS AND SUPPLY A policy of active discouragement and education may be pursued in several ways. A number of states, for instance, nave banned so- c alled headshops, where drug-related equipment is sold The determined user can still find ways of obtaining paraphernalia but open encouragement to the non-user is reduced by such a measure A much more effective form of discouragement, however, would be to actually reduce the level of supplies reaching this country.

Enormous quantities of marijuana reach the United States from the Caribbean and South America. It is a multi-billion dollar traffic that involves radio warning planes, large cargo ships, high-sp eed pickup boats secret landing strips, and large payoffs to local police It is not uncommon for seizures of ships to reveal loads of marijuana worth up to $40 million at street prices The Coast Guard has been overwhelmed by the volume of the trade, and t h e tenacity and equipment of the smugglers. Seizures now accoufit for probably less than 15 percent of the total making but a small .dent in massive profit be done to contain the staggering increase in the quantity of marijuana reaching this country, there must be a significant boost in the ,resources made available to the Coast Guard, the Drug Enforcement Administration, and other services involved with drug interception. Only by driving up the risks faced by smugglers do we stand much chance of reducing t h e drug flow If anything is to Some argue that reducing the availability of marijuana 'in this country might actually be counterproductive. If you deny People marijuana, they claim, they will merely turn to something iore dangerous. This is a spurious argu m ent. For the heavy user with psychiat-ric problems, marijuana is generally only a stepping stone to hard drugs, or a means of enhancing the effect of other substances If these people are denied marijuana it would make little difference to the damage they will inflict on themselves.

Far more important is the person who tries marijuana because it is inexpensive and freely available, and who then becomes a chronic user or moves on to hard drugs. A reduction in the supply of marijuana would lessen the chances of a casual introduc tion to the drug. Even among existing users, a switch to alcDhol or tobacco is far more probable than to hard drugs For an account of a typical Coast Guard encounter see the 'H'ashingt-on Post December 20, 1980 Of course, the rnarijua n a reachifig this country nas EG cme from somewhere, 2nd that ci'n present sensitive policy issues. In certain countries, the cultivation of marijuana for exporc to the United States has become 2 significant part of the domestic economy, and a major source of foreign exchange. There have Seen cases of the Unitea States supporting the actions of foreign governments seeking to reduce cultivation, sucn as Nexico, but this kind of cooperation is rare and not very effective.

Jamaica is a good example of the kind of problen faced by the United States. The country is a major supplier of marijuana to America. The trade is worth well over S1 billion a year equal to Jamaica's entire foreign debt, and greater than all ocher exports combined. Jamaica is also unstable a n d bankrupt and is a target of Cuban penetration When the Jmaican government changed hands in 1980, the United States found itself in a very delicate situation regarding the drug business. The new Prime Minister, Eddard Seaga, is a friend of the West, and s o the United States is understandably hesitant to undermine what is left of the island's ecor,omy. Eut marijuana is crucial to the economy. As Seaga pointed out recent ly The ganja (i-e marijuana) trade in the last several months was virtually what was ke e ping the economy alive Is3 According to him, the trade is "here to stay and the question is not whether it should be wiped out but wnetlher it should be completely legalized so as to bring the flow of several hundred million dollars in this .parallel mark e t through the official channels, and therefore have it count as part of our foreign exchange which would mean an extremely big boost to our foreign exchange Mr. Seagal c o mp 1 enen t evidence s tidy ed by a Me d i c a businesslike approach to the drug tr a de is convenient interpretation of the scientifi 1 rsports, he states with authority Iseem C to I 5 4 suggest there s no conclusive evidence that ganj a is harmful Mr. Seaga would be well advised to talk to some of Jamaica's leading psychiatrists at Kings t on Hospital, who seem to have reached somewhat different conclusions regarding the effects of marijuana with it presents many problems. It would be easy to drift into the feeling that really nothing can be done without damaging the While the situation in J amaica may be outrageous, dealing Washin2ton ?ost, Yovember 10, 1980 54 Ibid 55 See, for example, the report by Dr. John Hall, Chairman of che Departnient of Yedicine at Kingston Xospital, Jamaica, quoted in Russell laiLJU3fl3 Today, p. 28. 29 fabric of t h e country. But if the government of Jamaica (or any other country) condones the cultivation and exportation of a drug that is harmful to the people of the United States, it has only itself to blame for the consequences. It is an absurd form of foreign aid for the U.S. government to stand idly by while a country encourages the supply of a dangerous drug to America simply because that country needs foreign exchange!

In the interests of its own citizens, the U.S. goverment should state clearly that marijuana is dangerous and a threat to the American population; that it is an unfriendly act for any government to condone it and that policies will be adopted to dissuade such tacit support. The idea that Jamaica can only survive if marijuana cultivation is allowe d continue is ridiculous.

The reason that the industry is now so important to Jamaica is that 'it is highly profitable. If the incentives were altered other industries would develop. It should therefore be the goal of U.S. policy to apply penalties against Jamaica and similar countries if they continue to allow the trade to flourish, while offering American assistance to develop other industries. Tolerat ing the present state of affairs is an abrogration of responsibil ity by Washington. How can we justify putting our citizens in jail for'using marijuana when we refuse to deal effective1.y with the chief suppliers of the drug EDUCATION While effective action must be taken to deal with the flow of marijuana into this country, the' other weapon in the battle t o control the marijuana epidemic is education. People simply do not know the damage that the drug may do to them, and this misunder standing of its consequences is at the root of the growing disre spect for the law dealing with it. We spend enormous sums o f money teaching children how to use birth control devices but very little educating them about the e.ffects of a drug which large numbers of them use during the school break. The scale of the problem is so great that a major drug education program in the schools should be a priority But education should not be confined to the schoolroom.

Most adult users know little of the drug's effects, and parents usually have no idea how to recognize the symptoms of use or how to deal with the situation if they do rec ognize them. There are a number of organizations that do seek to educate parents such as the Citizens for Informed Choices on Marijuana, based in Stamford. Connecticut. The work of grows such as this is crucial and should be encouraged. In addition, group s such as the Ameri can Council on Marijuana, in New York City, have taken the lead in providhg succinct, readable scientific information for the layman. But a great deal more needs to be done, and both private and public resources shoula be made available 1 2 1 3 4 5 6 7 a 30 Xarijuar!a is a dangercus drug and tobacco in the way in which the lasting damage it car! cause It, is mite unlilie it remains in the s with only moderate aL US va cs ho ttn e i aEd While it may seen unjust to impose penalties or user s legalization and possibly decriminalization would be taken as an official declaration that the drug was safe.

This could lead to the acceleration of an already rapid growth in use.

The thrust of public policy should be a combination of active discouragement and restriction of supply, rather than increasing penalties fclr use.

The public should be made on the ability to drive. the influence of the drug level, ana drivers .should the penalties involved aware of the effect of marijuana Firmer penalties for Crivlng under should be enacted at the stat be made aware of the dangers and as they are regarding alcohol.

For medical purposes, marijuana should be treated like any other drug that appears to have some benefits for certain patients. Research should not be discouraged because the drug is used ille3ally for no?-therapeutic pur-poses.

The government and private institutions should take the lead in discouraging use of the drug, through a greatly expanded program of education in the schools, and among the general population.

Measures should be taken to interrupt the flow of marijuana into the country. Resources should be made available to enable the seizure rate to be increased substantially. In addition,.tougher steps should be taken to interrupt domestic production.

Sanctions or other pressures should be adopted against countries which allow the cultivation of marijuana for the American market. Damaging the health of U.S. citizens should no longer be considered acceptable as a means of relieving the economic plight of other nations.

Stuart M. Butler, Ph.D. Policy Analyst