Marijuana (also spelled marihuana) is a psychoactive drug made from the dried leaves and flowering parts of the hemp plant. It is one of the most strictly classified illegal drugs in the United States. Under the 1970 Controlled Substances Act, marijuana is listed as a Schedule I substance, which defines it as having ?a high potential for abuse? and ?no currently accepted medical use.? Marijuana is therefore classified more severely than cocaine and morphine, which as Schedule II drugs are also banned for general use, but can be prescribed by doctors. It is illegal to buy, sell, grow, or possess marijuana in the United States. Marijuana prohibition comprises a large part of the federal governments War on Drugs. Law enforcement officials made 600,000 marijuana-related arrests in 1996, and 800,000 in 1998-four out of five arrests being for possession alone. Under federal and state laws, many of which were strengthened in the 1980?s, people convicted of marijuana offenses face penalties ranging from probation to life imprisonment, plus fines and forfeiture of property. In addition to criminal justice efforts, the federal government, state government, and local communities spend hundreds of millions of dollars annually on prevention programs such as Drug Abuse Resistance Education (DARE), in which local police officers visit schools to teach young people to refrain from trying marijuana and other drugs.
However, public controversy has been growing over the two assumptions-high abuse potential and no legitimate medical use-that underlie marijuana?s status as a Schedule I drug. In turn, disputes over the abuse and medical potential have shaped differences of opinion over public policy. Many of those who question one or both of these assumptions about marijuana have advocated a full or partial relaxation of the governments blanket prohibition of the drug, while those who accept these assumptions generally are opposed to any full or partial legalization of marijuana.
Supporters of marijuana?s continued prohibition argue that the drug is easily abused and can lead to numerous physical and psychological harms. Short-term health effects-according to the NIDA (National Institute of Drug Abuse)-of the drug listed in this paper include memory loss, distorted perception, problems with learning and coordination, an increased heart rate, and anxiety attacks. Long-term effects according to NIDA-include increased risk of lung cancer for chronic marijuana smokers and possible damage to the immune and reproductive systems. In addition, marijuana opponents argue that many users attain a psychological dependence on the ?high? that marijuana can create. Such dependence can result in stunned emotional and social maturity as these users lose interest in school, job, and social activities. About 100,000 people each year resort to drug abuse treatment programs to end their marijuana addiction. Marijuana is also viewed by some commentators as a ?gateway? drug that can lead to the abuse of other dangerous and illegal substances, including cocaine and heroin On the other hand, critics of U.S marijuana policy argue that the dangers of marijuana have been exaggerated. They contend that many, not most, users of marijuana suffer no lasting harm, do not move onto other drugs, ad do not become addicts. Some surveys on marijuana use in America have shown that nine out of ten people who have tried marijuana have since quit. Researchers working with rats have found that marijuana is a far less addictive substance for the animals than cocaine or heroin Pro-Legalization activist R. Keith Stroup summed up the views of many who oppose marijuana prohibition when he asserted before a committee that ?moderate marijuana use is relatively harmless-far less harmless than that of either tobacco or alcohol.?
Whether or not marijuana, as a Schedule I drug, truly has ?no currently accepted medical use? is also a matter of public controversy. In November 1996, voters in two states, California and Arizona, passed referenda that legalized marijuana for medical use (these developments and the actions of other states have no impact on marijuana?s status as an illegal Schedule I drug). Supporters of the California and Arizona initiatives maintain that marijuana is effective in alleviating the symptoms of medical conditions such as AIDS, glaucoma, and multiple sclerosis. Anecdotal evidence of marijuana?s efficacy, advocates claim, comes from AIDS patients who have used marijuana to restore a appetite and cancer patients who have smoked it to combat nausea caused by chemotherapy treatments-often as a last resort when legally prescribed medicines failed. Those who contend that marijuana has useful medical purposes call for the government to at least reclassify the drug as a Schedule II substance that can be prescribed by doctors. As stated by Lester Grinspoon, a Harvard University psychiatrist, marijuana?s continued prohibition as a Schedule I substance ?is medically absurd, legally questionable, and morally wrong.?
The California and Arizona referenda legalizing medical marijuana were strongly opposed by prominent federal government officials, including the director of the Office of National Drug Control Policy, Barry McCaffrey, who criticized the measures as being ?dishonest? and asserted that marijuana ?is neither safe or effective? as medicine. Opponents argue that the very concept of medical marijuana is absurd because it is not, like most modern medicines, a synthesized chemical whose composition can be precisely manufactured and controlled. Instead, it is taken from a plant and consists of four hundred chemicals whose exact composition varies with each ?dose?. Furthermore, they assert, marijuana?s claimed medical effectiveness by clinical trials. Marijuana?s psychoactive properties may make people feel better, contends Robert L. Peterson, a former Michigan drug enforcement official, but that ?does not make a drug a medicine.? Marijuana opponents maintain that better legal medical alternatives to marijuana exist-including Marinol, a pill available by a physicians prescription that contains THC, the main active ingredient in marijuana. An additional concern voiced by many is that legalizing marijuana for medical purposes would send the wrong message to America?s youth. ?At a time when our nation is looking for solutions to the problem of teenage drug use,? asks Thomas A. Constantine, head of the Drug Enforcement Administration, ?how can we justify giving a stamp of approval to an illegal substance which has no legitimate medical use??
Whether or not marijuana?s possible medical advantages outweigh its potential harm is a central question in current debates about this controversial drug. This paper presents various opinions and viewpoints of marijuana and its uses, as well as information on its history and genetic make-up.
The marijuana, cannabis, or hemp plant is one of the oldest psychoactive plants known to mankind. There are three classifications or species of cannabis: Cannabis Sativa, Cannabis Indica, and Cannabis Ruderalis. The fiber has been used for cloth and paper and was the most important source of rope until the development of synthetic fibers. The seeds have been used as bird feed and sometimes as human food. The oil contained in the seeds was once used for lighting and soap and is now sometimes employed in the manufacture of varnish, linoleum, and artists? paints. The chemical compound responsible for the intoxicating and medicinal effects are found mainly in a sticky golden resin exuded from the flowers on the female plants. The marijuana plant contains more than 460 known compounds of which more than 60 have the 21-carbon structure typical of cannabinoids. The only cannabinoid that is both highly psychoactive and present in large amounts, usually 1-5 % in weight, is (-)3,4-trans-delta-1-tetrahydrocannabinol, also know as delta-1-THC, delta-9-THC or simply THC. A few other tetrahydrocannabinols are about as potent as delta-9-THC but are present in only a few varieties of cannabis and in much smaller quantities.
A native of central Asia, cannabis may have been cultivated as much as ten thousand years ago. It was certainly cultivated in China by 4000 B.C. and in Turkestan by 3000 B.C. It has long since been used as a medicine in China, Southeast Asia, Africa, the Middle East, and India for malaria, constipation, rheumatic pins, ?absent-mindedness?, and ?female problems?, to quicken the mind, to induce sleep, dysentery and fevers.
The medical use of cannabis was already in decline by 1890. The potency of cannabis preparations was to variant, and individual responses to orally ingested cannabis seemed erratic and unpredictable. Another reason for the neglect of research oh the analgesic properties of cannabis was that the greatly increased use of opiates after the invention of the hypodermic syringe in the 1850?s allowed soluble drugs to be injected for fast relief of pain; hemp products are insoluble in water and cannot be administered so easily by injection. Toward the end of the twentieth century, the development of synthetic drugs such as aspirin, chloral hydrate, and barbiturates, which are chemically more stable than cannabis indica and therefore more reliable, hastened the decline of cannabis as a medicine. But the new drugs had severe disadvantages. More than a thousand people died from aspirin-induced bleeding each year in the United States, and barbiturates are, of course, more dangerous. One may have expected physicians looking for a better analgesic to turn to cannabinoid substances, especially after 1940, when it became possible to study congeners (chemical relatives) of THC that might have more stable and specific effects.
But the Marijuana Tax Law of 1937 undermined any such experimentation. This law was the culmination of a campaign organized by the Federal Bureau of Narcotics under Harry Anslinger in which the public was led to believe that marijuana was addictive and its use led to violent crimes, psychosis, and mental deterioration. The film Reefer Madness, made as a part of Anslinger?s campaign, may be a joke to the sophisticated today, but it was once regarded as a serious attempt to address a social problem, and the atmosphere and attitudes it exemplified and promoted continue to influence our culture today.
Under the Marijuana Tax Law Act, anyone using the hemp plant for certain defined industrial or medical use was required to register and pay a tax of a dollar an ounce. A person using marijuana for any other purpose had to pay $100 an ounce. The law was not directly aimed at medicinal use of marijuana; it was aimed at the recreational use of marijuana.
By the 1960?s, as larger numbers of people began to use marijuana recreationally, anecdotes about its medical use began to appear, generally not in medical literature, but in the form of letters to popular magazines like Playboy. Meanwhile, legislative concern about recreational use increased, and in 1970 Congress passed the Comprehensive Drug Abuse Prevention and Control Act (also known as the Controlled Substances Act), which assigned psychoactive drugs to five Schedules and placed cannabis in Schedule I, the most restrictive. NORML petitioned this placement in 1972, asking that it be moved to Schedule II, therefore enabling it to be prescribed by physicians. Congress compromised 13 years later by placing synthetic delta-9-THC (dronabinol) as a Schedule II drug in 1985, but kept marijuana itself-and the THC derived from marijuana-in Schedule I.
?Marijuana can be harmful when abused, and its use by minors should be discouraged. However, when used in moderation and responsibly, marijuana is far less harmful than tobacco or alcohol. It?s continued criminal prohibition by the government is a wasteful and destructive social policy that results in the needless arrests of thousands of otherwise law-abiding citizens. Marijuana should be legalized or decriminalized. At the very least, it should be made available by medical prescription for patients who need it to alleviate suffering.? -R. Keith Stroup, founder of NORML (National Organization for the Reform of Marijuana Laws)
Since 1970, the National Organization for the Reform of Marijuana Laws has been a voice for Americans who believe it is both counter-productive and unjust to treat marijuana smokers as criminals. ?We do not suggest that marijuana is totally harmless or that it cannot be abused. That is true for all drugs, including those which are legal. We do not believe that moderate marijuana use is relatively harmless-far less harmful to the user than either tobacco or alcohol, for example-and that any risk presented by marijuana smoking falls well within the ambit of choice we permit the individual in a free society. Today, far more harm is caused by marijuana prohibition than by marihuana itself.
It?s time we put to rest the myth that smoking marijuana is a fringe or deviant activity, engaged in only by those on the margins of American society. In reality, marijuana smoking is extremely common, and marijuana is the recreational drug of choice for millions of mainstream, middle-class Americans. According to the NIDA (National Institute on Drug Abuse) data, between 65 and 71 million Americans have smoked marijuana at some point in their lives, and 10 million are current smokers (have smoked as at least once in the last month.) In fact, NIDA found that 61% of all illicit drug users report that marijuana is the only drug they have ever tried; this figure is raised to 80% if hashish is included (a marijuana derivative.)
At NORML, we believe that marijuana smokers, like those who drink alcohol, have a responsibility to behave appropriately and to assure that their recreational drug is conducted in a responsible manner. Neither marijuana nor alcohol consumption is ever an excuse for misconduct of any kind, and both smokers and drinkers must be held to the same standard as all Americans.
NORML Board of Directors in February 1996 issued the following statement that defines how any responsible marijuana smoker should act:
I. ADULTS ONLY
Cannabis consumption is for adults only. It is irresponsible to provide cannabis to children
II. NO DRIVING
The responsible cannabis user does not operate a motor vehicle or other dangerous machinery impaired by cannabis, nor (like other responsible citizens) impaired by any other substance or condition, including some medicines and fatigue.
III. SET AND SETTING
The responsible cannabis user will carefully consider his/her set and setting, regulating use accordingly.
IV. RESIST ABUSE
Use of cannabis, to the extent that it impairs health, personal development or achievement, is abuse, to be resisted by responsible cannabis users.
V. RESPECT RIGHTS OF OTHERS
The responsible cannabis user does not violate the rights of others, observes accepted standards of courtesy and public property, and respects preferences of those who wish to avoids cannabis entirely.? -Testimony of R. Keith Stroup on behalf of NORML before the Subcommittee on Crime of the Judiciary Committee, U.S. House of Representatives, on March 6, 1996
In November 1996, the people of California approved proposition 215, an initiative that could, in effect, make marijuana legally available as a medicine in the United States for the first time in many years. Under this new law, patients or their primary caregivers that possess or cultivate marijuana for medical treatment recommended by a physician are exempted from criminal prosecution. The treatment may be for ?cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief.? Physicians may not be penalized in any way for recommendation, which may be either written or oral. The passage of this law is only the beginning of a trend that presents new challenges for physicians, who will be asked to assume responsibilities for which many have not prepared themselves. As more and more patients approach them with questions about marijuana, they will have to provide answers and make recommendations. That means they must not only listen more carefully to their patients but also educate themselves and one another. They will have to learn which symptoms and disorders may be treated better with marijuana than with conventional medications, and they may need to explain how to use marijuana.
Cannabis is a strikingly safe, versatile and potentially inexpensive medicine. When reviewing its medical uses in 1993 after examining many patients and case histories, the following are those diseases, disorders, and pains that were immensely helped by marijuana: nausea and vomiting in cancer chemotherapy, the weight loss syndrome of AIDS, glaucoma, epilepsy, muscle spasms and chronic pain in multiple sclerosis, quadriplegia, and other spastic disorders, migraine, severe pruritus, depression, and other mood disorders. Since then, a dozen more have been identified, including asthma, insomnia, dystonia, scleroderma, Crohn?s disease, diabetic gastroparesis, and terminal illness.
For example, cannabis has also been found useful in the treatment of osteoarthritis. Aspirin is believed to have caused more than 1,000 deaths annually in the United States. More than 7,600 annual deaths and 70,000 hospitalizations caused by non-steriodal ant-inflammatory drugs (NSAIDs) are reported. Gastrointestinal complications of NSAIDs are the most commonly reported serious adverse drug reaction. Long term acetaminophen use is thought to be one of the most common causes of end-stage renal disease. Cannabis smoked several times a day is often as effective as NSAIDs or acetaminophens in osteoarthritis, and there have been no reports of death from cannabis.
It is often objected that the evidence of marijuana?s medical usefulness, although powerful, is merely anecdotal. It is true that there are no studies meeting the standards of the Food and Drug Administration, chiefly because legal, bureaucratic, and financial obstacles are constantly put in the way. The situation is ironical, since so much research has been done on marijuana, often in unsuccessful efforts to show health hazards and addictive potential, that we know more about it than about most prescription drugs. In any case, controlled studies can be misleading if the wrong patients are studies or the wrong doses are used, and idiosyncratic therapeutic responses can be obscured in group experiments. The chief legitimate concern is the effect of smoking on the lungs. Many physicians find it difficult to endorse a smoked medicine. Although cannabis smoke carries even more tabs and other particulate matter than tobacco smoke, the amount needed by most patients is extremely limited. Furthermore, when marijuana is an openly recognized medicine, solutions for this problem may be found, perhaps by the development of a technique for inhaling cannabinoid vapors. Even today, the greatest danger of using marijuana is not impurities in the smoke, but illegality, which imposes much unnecessary anxiety and expense on suffering people.
A synthetic version of delta-9-tetrahydrocannabinol, the main active substance in cannabis, has been available in oral form for limited purposes as a Schedule II drug since 1985. Both patients generally regard this medicine, dronabinol (Marinol), and physicians as less effective than smoked marijuana. A patient who is severely nauseated and constantly vomiting, for example, may find it almost impossible to keep a pill or capsule down. Oral THC is erratically and slowly absorbed into the bloodstream; the dose and duration of action of smoked marijuana are easier to titrate. Furthermore, oral THC occasionally makes many patients anxious and uncomfortable, possibly because of cannabidiol, one of the many substances in marijuana, has an anxiolytic effect.
Besides their direct responsibility to individual patients with respect to medical marijuana, physicians have another obligation that is social and ultimately political. Jerome P. Kaiser has identified it in his recent New England Journal of Medicine editorial entitled ?Federal Foolishness and Marijuana.? He describes the governments policies on medical marijuana as ?hypocritical? and predicts that physicians who ?have the courage to challenge the continued prescription of marijuana for the sick? will eventually force the government to reach some sort of accommodation. That important task will inevitably fall to the younger generation of doctors, including present and future medical students.
?Marijuana?s claimed healing power with regards to glaucoma, cancer, and pain relief have not been proven by scientific studies. Because of its damaging effects to the brain and lungs, marijuana should be considered a health hazard, not a medicine. The media should fully inform the public about the dangers of smoking marijuana.? -Dr. Paul Leithbert, substance abuse specialist.
There has been more extensive research on marijuana over the past 40 years than on any other substance. Cannabinoids from a single marijuana cigarette deposit in the fatty tissue of the body (brain, testes, ovaries, etc.) and remain there for three to four weeks. Repeated use of the drug produces THC storage in these vital organs for months. By contrast, when alcohol is consumed it is metabolized in a few hours.
Contrary to the arguments of its advocates, marijuana is physically and psychologically addictive. Additionally, when a user stops he experiences withdrawal symptoms. Also, myriads of psychological symptoms develop as use becomes chronic.
When a joint is inhaled, over 2,000 noxious chemicals invade the lungs. Users typically ?toke?, holding the smoke in their lungs to enhance the absorption of THC. This produces more rapid lung damage than smoking tobacco. Marijuana and tobacco share the same chemical compounds (except for the cannabinoids), but somehow cigarettes are deemed the more deadly, while pot is touted as a medical necessity. The high from pot has been described by its users as a euphoria, a pleasant, relaxed escape that causes one to become self-absorbed and to pay less attention to his surroundings. The anticipations of these sensations is the major reason for use. And with repeated use, one?s ability to think becomes dulled, concentration is more difficult, and pathological thinking develops. The ability to perform tasks-especially new ones-diminishes, the memory becomes impaired, the sense of time is altered, and an inertia or lack of motivation develops. In many users, an antimotivational syndrome sets in.
Chronic users often develop such problems as emotional instability, difficulty in absorbing and integrating new information, and decreased work performance. As the brain?s ?pleasure center? becomes exhausted, users have difficulty in experiencing pleasure and often put forth less effort to socialize. Users go from a sense of suspiciousness to a full-blown paranoia-and, eventually, to total ?burnout.?
In spite of the documented side effects associated with marijuana use, it has nonetheless been promoted as useful in the treatment of an amazing variety of ailments. Unfortunately, the truth about marijuana?s effectiveness in treating physical maladies is completely overblown:
Glaucoma. Proponents claim pot smoking lowers the pressure in the eyes of glaucoma patients. A small pressure drop does occur in some patients when marijuana is used two to four hours around the clock. This would mean, of course, that the user would be constantly stoned. In many users the pressure increases, however, and recent research indicates that marijuana users have a decreased circulation to the optic nerve-a serious problem. Also, there have been medications available for years that are as effective as marijuana and that have minimal side effects.
Cancer. Marijuana is advocated to fight nausea in patients receiving intensive chemotherapy. But it is really no better than the many safer anti-nauseates available. Also marijuana has been found to damage the immune-system, which is important in fighting cancer and other serious ailments like AIDS, infection, etc.
Pain. Marijuana is not an analgesic. For example, users frequently have toothaches which are not relieved with their marijuana smoking; they require the standard pain killers. Marijuana is not helpful in fighting other kinds of pain either.
In short, all the ?medical uses? for marijuana, including asthma, seizures, multiple sclerosis, muscle spasms, etc., are really just excuses to get high. Some users may be under the delusion they are being helped, but marijuana users typically smoke for the THC while still taking the standard medications for their disease. Synthetic delta-9THC (Marinol) is available by prescription for some conditions and is effective. Marijuana users say they prefer the side effects from cannabis to the side effects of prescription drugs, however.
In essence, then, rather than being a medicine, marijuana is a health hazard. Who would call a drug ?recreational? if they realized that chronic use caused permanent brain damage? Marijuana use is never cited by proponents as a factor in high school dropout and failure rates, as well as the increase in promiscuity and sexually transmitted diseases. Such is the case, however. Another area they ignore is the dramatic effect cannabis has on the ability for one to drive a car safely. Not only is the driver impaired in major ways while high, but for hours after the high wears off. Why are these important facts not better understood by the public? For more than 35 years the media have suppressed information on cannabis. The National Institute on Drug Abuse (NIDA) published an annual report on ?Marijuana and Health? for many years-each issue cataloguing the increasing THC content of the weed and the dramatic research findings on damage to the users body. These reports have been ignored by the media, although all levels of media outlets were supplied with NIDA findings.
In 1971 the National Organization for the Reform of Marijuana Laws (NORML) was founded. It soon became a highly organized and influential body. There are 80,000 members in many larger cities. NORML conducts seminars to train lawyers in defending users and pushers when they are arrested. The hearings in state houses across the country are highly choreographed by these lawyers. They often call in NORML?s national advisors-Lester Grinspoon, MD and Thomas Ungerleider, MD-for the hearings. For many years these two psychiatrists have been major activists in the marijuana war. Dr. Grinspoon declares that marijuana is a ?wonderful medicine? and finds it useful for almost everyday malady. Users who have major medical problems are featured witnesses at hearings. These patients declare that they would be dead except for their marijuana. The media (especially TV) featured these experts and patients, usually ignoring the testimony of legitimate medical experts.
If marijuana is legalized there are billions of dollars to be made by the unscrupulous. Billionaire financier George Soros, who admits to having experimented with cannabis, gave a million dollars for the California and Arizona pro-pot initiatives.
The FDA issues narcotic licenses to physicians. Under license guidelines, Schedule I substances ? have no accepted medical use?and have a high abuse potential.? Included in this category are heroin, marijuana, and LSD. Any physicians, however, can receive marijuana for use in legitimate medical research. But marijuana users want free access to the drug. For the more, the Psychotropic Convention Treaty of 1971 classifies marijuana as Schedule I drug. The U.S. is on of the 74 nations that have accepted the treaty.
A fascinating article, ? The Return of Pot,? by Hannah Rueban, appeared in the February 17, 1997 issue if The New Republic. A visit by Reuban to San Francisco?s Cannabis Cultivators Club demonstrated the total absurdity of state-sanctioned use of marijuana. Reuban stated, ? it?s as if the rotting of the late ?60s San Francisco described by Joan Didion in Slouching Toward Bethlehem has been preserved in reverse; the characters are the same, but the center was holding.? Reuban recounted the lives of the burnt out beings that frequent the clubs and made it obvious that ?medical marijuana? is the red herring that NORML plotted. The article should be must reading for state legislature facing the issue of legalizing ?medical marijuana.?
The views shared by many critics of marijuana is: Using marijuana for illness would be like prescribing moldy bread (containing penicillin) for phenomena or suggesting cigarette smoking for weight loss. Prescribing marijuana for any medical condition is totally irresponsible. Some doctors do and are either na?ve about the damage marijuana causes or perhaps are users themselves.
1. Ethan A. Nadelmann, American Heritage Magazine, Feb-Mar, 1993.
2. Tom Bowmen, ?Schmoke says debate on decriminalization of drugs is gaining momentum.?, The Sun Newspaper, 7-13, 1989.
3. American Journal of Nursing, Annual Report 1992.
4. Martin Evans. ?Schmoke urges NAACP to back decriminalization of drugs.?, The Sun, 1989.
5. Christopher Brown, ?Bring Drugs Within the Law.?, The Economist. Volume 13, 1993.
6. Encarta 98. Microsoft Corporation, 1997. CD-ROM.
7. Nadelmann, Ethan A., American Heritage Magazine,
8. Medical Marijuana, http://www.lec.org/Drug_Watch/
9. Secretary of State, California. Home Page (www.ssa.gov) Prop 215 text:
10. Brown, Christopher. “Bring Drugs Within the Law.” The Economist,
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