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Thursday, August 2, 2012

The Report of the National Commission on Marihuana


The Report of the National Commission on Marihuana and Drug Abuse

Marihuana: A Signal of Misunderstanding

Commissioned by President Richard M. Nixon, March, 1972



The National Commission on Marihuana and Drug Abuse
Marihuana: A Signal of Misunderstanding

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Table of Contents


The Report


I. Marihuana and the Problem of Marihuana


Origins of the Marihuana Problem
Visibility
Perceived Threats
Symbolism
The Need for Perspective
Historical Perspective
Cultural Perspective
The Search for Meaning
Skepticism
The Limits of Rationality
Formulating Marihuana Policy
Scientific Oversimplification
Philosophical Oversimplification
Sociological Oversimplification
Legal Oversimplification
The Report


II. Marihuana Use and Its Effects


The Marihuana User
Demographic Characteristics
Patterns of Use
Profiles of Users
Experimental Users
Intermittent Users
Moderate and Heavy Users
Very Heavy Users
Becoming a Marihuana User
Parental Influence
Situational Factors and Behavioral Correlates
Social Group Factors
The Dynamics of Persistent Use
Becoming a Multidrug User
Epidemiologic Studies
Profiles and Dynamics
Sociocultural Factors
Effects of Marihuana on the User
Botany and Chemistry
Factors Influencing Drug Effect
Dosage
Method of Use
Metabolism
Set and Setting
Tolerance
Reverse Tolerance
Duration of Use
Patterns of Use
Definition of Dependence
Effects Related to Pattern Use
Immediate Drug Effects
Subjective Effects
Body Function
Mental Function
The Intoxicated State
Unpleasant Reactions
Anxiety States
Psychosis
Conclusions
ShortTerm Effects
Long Term Effects
Very Long Term Effects
Tolerance and Dependence
General Body Function
Social Functioning
Mental Functioning
Motivation and Behavioral Change
Summary


III. Social Impact of Marihuana Use


Marihuana and Public Safety
Marihuana and Crime
The Issue of Cause and Effect
Marihuana and Violent Crime
Marihuana and Non Violent Crime
A Sociocultural Explanation
Marihuana and Driving
Marihuana, Public Health and Welfare
A Public Health Approach
The Population at Risk
Confusion and Fact
Assessment of Perceived Risks
Lethality
Potential for Genetic Damage
Immediate Effects
Effects of LongTerm, Heavy Use
Addiction Potential
Progression to Other Drugs
Preventive Public Health Concerns
Summary
Marihuana and the Dominant Social Order
The Adult Marihuana User
The Young Marihuana User
The World of Youth
Why Society Feels Threatened
Dropping Out
Dropping Down
Youth and Radical Politics
Youth and the Work Ethic
The Changing Social Scene


IV. Social Response to Marihuana Use


The Initial Social Response
The Change
The Current Response
The Criminal Justice System
Law Enforcement Behavior
Law Enforcement Opinion
The Non Legal Institutions
The Family
The Schools
The Churches
The Medical Community
Summary
The Public Response


V. Marihuana and Social Policy


Drugs in a Free Society
Drugs and Social Responsibility
A Social Control Policy for Marihuana
Approval of Use
Elimination of Use
Discouragement or Neutrality
Implementing the Discouragement Policy
The Role of Law in Effective Social Control
Total Prohibition
Regulation
Partial Prohibition
Recommendations for Federal Law
Recommendations for State Law
Discussion of Federal Recommendations
Discussion of State Recommendations
Discussion of Potential Objections
A Final Comment


The Appendix


Part One -- Biological Aspects


II. Biological Effects of Marihuana


Botanical and Chemical Considerations
Factors Influencing Psychopharmacological Effect
Dose-Response Relationship
Dose-Time Relationship
Route of Administration
Quantification of Dose Delivered
Effect of Pyrolysis on the Cannabinoids
Set and Setting
Tolerance
Reverse Tolerance
Metabolism
Pattern of Use
Amount of Drug Consumed
Duration of Use
Interaction With Other Drugs


Acute Effects of Marihuana (Delta 9 THC)
Subjective Effects
Lethality
Physiological Effects
Effects on Mentation and Psychomotor Performance
The Intoxicated Mental State
Unpleasant Reactions - Too Stoned and Novice Anxiety
Acute Psychoses
Persistent Effects After Acute Dose
Effects of Marijuana on Concomitant Behavior


Effects of Short-Term or Subacute Use
Animal Studies
 Human Experiments


Effects of Long-Term Cannabis Use
Dependence And Tolerance
Physiological Effects
Genetics and Birth Defects
Organic Brain Damage
Psychosis
Amotivational Syndrome
Recurrent Phenomenon

==========


I -- marihuana and the problem of marihuana

"There are no whole truths; all truths are half -truths. It is trying to treat them as whole truths that plays the devil."
Alfred North Whitehead (1953)

We are a nation of problem-solvers. We are restless and impatient with perceived gaps between the way things are and the way we think ought to be. Understandably, such an impulse toward self-correction never leaves us wanting for social problems to solve. Although it is a prerequisite to social progress, this problem-solving orientation misdirects our attention. In order to maximize public awareness we are apt to characterize situations as being far worse than they really are. Because any activity is commonly regarded as a move toward a solution, rhetoric and stopgap legislation sometimes substitute for rational reflection. We become so impressed with social engineering that we overlook inherent human limitations.
Since the mid-sixties, American society has been increasingly agitated by what has been defined as a marihuana problem. The typical sequences of "a national problem" have resulted: exaggeration, polarization and the inevitable demand for a. solution. The appointment of this Commission and the publication of this Report reflect the escalation of marihuana use into the realm of social problem. Since the beginning of our official life, we have grappled with the threshold question: Why has the use of marihuana reached problem status in the public mind?


Origins of the Marihuana Problem
Marihuana has been used as an intoxicant in various parts of the world for centuries and in this country for 75 years. Yet use of the drug has been regarded as a problem of major proportions for less than a decade. We will not find the reasons for contemporary social concern in pharmacology texts or previous governmental reports, for we are dealing with two separate realities: a drug with certain pharmacologic properties and determinable, although variable, effects on man; and a pattern of human behavior, individual and group, which has, as a behavior, created fear, anger, confusion, and uncertainty among a large segment of the contemporary American public. The marihuana behavior pattern is the source of the marihuana controversy.
The most apparent feature of the behavior is that it is against the law. But inconsistency between behavior and the legal norm is not sufficient, in itself, to create a social problem. Marihuana, has been an illegal substance for several decades; and the widespread violation of laws against gambling and adultery have not excited the public to the same extent as has marihuana-smoking in recent years.
At the same time, we suspect that illegality may play an important role in problem definition where drugs are concerned. Alcohol is of proven danger to individual and societal health and the public is well aware of its dangers, yet use of this drug has not been accorded the same problem status. Marihuana's illegality may have been a necessary condition for the marihuana problem, but the increased violation of the legal proscription does not by itself explain the phenomenon.
The Commission believes that three interrelated factors have fostered the definition of marihuana as a major national problem. First, the illegal behavior is highly visible to all segments of our society. Second, use of the drug is perceived to threaten the health and morality not only of the individual but of the society itself. Third, and most important, the drug has evolved in the late sixties and early seventies, as a symbol of wider social conflicts and public issues.

VISIBILITY
More than anything else, the visibility of marihuana use by a segment of our population previously unfamiliar with the drug is what stirred public anxiety and thrust marihuana into the problem area. Marihuana usage in the United States has been with us for a very long period of time, dating back to the beginning of the century. For decades its use was mainly confined to the underprivileged socioeconomic groups in our cities and to certain insulated social groups, such as jazz musicians and artists. As long as use remained confined to these groups and had a negligible impact on the dominant social order, the vast majority of Americans remained unconcerned. From the other side, the insulated marihuana user was in no position to demand careful public or legislative scrutiny.
However, all this changed markedly in the mid-1960's. For various reasons, marihuana use became a common form of recreation for many middle and upper class college youth. The trend spread across the country, into the colleges and high schools and into the affluent suburbs as well. Use by American servicemen in Vietnam was frequent. In recent years, use of the drug has spanned every social class and geographic region.
The Commission-sponsored National Survey, "A Nationwide Study of Beliefs, Information and Experiences," indicated that some 24 million Americans have tried marihuana at least once and that at least 8.3 million are current users.
Other surveys uniformly indicate that more than 40% of the U.S. college population have tried marihuana, and in some universities the figure is much higher. Also, use of the drug has become almost as common among young adults out of college, and among older teenagers in high school. The National Survey indicates that 39%, of young adults between 18 and 25 years of age have tried marihuana. The stereotype of the marihuana user as a marginal citizen has given way to a composite picture of large segments of American youth, children of the dominant majority and very much a part of the mainstream of American life.
Public confusion, anger, and fear over this development became increasingly apparent during the mid and late 1960's. Such mass deviance was a problem and the scope of the problem was augmented by frequent publicity. The topic of the usage of marihuana by the young received considerable attention from newspapermen and television reporters. The drug's youthful users abetted the media in this regard by flaunting their disregard of the law, Few of us have not seen or heard of marihuana being used en masse at rock concerts, political demonstrations and gatherings of campus activists.
In addition, new scientific and medical interest in marihuana and its use was stimulated by the sudden public interest. For the first time in the American experience, the drug became the subject of intensive scrutiny in the laboratories and clinics. Unfortunately, this research was conducted in the spotlight of public controversy. Isolated findings and incomplete information have automatically been presented to the public, with little attempt made to place such findings in a larger perspective or to analyze their meanings.
Any new marihuana research has had ready access to the news spotlight and often has been quickly assimilated into the rhetoric of the marihuana, debate. Science has become a weapon in a propaganda battle. Because neither the reporters nor the public have the expertise to evaluate this information, the result has been an array of conflicting anecdotal reports, clinical studies on limited populations, and surveys of restricted utility.
Visibility, intense public interest, and fishbowl research are all important components of the marihuana problem.

PERCEIVED THREATS
Although marihuana is taken by most users for curiosity or pleasure, the non-using public still feels seriously affected by use of the drug. Several decades ago it was popularly asserted that the drug brought about a large variety of social and individual ills, including crime and insanity. As a result it was prohibited by federal law in 1937. The marihuana explosion of the mid-sixties occurred within the context of 30 years of instilled fear. Although based much more on fantasy than on proven fact, the marihuana "evils" took root in the public mind, and now continue to color the public reaction to the marihuana phenomenon. Even beyond the violation of law, the widespread use of marihuana, is seen as a threat to society in other ways. And the threats grow proportionately as the controversy swells.
It has been astutely observed that any statement frequently repeated in public assumes the status of fact. With so many people continually arguing about marihuana, the public has understandably become alarmed and confused.
On the basis of the National Survey, we have tried to identify the ways in which the public feels threatened by marihuana use. Essentially these threats fall into three general categories: threats to the public safety, threats to the public health, and threats to the dominant social order.
In terms of public safety, the concern is with the relationship between marihuana and aggressive behavior, crime and juvenile delinquency. Threats to the public health usually refer initially to the impact of marihuana on the user. Lethality, psychosis, addiction potential and effects of chronic long-term use, are major concerns. Additionally, the fear exists that marihuana leads to the use of more dangerous drugs, especially LSD and heroin.
The threat which marihuana use is thought to present to the dominant social order is a major undercurrent of the marihuana problem. Use of the drug is linked with idleness, lack of motivation, hedonism and sexual promiscuity. Many see the drug as fostering a counterculture which conflicts with basic moral precepts as well as with the operating functions of our society. The "dropping out" or rejection of the established value system is viewed with alarm. Marihuana becomes more than a drug; it becomes a symbol of the rejection of cherished values.

SYMBOLISM
The symbolic aspects of marihuana are the, most intangible of the items to which the Commission must address itself, and yet they may be at the heart of the marihuana problem. Use of marihuana was, and still is, age-specific. It was youth-related at a time in American history when the adult society was alarmed by the implications of the youth " movement": defiance of the established order, the adoption of new life styles, the emergence of "street people," campus unrest, drug use, communal living, protest politics, and even political radicalism. In an age characterized by the so-called generation gap, marihuana symbolizes the cultural divide.
For youth, marihuana became a convenient symbol of disaffection with traditional society, an allure which supplemented its recreational attraction. Smoking marihuana may have appealed to large numbers of youth who opposed certain policies or trends, but who maintained faith in the American system as a whole. In ;a time when symbolic speech is often preferred to the literal form, marihuana was a convenient instrument of mini-protest. It was also an agent of group solidarity, as the widely-publicized rock concerts so well illustrate.
For the adult society, the decade of the sixties was a distressing time. The net effect of racial unrest, campus disruption, political assassination, economic woes and an unpopular war was widespread uneasiness. Attending a general fear that the nation was witnessing its own disintegration was a desire to shore up our institutions and hold the line. That line was easy to define where drugs, particularly marihuana, were concerned.
Use of drugs, including marihuana, is against the law. For many, marihuana symbolized disorder in a society frustrated by increasing lawlessness. Insistence on application of the law tended also to harden views, thereby escalating still further the use of marihuana as a symbolic issue.
The social conflicts underlying the drug's symbolic status have dissipated somewhat in the past few years; and in some ways, the Commission has similarly noted a partial deflation of the marihuana problem and of the emotionalism surrounding it. We are hopeful that our attempt to clarify the scientific and normative dimensions of marihuana use will further deemphasize, the problem orientation and facilitate rational decision-making.


The Need for Perspective

This Commission has the task of exploring the marihuana controversy from as many vantage points as possible in its attempt to make sound, realistic and workable policy recommendations. Because we are dealing essentially with a complex social concern rather than a simple pharmacologic phenomenon, any social policy decision must discuss the realities of marihuana as a drug, marihuana use as a form of behavior, and marihuana as a symbol.
Particularly important is the determination of the longevity of the behavior. Are we dealing with a behavior that is becoming rooted in our culture or are we experiencing an aberration, a fad that will in time, of its own accord, pass away?
The vortex of the marihuana controversy is the present, but the prudent policy planner must not be blinded by the deluge of recent statistics. It is important that we scan the past for clues about the meaning of certain behavior and the promise offered by various social policy responses. We are convinced that a wider historical understanding will also go a long way toward deflating marihuana as a problem.


HISTORICAL PERSPECTIVE

When viewed in the context of American society's ambivalent response to the non-medical use of drugs, the marihuana problem is not unique. Both the existing social policy toward the drug and its contemporary challenge have historical antecedents and explanations. Somewhat surprisingly, until the last half of the 19th century, the only drugs used to any significant extent for non-medical purposes in this country were alcohol and tobacco.
American opinion has always included some opposition to the nonmedical use of any drug, including alcohol and tobacco. From colonial times through the Civil War, abstentionist outcries against alcohol and tobacco sporadically provoked prohibitory legislation. One 18th century pamphleteer advised against the use of any drink "which is liable to steal away a man's senses and render him foolish, irascible, uncontrollable and dangerous." Similarly, one 19th century observer attributed delirium tremens, perverted sexuality, impotency, insanity and cancer to the smoking and chewing of tobacco.
Despite such warnings, alcohol and tobacco use took deep root in American society. De Tocqueville noted what hard drinkers the Americans were, and Dickens was compelled to report that "in all the public places of America, this filthy custom [tobacco chewing] is recognized." Nonetheless, the strain in our culture opposed to all non-medical drug use persisted and in the late 19th century gained ardent adherents among larger segments of the population.
Beginning in earnest around 1870, abstentionists focused the public opinion process on alcohol. As science and politics were called to the task, public attention was drawn to the liquor problem. "Liquor is responsible for 19% of the divorces, 25% of the poverty, 25% of the insanity, 37% of the pauperism, 45% of child desertion and 50% of the crime in this country," declared the Anti-Saloon League. "And this," it was noted, "is a very conservative estimate."
The Temperance advocates achieved political victory during the second decade of the 20th century. By 1913, nine states were under statewide prohibition, and in 31 other states local option laws operated, with the ultimate effect that more than 50% of the nation's population lived under prohibition. Four years later, Congress approved the 18th Amendment and on January 16, 1919, Nebraska became the 36th state to ratify the Amendment, thus inscribing national Prohibition in the Constitution.
Although on a somewhat smaller scale and with lesser results, public attention was simultaneously attracted to a growing tobacco problem. Stemming partly from the immediate popularity of cigarette-smoking, a practice introduced after the Civil War, and partly from riding the coattails of abstentionist sentiment, anti-tobacconists achieved a measure of success which had previously eluded them. The New York Time editorialized in 1885 that:
The decadence of Spain began when the Spaniards adopted cigarettes and if this pernicious habit obtains among adult Americans, the ruin of the Republic is close at hand. . . .
Between 1895 and 1921, 14 states banned the sale of cigarettes.
Although though there has been some posthumous debate about the efficacy of alcohol Prohibition as a means of reducing excessive or injurious use, the experiment failed to achieve its declared purpose: elimination of the practice of alcohol consumption. The habit was too ingrained in the society to be excised simply by cutting off legitimate supply.
In addition, the 18th Amendment never commanded a. popular consensus; in fact, the Wickersham Commission, appointed by President Hoover in 1929 to study Prohibition, attributed the Amendment's enactment primarily to public antipathy toward the saloon, the large liquor dealers and intemperance rather than to public opposition to use of the drug.
Subsequent observers have agreed that Prohibition was motivated primarily by a desire to root out the institutional evils associated with the drug's distribution and excessive use; only a minority of its supporters opposed all use. And in this respect, Prohibition succeeded. Upon repeal, 13 years after ratification, liquor was back, but the pre-Prohibition saloon and unrestrained distribution had been eliminated from the American scene.
Both the scope of the alcohol habit and the ambivalence of supporting opinion are manifested in the internal logic of Prohibition legislation. The legal scheme was designed to cut off supply, not to punish the consumer. Demand could be eliminated effectively, if at all, only through educational efforts. Only five states prohibited possession of alcohol for personal use in the home. Otherwise, under both federal and state law, the individual remained legally free to consume alcohol.
The anti-tobacco movement was not propelled by the institutions outrage or the cultural symbolism surrounding the alcohol problem It never succeeded on a national scale. Local successes were attributable to the temporary strength of the abstentionist impulse, together with the notion that tobacco-smoking was a stepping-stone to alcohol use Lacking the consensus necessary to reverse a spreading habit, tobacco "prohibition" never extended to possession. Insofar as the anti-tobacco movement was really a coattail consequence of alcohol Prohibition, is not surprising that all 14 states which had prohibited sale repealed their proscriptions by 1927.
By the early 1930's, the abstentionist thrust against alcohol and tobacco had diminished. State and federal governments contented themselves with regulating distribution and extracting revenue. When the decade ended, the general public no longer perceived alcohol and tobacco use as social problems. The two drugs had achieved social legitimacy.
A comparison between the national flirtation with alcohol and tobacco prohibition and the prohibition of the non-medical use of other drugs is helpful in analyzing the marihuana issue. In 1900, only a handful of states regulated traffic in "narcotic" drugs--opium, morphine, heroin and cocaine even though, proportionately, more persons probably were addicted to those drugs at that time than at any time since. Estimates from contemporary surveys are questionable, but a conservative estimate is a quarter of a million people, comprising at least 1% of the population. This large user population in 1900 included more females than males, more whites than blacks, was not confined to a particular geographic region or to the cities, and was predominantly middle class.
This 19th century addiction was generally accidental and well hidden. It stemmed in part from over-medication, careless prescription practices, repeated refills and hidden distribution of narcotic drugs in patent medicines. Society responded to this largely invisible medical addiction in indirect, informal ways. Self -regulation by the medical profession and pharmaceutical industry, stricter prescription practices by the state governments and regulation of labeling by the Federal Government in 1906 all combined in the early years of the new century to reduce the possibility of this accidental drug addiction.
About this same time, during the late 19th and early 20th centuries, attention within the law enforcement and medical communities was drawn to another use of narcotics----the "pleasure" or "street" use of these drugs by ethnic minorities in the nation's cities. Society reacted to this narcotics problem by enacting criminal legislation, prohibiting the non-medical production, distribution or consumption of these drugs. Within a very few years, every state had passed anti-narcotics legislation, and in 1914 the Federal Government passed the Harrison Narcotics Act.
The major differences between the temperance and anti-narcotics movements must be, emphasized. The temperance, movement was a matter of vigorous public debate; the anti-narcotics movement was not. Temperance legislation was the product of a highly organized nation-wide lobby; narcotics legislation was largely ad hoc. Temperance legislation was designed to eradicate known problems resulting from alcohol abuse; narcotic--, legislation was largely anticipatory. Temperance legislation rarely restricted private activity; narcotics legislation prohibited all drug-related behavior, including possession and use.
These divergent policy patterns reflect the clear-cut separation in the public and professional minds between alcohol and tobacco on the one hand, and "narcotics" on the other. Use of alcohol and tobacco were indigenous American practices. The intoxicant use of narcotics was not native, however, and the users of these drugs were either alien, like the Chinese opium smokers, or perceived to be marginal members of society.
As to the undesirability and immorality of nonmedical use of narcotics, there was absolutely no debate. By causing its users to be physically dependent, the narcotic drug was considered a severe impediment to individual participation in the economic and political systems. Use, it was thought, automatically escalated to dependence and excess, which led to pauperism, crime and insanity. From a sociological perspective, narcotics use was thought to be prevalent among the slothful and immoral populations, gamblers, prostitutes, and others who were already "undesirables." Most important was the threat that narcotics posed to the vitality of the nation's youth.
In short, the narcotics question was answered in unison: the nonmedical use of narcotics was a cancer which had to be removed entirely from the social organism.
Marihuana smoking first became prominent on the American scene in the decade following the Harrison Act. Mexican immigrants and West Indian sailors introduced the practice in the border and Gulf states. As the Mexicans spread throughout the West and immigrated to the major cities, some of them carried the marihuana habit with them. The practice also became common among the same urban populations with whom opiate use was identified.
Under such circumstances, an immediate policy response toward marihuana quite naturally followed the narcotics pattern rather than the alcohol or tobacco pattern. In fact, marihuana was incorrectly classified as a "narcotic" drug in scientific literature and statutory provisions. By 1931, all but two states west of the Mississippi and several more in the East had enacted prohibitory legislation making it a criminal offense to possess or use the drug.
In 1932, the National Conference of Commissioners on Uniform State Laws included an optional marihuana, provision in the Uniform Narcotic Drug Act, and by 1937 every state, either by adoption of the Uniform Act or by separate legislation, had prohibited marihuana use. In late 1937, the Congress adopted the Marihuana Tax Act, superimposing a, federal prohibitory scheme on the state scheme.
Not once during this entire period was any comprehensive scientific study undertaken in this country of marihuana, or its effects. The drug was assumed to be a 'narcotic' to render the user psychologically dependent, to provoke violent crime, and to cause insanity. Although media attention was attracted to marihuana use around 1935, public awareness was low and public debate non-existent. As long as use remained confined to insulated minorities throughout the next quarter century, the situation remained stable. When penalties for narcotics violations escalated in the 1950's, marihuana penalties went right along with them, until a first-offense possessor was a felon subject to lengthy incarceration.
With this historical overview in mind, it is not surprising that the contemporary marihuana experience has been characterized by fear and confusion on one side and outrage and protest on the other. As scientific and medical opinion has become better known, marihuana has lost its direct link with the narcotics in the public mind and in the statute books.
But extensive ambivalence remains about the policies for various drugs. Marihuana's advocates contend that it is no more or less harmful than alcohol and tobacco and should therefore be treated in similar fashion. The drug's adversaries contend that it is a stepping-stone to the narcotics and should remain prohibited. At the present time public opinion tends to consider marihuana less harmful than the opiates and cocaine and more harmful than alcohol and tobacco.
Interestingly, while marihuana. is perceived as less harmful than before, alcohol and tobacco are regarded as more harmful than before. In some ways, the duality which previously characterized American drug policy has now been supplanted by an enlightened skepticism as to the variety of approaches to the non-medical use of various drugs.
Despite this shift in attitudes, however, the use of alcohol and tobacco is not considered a major social problem by many Americans, while marihuana use is still so perceived.
This remains true despite the fact that alcoholism afflicts nine million Americans. According to the National Institute on Alcohol Addiction and Alcoholism of the National Institute of Mental Health: alcohol is a factor in half (30,000) of the highway fatalities occurring each year; an economic cost to the nation of $15 billion occurs as a result of acoholism and alcohol abuse; one-half of the five million yearly arrests in the United States are related to the misuse of alcohol (1.5 million offenses for public drunkenness alone) ; and one-half of all homicides and one-fourth of all suicides are alcohol related, accounting for a total of 11,700 deaths annually.
Similarly, tobacco smoking is not considered a major public concern despite its link to lung cancer and heart disease. According to the Surgeon General in The Health Consequences of Smoking, 1972:
cigarette smoking is the, major "cause" of lung cancer in men and a significant "cause" of lung cancer in women; the risk of developing lung cancer in both men and women is directly related to an individual's exposure as measured by the number of cigarettes smoked, duration of smoking, earlier initiation, depth of inhalation, and the amount of "tar" produced by the cigarette; and data from numerous prospective and retrospective studies indicate that cigarette smoking is a significant risk factor contributing to the development of coronary heart disease (CHD) including fatal CHD and its most severe expression, sudden and unexpected death.



CULTURAL PERSPECTIVE

Realizing the importance of social change in understanding the issues surrounding the use of marihuana and other drugs, the Commission decided early that an objective appraisal of cultural trends was vital for the, development of policy recommendations. Since neither the increase in marihuana use nor its attendant controversy is an isolated phenomenon, we sought a wider cultural perspective. To this end, the Commission sponsored a wide-ranging seminar on "Central Influences on American Life." With the cooperation of the Council for Biology in Human Affairs of the Salk Institute, we elicited a three-day conversation among 13 exceptionally thoughtful and perceptive observers of American life.*
*The participants included Jacques Barzun, as moderator, Mary Bingham, Claude T. Bissell, Kenneth Boulding, Robert R. Bowie, Theodore Caplow, Jay W. Forrester, T. George Harris. Rollo May, Jay Saunders Redding, Jonas Salk, Ernest van den Haag, and Leroy S. Wehrle.
It is well beyond both our mandate and our competence to attempt a definitive presentation of the status of the American ethical system However, we shall try to suggest some of the more salient influence in our changing society, recognizing that only against the backdrop of society's fears, aspirations and values can a rational response to marihuana be formulated. Although we are not prepared to identify specific causal connections between these social trends and marihuana use, we do believe that some of the major points raised in the discussion of cultural change provide essential background in understanding the marihuana problem.


The Search for Meaning

One overriding influence in contemporary America is the declining capacity of our institutions to help the individual find his place in society. As one of the participants at the Seminar observed:
A society is stable, peaceful, happy, not when it has rid itself of the tensions-because you never get rid of the tensions, because people's drives will be satisfied in ways that clash and so on-but when a very high proportion of the people feel fulfillment of some sort within the context which the society normally provides. The long-term problem now, for many many people, not just young people, is that this condition is not met.
Another noted:
What is wrong with our social system, it seems to me, is that it no longer inspires in people a feeling of purpose, meaningfulness and so on.
A number of institutional trends have joined to deprive the individual of a sense of communal inspiration. Perhaps most important is the economic element. Whereas the individual's economic achievement formerly gave his life broad social meaning and inspired his existence, automation and technological advance have tended to depersonalize the individual's role in the economy. Instead of the economic system being dependent on individual productivity, the individual is increasingly dependent on the system. As his work dwindles in significance to the total society, it diminishes in meaning for him. Moreover, as more and more of our people share the nation's affluence, Horatio Alger's example is no longer needed to climb the economic ladder.
A particularly emphatic manifestation of the declining economic demand on the individual is the institutionalization of leisure time. Whereas the economy used to require long hours of work, now it barely requires more than a five-day week. Expanding vacation time and reduced work-weeks tend to diminish the strength of the work ethic. The implications of enforced leisure time are only now becoming apparent, and the concept of "idle hands are the devil's plaything" has to be reexamined in terms of acceptable forms of non-work behavior. This new time component, allowing for the assertion of individuality, has produced both privileges and problems.
In the last decade we have seen the beginnings of the institutionalization of this leisure ethic. A leisure-time industry has sprung up to organize this time period for the individual. Many Americans, due to the nature of their jobs in an automated economic system, find little personal satisfaction in their work, and many are now searching for individual fulfillment through the use of free time. Where meaning is not found in either work or recreational pursuits, the outcome is likely to be boredom and restlessness. Whether generated by a search for individual fulfillment, group recreation or sheer boredom, the increased use of drugs, including marihuana, should come as no surprise.
Another social development which has chipped away at individual identity is the loss of a vision of the future. In an age where change is so rapid, the individual has no concept of the future. If man could progress from land transportation to the moon in 60 years, what, lies ahead? Paralleling the loss of the technological horizon is the loss of a vision of what the future, in terms of individual and social goals, ought to look like. Are times moving too fast for man to be able to plan or -to adjust to new ways and new styles? This sense of the collapsing time frame was best summed up by one of the Seminar participants:
.... there are great forces that have developed over the last several decades that cause one to lose sight of the distant future. Let me contrast a rural farm family of several decades ago which settled a farm. They expected their children to live there, they can imagine their grandchildren living there-there is an image of the future. There is really no one who [now] has any image of where his great grandchildren will he or what they will do. This comes about because of the nature of industrial society; it comes about because we have retirement plans instead of looking after one's own old age. There area whole set of these [factors].
Now the morality, the ethics get tied into it because ethics are really a long-time horizon concept. It's something you engage in because it's contrary to immediate reward and immediate gratification and so you look to some distant future. But as one loses sight of any future then I think the ethics and morality creep up to the very near term also . . . We have no one who has got an image of this country two hundred years from now, who is trying to create a structure that be believes will exist that long. So a number of these things . . . tie together in terms of the long-term goals and how they have shifted. In any of our systems there tend to be a conflict between the short-term and the long-term goals. If the long-term goals are lost sight of then the short-term expediencies seem to be the things that well up.
To the extent that planning for the future no longer gives the individual his inspiration, he must look to the present. Such a climate is conducive to pleasure-seeking, instant gratification and an entire life-perspective which our society has always previously disclaimed A third force depriving the individual of a presumed place in society is the loss of a sense of community, a sense of belonging. Mobility, mass living and rapid travel all conspire to destroy the smaller community. The family moves from place to place and then separates with each child going his own way. This global thinking leaves little time for home-town concern.
The dissipation of geographic roots parallels a social uprooting. As one of our Seminar participants noted:
When you grow up with a, small number of people with whom you have to live for a while, it does something which isn't done now. It forces you to face yourself. It forces you to ask what kind of pet-son you are, because you can't get away with it with a group you're going to have to live with. They know what you really are. The mobility has the effect of making it possible for people to live playing parts for years. It seems to me we see it among the youngsters: role playing as distinguished from being somebody. . . .
All of these social trends have their most potent impact on young people who are just beginning to develop their values, beliefs and commitments. The adult society has found it easier to adjust to the emergence of the leisure value. Having experienced it as a gradual process, they see it as a reward for previous toil. For many of our young, however, a substantial segment of leisure time may be considered an essential part of living; they have known no other experience. Similarly, an adult society, increasingly influenced toward the present, at least has developed an historical perspective. Also, adult values were internalized at a time when a future vision was possible. For many of the young, however, the present weighs more, heavily. This notion is best reflected in the vociferous youth response to the Vietnam conflict, the embodiment of a war fought for the future,
Finally, all of these cultural changes have occurred, especially for the young, in an environment of affluence. The successful economic system has maximized individual freedom. But the individual has been given unlimited choices at exactly the time when a, value system within which to make such choices is in doubt. Because he has no sense of direction, the result is restlessness, boredom and an increase in the likelihood of present-oriented choices. Self-destructive drug-taking is one form such behavior may take. One of our Seminar participants observed in this connection:
It seems to me that you've got this affluence. So that while most of us grew up with the feeling that the channels within which we were going to have to move and make choices were very narrow, channels for these youngsters look absolutely open. It's an absolutely a, la carte menu-it's the biggest a la, carte menu you can imagine. [This occurs] in a situation in which this sense of radical change is going on so fast that you can't master it, together with a feeling that the society is being operated by very large organizations which you can't get a grip on, giving one a sense of helplessness, of not knowing where to take hold. All these things inherently are disorienting to youngsters and don't give them a, feeling of challenge, [but rather] a doubt as to the meaning of their own lives, of the significance of their being here, [a sense of] being atoms. So then they do act like children in the sense of behaving violently to call attention to themselves. They do a whole lot of other things which, it seems to me, are the sort of things you often see when people feel their lives have no meaning.

Skepticism
Another major influence in contemporary American life with substantial relevance to the marihuana problem is the uneasy relationship between the individual and society's institutions, particularly the state. For 50 years, there has been a continuing upward flow of power to large institutional units, whether they be corporate conglomerates, labor unions, universities or the Government. We have created a society which "requires the individual to lean on society," observed one of our Seminar participants, "in ways that formerly he did not have to do. He used to lean on the clan, on the family, on the village. We have used bureaucracy to deal with these problems." For many, the Federal Government epitomizes this development, bureaucratizing a social response to the most human of needs.
We suspect that the implications of this trend for the individual, although inevitable, became more visibly apparent in the 1960's. Mass institutions must deal through rules; the individual becomes a number. "Intuitively, [the individual] feels that bureaucracies must make man into an object in order to deal with him." So we have a depersonalization at exactly the time that many individuals are casting about for identity and fulfillment.
Simultaneously, technological advance poses the awesome prospect of 1984: the intrusion of the omnipresent state into the private affairs of the individual. Computerized data-banks and electronic surveillance are perceived as restrictions on individuality at a time when the desire for personal privacy is ascendant.
Another cultural feature of governmental bureaucracy during the sixties has been failure to match expectations. Government promises the elimination of poverty, the dissipation of racial discrimination, the excision of drug abuse, and creates rising expectations. But government is often ill-equipped or unable to perform such monumental tasks. As individual helplessness increases, as the "responsibility" of the bureaucracy enlarges, those in need often feel that the gap between public declaration and performance must be the result of a conspiracy to fail. And for the rest of us, there is the credibility gap. The net result is a loss of confidence in society's institutions. Viewed from this perspective, youthful dissent, cynicism and disobedience of the 1960's were not such surprising consequences.
Still another significant feature of institutional life in contemporary America is the lag between purpose and implementation. That is, some of our social institutions have not yet begun to deal with the consequences of the social and economic changes which have occurred over the last several decades. The best example, and the one most germane to the youth, is the educational system. Two generations ago, the labor force could assimilate the large majority of the nation's youth. Neither a high school nor a college education was prerequisite to occupational choice or achievement. Increased educational attainment was presumed to be limited to either the privileged or the able and would be rewarded by certain careers.
Today, however, the labor force grows more quickly than the system is able to assimilate it, and the educational system now serves as custodian as well as teacher. Although we sincerely wish to achieve the democratic ideal of a highly educated populace, we also keep our children in school as long as possible because we have nothing else for them to do. The trend is strikingly apparent even in the last 20 years.
Percent enrolled in school
Age19501970
14-1594.798.1
16-1771.390.0
18-1929.447.7
20-249.021.5
This custodial function confronts educators with a dilemma. Attrition is not in society's best interest; thus, single-minded devotion to the highest levels of achievement would be dysfunctional. In a sense, because the system no longer wants to turn away its subjects, the notion of failure has lost its meaning. As one of the Seminar participants observed:
I think one of the problems is that there is no longer a penalty for failure. We-the educators-have had to lower standards in order to accommodate these people who need no longer fear failure. Of course this has been a cyclical thing, a wheel within a wheel. [If ] there is no longer a penalty for failure, then there is no longer the need to acquire.
The changing function of education has been felt in both the secondary schools and in our institutions of higher learning. Numerous high school graduates cannot read. Colleges and junior colleges have sprung up overnight to accommodate the population, but many provide classrooms with little specific purpose. Only slowly is the educational system beginning to come to grips with its role in a changed society. At the university level, many educators have been appalled at sacrifices which have ensued from the custodial feature; rote learning, they contend, has supplanted citizen and character education.




Uncertainty about the role of the educational system has not escaped the students, particularly at the college level. Many of our youth, pressed into longer attendance, question its need or desirability. The demand for "relevance" is but another reflection of the search for meaning, for an understandable role in society. Drug use has perhaps provided an outlet for some members of this restless generation, uncertain of its place.







The Limits of Rationality
The social response to the individual's search for meaning has fostered an ambivalence, an unwillingness to act, a paralysis. In large measure, according to one Seminar member, this default of authority reveals the intensity of the search:
In the same way we are getting universities that can't teach, families that can't socialize and police forces that can't catch criminals. In every case, the same issue is involved: the subject of authority questions the legitimacy of authority and the exerciser of it is unable to find-very often doesn't even try to find-a defense, because he feels in himself a sympathy, as do so many parents, with the challenge.
To a significant extent, society is waiting, hoping that the impulse for change will settle around certain fundamental attributes of the American ethic. At the present time, however, no consensus about the nature of these fundamentals exists. We are all looking for values that have deep roots, as we attempt to sort out the durable from the ephemeral.
All of the participants at our Central Influences Seminar agreed that the unique feature of this search was its a rational quality. As one observer put it:
We have been discussing the question of how we change a society. I don't think it's changed by rational intention. As I understand societies, historically and our own, what really is required to change it is something on a deeper level that involves myth, ritual, sacrament-a number of these functions that have always been related to societies. On these you can't just suddenly make up your mind and then prescribe.
Regarding our problem of authority, you cannot really ask the question: why can't these people hang onto their authority? They can't hang onto it because what gave them authority is something not of themselves, but part of the society, part of a ritual, a sacrament: a way of behaving in the group which gave them authority, [whether] professorial, parental or policy authority. In each one of these cases, what we see is not the diminishing of these men so much but rather the developing emptiness, the lack of the particular ethic that gave them authority to start with. This is why we are in a terrible dilemma.
What is essentially lacking is a system of ethics, morality or religion that gives birth -to the myths, the rituals, the sacraments that are its expression. These touch human beings on the unconscious level. These are the ways we see the world. They are not our conscious thought, but the ways we form ourselves, form each other, love each other or hate each other-in terms not so much of rational intention as a deeper unconscious-conscious and unconscious-which is my definition of a myth; much more of a feeling level, a living level. That is what is not present now.
What we need, below and above all of our deliberations, is the growth and development of an ethical system. We just do not have this now.
As we move into the 1970's, our society is collectively engaged in the task -of determining what America means, and how each individual should find fulfillment in `a changing age. From this wider perspective of flux emerges an uncertainty about what the increased prevalence of marihuana use means for the individual and the total society.


Formulating Marihuana Policy

Present symbolism, past implications, and future apprehensions all combine to give marihuana many meanings. These diverse notions of what marihuana means constitute the marihuana problem. In this atmosphere, the policy-maker's position is precarious insofar as no assumption is beyond dispute. Accordingly, the Commission has taken particular care to define the process by which a social policy decision should be reached.
In studying the arguments of past and present observers to justify a particular kind of marihuana policy, we conclude that a major impediment to rational decision-making in this area is oversimplification. As suggested earlier, many ingredients are included in the marihuana mix-medical, legal, social, philosophical, and moral. Many observers have tended to isolate one element, highlight it and then extrapolate social policy from that one premise. In an area where law, science and morality are so intertwined, we must beware of the tendency toward such selectivity.


SCIENTIFIC OVERSIMPLIFICATION
It is wrong to assume, as many have done, that a particular statement of marihuana's effects compels a given social policy or legal implementation. An accurate statement of the effects of the drug is obviously an important consideration, but it is conclusive only if the effects are extreme one way or the other. For example, if the use of a particular drug immediately causes the user to murder anyone in his presence, we have no doubt that a vigorous effort to eliminate use of that drug would be in order. On the other hand, if the effects of the drug are purely benign, presenting no danger whatsoever to the user or society, no reason would exist to suppress it.
We know of no psychoactive substance, including marihuana, which falls at either of these extremes. Thus, it begs the issue to contend, as some have done, that because we don't know enough about the effects of heavy, chronic use, we should maintain the status quo. We know a lot about the adverse effects of alcoholism and heavy cigarette smoking, and yet no responsible observer suggests that we should adopt total prohibition for these drugs. Similarly, previous estimates of marihuana's role in causing crime and insanity were based quite erroneous information; but to infer from this that marihuana should be considered totally benign and hence made freely available is also not logical. Both approaches are simplistic; both approaches fail to take into account the social context in which the drug is used and the dynamic factors affecting the role that marihuana use may or may not play in the future.
A similar manifestation of scientific oversimplification is the focus on causality. Many opponents of marihuana use feel compelled to establish a causal connection between marihuana use and crime, psychosis, and the use of other drugs, while, their adversaries focus the dispute on negating such relationships. The Commission believes that this tendency misses the mark.
The policy-maker's task is concerned primarily with the effects of marihuana on human behavior. For both philosophical and practical reasons, proof of causal relationships is next to impossible. At the same time, however, the extent to which marihuana use is associated with certain behaviors and whether any significant relationships exist can offer important clues.
We must be cautious when dealing with such data. Yet we cannot afford to paralyze the decision-making process simply because absolute "proof " is lacking. Spokesmen on both sides of the marihuana debate should focus not on causation but instead on the relevance of the association between various behavioral effects and marihuana use.
PHILOSOPHICAL OVERSIMPLIFICATION
Some partisans stoutly maintain that the state has no right to interfere with essentially private conduct or that the state has no right to protect the individual from his own folly. Some of the greatest minds of the Western world have struggled over such philosophical issue always with the same outcome: a recognition of the need to draw a line between the individual and his social surroundings. That is, everything an individual does, in private or not, potentially may affect others. The issue is really to determine when the undesirable effect upon others is likely enough or direct enough for society to take cognizance of it and to deal with it. Coupled with this is the further question of whether the nature of the behavior and its possible effect is such that society should employ coercive measures.
Advocates of liberalization of the marihuana laws commonly contend either that the decision to use marihuana is a private moral decision or that any harm flowing from use of the drug accrues only to the user. Defenders of the, present restrictions insist that society not only has the right but is obligated to protect the existing social order and to compel an individual to abstain from a behavior which may impair his productivity. Unfortunately, the issue is not so simple and the line often drawn between the private conduct and behavior affecting the public health and welfare, is not conclusive or absolutely definable.
For example, a, decision to possess a firearm, while private is considered by many to be of public magnitude, requiring governmental control. A decision to engage in adulterous conduct, although generally implemented in private, may have public consequences if society believes strongly in the desirability of the existing family structure. Similarly, excessive alcohol consumption, in addition to its adverse effects on individual health, may impair familial stability and economic productivity, matters with which the total society is concerned.
So, while we agree with the basic philosophical precept that society may interfere with individual conduct only in the public interest, using coercive measures only when less restrictive measures would not suffice this principle merely initiates inquiry into a rational social policy but does not identify it. We must take a careful look at this complicated question of the social impact of private behavior. And we must recognize at the outset the inherent difficulty in predicting effects on public health and welfare, and the strong conflicting notions of what constitutes the public interest.
Again and again during the course of our hearings, we have been startled by the divergence of opinion within different segments of our population. Sometimes the disagreement is quite vehement, and relates to the underlying social concerns of particular groups. For example, we were told repeatedly by leaders of the urban black communities that they wanted to purge all drug use from their midst, marihuana included, and that the "legalization" of marihuana would be viewed as part of a design to keep the black man enslaved.
On the other hand, we were informed repeatedly by the activist student element that the pre-sent social policy regarding marihuana was merely a tool for suppression of political dissent, and until the law was changed, there could be no hope of integrating the dissident population into the mainstream of American society.
Such statements reemphasize the degree to which marihuana is regarded as a symbol of a larger social concern.
The conflicting notions of the public interest by different segments of the population reinforced in the Commission's deliberations the realization that we have been called upon to recommend public policy for all segments of the population, for all of the American people. The public good cannot be defined by one segment of the population, the old or the young, users or non-users of marihuana, ethnic minorities or white majority. At the same time, the fears of each of these groups must be taken into consideration in arriving at the basic social objectives of the Commission's public policy recommendation. Where such fears are real, they must be confronted directly; where they are imagined, however, they must be put in perspective and, hopefully, laid to rest.
SOCIOLOGICAL OVERSIMPLIFICATION
Public debate and decision-making in our society suffer from the glorification of statistical data. After a particular social phenomenon, such as marihuana use, has been defined as a problem, armies of social scientific researchers set out to analyze and describe the problem. A sophisticated computer technology instantly translates millions of bits of data into correlations, probabilities and trends. The most striking findings are then fed to a data-hungry public. The result is data overload.
Descriptive information about the nature and scope of marihuana use as a behavior is an essential component of the policy-maker's knowledge-base. However, such information does not in itself have social policy implications. The policy-maker must define goals and evaluate means; only after he asks the right questions will statistical data suggest useful answers. Unfortunately, a tendency exists in the marihuana debate to assign prescriptive meanings to descriptive data without testing the underlying assumptions. Further, the data have often been accumulating in a fragmented way. No overall plan was devised beforehand; the result has been an ad hoc use of available data triggered by individual research interests rather than by long-term policy needs.
What does it mean that 24 million people have tried marihuana? Some have suggested that it means marihuana ought to be legalized. But does it mean the same thing if 15 million tried the drug once and have decided not to use it again? And does it mean the same thing if popular interest in the drug turns out to be a passing fancy, which wanes as suddenly as it waxed?
On the other side of the controversy, what does it mean that a substantial percentage of the public would favor increased penalties for marihuana use? The prescriptive implications of a democratic impulse may be offset by a preference for individual freedom of choice. Also, this segment of public opinion may have been influenced by incorrect information, such as unwarranted belief in marihuana's lethality or addiction potential. So, although the policy-maker must be aware of political realities, he must not allow his function to be supplanted by public opinion polls. This is an area which requires both awareness of public attitudes and willingness to assert leadership based on the best information available.
LEGAL OVERSIMPLIFICATION
Perhaps the major impediment to rational decision-making is the tendency to think only in terms of the legal system in general and of the criminal justice system in particular. This thinking is certainly understandable, given the history of marihuana's involvement with the criminal law. Nonetheless, the law does not exist in a social vacuum, and legal alternatives can be evaluated only with reference to the values and policies which they are designed to implement and the social context in which they are designed to operate.
Legal fallacies are apparent on both sides of the marihuana controversy. Many of the persons opposed to marihuana use look exclusively to the law for social control. This reliance on the law is stronger today because many of our fellow citizens are uneasy about the diminishing effectiveness of our other institutions, particularly when the non-legal institutions have been relatively lax in controlling drug related behavior. Increasing reliance is placed upon the legal system to act not only as policeman, but as father confessor, disciplinarian, educator, rehabilitator and standard-bearer of our moral code. Little or no thought is given to what impact this over-reliance on the law has on the viability of other social institutions, not to mention it's effect on the legal process.
A society opposed to marihuana use need not implement that policy through the criminal law. Non-legal institutions, such as the church, the school and the family, have great potential for molding individual behavior. Accordingly, the policy-maker must delicately assess the capacity of the legal system to accomplish its task and must consider the mutual impact of legal and non-legal institutions in achieving social objectives.
We recognize the short-sightedness of an absolute assumption that the criminal law is the necessary tool for implementing a social policy opposed to marihuana use. But equally short-sighted is the opposing contention which attempts to analyze the law separately from its underlying social policy objective. This argument assumes that if the law isn't working, or if the costs of enforcing the law outweigh its benefits, the law should, therefore, be repealed.
If society feels strongly enough about the impropriety of a certain behavior, it may choose to utilize the criminal law even though the behavior is largely invisible and will be minimized only through effective operation of other agencies of social control. Laws against incest and child-beating are good examples. In weighing the costs and benefits of a particular law, one must provide a scale and a system of weights. The scale is the normative classification of behavior, and the system of weights is the largely subjective evaluation of the importance of the values breached by the behavior. This weighing process is what is open to dispute.
In sum, no law works alone. Where an unquestioned consensus exists about the undesirability of a particular behavior and all social institutions are allied in the effort to prevent it, as is the case with murder and theft, the law can be said to "work" even though some murders and thefts may still be committed. Where society is ambivalent about its attitude toward the behavior and other institutions are not committed to its discouragement, the law cannot be said to be working, even though many people may not engage in the behavior because it is against the law.
The question is whether the social policy, which the law is designed to, implement, is being achieved to a satisfactory extent. To determine the role of law regarding marihuana, we must first look to society's values and aspirations, and then define the social policy objective. If we seek to discourage certain marihuana-related behavior, we must carefully assess the role of the legal system in achieving that objective.

The Report

In this Chapter, we have tried to put the marihuana problem in perspective. In the remainder of this Report, we explore several aspects of the phenomenon of marihuana use, its effects, its social impact and its social meaning, assessing their relative importance in the formulation of social policy.
In Chapter II, we consider the effects of the drug on the individual user, with particular attention to the size of the user population for whom various effects are relevant. The Commission emphasizes that this material is related only indirectly to its policy-making function. The social policy planner is concerned not about the effects on the individual per se, but about the impact of any adverse effect on his behavior and on the larger society and about the meaning of this behavior in the larger social perspective. The material in Chapter II serves primarily to educate and inform.
In Chapter III, the Commission evaluates the various threats which marihuana use is perceived to present to the public safety, public health, and dominant social order. This Chapter is designed to assess the social impact of marihuana use, the initial step in the policy making process.
In Chapter IV, we consider what role marihuana use plays and will play in the life of American society. This is the dynamic element of marihuana use and is the most intangible of the marihuana realities, but is particularly important from a policy-planning perspective. This consideration is the one most overlooked by contemporary observers and participants in the marihuana debate.
Because social meaning is not a directly measurable entity, we must examine the ways in which society responds to the behavior and whether such responses, both formal and informal, are fluid or. static. After analyzing public opinion, law enforcement behavior and the reactions of medical, educational, and other segments of the population, we then discuss what marihuana use has come to mean and is likely to mean in the future. Particularly important in this highly speculative endeavor is the wider cultural perspective which we described earlier in this Chapter.
In Chapter V, we bring this information to bear on a policy-making process. After establishing the philosophical framework, we explore the spectrum of social policy options, choosing the one we judge most suitable to the present time. Then we consider the range of legal alternatives for implementing this chosen policy, and select the one we believe to be most appropriate for achieving it.
In an addendum to the Report, we present some ancillary recommendations. Some of these recommendations flow from our basic premise, others are a result of independent evaluation by the Commission of other areas of concern.
We ask the reader to set his preconceptions aside as we have tried to do, and discriminate with us between marihuana, the drug, and marihuana, the problem. We hope that our conclusions will be acceptable to the entire public, but barring that, we hope at the least that the areas of disagreement and their implications will be brought into sharper focus.


Chapter II                                                                                                                                              

marihuana use and its effects


"Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence." John Adams (1770)

The ultimate objective of the Commission is to evaluate the total impact of actual and potential marihuana use on contemporary American society. This endeavor involves three phases: first, an evaluation of the nature and scope of contemporary American marihuana use; second, a careful reevaluation of the pharmacological effects of the drug on the human body with special emphasis on the drug's capacity to alter or modify behavior; and third, an evaluation of the impact of marihuana use on society. This chapter deals with the first and second phases, and Chapter Three deals with the third.
The Marihuana User
Cannabis has been used widely for many centuries in nonindustrialized countries of Asia and Africa. Today, as in earlier years, use of drug is concentrated primarily among lower socioeconomic groups. in these countries, the practice is estimated to be confined to a tenth of the lower socioeconomic, male population. Although such use of the drug is well-established, it offers little direct comparison with the American experience.
Although the commercial, industrial and therapeutic value of the hemp plant was widely recognized and exploited in the United States from the earliest days of its history, knowledge and use of its intoxicating and psychoactive properties remained largely unknown until about 1900.
At that time, the custom of smoking marihuana was generally limited to groups of Mexican itinerant workers in the border states of the Southwest. By 1910, marihuana use began to emerge in other southern states and cities, particularly New Orleans, and in the port cities along the Mississippi River. In time, these cities became distribution centers for enterprising sailors. From there, marihuana use spread cross-country to other urban centers, mining camps, railroad construction sites, farm labor camps, "bohemian" communities of artists and jazz musicians, and various other groups outside the mainstream of American society.
Recently, of course, use of the drug has spread to young, white, middle class groups and especially to high school and college populations.
DEMOGRAPHIC CHARACTERISTICS
On the basis of the Commission-sponsored National Survey, we have concluded that contemporary marihuana use is pervasive, involving all segments of the U.S. population. The Survey estimated that about 24 million Americans over the age of 11 years (15% of the adults 18 and over, and 14% of the 12-17 year olds) have used marihuana at least once, referred to in this Report as ever-users. Until recently twice as many males as females had used it; the most up-to-date studies of high school students, college-age individuals, and young adults carried out by the Commission indicate that this sex differential appears to be diminishing. In many youthful populations use is almost equally distributed between males and females.
Marihuana use does not appear to vary significantly by race. With respect to the religious affiliation of the users, Jews and Catholics appear to be slightly overrepresented as compared to Protestants.
Usage is highest in cities, towns, and suburbs but not uncommon in rural areas. States in the Northeast and West have considerably higher rates of use than have the North Central states, which in turn have significantly higher rates than those in the South.
Use is found in all socioeconomic groups and occupations, though slightly more predominant among persons with above-average incomes. A New York survey of the state's general population indicated that ever-use as well as regular use is almost equally prevalent among sales workers, clerical workers, skilled, semiskilled and unskilled workers, managers, owners, professionals and technical workers.
At the same time, the incidence of use seems to vary according to educational attainment. Among all adults not now in school, 5% of those with an eighth grade education or less have used the drug, contrasted with 11% of those who completed some high school, 14% of those who graduated from high school, 25% of those who completed some college and 21 % of those who graduated from college.
Age is presently one of the most significant correlates of marihuana use. Among the total population, those who have tried or used marihuana at least once, termed ever-users, are heavily concentrated in the 16-25 age bracket. Of all the ever-users, about half are in this group. At the same time, however, we should emphasize that use is by no means confined to teenagers and young adults.
The proportion of individuals in different age groups who have used marihuana is indicated in Figure 1.

The incidence of use is greatest among young people: 27% of the 16-17 year olds, 40% of the 18-21 year olds, and 38% of the 22-25 year olds have tried marihuana; at the low extremes, 6% of the 12-13 year olds and 6% of the over-50 generation have used the drug.
Among those now in school, incidence also seems to rise with increasing school level: Ever-users represent 44% of those persons now in college or graduate school; 30% of high school juniors and seniors; 17% of freshmen and sophomores; and 8% of students in junior high school.
At the same time, the use of the drug among adults is by no means confined to college students. Even among the 18-25 year olds, 75% of the ever-users are not now in school.
The initial patterns of contemporary marihuana use appear to be shifting; there is a trend toward increased use among college students as well as non-college students. Non-student users now span social class, income level and occupational classification. In addition, the proportion -of users increases during the teens, peaks during the young adult years and then falls off rapidly (Figure 1).
Having described the incidence of any use of marihuana ever, and demographic characteristics of the 24 million Americans who have tried the drug, we recognize the need to place this information into perspective. The policymaker must also be concerned with the patterns of use: frequency, amount consumed at each smoking, and duration of use.
PATTERNS OF USE
The most striking of the use patterns revealed in the National Survey is that 41 % of the adults and 45 % of the youth who have ever used marihuana reported that they no longer use the drug. Twenty-nine percent of the adults and 43% of the youth reported that they are still using marihuana (see Table 1). When asked why they bad terminated use, the overwhelming majority of adults (61%) specified, among other reasons, that they had simply lost interest in the drug.
Table I.-EXPERIENCE WITH MARIHUANA
Percent of ever-users
Frequency Adults Youth Designation
(18 and (12-17)
over)
Have used marihuana but no longer 41 45
se. lExperimenters.
Once a month or less 9 15
2-3 times pet month 8 10 Intermittent users.
Once per week 4 9 @
Several times per week 5 4 Moderate users.
Once daily 1 1 1
More than once daily 2 4 Heavy users.
No answer 30 12
These data indicate that at least 41% of the adults and 45% of the youth have used marihuana but have -discontinued use; 9% of the adults and 15% of the youth use the drug sporadically, once a, month or less. These persons can be characterized as experimental marihuana users.*
To ensure an understanding of this section of the Report, some definitions are required at this juncture. In this report, the Commission employs the following designations:
Frequency of Use 
Experimental-At least one trial to once a month or less.
Intermittent-Two to 10 times monthly.
Moderate-11 times monthly to once, daily.
Heavy-Several times daily.
Very Heavy-Almost constant intoxication with potent preparations; brain rarely drug free. 
Duration of Use
Short Term-Less than two years.
Long Term-Two to 10 years.
Very Long Term-Over 10 years. 
Twelve percent of the adults and 19% of the youth who have ever used marihuana can be designated intermittent users; they continue to use the drug more than once a month, but less than several times a week, probably on weekends. Six percent of the adults and five percent of the youth are moderate users who continue to use marihuana several times a week to once daily.
Finally, 2% of the adults and 4% of the youth who have ever used marihuana are heavy users: they use the drug several times daily. A very small fraction of these heavy users may be very heavy users, who are intoxicated most of their waking hours and probably use very potent preparations of the drug.
In addition to frequency, duration of use is an important variable in discussing use patterns and especially when considering drug effects. Most users in this country have smoked the drug over a short term, that is, less than two years. Others have used the drug over a long term, two to 10 years. Very few Americans can be considered very long term users, that is, over 10 years.
Another important element of use is the amount of marihuana used on each occasion. Most intermittent and moderate users average about one-half to one cigarette per occasion, usually at night. Most heavy users smoke at least one to two cigarettes an occasion, with a few using as many as five consecutively.
As this brief description of use patterns suggests, marihuana use and the marihuana user do not fall into simple, distinct classifications. Although it is possible to sketch profiles of various marihuana-using populations, no valid stereotype of a marihuana user or non-user can be drawn. The spectrum of individuals who use or have used marihuana varies according to frequency, intensity and duration of use. It is meaningless to talk of "the marihuana user" or "marihuana use" without first clarifying descriptive data.
*All respondents for the National Survey were asked to complete a self administered questionnaire. This instrument covered many sensitive areas, including a series of items on personal experience with marihuana and other drugs. Given the nature of the questions, the contractor took every precaution to insure that the interviewee responded honestly and that his responses were kept strictly confidential. Even the interviewer who orally administered the rest of the Survey was not permitted to view the written instrument.
One of the inevitable costs of such confidentiality is the risk that a certain percentage of respondents would not complete one or more of the questions. Where a significant number of questions remained unanswered, the questionnaire was not tabulated at all. However, in 30%, of the otherwise complete questionnaires, the adult respondents who had ever used the drug did not answer the question, "On the average, about how often do you use marihuana at the present time?"
Concerned about the meaning of this non-response rate, the, Commission directed the contractor to conduct a detailed analysis comparing the non-respondents with all respondents and with those individuals who had never used marihuana at all. On the basis of this analysis, we are confident that the overwhelming majority, if not all, of the non-respondents are experimenters.
In the flrst place, the demographic characteristics of the non-respondents coincide closely with those of the non-users and less frequent users. Very few of the young adults, where more frequent use is concentrated, failed to respond.
Secondly, the non-respondents are disproportionately located in the geographic regions where use was least prevalent and least frequent. For example, 50% of the ever-users in the North Central region failed to respond, compared to 71% in the West. Yet only 5% of the ever-users in the North Central region continue to use the drug more than once a week, compared to 21% in the West; and less than .5% of the ever-users in the North Central region use the drug more than once a day, as compared to 4% in the West.
PROFILES OF USERS 
Several studies by the Commission and many other recent college and high school surveys have elucidated a variety of personality types or categories of marihuana users. These profiles relate primarily to the patterns depicted above and to the meaning of marihuana use for various individuals. Essentially we will describe a continuum with much overlapping among the categories. The reader should understand that group identification is at best a hazardous occupation; the traits described are not exclusive to marihuana users. A much larger number of individuals who have not used the drug can be similarly described.
Experimental Users
The first and by far the largest group has been designated as "experimenters" because of their extremely infrequent or non-persistent marihuana usage. Experimentation with the drug is motivated primarily by curiosity and a desire to share a social experience. These experimenters are characteristically quite conventional and practically indistinguishable from the non-user in terms of life style, activities, social integration, and vocational or academic performance.
Disciplined, optimistic, and self-confident, experimenters appear to be as conventional, responsible, goal-oriented and orderly as non-users.
Intermittent Users
The intermittent users are motivated to use marihuana for reasons similar to those of the experimenters. They use the drug irregularly and infrequently but generally continue to do so because of its socializing and recreational aspects. For the intermittent user, marihuana often contributes to the establishment and solidification of close social relations among users similarly inclined. The individual has a sense of belonging to an intimate group.
Investigations of behavioral aspects of marihuana smoking clearly demonstrate that marihuana smoking is a social activity, believed by intermittent users to enhance the enjoyment of shared activities, especially music, art, films and food.
In a Commission-sponsored study to determine the effects of repeat doses of marihuana, under free access conditions, the subjects smoked almost exclusively in groups. A certain number of these individuals tended to share much of their leisure time in common activities, and marihuana, smoking was the focal activity around which other types of social interactions revolved, such as conversation, watching TV, listening to music and playing games. The intermittent users studied exhibited an increased sense of well-being, relaxation, and friendliness during these activities. They were more inclined to seek and emphasize the social rather than personal effects of the drug.
Intermittent marihuana users, like the experimenters, are generally conventional in most respects. They are more liberal politically and socially and they tend to stress education for personal improvement rather than for recognition or high grades. Like many non-users, these individuals are likely to be self-expressive, intellectually and culturally oriented, creative, and flexible. Placing a high value on experimentation and responsible, independent decision-making, they often manifest a desire to search for new experiences, resulting in some behaviors which depart from the norms of the larger society. Often accompanying their search is a sense of uncertainty about the future.
Moderate and Heavy Users
The final groups of marihuana users are the moderate and heavy users. This range is wide and includes individuals who use marihuana more than 10 times a month to several times a day. Practically all of the American research effort to date has focused on the large majority of individuals who use less often, that is, the experimental and intermittent users. Consequently, not enough is known about characteristics and behavior of the moderate and the heavy users, so it is difficult to distinguish accurately between the two groups. We suspect however that the moderate users share traits with both the intermittent and the heavy users. Having already discussed the intermittent group, we will now turn to the characteristics of the heavy group.
Heavy users seem to need the drug experience more often. Their initial and continued marihuana use is motivated not only by curiosity and an urge to share a social experience but also by a desire for "kicks," "expansion of awareness and understanding," and relief of anxiety or boredom.
Generally, the heavy marihuana user's life style, activities, values and attitudes are unconventional and at variance with those of the, larger society. These individuals are more pessimistic, insecure, irresponsible, and nonconforming. They find routine especially distasteful. Their behavior and mood are restless and uneven.
Heavy users place particularly strong emphasis on impulsive response in the interest of pleasure-seeking, immediate gratification, and individual expression. They tend to evidence social and emotional immaturity, are especially indifferent to rules and conventions, and are often resistant to authority. However, several surveys have also revealed that they tend to be curious, socially perceptive, skillful and sensitive to the needs of others, and possess broadly based, although unconventional, interests.
The Boston free-access study permitted the Commission to observe a group of individuals whose life styles, activities, values and attitudes are representative of a segment of the unconventional youthful subculture. The month-long period of controlled study during the fall prevented the participation of individuals who were married, steadily employed, or enrolled in school.
Individuals who smoked marihuana once a week or less were sought by the researchers but were exceedingly unusual among the population available for the study. Consequently, the group studies contrasted with the student and full-time working populations in which weekly marihuana use is more common. For this reason, the intermittent users studied appeared to be similar to, rather than different from, the moderate and heavy users studied. Both groups had used marihuana for an average of five years.
Under the study's confined conditions, participants tended to smoke more marihuana than they did "on the outside." The intermittent users, who by our definition averaged eight times a month under outside conditions, averaged three cigarettes a day during the study. The range was from one-half to six cigarettes daily.
The moderate and heavy users, who "on the outside" averaged 33 times a month, now averaged six-and-a-half cigarettes a day. The range was three-and-a-half to eight cigarettes. In discussing the Boston study, we will call this group "daily" users.
Smoking usually occurred at night, sometimes during the afternoon and only occasionally upon awakening. The intermittent and heavy users usually smoked one cigarette a session. The daily users were more likely to smoke more than one a session. A few individuals in the daily group could have been considered constantly intoxicated on a few occasions during the 21 -day period.
The mean age of the subjects studied was 23. Based on IQ testing, they were superior intellectually, although they had completed, on the average, only two-and-a-half years of college. Their job histories were rather erratic, characteristic of a pattern of itinerant living. The intermittent users -were from a middle or upper class background, while the daily users generally shared a lower socioeconomic status. Broken homes and instances of alcohol or drug abuse were more common in the family backgrounds of the daily users.
Alcohol was rarely used by the subjects. Use of hallucinogens and amphetamines was significantly more widespread and had begun earlier in the daily user group. In contrast to the intermittent group, the daily users almost uniformly reported that marihuana smoking produced relaxation, noting also increased alteration in perception or psychedelic-like effects. Similarly, they reported an increased sense of well-being, friendliness, carefreeness and decreased hostility. Additionally, the daily users appeared to demonstrate a moderate psychological dependence on the marihuana experience while the intermittent users demonstrated little or no psychological dependence.
Analysis of social-behavioral aspects of daily users' marihuana smoking clearly demonstrated that it is a pivotal social activity around which conversation, other personal interactions, and much of the users' lives revolve. Smoking almost exclusively occurred in groups and was the focal activity around which these groups formed. The daily users exhibited a readiness to take part in but not to initiate a smoking session.
In contrast to the intermittent users, all the daily users in a group smoked when marihuana was made available. Marihuana smoking appeared to be a primary means of reinforcing group solidarity. Yet these users were more inclined to seek the personal effects of the drug rather than the socializing effects sought by the intermittent users.
The social adjustment of the daily users, when judged from a traditional psychiatric standpoint, was impaired. Individuals tended to be more withdrawn and to interact less with each other than the intermittent users, regardless of the type of activity or state of intoxication. However, the daily users did appear to accommodate themselves better than the intermittent users to the effects of the intoxication on social interaction.
Despite a relatively high level of scholastic attainment and superior intelligence, many of the subjects were performing well below their intellectual capability, usually working at menial, mechanical or artisan tasks. They were not oriented toward achieving the traditional goals of the larger society.
Nonetheless, during the period of the Boston study, the subjects could not be characterized as displaying a general lassitude and indifference, carelessness in personal hygiene or lack of productive activity, all supposed to be characteristic of very heavy use. Even during the periods of heaviest marihuana smoking, they maintained a high level of interest and participation in a variety of personal activities, such as writing, reading, keeping up on current world events, and participating in athletic and aesthetic endeavors.
Additionally, all of the subjects maintained a desire to complete all aspects of the research study. Although they could be labeled 'underachievers" in terms of the traditional standards of the larger society, these individuals were motivated to pursue actively the interests and activities of their own subculture.
Generally, most studies which have been undertaken indicate that individuals who are heavy marihuana users cannot find a place for themselves in conventional society. Their heavy marihuana use may reflect and perhaps perpetuate their unconventionality while providing social acceptance in one of the non-conventional subcultures.
Very Heavy Users
The Commission's analysis of frequency, quantity and duration of marihuana use suggest that the United States is at the present time in a fortunate position. All of the studies available to the Commission have indicated that only a minute number of Americans can be designated as very heavy marihuana users. These studies uniformly indicate that chronic, constant intoxication with very potent cannabis preparations is exceedingly rare in this country.
The Commission believes that important distinctions must be made between the daily (moderate and heavy) American marihuana user and the very heavy hashish or charas user in other parts of the world where cannabis is widely cultivated and its use deeply ingrained. Many of the North African and Asian users do not employ the drug only as an intoxicant in the western sense. Instead, it is frequently used in "folk medical practice," in religious rites and as a work adjunct particularly in those occupations which are physically demanding, monotonous, unintellectual, and offer little possibility of advancement.
In these countries, very heavy use is typically associated with young males from a lower socioeconomic background. Nonetheless, use is more widespread among all ages and elderly chronic users are not uncommon.
Generally, these very heavy users consume high amounts of very potent preparations continually throughout the day so that they are rarely drug-free. These individuals evidence strong psychological dependence on the drug, requiring compulsive drug-taking. Clear-cut behavioral changes occur in these extreme cases. The very heavy User tends to lose interest in all activities other than drug use. A common element of the behavioral pattern is lethargy and social deterioration. Not surprisingly, these users have been held in low esteem and very heavy use has been subject to societal disapproval in almost all countries.
BECOMING A MARIHUANA USER
Our attempt to classify marihuana users is primarily for descriptive purposes. It does not imply that all individuals who resemble any of the categories are necessarily marihuana users. Nor is it implied that all marihuana users fit neatly or precisely into these slots. There is no "typical" marihuana user, just as their is no typical American. The most notable statement that can be made about the vast majority of marihuana users-experimenters and intermittent users-is that they are essentially indistinguishable from their non-marihuana using peers by any fundamental criterion other than their marihuana use.
But if most users and non-users of marihuana essentially are indistinguishable, why have some people chosen to use the drug and others not, and why have some people continued to use it and others not? An important part of the explanation is that use of marihuana, like all human behavior, occurs within specific social and cultural settings. The individual's biological characteristics and personality probably play an important role in determining the pattern his use will take. However, the cultural and social setting play a larger role in determining whether be will use it at all.
Numerous studies have demonstrated that the young person who chooses to use marihuana differs in some important sociological respects from his peer who does not choose to do so. These differences relate to his willingness to experiment with a drug, especially a forbidden one. in short, the process of becoming a marihuana user is not a " seduction of the, innocent" as is often portrayed. Based on interrelated familial, social and cultural factors, persons, especially young persons, who may choose to use marihuana can be predicted statistically.
Parental Influence
The decision to use marihuana is related to parental life style.
Parents provide the most important example of acceptable drug-taking behavior for their children. That marihuana users frequently have medicine-taking, cigarette-smoking, or liquor-drinking parents has been demonstrated. In a series of Canadian studies, grade and high school students who said their mothers took tranquilizers daily were three times more likely to try marihuana than the students who did not so report.
Beyond the influence of a drug-taking example, parents have the primary influence on their childrens' acquisition of skills, values and attitudes necessary to be mature and responsible adults. Many parents have oriented their children toward becoming independent, competent, educated, and adaptive adults.
Simultaneously, many young people observe in their parents' lives the trend toward shorter work periods, earlier retirement and increased emphasis on leisure time activities. It appears that the incidence of adolescent marihuana use is strongly correlated with this trend toward increased leisure time.
Situational Factors and Behavioral Correlates
All studies of the ever user, including the Commission-sponsored National Survey, have established that marihuana smoking is significantly correlated with a number of demographic variables. Males, college students, and residents of metropolitan areas, especially in the Northeast and West, are generally overrepresented in proportion to their percentage of the total population.
Among the behaviors statistically correlated with marihuana, use are radical politics, visits to psychiatrists, sexual freedom, and separate residences from parents. The most significant behavior seems to be use of legal drugs, especially alcohol and tobacco. Young people who choose to experiment with marihuana are fundamentally the same people, socially and psychologically, as those who use alcohol and tobacco. For example, in a study of high school youngsters, only 3% of all the nonsmokers in the sample had ever tried marihuana, compared with 50% of all the current cigarette smokers. Similarly, for alcohol drinking outside the family setting, only 2% of all the nondrinkers had tried marihuana, as compared to 27% of the drinkers. The National Survey tends to confirm the close association between marihuana use and cigarette smoking and alcohol use. Among all the adults sampled in the Survey, 71% had smoked cigarettes and 39% are current smokers. Similarly, of adult non-marihuana users, 70% have smoked cigarettes and 38% are current smokers. These percentages increase somewhat for marihuana users: 87 have smoked cigarettes and 54% are current cigarette smokers.
In regard to alcohol consumption, 40% of all the adults sampled indicated that they had not consumed beer or bard liquor in the 30 days prior to the survey. Marihuana users tended to have consumed alcohol more often than non-marihuana users (Table, 2).
Table 2.-LIQUOR CONSUMPTION DURING 30-DAY PERIOD 
1-4 5-10 11 or No
0 days days days more answer
days
Percent of nonmarihuana users. . 45 19 6 7 21
Percent of marihuana users...... 26 30 12 8 24
Social Group Factors
One of the most influential factors in determining behavior in contemporary America among adolescents and young adults is peer group influence. Knowing other people who use marihuana predisposes the individual to use marihuana, and having marihuana-using friends provides the social opportunity for the curious. Ile individual who is already part of a, social group which uses marihuana indicates by this choice that his attitudes and values are already to some degree compatible with illicit drug use.
Social peer groups are especially influential upon individuals who have not yet become "successful" adults, such as adolescents, college students and young adults, who spend a great deal of time and effort competing for status in situations where status opportunities are minimal. The social peer group provides an opportunity for achieving status among equals by demonstrating competence and autonomy. Outstanding performance in athletics, organizations or academics demonstrates competence but not autonomy because these activities are adult-oriented and controlled. Additionally, only a relative few are able to excel.
Opportunity to prove oneself is more readily available in the peer group. Often, adolescents participate in forms of delinquent behavior, termed symbolic infractions, in order to demonstrate autonomy and competence to their peers. These include joy-riding, vandalism, sexual promiscuity, underage drinking, violation of rules of decorum and dress, and purposeless confrontation with authority.
Marihuana use has recently been added to the list of infractions and offers several advantages for adolescents and young adults. Most important, it provides a shared group experience which offers the, shy, lonely, socially awkward neophyte a means of entrance to the group, complete with its own ceremonial initiation. Repetition of the behavior serves to increase closeness and commitment to the group. Usually the experience is pleasurable and the individual is able to control his level of intoxication. This delinquency is viewed as relatively harmless to oneself and others, although its symbolic impact on parents and authority is often greater than that of other common infractions.
Therefore, a, subtle process of acquiring attitudes favorable to drug use, of having friends and acquaintances who define the marihuana experience in acceptable and pleasurable terms, and of having a social belief system which prepares one to accept the conversion process to begin with, are all powerful complementary factors which direct a young person toward marihuana use. At this point, the use of marihuana provides further opportunities for acquiring new marihuana using friends and entering the social milieu of marihuana, users.
The Dynamics of Persistent Use
The cultural and social factors sketched above, in combination with the individual's somatic and psychic characteristics, determine the pattern of his drug behavior once he has chosen to experiment with it. The majority of individuals who reach this point progress no further and often discontinue marihuana use. The most common explanation for discontinuing use is loss of interest; the effect lost its novelty and became boring. Other less common reasons are fear of legal hazards, social pressure, and concerns over physical and mental drug effects. Among the infrequently noted reasons are: interference with other activities; replacement by alcohol; unavailability; cost; unpleasant experiences; fear of moral transgression; or progression to other forms of non-drug interests such as yoga, transcendental meditation, agrarian communes, esoteric religion and restrictive diets.
For those who continue use, psychosocial factors are important determinants of the use patterns. Many marihuana users are strongly committed to traditional society in which they desire to rise socially. They have chosen to participate fully in the traditional adult-oriented activities and the formal achievement-reward system. Their peer groups consist primarily of similarly oriented individuals. The infrequent use of marihuana by these persons is a social activity for fun and satisfies curiosity.
Those individuals who continue to use marihuana more frequently appear to be different types of people and oriented toward a different part of the social system. Most of them maintain stable career orientations and continue to function within the broader society. But they feel more burdened by the traditional system of social controls and more removed from contemporary society's institutions. These individuals tend to turn away from more traditional adult-oriented reward systems and intensify their peer-group orientation. Their interests and activities emphasize an informal "in-crowd," out-of-school or work orientation. The meaning of marihuana use by this peer group emphasizes the ideological character of usage. In contrast to the infrequent type of user, these individuals seem to build their self-identity around the marihuana-using peer group.
BECOMING A MULTIDRUG USER
The more one smokes marihuana, the more involved his interpersonal relationships are likely to become with his peers who share the experience with him. As he spends more time with this group, he begins to sever his contacts with conventional individuals and conventional routines. He may eventually view himself as a drug user and be willing to experiment with other drugs which are approved by his peer group. Only ;a small portion of the marihuana users who reach this stage are likely to become persistent, frequent users of these other drugs. The majority appear to experiment only.
Epidemiologic Studies
The Commission's studies have confirmed the association between marihuana usage and the consumption of other drugs for curiosity and pleasure. This association holds for all drugs, including over-thecounter and prescription pain relievers, tension relievers, sleeping pills, and stimulants as well as hashish, methamphetamines, cocaine, LSD and mescaline, and heroin. The National Survey showed that current marihuana users are about twice as likely to have used any illicit drugs than are those who have ceased using marihuana (Table 3).
Table 3.-ILLICIT DRUG USE BY ADULTS
Have used Currently
but no using
Substance Never used marihuana longer use marihuana
marihuana (percent)
(percent)
Hashish Less than 0.5 percent 28 63
LSD or mescaline Less than 0.5 percent 11 28
Methamphetamine Less than 0.5 percent 10 23
Cocaine Less than 0.5 percent 4 10
Heroin Less than 0.5 percent 1 4
The Commission additionally has contracted a study of 105 selected, middle class, young, working adults from California, who are marihuana smokers. Of this sample, 11% were daily marihuana users and 47% used it several times a week; 33% used it several times a month; 6% used it once to several times a year; and 3% had used it but were not currently using marihuana. The study indicates that while most of the subjects were frequent marihuana users, the incidence of other drug use was relatively low (Table 4).
Table 4.-FREQUENCY OF OTHER DRUG USE BY MARIHUANA USERS
Percent who use marihuana
Percent
Substance who Once to Several Several
never several times times Daily
used times a month a week
marihuana a year 
Hashish42312150
LSD964000
Mescaline7919002
Psilocybin964000
STP, DMT1000000
Heroin982000
Codeine8711002
Amphetamines897040
Barbiturates8610400
Cocaine7519240
Glue1000000
With the exception of marihuana and hashish, no drug was used by more than 25% of this population and this use was almost exclusively experimental. Interestingly, the more exotic drugs, mescaline and cocaine were more frequently used (21% and 25% of this sample respectively) than the common dangerous drugs: LSD (4%), heroin (2%), codeine (11%), barbiturates (14%), and amphetamines (11%).
Among high school students, marihuana, is normally the, first illicit drug used, although several recent studies have suggested that a significant number of students initiate illicit use, with other drugs. Of the marihuana users, a majority have used no other illicit drug, and they tend to be experimental or intermittent users of marihuana.
The more frequently the adolescent uses marihuana, the more likely he is to experiment with other drugs. For example, in one recent study of San Diego high school students of predominantly white middle socioeconomic background, 80% of the students who used marihuana weekly or more often had used other drugs, and 50% of this group had used LSD. In contrast, 33% of the less than weekly users bad used other drugs.
Profiles and Dynamics
The personality profile of the heavy marihuana user discussed earlier includes elements propelling him toward heavy involvement in the multiple-drug-using-subculture. Heavy drug use by these individuals may reflect and aggravate a total alienation and disaffiliation from American society and its institutions. This group hopes to find in drug use more than simple, fun or relief from boredom. The heavy use of drugs represents a shift into the drug subculture and an adoption of a totally new life style. Some observers feel that this shift provides a new identity which allows the individual to counteract his apathy and search for meaning in a society he views as unloving, lonely, and meaningless. He seeks to become involved with what he describes as the exciting, relevant, "real" experience of life. Additionally, he believes drug use provides new feelings and awareness needed to overcome barriers between himself, others, and the natural world.
The drug culture as a community also helps to meet the needs of the individual. It provides a ready supply of drugs, unites common experiences and secrets that enhance the drug experience, and protects the individual against undesired experiences and against "the outside world." Most important, the culture instills self-confidence by reassuring the individual that he has been wise in choosing this new identity.
Frequently, these are individuals who express feelings of loneliness, isolation and over-protection from their home and family. One frequent pattern involves an intimate, dominating mother and a distant, unemotional father. In some cases, the drug-use ritual and the, sense of community closeness offered by the drug subculture appear to satisfy certain personal needs. Additionally, joining the subculture provides a release from sheltered life, a test of competence, an opportunity to participate, and a chance to express anger. When the anger is turned inward instead of directed at society and family, drug use becomes a form of passive, self-destructiveness.
Sociocultural Factors
After the individual views himself as a drug user and has become immersed in the drug-using subculture, the drugs he chooses to experiment with and his pattern of use are determined primarily by non-drug factors well beyond the simple properties of the psychoactive chemical. These factors are predominantly socioeconomic and sociocultural, although psychic and somatic factors also play a role in determining who will continue and how intensively.
The availability of a distribution system which stocks the other drugs is essential. Most often, contact with this distribution system is increased by having friends or acquaintances who use or sell other drugs. However, much of the marihuana selling takes place, at the customer level between friends, and involves little profit and relatively small quantities of the drug. The marihuana user who only buys has little contact with the professional multidrug dealing system. However, the user-buyer-seller of marihuana is more involved with the multidrug system, uses more himself and has more friends who use and sell other drugs. This factor of being a seller rather than only a buyer-user is influential in determining the degree of an individual's involvement with and commitment to the use of other drugs.
Marihuana use does not itself determine which drugs the heavily involved user will choose to use. Generally, the selection of other drugs is influenced by the social group. For example, blacks and whites have roughly equal rates of trying and using marihuana, but their choice of other drugs and the styles of drug use are quite different and distinctive, due to their frequently different sociocultural backgrounds. Additionally, one recent study of white high school and college students revealed different patterns of further drug use among males and females. Men and women used marihuana in equal numbers, but the men who used other drugs tended to use hallucinogens while the women tended to use amphetamines.
An extensive survey of drug use among 3,500 liberal arts undergraduates attending 14 campuses in the New York area demonstrated the racial character of drug use among this population (Table 5).
Table 5.-RACIAL CHARACTER OF DRUG USE
Meth- Amphet- Hallu-
Percentage tried drugs Heroin Cocaine amphet- amine cinogens
mine
Blacks................ 9 16 5 9 13
Whites................ 4 7 11 19 21
According to recent studies, heroin usage is not common among white marihuana users. Heroin is most strongly linked to marihuana use in black and Spanish-speaking ghettos where many feel they have little chance of personal advancement and self-fulfillment. In such communities, a segment of the population constructs new illegitimate but accessible avenues for social coping. For some this involves the hustle (non-violent stealing) and the excitement of obtaining and using heroin and cocaine. They regard marihuana as a "cool" drug and use it for its social and calming effects.
In contrast, studies have demonstrated that the psychedelics are more often used by the white, middle to upper middle class, college educated populations. The typical use of these drugs in high school college and working populations is episodic and experimental, and is usually discontinued rather rapidly in contrast with marihuana use, which for many persons is of long duration. In many instances, psychedelic drug use begins almost simultaneously with marihuana.
For a few, drug use becomes an ideologic focus, reflecting disillusionment with society and rejection of the "establishment." These and other motives, including mere pleasure-seeking, lead to continued use of LSD and other hallucinogens. Marihuana is viewed as a dilute LSD and is often used to enhance or prolong the effects of that drug. Sometimes it is encountered after first LSD use.
Methamphetamine, or "speed," use is more characteristic of those lower socioeconomic white, youth who are not school or work oriented. Living for the moment is the characteristic attitude of the speed scene. The speed user views marihuana as he does alcohol and uses it for fun or for its calming effects.
For these three groups of illicit drug users, marihuana use has different meanings and is secondary in importance to the use of the other drugs. Whether or not marihuana leads to other drug use depends on the individual, on the social and cultural setting in which the drug use takes places, and on the nature of the drug market. Its use, however, is neither inevitable nor necessary.
The Effects of Marihuana on the User
The previous section has attempted to paint a broad picture of the marihuana user. This section will deal with the, drug and its effects on these individuals.
The meaning of drug often varies with the context in which it is used. The physician would define a drug as any substance used as a medicine in the treatment of physical or mental disease. Today, due to the influence of many factors, the layman may focus on the negative connotations of drugs, such as the stupefying, poisoning, habit-forming misuse of the opiate drugs. The considerably wider and more scientific definition of a drug which will be used in this section is: any chemical substance which has an action on living tissues.
A psychoactive drug is any substance capable of modifying mental performance and individual behavior by inducing functional or pathological changes in the central nervous system. 
As defined, psychoactive drugs exert their major effect on the state of the mind including emotions, feelings, sensibility, consciousness and thinking. The definition implies neither positive nor negative meanings. Chemical substances are not inherently good or bad. All substances, including medicines and foods, which man has chosen to consume have certain desired effects (whether therapeutically beneficial or pleasurable) and undesired effects (whether detrimental or unpleasant). For example, eating food is certainly a necessary and pleasurable activity. However, obesity plays an important role in many diseases, including diabetes, high blood pressure and heart attacks, and tends to limit physical activities.
The classification of any drug effect as either beneficial or harmful often greatly depends on the values the classifier places on the expected effects. This is especially relevant with respect to the psychoactive drugs such as tranquilizers, stimulants, coffee, cigarettes, alcohol, marihuana and other licit or illicit drugs. For all of these drugs, the weights of benefit and harm are difficult to determine when viewed merely in terms of their stated effects.
BOTANY AND CHEMISTRY 
Marihuana refers to a preparation derived from a plant, cannabis sativa L. The preparation contains varying quantities of the flowers and their resinous secretions, leaves, small stems and seeds. These plant parts contain many chemical substances. The chemical substance which produces the major drug effects is tetrahydrocannabinol (THC). According to current information, the amount of THC present determines the potency of the preparation. Hereinafter, any reference to drug content or drug effect of marihuana will, for all practical purposes, mean that of tetrahydrocannabinol.
The drug content of the plant parts is variable, generally decreasing in the following sequence: resin, flowers, leaves. Practically no drug is found in the stems, roots or seeds. The potency and resulting drug effect of marihuana fluctuates, depending on the relative proportions of these plant parts in the marihuana mixture.
Most marihuana available in this country comes from Mexico and has a THC content of less than 1%. Marihuana of American origin often contains less than two-tenths of 1% THC. Marihuana originating in Jamaica and Southeast Asia often has a 2% to 4% THC content.
Marihuana is the least potent preparation of the plant. Jamaican ganja, containing primarily the flower tops and the small leaves or bracts, has a THC content of about 4% to 8% depending on the mixture. Indian ganja is less potent. The most potent preparation is hashish (charas) which is composed of only the drug-rich resinous secretions of the flowers. Generally, the THC content of hashish is 5 % to 12 %.

FACTORS INFLUENCING DRUG EFFECT
A number of variable factors exert an important influence on the psychopharmacologic effects of marihuana in man, as is true for all drugs. Failure to take these factors into consideration probably accounts for a large part of the inconsistency and controversy surrounding the description of the drug effect.
Dosage
The dosage or quantity of the drug (tetrahydrocannabinol) consumed is the most important variable. As with most drugs, the larger the dose taken, the greater the physical and mental effect will be and the longer the effect will last. The effect of a high dose of marihuana on an individual would be quite different from the effect of a low, usual "social" dose.
Method of Use
The method of use has a bearing upon the drug effect. The method is directly related to both dosage and time lapse before the drug effect is felt. Injection directly into a vein delivers the total dose immediately, producing a rapid, maximal response of minimal duration. Smoking and inhalation cause rapid but less efficient delivery of the dose; variable quantity of the drug is destroyed during burning or escapes into the air and does not reach the lungs. Oral ingestion produces different effects, according to the system in which the drug is dispersed. Generally, oral ingestion diminishes the drug effect, but prolongs it.
Metabolism
Another factor which influences the effect of the drug is metabolism. During the metabolic process, the body cells, principally in the liver and lungs, chemically alter drug substances, changing their activity and providing for their elimination from the body. Increasing evidence indicates that marihuana is first changed by the body in a way that activates or enhances the drug effect and is subsequently altered in a way that inactivates the drug prior to its removal from the body.
The rate and direction of these metabolic steps can significantly influence the effect of marihuana. For instance, individuals with extensive exposure to marihuana or other drugs metabolize more rapidly, and perhaps differently, from those individuals with no drug exposure.
Set and Setting
An important variable in discussing the effect of marihuana on the user is the social and emotional environment; that is, the individual's "set" and "setting."
"Set" refers to a combination of factors that create the "internal environment" of the individual, including personality, life style, and philosophy, past drug experiences, personal expectations of drug effect, and mood at the time of the drug experience.
"Setting" refers to the external environment and social context in which the individual takes the drug. These factors are most influential when drugs are taken at low dosages and, like marihuana, produce minimal physical and subtle subjective mental effects. The effect of marihuana generally will be quite different for an intermittent social adult smoker from that of a youth deeply involved in the youthful drug subculture. These factors partially account for the belief of a marihuana user that he is experiencing a "high" in certain experiments even when he is given a non-marihuana substance (placebo) but is told it is marihuana.
Tolerance
Another important factor that determines the immediate effect of any drug is tolerance. Tolerance has two different connotations. The first, initial tolerance, is a measure of the amount of a drug which a subject must receive on first exposure to produce a designated degree of effect. A variety of innate and environmental factors contributes to initial tolerance among individuals. Different individuals require varying amounts of the drug to attain the same physical and mental effect.
The second connotation, which shall be referred to when we use the word tolerance, is that of an acquired change in tolerance. That is, within the same individual, as a result of repeated exposure to the drug, the same dose of the drug may produce a diminishing effect so that an increased amount of the drug is required to produce the same specified degree of effect.
Tolerance develops at differential rates to given effects of the same drug. If tolerance has developed to one specific effect, it has not necessarily developed to other specific effects.
By definition, the development of tolerance is neither beneficial nor detrimental. If tolerance develops rapidly to the desired mental effect of a "high" but slowly to the behavioral or physical effects, rapid increase in dose would be necessary in order to have the desired effect, and progressive behavioral and physical disruption would be seen. This is the pattern for amphetamines.
However, if tolerance develops slowly or not at all to the desired mental effects but more rapidly to the behaviorally or physically disruptive effects, no dosage increase or only a slight one would be necessary and the unpleasant and undesired effects would progressively diminish.
With regard to marihuana, present indications are that tolerance does develop to the behaviorally and physically disruptive effects, in both animals and man, especially at high frequent doses for prolonged time periods. Studies in foreign countries indicate that very heavy prolonged use of very large quantities of hashish leads to the development of tolerance to the mental effects, requiring an increase in intake to reach the original level of satisfaction. However, for the intermittent use pattern and even the moderate use pattern, little evidence exists to indicate the development of tolerance to the desired "high," although the high may persist for a shorter time period. During the Boston free-access study, no change was apparent in the level of the high produced by a relatively large dose of the drug over a 21-day period of moderate to heavy smoking.
The fact that some individuals smoke more of the drug than others may merely reflect a desire for a different level of "high." There is a tendency to develop a tolerance to the physical effects and behaviorally disruptive effects, especially the depressant effects, in heavy daily users. The development of such behavioral tolerance of this nature may explain the fact that experienced marihuana smokers describe a lower occurrence rate of undesirable drug effects. The development of tolerance may also explain why these smokers exhibit normal behavior and competent performance of ordinary tasks, while not appearing intoxicated to others even though they are at their usual level of intoxication.
Reverse Tolerance
Repeated exposure to marihuana has been said to cause an individual to need lesser amounts of the drug to achieve the same degree of intoxication. This "reverse tolerance" may be related to one's learning to get high or to the recognition of the subtle intoxication at low doses. Or perhaps, such tolerance reflects an increase in the body's ability to change the drug to an active chemical. To date, the existence of "reverse tolerance" has not been substantiated in an experimental setting.
Duration of Use
Tolerance development is only one of a variety of occurrences which possibly are related to repetitive use of marihuana. Any discussion of drug effect must also take into account the time period over which the drug use occurs. Immediate effects of a single drug experience must be contrasted with effects of short-term use and the effects of longterm use in order to detect any cumulative effects or more subtle, gradually occurring changes.
This issue of an individual's change over a period of years is quite complex; a multitude of factors other than marihuana use may affect his life. As previously defined, short-term refers to periods of less than two years, long-term to periods of two to 10 years, and very long-term to periods greater than 10 years. Most of the American experience involves short-term and long-term use, with low doses of weak preparations of the drug.
Patterns of Use
The drug effect of marihuana can be realistically discussed only within the context of who the user is, how long he has used marihuana, how much and how frequently he uses it, and the, social setting of his use.
In general, for virtually any drug, the heavier the pattern of use, the greater the risk of either direct or indirect damage. For purposes of this discussion, the patterns of use developed in the first section of this chapter will be utilized. Because frequency of use is presently the, primary determinant of use patterns in this country, we employ similar designations:
(1) The experimenter who uses marihuana, at most a few times over a short term and then generally ceases to use it, or uses once a month or less;
(2) The intermittent user who uses marihuana, infrequently, that is more than once monthly but less than several times a week;
(3) The moderate user who uses it from several times a week to once daily, generally over a long term;
(4) The heavy user who uses it several times a day over a long term and;
(5) The very heavy user who is constantly intoxicated with high tetrahydrocannabinol content preparations, usually hashish, over a very long term.
Again, these classifications are not intended to be rigid but are designed to facilitate a discussion of the many usage patterns.


Definition of Dependence 
Before describing the effect of marihuana, on the user, two additional definitions are required. They concern the concept of dependence which has so clouded public and professional consideration of psychoactive drugs. Throughout the remainder of this report, we refer Separately to psychological and physical dependence, defined as follows:
Psychological dependence is the repeated use of psychoactive drugs leading to a conditioned pattern of drug-seeking behavior. The intensity of dependence varies with the nature of the drug, the method, frequency, and duration of administration, the mental and physical attributes of the individual, and the characteristics of the physical and social environment. Its intensity is at its peak when drug-seeking becomes a compulsive and undeviating pattern of behavior.
Physical dependence is the state of latent hyper-excitability which develops in the central nervous system of higher mammals following frequent and prolonged administration of the morphine-like analgesics, alcohol, barbiturates, and other depressants. Such dependence is not manifest subjectively or objectively during drug administration. Specific symptoms and signs, the abstinence syndrome, occur upon abrupt termination of drug administration; or with morphinelike agonists by administering the specific antagonists.


EFFECTS RELATED TO PATTERN USE
Set out below is a brief summary of effects of marihuana, related to frequency and duration of use. The remainder of the Chapter discusses the effects of immediate, short-term, long-term and very long-term use of the drug.
Experimenters and
intermittent users ------ Little or no psychological dependence.
Influence on behavior related largely to
conditioning to drug use and its social
value to the user.
No organ injury demonstrable.
Moderate users ------------ Moderate psychological dependence in-
creasing with duration of use.
Behavioral effects minimal in stable per-
sonalities, greater in those with emo-
tional instability.
Probably little if any organ injury.
Duration of use increases probability of
escalation of all effects including shift
from moderate to heavy use.
Heavy users -------------- American "pot head."
Strong psychological dependence.
Detectable behavior changes.
Possible organ injury (chronic diminution of pulmonary function).
Effects more easily demonstrable with long-term use. 
Very heavy users ---------- Users in countries where the use of cannabis has been indigenous for centuries.
Very strong psychological dependence to point of compulsive drug seeking and use.
Clear-cut behavioral changes.
Greater incidence of associated organ injury.
IMMEDIATE DRUG EFFECTS
The immediate effects are those which occur during the drug intoxication or shortly following it. The user is aware of some of these effects, for they often cause him to use the drug. At the same time, many changes may occur in his body which can be measured by others but are not obvious to him.
Subjective Effects
A description of an individual's feelings and state of consciousness as affected by low doses of marihuana is difficult; the condition is not similar to usual waking states and is the result of a highly individual experience. Perhaps the closest analogies are the experience of day dreaming or the moments just prior to falling asleep. The effect is not constant and a cyclical waxing and waning of the intensity of the intoxication occurs periodically.
At low, usual "social" doses, the intoxicated individual may experience an increased sense of well-being; initial restlessness and hilarity followed by a dreamy, carefree state of relaxation; alteration of sensory perceptions including expansion of space and time; and a more vivid sense of touch, sight, smell, taste, and sound; a feeling of hunger, especially a craving for sweets; and subtle changes in thought formation and expression. To an unknowing observer, an individual in this state of consciousness would not appear noticeably different from his normal state.
At higher, moderate doses, these same reactions are intensified but the changes in the individual would still be scarcely noticeable to an observer. The individual may experience rapidly changing emotions, changing sensory imagery, dulling of attention, more altered thought formation and expression such as fragmented thought, flight of ideas, impaired immediate memory, disturbed associations, altered sense of self-identity and, to some, a perceived feeling of enhanced insight.
At very high doses, psychotomimetic phenomena may be experienced. These, include distortions of body image, loss of personal identity, sensory and mental illusions, fantasies and hallucinations.
Nearly all persons who continue to use marihuana describe these usual effects in largely pleasurable terms. However, others might call some of these same effects unpleasant or undesirable.
As discussed earlier, a wide range of extra-drug factors also influences marihuana's effects. The more the individual uses marihuana and the longer he has been using it, the more likely the experiences will be predominantly pleasurable, and the less likely the effects will be unpleasant. An increasing sensitization to those effects viewed as pleasant occurs as the user has more experience with the drug.
Persons subject to unpleasant reactions may eliminate themselves from the using group although the occasional experience of an unpleasant effect does not always discourage use.
Body Function
A large amount of research has been performed in man and animals regarding the immediate effect of marihuana on bodily processes. No conclusive evidence exists of any physical damage, disturbances of bodily processes or proven human fatalities attributable solely to even very high doses of marihuana. Recently, animal studies demonstrated a relatively large margin of safety between the psychoactive dose and the physical and behavioral toxic and lethal dose. Such studies seemed to indicate that safe human study could be undertaken over a wide dose range.
Low to moderate doses of the drug produce minimal measurable transient changes in body functions. Generally, pulse rate increases, recumbent blood pressure increases slightly, and upright blood pressure decreases. The eyes redden, tear secretion is decreased, the pupils become slightly smaller, the fluid pressure within the eye lessens and one study reports that the eyeball rapidly oscillates (nystagmus).
A minimal decrement in maximum muscle strength, the presence of a fine hand tremor, and a decrease in hand and body steadiness have also been noted. Decreased sensitivity to pain and overestimation of elapsed time may occur.
The effects of marihuana on brain waves are still unclear and inconsistent. Generally, the intoxication produces minimal, transient changes of rapid onset and short duration. Sleep time appears to increase, as does dreaming.
Investigation of the effects of marihuana on a wide variety of other bodily function indices has revealed few consistently observed changes.
These few consistently observed transient effects on bodily function seem to suggest that marihuana is a rather unexciting compound of negligible immediate toxicity at the doses usually consumed in this country. The substance is predominantly a psychoactive drug. The feelings and state of consciousness described by the intoxicated seem to be far more interesting than the objective state noted by an observer.
Mental Function
Marihuana, like other psychoactive substances, predominantly affects mental processes and responses (cognitive tasks) and thus the motor responses directed by mental processes (psychomotor tasks). Generally, the degree of impairment of cognitive and psychomotor performance is dose-related, with minimal effect at low doses. The impairment varies during the period of intoxication, with the maximal effect at the peak intoxication. Performance of simple or familiar tasks is at most minimally impaired, while poor performance is demonstrated on complex, unfamiliar tasks. Experienced marihuana users commonly demonstrate significantly less decrement in performance than drug-naive, individuals.
The greater his past marihuana experience, the better the intoxicated individual is able to compensate for drug effect on ordinary performance at usual doses. Furthermore, marked individual variation in performance is noted when all else is held constant. The effect of marihuana on cognitive and psychomotor performance is therefore highly individualized and not easily predictable. Effects on emotional reactions and on volition are equally variable and are difficult to measure under laboratory conditions, but can be significant.
The Intoxicated State
Studies of intoxicated persons have suggested possible explanations for the subtle effects on mental processes produced by marihuana, Generally, a temporary episodic impairment of short-term memory occurs. These memory voids may be filled with thoughts and perceptions extraneous to organized -mental processes. Past and future may become obscured -as the individual focuses on filling the present momentary memory lapse. His sense of self -identity may seem altered if he cannot place himself in his usual time frame.
This altered state of mind may be regarded by the individual as pleasant or unpleasant. The important factors of dosage and set and setting play a most important role in this determination. When the nature of the drug-taking situation and the characteristics of the individual are optimal. the user is apt to describe his experience as one of relaxation, sensitivity, friendliness, carefreeness, thoughtfulness, happiness, peacefulness, and fun. For most marihuana users who continue to use the drug, the experience is overwhelmingly pleasurable.
Unpleasant Reactions
However, when these circumstances are not optimal, the experience may be unpleasant and an undesirable reaction to the marihuana intoxication occurs. In these instances, anxiety, depression, fatigue or cognitive loss are experienced as a generalized feeling of ill-being and discomfort. A heavy sluggish feeling, mentally and physically, is common in inexperienced marihuana smokers who overshoot the desired high or in persons who might orally ingest too large a dose. Dizziness, nausea, incoordination, and palpitations often accompany the "too stoned" feeling.
Anxiety States
"Novice anxiety reactions" or feelings of panic account for a majority of unpleasant reactions to marihuana. When the distortion of self image and time is recognized by the individual as drug-induced and temporary, the experience is viewed as pleasurable. Anxiety -and panic result when these changes cause the individual to fear that the loss of his identity and self-control may not end, and that he is dying or "losing his mind." These anxiety and panic reactions are transient and usually disappear over a few hours as the drug's effects wear off, or more quickly with gentle friendly reassurance.
The large majority of these, anxiety reactions occur in individuals who are experimenting with marihuana. Most often these individuals have an intense underlying anxiety surrounding marihuana use, such as fears of arrest, disruption of family and occupational relations, and possible bodily or mental harm. Often they are older and have relatively rigid personalities with less desire for new and different experiences.
The incidence of these anxiety reactions may have decreased as marihuana use has become acceptable to wider populations, as the fears of its effects have lessened and as users have developed experience in management of these reactions.
Psychosis
Rare cases of full-blown psychotic episodes have been precipitated by marihuana. Generally, the individuals had previous mental disorders or had poorly developed personalities and were marginally adjusted to their life situation. Often the episode occurred at times of excessive stress. These episodes are characteristically temporary. Psychotherapy and sometimes medications are useful in prompt control and treatment of this psychological reaction. In addition, rare nonspecific toxic psychoses have occurred after extremely high doses. This state of nonspecific drug intoxication or acute brain syndrome is self-limited and clears spontaneously as the drug is eliminated from the body.

Conclusions
In summary, the immediate effect of marihuana on normal mental processes is a subtle alteration in state of consciousness probably related to a change in short-term memory, mood, emotion and volition. This effect on the mind produces a varying influence on cognitive and psychomotor task performance which is highly individualized, as well as related to dosage, time, complexity of the task and experience of the user. The effect on personal, social and vocational functions is difficult to predict. In most instances, the marihuana intoxication is pleasurable. In rare cases, the experience may lead to unpleasant anxiety and panic, and in a predisposed few, to psychosis.
SHORT-TERM EFFECTS 
The effect of an enormous daily oral dose of the drug (up to about one hundred thousand times the minimal behaviorally effective human dose) was recently studied in rats and monkeys for three months. A severe, generalized nervous system depression was evident the first few days. Evidence of cumulative toxicity was observed at these doses. Severe central -nervous system depression produced fatalities in some rats in the first few days until tolerance developed. Later, extreme hyperactivity developed.
The monkeys experienced severe central nervous system depression and one group showed mild hyperactivity, but all rapidly returned to normal behavior after the development of tolerance to these effects. Minimal dose-related toxic effects on bodily organs were noted at autopsy at the conclusion of the experiment. These non-specific findings of unknown meaning included bypocellularity of the bone marrow and spleen and hypertrophy of the adrenal cortex.
A 28-day study employing intravenous administration of from one to ten thousand times the minimal effective human dose to monkeys produced -similar findings clinically. In the high dose groups delayed deaths from acute hemorrhagic pneumonia were possibly caused by accumulation of clumps of THC in the lung producing irritation similar to that seen at the injection sites. No other organ pathology was noted. These animal studies illustrated that the margin of safety between active dose and toxic dose was enormous.
A few studies have recently been carried out to observe the effect of a few weeks of daily marihuana smoking in man. The amount smoked was a relatively large American dose. Frequency of use was once to several times daily.
During the 21-day Boston free-access study, no harmful effects were observed on general bodily functions, motor functions, mental functions, personal or social behavior or work performance. Total sleep time and periods of sleep were increased. Weight gain was uniformly noted.
No evidence of physical dependence or signs of withdrawal were noted. In the heaviest smokers, -moderate psychological dependence was suggested by an increased negative mood after cessation of smoking.
Tolerance appeared to develop to the immediate effects of the drug on general bodily functions (pulse rate) and psychomotor-cognitive performance (time estimation, short-term memory, and shootinggallery skill) but not to the "high." Marihuana intoxication did not significantly inhibit the ability of the subjects to improve with practice through time on these psychological-motor tasks.
Neither immediate nor short-term (21 day) high-dose marihuana intoxication decreased motivation to engage in a variety of social and goal-directed behaviors. No consistent alteration that could be related to marihuana smoking over this period of time was observed in work performance of a simple task, participation in aspects of the research study, or interest and participation in a variety of personal activities, such as writing, reading, interest and knowledge of current world events, or participation in athletic or aesthetic activities.
Marihuana smoking appeared to affect patterns of social interactions. Although use of the drug was found to be a group social activity around which conversation and other types of social behavior were centered, it was not uncommon for some or all of the smokers to withdraw from the social interaction and concentrate on the subjective drug experience.
During the first part of the smoking period, both intermittent and daily users demonstrated a marked decrement in total interaction. Total interaction continued to diminish among intermittent users but increased above presmoking levels among the daily users during the later parts of the smoking period. The quality of the interaction was more convivial and less task-oriented when marihuana was available to the group.
Additionally, an assessment of the effect of marihuana on risktaking behavior revealed that daily users tended to become more conservative when engaging in decision-making under conditions of risk.
LONG-TERM EFFECTS
Our knowledge about marihuana is incomplete, but certain behavior characteristics appear to be emerging in regard to long term American marihuana use which, for the most part, is significantly less than 10 years. These impressions were confirmed in the Boston free-access study. The group of American young adults studied averaged five years (range 2-17 years) of intermittent or daily use, of marihuana.
No significant physical, biochemical, or mental abnormalities could be attributed solely to their marihuana smoking. Some abnormality of pulmonary function was demonstrated in many of the subjects which could not be correlated-with quantity, frequency or duration of smoking marihuana and/or tobacco cigarettes. (One other investigation recently completed uncovered no abnormalities in lung or heart functioning of a group of non-cigarette smoking heavy marihuana users). Many of the subjects were in fair to poor physical condition, as judged by exercise tolerance.
The performance of one-fifth of the subjects on a battery of tests sensitive to brain function was poorer on at least one, index than would have been predicted on the basis of their IQ scores and education. But a definite relationship between the poor test scores and prior marihuana or hallucinogen use could not be proven.
In the past few years, observers have noted various social, psychological and behavioral changes among young high school and college age Americans including many who have used marihuana heavily for a number of years. These changes are reflected by a loss of volitional goal direction. These individuals drop out and relinquish traditional adult roles and values. They become present rather than future oriented, appear alienated from broadly accepted social and occupational activity, and experience reduced concern for personal hygiene and nutrition.
Several psychiatrists believe they have detected clinically that some heavy marihuana-using individuals appear to undergo subtle changes in personality and modes of thinking, with a resulting change in life style. In adopting this new life style, a troubled youth may turn toward a subculture where drug use and untraditional behavior are acceptable.
This youthful population resembles in many respects the marihuana smoker described in the Boston study. No evidence exists to date to demonstrate that marihuana use alone caused these behavioral changes either directly or indirectly. Many individuals reach the same point without prior marihuana use or only intermittent or moderate use; and many more individuals use marihuana as heavily but do not evidence these changes. For some of these young people, the drop out state is only a temporary phase, preceding a personal reorganization and return to a more conventional life style.
If heavy, long-term marihuana use is linked to the formation of this complex of social, psychological and behavioral changes in young people, then it is only one of many contributing factors.
VERY LONG-TERM EFFECTS OF HEAVY AND VERY HEAVY USE 
Knowledge of the effects of very heavy, very long-term use of marihuana by man is still incomplete. The Commission has extensively reviewed the world literature as well as ongoing studies in Jamaica and Greece, and carefully observed very heavy, very long-term using populations in countries in other parts of the world, such as Afghanistan and India. These populations smoke and often drink much stronger drug preparations, hashish and ganja, than are commonly used in America. From these investigations, some observable consequences are becoming much clearer.
Tolerance and Dependence
Some tolerance does occur with prolonged heavy usage; large drug doses are necessary for the desired effects. Abrupt withdrawal does not lead to a specific or reproducible abstinence syndrome and physical dependence has not been demonstrated in man or in animals. The very heavy users studied did evidence strong psychological dependence, but were able to cease use for short periods of time. In these users,
withdrawal does induce, symptoms characteristic of psychological dependence. The anxiety, restlessness, insomnia, and other non-specific symptoms of withdrawal are very similar in kind and intensity to those experienced by compulsive cigarette smokers.
Although the distress of withdrawal exerts a very strong psychogenic drive to continue use, fear of withdrawal is, in most cases, not adequate to inspire immediate criminal acts to obtain the drug.
General Body Function
In the Jamaican study, no significant physical or mental abnormalities could be attributed to marihuana use, according to an evaluation of medical history, complete physical examination, chest x-ray, electrocardiogram, blood cell and chemistry tests, lung, liver or kidney function tests, selected hormone evaluation, brain waves, psychiatric evaluation, and psychological testing. There was no evidence to indicate that the drug as commonly used was responsible for producing birth defects in offspring of users. This aspect is also being studied further.
Heavy smoking, no matter if the substance was tobacco or ganja, was shown to contribute to pulmonary functions lower than those found among persons who smoked neither substance. All the ganja smokers studied also smoked tobacco. In Jamaica, ganja is always smoked in a mixture with tobacco; and many of the subjects were heavy cigarette smokers, as well.
In a study of a Greek hashish-using population preliminary findings revealed poor dentition, enlarged livers, and chronic bronchitis. Further study is required to clarify the relationship of these to hashish use, alcohol or tobacco use, or general life style of this user population.
Social Functioning
Similarly, the Jamaican and Greek subjects did not evidence any deterioration of mental or social functioning which could be attributed solely to heavy very long-term cannabis use.
These individuals appear to have used the drug without noticeable behavioral or mental deviation from their lower socioeconomic group norms, as detected by observation in their communities and by extensive sociological interviews, psychological tests and psychiatric examination.
Overall life style was not different from non-users in their lower socioeconomic community. They were alert and realistic, with average intelligence based on their education. Most functioned normally in their communities with stable families, homes, jobs, and friends. These individuals seem to have survived heavy long-term cannabis use without major physical or behavioral defects.
Mental Functioning
The incidence of psychiatric hospitalizations for acute psychoses and of use of drugs other than alcohol is not significantly higher than among the non-using population. The existence of a specific longlasting, cannabis-related psychosis is poorly defined. If heavy cannabis use produces a, specific psychosis, it must be quite rare or else exceedingly difficult to distinguish from other acute or chronic psychoses.
Recent studies suggest that the occurrence of any form of psychosis in heavy cannabis users is no higher than in the general population. Although such use is often quite, prevalent in hospitalized mental patients, the drug could only be considered a. causal factor in a, few cases. Most of these were, short-term reactions or toxic overdoses. In addition, a concurrent use of alcohol often played a role in the, episode causing hospitalization.
These findings are somewhat surprising in view of the widespread belief that cannabis attracts the mentally unstable, vulnerable individual. Experience in the United States has not involved a level of heavy marihuana, use comparable to these foreign countries. Consequently, such long-lasting psychic disturbances possibly caused by heavy cannabis use have not been observed in this country.
Motivation and Behavioral Change
Another controversial form of social-mental deterioration allegedly related to very long-term very heavy cannabis use is the "amotivational syndrome." It supposedly affects the very heavy using population and is described world-wide as a, loss of interest in virtually all activities other than cannabis use, with resultant lethargy, amorality, instability and social and personal deterioration. The reasons for the occurrence of this syndrome are varied and hypothetical; drug use is only one of many components in the socioeconomic and psychocultural backgrounds of the individuals.
Intensive studies of the Greek and Jamaican populations of heavy long-term cannabis users appear to dispute the sole causality of cannabis in this syndrome. The heavy ganja and hashish using individuals were from lower socioeconomic groups, and possessed average intelligence but had little education and small chance of vocational advancement. Most were married and maintained families and households. They were all employed, most often as laborers or small businessmen, at a level which corresponded with their education and opportunity.
In general, their life styles were dictated by socioeconomic factors and did not appear to deteriorate as a result of cannabis use. The Jamaicans were working strenuously and regularly at generally uninteresting jobs. In their culture, cannabis serves as a work adjunct. The users believe the drug provides energy for laborious work and helps them to endure their routine tasks.
In contrast, others have described Asian and African populations where heavy to very heavy hashish or charas smoking for a very long time is associated with clear-cut behavioral changes. In these societies, the smokers are mostly jobless, illiterate persons of the lowest socioeconomic backgrounds. They generally begin to use the drug in their early teens and continue its use up to their 60's.
The users prefer to smoke in groups of two to 20, generally in a quiet place out of the reach of non-smokers. Weakness, malnutrition and sexual difficulties, usually impotence, a-re common. Some of them report sleep disturbances.
Most users who have used the drug for 20 to 30 years are lazy and less practical in most of their daily acts and reluctant to make decisions. However, their ability to perform non-complicated tasks is as good as non-smokers.
Although the smokers think they become faster in their daily work, a general slowness in all their activities is noticed by others. This user population is typically uncreative. They make little if any significant contribution to the social, medical or economic improvement of their community.

SUMMARY
Once existing marihuana, policy was cast into the realm of public debate, partisans on both sides of the issue over-simplified the question of the effects of use of the, drug on the individual. Proponents of the prohibitory legal system contended that marihuana, was a, dangerous drug, while opponents insisted that it was a harmless drug or was less harmful than alcohol or tobacco.
Any psychoactive drug is potentially harmful to the individual, depending on the intensity, frequency and duration of use. Marihuana is no exception. Because the particular hazards of use differ for different drugs, it makes no sense, to compare the harmfulness of different drugs. One may compare, insofar as the individual is concerned, only the harmfulness of specific effects. Is heroin less harmful than alcohol because, unlike alcohol, it directly causes no physical in-jury? Or is heroin more harmful than alcohol because at normal doses its use is more incapacitating in a behavioral sense?
Assessment of the relative dangers of particular drugs is meaningful only in a wider context which weighs the possible benefits of the drugs, the comparative scope of their use, and their relative impact on society at large. We consider these questions in the next Chapter, particularly in connection with the impact on public health.
Looking only at the effects on the individual, there, is little proven danger of physical or psychological harm from the experimental or intermittent use of the natural preparations of cannabis, including the resinous mixtures commonly used in this country. The risk of harm lies instead in the heavy, long-term use of the drug, particularly of the most potent preparations.
The experimenter and the intermittent users develop little or no psychological dependence on the drug. No organ injury is demonstrable.
Some moderate users evidence a degree of psychological dependence which increases in intensity with prolonged duration of use. Behavioral effects are lesser in stable personalities but greater in those with emotional instability. Prolonged duration of use does increase the probability of some behavioral and organic consequences including the possible shift to a heavy use pattern.
The heavy user shows strong psychological dependence on marihuana and often hashish. Organ injury, especially diminuation of pulmonary function, is possible. Specific behavioral changes are detectable. All of these effects are more apparent with long-term and very long-term heavy use than with short-term heavy use.
The very heavy users, found in countries where the use of cannabis has been indigenous for centuries, have a compulsive psychological dependence on the drug, most commonly used in the form of hashish. Clear-cut behavioral changes and a greater incidence of associated biological injury occur as duration of use increases. At present, the Commission is unaware of any similar pattern in this country.


Chapter III                                                                                                                         

Social Impact of marihuana use




"Man is a creature who lives not upon bread alone but principally by catchwords." -Robert Louis Stevenson,
Virginia Puerisque (1881)

Implicit in existing social and legal policy toward marihuana is the view that society suffers in some way from use of the drug. When the widespread practice of marihuana smoking appeared in the United States in the early decades of the 20th century, the medical, law enforcement, newspaper, and legislative communities immediately indicted the drug. They assumed that the drug posed serious dangers to individual health; but more importantly, they viewed it as a menace to the public order. Crime, insanity and idleness were thought to be the inevitable consequences of its use.
That some of these original fears were unfounded and that others were exaggerated have been clear for many years. Yet, many of these early beliefs continue to affect contemporary public attitudes and concerns. Consequently, one of the Commission's most important tasks is to evaluate carefully all data relevant to the social impact of marihuana use. We must determine whether and in what respects social concern is justified. What is myth and what is reality?
The literature pertaining to -the presumed effects and consequences of marihuana use still reveals a wide diversity of opinion about social impact. Careful scrutiny is inhibited by the prevalence of hearsay, rhetoric and undocumented assertions about the effects and consequences of marihuana use. Nonetheless, evidence is mounting and a number of significant trends have recently emerged. In the previous Chapter we explored the evidence regarding the nature and scope of contemporary marihuana use, and the effects of the drug on the individual user. Now we must consider the impact on society of behavior resulting from use of marihuana.
In dealing with the behavioral consequences of marihuana, use, the Commission has made, a concerted effort to review and evaluate the enormous body of existing popular and scientific literature, and has itself initiated new empirical research, including national surveys, retrospective studies and controlled laboratory experiments.
Awareness of the difficulties involved in investigating an inherently complex social phenomenon and applying its research findings to policy decisions has fostered particular sensitivity to the quality of previous and Commission-sponsored research. As such, considerable attention was given to such basic research questions as:
What behavioral effects are most relevant in assessing the consequences of marihuana use?
What measures produce the most valid data concerning given effects?
What reliance should be placed on various research techniques, such as self-reporting, controlled experiments, clinical observations and statistical relationships?
What generalizations can be made from particular populations studied?
What are the limits of given data in terms of inference. interpredation and attribution of cause?
With respect to the Commission's own research program, the process of selection and allocation of resources was indeed difficult, and some areas of inquiry have undoubtedly been either neglected or shortchanged. Nonetheless, we believe that the studies undertaken and information gathered will add significantly to our understanding of the conditions and circumstances under which marihuana use is likely to affect adversely the public safety, public health and welfare, and dominant social order.
Marihuana and Public Safety
The belief that marihuana is causally linked to crime and other antisocial conduct first assumed prominence during the 1930's as the result of a concerted effort by governmental agencies and the press to alert the American populace to the dangers of marihuana use. Newspapers all over the country began to publish lurid accounts of "marihuana atrocities." In the absence of adequate understanding of the effects of the drug, these largely unsubstantiated stories profoundly influenced public opinion and gave birth to the stereotype of the marihuana user as physically aggressive, lacking in self-control, irresponsible, mentally ill and, perhaps most alarming, criminally inclined and dangerous. The combination of the purported effects of the drug itself plus the belief that it was used by unstable individuals seemed to constitute a significant danger to public safety.
Now, more than 30 years later, many observers are skeptical about the existence of a cause-effect relationship between marihuana use and antisocial conduct.
MARIHUANA AND CRIME 
Over the years, there have been several hypotheses about the relationship between marihuana and antisocial conduct. The earliest view was that marihuana causes or leads to the commission of aggressive and violent criminal acts such as murder, rape and assault. These acts are committed, it has been argued, because marihuana allegedly produces a relaxation of ordinary inhibitions, a weakening of impulse control and a concomitant increase in aggressive tendencies while the user is under its influence.
Marihuana's alleged criminogenic role is not always limited to violent or aggressive behavior. Some commentators also postulate that marihuana leads to or causes non-violent forms of criminal or delinquent conduct, ranging from sexual promiscuity to grand larceny. Underlying this second causal hypothesis are the assumptions that marihuana frequently impairs judgment, distorts reality and diminishes, at least temporarily, the user's sense of personal and social responsibility. Regular or heavy use over an extended period of time is felt to interfere, perhaps irreversibly, with the orderly development of psychosocial and moral maturity.
As indicated above, however, a growing uncertainty prevails about ,the existence of a causal link between marihuana use and antisocial conduct. In fact, recent surveys, including several sponsored by the Commission, suggest that large segments of the professional public, particularly the law enforcement and criminal justice communities, are no longer willing to assert a, cause-effect relationship but observe, instead, the existence of a statistical association. 
The Issue of Cause and Effect
The controversy over the cause-effect relationship between marihuana use and criminal, violent or delinquent behavior poses a number of serious problems for the investigators Proponents and opponents of the causal view tend to rely on different kinds of evidence and to call upon different types of experts, thereby differing substantially in the kinds of information they accept as relevant, reliable or valid.
Practitioners, such as police and probation officers for example, frequently cite case examples in which apprehended offenders are found to be in possession of marihuana at the time of arrest. The mere presence of the drug or the fact that an offender is a known user of marihuana is sometimes deemed sufficient to establish a causal link between the marihuana and the offense.*
Empiricists, on the other hand, would deny that the simple presence of the drug constitutes a satisfactory demonstration of a causal relationship between marihuana use and the crime in question. They would defer, instead, to the results of empirical studies designed explicitly to test the assertion. Essentially, they emphasize that even if some offenders do use marihuana, an equal or larger number of offenders do not, and there are certainly large numbers of marihuana users in the population-at-large who never engage in the kinds of antisocial conduct deemed to be related to or caused by the use of the drug.
Proving any positive and direct relationship, be it causal or otherwise, between two inherently complex social phenomena is fraught with enormous difficulties. The relationship of marihuana use to crime, violence, aggression or juvenile delinquency presents no exception. Before examining the evidence with respect to the existence of a causal connection, certain basic considerations deserve at least brief mention here.
To prove, the existence of a positive and direct relationship, one would be required to demonstrate that the alleged offender was, indeed, a marihuana, user; that he was under the influence of the drug at the time he committed the offense; and that the crime was directly attributable to the effects of the marihuana. The kinds of evidence necessary to establish these facts are not easy to obtain.
First, evidence of the use of marihuana by the accused is generally dependent upon either direct admission of use, hearsay evidence, or inferences derived from knowledge of possession (that is, the offender was found to have marihuana on his person or in his possession at the time of arrest).
Second, because no chemical tests presently exist outside the laboratory to identify the presence of marihuana in the body of the accused, it is difficult if not impossible to prove that the offender was definitely under the influence of marihuana when he committed the offense.
Third, in order to prove that the marihuana represented the significant contributory or precipitating variable, all other factors possibly related to the offense would have to be examined and excluded.
The problems of validation are further compounded by additional variations in behavior attributable to: (a) the pharmacological potency of the drug; (b) possible adulteration of the marihuana; (c) the interaction of marihuana with other drugs simultaneously ingested; (d) differing individual response to similar dosage levels; (e) the time-action function; (f) the cumulative effect of marihuana use; and (g) various social, psychological and situational variables such as set and setting, individual expectations, personal predispositions or preexisting impulse disorders.
Despite the inherent complexities of the issue and the difficulties in securing reliable and valid evidence, a relatively large body of research is now available pertaining to the criminogenic effects of marihuana upon the individual and the nature and extent to which the drug constitutes a danger to public safety. In the following section, we present the available evidence and assess the strength and direction of the alleged relationships between marihuana use and violent or aggressive behavior and also non-violent forms of criminal and delinquent behavior.
*In the widely publicized Licata case of the 1930's. for example, a 16-year-old cannabis user was charged with the ax murder of his family and the offense was directly attributed to the effects of marihuana. There was, however. no precise information available regarding the use of marihuana in relation to the crime. Nor. in the various accounts of the case, was there generally any reference to the fact that several of the boy's relatives had previously been committed to mental institutions; that the police hall, about one year prior to the offense (and presumably before the youth's alleged use of marihuana) attempted to commit him for his bizarre behavior; or that shortly after the crime, the boy began to exhibit the symptoms of paranoid schizophrenia.
Marihuana and Violent Crime 
As indicated earlier, the belief that marihuana causes or leads to the commission of violent or aggressive acts first emerged during the 1930's and became deeply embedded in the public mind. Until recently, however, these beliefs were generally based on the anecdotal case examples of law enforcement authorities, a few clinical observations and several quasi-experimental studies of selected populations comprised of military offenders, convicted or institutionalized criminals or delinquents and small groups of college students. Few efforts were made to compare the incidence of violent or aggressive behavior in representative samples of both user and non-user populations.
Even in these early observations and investigations, however, no substantial evidence existed of a causal connection between the use of marihuana and the commission of violent or aggressive acts. Indeed, if any relationship was indicated, it was not a positive and direct causal connection but in inverse or negative statistical correlation.
Rather than inducing violent -or aggressive behavior through its purported effects of lowering inhibitions, weakening impulse control and heightening aggressive tendencies, marihuana was usually found to inhibit the expression of aggressive impulses by pacifying the user, interfering with muscular coordination, reducing psychomotor activities and generally producing states of drowsiness lethargy, timidity and passivity.
In fact, only a small proportion of the marihuana users among any group of criminals or delinquents known to the authorities and appearing in study samples had ever been arrested or convicted for such violent crimes as murder, forcible rape, aggravated assaultor armed robbery. When these marihuana-using offenders were compared with offenders who did not use marihuana, the former were generally found to 'have committed less aggressive behavior than the latter.
In an effort to accumulate data on the relationship between marihuana use and aggressive or violent criminal behavior, the Commission sponsored several studies designed to assess the purported causal relationship.
First, the Commission wanted to tap the unique experience of the law enforcement and criminal justice communities. Representative samples of prosecuting attorneys, judges, probation officers and court clinicians were asked their opinions about the relationship between marihuana use and the commission of aggressive or violent criminal acts. When asked to evaluate the statement that "most aggressive acts or crimes of violence committed by persons who are known users of marihuana occur when the offender is under the influence of marihuana," three-quarters of the judges, probation officers and clinicians indicated either that the statement was probably untrue or that they were unsure of its accuracy. Of these three groups, a greater proportion of clinicians (76.5%) thought the statement false than did the probation officers (60%)and judges (44.2%).
In a separate mail survey of the chief prosecuting attorneys in the 50 states-the group which has often supported the causal hypothesis-52% of the respondents stated that they either did not believe or were uncertain of the truth of the proposition that use of marihuana leads to aggressive behavior.
We have already noted that only a small fraction of the offender populations in past studies were found to have been arrested for crimes of violence. Similarly, in a Commission-sponsored study of 1,776 16to-21-year-olds arrested in five New York counties for marihuana law violations between 1965 and 1969, onlv a small percentage bad either previously or subsequently come to the attention of authorities for such offenses as assault or robbery. In fact, less than 1% of the offenders in this sample had been arrested for these offenses prior to their first marihuana arrest, and less than 3% were known to the Federal Bureau of Investigation for these offenses subsequent to their marihuana violation.
Perhaps more important than professional opinion or the incidence of violent offenses in an offender population, however, is the determination of the extent to which marihuana use is related to violent or aggressive behavior in the general population.
In a Commission-sponsored survey, face-to-face interviews were conducted with a representative sample of 559 West Philadelphia residents in order to ascertain the extent of marihuana use in this heterogeneous population and the relative involvement of marihuana users and nonusers in violent criminal behavior. In corroboration of the earlier findings, the researchers found no significant differences in the proportions of users and non-users; who stated that they had committed any of the aggressive or violent crimes enumerated.
Further, no findings indicated that marihuana was generally or frequently used immediately prior to the commission of offenses in the very small number of instances in which these offense's did occur. In contrast, however, the aggressive and violent offenders in this sample did report with significantly greater frequency the use of alcohol within 24 hours of the offense in question.
These findings should be considered in fight of an earlier West Coast study of disadvantaged minority-group youthful marihuana users, many of whom were raised in a combative and aggressive social milieu similar to that found in several of the West Philadelphia sampled neighborhoods. The data show that marihuana users were much less likely to commit aggressive or violent acts than were those who preferred amphetamines or alcohol. They also show that most marihuana users were able to condition themselves to avoid aggressive behavior even in the face of provocation. In fact, marihuana was found to play a significant role in youth's transition from a "rowdy" to a "cool," non-violent style.
The Commission is aware of the claim that a few emotionally unstable or impulsive individuals have become particularly aggressive or impulsive under the influence of marihuana. As we have noted, some newspaper accounts have attributed sensational homicides or sexual assaults to marihuana-induced transitory psychotic states on the part of the user. No evidence exists, however, to indicate that marihuana was responsible for generating or creating excessive aggressiveness or impulsivity in individuals having no prior history of impulse or personality disorder. The most that can be said is that in those rare instances, marihuana may have aggravated a preexisting condition.
In sum, the weight of the evidence is that marihuana does not cause violent or aggressive behavior, if anything, marihuana generally serves to inhibit the expression of such behavior. Marihuana-induced relaxation of inhibitions is not ordinarily accompanied by an exaggeration of aggressive tendencies.
No evidence exists that marihuana use will cause or lead to the commission of violent or aggressive behavior by the large majority of psychologically and socially mature individuals in the general population.
Marihuana and Non-Violent Crime
A second hypothesis reflecting the statements of significant numbers of government officials is that marihuana plays a major role in the commission of other, essentially non-violent, forms of criminal and delinquent behavior.
In general, those espousing this more general cause-effect relationship assume that the drug frequently produces, in addition to the lowering of inhibitions, impairment of judgment, distortion of reality and at least temporary reduction of a sense of personal and social responsibility. Indeed, the earlier stereotype of the marihuana user was that of an immoral, physically debilitated, psychologically unstable and criminally marginal man whose state of severely and irreversibly underdeveloped psychosocial and moral maturity was said to derive directly from his continued use of marihuana.
As indicated earlier, neither the inherent complexities of the issue nor the previously inconclusive empirical evidence has deterred the formulation and expression of strong opinions about the relationship of marihuana use to crime and delinquency. Opinion in this area, quite apart from the empirical evidence, has long assumed critical importance in the development of social policy.
The Commission has addressed the issue in three different ways. One was to assess the state of current public and professional opinion relative to the general proposition that marihuana causes or leads to the commission of criminal or delinquent acts. A second approach was to review the professional literature addressed to the issue, and a third was to initiate empirical investigations of our own.
The opinion surveys found that substantial numbers of persons raised serious questions about the existence of a causal relationship between marihuana use and criminal or delinquent behavior. Confusion and uncertainty about the existence of such a relationship have been expressed by both youth and adults, including practicing professionals in the criminal justice system.
Recent data suggest that some of this confusion may be the result of a fairly widespread misconception about the addiction potential of marihuana. To the extent that persons believe marihuana users are physically dependent on the -drug, they may assume that, like the heroin user, the marihuana user commits his offenses in order to support what is perceived as a drug habit; and that, like the heroin model, offenses are committed more often in the desperate attempt to obtain the drug rather than under its influence following use. There is no evidence that this is the case, even for those who use the drug heavily.
In the Commission-sponsored National Survey, the respondents were asked whether they agreed or disagreed with the statement that "many crimes are committed by persons who are under the influence of marihuana." Fifty-six percent of the adult population and 41% of the youth indicated agreement. As in the Survey generally, there was a significant difference of opinion according to age in the adult population. While 69% of the over-50 age group agreed with this statement, only about one-third of the 18-to-25 age group and the 14-to-17-yearolds agreed. One of every four youth respondents and 18% of the adults said they were "not sure" of the existence of such a relationship between marihuana use and crime.
Much greater consensus exists, even between generations, regarding the association of alcohol and crime. While 56% of all adults expressed their belief that many crimes are committed by persons under the influence of marihuana, 69% of these same adults believed that alcohol was related in the same way. Only 7% felt unsure about the alcohol crime relationship, in contrast to 18% who expressed uncertainty about the relationship between crime and marihuana.
The Commission also surveyed opinion within the criminal justice community. A sample of 781 judges, probation officers and court clinicians replied to a questionnaire which asked respondents to indicate whether or not their professional experience led them to believe that "use of marihuana causes or leads to antisocial behavior in the sense that it leads one to commit other criminal or delinquent acts." Of all respondents, 27% believed this to be the case. Within each professional group, 34% of the judges, 18% of the probation officers and 2% of the clinicians indicated their agreement.
On the assumption that some, proportion, however small, of marihuana users might ultimately be arrested for non-drug offenses, these officials were also asked to assess the relative, truth of the statement that "most non-drug offenses committed by persons who are known users of marihuana or are found to have marihuana on their person or in their possession occur when the offender is under the influence of marihuana." Seventy-one percent of the responding judges, 75% of the probation officers and 85% of the court clinicians either thought the statement false or were unsure of its accuracy.
Respondents likewise rejected, however, the proposition that these crimes perpetrated by marihuana users occur when the offender is attempting to obtain the drug rather than while under its influence; 65.6% of the judges, 64.6% of the probation officers and 78.3% of the court clinicians either denied or were unsure of the truth of this proposition.
In short, marihuana, is not generally viewed by participants in the criminal justice community as a major contributing influence in the commission of delinquent or criminal acts.
This increasing professional skepticism is buttressed by the weight of research findings. A comprehensive review of the literature revealed that in the various offender populations studied for this purpose, only a small percentage were marihuana users. In only a handful of cases did researchers report that criminal conduct followed the use of marihuana. Generally, the rate of self -reported, non-drug crime did not significantly differ between users and non-users.
Both of the Commission-sponsored studies (the New York and Philadelphia studies referred to earlier) corroborated this research consensus. In the Philadelphia study, for example, less than 10% of the sample were known to the police, and there were no significant differences among marihuana users and non-users in the sample who reported the commission of major criminal acts when statistical controls were applied. Further, most of the first offenses committed by users occurred prior to their use of marihuana, and only in rare instances did the offenses immediately follow (within 24 hours) upon the use of marihuana (five cases out of 741 first offenses and 19 cases out of 516 most recent offenses).
Likewise, the New York study revealed that about one-fifth of -the marihuana law violators arrested between 1965 and 1969 were found to have previous arrest records. Of those with previous arrests, the great majority of offenses (86%) involved traffic violations and minor violations of the vagrancy statutes. In but 10% of the cases the previous arrests were for assault, robbery, burglary or larceny.
In essence, neither informed current professional opinion nor empirical research, ranging from the 1930's to the present, has produced systematic evidence to support the thesis that marihuana use, by itself, either invariably or generally leads to or causes crime, including acts of violence,, juvenile delinquency or aggressive behavior. Instead the evidence suggests that sociolegal and cultural variable's account for the apparent statistical correlation between marihuana use and crime or delinquency.
A Sociocultural Explanation 
The persistent belief that some relationship exists between marihuana use and crime is not without statistical support. Undoubtedly, the marihuana user of the 1920's and 1930's was overrepresented in the nation's jails and penitentiaries and in the general crime and delinquency statistics. Especially during the late 1920's and early 1930's when the nation was preoccupied with lawlessness, the translation of this statistical correlation into a causal hypothesis is not surprising.
The increasing incidence of use in the mid-sixties by white, affluent, middle class, high school youth, college students and adults has occasioned a reevaluation of the marihuana user and a reexamination of the crime issue. The overwhelming majority of the new marihuana offenders have had no previous arrests, and come from the normally low risk, middle and upper socioeconomic population groups.
Recent public opinion surveys suggest that considerable social disapproval is attached to the "hippie" life style, unconventional mode of dress and apparent disregard for the law displayed by many of these individuals. Nonetheless, fewer persons are now willing to classify as criminal those marihuana users whose only contact with the law has been as a result of their marihuana use. Perceptions have undergone a change as a result of the increased usage of marihuana among youth of the dominant social class. Nonetheless, a statistical association remains.
First, the majority of both marihuana users and offenders other than actual marihuana law violators fall into the 14-to-25-year age group. Second, the majority of those arrested for marihuana law violations as well as other delinquent or criminal acts were, and to a much lesser degree, still are, drawn from the same "high risk" populations, such as minority groups, socially and economically disadvantaged, young, male, inner-city residents.
Third, various offender populations subjected to study often included a number of marihuana users, although it was not the marihuana violations per se but other, more serious criminal conduct that originally brought most of them to the attention of the authorities. Finally, during the past five years, marihuana law violators have increasingly swelled the crime and delinquency statistics; in most cases, their only contact with the law has been for these marihuanaspecific offenses.
The Philadelphia study corroborated this continuing statistical association. The simple relationship between using marihuana and committing offenses was positive and statistically significant, and there was also a high correlation between frequency of smoking marihuana and committing offenses. These direct associations were reduced to insignificance, however, upon further analysis of the data, and other explanations for the coincidence of marihuana use and crime became evident. These included: race, education, age, the use of other drugs, and having drug-using friends.
We conclude that some users commit crimes more frequently than non-users not because they use marihuana but because they happen to be the kinds of people who would be expected to have a higher crime rate, wholly apart from the use of marihuana. In most cases, the differences in crime rate between users and non-users are dependent not on marihuana use per se but on these other factors.
In summary, although the available evidence suggests that marihuana use may be statistically correlated with the incidence of crime and delinquency, when examined in isolation from the other variables, no valid evidence was found to support the thesis that marihuana' by itself, either inevitably, generally or even frequently causes or precipitates the commission of crime, including acts of violence, or juvenile delinquency. 
Within this framework, neither the marihuana user nor the drug itself can be said to constitute a danger to public safety. For, as two researchers have so cogently stated for the Commission, "Whatever an individual is, in all of his cultural, social and psychological complexity, is not going to vanish in a puff of marihuana smoke."
MARIHUANA AND DRIVING 
Within the context of public safety another issue which merits attention is the extent to which drivers under the influence of marihuana constitute a hazard on the nation's streets and highways. Although in recent years increasing attention has been given to this issue, at present little empirical evidence exists to inform discussion.
To assess the actual and potential impact of marihuana on traffic safety, a number of basic research questions must be answered.
the extent to which marihuana, users actually drive while under the influence of the drug
the extent to which marihuana users driving while "high" commit traffic violations and are involved in traffic accidents
the amounts of marihuana consumed immediately prior to the commission of traffic violations or the involvement in traffic accidents and the drug's role in these events
the nature and extent to which marihuana actually impairs psychomotor skills, judgment and driving performance
To date, the generalizations made concerning the effects of marihuana on driving behavior have generally been based on statistical studies of traffic violations and accidents and inferences drawn from more general studies of the physiological and psychological consequences of marihuana use, such as changes in pulse rate, reaction time, neuromuscular coordination, time estimation and spatial perceptions.
Such studies pose serious limitations in the nature, reliability and validity of the data. The basic problems derive from difficulties in identifying and attributing cause. A major obstacle in such retrospective analysis is the inability to separate the effects of marihuana from those possibly engendered by the use of other drugs, such as alcohol, tranquilizers and amphetamines. Finally, conclusive analysis is impossible until a reliable technique is developed for measuring the level of marihuana present in the body of the driver at the time of his violation or accident.
Prospective experimental studies of actual reactions to road conditions and traffic emergency situations would undoubtedly provide the most reliable and valid data, but such studies would themselves endanger the public and have not been undertaken. Researchers have relied, therefore, on controlled laboratory simulator studies and direct interviews with those who have admitted to driving while under the influence of marihuana.
With respect to the simulator studies , the available evidence suggests that while, in some cases, marihuana has produced interference with certain motor or mental abilities which affect driving behavior, these effects were generally believed to be readily overcome by the exercise of extreme caution by the driver and a significant reduction in speed.
The few driving simulator tests completed to date have generally revealed no significant correlations between marihuana use and driving disabilities. Comparison of the simulator scores of users and nonusers, however, did reveal small but nonsignificant differences in the number of speedometer errors made.
These simulator studies also examined the comparative effects of alcohol and marihuana on driving scores. The findings of one study, though controversial, suggested that intoxication resulting from low doses of marihuana was less detrimental to driving performance than was the presence of alcohol at the legally prohibited blood level of .10%.
The methodological limitations of the study raise serious questions about the reliability and validity of the findings. As one critic has noted, "It does not follow automatically that lack of effect of a drug on the simulated task will correlate with lack of effect on the actual task." Further , the use of dissimilar doses of alcohol and marihuana has led another critic to assert that "finding that a heavy dose of alcohol caused more impairment than a mild dose of marihuana is neither surprising nor helpful in assessing the relative effects of the two drugs in the relative doses in which they are normally used."
Recent research has not yet proven that marihuana use significantly impairs driving ability or performance. The Commission believes, nonetheless, that driving while under the influence of any psychoactive drug is a serious risk to public safety; the acute effects of marihuana intoxication, spatial and time distortion and slowed reflexes may impair driving performance. That the risk of injury may be greater for alcohol than for marihuana matters little.
Obviously, Much more research needs to be undertaken in this area. Hopefully, recent studies sponsored by the National Institute of Mental Health and other agencies will soon provide the concrete information that is needed.
Marihuana, Public Health and Welfare
As the feared threat to public safety through violent crime has diminished in recent years, policy-makers and the public have begun increasingly to view marihuana and other illicit drug use as a public health concern. The National Survey indicates that American adults regard drug abuse as the third most pressing problem of the day, closely following the economy and Vietnam. However, public attitudes reflect considerable confusion about the facts concerning marihuana and drugs in general.
This confusion has resulted from too little understanding of the motives for drug use as well as inadequate knowledge of the classification of drugs according to their main effects. Legal penalties have frequently mirrored this confusion, and the resulting inconsistencies cause, many young people to lose confidence in adult authority. Even in the medical profession, much uncertainty is evident, and for most of the general public there is no clear authority to whom they can turn for guidance.
A PUBLIC HEALTH APPROACH 
The Commission broadly defines public health concerns as all health problems which affect people en masse and are thereby difficult to treat on a traditional physician-to-patient basis. This category would include social and economic dependence and incapacity. A health problem which spreads to other susceptible members of the society cannot be controlled by the individual physician. This view coincides with the concept of preventive medicine, recognizing that all public health problems must be dealt with on both an individual and societal level.
To illustrate, the increasing incidence of deaths due to lung cancer subsequent to chronic, heavy tobacco usage is a major public health concern. In this instance, prevention of smoking and ascertaining the cause of the malignancies, rather than the individual treatment of each case by a physician, define the public health dimension. A major concern exists because the population at risk is large and growing, and the risk of harm is great.
In addition to the risk of large numbers of the populace being affected, the issue of contagion must also be examined. Unlike infectious diseases such as influenza and smallpox, where the person affected " catches" the ailment unintentionally, those individuals who use marihuana choose to come into contact with it. The contagion model is relevant only insofar as social pressure from proselytizing friends and social contacts play a role in spreading the use of the, drug. This dimension exists with marihuana, as well as alcohol and tobacco.
After assessing the potential harm to the individual and society, the size of the population at risk and the contagion aspect, society must determine the nature of the control mechanism used to deal with the problem, and how nine]) of its health resources, manpower and facilities will be allocated to meet the perceived threat to the public health. Therefore, an analysis of the relative risk of marihuana use must be undertaken. We must examine not only the effects of the drug on the individual but also determine which groups are at risk and why.
Practically all substances consumed by man are potentially dangerous to the physical or mental health of the individual if used irresponsibly or by particularly sensitive persons. Certain substances are sufficiently complex in their effects that societal control is necessary to reduce risk, for example, fluorides added to the water supply, prescription drugs, and food additives. The degree of concern and control varies, depending on relative public health dangers. 
The Population At Risk 
Before the dangers can be assessed, the population at risk must be defined. Viewing the public health picture on a large scale, the United States in 1972 may still be considered fortunate with regard to marihuana usage. While it is the third most popular recreational drug, behind alcohol and tobacco, it has not been institutionalized and commercialized.
Most of the Americans who have used marihuana have been merely experimenting with it. As noted in Chapter 1, there are 24 million Americans who have tried marihuana at one time or another, with 8.3 million still using it. Of those who have quit, most say they have simply lost interest in it. The same Survey shows that experience with marihuana peaks in the 18-to-25-year-old group and falls off sharply thereafter. A fact of some significance is that at least 71% of all adults (18-years and older) and 80% of youth (12-to-17-years) have never used marihuana at all.*
The Survey also indicates that the majority of those youth and adults who continue to use marihuana do so intermittently, that is, between one and 10 times a month. These individuals are classified as intermittent marihuana smokers who use the drug for its socializing effects. They are, for the most part, ordinary Americans who are either in school or are employed.
About 2% of those who have ever used marihuana, or 500,000 people, now use the drug heavily. They use the drug several times a day. These individuals use marihuana for its personal drug effects in addition to its socializing effects. Generally, their life styles, values, attitudes, behaviors and activities are unconventional. Marihuana plays an important role in their lives. Because the risk of psychological, and perhaps physical, harm from marihuana increases with the frequency quantity and duration of its use, these heavy marihuana users constitute the greatest at-risk population in the United States today.
The heavy marihuana user presents the greatest potential concern to the, public health. It is the Commission's opinion that these heavy marihuana users constitute a source of contagion within American society. They actively proselytize others into a drug-oriented way of life. The effectiveness of peer group pressure has been described earlier in Chapter II
We anticipate that this at-risk population would increase in number should a policy of institutionalized availability be adopted toward marihuana. Although marihuana is readily available illicitly in the United States today, a policy permitting its legal distribution could be expected to bring about an increase in users, with some percentage of them becoming heavy users. It is the availability of the drug, coupled -with a governmental policy of approval or neutrality, that could escalate this group into a public health and welfare concern. While this is speculative, it is a concern which cannot be dismissed. The experience with the rise in the use of tobacco and alcohol makes clear the probable consequences of commercial exploitation.
Another concern of the Commission is the experience of other countries which have large heavy user populations. While the pattern of behavior in one country is not automatically similar to a pattern of behavior in another country, the existence of heavy user populations constitutes a serious public health concern which must be avoided in this country. The availability of the drug alone does not seem to determine increased usage; supply and governmental inaction appear to tip the balance toward increased use. The proportion of our population susceptible to this pattern of use is conjectural but good preventive public health requires limiting the number to an irreducible minimum. 
*In the self-administered instrument, several separate questions were utilized to elicit the respondent's experience with marihuana. This technique permitted an analysis of consistency of responses, and also minimized the possibility of nonresponse. Nevertheless, 14% of the adults and 6% of the youth did not respond to enough of these questions to ascertain whether they had ever tried marihuana or not. 
Percentage who- Adult Youth
Ever used ------------------------------------- 15 14
Never used ------------------------------------ 71 so
No response ----------------------------------- 14 6
Confusion and Fact 
One of the primary sources of confusion surrounding the use of marihuana and other psychoactive drugs is the ambiguity of the term "drug abuse." In many quarters the excessive use of any drug is considered drug abuse, regardless of the effect of the drug on the individual or his behavior. In order to clarify this issue the Commission defines psychoactive drug abuse as follows: 
Drug abuse is the use of psychoactive drugs in a way likely to induce mental dysfunction and disordered behavior. 
It should be emphasized that demonstrable pathology of organ systems, including the brain, is not a necessary characteristic of psychoactive drug abuse. There are numerous non-psychoactive drugs which can induce extensive organ pathology but do not modify behavior; such drugs leave their imprint primarily on the individual, not on society. The Commission believes that many of the perplexing issues relating to psychoactive drugs, including marihuana, can be clarified if drug abuse refers only to the impact of drug-induced behavior on society.
Three types of such drug-induced behavior are considered unacceptable in most organized societies: (1) aggressiveness leading to violence; (2) loss of psychomotor control; (3) mental or physical disorder leading to social and economic incapacity or dependency.
This is not to say that society is unconcerned about the harmful effects of psychoactive drugs on the individual, or that such effects do not merit the attention of public health officials. Cigarette smoking, although affecting primarily the individual, is surely a matter of public health concern. We believe, however, that the term drug abuse, with its attendant societal disapprobation, should be reserved for drug taking which has a more direct effect on society through disordered behavior.
Beyond the confusion surrounding the term drug abuse, a rational evaluation of the public health impact of marihuana use is also inhibited by extensive misinformation about the drug. Recently, a great deal of research has increased significantly our knowledge about marihuana. Further research data are necessary before ;a conclusive statement about marihuana and public health can be made. However, enough is known today to discuss some of the public perceptions in detail. And sufficient data are presently available to allow for rational decision-making.
ASSESSMENT OF PERCEIVED RISKS
The Commission believes that marihuana. is perceived by the American public to present the following risks to the public health:
lethality
potential for genetic damage or teratogenicity
immediate adverse physical or mental effects
long-term physical or mental effects including psychosis and "amotivation" syndrome
"addiction" potential
* progression to other stronger drugs, especially heroin
Lethality
The Commission's National Survey revealed that 48% of adults believe that some people have died from marihuana use. A careful search of the literature and testimony of the nation's health officials has not revealed a single human fatality in the United States proven to have resulted solely from ingestion of marihuana. Experiments with the drug in monkeys demonstrated that the dose required for overdose death was enormous and for all practical purposes unachievable by humans smoking marihuana. This is in marked contrast to other substances in common use, most notably alcohol and barbiturate sleeping pills.
Of comparative note, 89% of all adults in the same Survey believe that some people have died from using alcohol. This indicates that public opinion regarding alcohol and its potential lethality is more accurate than it is for marihuana. At the same time, factual knowledge regarding the inherent danger in using a substance, for example alcohol, seemingly does not deter many persons from using it irresponsibly.
Potential For Genetic Damage 
The thalidomide tragedies of the 1950's have taught us to ponder carefully the possibility of genetic damage subsequent to any drug use. The much publicized controversy regarding LSD and subsequent genetic damage has led investigators to study marihuana and its possible genetic effects. Although a number of studies have been performed, at present no reliable evidence exists indicating that marihuana causes genetic defects in man.
Early findings from studies of chronic (up to 41 years), heavy (several ounces per day) cannabis users in Greece and Jamaica also failed to find such evidence. In all its studies, the Commission found no evidence of chromosome damage or teratogenic or mutagenic effects due to cannabis at doses commonly used by man. However, since fetal damage cannot be ruled out, the use of marihuana like that of many other drugs, is not advisable during pregnancy.
Immediate Effects
The intoxicant effects of marihuana on the mental function of the user does have potential health significance both for the individual and others with whom he may come in contact. Because marihuana is a psychoactive drug, it is important to examine the acute toxic effects which may occur in certain predisposed individuals and which increase with the potency of the preparation.
The Commission has reviewed numerous clinical studies describing acute panic reactions and transient psychotic-like episodes which occur as acute effects of the drug intoxication. In addition, a predisposed individual might experience aggravation of a latent psychotic state or other underlying instability. Although severe abnormal psychological states are rare when compared to the total number of marihuana users, lesser problems are not rare, and they may endanger both the individual and those around him at the time of their occurrence. The individual contemplating use is not capable of predicting whether he is predisposed by his particular circumstances to an undesirable mental reaction. The undesirable consequences occurring while an individual is involved in complex tasks such as driving or operating machinery or tasks requiring fine psychomotor precision and judgment are all too imaginable.
From a public health point of view, the immediate effects of marihuana intoxication on the individual's organs or bodily functions are of little significance. By and large these effects, which have been carefully outlined in Chapter 11 of the Report, are transient and have little or no permanent effect upon the individual.
Effects Of Long-Term, Heavy Use
To determine the long-term chronic effects of heavy marihuana use, the Commission has carefully reviewed the world literature and contemporary studies of heavy, chronic (up to 41 years) cannabis users in the world. In addition, lower socioeconomic populations in Afghanistan, Greece, and Jamaica have been examined.
Effects On The Body 
These recent studies in Greece and Jamaica report minimal physical abnormalities in the cannabis users as compared with their non-using peers.
Minimal abnormalities in pulmonary function have been observed in some cases of heavy and very heavy smokers of potent marihuana preparations (ganja or hashish). However, one study concluded the cause was smoking in general no matter what the substance. The other study could not express any conclusion because of the absence of a control population. Such decrements in normal pulmonary capacity may represent early warning signals in the development of chronic lung disease. They must be considered in any program of early prevention of disease and future disability.
No objective evidence of specific pathology of brain tissue has been documented. This fact contrasts sharply with the well-established brain damage of chronic alcoholism.
Effects On The Mind 
No outstanding abnormalities in psychological tests, psychiatric interviews or coping patterns have been conclusively documented in studies of cannabis users in other countries of the world. Further research in this important area is necessary before definite conclusions can be drawn relating or linking marihuana to mental dysfunction because available psychological tests do not measure certain higher mental functions very accurately.
Cannabis use has long been known to precipitate short-term phychotic-like episodes in predisposed individuals or those who take excessive doses. Some observers report that the prevalence of shortterm psychoses as well as the psychotic episodes of longer duration in heavy cannabis users are compatible with the prevalence rate of psychosis in the general population and, therefore, may not be attributable to cannabis use. In fact, some believe that in populations under stress where marihuana is widely used, occurrence of the acute psychotic-like episodes occur less often than one would expect in such a population. Other researchers have disagreed with these conclusions, and the matter is still controversial. 
Effects On Motivation 
The Commission is deeply concerned about another group of behavioral effects that have been described in other nations as being associated with the heavy, long-term use of cannabis. This behavioral condition has been termed the "amotivational syndrome." An extreme form has been reported in populations of lower socioeconomic males in several developing nations. These reports describe lethargy, instability, social deterioration, a loss of interest in virtually all activities other than drug use. This state of social and economic disability also results in precipitation and aggravation of psychiatric disorders (overt psychotic behavior) and possible somatic complications among very heavy, very long-term users of high potency cannabis products. However, in the populations so far observed in Jamaica, Greece, and Afghanistan, physical and psychosocial deterioration was not reported. The life styles of these populations appeared to be conditioned by cultural and socioeconomic factors. Some researchers believe cannabis' may serve to keep these individuals stratified at this lower socioeconomic level.
The occurrence of a similar, though less intense, syndrome has been identified recently with heavy marihuana use among young persons in the Western world, including the United States. Some clinicians have described the existence of a complex of subtle social, psychological and behavioral changes related to a loss of volitional goal direction in certain individuals, including some long-term heavy users of marihuana. Such persons appear to orient only to the present. They appear, alienated from generally accepted social and occupational activities, and they tend to show a reduced concern for personal hygiene and nutrition.
Some clinicians believe that this picture is directly caused by the action of marihuana. However , other behavioral scientists believe that among impressionable adolescents, marihuana-induced suggestibility may facilitate the rapid adoption of new values and behavior patterns, particularly when the drug is taken in a socially alienated subculture that advocates and strongly reinforces such changes.
Whichever interpretation one accepts, the fact is apparent that the chronic, heavy use of marihuana may jeopardize social and economic adjustments of the adolescents We believe this is one concern which merits further research and evaluation. On the basis of past studies, the chronic, heavy use of marihuana, seems to constitute a high-risk behavior, particularly among predisposed adolescents. This consideration is especially critical when we consider the adolescent who is in the throes of a normally turbulent emotional process. The Commission has reviewed numerous reported studies and heard the testimony of several clinicians dealing with heavy users of marihuana who exhibit this particular behavior pattern. Although the United States does not, at the present time, have a large number of such persons within its population, the incidence is too frequent to ignore. Expanded epidemiologic studies are imperative to obtain a better understanding of this complex behavior.
Addiction Potential
Unfortunately, fact and fancy have become irrationally mixed regarding marihuana's physiological and psychological properties. Marihuana clearly is not in the same chemical category as heroin insofar as its physiologic and psychological effects are concerned. In a word, cannabis does not lead to physical dependence. No torturous withdrawal syndrome follows the sudden cessation of chronic, heavy use of marihuana. Although evidence indicates that heavy, long-term cannabis users may develop psychological dependence, even then the level of psychological dependence is no different from the syndrome of anxiety and restlessness seen when an American stops smoking tobacco cigarettes.
Progression To Other Drugs
As noted in Chapter 11, to say marihuana leads to any other drug avoids the real issue and reduces a complex set of variables to an oversimplified premise of cause and effect. If any one statement can characterize why persons in the United States escalate their drug use patterns and become polydrug users, it is peer pressure. Indeed, if any drug is associated with the use of other drugs, including marihuana, it is tobacco, followed closely by alcohol. Study after study which the Commission reviewed invariably reported an association between the use of tobacco, and, to a lesser extent, of alcohol with the use of marihuana and other drugs.
The fact should be emphasized that the overwhelming majority of marihuana users do not progress to other drugs. They either remain with marihuana or foresake its use in favor of alcohol. In addition, the largest number of marihuana users in the United States today are experimenters or intermittent users, and 2% of those who have ever used it are presently heavy users. Only moderate and heavy use of marihuana is significantly associated with persistent use of other drugs.
Some persons in our society are interested in experimenting with a series of drugs, and there is no uniformity regarding which drug these multidrug users take first. In some cases, the drug used is a matter of preference; in others, a matter of availability; and in further instances, it matter of group choice.
Citizens concerned with health issues must consider the possibility of marihuana use leading to use of heroin, other opiates, cocaine or hallucinogens. This so-called stepping-stone theory first received widespread acceptance in 1951 as a result of testimony at Congressional hearings. At that time, studies of various addict populations repeatedly described most heroin users as marihuana users also. The implication of these descriptions was that a causal relationship existed between marihuana and subsequent heroin use. When the voluminous testimony given at these hearings is seriously examined, no verification is found of a causal relationship between marihuana use and subsequent heroin use.
Again, we must avoid polarity on this issue. To assume that marihuana use is unrelated to the use of other drugs would be inaccurate. As mentioned earlier, the heavy or very heavy marihuana users are frequently users of other drugs. The stepping-stone theory holds that the adolescent begins the use of illicit drugs with marihuana, and later proceeds to heroin in the search for greater thrills. The opposing viewpoint holds that the large majority of marihuana users never become heroin addicts and denies the validity of a causal relationship.
In the National Survey, among the adult respondents, 70% thought that marihuana makes people want to try stronger drugs such as heroin; 56% of the youth in the 12-to-17-year-old category agreed with the same statement. These perceptions contrast with another finding in the same Survey which revealed that 4% of current marihuana users have tried heroin. On the other hand, very few respondents perceived alcohol and tobacco to be precipitants of other drug use.
Studies of the escalation process demonstrate that the rates of progression vary from one group to another and from one segment of the population to another. There is no set proportion of marihuana users who "escalate" to the use of other drugs. The other drugs which some marihuana smokers use vary according to the social characteristics of the population in question. Within some groups, heroin may be the choice; in other groups, it may be LSD.
Marihuana use per se does not dictate whether other drugs will be used; nor does it determine the rate of progression, if and when it, occurs, or which drugs might be used. As discussed in Chapter 11, the user's social group seems to have the strongest influence on whether other drugs will be used; and if so, which drugs will be used.
PREVENTIVE PUBLIC HEALTH CONCERNS 
The hallmark of a good health care delivery system is preventing as much illness as possible. This objective is achieved by means of immunizations, regular routine checkups, and educational programs.
Education programs regarding marihuana have been notably ineffective, partly due to an exaggeration of the effects of using the drug and partly because the effects of the opiates and marihuana have been compared inaccurately. As a result, many persons have developed a conscious or unconscious denial of nearly all dangers associated with marihuana use. Some educators believe that drug programs merely sharpen the curiosity of children and tempt them to use drugs which they otherwise would not use. Others believe that the responsibility should not be lodged with the schools but rather with the home or the community.
Because of the uncertainty about the efficacy of these, programs, education programs dealing with drug usage simply do not exist in the school systems of a number of major cities; in others, token programs are offered in response to the demand that something be done. Health educators have the responsibility to help this vulnerable group of Americans become aware of all options so that they are able to make enlightened choices.
The educational role of physicians and other clinical health personnel should not be underestimated. The National Survey shows that the public believes young people should receive information concerning marihuana first from schools and second from family physicians. The health professional has a unique position as both teacher and confidant to an individual struggling with a "drug abuse" problem. Honest, sincere, and confidential guidance from a physician may prevent later difficulties to both the individual and the society. The Commission believes that action must be taken to inform and support the physician in his role as confidant and counsellor to those seeking assistance.
Considering the current patterns of marihuana use in the United States, the need for treatment and/or rehabilitation does not appear necessary for the vast majority of persons who are experimenting with the drug or using it intermittently. Rather, these persons need to be realistically educated regarding the potential hazards they face. To this end, a comparison of the personal and public health risks of marihuana and those of heroin, cocaine, amphetamines, and other drugs would be useful. 
A concern for public health also requires thoughtful consideration of the consequences of any change in public policy. We have objectively appraised the present scope of public health concerns concluding that the most serious risk lies with the population of heavy users, which is, at this time, quite small in this country.
Now, we must soberly consider the likely effect of adoption of a social policy of neutrality or approval toward marihuana use. Any legal policy which institutionalizes availability of the drug carries with it a likely increase in the at-risk population. This factor is not necessarily conclusive in itself , but it does weigh heavily for the policymaker. Even though the proportion of heavy users in the total using population might not increase if such a social or legal policy were adopted, the absolute number of heavy users would probably increase. Thus, we would have an increase in the at-risk segment of the populace. A greater stress would thereby be placed on the general health care delivery system in all the areas of health concern described earlier.
Regardless of emerging social policy, greater emphasis must be placed on educating our youth regarding the prospective dangers inherent in expanded marihuana use. This anticipatory guidance can serve to defuse or at least forestall a potentially serious social phenomenon.
Summary
From what is now known about the effects of marihuana, its use at the present level does not constitute a major threat to public health. However, this statement should not lead to complacency. Marihuana is not an innocuous drug. The clinical findings of impaired psychological function, carefully documented by medical specialists, legitimately arouse concern. These studies identify marihuana-related problems which must be taken into account in the development of public policy. Unfortunately, these marihuana-related problems, which occur only in heavy, long-term users, have been over generalized and overdramatized.
Two percent of those Americans who have ever used marihuana are now heavy users and constitute the highest risk group. Strong evidence indicates that certain emotional changes have taken place among predisposed individuals as a result of prolonged, heavy marihuana use. The clinical reports in the literature describing transient psychoses, other psychiatric difficulties, and impairment of cognitive function subsequent to use of marihuana and of other drugs do not prove causality but cannot be ignored.
The causes of these emotional difficulties are much too complex to justify general conclusions by the public or the press. The mass media have frequently promoted such clinical reports to appear as far reaching events affecting the entire population. The clinician sees only the troubled Population of any group. In evaluating a public health concern, the essential element is the proportion of affected persons in the general group. The people responsible for evaluating public health problems must concern themselves with the proportion of people out of the total population who are affected by any specific condition. The highest risk groups should be identified as the source of primary concern. A recognition that a majority of marihuana users are not now a matter of public health concern must be made so that public health Officials may concentrate their attention where it will have maximum impact.
The concept of relative risk is crucial to an evaluation of the impact of marihuana on public health. We believe that experimental or intermittent use of this drug carries minimal risk to the public health, and should not be given overzealous attention in terms of a public health response. We are concerned that social influences might cause those who would not otherwise use the drug to be exposed to this minimal risk and the potential escalation of drug-using patterns. For this group, we must deglorify, demythologize, and deemphasize the use of marihuana and other drugs.
The Commission reemphasizes its concern about the small minority of heavy, long-term marihuana users who are exposed to a much greater relative risk of impaired general functioning in contemporary America. Public health officials should concentrate their efforts on this group. Fortunately, the group has to date not grown sufficently in size to warrant its being considered a major public health concern.
We retiterate, too, the public health implications of an increase in the at-risk population. We suspect that such an increase is most likely if a sudden shift in social policy significantly increased availability of the drug. One of the factors we consider in Chapter V when evaluating the various social policy options and legal implementations is the effect of each policy on incidence and patterns of use. Regardless of how heavy this particular variable will weigh in that process, we must state that a significant increase in the at-risk population could convert what is now a minor public health concern in this country to one of major proportions.
Marihuana And The Dominant Social Order
For more than 30 years it has been widely assumed that the marihuana user constitutes a threat to the well-being of the community and the nation. Originally, the users were considered to be "outsiders" or marginal citizens. Included were such people as hustlers, prostitutes, itinerant workers, merchant seamen, miners and ranchhands, water-front day laborers and drifters, many of whom were drawn from the lower socioeconomic segments of the population.
Concerns about marihuana use expressed in the 1930's related primarily to a perceived inconsistency between the life styles and values of these individuals and the social and moral order. Their potential influence on the young was especially worrisome. When marihuana was first prohibited, a recurrent fear was that use might spread among the youth. And in the late 1930's and 1940's, the attraction of young people to jazz music was thought to be in part related to marihuana use by this "outsider" population.
Throughout this early period, American society, in reaction to its fear of the unfamiliar, translated rumor about the criminality and immorality of the marihuana user into "unquestioned fact" which, in turn, was translated into social policy.
From the mid-thirties to the present, however, social perceptions have undergone significant change in response to the emergence of new and challenging social problems. As marihuana, use has spread to include the affluent, middle class, white high school and college-age youth as well as minority group members of lower socioeconomic circumstances in urban core areas, the concept of marginality has become blurred.
Also, as the use of marihuana has increased, those individuals formerly labeled as marginal and threatening have been replaced by a more middle class, white, educated and younger population of marihuana smokers. A stereotyped user no longer exists, and therefore, the question now properly focuses on who poses a threat to the dominant order.
The Adult Marihuana User 
Despite the fact that substantial numbers of adults use marihuana, society does not appear to feel greatly threatened by this group, probably because included in the group are a considerable number of middle class individuals who are regularly employed and whose occupational and social status appear to be similar to those of peers and colleagues who do not use marihuana.
In the course of its fact-finding effort, the Commission has met with several groups of socially and economically "successful" marihuana users in the professions of law, medicine, banking, education and business. In most cases, these persons, in their external appearances, seemed to be mature and responsible adults whose social attitudes and behavior did not mark them as radical ideologues or essentially irresponsible individuals.
For the most part, use of marihuana by adults has been found to be more directly related to the facilitation of social interaction (much like the adult use of alcohol in social gatherings) than to any other factor. Although their marihuana smoking behavior is illegal, most adult users are not ordinarily considered by their peers to be criminal nor is their use generally likely to result in arrest.
Because the adult user generally maintains low visibility, is primarily a recreational user, is not usually involved in radical political activity and maintains a life style largely indistinguishable from his non-using neighbors, he is not ordinarily viewed as a threat to the dominant social order. In short, aside from his use of marihuana, the adult recreational user is not generally viewed as a significant social problem.
The Young Marihuana User 
The widespread use of marihuana by millions of young people of college and high school age has been viewed by many as a direct threat to the stability and future of the social order.
Many parents, adults in general, and government officials have expressed concern that young people who use marihuana often reject the essential values and traditions upon which the society is founded. Some have suggested that youthful marihuana use is, in itself, an indication of the rejection of responsibility and a sign of reckless hedonism which may well interfere with an orderly maturation process. Others see youthful marihuana use as part of a pattern of conduct which produces dropping out, underachievement and dependency.
In short, the mass character of youthful marihuana use has been frequently interpreted as a rejection of the institutionalized principles of law and a lack of concern for individual social responsibility, which threatens the social and political institutions.
Implicit in this view is the assumption that a young person who uses marihuana in spite of the law cannot be expected to assume an individually and socially responsible, adult role. The strength of this fear is drawn largely from the vocal and visible "counterculture" to which marihuana is often tied. Not surprisingly, the concerns posed by an alternate youthful life style are extended to the drug itself.
Threats to the social order are often seen, for example, in the character of youthful leisure time activities, such as attendance at rock concerts, occasioned by the high mobility and affluence of today's youth. They are also seen in the new modes of speech and dress and in the seemingly casual manner of their day-to-day living. Equally troublesome for many, however, is the idea of intentional intoxication for purposes of recreation.
Such conduct and the more casual attitude toward sexual relationships as well as participation in radical politics have provoked increasing concern throughout the adult society. The National Survey illustrates the extent to which the older adult perceives youthful marihuana use as part of a much larger pattern of behavior which bodes ill for the future of the nation.
First, the older the adult respondent, the more likely he was to picture the marihuana user as leading an abnormal life. Only 9% of the over-50 generation agreed with the statement that "most people who use marihuana lead a normal life." Nineteen percent of the 35to-49 age group and 29% of the 26-to-34-year-olds were of the same belief. Conversely, half of the young adults (18-to-25) considered most marihuana users normal. This fact is not surprising since many of their contemporaries are marihuana users.
Second, the marihuana user, as envisioned by adults, is typically a youthful dropout from society. He doesn't like to be with other people, is uninterested in the world around him, is usually lazy and has an above-average number of personal problems.
Third, the less optimistic the adult respondent was about the nation's youth, the more likely he was to oppose alteration of the marihuana laws and to envision major social dislocations if the laws were changed. Fifty-seven percent of the adult population in general agreed with the statement, "if marihuana were legal, it would lead to teenagers becoming irresponsible and wild." Among those adults who most disapproved of youthful behavior in general, 74% agreed with the quoted statement. Similarly, 84% of the non-approving adults favored stricter laws on marihuana.
As we discussed in Chapter I, marihuana's symbolic role in a perceived generational conflict has brought marihuana use into the Category of a social problem. Today's youthful marihuana user is seen as a greater threat to the social order than either the marginal user of earlier times or the adult user of the present. Since the concerns about marihuana today relate mostly to youth, the remainder of this section will focus on these youth-related issues. 
'THE WORLD OF YOUTH 
Youth of today are better fed, better housed, more mobile, more affluent, more schooled and probably more bored with their lives than any generation which has preceded them.
Adults have difficulty understanding why such privileged young people should wish to offend by their language and appearance and spend so much effort trying to discredit those institutions of society which have made possible the privileges which those youth enjoy. Many adults perceive the present level of youthful discontent to be of a greater intensity than has been true of past generations.
Marihuana has become both a focus and a symbol of the generation gap and for many young people its use has become, an expedient means of protest against adult values.
Adults in positions of authority, parents, teachers, policy officials, judges, and others often view marihuana use as the sign of youth's rejection of moral and social values and of the system of government under which they live. The problem is that both youth and adults tend to make pronouncements and are frequently unable to reason together in logical fashion. Instead they overstate their positions in such a way that effective resolution of their differences becomes very difficult.
In effect, each group takes the rhetoric of the other at face value. For youth, however, marihuana use plays many roles, only one of which is a symbolic assault on adult authority and values.
Marihuana use, for many young people, has become a part of a ritual. It takes on the aspect of participating in a shared experience which, for some if not all, is enjoyable in itself. For many, it becomes an even more interesting experience because it is forbidden.
Some of the rituals concerned with the purchase, storage, preparation, and use of marihuana take on a mystique similar to the time of Prohibition when people went through certain rituals necessary to get a drink in a speak-easy. The three knocks and "Joe sent me" cues have been replaced by the not-so-secret handshakes, the new vocabulary of youth and other exclusionary devices to delineate the "in" group.
The use of marihuana is attractive to many young people for the sense of group unity and participation which develops around the common use of the drug. This sense tends to be intensified by a sense of "common cause" in those circumstances where users are regarded as social or legal outcasts.
They know, too, that many of their peers who share the marihuana experience and also share the designation of lawbreaker are, in reality, productive and generally affirmative individuals who are interested neither in promoting the downfall of the nation nor in engaging in acts which would harm the general well-being of the community.
In short, many youth have found marihuana use to be a pleasurable and socially rewarding experience. They have found that the continuance of this behavior has brought them more pleasure than discomfort, more reward than punishment.
Youth have increasingly come to see law enforcement activity directed at marihuana use as an unreasonable and unjustifiable rejection of their generation. Most of these youth have grown up with a positive image of the police as protectors of society. Now, many are confronted with the possibility of police intrusion into their private lives and the threat of a criminal record. The unfortunate result, in many instances, has been a blanket rejection and distrust of both the agents and institutions of government.
In part, marihuana use as a social behavior is an unintended byproduct of the formal and informal educational process. Some persons even suggest that youthful drug usage is a "success" in terms of the educational and socialization process. Our society values independence of thought, experimentation, and the empirical method, often reinforcing this attitude by such advertising cliches as "make up your own mind," "be your own man...... judge for yourself."
Although experimentation with regard to drugs should not be considered a "success, the Commission does believe that the educational efforts necessary to discourage this curiosity, which may be valuable in other matters, have not succeeded. We understand why teenagers and young adults encouraged over the years to make up their own minds have not been restrained by exaggerated accounts of marihuana's harmful effects, or by the more recent assertions that a true evaluation of marihuana uses requires more research. The Scottish verdict of "not proven" does little to restrain youthful curiosity.
In the previous Chapter, we emphasized the difference between the vast majority of experimenters and intermittent users and the small group of moderate and heavy users who generally use drugs other than marihuana as well. The former do not differ significantly from non-users on many indices of social integration. Various studies indicate that they maintain normal patterns of living and social interaction, and are employed, competent citizens.
On the other hand, there undoubtedly are a number of persons who have used marihuana and have exercised poor judgment, performed inadequately, or behaved irresponsibly while under the drug's influence, thus jeopardizing themselves or others. The fact remains, however, that a certain number of these persons were immature and irresponsible individuals even prior to marihuana use, who would be expected to have poor or impaired judgment whether or not marihuana was involved.
The marihuana user is not, for the most part, a social isolationist or a severely disturbed individual in need of treatment or confinement. Most users, young or old, demonstrate an average or above-average degree of social functioning, academic achievement and job performance. Their general image of themselves and their society is not radically different from that of their non-marihuana-using peers. The majority of both groups tends to demonstrate equal interest in corporate concerns.
Based upon present evidence, it is unlikely that marihuana users will become less socially responsible as a result of their marihuana use or that their patterns of behavior and values will change significantly.
WHY SOCIETY FEELS THREATENED
Society appears to be concerned about marihuana use primarily because of its perceived relationship to other social problems. We noted in the discussion of marihuana and public health that the focus of social concern should be the heavy users and the possibility that their numbers will increase. Here we consider the perceived impact of marihuana use upon the institutions and proclaimed goals of the society.
Dropping Out 
Many parents have a genuine fear that marihuana use leads to idleness and "dropping out." During the 1960's, marihuana use, as well as the use of other psychoactive drugs, became equated with unconventional youth life styles. When a number of young people adopted unconventional life styles, many adults tended to view long hair, unkempt appearance and drugs as symbols of counterculture.
They concluded that anyone who allowed his hair to grow or gave little attention to his clothing or appearance was probably a drug user with little or no motivation to achieve and no interest in conventional goals.
A number of researchers and clinicians have observed the use of marihuana or hashish in other societies, particularly among poor, lower class males. Some have observed that many of these individuals are generally unmotivated and ordinarily appear to show little aspiration or motivation to improve their way of life, regardless of whether they are judged by the standards of the more prosperous members of their own society or by middle class standards of contemporary American society.
One of the problems with this type of analysis is that it fails to perceive the social and cultural realities in which the phenomenon takes place. In the Middle East and in Asia where hashish is used, the societies, in all instances, are highly stratified with people in the lower classes having virtually no social or economic mobility. Poverty, deprivation and disease were the conditions into which these people were born and in which they remain, regardless of whether they use cannabis. In this context, a person's resignation to his status in life is not likely to be caused or greatly influenced by the effects of cannabis. Any society will always have a certain number of persons who, for various reasons, are not motivated to strive for personal achievement or participate fully in the life of the community. Therefore, the determination is difficult to make whether cannabis use influences a person to drop out and, if it does, to what extent.
Some individuals possess particular personality as well as psychosocial characteristics which in specified instances could produce amotivation or dropping out. However, little likelihood exists that the introduction of a single element such as marihuana use would significantly change the basic personality and character structure of the individual to any degree. An individual is more likely to drop out when a number of circumstances have joined at a given point in his lifetime, producing pressures with which he has difficulty in coping. These pressures often coincide with situations involving painful or difficult judgments resulting from a need to adjust to the pressures of the social environment.
Many young people, particularly in the college population, are shielded in their earlier years from experiences which might be emotionally stressful or unpleasant. Some young people, so sheltered, are neither equipped to make mature and independent judgments nor prepared to enjoy the new-found freedom of the university or college in a mature and responsible way. Some of these students are often unable to cope with social or academic adversity. After being sheltered for so long, some of these young people may be easily attracted to experiences which promise new excitement and to fall under the influence of a peer group whose values and living patterns may be inimical to a productive, healthy and continuous process of personal growth and maturity. In these instances, marihuana serves as the medium by which these individuals encounter social and psychological experiences with which they are ill-equipped to cope.
Certain numbers of these young people have demonstrated what is described as amotivation long before the smoking of marihuana became fashionable. Adolescence is often a particularly difficult period of searching in many directions at the same time. In addition to seeking a concept of "self" the adolescent is, at the same time, attempting to comprehend the nature of the world around him and to identify his status and role in society.
Different individuals, with different backgrounds, socialization patterns, belief systems and levels of emotional maturity cope with the period of transition from childhood to adulthood in different ways., For a small number, dropping out might be one of these coping mechanisms whether or not they use marihuana. For others, the response to the difficult adjustments of adolescence takes other forms, some of which are more, acceptable, "normal" and easier for adults to understand.
The young person who does not find it possible to cope with the pressures of his adolescent developmental period in ways convenient to the understanding of adult society should not be rejected, stigmatized or labeled. He requires both support and understanding and the opportunity to participate in roles which have meaning for him and in ways in which he feels comfortable. For a certain number of young people, marihuana and the mystique of the experience eases this passage by helping them share their feelings, doubts, inadequacies and aspirations with peers with whom they feel safe and comfortable. 
Dropping Down
Apart from the concern over youthful dropping out and idleness, there is also widespread concern about "dropping down" or underachieving.
Parents frequently express fear that marihuana will undermine or interfere with academic and vocational career development and achievement by focusing youthful interests on the drug and those associated with the drug subculture. Some parents make considerable sacrifices for their children to go to school, and the fears that marihuana might undermine the academic, emotional and vocational development of their young are quite understandable.
The Commission reviewed a number of studies related to marihuana use by high school and college youth. No conclusive evidence was found demonstrating that marihuana by itself is responsible for academic or vocational failure or "dropping down," although it could be one of many contributory reasons. Many studies reported that the majority of young people who have used marihuana received average or above-average grades in school.
In part, underachievement is related to a view of what one individual judges to be the achievement capacity of another. This judgment is often made without concern for what the individual himself feels about his potential, his interests and his goals. Perceptions about achievement also frequently fail to take into consideration the individual feelings about the goals of his peers and the values of the larger society, including the relative prestige and status attached to various academic programs, occupations and professions. 
Youth and Radical Politics 
Aside from the issue of unconventional life styles and the concerns evoked by them, the other major concern of the sixties which related to youth and drugs was radical politics.
During the latter half of the decade, youthful anti-war groups were organized on many of the nation's college campuses and high schools. These groups could be divided into two segments. The largest segment consisted of concerned, sometimes confused, frustrated and well-meaning petition signers and demonstrators. Within this large group there was a small coterie of individuals who constantly sought to turn the demonstration into a confrontation and to protest for peace by means of violence. The second segment consisted of organizations of individuals whose stated purpose was to undermine the social and political stability of the society through violent means.
What must be clearly understood, however, is that among the young people, and some not so young, who protested against the war in Vietnam, only a minority were bent on violence and manipulated and corrupted these otherwise peaceful demonstrations for their own purposes.
At the various gatherings, a number of the young people protesting in these mass groups did smoke marihuana. We will never know how many were initiated to marihuana use during the course of these peace demonstrations. The fact remains, however, that in the large campins, such as those in Washington, marihuana was involved in two ways. First, there was the "normal" use in which the smoking was part of the social experience. Individuals came together and smoked, in part, to acknowledge and strengthen group solidarity. Second, another quite different aspect of the marihuana use at these gatherings said, in effect, "we know it's illegal but go and arrest all of us for doing it. . . ." This aspect can perhaps best be characterized as a symbolic challenge to authority.
Unfortunately, however, the media, particularly television and some of the news magazines, sometimes portrayed the image of a group of young people plotting the overthrow of the nation by violent means while under the influence of marihuana. In those relatively few instances where explosives and other violent means were employed, the evidence points to a cold and calculated plan which was neither conceived nor executed under the influence of marihuana.
As a result of these protests and demonstrations, therefore, radical politics has been seen by many as a mechanism through which large numbers of young people would be introduced to marihuana as well as to other drugs. Radical political activity or mass political protest is viewed by some as a threat to the welfare of the nation and is assumed to be aided and encouraged by our enemies.
The involvement of large numbers of youth in political activism and the concomitant public concern about drug use have beclouded the issue of marihuana use and have led to a broadening of the concerns about marihuana on the part of adults.
Some of the radical movement's leaders abetted this tendency by pointing out the alleged irrationality and unfairness of the marihuana laws to recruit members to their ranks. Not surprising is the fact that 45% of the adult respondents in the National Survey felt that marihuana is often promoted by people who are enemies of the United States. Nor is it surprising that this belief is a function of age. While 22% of all young people (12-to-17 years of age) and 26% of young adults (18-to-25 years) identified marihuana with national enemies, more than one-half (58%) of those persons 50 years and older did so.
Youth and the Work Ethic 
Of the many issues related to youth and the use of marihuana, one that greatly troubles many adults, is youthful attitudes toward work. The work ethic in our society is based on a belief that work is a good and necessary activity in and of itself.
The traditional view holds that work is not only a right and moral act but that it keeps people from mischief and from wasting time on harmful recreational pleasures. The rationale for this thesis is that work in American society has served as the primary means by which persons acquired the treasured symbols of society.
In fact, throughout much of our history, with the exception of the small number who inherited or married wealth, no ethical alternative to work existed. In recent years, the increased emphasis placed upon leisure time activities has resulted in shorter work weeks, longer vacation periods and more paid holidays.
Among the concerns of the adults about today's youthful attitudes toward work and leisure are that young people seem to enjoy their recreational pursuits so much that they forget that to a considerable degree their enjoyment is paid for by the labor of others.
Many young people do not express the same level of concern as their parents did about preparing themselves for a career and "getting ahead in the world." In part, this attitude is attributable to the fact that increasingly, the results of this labor are not tangible, material goods. Service occupations generally do not produce such tangible products, and even in manufacturing industries the individual worker is usually too remote from the product to feel any pride or interest in it. In both instances, the traditional symbol of the "manhood" of work, a tangible product, is no longer present.
In sum, society has become increasingly disturbed by certain attitudes of today's youth which seem to stress pleasure, fun, and enjoyment without a counterbalancing concern for a disciplined and sustained work effort. Nevertheless, the number of young people who view work as unimportant is small when compared to the total number of young people. The Commission has found no evidence to suggest that the majority of youth are unwilling or incapable of productive and disciplined work performance. In fact, the great majority of young people are performing their tasks in industry, the professions and education quite effectively.
Although many young people delay entry into the work force to enjoy the fruits of our prosperous society, this delay does not mean they will not one day contribute their best efforts to the continued growth and advancement of the nation.
The Changing Social Scene 
The present confusion about the effects of youthful marihuana use upon the dominant social order is caused by a variety of interrelated social concerns, many of them emotionally charged issues, including anti-war demonstrations, campus riots, hippie life styles, the rising incidence of crime and delinquency and the increased usage of all illicit drugs. The focus of concern about marihuana is aggravated by the data overload mentioned in Chapter 1, by the outpouring of incidental information about the drug and its effects in a form and volume far beyond the capacity of the readers or listeners to assimilate or interpret. Rather than informing the public, much of the data disseminated has produced frustration and misinterpretation of the information presented.
Adult society, including parents and policy-makers, finds it difficult to comprehend and account for many of the attitudes and behavior of the young, including the use of marihuana. In many cases the adults are still influenced by the myths of an earlier period which overstated the dangers of the drug. At a time of great social change and turbulence, the tendency to depend on the "traditional wisdom," and its moral justification, is a strong one.
Just as youth must try to understand and appreciate the strengths of the institutions of our society, adults must try to understand the times through the eyes of their children. Where marihuana is concerned, society must try to understand its role in the lives of those who use it. The key to such understanding lies in the changes which have taken place in society within recent years and the effects these changes have had on succeeding generations of youth. The increased use of marihuana is only one of these effects.
One focal point in discussion between generations is the contrast between the use of marihuana and the use of alcohol. Many young people perceive that marihuana is less dangerous than alcohol in terms of its addiction potential and long-term physical and psychological consequences. Many believe also that marihuana - and other psychoactive drugs make it possible to expand their perceptions and see this as a perfectly legitimate objective.
Viewed against the background of the profound changes of recent years in the fields of economics, politics, religion, family life, housing patterns, civil rights, employment and recreation, the use of marihuana by the nation's youth must be seen as a relatively minor change in social patterns of conduct and as more of a consequence of than a contributor to these major changes.
When the issue of marihuana use is placed in this context of society's larger concerns, marihuana does not emerge as a major issue or threat to the social order. Rather, it is most appropriately viewed as a part of the whole of society's concerns about the growth and development of its young people.
In view of the magnitude and nature of change which our society has experienced during the past 25 years, the thoughtful observer is not likely to attribute any of the major social problems resulting from this change to marihuana use. Similarly, it is unlikely that marihuana will affect the future strength, stability or vitality of our social and political institutions. The fundamental principles and values upon which the society rests are far too enduring to -go up in the smoke of a marihuana cigarette.


Chapter IV                                                                                                               

social response to marihuana use




"I find the great thing in this world is not so much where we stand, as in what direction we are moving: To reach the port of heaven, we must sail sometimes with the wind and sometimes against it-but we must sail and not drift, nor lie at anchor."
Oliver Wendell Holmes, The Autocrat of the Breakfast Table (1858)

A general interpretation of the National Survey indicates that roughly one-quarter of the American public is convinced that criminal sanctions should be withdrawn entirely from marihuana use. Another fourth of the public is equally convinced that existing social and legal policy is appropriate, and would ordinarily jail possessors, with the exception of young first offenders. Approximately half of the citizenry is confused about what marihuana means and ambivalent about what society ought to do about its use. This half of the population is unenthusiastic about classifying the marihuana user as a criminal, but is reluctant to relinquish formal control over him.
In considering social and legal policy alternatives, the Commission has analyzed the pattern of social response to marihuana use. 
The Initial Social Response
As we noted in Chapter I, the initial social reaction to marihuana use was shaped by the narcotics policy adopted by the Federal Government. In the early legislation, marihuana was officially characterized as a narcotic on the basis of the widely shared assumption that it was a habit-forming drug, leading inevitably to a form of dependence. Although the medical community was aware that marihuana was distinguishable from the opiates in that it did not produce physical dependence, no functional distinction was drawn; it was assumed that most users were psychologically compelled to continue using the drug. As one psychiatrist noted in 1934, the marihuana "user wants to recapture over and over again the ecstatic, elated state into which the drug lifts him . . . The addiction to cannabis is a sensual addiction: it is in the services of the hedonistic elements of the personality."
The notion of psychological dependence is still ill-defined, and was understood even less in the early days of American marihuana use. The Commission has concluded that the automatic classification of marihuana as "addictive" was derived primarily from an underlying social perception of the substrata of society which used the drug: aliens, prostitutes, and persons at the bottom of the socioeconomic ladder.
Additional characteristics of the opiates were also transferred to marihuana. Particularly important in this regard was the association of marihuana with aggressive behavior and violent crime. One district attorney in New Orleans, where marihuana use was particularly common, wrote in 1931:
It is an ideal drug to cut off inhibitions quickly . . . At the present time the underworld has been quick to realize the value of this drug in subjugating the will of human derelicts to that of a master mind. Its use sweeps away all restraint, and to its influence may be attributed many of our present day crimes. It has been the experience of the Police and Prosecuting Officials in the South that immediately before the commission of many crimes the use of marihuana cigarettes has been indulged in by criminals so as to relieve themselves from the natural restraint which might deter them from the commission of criminal acts, and to give them the false courage necessary to commit the contemplated crime.
By 1931, those states in which marihuana use was at all common had formally responded with a total eliminationist policy. They generally amended the preexisting narcotics legislation to include marihuana. Meanwhile, in 1929, the Federal Government already had classified marihuana officially as a "habit-forming drug along with the opiates and cocaine, in the legislation which established two federal "farms" for treating narcotics addicts in Fort Worth, Texas, and Lexington, Kentucky.
During the 1930's, the remaining states criminalized marihuana use by adopting the Uniform Narcotic Drug Act, in which the drug was included (optionally) in the definition of narcotic drugs. Then, in 1937, Congress adopted the Marihuana Tax Act, completing the initial period of official response to marihuana use.
A difference of opinion among historians still exists as to why policymakers thought national legislation was necessary at that time. Whatever the reason, however, Congress responded swiftly, without much attempt to learn the facts about the drug and its use. The assumptions underlying that legislation were summarized in the Report of the House Ways and Means Committee:
Under the influence of this drug the will is destroyed and all power of directing and controlling thought is lost. Inhibitions are released. As a result of these effects, it appeared from testimony produced at the hearings that many violent crimes have been and are being committed by persons under the influence of this drug. Not only is marihuana used by the hardened criminals to steel them to commit violent crimes, but it is also being placed in the hands of high-school children in the form of marihuana cigarettes by unscrupulous peddlers. Cases were cited at the hearings of school children who have been driven to crime and insanity through the use of this drug. Its continued use results many times in impotency and insanity.
When Congress escalated penalties for narcotics offenses in 1951 and again in 1956, marihuana was included, with the following effects:
Possession Minimum sentence
First offense ------------------------------------------ 2 years
Second offense ---------------------------------------- 5 years
Third and subsequent offense --------------------------- 10 years
Fine ------------------------------------------------- $20,000
Sale Minimum sentence
First offense ------------------------------------------ 5 years
Second and subsequent offense --------------------------- 10 years
Sale to minor by adult ---------------------------------- 10 years
Parole or probation were made unavailable to all except first offenders in the possession category.
The perceptions of 1937 were perpetuated in the comments of Senator Price M. Daniel, Chairman of the Senate subcommittee considering the 1956 Act, although by now an important new factor had been added:
Marihuana is a drug which starts most addicts in the use of drugs. Marihuana, in itself a dangerous drug, can lead to some of the worst crimes committed by those who are addicted to the habit. Evidently, its use leads to the heroin habit and then to the final destruction of the persons addicted.
The Change
With the adoption of marihuana use by middle and upper class college youth in the mid-60's, the exaggerated notion of the drug's dangers and the social tension so widespread during this period combined to reopen the question of the impact of marihuana use. But governmental policy held to the appropriateness of existing law.
Arrests, prosecutions, convictions and sentences of imprisonment all increased at both the federal and state levels. Marihuana arrests by the U.S. Bureau of Customs increased approximately 362% from fiscal year 1965 to 1970. Arrests by the Bureau of Narcotics and Dangerous Drugs, an agency which concerns itself primarily with sale, rose 80% from 1965 to 1968. Because major responsibility for enforcing the possession laws lies at the state level, state arrests rose dramatically (1,000%) during the five years from 1965 to 1970. Although the data compiled by the Federal Bureau of Investigation are not comprehensive, the FBI sample tracks the continuing increase of state arrests (Table 6).
Table 6.-STATE MARIHUANA ARRESTS
YearArrestsPercentage increase
196518,815
196631,11965.39
196761,84398.73
196895,87055.02
1969118,90324.02
1970188,68258.68
In the wake of this upsurge in marihuana arrests, the criminal justice system faced a far from usual "criminal" population. Nonetheless, judging from federal figures, the number of people prosecuted, convicted, and incarcerated did rise substantially as prosecutors and judges attempted to carry out the law.
Beginning in 1966, however, the proportion of defendants ultimately convicted declined gradually, as did the percentage of defendants who were incarcerated, and the average length of their sentences. This response reflected an attempt to -mitigate the harshness of the law as applied to this new user population. By 1968, the trend toward leniency seemed to have temporarily leveled off, before it accelerated again in 1969 (Table 7).
Paralleling the vigorous law enforcement effort between 1965 and 1968 was a punitive reaction in the schools and large numbers of students using marihuana were suspended, expelled or referred to the police. Similarly, the military's first reaction to the surge of marihuana use took the form of court-martial, administrative punishment, or discharge from the service.
Table 7.-DISPOSITION OF FEDERAL MARIHUANA ARRESTS
YearTotal defendantsPercent convictedPercent incarceratedAverage length of sentence (in months)
19648549
1965523905258.2
1966746874553.7
19679418038.551.0
19681,4337939.451.2
19692,1897634.352.6
19702,0827327.446.7
19713,3236028.539.9
The family, however, suffered the most from the sudden conflict between accepted norms and this expression of youthful independence. The use of drugs, particularly marihuana, became a significant barrier between parent and child. Many young people adopted marihuana as a symbol of their uneasiness with society's prevailing norms.
As noted in Chapter 1, the sudden increase in marihuana use precipitated extensive research by the medical and scientific communities. By 1969, a consensus emerged holding that many of the earlier beliefs about the effects of marihuana were erroneous. Available U.S. data seemed to indicate that dependence on the drug was rare, as was the incidence of psychosis among marihuana users. Particularly important was the recognition that there was little, if any, convincing proof that marihuana caused aggressive behavior or crime. As such findings accumulated, public attention was drawn increasingly to the consequences of existing policy: soaring arrests, convictions and in some states, lengthy sentences.
Policy-makers, in social institutions and government, as well as the public began to believe that the harshness of the criminal penalties was far out of proportion to the dangers posed by the drug. As users were incarcerated, newspapers and television stations often brought the matter to public attention, particularly when the arrested youngster came from a prominent family.
Official response to this development was twofold: a trend toward leniency in marihuana cases within the legal system, and a recognition by policy-makers of widespread uncertainty regarding the effects of marihuana.
Reflecting the first response, the courts, prosecutors and police applied existing law more leniently, and the law-makers in most states and at the federal level changed the letter of the law, reducing the penalties for possession of marihuana, generally to a misdemeanor (up to a year in jail). In the process, they repealed the mandatory minimums which had been of major concern to the judiciary.
By June 1970, 24 states and the District of Columbia had reduced the penalties, although 34 states and the District still classified marihuana as a narcotic. Meanwhile, on the federal level, Congress had been considering the Nixon Administration's comprehensive proposal to overhaul the national government's patchwork of drug legislation.
Since the passage of the Harrison Narcotics Act in 1914, federal drug laws had taken the form of tax measures, an approach compelled for constitutional reasons. The Marihuana Tax Act of 1937 followed the same format. The result, however, was a complex set of offenses involving order forms and registrations. When the Supreme Court declared certain aspects of the Tax Act unconstitutional in 1969, revision of the law became essential. Taking up the challenge, the Administration proposed a major piece of legislation which tightened control over pharmaceutical distributions and also reappraised the penalty structure for narcotics and dangerous drug offenses.
Possession of all drugs, including marihuana, was reduced to a misdemeanor. Special treatment for first offenders was provided, allowing expungement of the record upon satisfactory completion of a probationary period. Casual transfers of marihuana were treated in the same manner as possession. After a series of wide-ranging hearings, Congress passed the Comprehensive Drug Abuse Prevention and Control Act, and on October 27, 1970, the President signed it into law.
After passage of the new federal drug law, the Conference of Commissioners on Uniform State Laws adopted a Uniform Controlled Substances Act, conforming in structure and emphasis to the federal law. Although the Uniform Act specifies no penalties, the Commissioners recommended that possession of all drugs be a misdemeanor.
At this writing, 42 of the states and the District of Columbia classify possession as a misdemeanor or have adopted special provisions so classifying possession of small amounts of marihuana. In half of the remaining eight jurisdictions, the courts have discretion to sentence possessors as misdemeanants.
In 11 jurisdictions, casual transfers are treated in the same manner as possession, and in 27 jurisdictions, conditional discharge is available to certain classes of offenders.
The second characteristic of the 1969-70 official response was its acknowledgment of uncertainty. No longer perceived as a major threat to public safety, marihuana use had now become primarily an issue of private and public health. Scientific researchers were asked to define the nature and scope of the health concern. In a sense, lawmakers took the minimum official action dictated by social and scientific realities, but were uncertain where to go from there. The need to know more about the effects of the drug, particularly its chronic, long-term effects, became the core of official response.
Many states appointed special task forces and commissions to report on marihuana and drug abuse in general. Congress directed the Department of Health, Education and Welfare to file annual Reports on Marihuana and Health and, in the Comprehensive Drug Abuse Prevention and Control Act of 1970, established this Commission.

The Current Response
In addition to an objective appraisal of the effects of marihuana use, this Commission was directed to evaluate the efficacy of existing law. The marihuana laws were and still are the focus of much public debate. We have recognized from the outset that a meaningful evaluation of the law is dependent upon an understanding of objectives and the social context in which the law operates. Particularly important in this connection are the attitudes and practices of society's non-legal institutions and the general direction of public opinion.
In order to comprehend the entire range of contemporary social response, the Commission launched a threefold inquiry. First, we designed a series of projects designed to ascertain opinion and behavior within the criminal justice system. Included were an analysis of all marihuana arrests during the last six months of 1970 in six metropolitan jurisdictions, a similar study of all federal marihuana arrests during 1970, an opinion survey of all local prosecuting attorneys, and a similar survey of attitudes among a representative sample of Judges, probation officers, and court clinicians.
We next focused on the practice and opinion of the medical, clerical, educational, and business communities. To this end, we solicited written responses from representative groups, invited various spokesmen to testify before us, made numerous field visits to secondary schools, colleges and universities and surveyed opinion in free clinics and university health services. We also launched a study of drug use and abuse in industry which will be covered in our second Report on drug abuse.
Finally, we commissioned the National Survey of public opinion about marihuana to which we have previously referred.

THE CRIMINAL JUSTICE SYSTEM
How does the criminal justice system respond when an enormous increase in an illegal conduct, of a primarily private nature, makes full enforcement of the law impossible, and when there is widespread doubt about the rationale for making the conduct illegal? This question guided our analysis of the responses and opinions from members of the criminal justice system.
Law Enforcement Behavior
On the basis of a detailed study of all federal marihuana arrests during 1970 and of a sample of state arrests during the last half of 1970 in Cook County, Illinois; Dallas, Texas; Omaha, Nebraska; Tucson, Arizona; San Mateo County, California; and the Washington, DC Metropolitan Area, we present the following findings.
FEDERAL The federal authorities make little or no effort to seek out violators of laws proscribing possession of marihuana. The Federal Government ceded responsibility for enforcement of possession laws to the states several years ago. However, in the course of general enforcement activity, the Federal authorities do make possession arrests. If a person is arrested at the Federal level for possession or casual transfer of small or moderate amounts of marihuana, the case generally is either dropped or turned over to the states for prosecution.
The Bureau of Narcotics and Dangerous Drugs does not concentrate much of its energy on marihuana. By its own estimate, approximately 6% of its investigative efforts are directed at marihuana offenses. Most BNDD marihuana arrests occur as a result of the agency's general investigation into the commercial distribution of all drugs.
The overwhelming majority of all federal marihuana arrests occur at or near the borders, as the Bureau of Customs, sometimes in cooperation with the Border Patrol of the Immigration and Naturalization Service, attempts to interdict the importation of the drug.
State
At the state level, where enforcement of the possession laws is focused, about 93% of the arrests in our sample were for this offense. Yet, there was little formal investigative effort to seek out violators of the possession laws. Instead, 69% of all marihuana arrests arose from spontaneousor accidental situations where there had been no investigation at all. Well over half of these spontaneous arrests occurred when police stopped an automobile and saw or smelled marihuana. The remaining spontaneous arrests occurred when police stopped persons on the street or in a park and discovered marihuana.
In an additional 16% of the cases, the marihuana arrest resulted from police follow-up of a phoned tip or similar lead. In less than 11% of all the cases was there any significant police involvement. (Scope of investigation was unknown in about 4% of the cases).
Because of this enforcement pattern, arrests were concentrated among the young. Typically the arrestee was a white male, in school or employed in a blue collar job, without a prior record. Of those arrested at the state level:
* 58% were under 21; 30% were between 21 and 26; 10% were over 26 (2% unknown)
* 85% were male; 15% were female
* 77% were white; 21% were black; 2% were Spanish speaking
* 27% were students, 2% were military; 28% were employed in blue collar jobs; 15% were employed in white collar jobs; 11% were unemployed (16% unknown)
* 44% had not been arrested previously; 31% had been arrested previously (in 25% of the cases, the extent of prior contact was unknown) ; only 6% of the arrestees had been previously inearcerated
Such arrestees generally possessed only small amounts of marihuana. Of our entire sample of 3,071 arrests:
  • 67% were for possession of less than one ounce (18% were for less than one gram; 23% were for between one and 5 grams; 26% were for between 5 and 30 grams)
  • 7% were for possession of between one ounce and 4 ounces
  • 8% were for possession of over 4 ounces
  • 13% were for possession of unknown quantities
  • 3 % were for transfer of less than one ounce
  • 3% were for transfer of over one ounce,*
Offenders at the state level were generally arrested in groups.
* 29 % were arrested alone
* 24% were arrested with one other person
* 43% were arrested with two or more other persons (4% unknown) Faced with this population of offenders, the criminal justice System responded often by dismissing or diverting to a noncriminal institution the young first-offense possessor of small amounts. 
Adult Cases
At least 48% of the cases were terminated in the defendant's favor:
The police themselves disposed of l0% of the cases, refraining from filing charges, or diverting the case, to some other institution.
The prosecution declined to file complaints in an additional 7% of the cases.
An additional 28% of the cases were dismissed in the course of pretrial judicial proceedings.
In 3% of the cases, the defendant was acquitted at trial.
*Because the figures have been rounded off, the total is not always 100%.
Juvenile Cases
At least 70% of the cases were terminated in the youth's favor:
The police themselves disposed of 21% of the cases, refraining from referring the youth to juvenile authorities or diverting the case to some other agency.
An additional 48% of the cases were dismissed either because the juvenile officer responsible for filing a delinquency petition refused to do so, or because the judge dismissed the case prior to trial.
in 1% of the cases, the juvenile was found innocent.
Of the entire sample of arrests, both adult and juvenile, 33% of those apprehended were ultimately sentenced,, after pleading guilty or being found guilty. (Since 11% of the 3,071 cases -were still pending at the time of our study, and disposition was unknown in 2% of the cases, the figure may be as high as 40% of all arrests).
Of those convicted for possession of marihuana, 24% were incarcerated, usually for a year or less. Most of the remaining persons were put on probation, although some were fined only. By comparison, of those convicted of sale (5% of the convicted individuals), 65% were incarcerated, usually for over a year.
In short, in the 2,610 cases where disposition was final and was available to 6% of those apprehended were ultimately incarcerated.
From this analysis of enforcement behavior. it appears that the law enforcement community has adopted a policy of containment. Although effort is sometimes expended to seek out private marihuana use, the trend is undoubtedly to invoke, the marihuana possession laws only when the behavior (possession) comes out in the open. We were told by police officials in some cities, for example, that arrests are made only when marihuana use is flaunted in public.
The salient feature of the present law has become the threat of arrest for indiscretion. The high percentage of cases which, after arrest, are disposed of by dismissal or informal diversion attests to the ambivalence of police officials, prosecutors and judges about the appropriateness of existing law. Anyone processed through the entire system does run a risk of incarceration, especially when the individual had a prior record and the offense was sale or possession of a significant amount.
Law Enforcement Opinion
Prosecutorial opinion toward the existing system suggests both a containment objective and a, flexible, response. As to prosecution policy:
31% of the prosecutors state that they would not prosecute anyone one arrested at a private, social gathering of marihuana users who are passing a cigarette.
Large numbers of prosecutors admit that they consider factors other than strength of the evidence in deciding whether or not to prosecute a possession case; 41% cite age, 38% cite lack of prior record, 36% consider the amount of marihuana seized and 26% take into account the family situation of the accused; 31% thought one or another of these non-legal factors was most important in his decision
29% of the prosecutors acknowledge that they use informal probation in lieu of prosecution in some cases.
As to the efficacy of existing law, a majority of the prosecutors agree that the marihuana laws do not deter, or deter only minimally:
Persons under 30 from initiating use (53%)
Users from using regularly (56%)
Users from transferring small amounts for little or no remuneration (55%)
From the studies made by the Commission of enforcement practices, we consider this to be a realistic assessment.
Conversely, however, the prosecutors agree that the laws have a significant effect in deterring users from smoking marihuana openly (62%) and persons over 30 from initiating use (44%).
We also asked the district attorneys for their views on an appropriate legal policy concerning marihuana use. Their opinions tend to fall in three groups. One group, representing about 25% of the prosecutors, favors the status quo, and does not want any further reduction in penalties. A fifth of the prosecutors conclude, on the basis of their experience, that possession of marihuana, and perhaps sale of the drug, should be removed entirely from the criminal justice system.
The remaining prosecutors, a majority, is willing to consider mitigation of the harshness of the law either by legislation or by benign exercise of discretion, but is reluctant to relinquish formal, criminal control. These prosecutors doubt the deterrent value of the law and are willing to be lenient in appropriate cases, but they believe some use of the legal system is necessary to prevent all increase in marihuana use.
Underlying these opinions are diverse attitudes about marihuana use and the efficacy of existing law. For example, prosecutors who doubt the efficacy of existing law and reject the "escalation" and "aggressive behavior" hypotheses, are generally willing to modify the laws by their enforcement policies and by legislative reform (Table 8).
The same general pattern of practice and opinion emerges at the judicial and dispositional level. Only 13% of the responding judges would jail an adult for possession of marihuana and only 4% said they would incarcerate a minor. Lesser proportions of probation officers and clinicians would imprison adults (8% and 1%) and minors (2% and %). Conversely, 11% of the Judges, 15.5% of the probation officers and 63.5% of the clinicians noted that they would assess no penalty for possession by adults. For minors, the proportions are 3%, 5%, and 35% respectively.
Table 8.-DISTRICT ATTORNEYS, OPINIONS
Percent who
Percent who Percent who believe the
believe believe marihuana Percent
Change favored marihuana marihuana laws do not who utilize
leads to leads to deter persons informal
hard drug aggressive under 30 probation
use behavior from initi-
ating use
None 87.1 47 51.3 28.5
Reduction of possession
penalties 68.8 35.1 63.2 34.3
Preclusion of incarceration. . 64.7 33 59 33.2
Decriminalization of
possession of small
amounts 41.5 21.9 67.2 37.4
Legalization of marihuana. .. 32.2 11.1 69 37.8
How to read table: 87.1%, of the prosecutors who favor no change in existing law believe that marihuana leads to the use of hard drugs; in contrast, 32.2% of the prosecutors who favor legalization believe that marihuana leads to the use of hard drugs.
With regard to appropriate legal policy, the judges exhibit the same inclination as the prosecutors to look for alternatives within a formal control system which would avoid the use of criminal penalties. We asked essentially the same question in two ways and received similar responses (Table 9).
The judges, as a group, are less enthusiastic about criminal control than the prosecutors, but are equally unwilling to relinquish formal control. By contrast, the probation officers and clinicians, who have more personal contact with these offenders and are perhaps more intensively aware of the control potential of the criminal justice systern, are highly skeptical about formal control (Tables 10, -and 11).
In conclusion, as one proceeds through the criminal justice system, from district attorneys to court clinicians, the people responsible for the functioning of that system seem to be decreasingly enthusiastic about the appropriateness of criminal control and decreasingly insistent on any technique for formal control.
Table 9.*-JUDGES, OPINIONS
Types of Means of control Percent Statutory schemes Percent
control for adult users who for possession who
favored favored
Informal Personal choice 11 Control outside 24.3
control Informal social 22 criminal justice
control system
Non-criminal Required treatment 21 Expungement of 57.9
formal Other 11 criminal record
control
Criminal Criminal law 25 Control within 11.5
control criminal justice
system
'Because of a small percentage of non-responses, figures do not always total 100%.
How to read table: When asked to identify the appropriate means of control for adult users, 33% of the judges opted for informal control (1 1% would rely on personal choice and 22%, would rely on informal social control). Similarly, when asked about the appropriate statutory scheme for possession, 24.3% of the judges preferred control outside the criminal justice system, a functional equivalent of "informal control."
Table 10.*-PROBATION OFFICERS' OPINIONS
Types of Means of control Percent Statutory schemes Percent
control for adult users who for possession who
favored favored
Informal Personal choice 21 Control outside 35.5
control Informal social 32.7 criminal justice
control system
Non-criminal Required treatment 11.8 Expungement of 54.5
formal Other 10 criminal record
control
Criminal Criminal law 15.5 Control within 9
control criminal justice
system
*Because of a small number of non-responses, the figures do not always total 100%.
To supplement our survey of behavior and opinion within the criminal justice system, we also solicited the views of the American Bar Association. The President of the A13A in turn urged the respective Committees of the Association to submit their views to us. The two Committees directly concerned with the drug area, the Committee on Alcoholism and Drug Reform of the Section oNn Individual Rights
Table ll.*-CLINICIANS, OPINIONS
Types of Means of control Percent Statutory schemes Percent
control for adult users who for possession who
favored favored
Informal Personal choice 61.7 Control outside 74
control Informal social 21 criminal justice
control system
Non-criminal Required treatment 1 Expungement of 22.6
formal Other 10 criminal record
control
Criminal Criminal law 3.5 Control within 0
control criminal justice
system
'Because of a small number of non-responses, the figures do not always total 100%.
and Responsibilities, and the Committee on Drug Abuse of the Section on Criminal Law, were in essential agreement regarding the appropriate course of action.
Both Committees expressed doubt about the wisdom and legitimacy of existing policy and about the, capacity of the criminal justice system to deal with marihuana use. They both urged the Commission to recommend the removal of criminal penalties from possession of the drug for personal use and casual non-profit transfers. Both Committees suggested that a regulatory approach to distribution of the drug be given serious consideration.

THE NON-LEGAL INSTITUTIONS
Law enforcement authorities, given available and prospective resources, cannot possibly enforce the existing marihuana laws fully. The best they can do is keel) marihuana use contained and out of sight. In addition, many officials within the criminal justice system are reluctant to enforce the marihuana laws, being either uncommitted to the usefulness of this particular law or opposed to the law itself. The net result is for the legal system to leave much of the responsibility for social control to other social institutions such as family, schools, churches, and the medical profession. Since these other institutions themselves have relied heavily on the legal system for control, caution and confusion now dominate the social response to marihuana use.
The diminishing severity of the law enforcement response may not have occurred if the other institutions of society had continued to regard the marihuana user as a criminal. However, many of these institutions have come to view the marihuana user primarily in social or medical terms, and to recommend a form of social control in accord with their respective self-interests or orientations. In many cases, the ,attitudes of these other institutions mirror that of the criminal justice system: uncertainty about the proper role of formal legal control.
The Family
The most important institution for instilling social norms is the family. Parental attitudes generally parallel public opinion, and specific responses in our National Survey suggest an inclination among parents and non-parents to deal with youthful marihuana users through discussion and persuasion rather than harsh or punitive measures. When asked what action they would take upon discovering that one of their teenage children was smoking marihuana with friends, 47% of the adults responded that they would use persuasion and reason. Twenty-three percent favored a punitive approach. Interestingly, 9% of the latter group felt so strongly about the matter that they were willing to report their own child to the police. A considerable number, 35% indicated that they were uncertain about what to do, or failed to respond to this multiple response question.
The non-punitive trend was also apparent when the adults were asked what they would do if their teenage child was arrested for a marihuana offense. A substantial number (58%) indicated they would attempt to extricate their child from the situation, many not wishing their child to have a police record, while 34% expressed the sentiment that the child's arrest would help him learn a lesson.
The Schools
Marihuana use continues to increase among high school and college students. The National Survey reveals that 30% of the high school juniors and seniors have used marihuana. The National Survey also reveals that 44% of those currently attending college at the graduate or undergraduate levels have used it, while other surveys indicate this figure is significantly higher in some major universities.
Not surprisingly, there has been, during the last two years, ail appreciable change in the attitudes of school administrators, faculty and even of the boards of education and trustees toward marihuana use, Administrators at the secondary and college levels are generally more relaxed and tolerant toward marihuana, use than they were during the mid-1960's, when support for a punitive response was common. After the initial shock of widespread use dissipated, many school officials came to believe that strong disciplinary action, including suspension and arrest, was counterproductive. In addition, as the evidence accumulated that marihuana, was not as dangerous as had once been thought, parental and community pressures were sometimes brought to bear on school administrators to be less punitive and more understanding of marihuana use.
At the secondary level, the policies very somewhat from state to state and even within states. Nevertheless, school boards generally seem to have become less enthusiastic about suspension and arrest as an appropriate response to marihuana use. One school administrator in Philadelphia noted sarcastically that if all users were suspended or arrested, the high schools would become empty cells, with their entire clientele turned out onto the streets.
A West Coast official emphasized that student alcohol use was a much more serious problem than marihuana use; he even suggested that legalization of marihuana might reduce alcohol use among the young. The Commission ascertained that no suspensions for marihuana use had occurred during 1971 in the entire school system of a southern metropolitan area. Although security officers in that system did make 20 arrests, they were all for selling marihuana and other drugs.
At the secondary level, then, increased reliance is being placed on persuasion rather than discipline, as a means of discouraging marihuana use. Drug education programs, now being instituted in almost every school system, often include information about alcohol and tobacco. We will explore the various pedagogical techniques employed in such programs and will attempt to evaluate them in our next Report.
At the college level, the response is even more lenient. In many cases official neutrality or even protection against police intervention substitutes for the restraint common at the secondary level. Under formal or informal arrangements with local law enforcement officials, many schools bar on-campus arrests for marihuana use. Apparently they have concluded that enforcement of the marihuana laws causes more harm. than does use of the drug. In some cases, college authorities have substituted their own policy for society's official policy. The Commission learned at one of its hearings in Chicago, for example, that a major Midwestern university explicitly declared that students would be subject to university disciplinary action if they were found in possession of more than one week's supply of marihuana.
Control at the college level is usually considered a medical Concern and is handled either through the university health centers or free clinics. The trend toward leniency is also apparent in the policy responses of the representative sample of university health service and free clinic physicians. whose profession presumably brings them into contact with the population most it risk from marihuana. Among personnel of the free clinics, 62% of the respondents favor legalization; 5% would continue the present policy, and the remainder would either reduce penalties (11%) or await further research (22%).
Even among the "establishment-oriented" health service personnel, similar attitudes prevail. Nineteen percent would continue the present policy, and 16% would legalize. Of the remaining 55% (10% did not respond), 38% would reduce, penalties and 17% would await further research. This pattern of views bears a striking resemblance to that of the prosecuting attorneys, and indeed of the public at large. The large majority indicates uneasiness with the present system and opposition to legalization, but is uncertain about exactly what to do.
The Churches
The nation's churches play a major role in the process by which society's norms and values are transmitted to the young. Moral education, through individual and family counseling by church personnel, is influential in the process of social control, particularly for adolescents. Consequently, the Commission sought to learn the attitudes, responses and recommendations of the clergy.
The larger societal uncertainty about the social and moral implications of marihuana use is also reflected in the attitudes of religious institutions. For example, Dr. Thomas E. Price, speaking for the National Council of Churches of Christ in the U.S.A. before the Commission, referred to marihuana as a "tightly drawn moral knot." This uncertainty has led many religious groups to minimize a punitive and repressive response to marihuana use in their official statements and formal programs. Instead, they have concentrated on educational and rehabilitative programs.
Many church spokesmen have urged a reconsideration of social and legal policy. The range of their suggestions for change reflects, once again, widespread uncertainty. Some ask for some form of "adequate" punishment or supervision so as to discourage marihuana use. Others say "reform or elimination" of penalties for possession would be appropriate. And there are those who suggest legalization with some government regulation. Some church spokesmen have defended existing policy, recommending only that the law be more strictly and uniformly enforced.
The Medical Community
In contrast to the mixed opinions of other segments of society, the medical profession has a rather broad consensus at the present time. In a series of responses from various medical societies, associations and committees, we found certain recurrent themes. Every medical group emphasized the need for more research into the effects of marihuana. There was uniform emphasis on how marihuana, as a "drug," affects heart, head, blood, brain and so on, but not on how it affects society as a behavior. The consensus was that marihuana, the drug, poses some danger for the individual, physically or psychologically. The only major disagreement is about the degree of such danger.
The second recurrent theme was that marihuana should definitely not be legalized. Legalization would imply sanction, medical groups said, with a probable, increase in use as a result. One doctor compared legalization with the failure of Prohibition: "The fact [that] Prohibition was a failure doesn't make alcoholism a good thing and the six million or so (alcoholics) we have are no bargain. Therefore, since there is no legitimate use for marihuana it seems rather silly to legalize its use to initiate a second headache." Another reason commonly given by physicians for opposing legalization is that such a step should be taken if and when it is proven that marihuana is not dangerous.
The third common theme of medical opinion was a call for a more. lenient approach toward users, again a position reflected in almost every quarter of society. One officer of a public health association told a convention: " (Our committee) deplores the strong punitive measures suggested by some because we feel that a jail sentence for the offense of smoking marihuana is not likely to solve the problem of eliminating marihuana use. On the contrary, a prison sentence is likely to do great damage to a young person's personality as well as to his future career." Another group called for prosecutors to use discretionary powers in handling youthful first offenders.
When discussing penalties, the medical community begins to take, a look at marihuana use as a form of social behavior rather than simply a drug which produces certain physical and psychological effects. One doctor wrote: "Because marihuana in present patterns of use is, by and large, a relatively innocuous drug and because its use has many motivations from simple curiosity to symbolism of hostility to the 'establishment', the legal penalties in many jurisdictions throughout the United States are excessively punitive."

Summary
Social institutional spokesmen now commonly recognize that control of marihuana is only partially a law enforcement problem. Opinions cluster around the propositions that society should not be punitive on the one hand, but should not make the drug available, at least for now. Beyond these points, however, uncertainty prevails. There is no common vision of an appropriate social control policy.
Each institution is going about the business of control in its own way. Parents emphasize mutual communication. The secondary schools emphasize health education. The colleges recognize personal freedom so long as it does not jeopardize the educational enterprise. Churches emphasize uncertainty about the moral implications of marihuana use. The medical fraternity stresses the need for further research into the health consequences of marihuana use. Uncertainly is the common denominator.
THE PUBLIC RESPONSE
For most Americans marihuana use is not an abstract phenomenon. Fifteen percent of the adult population, the National Survey revealed, has tried the drug and 44% of the non-trying adults personally know someone who has used the drug. Fourteen percent of the youth have tried the drug and 58% of the non-triers personally know someone who has used the drug. Indeed, six percent of the non-trying youth indicated that half or more of their friends used marihuana.
The public is also aware of the consequences of the existing system and concerned about its impact. Ninety-seven percent of the adults know that selling marihuana is against the law. Only a few less, 94%, know that possession is against the law. In fact, one fourth of the adults know someone who has been arrested on a possession charge. Ninety-two percent of the youth know that sale is prohibited, and four out of five know that possession is against the law. Fifty-three percent of the 16- and 17-year-olds actually know someone who has been arrested for possession.
Acutely aware of the legal consequences of use, the public is also cognizant of the difficulties encountered by the criminal justice system in its attempt to enforce a widely-violated law, Adults were asked whether they mostly agreed or mostly disagreed with a series of 12 selected propositions regarding the desirability of maintaining or altering the present system of marihuana control. The two propositions which received the most support relate to problems inherent in the existing laws.
Eighty-three percent of the adults mostly agreed with the statement that "because of marihuana a lot of young people who are not criminals are getting police records and being put in jail." And 76% agreed that "laws against marihuana are very hard to enforce because most people use it in private."
Marihuana use is more personal than most public issues, but it is also more confusing. Bombarded in recent years -with contradictory "findings" and statistics about the effects of marihuana, and with conflicting arguments about public policy, the public tends to believe everything, whether pro or con. Particularly important in this regard is the widespread acceptance of beliefs which have little basis in fact.
Approximately half of the adult public believes that "many crimes are committed by persons who are under the influence of marihuana," and that "some people have died from using it." Seven of every 10 adults believe that "marihuana makes people want to try stronger things like heroin." Although the probability that a person believes these statements increases with age, a significant percentage of all groups are represented.
The underlying confusion is strongly indicated in the contradictory attitudes toward various reasons for maintaining or changing the law. For example, 43% of the adults thought, in the context of an argument for making marihuana legal, that "it should be up to each person to decide for himself, like with alcohol or tobacco." Yet 75% of the adults agreed, in the context of an argument for keeping the laws the way they are, that "there are already too many ways for people to escape their responsibilities. We don't need another one."
Youth tend to be less convinced than adults that marihuana use may be fatal to the user, or cause him to commit crime or lead him to use other drugs; but young people as a group also are noticeably more uncertain about these matters. One of every four young people indicated that they were unsure whether marihuana caused death or crime, and one of every six expressed uncertainty regarding the progression to other drugs. Similarly, young people were more than twice as likely as adults to have "no opinion" about the various propositions regarding the need for legal change.
Public attitudes toward marihuana exhibit both doubt and tension. On the one hand, we note an acute awareness of the legal consequences of marihuana use and an appreciation of the adverse impact of processing users through the criminal justice system. On the other hand, we note some misconceptions about the dangers of marihuana and confusion about the consequences of changing or maintaining the present system.
Public responses on the basic questions of social and legal policy reflect the underlying ambivalence. The overwhelming majority of the public does not want to treat the marihuana user harshly. This attitude appeared repeatedly through the entire Survey. When asked "For the good of the country, which of the following courses of action would be the best thing to do about [marihuana use] ?" the public responded in the following manner:
Percentage Youth Adults* 12-17
Handle the problem mostly through the police and courts:
the process of arrest, conviction, punish-
ment ------------------------------------------ 37 90
Handle the problem mostly through medical clinics:
the process of diagnosis, treatment, care ----------- 51 48
Don't worry about the use of marihuana, but spend time and money on preventing and solving other crimes
No opinion --------------------------------------- 5 20
*Some adults gave more than one answer.
Adults and youth were also asked to look at marihuana use from the perspective of the system, and to identify the appropriate penalty for possession of marihuana. Both groups were reluctant to put users in jail, especially for a first offense. Eighty-three percent of the adults and 64% of the youth would not incarcerate a youthful first offender; 54% of the adults and 41 % of the youth would not even give the young offender a police record (Table 12).
Table 12.-ADULTS' VIEWS ON POSSESSION PENALTIES
If defendant is teenager If defendant is adult
Penalty
First Previous First Previous
offense conviction offense conviction
(percent) (percent) (percent) (percent)
No penalty 20 Total 6 Total 13 Total 7 Total
Fine (no police record).. 34 83 11 37 28 64 6 24
Probation 29 20 23 11
Jail sentence
Up to a week 8 Total 20 Total 11 Total 14 Total
Up to a year 3 13 24 56 12 32 24 70
More than a year 2 12 9 32
No opinion 4 7 4 6
YOUNG PEOPLES, (age 12-17) VIEWS ON POSSESSION PENALTIES
If defendant is teenager If defendant is adult
Penalty
First Previous First Previous
offense conviction offense conviction
(percent) (percent) (percent) (percent)
No penalty 13 Total 6 Tota I 11 Tota 1 7 Total
Fine (no police record).. 28 64 9 35 21 50 7 27
Probation 23 20 18 13
Jail sentence
Ur, to a week 8 Total 13 Tota 1 16 Total 12 Tota I
Up to a year 6 19 21 51 11 36 18 59
More than a year 5 17 9 29
No opinion 17 14 14 14
Interestingly, the youth population as a whole was less lenient than the adult population as a whole. Within each group, however, the older teenagers and young adults were the most tolerant in all respects.
These statistics suggest that the I public generally prefers leniency when responding to questions specifically directed to marihuana use. But when asked about "control" or "the law" in general, the response often appears quite harsh. For example, when asked to consider a range of five alternative control schemes, most adults tended to resist change.
Thirty-one percent of the adults thought that making marihuana legally available through regulated channels (like alcohol) was acceptable but 67% thought it was unacceptable. Although 23% thought the removal of criminal sanctions from possession was acceptable, 74% thought this approach was unacceptable. On the other hand, 56% of the adults thought that the existing laws were, acceptable; yet 41% found the present law unacceptable. Finally, 72% thought "stricter laws" would be acceptable, while only 26% thought such a change would be unacceptable. Indeed 43% thought stricter laws were the "ideal solution" and 62% thought this was the best of the alternatives.
These responses seem to be contradictory. We are puzzled about what the respondents thought they meant when they expressed a preference for stricter laws.
They probably did not mean stricter penalties for possession. Such an interpretation would be entirely inconsistent with responses to questions aimed directly at appropriate policy toward users. Under existing law some states still treat first offenders as felons and most states treat multiple offenders as felons. But, only a third of the adult respondents would put an adult multiple offender in jail for more than a year.
The preference for stricter laws might be interpreted to mean heavier penalties for sale, or better enforcement of existing proscriptions against trafficking. Two-thirds of the adults did indicate that they preferred heavier penalties for sale than for possession. But penalties for selling for profit are already quite heavy in every jurisdiction.
We suspect that a majority of the public, including many of those favoring "stricter laws," is actually disturbed about the increase in marihuana use and would like a system which would work better than the existing system to discourage use. A majority of the adult public seeks a better system of control, albeit one which is not punitive toward the user. Apparently uneasy about the individual and social consequences of the present system, the large center of public opinion is nonetheless reluctant to relinquish formal control.
This insistence on maintenance of formal controls over the user rests upon two interrelated factors: respect for law and faith in the efficacy of legal control. First, the public does not believe the, legal order should wither away simply because many people choose to violate the laws against marihuana use. Obedience, of the, law is highly valued in our society.
This factor is illustrated clearly by the widespread public disagreement with the following arguments for changing the law: 76% of the adults disagreed with the statement that "young people would have more respect for the law if marihuana were made legal;" and four out of five adults disagreed with the statement that "so many people are using marihuana that it should be made legal."
Second, most adults believe that legal remedies, even though not punitive, are necessary to discourage use of the drug. This belief is tied largely to their understanding of the effects of the drug and is reflected in the response to the question about "the best way" to handle the use of marihuana. As we noted earlier, 51% of the public thought that marihuana use ought to be handled as a medical problem.
Also, the substantial majority of people who are reluctant to incarcerate possessors do prefer the imposition of fines without a police record or probation. Both of these alternatives retain formal control over the user and indicate faith in the deterrent value of the law. The public responses in this respect bear a striking resemblance to those of the judges and probation officers, who repeatedly indicated a preference for non-punitive formal control.
This interpretation of dominant opinion was drawn from ostensibly inconsistent responses to a long series of questions on appropriate social and legal policy. A substantial minority of the public, however, exhibited a consistent pattern of response to all questions. About a quarter of the public is convinced that the criminal sanction should be withdrawn entirely from marihuana use. Another quarter of the public prefers the criminal approach, even for the user.
In sum, the existing system is not supported by the consensus of public opinion that once existed. There is a consensus that punitive measures are generally inappropriate. There is also a predominant opinion that the legal system should not abandon formal control.


Chapter V

marihuana and social policy


"The difficulty in life is the choice."
George Moore (1900)
A constant tension exists in our society between individual liberties and the need for reasonable societal restraints. It is easy to go too far in either direction, and this tendency is particularly evident where drugs are concerned.
We have guided our decision-making by the belief that the state is obliged to justify restraints on individual behavior. Too often individual freedoms are submerged in the passions of the moment, and when that happens, the public policy may be determined more by rhetoric than by reason. Our effort has been to minimize the emotional and emphasize the rational in this Report.
Drugs In a Free Society
A free society seeks to provide conditions in which each of its members may develop his or her potentialities to the fullest extent. A premium is placed on individual choice in seeking self-fulfillment. This priority depends upon the capacity of free citizens not to abuse their freedom, and upon their willingness to act responsibly toward others and toward the society as a whole. Responsible behavior, through individual choice, is both the guarantor and the objective of a free society.
DRUGS AND SOCIAL RESPONSIBILITY
The use of drugs is not in itself an irresponsible act. Medical and scientific uses serve important individual and social needs and are often essential to our physical and mental well-being. Further, the use of drugs for pleasure or other non-medical purposes is not inherently irresponsible; alcohol is widely used as an acceptable part of social activities.
We do think the use of drugs is clearly irresponsible when it impedes the individual's integration into the economic and social system. A preference for individual productivity and contribution to social progress in a general sense still undergirds the American value structure, and we emphasize the policy-maker's duty to support this preference in a public policy judgment.
At the same time, in light of the emerging leisure ethic and the search for individual meaning and fulfillment noted in Chapter 1, we cannot divorce social policy from the questions raised by the recreational use of drugs. Productivity and recreation both have a place in the American ethical system. They are not inconsistent unless the individual's use of leisure time inhibits his productive role in society.
Drugs should be servants, not masters. They become masters when they dominate an individual's existence or impair his faculties. To the extent that any drug, including alcohol, carries with it risks to the well-being of the user and seriously undermines his effectiveness in the society, that drug becomes a matter of concern for public policy.
An essential step in the process of policy-formation is a determination of the circumstances under which use of any given drug' poses such risks. For some drugs, the risks may be so great that all permissible measures should be taken to eliminate use. For other drugs, such risks may be present only under certain specific circumstances, in which case society may defer to responsible individual choice on the matter of recreational use but take appropriate steps to minimize the incidence and consequences of dysfunctional use. In our Report next year, for which studies are already underway, we will consider from this perspective the whole range of drugs now used for non-medical purposes.
A Social Control Policy for Marihuana
In formulating a Marihuana policy, our strongest concern is with irresponsible use, whether it be too often, too much, indiscriminate, or under improper circumstances. The excessive or indiscriminate use of any drug is a serious social concern; and this is particularly true of marihuana since we still know very little about the effects of long term, heavy use. We have little doubt that the substantial majority of users, under any social control policy, including the existing system, do not and would not engage in irresponsible behavior.
In identifying the -appropriate social control policy for marihuana, we have found it helpful to consider the following policy options:
I Approval of Use.
II Elimination of Use.
III Discouragement of Use.
IV Neutrality Toward Use.
APPROVAL OF USE
Society should not approve or encourage the recreational use of any drug, in public or private. Any semblance of encouragement enhances the possibility of abuse and removes, from a psychological standpoint, an effective support of individual restraint.
For example, so long as this society (not only the government, but other institutions and mass advertising as well) in effect approved of the use of tobacco, the growing medical consensus about the dangers of excessive use did not make a significant impression on individual judgment. With the Surgeon General's Report on Tobacco in 1964, Smoking and Health, a very real change has occurred in the way society now thinks about cigarettes.
The institutions of society definitely add their influences to the variety of social pressures which persuade individuals to use any kind of drugs. Rational social policy should seek to minimize such social pressures, whether they come from peers, from the media, from social custom, or from the user's sense of inadequacy. Official approval would inevitably encourage some people to use the drug who would not otherwise do so, and would also increase the incidence of heavy or otherwise irresponsible use and its complications. On this basis we reject policy option number one, approval of use.
ELIMINATION OF USE
For a half-century, official social policy has been not only to discourage use but to eliminate it (option number two). With the principal responsibility for this policy assigned to law enforcement, its implementation reached its zenith in the late 1950's and early 1960's when marihuana-related offenses were punishable by long periods of incarceration. This policy grew out of a distorted and greatly exaggerated concept of the drug's ordinary effects upon the individual and the society. On the basis of information then available, marihuana was not adequately distinguished from other problem drugs and was assumed to be as harmful as the others.
The increased incidence of use, intensive scientific reevaluation, and the spread of use to the middle and upper socioeconomic groups have brought about the informal adoption of a modified social policy. On the basis of our opinion surveys and our empirical studies of law enforcement behavior, we are convinced that officialdom and the public are no longer as punitive toward marihuana use as they once were.
Now there exists a more realistic estimate of the actual social impact of marihuana use. School and university administrators are seldom able to prevent the use of marihuana by their students and personnel and are increasingly reluctant to take disciplinary action against users. Within the criminal justice system, there has been a marked decline in the severity of the response to offenders charged with possession of marihuana.
In our survey of state enforcement activities, only 11% of all marihuana arrests resulted from active investigative activity, and most of those were in sale situations. For the most part, marihuana enforcement is a haphazard process; arrests occur on the street, in a park, in a car, or as a result of a phone call. Among those arrested, approximately 50% of the adults and 70% of the juveniles are not processed through the system; their cases are dismissed by the police, by the prosecutors or by the courts. Ultimately less than 6% of all those apprehended are incarcerated, and very few of these sentences are for possession of small amounts for personal use.
In the law enforcement community, the major concern is no longer marihuana but the tendency of some users to engage in other irresponsible activity, particularly the use of more dangerous drugs. Official sentiment now seems to be a desire to contain use of the drug as well as the drug subculture, and to minimize its spread to the rest of the youth population. Law enforcement policy, both at the Federal and State levels, implicitly recognizes that elimination is impossible at this time.
The active attempt to suppress all marihuana use has been replaced by an effort to keep it within reasonable bounds. Yet because this policy still reflects a view that marihuana smoking is itself destructive enough to justify punitive action against the user, we believe it is an inappropriate social response.
Marihuana's relative potential for harm to the vast majority of individual users and its actual impact on society does not justify a social policy designed to seek out and firmly punish those who use it. This judgment is based on prevalent, use patterns, on behavior exhibited by the vast majority of users and on our interpretations of existing medical and scientific data. This position also is consistent with the estimate by law enforcement personnel that the elimination of use is unattainable.
In the case of experimental or intermittent use of marihuana, there is room for individual judgment. Some members of our society believe the decision to use marihuana is an immoral decision. However, even during Prohibition, when many people were concerned about the evils associated with excessive use of alcohol, possession for personal use was never outlawed federally and was made illegal in only five States.
Indeed, we suspect that the moral contempt in which some of our citizens hold the marihuana user is related to other behavior or other attitudes assumed to be associated with use of the drug. All of our data suggest that the moral views of the overwhelming majority of marihuana users are in general accord with those of the larger society.
Having previously rejected the approval policy (option number one), we now reject the eliminationist policy (option number two). This policy, if taken seriously, would require a great increase in manpower and resources in order to eliminate the use of a drug which simply does not warrant that kind of attention.
DISCOURAGEMENT OR NEUTRALITY
The unresolved question is whether society should try to dissuade its members from using marihuana or should defer entirely to individual judgment in the matter, remaining benignly neutral. We must choose between policies of discouragement (number three) and neutrality (number four). This choice is a difficult one and forces us to consider the limitations of our knowledge and the dynamics of social change. A number of considerations, none of which is conclusive by itself, point at the present time toward a discouragement policy. We will discuss each one of them separately.
1. User Preference Is Still Ambiguous
Alcohol and tobacco have long been desired by large numbers within our society and their use is deeply ingrained in the American culture. Marihuana, on the other hand, has only recently achieved a significant foothold in the American experience, and it is still essentially used more by young people. Again, the unknown factor here is whether the sudden attraction to marihuana derives from its psychoactive virtues or from its symbolic status.
Throughout this Commission's deliberations there was a recurring awareness of the possibility that marihuana use may be a fad which, if not institutionalized, will recede substantially in time. Present data suggest that this is the case, and we do not hesitate to say that we would prefer that outcome. To the extent that conditions permit, society is well advised to minimize the number of drugs which may cause significant problems. By focusing our attention on fewer rather than more drugs, we may be better able to foster responsible use and diminish the consequences of irresponsible use.
The more prudent course seems to be to retain a social policy opposed to use, attempting to discourage use while at the same time seeking to deemphasize the issue. Such a policy leaves us with more options available when more definitive knowledge of the consequences of heavy and prolonged marihuana use becomes available.
2. Continuing Scientific Uncertainty Precludes Finality
In 1933 when Prohibition was repealed, society was cognizant of the effects of alcohol as a drug and the adverse consequences of abuse. But, because so many people wished to use the drug, policy-makers chose, to run the risk of individual indiscretion and decided to abandon the abstentionist policy. There are many today who feel that if the social, impact of alcohol use had then been more fully understood, a policy of discouragement rather than neutrality would have been adopted to minimize the negative aspects of alcohol use.
Misunderstanding also played an important part when the national government adopted an eliminationist, marihuana policy in 1937. The policy-makers knew very little about the effects or social impact of the drug; many of their hypotheses were speculative and, in large measure, incorrect.
Nevertheless, the argument that misinformation in 1937 automatically compels complete reversal of the action taken at that time is neither reasonable nor logical. While continuing concern about the effects of heavy, chronic use is not sufficient reason to maintain an overly harsh public policy, it is still a significant argument for choosing official discouragement in preference to official neutrality.
3. Society's Value System Is In a State of Transition
As discussed in Chapter 1, two central influences in contemporary American life are the individual search for meaning within the context of an increasingly depersonalized society, and the collective search for enduring American values. In Chapter IV, we noted that society's present ambivalent response to marihuana use reflects these uncertainties.
For the reasons discussed in the previous Chapters, a sudden abandonment of an official policy of elimination in favor of one of neutrality toward marihuana would have a profound reverberating impact on social attitudes far beyond the one issue of marihuana use. We believe that society must have time to consider its image of the future. We believe that adoption of a discouragement policy toward marihuana at this time would facilitate such a reappraisal while official neutrality, under present circumstances, would impede it.
4. Public Opinion Presently Opposes Marihuana Use
For whatever reasons, a substantial majority of the American public opposes the use of marihuana, and would prefer that their fellow citizens abstain from using it. In the National Survey, 64% of the adult public agreed with the statement that "using marihuana is morally offensive` (40% felt the same way about alcohol).
Although this majority opinion is not by any means conclusive, it cannot be ignored. We are well aware of the skeptics in with which marihuana user, and those sympathetic to their wishes, view the policy making process; and we are particularly concerned about the indifference to or disrespect for law manifested by many citizens and particularly the youth.
However, we are also apprehensive about the impact of a major change in social policy on that larger segment of our population which supports the implications of the existing social policy. They, too, might lose respect for a policy-making establishment which appeared to bend so easily to the wishes of a "lawless" and highly vocal minority.
This concern for minimizing cultural dislocation must, of course, be weighed against the relative importance of contrary arguments. For example, in the case of desegregation in the South, and now in the North, cult-Lire shock had to be accepted in the light of the fundamental precept at issue. In the, case. of marihuana, there is no fundamental principle supporting the use of the drug, and society is not compelled to approve or be neutral toward it. The opinion of the majority is entitled to greater weight.
Looking again to the, experience with Prohibition, when an abstentionist policy for alcohol was adopted on the national level in 1918, its proponents were not blind to the vociferous opposition of a substantial minority of the people. By the late 1920's and early 1930's, the ambivalence of public opinion toward alcohol use and the unwillingness of large numbers of people to comply with the new social policy compelled reversal of that policy. Even many of its former supporters acknowledged its futility.
With marihuana, however, the prevailing policy of eliminating use had never been opposed to any significant degree until the mid-1960's. Unlike the prohibition of alcohol, which had been the subject of public debate off and on for 60 years before it was adopted, present marihuana policy has not until now engaged the public opinion process, some 50 years after it first began to be used. Majority sentiment does not appear to be as flexible as it was with alcohol.
5. Neutrality Is Not Philosophically Compelled
Much of what was stated above bespeaks an acute awareness by the Commission of the subtleties of the collective consciousness of the American people, as shown in the National Survey. There is a legitimate concern about what the majority of the non-using population thinks about marihuana use and what the drug represents in the public mind. The question is appropriately asked if we are suggesting that the majority in a free society may impose its will on an unwilling minority even though, as it is claimed, uncertainty, speculation, and a large degree of misinformation form the basis of the predominant opinion. If we have nothing more substantial than this, the argument goes, society should remain neutral.
To deal with this contention, one must distinguish between ends and means. Policy-makers must choose their objectives with a sensitivity toward the entire social fabric and a vision of the good society. In such a decision, the general public attitude is a significant consideration. The preferred outcome in a democratic society cannot be that of the policy-makers alone; it must be that of an informed public. Accordingly, the policy-maker must consider the dynamic relationship between perception and reality in the public mind. Is the public consensus based on a real awareness of the facts? Does the public really understand what is at stake? Given the best evidence available, would the public consensus remain the same?
Assuming that dominant opinion opposes marihuana use, the philosophical issue is raised not by the goal but by how it is implemented. At this point, the interests of the unwilling become important. For example, the family unit and the institution of marriage are preferred means of group-living and child-rearing in our society. As a society, we are not neutral. We officially encourage matrimony by giving married couples favorable tax treatment; but we do not compel people to get married. If it should become public policy to try to reduce the birth rate, it is unlikely that there will be laws to punish those who exceed the preferred family size, although we may again utilize disincentives through the tax system. Similarly, this Commission believes society should continue actively to discourage people from using marihuana, and any philosophical limitation is relevant to the means employed, not to the goal itself.
FOR THESE REASONS, WE RECOMMEND TO THE PUBLIC AND ITS POLICY-MAKERS A SOCIAL CONTROL POLICY SEEKING TO DISCOURAGE MARIHUANA USE, WHILE CONCENTRATING PRIMARILY ON THE PREVENTION OF HEAVY AND VERY HEAVY USE.
We emphasize that this is a policy for today and the immediate future; we do not presume to suggest that this policy embodies eternal truth. Accordingly, we strongly recommend that our successor policy planners, at an appropriate time in the future, review the following factors to determine whether an altered social policy is in order: the state of public opinion, the extent to which members of the society continue to use the drug, the developing scientific knowledge about the effects and social impact of use of the drug, and the evolving social attitude toward the place of recreation and leisure in a work-oriented society. In our second Report next year, we will carefully review our findings to see if our perceptions have changed or if society has changed at that time.
Implementing The Discouragement Policy
Choice of this social control policy does not automatically dictate any particular legal implementation. As we noted in Chapter 1, there is a disturbing tendency among participants in the marihuana debate to assume that a given statement of the drug's effects, its number of users or its social impact compels a particular statutory scheme.
Law does not operate in a social vacuum, and it is only one of the institutional mechanisms which society can utilize to implement its policies. Consequently, the evaluation of alternative legal approaches demands not only logic but also a delicate assessment of the mutual relationship between the law and other institutions of social control, such as the church, the family and the school.
THE ROLE OF LAW IN EFFECTIVE SOCIAL CONTROL
Social control is most effectively guaranteed by the exercise of individual self-discipline. Elementary social psychology teaches us that restraint generated within is infinitely more effective and tenacious than restraint imposed from without.
One of the participants at our "Central Influences" Seminar observed:
When people grow up into a society, the principal aim is to internalize drives-that is, I assume they come up 'with certain drives which can be satisfied in many ways and you're trying to internalize, ways of satisfying those drives which will be compatible with life in a community and also satisfying to the individual. The external restraints can only complement this, they cannot possibly substitute for it.
The supplemental effect of external restraints, particularly legal restraints, must also be weighed against the nature of the control sought. It was put this way at our Seminar:
Think of the social welfare function as a mountain-the hill of the Lords really. Large parts of it are something of a plateau; that is you can be all sorts of places on it and be safe. You don't have to maximize. This is an economist's fallacy. You can have all sorts of variations, you can be Socialists, Capitalists, Mormons, Adventists and get away with it-even Liberals. But there are cliffs, and you can fall off of them. This is what we are worrying about today. We are nervous about these cliffs.
The "no-no's"-as the kids call them-are the fences on these cliffs. That is, we have set up taboos and say there's a cliff there. Now -one of the problems socially is that we set up "no-no's" where there are no cliffs. There are no cliffs and people jump over these [fences] and they say, "No cliffs! See no cliffs!" [Then, over other fences-and] chop-chop-chop-crash! See, it's just as dangerous to set up fences without any cliffs as not have fences where there are cliffs.
To this functional consideration of external restraint, we must also add the philosophical faith in the responsible exercise of individual judgment which is the essence of a free society. To illustrate, a preference for individual productivity underlies this society's opposition to indiscriminate drug use, the fact that so few of the 24 million Americans who have tried marihuana use it, or have used it, irresponsibly, testifies to the extent to which they have internalized that value.
The hypothesis that widespread irresponsibility would attend freer availability of marihuana suggests not that a restrictive policy is in order but rather that a basic premise of our free society is in doubt. We note that the escalation thesis, used as an argument against marihuana rather than as a tool for understanding individual behavior, is really a manifestation of skepticism about individual vulnerabilities. For example, one-half of the public agreed with the statement that "if marihuana were made legal, it would make drug addicts out of ordinary people."
At the same time, we do feel that the threat of excessive use is most potent with the young. In fact, we think all drug use should continue to be discouraged among the young, because of possible adverse effects on psychological development and because of the lesser ability of this part of the population to discriminate between limited and excessive use.
Social policy implementation in this regard is extraordinarily difficult. For example, although existing social policies toward tobacco, alcohol and marihuana alike oppose their use by the young, those policies are far from being fully effective. For example:
Tobacco
The National Survey (1971) indicates that of young people age 12-to-17,
  • 50 % have smoked at one, time or another;
  • 15% smoke now; and
  • At least 8% smoke at least a half a pack a day.
In a 1970 sample of smoking habits in the 12-to-18 population conducted for the National Clearinghouse for Smoking and Health, it was found that:
  • 18.5% of the boys and 11.9% of the girls were regular smokers; and
  • About 8% of the boys and 5% of the girls smoked more than a half a pack a day.
Alcohol
The National Survey also ascertained the drinking pattern during the previous month of young people aged 12-to-17, finding that:
  • At least 23% had used beer during that month, at least 14% had used wine and at least 12% had used hard liquor; and
  • 6% had used beer five or more days during the months 3% had used wine five or more days, and 3% had used hard liquor five or more days.
Marihuana
Of the 12-to-17 population, the Survey found that:
  • 15% of this population had tried marihuana;
  • At least 6 % still use it; and
  • Less than 1% use it once a day or more
The inclination of so many young people to experiment with drugs is a reflection of a so-called successful socialization process on one hand, and of society's ambivalence to the use of drugs on the other. This entire matter will occupy much of our attention in the coming year, but it is essential that we make a few anticipatory comments now.
This nation tries very had to instill in its children independence, curiosity and a healthy self-assurance. These qualities guarantee a dynamic, progressive society. Where drugs are concerned, however, we have relied generally on authoritarianism and on obedience. Drug education has generally been characterized by overemphasis of scare tactics. Some segments of the population have been reluctant to inform for fear of arousing curiosity in young minds. Where drugs are concerned, young people are simply supposed to nod and obey. -
This society has always been and continues to be ambivalent about the non-medical (in the strict sense) use of drugs. And this ambivalence does not escape our children. If we can come to grips with this issue, we might convince our youth that the curiosity that is encouraged in other aspects of our culture is undesirable where drugs are concerned.
The law is at best a highly imperfect reflection of drug policy. The laws proscribing sale of tobacco to minors are largely ignored. Prohibitions of sale of alcohol to minors are enforced sporadically. As to marihuana, there are areas throughout this nation where possession laws are not enforced at all. In other sections, such proscriptions are strictly enforced, with no apparent decrease in marihuana use.
As a guiding doctrine for parents and children, the law is certainly confusing when it imposes widely varying punishments in different states, and even in different courts of the same state, all for use of the same substance, marihuana. That marihuana use can be treated as a petty offense in one state and a felony in another is illogical and confusing to even the most sincere of parents.
The law is simply too blunt an instrument to manifest the subtle distinctions we draw between the motivations and the circumstances of use. At the same time, legal status carries a certain weight of its own, and other institutions must take account of the law in performing their functions.
In legally implementing our recommended social policy, we seek to maximize the ability of our schools, churches and families to be open and honest in discussing all drugs, including marihuana. The law must assist, not impede. In this respect, we note with concern the counterproductive tendency in our society to seek simple solutions to complex problems. Since the statutory law is a simple tool, the tendency in our society to look to the law for social control is particularly strong.
We have discussed the four basic social policy objectives of elimination, discouragement, neutrality and approval of marihuana use and have selected discouragement of use, with emphasis on prevention of heavy and very heavy use, as our generalized aim. We have considered three legal responses, each with a wide range of alternatives:
1. Total Prohibition.
2. Partial Prohibition.
3. Regulation.
TOTAL PROHIBITION
The distinctive feature of a total prohibition scheme is that all marihuana-related behavior is prohibited by law. Under the total prohibition response now in force in every state and at the federal level, cultivation, importation, sale, gift or other transfer, and possession are all prohibited acts. In 11 states and the District of Columbia, simply being present knowingly in a place where marihuana is present is also prohibited; and many states prohibit the possession of pipes or other smoking paraphernalia. For our purposes, the key feature of the total prohibition approach is that even possession of a small amount in the home for personal use is prohibited by criminal law.
From the very inception of marihuana control legislation, this nation has utilized a policy of a total prohibition, far more comprehensive than the restrictions established during the prohibition of alcohol.
Until recent years, society was operating under an eliminationist policy. The exaggerated beliefs about the drug's effects, social impact, and user population virtually dictated this legal approach. During this entire, period, total prohibition was sought through the use of heavier and heavier penalties until even first-time possession was a felony in every jurisdiction, and second possession offenses generally received a mandatory minimum sentence without parole or probation. Yet the last few years have seen society little by little abandoning the eliminationist policy in favor of a containment policy.
Under the total prohibition umbrella, this containment policy has been implemented by a unique patchwork of legislation, informal prosecutorial policy and judicial practice. Possession is now almost everywhere a misdemeanor. Although some term of incarceration remains as a penalty for possessors, it is generally not meted out to young first offenders or to possessors of small -amounts. Instead, most such offenders are dismissed or informally diverted to agencies outside the criminal system by those within the system who are trying to help them avoid the stigma of a criminal record.
Offenders who are processed within the criminal justice system generally receive fines and/or probation. In many jurisdictions, enforcement officials make little or no effort to enforce possession proscriptions, concentrating instead on major trafficking. Possessors are generally arrested only when they are indiscreet or when marihuana is found incident to questioning or apprehension resulting from some other violation. From our surveys, state and federal, we have found that only minimal effort is made to investigate marihuana possession cases.
Such a tendency is a reflection of the adoption of a containment policy. By acting only when marihuana appears above ground, enforcement officials are helping to keep its use underground. The shift away from the elimination policy has been matched by a similar shift in legal implementation, but the distinctive feature of the total prohibition scheme still remains: all marihuana-related behavior, including possession for personal use within the home, is prohibited by criminal law.
Is such a response an appropriate technique for achieving the social control policy we outlined above? The key question for our purposes is whether total criminal prohibition is the most suitable or effective way to discourage use and whether it facilitates or inhibits a concentration on the reduction and treatment of irresponsible use. We are convinced that total prohibition frustrates both of these objectives for the following reasons.
1. Application of the Criminal Law to Private Possession Is Philosophically Inappropriate
With possession and use of marihuana, we are dealing with a form of behavior which occurs generally in private where a person possesses the drug for his own use. The social impact of this conduct is indirect, arising primarily in cases of heavy or otherwise irresponsible use and
from the drugs symbolic aspects. We do not take the absolutist position that society is philosophically forbidden from criminalizing any kind of "private" behavior. The phrase "victimless crimes," like "public, health hazard, has become a rhetorical excuse for avoiding basic social policy issues. We have chosen a discouragement policy on the basis of our evaluation of the actual and potential individual and social impact of marihuana use. Only now that we have done so can we accord appropriate weight to the nation's philosophical preference for individual privacy.
On the basis of this evaluation we believe that the criminal law is too harsh a tool to apply to personal possession even in the effort to discourage use. It implies an overwhelming indictment of the behavior which we believe is not appropriate. The actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior, a step which our society takes only 'with the greatest reluctance.
2. Application of the Criminal Law Is Constitutionally Suspect
The preference for individual privacy reflected in the debate over the philosophical limitations on the criminal law is also manifested in our constitutional jurisprudence. Although no court, to our knowledge, has held that government may not prohibit private possession of marihuana, two overlapping constitutional traditions do have important public policy implications in this area.
The first revolves around the concept that in a free society, the legislature may act only for public purposes. The "police powers" of the states extend only to the "public health, safety and morals." In the period of our history when the people most feared interference with their rights by the government, it was generally accepted that this broad power had an inherent limitation. For example, early prohibitions of alcohol possession were declared unconstitutional on the basis of reasoning such as that employed by the Supreme Court of Kentucky in 1915 in the case of Commonwealth v. Campbell:
It is not within the competency of government to invade the privacy of the citizen's life and to regulate his conduct in matters in which alone is concerned, or to prohibit him any liberty the exercise which will not directly injure society.
Noting that the defendant was "not charged with having the liquor in his possession for the purpose of selling it, or even giving it to another," and that "ownership and possession cannot be denied when that ownership and possession is not in itself injurious to the public," the Kentucky court concluded that:
The right to use liquor for one's own comfort, if they use it without injury to the public, is one of the citizen's natural and inalienable rights.... We hold that the police power-vague and wide and undefined as it is-has limits. . . .
Even the perceived dangers of opium were not enough to convince some members of the judiciary that the government could prohibit possession. It is historically instructive to consider these words, penned in 1890, by Judge Scott in Ah Lim v Territory:
I make no question but that the habit of smoking opium may be repulsive and degrading. That its effect would be to shatter the nerves and destroy the intellect; and that it may tend to the increase of the pauperism and crime. But there is a vast difference between the commission of a single act, and a confirmed habit. There is a distinction to be recognized between the use and abuse of any article or substance.... If this act must be held valid it is hard to conceive of any legislative action affecting the personal conduct, or privileges of the individual citizen, that must not be upheld.... The prohibited act cannot affect the public in any way except through the primary personal injury to the individual, if it occasions him any injury. It looks like a new and extreme step under our government in the field of legislation, if it really was passed for any of the purposes upon which that character of legislation can be sustained, if at all.
As a matter of constitutional history, a second tradition, the application of specific provisions in the Bill of Rights, has generally replaced the notion of "inherent" limitations. The ultimate effect is virtually the same, however. The Fourth Amendment's proscription of "unreasonable searches and seizures" reflects a constitutional commitment to the value of individual privacy. The importance of the Fourth Amendment to the entire, constitutional scheme was eloquently described by Justice Brandeis in 1928 in the case of Olmstead v U.S.:
The makers of our Constitution undertook to secure conditions favorable to the pursuit of happiness. They recognized the significance of man's spiritual nature, of his feelings and his intellect. They knew that only a part of the pain, pleasure and satisfaction of life are to be found in material things. They sought to protect Americans in their beliefs, their thoughts, their emotions and their sensations. They conferred, as against the Government, the right to be let alone-the most comprehensive of rights and the right most valued by civilized men.
Although the Fourth Amendment is itself a procedural protection, the value of privacy which it crystallizes is often read in conjunction with other important values to set substantive limits on legislative power. The Supreme Court, in the case of Griswold vs. Connecticut, held in 1965 that Connecticut could not constitutionally prohibit the use of birth control devices by married persons. Although the Justices did not agree completely on the reasons for their decision, Justice Douglas stated in the opinion of the Court:
The present case, then, concerns a relationship lying within the zone of privacy created by several fundamental constitutional guarantees. And it concerns a law which, in forbidding the use of contraceptives rather than regulating their manufacture or sale, seeks to achieve its goals by means of having a maximum destructive impact upon that relationship. Such a law cannot stand in light of the familiar principle, so often applied by this Court, that a "governmental purpose to control or prevent activities constitutionally subject to state regulation may not be achieved by means which sweep unnecessarily broadly and thereby invade the area of protected freedom." (citation omitted) Would we allow the police to search the sacred precincts of marital bedrooms for telltale signs of the use of contraceptives? The very idea is repulsive to the notions of privacy surrounding the marriage relationship.
Four years later, the Supreme Court, in Stanley v. Georgia, held that even though obscenity is not "speech" protected by the First Amendment, a state cannot constitutionally make private possession of obscene material a crime. The Court's reasoning is revealed in the following language:
[The] right to receive information and ideas, regardless of their social worth, (citation omitted), is fundamental to our free society. Moreover, in the context of this case- a prosecution for mere possession of printed or filmed matter in the privacy of a person's own home-that right takes on an added dimension. For also fundamental is the right to be free, except in very limited circumstances, from unwanted governmental intrusions into one's privacy ...
While the judiciary is the governmental institution most directly concerned with the protection of individual liberties, all policy-makers have a responsibility to consider our constitutional heritage when framing public policy. Regardless of whether or not the courts would overturn a prohibition of possession of marihuana for personal use in the home, we are necessarily influenced by the high place traditionally occupied by the value of privacy in our constitutional scheme.
Accordingly, we believe that government must show a compelling reason to justify invasion of the home in order to prevent personal use of marihuana. We find little in marihuana's effects or in its social impact to support such a determination. Legislators enacting Prohibition did not find such a compelling reason 40 years ago; and we do not find the situation any more compelling for marihuana today.
3. Total Prohibition Is Functionally Inappropriate
Apart from the philosophical and constitutional constraints outlined above, a total prohibition scheme carries with it significant institutional costs. Yet it contributes very little to the achievement of our social policy. In some ways it actually inhibits the success of that policy.
The primary goals of a prudent marihuana social control policy include preventing irresponsible use of the drug, attending to the consequences of such use, and deemphasizing use in general. Yet an absolute prohibition of possession and use inhibits the ability of other institutions to contribute actively to these objectives. For example, the possibility of criminal prosecution deters users who are experiencing medical problems from seeking assistance for fear of bring attention to themselves. In addition, the illegality of possession and use creates difficulties in achieving an open, honest educational program, both in the schools and in the home.
In terms of the social policy objective of discouraging use of the drug, the legal system can assist that objective in three ways: first, by deterring people from use; second, by symbolizing social opposition to use; and finally, by cutting off supply of the drug.
The present illegal status of possession has not discouraged an estimated 24 million people from trying marihuana or an estimated eight million from continuing to use it. Our survey of the country's state prosecuting attorneys shows that 53% of them do not believe that the law has more than a minimal deterrent effect in this regard. Moreover, if the present trend toward passive enforcement of the marihuana law continues, the law ultimately will deter only indiscreet use, a result achieved as well by a partial prohibition scheme and with a great deal more honesty and fairness.
A major attraction of the law has been its symbolic value. Yet, society can symbolize its desire to discourage marihuana use in many other, less restrictive ways. The warning labels on cigarette packages serve this purpose, illustrating that even a regulatory scheme could serve a discouragement policy. During Prohibition, the chosen statutory implementation symbolized society's opposition to the use of intoxicating beverages; yet, most jurisdictions did not think it necessary to superimpose a proscription of possession for personal use in the home.
Finally, prohibiting possession for personal use has no substantive relation to interdicting supply. A possession penalty may make enforcement of proscriptions against sale a little easier, but we believe this benefit is of minimal importance in light of its costs.
The law enforcement goal repeatedly stated at both the federal and state levels has been the elimination of supply and the interdiction of trafficking. These avowed aims of law enforcement make sense, since they are the most profitable means of employing its manpower and resources in this area.
Indeed, the time consumed in arresting Possessors is inefficiently used when contrasted with the same amount of time invested in apprehending major dealers. Although a credible effort to eliminate supply requires prohibitions of importation, sale and possession-with intent-to-sell, the enforcement of a proscription of possession for personal use is minimally productive.
As noted, most law enforcement officials, district attorneys and judges recognize the ineffectiveness of the possession penalty. as a deterrent. Its perpetuation results in the making of what is commonly referred to as "cheap" cases that have little or no impact on deterring sale.
The marihuana supply system can be viewed as pyramid with the major bulk of marihuana entering the system at top of the pyramid and then descending to the base which represents the user population. Common sense dictates where law enforcement should devote its efforts. To remove the profit from the traffic requires arresting sellers, not users. The oft-heard argument that the police need possession penalties to compel users to reveal their sources is not convincing. "Turning informants" at the base of the pyramid is of marginal value and limited utility in reaching upwards toward the apex. Further, the National Survey showed that 60% of the users don't "buy" marihuana but get it from a friend. The volume of traffic in the drug at these levels is at best minimal.
In short, personal possession arrests and even casual sales, which account for more than 95% of the marihuana arrests at the state local level, occur too low in the chain of distribution to diminish supply very effectively.
In addition to the misallocation of enforcement resources, another consequence of prohibition against possession for personal use is the social cost of criminalizing large numbers of users. Our empirical study of enforcement of state and federal marihuana laws indicates that almost all of those arrested are between the ages of 18 and 25, most have jobs or are in school, and most have had no prior contact -with the criminal justice system. The high social cost of stigmatizing such persons as criminals is now generally acknowledged by the public at large as well as by those in the criminal justice system.
According to the National Survey, 53% of the public was unwilling to give young users a criminal record and 87% objected to putting them in jail. The nation's judges expressed an overwhelming disinclination to sentence and convict users for marihuana possession. Of these judges only 13% thought it was appropriate to incarcerate ail adult for possession and only 4% would jail a juvenile for marihuana possession. This disinclination is reflected in the low percentage of arrested users who are convicted, and the even lower percentage who are jailed.
Even among the nation's prosecutors, a substantial majority favor the present trend toward avoiding incarceration for first offenders. Most jurisdictions have devised informal procedures for disposing of cases in lieu of prosecution. Our empirical study shows that 48% of the adult cases, and 70% of the juvenile cases, were dropped from the system at some point between arrest and conviction. The picture displayed is one of a large expenditure of police manpower to enforce a law most participants further along the line are not anxious to apply.
Other disturbing consequences of laws proscribing possession for personal use are the techniques required to enforce them. Possession of marihuana is generally a private behavior; in order to find it, the police many times must operate on the edge of constitutional limitations. Arrests without probable cause, illegal searches and selective enforcement occur often enough to arouse concern about the integrity of the criminal process.
Yet another consequence of marihuana possession laws is the clogging of judicial calendars. President Nixon has noted that one of the major impediments to our nation's efforts to combat serious crimes is the fact that the judicial machinery moves so slowly. Swift -arrests, prosecution, trial and sentence would significantly improve the deterrent effect of law. Yet the judicial system is overloaded with petty cases, with public drunkenness accounting for about 50% of all non-traffic offenses.
In his March 1971 address to the National Conference on the Judiciary, President Nixon said:
What can be done to break the logjam of justice today, to ensure the right to a speedy trial-and to enhance respect for law? We have to find ways to clear the courts of the endless stream of "victimless crimes" that get in the way of serious consideration of serious crimes. There are more important matters for highly skilled judges and prosecutors than minor traffic offenses, loitering and drunkenness.
To this list we would add marihuana possession, which accounts for a rising percentage, of judicial caseloads. In Chicago alone, during the last half of 1970, there were more than 4,000 possession arrests.
A final cost of the possession laws is the disrespect which the laws and their enforcement engender in the young. Our youth cannot understand why society chooses to criminalize behavior with so little visible ill-effect or adverse social impact, particularly when so many members of the law enforcement community also question the same laws. These young people have jumped the fence and found no cliff. And the disrespect for the possession laws fosters a disrespect for all law and the system in general.
On top of all this is the distinct impression among the youth that police may use the marihuana laws to arrest people they don't like for other reasons, whether it be their politics, their hair style or their ethnic background. Whether or not such selectivity actually exists, it is perceived to exist.
For all these reasons, we believe that the possession offense is of little functional benefit to the discouragement policy and carries heavy social costs, not the least of which is disrespect and cynicism among some of the young. Accordingly, even under our policy of discouraging marihuana use, the better method is persuasion rather than prosecution. Additionally, with the sale and use of more hazardous drugs on the increase, and crimes of violence escalating, we do not believe that the criminal justice system can afford the time and the costs of implementing the marihuana possession laws. Since these laws are not mandatory in terms of achieving the discouragement policy, law enforcement should be allowed to do the job it is best able to do: handling supply and distribution.
A criminal fine or similar penalty for possession has been suggested as a means of alleviating some of the more glaring costs of a total prohibitory approach yet still retaining the symbolic disapproval of the criminal law. However, most of the objections raised above would still pertain: the possibilities of invasion of personal privacy and selective enforcement of the law would continue; possessors would still be stigmatized as criminals, incurring the economic and social consequences of involvement with the criminal law; the symbolic status of marihuana smoking as an anti-establishment act would be perpetuated.
On the other hand, a fine most likely would deter use no more than does the present possibility of incarceration. It would continue to impede treatment for heavy and very heavy use and would persist in directing law enforcement away from the policy's essential aim which is to halt illegal traffic in the drug.
For all these reasons, we reject the total prohibition approach and its variations.
REGULATION
Another general technique for implementing the recommended social policy is regulation. The distinguishing feature of this technique is that it institutionalizes the availability of the drug. By establishing a legitimate channel of supply -and distribution, society can theoretically control the quality and potency of the product. The major alternatives within this approach lie in the variety of restraints which can be imposed on consumption of the drug and on the informational requirements to which its distribution can be subject.
We have given serious consideration to this set of alternatives; however, we are unanimously of the opinion that such a scheme, no matter how tightly it might restrict consumption, is presently unacceptable.
1. Adoption of a Regulatory Scheme at this Time Would Inevitably Signify Approval of Use
In rejecting the total prohibition approach, we emphasized the symbolic aspects. In essence, we do not believe prohibition of possession for personal use is necessary to symbolize a social policy disapproving the use. Theoretically, a tightly controlled regulatory schemes with limited distribution outlets, significant restraints on consumption prohibition of advertising and compulsory labeling, could possibly symbolize such disapproval. Our regulatory policy toward tobacco is beginning to slowly to reflect a disapproval policy toward Cigarette smoking. Nonetheless, given the social and historical context of such a major shift in legal policy toward marihuana, we are certain that such a change would instead symbolize approval of use, or at least a position of neutrality.
The Commission is concerned that even neutrality toward use as a matter of policy could invest an otherwise transient phenomenon with the status of an accepted behavior. If marihuana smoking were an already ingrained part of our culture, this objection would be dispelled. However, we do not believe that this is the case,. We are inclined to believe, instead, that the present interest in marihuana is transient and will diminish in time of its own accord once the major symbolic aspects of use are deemphasized, leaving among our population only a relatively small coterie of users. With this possibility in mind, we are hesitant to adopt either a policy of neutrality or a regulatory implementation of our discouragement policy. The law would inevitably lose its discouragement character and would become even more ambiguous in its rationale and its enforcement.
The effect of changing a social policy direction may be seen with tobacco policy. In recent years, society has ostensibly adopted a policy of discouraging cigarette smoking. This new policy has been implemented primarily in the information area through prohibition of some forms of advertising and through compulsory labeling. Yet, the volume, of cigarettes used increased last year. We believe that the failure of the new policy results from the fact that it supplants one that formerly approved use. This set of circumstances argues against any policy which would be regarded as approval of use, including a regulatory scheme. It is always extremely difficult to transform a previously acceptable behavior into a disapproved behavior.
2. Adoption of a Regulatory Scheme Might Generate a Significant Public Health Problem
We noted above that institutionalizing availability of the drug would inevitably increase the incidence of use, even though that incidence might otherwise decrease. Of greater concern is the prospect that a larger incidence of use would result in a larger incidence of long term heavy and very heavy use of potent preparations.
There are -now approximately 500,000 heavy users of less potent preparations in this country, representing about 2% of those who ever tried the drug. Even if the prevalence of -heavy use remained the same in relation to those who ever used, this at-risk population would inevitably increase under a regulatory scheme. If the emotional disturbances found in very heavy hashish users in other countries were to occur in this country, the adverse social impact of marihuana use, now slight, would increase substantially.
We have acknowledged that society, nonetheless, chose to run such a risk in 1933, when Prohibition was repealed. But alcohol use was already well-established in this society, and no alternative remained other than a regulatory approach. In light of our suspicion that interest in marihuana is largely transient, it would be imprudent to run that risk for marihuana today.
3. Adoption of a Regulatory Scheme Would Exacerbate Social Conflict and Frustrate a Deemphasis Policy
A significant segment of the public on both sides of the issue views marihuana and its "legalization" in a highly symbolic way. Any attempt to adopt a regulatory approach now would be counterproductive in this respect. The collision of values resulting from such a dramatic shift of policy would maintain the debate at a highly emotional level and would perpetuate the tendency to perceive marihuana use as a symbol of the struggle between two conflicting philosophies.
4. Not Enough Is Known About Regulatory Models In This Area
Advocates of legalization of marihuana are often inclined to propose a licensing scheme or an "alcohol model" without offering a specific program of regulation taking all the variables into account. Responsible policy planning cannot be so cursory. Consequently, we have given serious study to the many issues presented by such a scheme and to the nation's experience with other drug licensing schemes. On the basis of our inquiry, we are convinced that such a step should not be taken unless a realistic assessment of the efficacy of existing schemes and their potential application to marihuana indicates it would be successful. Such an assessment raises a number of disturbing questions.
The regulatory approaches which this nation has used in the cases of alcohol and tobacco have failed to accomplish two of their most important objectives: the minimization of excessive use and the limitation of accessibility to the young. Despite the warning and restraints on distribution and consumption, more than 50 million Americans smoke cigarettes regularly, and more than nine million Americans are "problem" drinkers. We have previously cited data indicating how many of our children begin habits which have been legally forbidden to them. Since the young user and the chronic user of marihuana are of primary concern to our public health officials, the lack of success with alcohol and tobacco discourages an assumption that the regulation of supply would minimize use by the younger generation.
Another important purpose of a regulatory scheme is to channel the product through a controlled system of supply and distribution. In that way the quality and quantity of the substance can be regulated. The efficacy of such a scheme as applied to marihuana is questionable.
Cannabis can be grown easily almost anywhere in the United States with little or no human assistance. Even if a legitimate source of supply were established, it is likely that many persons would choose to ignore the legitimate source and grow their own, the purity of which would not be in question. If such a practice were illegal, the necessity for a concerted governmental eradication program is raised, which would involve a monumental law enforcement effort. According to the U.S. Department of Agriculture, there are presently an estimated five million acres of wild marihuana growing in this country and an undetermined number of acres under cultivation.
Yet, if such a practice were not forbidden, the revenue-raising, product-control and consumption-restriction features of a regulatory scheme would be threatened. Instructive to note is the fact that intensive regulation of alcoholic beverage production 'has not eliminated illicit production. During 1970, in fact, 5,228 illegal stills were destroyed by the Alcohol, Tobacco and Firearms Division of the U.S. Treasury and 5,279 persons were arrested. In 1971, 3,327 illegal stills were destroyed and 5,512 persons were arrested.
Another disturbing question is raised by the issue of potency regulation. Most advocates of legalization stipulate potency limitations as one feature of their scheme. Presumably they would limit the THC content of the regulated product. This is not an easy undertaking. Especially when cannabis is so easily grown and a black market is so easily created, we are dubious about the success of a regulatory scheme distributing only a product with low THC content. Again, attention must be paid the prospect of increased hashish use under a regulatory scheme; merely stipulating potency control is not sufficient. As we noted in Chapter II, the heavy, long-term use of hashish is a source of major concern to the Commission from both private and public health standpoints.
These are a few of the problems confronting the policy-maker if be seeks to devise an effective regulatory system of distribution for what is, in fact, a universally common plant. Our doubts about the efficacy of existing regulatory schemes, together with an uncertainty about the permanence of social interest in marihuana and the approval inevitably implied by adoption of such a scheme, all impel us to reject the regulatory approach as an appropriate implementation of a discouragement policy at the present time.
Future policy planners might well come to a different conclusion if further study of existing schemes suggests a feasible model; if responsible use of the drug does indeed take root in our society; if continuing scientific and medical research uncovers no long-term ill effects; if potency control appears feasible and if the passage of time and the adoption of a rational social policy sufficiently desymbolizes marihuana so that availability is not equated in the public mind with approval.
PARTIAL PROHIBITION
The total prohibition scheme was rejected primarily because no sufficiently compelling social reason, predicated on existing knowledge, justifies intrusion by the criminal justice system into the private lives of individuals who use marihuana. The Commission is of the unanimous opinion that marihuana use is not such a grave problem that individuals who smoke marihuana, and possess it for that purpose, should be subject to criminal procedures. On the other hand, we have also rejected the regulatory or legalization scheme because it would institutionalize availability of a drug which has uncertain long-term effects and which may be of transient social interest.
Instead we recommend a partial prohibition scheme which we feel has the following benefits:
Symbolizing a continuing societal discouragement of use;
Facilitating the deemphasis of marihuana essential to answering dispassionately so many of the unanswered questions;
Permitting a simultaneous medical, educational, religious, and parental effort to concentrate on reducing irresponsible use and remedying its consequences;
Removing the criminal stigma and the threat of incarceration from a widespread behavior (possession for personal use) which does not warrant such treatment;
Relieving the law enforcement community of the responsibility for enforcing a law of questionable utility, and one which they cannot fully enforce, thereby allowing concentration on drug trafficking and crimes against persons and property;
Relieving the judicial calendar of a large volume of marihuana possession cases which delay the processing of more serious cases; and
Maximizing the flexibility of future public responses as new information comes to light.
No major change is required in existing law to achieve all of these benefits. In general, we recommend only a decriminalization of possession of marihuana for personal use on both the state and federal levels. The major features of the recommended scheme are that: production and distribution of the drug would remain criminal activities as would possession with intent to distribute commercially; marihuana would be contraband subject to confiscation in public places; and criminal sanctions would be withdrawn from private use and possession incident to such use, but, at the state level, fines would be imposed for use in public.*
Specifically, we recommend the following statutory schemes.
RECOMMENDATIONS FOR FEDERAL LAW
Under the Comprehensive Drug Abuse Prevention and Control Act of 1970, Congress provided the following scheme with respect to marihuana, by which was meant only the natural plant and its various parts, not the synthetic tetrahydrocannabinol (THC) :
  • Cultivation, importation and exportation, and sale or distribution for profit of marihuana are all felonies punishable by imprisonment for up to five years for a first offense and by up to 10 years for a second offense (the available penalty is doubled for sale to a minor).
  • Possession of marihuana with intent to distribute is a felony punishable by imprisonment for up to five years for the first offense and by up to 10 years for a second offense.
  • Possession of marihuana for personal use is a misdemeanor punishable by up to one year in jail and a $1,000 fine for first offense and by up to two years in jail and a $2,000 fine for second offense (expungement of criminal record is available for first offenders).
  • Transfer of a small amount of marihuana for no remuneration is a misdemeanor punishable by up to one year in jail and a $1,000 fine for first offense and by up to two years in jail and a $2,000 fine for second offense (Congress singled out marihuana in this way to allow misdemeanor treatment of casual transfers and permitted first offender treatment, as allowed for possession for personal use).
The Commission recommends only the following changes in federal law:
  • POSSESSION OF MARIHUANA FOR PERSONAL USE WOULD NO LONGER BE AN OFFENSE, BUT MARIHUANA POSSESSED IN PUBLIC WOULD REMAIN CONTRABAND SUBJECT TO SUMMARY SEIZURE AND FORFEITURE.
  • CASUAL DISTRIBUTION OF SMALL AMOUNTS OF MARIHUANA FOR NO REMUNERATION, OR INSIGNIFICANT REMUNERATION NOT INVOLVING PROFIT WOULD NO LONGER BE AN OFFENSE.
The Commission further recommends that federal law be supplemented to provide:
  • A PLEA OF MARIHUANA INTOXICATION SHALL NOT BE A DEFENSE TO ANY CRIMINAL ACT COMMITTED UNDER ITS INFLUENCE, NOR SHALL PROOF OF SUCH INTOXICATION CONSTITUTE A NEGATION OF SPECIFIC INTENT. 
* Commissioners Rogers, Congressman from Florida, and Carter, Congressman from Kentucky, agree with the Commission's selection of a discouragement policy and also agree that criminalization and incarceration of individuals for possessing marihuana for their own use is neither necessary nor desirable as a means of implementing that policy.
At the same time, both Commissioners feel that the contraband concept is not a sufficiently strong expression of social disapprobation and would recommend in addition a civil fine for possession of any amount of marihuana in private or in public.
Both Commissioners feel that the civil fine clearly symbolizes societal disapproval and is a simple mechanism for law enforcement authorities to carry out. If a person is found by a law enforcement officer to be in possession of marihuana, the officer would issue such person a summons to appear in court on a fixed day. Although a warrant would not issue for Research of a private residence unless there were probable cause to believe a criminal offense was being committed, a police officer legitimately present for other reasons could issue a civil summons for violation of the "possession" proscription.
Commissioners Rogers and Carter believe that the legal system must be utilized directly to discourage the person from using marihuana rather than being utilized only indirectly as In the case of contraband.
This civil fine would not be reflected in a police record, nor would it be considered a criminal act for purposes of future job consideration, either in the private sector or for government service.
Agreeing with the other Commissioners that the casual transfers of marihuana for no profit should be treated in the same manner as possession for one's own use, Congressmen Rogers and Carter do not agree that it should extend to transfers involving remuneration. They prefer the limiting language of the Comprehensive Drug Abuse Prevention and Control Act of 1970 which does not include the term "or insignificant remuneration not involving a profit."
Apart from the addition of the civil fine to the contraband recommendation in the respects set out above, Congressmen Carter and Rogers are in complete agreement with the statutory recommendations set out in the Report.
Commissioner Ware concurs completely with the statements made by Congressmen Rogers and Carter but wishes to reemphasize that the social policy and legal scheme adopted is applicable only to marihuana and should not be construed to embrace other psychoactive drugs. The policy set forth in this Report, subject to the already noted comments of the two Congressional Commissioners, makes sense for marihuana on the basis of what is known about the drug and in the absence of any conclusive showing which would verify some of the anecdotal law enforcement testimony heard by the Commission regarding criminal behavior exhibited while under the influence of marihuana.
Commissioner Ware feels that some penalty short of criminalizing the user, such as a civil fine or some type of intensive drug education, will act as a positive deterrent toward minimizing the incidence of marihuana use especially among the young. Further, he is opposed to the use of any drug for the express purpose of getting intoxicated, and includes alcohol within this category. The Commissioner feels that what is needed is an internalizing of discipline among our citizenry, with the legal system assisting this process through the use of disincentives.
Commissioners Hughes, Senator from Iowa, and Javits, Senator from New York, feel that the Commission has taken a major, highly laudable step in recommending that the private use of marihuana be taken out of the criminal justice system. They concur in its threshold judgment that overall social policy regarding this drug should seek to discourage use, while concentrating primarily on the prevention of irresponsible use. They disagree, however, with three specific recommendations relating to the implementation of this discouragement policy.
First, they would eliminate entirely the contraband provision from the partial prohibitory model adopted by the Commission. They want it eliminated first because its legal implications are confusing and the subject of disagreement even among lawyers. Whether or not possession of a given substance is criminal, possession of material designated as contraband makes that possession unlawful. Also, marihuana designated as contraband would be subject to government search and seizure, even though the underlying possession is no longer criminal. The provision-which does not apply to marihuana held for personal use within the home is considered by both Commissioners to be an unnecessary "symbol" of the discouragement policy. It will not foster elimination of the misunderstanding and mistrust which is a hallmark of our current marihuana policy.
Commissioner Hughes and Javits seek to eliminate it also because as a practical matter it serves no useful law enforcement purpose within the overall partial prohibitory model. If marihuana held for personal use within the home is not contraband, why should marihauna held for personal use within one's automobile be contraband? The area of operation of the contraband provision is extremely narrow. If one possesses more than one ounce of marihuana in public, it may be seized without regard to the contraband doctrine since such possession is a criminal violation.
Since the contraband provision does not apply to marihuana possession and use in private, the only effective area covered by the contraband provision is the area of possession in public of less than one ounce. The Commission has chosen to remove the stigma of the criminal sanction in this kind of case. To impose instead a contraband provision, which it is argued is in the nature of a civil "in rem" seizure which does not operate against the person, is to cloud the issue and to weaken the force of the basic decriminalization. A persuasive justification simply has not been made.
Both Commissioners seek to eliminate it also because they believe that the voice of the Commission should be loud and clear that the preservation of the right of privacy is of paramount importance and cannot be casually jeopardized in the pursuit of some vague public or law enforcement interest which has not been defined and justified with clarity and precision.
The second area of disagreement with the Commission's recommendations concerns the casual distribution of marihuana and the not-for-profit sale. As understood:
(1) The totally donative transfer is not subject to criminal penalty, regardless of where it takes place.
(2) The transfer of small amounts for insignificant remuneration not involving a profit is not subject to criminal penalty (except if it is accomplished in public, in which case it is subject to criminal sanction), but (3) The transfer of "large amounts" for "significant" remuneration not involving a profit is subject to criminal penalty.
Footnote 4 on page 158 of the Report, the Commission refers to a Report of The Senate Judiciary Committee on the Comprehensive Drug Abuse Prevention and Control Act of 1970. In substance, it implies that within the meaning of the Act, transfers of -more than one or two marihuana cigarettes in return for 50 cents or one dollar to cover cost are not intended to be covered as casual transfers, but rather are to be treated as unlawful sales.
Commissioners Hughes and Javits feel that the Commission has failed to set forth a clear standard which will adequately inform the public of their obligations under the law. The recommendation and its discussion in the Report are confusing and fail to provide the individual with sufficient guidance to allow him to act without having to dodge in and out of illegality. It also undermines a basic, stated objective of the Commission i.e., to concentrate the weight of the criminal sanction upon significant supply and distribution activities, rather than upon casual consumption.
Moreover, proscribing even the most casual not-for-profit transfers when they occur in public is, in their opinion, wrong. Such transfers are necessarily incident to private possession and use. To hold that they should be subject to criminal sanction is logically inconsistent with the Commission's rationale and recommendation on decriminalization of such private activities.
Instead, both Commissioners recommend that all not-for-profit sales be excluded from the criminal sanction. It Is fundamental that there be a clear separation between the serious, commercial, profit-making-seller, or "pusher" as he is known, and the individual who merely splits the cost of a reasonable supply of the drug with his friends or acquaintances.
Thirdly, exception is taken to the retention of the criminal sanction on public possession of more than one ounce. The individual who buys an ounce and a half would be a criminal when he buys on the corner, when he puts it in his pocket, when he gets in his car and drives home, when he is on his doorstep, but not when he crosses the threshold of his home. Commission policy should direct the attention of the law enforcement community to the person who sells the drug for profit, and not to the person who uses the drug privately.
If an individual has more than a few ounces in his possession, and there is probable cause to believe that he intends to sell it for profit, that activity is already covered under the Commission's recommendation that possession with intent to sell is illegal. Therefore, there is no need to further proscribe simple public possession.
All the component parts of the recommended policy of the Commission should be consistent with its objective of non-interference with casual transfers and possession and use which is essentially and fundamentally private and personal.
The contraband device, the not-for-profit sale, and public possession of some reasonable amount which should be presumed to be necessarily incident to private use should all be removed from the ambit of legal sanction. To do so would be to strike down "symbols" of a public policy which had never been adequately justified in the first instance. Such steps would in no way jeopardize the firm determination of the Commission that the use of marihuana ought to be discouraged.

RECOMMENDATIONS FOR STATE LAW
Under existing state marihuana laws, cultivation distribution and possession with intent to distribute are generally felonies and in most states possession for personal use is a misdemeanor. The Commission strongly recommends uniformity of state laws and, in this regard, endorses the basic premise of the Uniform Controlled Substances Act drafted by the National Conference of Commissioners on Uniform State Laws. The following are our recommendations for a uniform statutory scheme for marihuana, by which we mean, as under existing federal law, only the natural cannabis plant and its various parts, not the synthetic tetrahydrocannabinol (THC)
Existing Law
CULTIVATION, SALE OR DISTRIBUTION FOR PROFIT AND POSSESSION WITH INTENT TO SELL WOULD REMAIN FELONIES (ALTHOUGH WE DO RECOMMEND UNIFORM PENALTIES).
Private Activities
POSSESSION IN PRIVATE OF MARIHUANA FOR PERSONAL USE WOULD NO LONGER BE AN OFFENSE.
DISTRIBUTION IN PRIVATE OF SMALL AMOUNTS OF MARIHUANA FOR NO REMUNERATION OR INSIGNIFICANT REMUNERATION NOT INVOLVING A PROFIT WOULD NO LONGER BE AN OFFENSE.
Public Activities
POSSESSION IN PUBLIC OF ONE OUNCE OR UNDER OF MARIHUANA WOULD NOT BE AN OFFENSE, BUT THE MARIHUANA WOULD BE CONTRABAND SUBJECT TO SUMMARY SEIZURE AND FORFEITURE.
POSSESSION IN PUBLIC OF MORE THAN ONE OUNCE OF MARIHUANA WOULD BE A CRIMINAL OFFENSE PUNISHABLE BY A FINE OF $100.
DISTRIBUTION IN PUBLIC OF SMALL AMOUNTS OF MARIHUANA FOR NO REMUNERATION OR INSIGNIFICANT REMUNERATION NOT INVOLVING A PROFIT WOULD BE A CRIMINAL OFFENSE PUNISHABLE BY A FINE OF $100.
PUBLIC USE OF MARIHUANA WOULD BE A CRIMINAL OFFENSE PUNISHABLE BY A FINE OF $100.
DISORDERLY CONDUCT ASSOCIATED WITH PUBLIC USE OF OR INTOXICATION BY MARIHUANA WOULD BE A MISDEMEANOR PUNISHABLE BY UP TO 60 DAYS IN JAIL, A FINE OF $100, OR BOTH.
OPERATING A VEHICLE OR DANGEROUS INSTRUMENT WHILE UNDER THE INFLUENCE OF MARIHUANA WOULD BE A MISDEMEANOR PUNISHABLE BY UP TO ONE YEAR IN JAIL, A FINE OF UP TO $1,000, OR BOTH, AND SUSPENSION OF A PERMIT TO OPERATE SUCH A VEHICLE OR INSTRUMENT FOR UP TO 180 DAYS.
A PLEA OF MARIHUANA INTOXICATION SHALL NOT BE A DEFENSE TO ANY CRIMINAL ACT COMMITTED UNDER ITS INFLUENCE NOR SHALL PROOF OF SUCH INTOXICATION CONSTITUTE A NEGATION OF SPECIFIC INTENT.
A PERSON WOULD BE ABSOLUTELY LIABLE IN CIVIL COURT FOR ANY DAMAGE TO PERSON OR PROPERTY WHICH HE CAUSED WHILE UNDER THE INFLUENCE OF THE DRUG.
DISCUSSION OF FEDERAL RECOMMENDATIONS 
The recommended federal approach is really a restatement of existing federal policy. From official testimony and record evaluation, we know that the federal law enforcement authorities, principally the Federal Bureau of Narcotics and Dangerous Drugs and the Bureau of Customs, do not concentrate their efforts on personal possession cases. The avowed purpose of both Bureaus is to eliminate major traffickers and sources of supply. For the most part, the federal agencies have left possession enforcement to the states. Underlying this approach is a need -to maximize the use of enforcement resources for major priorities and allow the states, in exercising their "police powers," to assume the responsibility for local activities, including possession for personal use.
By withdrawing the criminal sanction from possession for personal use we are, in effect, codifying official policy. In addition, such a scheme follows the model chosen for alcohol in the Volstead Act, and also revives the approach taken by Congress in the Drug Abuse Control Amendments (DACA) of 1965. We are in agreement with the original thrust of DACA, when Congress brought previously uncontrolled drugs, LSD, barbiturates and amphetamines, under control but did not assess criminal penalties for possession for personal use.
Instead, Congress placed on the prosecution the burden of proof that the possession was for purposes of sale. Regardless of whether or not Congress was wise in imposing a penalty in 1968 for possession for personal use, a subject we will consider in our next Report, we think the original DACA concept is enlightened where marihuana is concerned.
At the same time, present federal law classifies marihuana as contraband, and this feature should be maintained. The contraband concept serves the discouragement policy in two ways: it assists the removal of supply from the market and it symbolizes a continuing societal opposition to use. Accordingly, if a person is found in possession of marihuana in public and the government is unable to prove any intent to sell, it may nevertheless seize the marihuana and confiscate it is contraband.
The contraband provision would apply only to possession in public and would not extend to possession for personal use in the home. During Prohibition, the Federal Government and most of the states employed a similar statutory limitation. For example, the Volstead Act provided that a private dwelling could not be searched "unless it is being used for the unlawful sale of intoxicating liquor. . . ." I The impact of this contraband concept is that marihuana possessed or found in public can be summarily seized by law enforcement officials and forfeited to the state for subsequent destruction .2 The criminal justice system is not involved in the process. The individual receives no record of any kind; he simply loses the economic value of the marihuana.3
With regard to the casual distribution of small amounts of Marihuana for no remuneration or insignificant remuneration not involving a profit we are following the approach taken in the Comprehensive Drug Abuse Prevention and Control Act of 1970 which in essence treats such casual transfers as the functional equivalent of possession. In doing so, Congress recognized that marihuana is generally shared among friends and that not all people who distribute marihuana are "Pushers."*
'§ 39. Unlawful P0ssession of liquor or property designed for manufacture thereof ; search warrants. It shall be unlawful to have or possess any liquor or property designed for the manufacture of liquor intended for use in violating this chapter or which has been so used, and no property rights shall exist in any such liquor or property. A search warrant may issue as provided in [sections 611 to 631 and 633 of Title 181 and such liquor, the containers thereof, and such property so seized shall be subject to such disposition as the court may make thereof. if it is found that such liquor or property was so unlawfully held or possessed, or had been so unlawfully used, the liquor, and all property designed for the unlawful manufacture of liquor, shall be destroyed, unless the court shall otherwise order. No search warrant shall issue to search any private dwelling occupied as such unless it is being used for unlawful sale of intoxicating liquor, or unless it is in part used for some business purpose such as a store, shop, saloon, restaurant, hotel, or boarding 'house. 'Me term "private dwelling" shall be construed to include the room or rooms used and occupied not transiently but solely as a residence in an apartment house, hotel or boarding house. The property seized on any such warrant shall not lie taken from the officer seizing the same on any writ of replevin or other like process. (Oct. 28, 1919, e. 85, Title 11, § 25, 41 Stat. 315)
'The federal and state provisions presently in force regarding the seizure and forfeiture of an automobile transporting marihuana would no longer be applicable. They would still remain in force for other controlled drugs classified as contraband.
3 See the views of Commissioners Rogers, Carter, Ware, Hughes and Javits expressed in the footnote on pages 151-156.

The accuracy of Congress' appraisal is underscored by the National Survey. When people who had used marihuana were asked how they first obtained the drug, 61% of the adults and 76% of the youth responded that it had been given to them. Only 4% of the adults and 8% of the youth said that they had bought it. When asked who their source had been, 67% of the adults and 85% of the youth responded that it had been a friend, acquaintance or family member.
The close association between the concepts of casual transfer and personal possession is also underscored by the fact that 56% of the prosecutors in our survey thought that the present law did not deter casual transfer at all or deterred it only minimally.
With regard to importation and exportation, we recommend no change in existing law and make the following observations. First, the United States must maintain its international standing and, as a member of the community of nations, this country should do everything in its power to restrict the exportation of marihuana to other countries and to penalize such international traffic.
As to importation of marihuana, the most effective way to discourage use is to cut off supply at the top of the pyramid. Recognizing that most of the marihuana consumed in the United States comes from abroad, we feel that the Bureau of Customs at the borders should have all necessary authority to halt and interdict supplies intended for consumption in this country. There has been a long-standing practice of excepting ports and borders from procedural rules applying within the United States. One example is that Customs officials are allowed to search without the showing of probable cause, even though such a showing is mandatory for searches conducted within the United States. We can see a legitimate reason for continuing this policy.
*In considering this relationship, the Senate, in the Report of the Committee on the Judiciary of the United States Senate regarding S. 3246 (a precursor bill to the new Federal law) stated:
The language "distributes a small amount of marihuana for no remuneration or insignificant remuneration not involving a profit" as contained in section 501 (c) (4) is intended to cover the type of situation where a college student makes a quasi-donative transfer of one or two marihuana cigarettes and receives 50 cents or a dollar in exchange to cover the cost of the marihuana.
Transfers of larger quantities in exchange for larger amounts of money, or transfers for profit, are not intended to be covered by this section, but rather are to be covered by section 501 (c) (2) which deals 'with unlawful distribution. This language sketches a prototype situation which the Committee had in mind; however, the wording of the Federal Act and of our recommendations is not intended to establish inflexible rules. The objective in both provisions is to distinguish between commercial sellers and casual distributors. Ultimately the courts will have the responsibility of drawing this distinction according to the evidence in individual cases. The recommended provision intentionally establishes a loose standard not tied to specific amounts of marihuana or money.
See also the views of Commissioners Rogers, Carter, Ware, Hughes and Javits expressed in the footnote on pages 151-156.
DISCUSSION OF STATE RECOMMENDATIONS 
The states have primary responsibility for enforcing the existing proscriptions against possession for personal use. Their present efforts are designed mainly to keep marihuana use contained, and in private. Such an enforcement policy is consistent with our social policy approach, and is an appropriate exercise of the states' obligations to maintain public order. So while we see no need for criminal sanctions against possession for personal use or against casual transfers, we recommend a number of provisions for confining marihuana use to the home.
The first point is that even marihuana possessed for personal use is subject to summary seizure and forfeiture if it is found in public. This concept is now applicable under federal law which we commend also to the states. In our view, the contraband feature symbolizes the discouragement policy and will exert a, major force in keeping use private.
Another means of symbolizing the discouragement policy which has been suggested is the imposition of a civil fine on those possessing marihuana outside the home for personal use.* Under such an approach, a fine would be levied and processed outside the criminal justice system. Essentially, possession of marihuana would be the equivalent of a traffic offense in those jurisdictions where such an offense is not criminal.
Such a scheme would accomplish little more than that achieved under a partial prohibition scheme. Warrants would presumably not be issued for searches of private residences, and possession offenses would be detected only by accident or if the offender uses the drug in public. The more direct way to confront such behavior is a penalty against public use.
A further problem with the civil fine approach lies in the area, of non-payment of the fine. With traffic tickets, or with civil fines levied against industrial polluters, society can compel compliance by withdrawing its permission to engage in regulated activity. For example, it can revoke the motorists' license to drive or the polluters' license to do business within the state. In short, the state has remedies beyond the criminal law to achieve its policy goal. The same would not be true for the marihuana user and enforceability of the statute would ultimately require court action.
*See the views of Commissioners Rogers, Carter and Ware expressed in the footnote on pages 151-153.
As we have suggested, a central feature, of our statutory approach at the state, level would be a vigorously enforced prohibition of public use. No intoxicant should be used in public, both because it may offend others and because the user is risking irresponsible behavior if he should be under its influence in public. Moreover, where marihuana is concerned, continuing societal disapproval requires that the behavior occur only in private if at all. Public use, under the proposed scheme, would therefore be punishable by a fine of $100.
We also recognize the need for some prophylactic measure for anticipating distribution, even though there may be no intent to sell for profit. To this end, and in order to deter public use, possession and transfer, we have drawn a line at one ounce of marihuana. Possession in public of more than this amount would be punishable by a fine of $100.
For these same reasons, we believe the states should prohibit all transfers outside the home, whether or not for remuneration. A transfer for profit would be a felony, as under present law. A casual transfer of a small amount would be punishable by a fine of $100.
Taken together, the contraband feature, the proscriptions of public use and public possession of more than an ounce (even if for personal use) and the prohibition of public transfers will reflect the discouragement policy underlying the entire, scheme.
The remaining set of recommendations alms at irresponsible behavior under the influence of marihuana. Whatever the precise legal scheme employed, these provisions should be included.
First, the "drunk and disorderly" statutes presently in force in the states are useful tools for maintaining public order. We would suggest similar statutes in the case of marihuana, punishing offenders by up to 60 days in jail, a fine of $100, or both. Law enforcement authorities must have a means to halt antisocial behavior exhibited incidental to marihuana use.
The second aspect of irresponsible behavior is the operation of automobiles, other vehicles, or any potentially dangerous instrument while under the influence of marihuana. Such behavior is gross negligence in itself, risking harm to others unnecessarily. In addition to penalizing a person who "drives under the influence" as a serious misdemeanant, we would impose absolute civil liability on anyone who harms the person or property of another while under the influence of marihuana.
Finally, no one should be able to limit his criminal accountability by alleging that he was under the influence of marihuana at the time of the crime. Under both federal and state law, the defendant should not be able to negate the mental element of "specific intent," which some offenses carry, by pleading that he was under the influence of marihuana and was therefore unable to have formed such an intent. Unlike many users of heroin, the user of marihuana is not physically dependent on the drug. The use of the drug is usually a matter of choice. Although we believe on the basis of available evidence that there is no causal connection between marihauna use and crime, we would under no circumstances allow a person to escape the consequences of his actions by hiding behind the cloak of marihuana use.
DISCUSSION OF POTENTIAL OBJECTIONS
Having discussed our recommended scheme at the federal and state levels, we think it useful to answer some objections we anticipate will be raised. Possible objections are:
1. Partial prohibition is not a sufficient reflection of the discouragement policy.
2. Partial prohibition is logically inconsistent.
3. A possession penalty is necessary for effective enforcement of sale proscriptions.
4. Partial prohibition won't "work" for marihuana any more than it did for alcohol.
5. A possession offense is essential as a device for detecting problem users.
6. Retention of a possession offense is required by our international obligations.
7. A firm distinction should be drawn between less potent and more potent preparations.
1. The Partial Prohibition Approach Is a Sufficient Reflection of the Discouragement Policy
To those who would argue that a criminal sanction against use is a necessary implementation of an abstentionist policy, we need only respond that this country has not generally operated on that assumption. We would be astounded if any person who lived during the 1920's was not aware of a definite governmental policy opposed to the use of alcohol. Yet, only five states prohibited possession for personal use during Prohibition. The failure of the 18th Amendment, the Volstead Act and 43 state prohibition acts to criminalize private possession certainly did not signify official approval of or neutrality toward alcohol use.
As we pointed out in Chapter 1, our nation has not generally seen fit to criminalize private drug-related behavior; only in the narcotics area was possession made a crime and marihuana was brought within the narcotics framework because of unfounded assumptions about its ill effects. We think it is time to correct that mistaken departure from tradition with respect to marihuana. As during Prohibition, the drug will remain contraband, and its distribution will be prohibited.
Even as late as 1965, an abstentionist drug policy was not thought to require prohibition for personal use. At that time, Congress enacted the Drug Abuse Control Amendments, bringing LSD, amphetamines and barbiturates under federal control. National policy was clearly opposed to use of the hallucinogens and the non-prescription use of amphetamines and barbiturates, yet Congress did not impose a penalty for possession. Whether or not Congress' subsequent decision in 1968, to impose such a penalty was appropriate is an issue we will cover in our next Report after analyzing the individual drugs controlled. The important point now is that such a penalty is not a necessary feature of a discouragement policy for marihuana, regardless of its, propriety for other drugs.
  1. The Partial Prohibition Approach Is Not Logically Inconsistent
It will. be, argued that a law which permits a person to acquire and use marihuana but does not permit anyone to sell it to him for profit is logically unsound. We do not agree. If we had recommended a social policy of approval or neutrality toward use, partial prohibition would indeed have been illogical. However, under a discouragement policy, such a, scheme is perfectly consistent.
Under partial prohibition, use is discouraged in three main ways. First, law enforcement authorities will make a concerted effort to reduce the supply of the drug. If a person wishes to use marihuana, he will have to seek out a person to sell it to him; and if his seller is in the business of distributing marihuana for profit, the seller is violating the law.
Second, the user will have to confine his disapproved behavior to the home. If lie uses the drug in public, he has committed an offense; if lie possesses it in public, it may be summarily seized as contraband.
Third, continuing efforts will be made by educators, public health officials, and official government spokesmen to discourage use. Realizing that educational efforts are not always successful, we would hope for a sound program. In any event, the law should be an ancillary rather than a focal consideration.
There is nothing theoretically Inconsistent about a scheme which merely withdraws the criminal sanction from a behavior which is not immoral but which is disapproved. The individual is being allowed to make his own choice. Hopefully, he will choose not to use marihuana. If he chooses to do so, however, he will have to do so discreetly and in private. Apart from its ultimate possession by the user, however, all marihuana-related activity is prohibited. The drug is contraband from its initial growth, through its harvest and distribution. It ceases to be contraband only when possessed and used in the home.
3. Prohibition of All Possession Is Not Essential to Prohibition of Sale
The other side of the "inconsistency" objection is the argument by law enforcement officials that they cannot adequately enforce proscriptions against sale without a possession penalty. We disagree. We have already explained that enforcement of a possession offense to some extent impedes the effort to reduce supply. Possession cases are generally regarded in the law enforcement community and by judges and prosecutors as "cheap" cases. Few seriously contend that prosecution of possessors reduces supply.
Some persons argue in response that the law should remain on the books as a tool not against the possessor but against the seller. They say that a possession offense is helpful in three ways. First, a prosecution can be used as a bargaining tool to encourage the possessor to reveal his source; this is called "turning an informant." Second, the police may know that a person is a seller, but may not be able to prove either sale or intent to sell, so they can at least charge such suspected sellers with simple possession.
Third, a corollary of the second argument is that the possession offense provides a useful tool in the "plea bargaining" process. That is, a seller may plead guilty to the lesser offense of possession, now generally a misdemeanor, instead of running the risk of trial and conviction of the more serious offense of sale, generally a felony. The prosecution may accept such a "bargain' if it is uncertain of the strength of the case, to avoid delay in sentencing, to reduce judicial backlog or in return for information from the defendant.
From an institutional standpoint, we do not find these arguments persuasive. First, if a possession offense is on the books, possession is a criminal activity. We oppose criminalizing conduct when its purpose and intent is directed not toward that conduct but toward another behavior.
In answer to the informant argument, the marihuana user (and this may not be true of other drugs) is simply too low in the distributional chain to help very much. As indicated earlier, the National Survey shows most users receive their marihuana from their friends or acquaintances either as a gift or at cost. Rarely is the time spent on him or on his "source" a fruitful allocation of the law enforcement official's time. Also, it is institutionally improper to hold the criminal sanction over a person to force him to talk, when we otherwise would be unwilling to use that sanction.
As to the "lack of proof" and "plea bargaining" arguments, we believe they challenge a fundamental tenet of our criminal justice system. That is, under our law, a person is not guilty just because the police think he is guilty; his offense must be proven beyond a reasonable doubt to a judge or jury. If a possession offense were not on the books, the police would have to gather enough evidence to convict the seller of sale or of possession with intent to sell, and the prosecution would have to convince the judge beyond a reasonable doubt. The defendant, suspected seller or not, is entitled to due process of law.
The "lack of proof" argument is nothing more than a plea for an "easy out" when the police do not have enough evidence. This simply represents an admission that law enforcement officials want a possession offense which they can apply selectively, to people whom they think, but cannot prove, are sellers. Such a notion is inconsistent with the basic premise of our system of equal treatment under the law. If "simple" possession is not an offense for some, it is not an offense for all. A "known seller" is entitled to the same rights as anyone else: criminal conduct must be proved beyond a reasonable doubt. We do not favor coddling criminals. We do insist, as did the framers of the Constitution, that suspected criminal behavior be proved.
4. That Partial Prohibition Did Not "Work" For Alcohol Doesn't Mean It Won't For Marihuana
Prohibition failed to achieve its avowed purpose of eliminating the use of intoxicating liquors from American life. Risking an oversimplification, we think two reasons were essentially responsible for this failure: the unwillingness of a substantial minority, and probably a majority, of the American public to discard a habit deeply ingrained in their lives; and the inability of the law enforcement community to eliminate the bootlegging traffic which catered to this continuing demand.
As we have repeatedly noted, one of the reasons for adoption of a partial prohibition approach is uncertainty about the extent to which marihuana use is ingrained in American culture. Indeed, adoption of partial prohibition is the best way to find out for sure. If the social interest turns out to be only transient, this policy will prove particularly appropriate.
Similarly, an increase in marihuana use may be prevented by a concerted effort to eliminate major trafficking, the scope of which is presently only a small fraction of Prohibition bootlegging. We do not pretend that supply of a plant so easily grown can be eliminated. However, an intensive effort to eliminate commercial criminal enterprise should have some impact on the extent of use.
5. The Possession Offense Is Not Required as a Detection Device 
In addition to their deterrent and symbolic functions, the drug possession laws serve a third function not shared by most other criminal laws. Like laws against public drunkenness, they facilitate societal detection of drug-dependent persons. Ideally, such persons, although apprehended by law enforcement authorities, may be detained for purposes of treatment and rehabilitation.
Whatever the merits of such an argument for the opiates and alcohol, such an argument does not apply to marihuana. Only a very small percentage of marihuana users are drug-dependent or are in need of treatment. Their dependence is generally upon multiple drug use, not on marihuana. In any event, the existence of such a small population does not justify retention of the possession offense as a detection device.
6. International Obligations Do Not Require Maintenance of a Possession Penalty
Some have raised the possibility that removal of simple possession criminal penalties would contravene this country's obligations under the Single Convention on Narcotic Drugs (1961), to which it became a signatory in March, 1967. We do not believe the provisions of that Convention compel the criminalization of possession for personal use.
Nowhere in the Convention are its Parties expressly required to impose criminal sanctions on possession for personal use. Article 4 requires Parties to "take such legislative and administrative measures as may be necessary . . . . to limit exclusively to medical and scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of drugs." Penal sanctions are not necessarily included in this formulation.
Article 36, which deals specifically with penal provisions, requires each party to adopt "such measures as will ensure" that the listed activities, including possession, "shall be punishable offenses." Some have argued that this provision requires prohibition of personal use.
However, from a comprehensive study of the history of the Convention, the Commission has concluded that the word "possession" in Article 36 refers not to possession for personal use, but to possession as a link in illicit trafficking. This interpretation is bolstered also by the failure to include "use" in Article 36 even though it has been included in Article 4.
Finally, we must consider Article 33, which provides that "the Parties shall not permit the possession of drugs except under legal authority." This Article also does not require the imposition of any sanctions on possession for personal use. Experts consulted by the Commission have indicated that this Article may, nevertheless, require that the Parties to limit possession and use to medical and scientific purposes. To affirmatively allow drugs to remain in the possession of persons for non-medical use would in this view contravene Articles 4 and 33 to read together. From this perspective our international obligations may require the classification of marihuana, as contraband. For this reason, together with a desire to symbolize our discouragement policy in a clear way, we have included the contraband feature in our legal implementation scheme.
In conclusion, our reading of the Convention is that a Party may legitimately decide to deal with non-medical use and possession of marihuana through an educational program and similar approaches designed to discourage use.
7. No Potency Distinction is Necessary at the Present Time
Following the approach taken in the Comprehensive Drug Abuse Prevention and Control Act of 1970, we have drawn a line between the natural cannabis plant and the synthetic tetrahydrocannabinols. "Marihuana" is defined as any and all parts of the natural plant. That we choose this approach for purposes of statutory implementation does not mean that we are unaware of the difference between the less potent and more potent preparations of the natural plant.
As noted in Chapters 11 and III, the highest risk of cannabis use to the individual and society arises from the very long-term, very heavy use of potent preparations commonly called hashish. No such pattern of use is known to exist in the United States today.
The predominant pattern of use in the United States is experimental or intermittent use of less potent preparations of the drug. Even when hashish is used, the predominant pattern remains the same. In addition, whatever the potency of the drug used, individuals tend to smoke only the amount necessary to achieve the desired drug effect.
Given the prevailing patterns of use, the Commission does not believe it is essential to distinguish by statute between less potent and more potent forms of the natural plant. Reinforcing this judgment are the procedural and practical problems attending an effort to do so.
If the criminal liability of ail individual user is dependent on the THC content of the substance, neither lie nor the arresting officer will know whether he has committed a crime until an accurate scientific determination is made. Even if such accurate determinations were feasible on a large scale, which is not now the case, such after-the-fact liability is foreign to our criminal laws.
Under present circumstances, then, a statutory line based on potency is neither necessary nor feasible. We emphasize also that any legal distinction is an artificial reflection of the Commission's major concern: the heavy use of the drug over a long term. The most emphatic element of official policy should be to discourage such use, especially of the more potent preparations. Unfortunately precise legislative formulations regarding the amount of the drug presumed to be for personal use do not assist this effort at all. Whether it is lawful to possess one ounce of hashish or a proportionate amount based on potency (for example, one-fourth ounce), an individual prone to use the drug heavily will do so. Society's resources should be committed to the task of reducing supply of the drug and persuading our citizens not to use it. Expenditure of police time and financial resources in an attempt to ascertain the THC content of every seized substance would make little, if any, contribution to this effort.
A Final Comment
In this Chapter, we have carefully considered the spectrum of social and legal policy alternatives. On the basis of our findings, discussed in previous Chapters, we have concluded that society should seek to discourage use, while concentrating its attention on the prevention and treatment of heavy and very heavy use. The Commission feels that the criminalization of possession of marihuana for personal is socially self-defeating as a means of achieving this objective. We have attempted to balance individual freedom on one hand and the obligation of the state to consider the wider social good on the other. We believe our recommended scheme will permit society to exercise its control and influence in ways most useful and efficient, meanwhile reserving to the individual American his sense of privacy, his sense of individuality, and, within the context of ail interacting and interdependent society, his options to select his own life style, values, goals and opportunities.
The Commission sincerely hopes that the tone of cautious restraint sounded in this Report will be perpetuated in the debate which will follow it. For those who feel we have not proceeded far enough, we are reminded of Thomas Jefferson's advice to George Washington that "Delay is preferable to error." For those who argue we have gone too far, we note Roscoe Pound's statement, "The law must be stable, but it must not stand still."
We have carefully analyzed the interrelationship between marihuana the drug, marihuana use as a behavior, and marihuana as a social problem. Recognizing the extensive degree of misinformation about marihuana as a drug, we have tried to demythologize it. Viewing the use of marihuana in its wider social context, we have tried to desymbolize it.
Considering the range of social concerns in contemporary America, marihuana does not, in our considered judgment, rank very high. We would deemphasize marihuana as a problem.
The existing social and legal policy is out of proportion to the individual and social harm engendered by the use of the drug. To replace it, we have attempted to design a suitable social policy, which we believe is fair, cautious and attuned to the social realities of our time.
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FROM APPENDICES                                      


II. Biological Effects of Marihuana
Botanical and Chemical Considerations


Cannabis sativa is one of man's oldest and most widely used drugs. The substance has been used in various ways as long as medical history has been recorded and is currently used as a multipurpose drug throughout the world (Adams, 1942; Adams, 1941-1942; Grinspoon, 1969; Indian Hemp, 1969; Walton, 1938).
During the past few years, a resurgence of the use of marihuana by western society, its increased importance as a social issue and the development of more precise compounds and analytic techniques have sparked dormant scientific interest in the substance. However, this effort has added little to what was already known about the clinical syndrome produced by cannabis (Hollister, 1971) and described by investigators during the last 100 years (Hollister, 1971; Beaudelaire, 1861; Moreau, 1845; Lewin, 1964; Indian Hemp, 1969; Mayor's Committee, 1944).
Strongly held, diametrically opposed opinions exist about whether the ultimate effects of cannabis use are harmful, harmless, or beneficial to human functioning (Pillard, 1970).
Despite these conflicting opinions, from a scientific perspective, the literature on marihuana is as clear, if not clearer, than for many other botanical substances consumed by man. Most of the older reports suffer from multiple scientific defects such as biased sampling, lack of adequate controls, unsophisticated techniques, and use of unstandardized marihuana of unknown potency. Nevertheless, much is known about the use of cannabis by man. Marihuana has a unique position in the multitude of pharmaceuticals in that human experimentation has been greater than laboratory animal experimentation.
The crucial experiments about social effects from chronic use will be settled by close observation of those who use the drug. The issues of potential therapeutic utility; mechanisms of mental function alteration; and the relationship to mental illness will require more extensive laboratory experimentation (Hollister, 1971).

Botanical and Chemical Considerations

In the past several years considerable progress has been made in adding to the understanding of marihuana as a complex drug containing botanical substance. Much important information has been obtained from intensive investigation of marihuana of worldwide origin cultivated under Government contract by the University of Mississippi (Doorenbos et al., 1971).
Marihuana is a preparation derived from the hemp plant, Cannabis sativa. This plant is an annual which either is cultivated or grows freely as a weed around the world, including most of the United States. When cultivated in temperate climates, plantings are made in May to June. The seeds germinate in less than a week. in moist soil. After thinning, the plants grow as rapidly as two feet a week during the peak growing season. They can reach a height of up to 18 feet at maturity, approximately three to five months after planting. Growth is greatly inhibited by inadequate light, water or soil nutrients.
Marihuana is produced by cutting the stem beneath the lowest branches, air drying, and stripping seeds, bracts, flowers, leaves and small stems from these plants. Stems and seeds are variably removed using a mesh screen producing manicured marihuana. Hashish is produced by scraping the thick resinous material secreted by the flowers (Doorenbos et al., 1971).
Many morphological variations in branching and leaf structure are observed among plants produced by different seed types. The characteristic leaf is palmately-compound and contains an odd number of coarsely serrated leaflets. Plants of a given seed type generally grow at similar rates and resemble each other. Thus, botanists believe, Cannabis sativa represents a single species which has not stabilized and has many variations (Doorenbos et al., 1971).
Cannabis Sativa is a dioecious species with separate male and female plants, both producing flowers. Some monoecious variants are reported. Pollination appears to be accomplished by air currents. Bees are attracted by male flowers but not by female flowers. Sex cannot be established until flowering begins and the structure of the male and female flower is distinct. Male plants begin shedding leaves shortly after flowering, shied their pollen and die. Female plants lose their older leaves as the seed matures. After shedding their seed, they die. Contrary to popular belief, there is no significant difference in drug content between male and female plants at equivalent states of maturity (Fetterman et al., 1970; Ohlsson et al., 1971). Male plants mature earlier than the females, shed their pollen and die while the female plant is continuing to mature.
The drug content of the plant parts is variable. Generally, the, drug content decreases in the following order: bracts, flowers, leaves. Practically no cannabinoids are found in the stems, roots and seeds. Obviously, fluctuations in pharmacologic activity of a sample of Marihuana, depend on the mixture of these plant parts which is determined by the manicuring process (Fetterman et al., 1970).
Different variants of the plant contain different amounts of psychoactive drug. Variants of cannabis Sativa cover a spectrum of drug contents. Generally, they can be classified as either drug or fiber genotype. Drug type is high in THC and low in cannabidiol and the fiber type is the converse. This type is determined genetically and transmitted by the seed.
Thus, seeds from different geographical areas produce plants with a wide range of drug content. For example, when grown under similar conditions, plants grown from seeds from Mexico may contain 15 times more psychoactive drug than those grown from seeds from Iowa. Of course, individual plants of the same variant often contain greatly different drug content (Fetterman, et al., 1970).
Environmental factors are not as important as heredity in determining type, but they influence to some degree the drug content. However, environmental factors, including type of soil, water, growing space, temperature and light do play an important role in determining the size and vitality of the plant (Doorenbos et al., 1971; Ohlsson et al., 1971; Phillips et al., 1970).
This notorious variability of cannabis preparations causes many disadvantages for detailed and reproducible biological work. Consequently, much effort has been expended to provide a firm chemical basis in order to provide pure and well-defined substances for research.
The major naturally occurring active component of cannabis, 1-delta 9-trans tetrahydrocannabinol, was not isolated in a pure form and its structure illucidated until 1964 (Gaoni and Mechoulam, 1964; Mechoulam and Gaoni, 1967; Mechoulam et al., 1970). In addition, the A' isomer, which is usually present in small quantities in the natural product representing less than 10% of the combined THC content, has a similar spectrum of activity (Hively et al., 1966). These two chemicals, available by industrial synthesis (Fahrenholtz et al., 1967; Petrzilka and Sikemeier, 1967) or by extraction from the natural plant, can apparently reproduce fully the effects of the crude drug in animals and man. More than 20 natural cannabinoids have been identified in the plant (Figure 1) (Mechoulam, 1970; Shani and Mechoulam, 1970; Doorenbos et al., 1971).
All but Delta 11 and Delta 9 THC are inactive psychopharmacologically and do not seem to exert potentiating or other effects. However, new compounds, cannabinoids and non-cannabinoids, are being isolated from the plant and require further investigation. Several studies may indicate that some material present in natural marihuana may act synergistically with THC and potentiate its psychological effect Leniber (1972) Paton and Pertwee (1971) suggest cannabidiol may play this role.
The chemical nomenclature of tetra-hydrocannabinols is in a state of confusion due to the existence of two numbering systems. The dibenzopyran or formal system treats the compound as substituted dibenzopyrans ( Delta 9 THC) while the monoterpenoid system considers them as substituted terpenes (Al THC). The formal system will be used hereafter (Figure 2).
Many of the natural cannabinoids are present in the plant as acids. These acids are believed to be psychopharmacologically inactive. However, they are converted rapidly when heated, and slowly when stored into their respective active neutral components (Figure 3) (Waller, 1971). This conversion (decarboxylation) does not apparently occur when the acids are absorbed after oral consumption (Mechoulam, 1970).
The proposed biogenesis (Figure 4) of All THC appears to proceed through cannabidiol (CBD). Cannabis variates of the fiber type apparently do not perform this conversion. Thus, cannabidiol is the cannabinoid present in the largest percentage in the non-drug variety (Phillips et al., 1970). Marihuana appears to lose its potency over time due to conversion of THC to cannabinol (CBN) (Mechoulam, 1970) and this also apparently occurs more quickly for hashish implying the presence of a stabilizing substance in the whole plant (Figure 5).
Recently, the n-propyl homologue, of Delta 9 THC has been isolated from crude marihuana. It has about 20% of the activity of Delta THC in mice, and probably makes only a small contribution to the total marihuana effect (Gill, 1971). Merkus (1971) and Vree et al. (1971) have recently identified propyl and methyl cannabinol homologues in hashish in extremely small quantities.
In addition, numerous other non-cannabinoids have been identified in the natural material. Most of these have little or no psychoactivity (Gill et al., 1970; Bercht et al., 1971). Recently, waxes. starches, oils, terpenes and simple nitrogenous compounds including muscarine, choline and trigonelline as well as volatile low-molecular weight piperdines have been isolated.
Additionally, four more complex nitrogenous containing compounds of the generally-accepted alkaloid type have been reported in marihuana leaves in minute concentrations (average 0.002%). These produced decreased activity but no acute toxicity in mice (Klein et al., 1971).
Another laboratory has isolated two steroids and triterpenes from. marihuana as well as tyramine amide derivatives from the roots (Doorenbos et al., 1971).
Analysis of the smoke obtained from marihuana has been investigated. As in the case of any combustible plant, a gas and particulate phase is produced. Both these phases are delivered to the lung. Both the gas and particulate phase consist of compounds present in approximately the same percentages as other burned cellulose containing materials except for the cannabinoid fraction. This includes carbon dioxide, carbon monoxide, and hydrogen cyanide gases. (Truitt et al. , 1970)
The remainder, the smoke condensate, consists of a complex mixture of relatively non-volatile compounds. Included in this mixture are the cannabinoids (16%), carbohydrates and alcohols (8%), fatty and aromatic acids (11%), polybasic acids (7%), aliphatic amines (1%), aromatic phenols (27%), aliphatic phenols (6%), tannin (6%), unidentified compounds (18%) (Truitt et al., 1970).
Another group of investigators (Magus and Harris, 1971) compared the tar collected from combustion of marihuana cigarettes with the tar yielded from tobacco cigarettes. They reported that the total tar yield from marihuana was slightly less than half that produced by an equal weight of tobacco. The tar contained similar constituents based on typical changes produced on skin of mice.
In addition, there a multitude of synthetic compounds related to the naturally occurring Delta 9 THC derivatives and much more potent (Figure 6). A large number of bomologues have been prepared all with similar activity but differing widely in their potency.
In general, the activity of these compounds increases dramatically over that of A' THC by lengthening the 3 alkyl side chain to 6 and 7 carbons, with additional branching in the alpha and beta positions. The dimethylheptyl analogue (EA1476 or DMHP) is the most active having 50 times the activity of A' THC. The 1-methyloctyl substitution (MOP, EA1465) is the next most potent, compound. The 1,2-dimethylortyl substitution resulted in a 251 fold decreased activity from DMHP. (Domino et al., 1972; Sim and Tucker, 1963)
Numerous variations of the basic structures in the cyclohexene moeity of the molecule, as well as the replacement of -both methyl groups-by-hydrogen resulted in partial and even complete, loss of activity (Domino et al., 1972; Sim and Tucker, 1963).
Mechoulam. (1971) has summarized the investigations related to the structure activity relationships of the cannabinoids as follows:
(1) The pyran ring with a hydroxyl group at 1 position and an alkyl group at the 3 position is an essential requirement for psychotomimetic activity, eg., cannabidiol is inactive.
(2) The aromatic hydroxyl group has to be f reo or esterified for activity.
(3) The presence of a carboxyl, acetyl or carbomethoxyl group in position 2 or 4 renders the compound inactive. Substitution with an alkyl ,group at position 2 retains activity.
(4) Dextrorotary (+) delta-9-THC is inactive whereas its optical isomer levorotary (-) delta9-THC is active.
(5) Maximal activity is seen if the double bond is in the delta-9 or delta-8 position. The delta,-6a, 10a-THC is relatively inactive. 9 (6) The activity of the delta-6a, 10a-THC can be increased by replacement of the pentyl side chain with a hexyl side chain to form synhexyl which is an active compound. Branching of the side chain may lead to considerable increase in potency. The substitution of a dimethyllheptyl side chain for the pentyl side chain in the delta-6a, 10a analogue of THC to form DMHP or EA1476 results in a marked increase in pharmacologic activity.
(7) Substituents at the 9 and 10 position have to be in the plane of the ring (that is equatorial) in order that high activity be retained.
More detailed information on materials, chemistry, bioassays, analytical methods, and methodology for detecting THC or its metabolites in biological fluids may be obtained from The Metabolism of the Tetrahydrocannabinols (Lemberger, 1972) and The Secretary of Health, Education and Welfare, 1972 Report on Marihuana and Health.

Factors Influencing Psychopharmacological Effect


A renewed interest in marihuana studies has been prompted by the recent clarification of the complexities of its chemistry, new techniques to quantity the amounts of active drug in natural materials, and the availability of purified tetrahydrocannabinols. These advances allow more precise scientific research on psychiopharmacological effect.
DOSE-RESPONSE RELATIONSHIP
A major advance has been a quantification of dose of THC in relation to clinically observable phenomena. This has been extensively studied over a wide dose range for marihuana (Rodin and Domino, 1970; Melges et al., 1970; Tinklenberg et al., 197O; Weil et al., 1968; Meyer et al., 1971; Clark and Nakashima, 1968; Clark et al., 1970; Jones and Stone, 1970; Mayor's Committee, 1944; Manno et al., 1970) and Delta 9 tetrahydrocannabinol (Isbell et al., 1967; Waskow et al., 1970; Hollister et al., 1968; Perez-Reyes and Lipton, 1971; Lemberger et -al., 1971; Dornbush and Freedman, 1971).
Investigations by Isbell et al. (1967), Kiplinger et al. (1971) and Renault et al. (1971) have clearly demonstrated that when reliable quantities of smoked marihuana or THC are delivered to the subject, a reproducible linear dose-dependent effect occurs on indices of physiologic, psychomotor, and mental performance as well as on mood and subjective experiences over a dose range of 12.50 to 200 micrograms of Delta 9 THC per kilogram of body weight.
In a 154 pound man this is comparable to consuming 0.88 to 17.5 milligrams of Delta 9 THC or 88 to 150 milligrams of marihuana containing one percent Delta 9 THC. It is generally assumed that good quality marihuana available in the United States contains 1% Delta 9 THC and an average marihuana cigarette consists of 500 milligrams of marihuana; thus, 5 milligrams of Delta 9 THC (Hollister, 1971).
As with most drugs, the larger the dose taken, the greater the psychopharmacologic effect. Isbell et al. (1967) noted that clinical syndromes vary from a mild euphoric feeling of relaxation at low doses (25 micrograms per kilogram) to an intensive hallucinogenic-like experience at high doses (250 micrograms per kilogram).
DOSE-TIME RELATIONSHIP
Similar time-action curves have been demonstrated for smoked Delta 9 THC and equivalent quantities of smoked marihuana (Hollister et al.,1968; Isbell et al., 1967 Renault et ai., 1971 Kiplinger et al., 1971). Symptoms began almost immediately after smoking (2-3 minutes). At lower doses, the peak effect is seen at 10 to 20 minutes and the duration of effect is 90 minutes to two hours. At higher doses, symptoms persist for three to four hours.
Therefore, as with most drugs, the larger the dose taken, the longer the action. The subjective symptoms experienced by the subject appear to parallel in time the subjective effects and some physiological indices such as pulse rate (Isbell et al., 1967; Hollister, 1968 - Renault and Schuster, 1971; Kiplinger et al., 1971; Galanter et al., 1972; Lemberger et al., 1971). Others such as reddening of the eyes have a delayed peak response and longer duration (Kiplinger et al., 1971).
ROUTE OF ADMINISTRATION
A second factor which influences the effect experienced by the user is the manner in which the substance is consumed. That is, whether it is smoked, swallowed or injected.
Isbell et al. (1967) demonstrated that smoked material is two and a half to three times as effective as orally consumed marihuana in the form of a 95% ethanolic solution in producing equivalent physiologic and subjective effects.
In addition, the oral time-action curve is extended with onset of symptoms one-half to one hour after administration. A peak effect is reached in two to three hours and the effect persists for three to five hours at low doses and six to eight hours at larger doses (Hollister et al., 1968; Isbell, et -al., 1967; Lemberger et al., 1971; Perez-Reyes, and Lipton, 1971).
In general, the effects produced by ingested THC or ingested marihuana extract are comparable to those produced by nearly one-third the amount of smoked and inhaled THC or marihuana (Hollister, 1971).
Recent work has been reported which clarifies these findings. Lemberger et a]. (1971) studied absorption into the blood utilizing radioactive labeled THC by three routes of administration: smoked, ingested in 95% ethanolic solution in cherry syrup, and intravenously injected. The first appearance of the drug into the, blood was immediate intravenously; almost immediate, by inhalation; and delayed for 15 to 30 minutes when ingested.
Perez-Reyes and Lipton (1971) using labeled AO THC demonstrated that rate of absorption by the gastrointestinal tract, and the duration of action is greatly influenced by the vehicle used to ingest the drug. Speed and completeness of absorption varied when the THC was dissolved in 100% ethanol or sesame oil or emulsified with a bile salt (sodium glycocholate), and administered to a subject who had fasted 12 hours. With the bile salt vehicle, the physiologic and subjective effects were noted between 15 to 30 minutes after ingestion and lasted two to three hours. In contrast, the effects, with ethanol or sesame oil, appeared after one ,hour and lasted four to six hours.
Hollister and Gillespie (1970) hypothesized that this delayed gastrointestinal absorption of THC might be accounted for by the nonpolar vehicle required to dissolve TUC or marihuana extracts.
Furthermore, Perez-Reyes and Lipton (1971) found that the peak levels and duration of radioactivity in the plasma paralleled the physiologic and subjective effects, although the plasma levels remained high for a longer period of time than the effect. Subjects receiving the drug emulsified in sodium glycocholate or dissolved in sesame oil had three times higher plasma levels of radioactivity with much less excreted in the feces than those receiving the drug dissolved in ethanol.
These results indicate that the THC was poorly absorbed from the gastrointestinal tract when given in all alcoholic solution. The sesame oil solution and the glycocholic acid preparation allowed more complete absorption and the latter preparation was much faster. It is of interest that the degree of subjective high after ingestion of 37 milligrams Delta 9 THC also parallels the plasma radioactivity.
Thus, the subjects reported their experience, as intense and unpleasant both with the bile salt and the sesame oil, and as moderate and entirely pleasant with ethanol. (Perez-Reyes and Lipton, 1971) This correlates well with earlier findings of Hollister et a]. (1968).
QUANTIFICATION OF DOSE DELIVERED
The problem in quantifying the THC dose delivered by different routes of administration has been clarified by several studies using radioactive compounds. However, until a method for determining the THC blood concentration is developed, only estimates oil amount delivered are possible.
Radioautographic studies clearly demonstrate that intravenous injection gives the, most complete and consistent delivery (Lemberger et a]., 1971; Me Isaac et M., 1971; Ho et a]., 1971; Kennedy and Waddell, 1971; Idanpaan-Heikkila, 1971). These investigators have demonstrated that THC is poorly absorbed from the injection site after intraperitoneal or subcutaneous injection.
As discussed earlier, the completeness of absorption ocurring after oral administration of THC appears to depend upon the vehicle. Judged by radioactivity levels, almost complete absorption of the THC occurs with an oil or bile acid vehicle, but absorption is incomplete with an alcohol vehicle. (Perez-Reyes et al., 1971)
Recent animal studies performed for NIMH indicated that the oral dose necessary to produce comparable gross behavioral changes in lab animals is about three times higher than the intravenous dose (Marihuana and Health. 1971: 171). Ferraro (1971) demonstrated the comparability of effective oral doses of THC in chimpanzees and humans. Furthermore, preliminary work performed in the laboratories of M. Isaac (1971) and Harris (1971) and Mechoulam (1971) appear to indicate that the intravenously administered dose of Delta 9 THC necessary to produce detectable behavioral changes in monkeys (20 to 50 microgram/ kg) on conditioned learning tasks is comparable to that in man. (Kiplinger et a]., 1971; Lemberger et al., 1971).
The dose of THC absorbed from natural marihuana extracts ingested orally is uncertain. THC is present as an acid in variable quantities in natural marihuana. THC acid has not presently been proven to be active. Claussen and Korte (1968) reported that the THC carboxylic acid is converted to free THC during the smoking process. Whether these, acids are active themselves; are absorbed from the gastrointestinal tract or converted there into THC; or are decarboxylated in the, body is unknown presently.
Because inhalation is the most widely used route of administration of marihuana, several laboratories have investigated the effect of combustion and smoking oil marihuana. Because techniques and conditions varied between laboratories, precise quantification of the delivery to the smoker's lungs is uncertain.
Manno, et al. (1970) calculated that about 50% of the THC contained in a marihuana cigarette would be delivered to the smoker's lungs for absorption if the entire cigarette were smoked in 10 minutes and each inhalation was retained for 30 seconds with no sidestream loss. Truitt (1971) and co-workers (Foltz et al., 1971) found that 50%c of THC was pyrolyzed and 6% was lost in the side stream while noting that almost 21% of the THC remained in the butt when three-fourths of the cigarette is consumed.
Agurell and Leander (1971) studied the transfer of THC using actual smoking subjects where only the main stream smoke was collected. They found that 14-29%% of the THC was transferred in the mainstream smoke for a cigarette and 45% for a pipe. However, they stated that this amount transferred would be comparable if no butt was left.
Agurell and Leander found that the amount transferred was not effected by depth of inhalation but that smokers using deep inhalation retained 80% of the transferred THC while those using superficial inhalation tended to exhale more than 20% of the transferred THC. Mikes and Waser (1971) also found about 22% in the mainstream smoke.
These divergent data appear to be comparable when corrected for loss to sidestream and retention in the unsmoked portion. Thus, the efficiency of delivery of THC by smoking and inhalation using good techniques, and smoking the entire cigarette approximates 40-50% of the original THC contained. A small fraction is lost in the uninhaled sidestream smoke, about 50% is destroyed during pyrolysis and a variable amount is exhaled from the respiratory dead space.
In apparent confirmation, Lemberger et al. (1971, 1972), using radiolabeled THC added to a marihuana cigarette, found that the initial plasma level of radioactivity after smoking was about onehalf the level after intravenous injection. Oral administration of the same dose of THC in an alcohol vehicle produced about one-half the peak level as smoking. However, Galanter et al. (1972) noted marked variability in the amount of THC absorbed using a standardized routine of inhaling, breath-holding and finishing the cigarette within a set time period.
EFFECT OF PYROLYSIS ON THE CANNABINOIDS
Several investigators have studied the effect of pyrolysis on the cannabinoids. Most have concluded that only negligible changes occur in the original cannabinoid fraction of marihuana except for decarboxylation of the acids to the cannabinoids. No evidence was found for isomerization of Delta 9 THC or Delta 8 THC nor the formation of any new pyrolysis products (Manno et al., 1970; Coutselinis & Miras, 1970; Claussen and Korte, 1968; Foltz et al., 1971; Agurell and Leander, 1971). Mikes and Waser (1971) suggested that a small percentage of cannabidiol was converted to Delta 9 THC, but this observation was not confirmed by the other groups.
Coutselinis and Miras (1970) noted that less THC was destroyed during smoking when Delta 9 THC was the only cannabinoid present rather than when a resin or a mixture of cannabinoids were present. This was believed to be at least partially accounted for by the distribution of THC in the cigarette. More destruction occurred when the THC was evenly distributed in the cigarette than when it was present in a well-defined lump.
SET AND SETTING
A most important variable encountered when evaluating the effect of marihuana is the interaction of the drug with the non-drug factors, set and setting. Set refers to the drug-taker's biological make-up including personality, past drug experiences, personal expectations of drug effect, and mood at the time of the drug experience. Setting refers to the external surroundings and social context in which the individual takes the drug. Set and setting exert their largest effect on psychoactive drugs, like marihuana, with subtle subjective mental effect and minimal physiological effect. Set and setting exert a variable but often marked influence on the potential drug effects (Waskow et al., 1970; Wickler, 1970).
The results of a series of experiments by Jones (1971) suggests the subjective state produced by "a socially relevant dose of smoked marihuana.... 9mg THC" is determined more by set and setting than by the THC content of the marihuana.
In one experiment, a greater variety and more intense pleasurable symptoms occurred in a fourman group allowing unstructured interpersonal interaction than in unstructured solitary test situations. Contrasting behavioral patterns were observed by the investigator and reported subjectively by the individuals. Subjects tested individually demonstrated a relaxed, slightly drowsy, undramatic state as they read, listened to the radio, or sit doing nothing. In the group setting there was elation, euphoria, uncontrolled laughter, a marked lack of sedation and much conversation. (Jones, 1971)
This strongly emphasizes the importance of setting in the marihuana experience. The reason is apparent why marihuana is usually used with other people. However, most investigators studying its effects evaluate their subjects alone, in well-controlled, sterile, scientific laboratories.
The importance of the placebo effect (the subject experiences a drug effect from an inert material) to the "social high" obtained from marihuana was studied in another experiment (Jones and stone, 1970; Jones, 1971). Misjudgments of the pharmacologic potency of both the smoked placebo (marihuana without THC) and active marihuana were commonly made by the subjects although physiologic and performance indices routinely matched the distinction correctly. The smoking of a material that smells and tastes like marihuana by individuals with marihuana experience appeared to produce a mental state that is interpreted as being high if combined with the expectation of becoming high.
The importance of learning to get high was demonstrated when individuals who smoked marihuana less than twice a month were compared with those who used marihuana at least seven times a week. Although both groups rated the active marihuana equally potent, the frequent users rated the placebo equally to the active drug, while the infrequent users experienced significantly less high from the placebo.
The infrequent users' experiences appears to reflect mainly pharmacologic factors with moderate set-setting influence. However, the frequent users' response to the placebo appears to reflect mainly learned set-setting influence and minimal pharmacologic factors. (Jones, 1971)
Smith and Mehl (1970) call learning to get high " reverse tolerance." During the early exposures to marihuana the individual learns to appreciate the subtle drug effect with repeated experience with the drug. Consequently, less drug may be required to experience the desired high in the early stages of marihuana use.
Further evidence for this is seen when the familiar smoking route and smell and taste cues are made ineffective by giving the active and inactive material by the oral route (Jones and Stone, 1970). Both groups of users can significantly distinguish the intoxication produced by 25mg of active material. But the frequent user rates this high significantly poorer than his smoking high while the infrequent user rates them correctly.
TOLERANCE
The development of tolerance is another important factor that may influence the psychophysiological effects of marihuana. Although tolerance occurs with many drugs and the process has been studied for over a century, the mechanism of this complex phenomenon is not completely known. Kalant et a]., (1971) have extensively discussed tolerance to the psychotropic drugs.
Tolerance has two different connotations. The first, termed "initial tolerance," is an expression of the dose of the drug which the subject must receive at his first exposure to produce a designated degree of effect. These authors state that a variety of congenital and environmental factors contribute to the wide range of differences in "initial tolerance" observed among different individuals, sexes, species, age groups and so on.
The second meaning of tolerance is that of an "acquired change in tolerance" within the same individual as a result of repeated drug exposures so that an increased drug dose is required to produce the same specified degree of effect, or the same dose produces less effect. In this chapter, tolerance will be used synonymously with "acquired increase in tolerance." -Tolerance can only be discussed for each specific drug action and not for all the actions of a given drug on the body. That is, tolerance occurs at different rates for some of the various effects of the same drug on the body and may not occur for other effects of the same drug. The relationship between "initial tolerance" and "acquired change in tolerance" has not been clearly established.
There are two classes of tolerance based on possible mechanisms. The first, dispositional tolerance refers to changes in absorption, distribution, excretion and metabolism which produce a reduction in the intensity and duration of contact between the drug and the target tissue on which it acts.
The second, functional tolerance includes changes in the properties and functions of the target tissue making it less sensitive to the same dose of the drug. Physiological tolerance implies a, change in the target organ while psychological or "learned tolerance" implies the acquisition of new skills or functions to replace those changed in the target tissue (Kalant et al., 1971).
Considerable evidence is accumulating which demonstrates that tolerance does develop in numerous animal species (pigeons, rats, dogs, monkeys, chimpanzees, mice) to the behavioral and physiological effects of marihuana and THC in doses many times larger (from 1 mg. to 500 mg./ kg/day) than the minimal active dose (Carlini, 1968; Silva et al., 1968; McMillan et al., 1970, 1971; Frankenheim et al., 1971; Carlini et al., 1970; Thompson et al., 1971; Pirch et al., 1972; Ferraro, 1971; Elsinore, 1970; Cole et al., 1971).
Lipparini et al. (1969) were not able to demonstrate tolerance in the rabbit.
Tolerance, appears to develop rapidly to high doses even when injections are spaced up to about a week apart. Tolerance to high doses appears to be long-lasting with little loss of tolerance even after a month. But at low doses in the behavioral range, tolerance appears to completely dissipate in a few days after a single dose. The magnitude of tolerance development can be large. After repeated exposure, a dose of over one hundred times the original produces little effect (McMillan et al., 1971).
The development of tolerance to THC in animals occurs for some effects but not for others (McMillan et al., 1971; Pirch et al., 1972; Thompson et al., 1971 ). This differential development of tolerance may explain why tolerance to certain effects studied has not been demonstrated (Masur and Khazan, 1970; McMillan et al., 1971; Barry and Kubena, 1971; Kubena et al., 1971).
Lomax (1971) and Thompson et al. (1971) have noted that the development of tolerance to one effect of the drug (hypothermia or sedation) may allow the expression of the opposite effect (hyperthermia or stimulation) to which tolerance does not develop.
Cross tolerance has been demonstrated between delta-9-THC, delta-8-THC and its synthetic analogues. Cross tolerance, has not been demonstrated between THC and lysergic acid diethylamide (LSD), mescaline or morphine (McMillan et al., 1970).
Preliminary work performed by McIsaac (1971) and Harris et al., (1972) demonstrated a reduction in the duration and quality of response on a conditioned learning task by monkeys on the seeond intravenously administered dose of THC. Tolerance developed extremely rapidly so that no effect on behavior was seen after five days. After a. two-week period without THC, the animals were retested and the same degree of tolerance had persisted. The researchers believe these observations might indicate a rapid behavioral adaption or "learned" functional tolerance.
However, evidence indicates that dispositional tolerance and/or physiological type of functional tolerance also plays a role at least at higher doses. Tolerance develops to the central nervous system depressant effects, hypotherma hypopnea (Thompson et al., 1971) and the EEG effects (Pirch et al., 1971) of the drug. McMillan et al., (1971) have demonstrated that tolerance to the effects of THC on behavior can be blocked by the hepatic microsomal enzyme inhibitor, SKF-525-A which has been shown to be a potent inhibitor of THC metabolism (Dingell et al., 1971). Methodological techniques must be, developed which will allow microdistribution studies to be performed in tolerant animals with low doses of THC before the mechanism of tolerance development can be clarified.
Evidence for the development of marked tolerance by man has been suggested by studies of heavy daily very long term users of hashish, charas or ganja in foreign countries. Reports from the, Eastern literature (Chopra and Chopra, 1939; Dhunjibhoy, 1930; Ewans, 1904) and more recently from Greece (Miras, 1965; Fink et al., 1971) and Afghanistan (Weiss, 1971) relate daily consumption of enormous quantities of potent cannabis preparation estimated to contain up to about one gram of THC per day.
Weiss (1971) has noted that daily charas smokers start with small doses and then in order to achieve the same effect gradually increase their daily dose about 5-6 times over a 20 to 30 year period. Generally, most reach their maximum dose by age 40 and then gradually decrease their daily dose by 50% usually ceasing use by their 60's. Some smokers have been noted to raise their original daily dose up to a maximum of 10 times within the first two years.
Others have noted that moderate use for many years does not necessitate increased doses (Sigg, 1963).
At least part of the increase in daily amount of drug used is accounted for by the finding that the duration -of the intoxication becomes shorter over the years so that the very heavy smoker must consume the drug more frequently to remain intoxicated. Additionally, smokers report that they have on occasion discontinued use for days or months after which they experienced similar effects at smaller doses (Weiss, 1971).
Fink et al. (1971) noted that as hashish users total daily dose was decreased by more than half over the years, the frequency of use per day declined correspondingly.
Rubin and Comitas (1972) noted that very long term Jamaican ganja smokers generally consumed an average of seven spliffs daily (a ganja cigarette several times the size of an American marihuana cigarette) with a maximum of 24.
Further evidence for the development of tolerance, at least to certain of the depressant effects, is that these very long term smokers apparently tolerate the extremely high doses well without dysphoria or decreased ability to perform their usual activities (Weiss, 1971; Fink et al., 1971; Rubin and Comitas, 1972).
Smith and Mehl (1970) noted the, accumulating American anecdotal evidence of mild tolerance development after heavy daily use for a number of years. Jones (1971) and Meyer et a]. (1971) have suggested diminished effect on physiologic and psyochomotor performance, that is, little or no impairment of function in daily users compared with infrequent, intermittent users of marihuana. Additionally, several investigators have noted that frequent users had little or no impairment on psychomotor performance tasks while marihuananaive individuals given the same dose had impaired function. (Clark et al., 1968, 1970; Jones and Stone, 1970; Mayor's Committee, 1944; Weil et al., 1968).
Subsequently (Mendelson et al., 1972) repetitive daily (free access) use over a 21-day period by groups of long-term intermittent (average 7.7 sessions per month) and moderate, marihuana users (daily average, 33 smoking sessions per month) was studied. The development, of tolerance was strongly suggested to the physiological pulse rate and general depressant effect on activity as well as psychological effects which impair recent memory, time estimation and psychomotor coordination.
No tolerance development occurred to the subjective effects of marihuana for experienced users over the 21-day period (global "highness", somatic, perceptual, awareness, feeling, control, friendliness, ambivalence and altered thinking). Furthermore, with the exception of a higher ambivalence rating for the daily riser group, there were no differences in the subjective reports of the daily users or intermittent users. (Mendelson et al., 1972). The ambivalence score is believed (Katz et al., 1968) to be the best measure of "psychedelic ef fects" of hallucinogenic drugs.
In a prior study (Meyer et al., 1971) found that while the heavy smokers experienced more profound subjective effects soon after smoking, they were less intoxicated than the intermittent users one hour later.
These findings suggest to the investigators that the quality of the "high" may be different for heavy and intermittent users and may change with heavy use. Tolerance, to the subjective effects of marihuana may occur predominantly to the depressant effects so that the stimulatory effects (or hallucinatory-like) would be predominant in the heavy users. The intermittent users who smoked marihuana several times daily in the, current study showed no increase in the ambivalence, rating.
The increased daily frequency of marihuana use by both groups over time by shortening the interval between smoking sessions appears consistent with earlier observations (Meyer et al., 1971) that the duration of the desired "high" is shorter in heavy users than in intermittent users.
Fink et al. (1971) confirmed several of these findings in a study in which intermittent users smoked a fixed dose (14 mg. of THC) of marihuana. They noted a suggestion of development of tolerance to pulse rate, short-term memory, digit symbol substitution but not to the subjective high or EEG changes. However, the subjects did feel that the duration of the intoxication shortened progressively during the second half of the experiment.
Schuster and Renault (1971) administered twice daily fixed doses of marihuana (smoke from 430 mg. of marihuana with 1.5% THC content) to intermittent users over a 10-day period. A peak tachycardia, of 20 to 30 beats per minute and a usual social high were produced. Preliminary observations revealed the development of tolerance to time estimation in a few days, but no evidence for tolerance to the tachycardia, orthostatic blood pressure, or rating of the high.
Hollister (1971), in preliminary studies found no significant evidence of tolerance after five daily oral doses of 20 mg. of THC. Clinical responses measured were subjective judgment of the high, mood, pulse rate, reading comprehension or excretion of urinary metabolites.
REVERSE TOLERANCE
Smith and Mehl's (1970) clinical observations of many marihuana smokers suggest a J-shaped time curve of tolerance to marihuana. A novice marihuana smoker often reports feeling no high or requiring considerably more drug to get high on his first few trials with the drug than after he obtains more experience with the drug. This phenomenon has been called "reverse tolerance." These clinicians believed this represented "learning to get high" or acquiring the ability to appreciate or become sensitive to the subtle aspects of the intoxication.
Goode (1971) found that more frequent and term marihuana smokers tend to require fewer "joints" to get high but differences were not statistically significant.
Weil et al. (1968) reported that experienced users of marihuana achieved a "high" after being given the same dose as naive (non-users) persons who did not experience a high but did demonstrate objective physiologic and psychomotor drug effects.
Meyer et al. (1971) found that heavy marihuana, users (daily for three years) were most sensitive to the "high" and required less marihuana to achieve a social high than infrequent intermittent users (use one to four times per month for less than two years).
Phillips et al. (1971) reported an increase in severity of symptoms after repeated administration of THC to rats. This "sensitization" may be a correlate of reverse tolerance.
Lemberger et al. (1971) supplied additional evidence for reverse tolerance based on the intravenous administration of 0.5 mg of THC to experimental subjects. Naive subjects experienced no effect from this small dose. However, daily marihuana users, who were told they were receiving a non-pharmacologically active dose of THC, reported a "marihuana high," which lasted up to 90 minutes.
Lemberger et al. (1971, 1972) and Mechoulam (1970) suggested the possibility that enzymes necessary to convert THC to a more active compound require prior use of marihuana.
Reverse tolerance appears to be a complex phenomenon. Jones (1971) presented evidence which stressed the importance of expectation, setting and prior drug experience on learning to get "high." As the user gains more experience with marihuana, the more the individual's mind is able to respond to the expectation of the "high" by actually becoming high when given an inert material which smells and looks like marihuana.
Weil (1971) believes that the capacity to get "high" is an inherent characteristic of each individual's mind. He, believes that marihuana facilitates the user's abilitv to achieve this altered state of consciousness, that is, learn how to get high.
Mendelson et al. (1972) did not find evidence for reverse tolerance. In fact, the daily users were more likely than the intermittent users to smoke two cigarettes per occasion. Both groups had had an average of five years of marihuana use. Several other investigators did not obtain any evidence of reverse tolerance after repetitive daily use in experienced subjects (Hollister, 1971; Schuster and Renault, 1971; Fink et al., 1971).
METABOLISM
Metabolism of the drug by the body exerts an important influence on the psychopharmacologic effect of marihuana. Many laboratories in many countries have been examining the metabolism, of the cannabinoids using in vitro liver microsomal enzyme preparations.
With the recent availability of radiolabeled Delta 9 and Delta l THC, cannabinol and cannabidiol much activity has occurred in vivo in animals. A comprehensive review of these areas including studies of absorption, disposition, excretion, metabolism and stimulation-inhibition of metabolism is beyond the scope of this report. Readers interested in further details in this area are referred to an excellent comprehensive review by Lemberger (1972).
From animal and in vitro studies it appears that the liver rapidly changes Delta 9 and Delta 11 THC in a similar manner by hydroxylation to 11-OH THC. This compound appears to be as potent or possibly more potent pharmacologically than the parent compounds This metabolite appears to be, rapidly hydroxylated to 8-11 dihydroxy Delta 9 THC (7-11 dihydroxy All THC) which is inactive. The 8-OH Delta THC appears to be a minor active metabolite (Christensen et al., 1971; Burstein et 1970; Ben-Zvi et al., 1970; Foltz et al., 1970; Wall et al., 1970,71; Nilsson et al., 1970).
These metabolites are excreted primarily into the bile and then to the feces. Some evidence exists for an enterohepatic circulation returning the drug to the blood. (Miras and Coutselinis, 1970; Klausner and Dingell, 1971)
Another metabolic pathway appears to be present resulting in a series of acidic metabolites excreted primarily in the urine (Agurell et al, I., 1970). Recently, Burstein and Rosenfeld (1971) isolated and identified a majo r rabbit urinary metabolite, 11-carboxy-2'-hydroxy-Delta 9 THC. They postulate that other acidic metabolites might be esters or amides of this compound (Figure 7).
Recently, Nakazawa and Costa (1971) demonstrated that A' THC was metabolized by lung microsomes forming two unidentified products not found in liver homogenates.
Lemberger et al. (1970, 1971, 1972) and Galanter et al. (1972) have performed metabolic studies in mail using intravenous, oral and smoked Delta 9 THC. These studies indicate that the THC disappears from the plasma in two phases.
The initial rapid phase has two components and represents metabolism by the liver and redistribution from the blood to the tissues. The slower second phase represents tissue retention and slow release and subsequent metabolism.
The plasma 1/2 life of THC was significantly shorter in daily users than nonusers at both the first component of phase one (10 minutes versus 13 minutes) and phase two (27 hours versus 56 hours). Tissue distribution was similar in daily and nonuser (1/2 life 2 hours).
Therefore, immediate metabolism of THC and subsequent metabolism is more rapid for daily user than the non-user implying specific enzyme induction. THC persists in the plasma for a considerable period of time, at least three days, with a half life of 57 hours for nonusers and 28 hours for daily users.
The presence of 11-hydroxy THC and more polar metabolites in the plasma of both users and nonusers within 10 minutes indicates that the metabolite probably accounts for the pharmacological activity of marihuana, not THC.
Further metabolism of the 11-hydroxy THC to more polar inactive 8-11 dihydroxy A' THC metabolite occurs more rapidly in users than nonusers. During the first few hours after injection, unchanged THC, its polar metabolites and nonpolar metabolites in the plasma, decline rapidly and then level off as they are distributed to the tissues. THC persists in the plasma, for at least three days, and both users and non-users excrete metabolites in the urine and feces for more than a week.

Delta-9-THC is extensively metabolized to more polar compounds which were excreted in the urine and feces. Urinary excretion and biliary excretion (reflected a day later in the feces) was greatest during the initial 24 hours, then gradually tapered off. All THC is metabolized since no unchanged THC was excreted in the feces or urine. No difference in total cumulative excretion was observed but a significantly larger percentage of the metabolites were excreted in the urine of users than nonusers. About 40-45% of the metabolites were collected in the feces in both groups in one week. Urinary excretion in this period accounted for 30% in daily users and 22% in nonusers. (Lemberger et al., 1970, 1971, 1972)
Perez-Reyes et al. (1971) found a similar pattern of excretion of metabolites after oral administration.
Urine contained no Delta 9 THC, only a small quantity (3%) of 11-hydroxy THC and 90% more polar acidic compounds as yet unidentified. (Lemberger, 1971). Preliminary studies by Burstein and Rosenfeld ('1971) suggest that these human acidic urinary metabolites are identical to the 11-carboxy-2' hydroxy THC found in rabbits.
In man, Lemberger et al. (1971, 1972) found that 11-OH THC and 8-11-OH THC were primarily excreted in the feces. Twenty-two percent of the metabolites in the feces were unchanged 11-hydroxy THC and slightly less were 8-11-dihyd-roxy THC. The remainder were unidentified more polar compounds, perhaps conjugates of these metabolites.
All user subjects (Lemberger et al., 1970, 1971, 1972) but no non-user noted a high after intravenous injection of the 0.5 mg dose of Delta 9 THC. This would be a dose range of 5 to 7 micrograms/kg. Highs have been noted by Kiplinger et al. (1971) with smoking THC to deliver a dose of 6.25 micrograms/kg. The high for some lasted up to 90 minutes. Thus, the plasma levels of Delta 9 THC and its metabolites seen after intravenous injection suggest that psychopharmacologic effects are seen in the first component of the rapid phase and terminated by redistribution and metabolism after the initial phase. The 11-hydroxy Delta 9 THC would be present at this early phase and is probably responsible for the activity of Delta 9 THC in marihuana.
Further evidence that the 11-OH Delta 9 THC is responsible for marihuana's effect was seen in oral and inhalation studies. By the oral route, blood levels of unchanged THC were relatively low compared to the radioactivity levels of the metabolic products at the time of peak subjective effect. While the blood level of unchanged THC at the peak oral effect was identical to that after intravenous injection of the 0.5 mg. dose, the psychologic, effect was much more pronounced after oral administration of the larger 20 mg. dose of THC. Again after inhalation, the plasma levels of the metabolites correlate temporally with the subjective effects but the plasma levels of unchanged Delta 9 THC do not. (Lemberger, 1970, 1971, 1972; Galanter, 1972)
PATTERN OF USE
The drug effect of marihuana can only be realistically discussed within the context of who the user is, how long he has used, how much and how frequently he uses and what is the social context of the use. In general, for virtually any drug the heavier the use pattern, that is the longer the duration, the more frequently the use and the larger the quantity used on each occasion, the greater the risk for either direct or indirect damage.
Tolerance development is only one of a variety of occurrences which are related to the repetitive use of marihuana. Any discussion of drug effect must take into account the time period over which the drug is used (duration of use). This is necessary in order to detect cumulative effects or more subtle gradually-occurring changes. Of course, the issue of causality is quite complex because of the multitude of factors other than marihuana use that have a direct or indirect effect on the individual over a period of years.
For the purposes of this report, immediate or acute effects will refer to those drug effects which occur during the drug intoxication or shortly following it. Short-term or sub-acute will arbitrarily refer to periods of less than two years; long-term, from two to 10 years; and very long term (or chronic), greater than 10 years.
Frequency of use, will arbitrarily be designated in the following manner: experimental use refers to use of marihuana at least one time but not more than once a month; intermittent use refers to use more than once a month but not more than 10 times a month (several times a week) ; moderate use refers to use of the drug more than 10 times a month but not more than once a day; heavy use designates use more than once, daily and very heart use refers to use many times a day, usually with potent preparations (high THC content), producing almost continual intoxication so that the smoker's brain is rarely drug free.
AMOUNT OF DRUG CONSUMED
Relatively little actual data are available on the amount of marihuana, smoked per occasion or per day by current users in the United States. (McGlothlin, 1971, 1972). Estimates of the quantity of THC consumed are difficult because of the variability of potency as well as weight and size of the marihuana cigarette ("joint") and the degree of cleaning of stems and seeds from the dried leaves manicuring").
The analytic data available indicates most of the marihuana used in the United States is of Mexican origin and averages about I % THC per dry cleaned weight of marihuana (Lerner and Zeffert, 1968; Jones, 1971). Subjective ratings by experienced marihuana users appear to substantiate the data that marihuana containing 1% THC is of average quality (Jones and Stone, 1970; Weil et al., 1968).
Marihuana cigarettes are estimated (McGlothlin, 1971, 1972) to average about 0.5 g in weight and, therefore, contain about 5 mg of THC. Cigarettes used in the eastern states are generally smaller than those, rolled in the west (McGlothlin, 1971; New York Police Department, 1969, 1970)
Most data indicates that for the large majority of users one-half to one cigarette (2.5 to 5 mg THC) is sufficient to "get high" in intermittent moderate users, although often two or more cigarettes were smoked to achieve additional effect (Nisbet and Vakil, 1972; Shean and Fechtmann, 1971; McGlothlin et al., 1970- McGlothlin, 1972; Jones, 1971; Goode, 1970).
Current American daily users appear to consume one to two cigarettes per occasion (Jones, 1971) although some users estimate they smoke three to five cigarettes per occasion (McGlothlin et al., 1970). Goode (1971), however, found practically no relationship between amount required to get high and frequency of use (daily to less than monthly) or duration of use (less than two years to six or more years). In fact, the heavy and longer term users were less likely to require more "joints."
Thus, the estimated 15 mg THC for current daily users is about one-half that estimated for confirmed regular users 30 years ago in the United States (Mayor's Committee, 1944; Charen and Perelman, 1946) and one-third to one-fourth the median daily consumption of daily users in North Africa and India.
The maximum daily consumption of 10 cigarettes (50 mg THC) for current heavy U.S. marihuana smokers (Jones, 1971; McGlothlin, 1972) is about the same as the average amount consumed by daily chronic users in other countries, and about one-fourth or less of the maximum in these countries (Soueif, 1967; Sigg, 1963; Indian Hemp Drug Commission's Report, 1893-1894; Chopra, 1940; Chopra and Chopra, 1939).
Studies of American military in Vietnam (U.S. Congress, 1971; Colbach and Crowe, 1970; Forrest, 1970), and Germany (Tennant et al., 1971) described the daily use of quantities of hashish or potent marihuana comparable to amounts consumed by regular chronic users in other countries.
Experimental data appear to confirm these estimates of quantity of THC consumed. Isbell et al. (1967) and Jones (1971) found that most subjects reported a normal "high" after smoking 5-10 mg of THC. Meyer et al. (1971) found that a "very high" state was attained by ad libitum smoking of 3.12 mg THC by daily users and 3.78 mg THC by intermittent users.
In experiments by Johnson and Domino (1971), subjects were urged to smoke until they were as high as they had ever been on marihuana and felt they could not smoke any more. These subjects smoked from one to four cigarettes containing 8.7 mg of THC to reach this level of intoxication. The range was from 8.7 to 30 mg of THC with a mean of about 20 mg THC.
Intermittent and daily users were allowed to smoke marihuana on a free choice basis over a 21day period in studies by Mendelson et al. (1972). Each cigarette contained one gram of marihuana of approximately 2% THC content, or about 20 mg of THC.
Subjects were asked to rate their high on a 10 point scale with 10 corresponding to highest ever; five as moderately high and zero, no effect. Ratings for the daily user group ranged from zero to nine with an average of about six for all cigarettes rated. Individual means ranged f rom three to about seven. On almost all occasions, subjects in both groups smoked the entire cigarette.
Kiplinger et al. (1971) and Lemberger, et al. (1971) noted that daily long-term users were able to detect effects of the "high" at doses calculated to deliver as low as 5-7 micrograms/kg THC (equivalent to smoking about 100 mgs. of marihuana containing 1 % THC). Perhaps this explains the finding that many users are able to "get high" smoking US wild-growing marihuana containing front near zero to 0.5% THC (Lerner, 1969; Phillips et al., 1970; Fetterman et al., 1971).
Several ad libitum experiments were performed with marihuana of unknown composition (Williams et al., 1946; Siler et al., 1933) using "confirmed regular marihuana users" confined over a 39 and six-day period. The users, who generally consumed three cigarettes per day, under these rather artificial conditions of the, experiment consumed means of 17 (range nine to 26) and five (range one to 20) cigarettes per day respectively.
Miras and Coutsilinis (1970) reported recent experimental data on chronic Greek hashish users who routinely use, single smoked doses of hashish containing 100 mg of THC. Under ad libitum conditions, these users averaged 150-350 mg of THC per day over a 30-day period.
The subjects studied during a 21-day period of free choice Marihuana consumption by Mendelson et al. (1972) generally consumed all of one cigarette containing 20 mg of THC per smoking session. 'The subjects who were previously daily users were more likely during the experiment to consumer more, than one, cigarette per session than the, previously intermittent users.
Individual consumption by the intermittent users ranged from an average of about one-half to
six cigarettes per day (group mean three) while the daily users consumed an average of three-anda-half to nine cigarettes per day (group mean six-and-a-half). Reasons given by the subjects for the dramatic shift in the frequency of marihuana use included boredom, testing the limits of their endurance, demonstrating its harmlessness to the research staff, and subtle social pressure.
DURATION OF USE
Very little American data exists on the duration of marihuana use. Practically no data exists which demonstrates the extent that persons who initiated marihuana use some 20-40 years ago have continued its use. Robins and Murphy (1967) in a follow-up study of St. Louis black males noted that 20% of those who had tried marihuana by age 24 were still using it to some degree 15 years later. McGlothlin et a]. (1970, 1971) reported on a sample of predominantly white adults who began using, marihuana in adolescence and had continued infrequent use for more than 20 years.
In the case of Western and particularly middle class American use of marihuana, the rapid climb to prominence of the phenomenon since the midsixties raises the question of whether the entire drug movement is transient or permanent. Certainly, the majority of the youthful users and many of the adults have used the drug less than 10 years and probably less than five years.
One 1970 survey (Lipp, 1970) revealed that 77% of those students who initiated marihuana use four to five years earlier were still using it to some degree. A recent study (Walters et a]., 1972) indicates that students who first used marihuana before entering college in September 1965 and had continued use of marihuana in February 1969 ("old user") differed from the, vast majority of users who began their drug use in college ("new user").
The old user is more likely to experiment with a wide variety of drugs, to be extremely active in radical political organizations, to be alienated from American society, to be less definite about career plans, and to have more heterosexual activities.
The Commission-sponsored National Survey indicated that marihuana use by both youth (12-17 years of age) and adults (18 and over) is experimental in approximately 75% of those who have ever used marihuana. These individuals have, either stopped using it (66% of adults and 57% of youth) or are, using, it once, a month or less. In contrast, 13% of the ever used subsample (12% adults, 16% youth) use marihuana once a week or more.
In other non-Western countries, cannabis use frequently persists for long periods. Especially in the East, persons using it for 20-40 years or more are not uncommon. In other cultures, initiation is most common in adolescence. Once the habit is established it is likely to continue on a daily basis for many years and frequently continues as a lifetime practice (Weiss, 1971; Sigg, 1963; Soueif, 1967; Watt, 1936; Chopra and Chopra, 1939; Bouquet, 1951; VN, 1957).
Probably the duration of use will vary considerably depending on cultural acceptance or rejection (McGlothlin, 1972).
INTERACTION WITH OTHER DRUGS
Little experimental work has been done on the interaction between marihuana and other drugs used socially or medically although this will become an important area as usage increases.
Marihuana is often used with sweet wines to enhance its effect. Some evidence for an additive effect of marihuana and alcohol on motor and mental performance and subjective effect has been seen experimentally (Manno et al., 1971; Jones and Stone, 1970). Some degree of additive effects would be expected with barbiturates based on their similarity to alcohol. A more complex, mixed pattern of effect might be expected with amphetamines and hallucinogens. These latter combinations are rarely used socially (Hollister, 1971).



Acute Effects of Marihuana

(Delta 9 THC)
SUBJECTIVE EFFECTS
Descriptive accounts of marihuana intoxication have been written by noted authors, Beaudelaire (1961), scientists, Moreau (1945), and common users Tart, 1970, 1971; Isbell et al., 1967; Report by Advisory Committee, 1968). Adequate description of the state of mind produced by low doses is difficult because it is not approximated in the usual states of consciousness or by other commonly used drugs. The closest non-drug approximation may be the altered state of consciousness experienced in the hypnotic trance or transcendental meditation or the, transition zone between waking and sleep (Weil, 1971). Due to the highly subjective nature of the experience, there is much individual variation in the effects described.
Tart (1970, 1971) studied the range of potential common effects in an extensive survey of 150 users. Changes noted by these studies at low doses (usually smoked dose about five mg. THC) include euphoria, with restlessness and mild mental confusion. Sensory perception of the external environment. is altered. Users often perceive an overestimation or slowing of elapsed time and expansion of space, enhanced sense of tactile, olfactory, gustatory perceptions and often a feeling of hunger. Visual alterations reported are more vivid imagery and seeing forms and patterns in objects that are usually amorphous. Increased awareness of subtle qualities of sound such as purity, distinctness or rhythm are characteristically perceived by users. A dreamy, relaxed state and disinhibition, with uncontrollable laughter is reported and users often believe that interpersonal relations are altered, and act to potentiate social interaction.
At moderate doses intensifications of changes experienced are reported. Users' reports include disturbed associations, dulling of attention, vivid visual imagery, fixed ideas, rapidly changing positive and negative emotions, fragmentation of thought, flight of ideas, impaired immediate memory, altered sense of identity, increased suggestibility and a feeling of enhanced insight. At higher doses, interpersonal relations are dulled and the user feels less social and more withdrawn.
At larger doses psychotomimetic (hallucinogenic-like) phenomena are experienced in a wavelike fashion. These include distortion of body image, depersonalization, visual illusions and distortions, synesthesia, dream-like fantasies and vivid hallucinations.
Data from Isbell et a]. (1967) and Perez-Reyes et al. (1971) have indicated that the hallucinogenic oral dose is in the range of 0.4 to 0.5 mg./kg Delta 9 THC. Thus, the hallucinogenic dose is 80 times larger than the delivered dose of smoked marihuana producing minimal subjective effects (five micrograms/kg.) or about 11 to 14 times larger than the usual smoked dose.
LETHALITY
There is no conclusive evidence that short-term marihuana use alone directly results in any physical damage to man. A few scattered fatalities associated with marihuana use are occasionally reported. Most are from 19th century Indian experiences with large oral doses of charas (Deakin, 1880; Bouquet, 1951; Ewens, 1904, Walton, 1938; Indian Hemp Drugs, 1893). Brill et al. (1970) and Smith (1968) have noted that there have not been any reliable reports of human fatalities attributable purely to marihuana, although very high doses have been administered by users.
A frequently cited recent report from Belgium by Heyndrickx et al. (1970) describes an essentially negative pathological and toxicological study of a 23-year-old man found dead in the presence of marihuana, and hashish. A cannabinoid was detected in his urine. However, this finding in no way inculpates marihuana as the responsible agent. There are many possible causes of sudden death which are not toxins and do not produce observable pathology; e.g. anaphylactic reactions, insulin shock, cardiac arhythmias, etc.
A case report (Nahas, 1971) of an attempted suicide by smoking hashish, recently in France is even more anecdotal. An individual was reported to have smoked consecutively ten pipes of hashish containing approximately 200 mg of Delta 9 THC each before losing consciousness. But recovery occurred after supportive treatment.
Another case report (Hughes et al., 1970) relates severe diabetic coma with ketoacidosis after the ingestion of huge amounts of marihuana by a mental patient. However, it appears that the pronounced vomiting secondary to the marihuana ingestion caused a severe electrolyte imbalance and alkalosis. Possibly a vulnerable glucose-regulating system responded to the severe stress inappropriately. Retrospectively, there was no history of diabetes noted previously but this was not confirmed or ruled out by lab tests prior to the episode.
Several case reports (Henderson and Pugsley, 1968 King and Cowen, 1970; King et al., 1970; Lundberg et al., 1971; Gary and Keylon, 1970) noted acute severe, physiological disturbances and acute collapse (shock, chills and fever) subsequent to intravenous injection of suspensions of marihuana. These symptoms may have been due to an allergic reaction to injected foreign plant material, to a bacteremia and/or to the injection of insoluble particles which are filtered by the organs. The symptoms may be considered a complication of the mode of use, rather than results of the drug.
Although a median lethal dose has not been established in man (Brill et al., 1970), one has been found in laboratory animals. Earlier reports (Lowe, 1946; Joachimoglu, 1965) used materials of uncertain potency and composition. Recent studies utilized carefully quantified materials. One group, Phillips et al. (1971), utilizing THC extracted from marihuana, demonstrated the following LD50 (the dose that causes death in 50% of the animals) in units of mg/kg of Delta 9 THC from mice,/rats: oral 481.9/666, intraperitoneal 454-9/ 372.9, intravenous 28.6/42.47.
Thompson et al. (1971) under contract to the National Institute of Mental Health have recently carried out extensive studies in rats, dogs and monkeys in order to define the range of toxicity of the drug. The group used synthetic Delta 9 and A' THC and a crude marihuana extract (CME) of carefully define composition. Delta 9 THC was more potent than Al THC. CME was less potent than a similar quantity of A' THC.
Acute toxicity was studied using intravenous, intraperitoneal and oral routes of administration in rats. An LD50 similar to that reported by Phillips et al. (1971) was found by the intravenous route (20 mg/kg of THC) and intraperitoneal route (400 mg/kg) but higher values were noted with oral administration (1140 mg/kg). Interestingly, the LD50 for males was 1400 mg/kg while for females it was 700 mg/kg by the oral route. The minimal lethal dose orally was between 225 and 450 mg/kg.
An LD50 was not attainable in monkeys and dogs by the oral route. Enormous dose levels (over 3000 mg/kg of Delta 9 THC) were administered without lethality to most animals. A dose of about 1000 mg/kg THC was the lowest dose which caused death in any animals The completeness of intestinal absorption of THC at these high doses is unknown. Behavioral changes in the survivors included sedation, huddled posture, muscle tremors, hypersensitivity to sound and hypermobility.
The cause of death in the rats and mice subsequent to oral THC was profound central nervous system depression leading to dyspnea, prostration, weight loss, loss of Fighting reflex, ataxia, and severe fall in body temperature which led to cessation of respiration from 10 to 46 hours after single dose oral administration. No consistent pathological changes were observed in any organs. The cause of death when it rarely occurred in the higher species did not appear to be related to the same mechanism as in the rats.
Using intravenous administration, the acute one dose LD50 for Delta 9 THC was 100 mg/kg in dogs and 15.6 to 62.5 mg/kg in monkeys depending on concentration of the solution. The minimal lethal intravenous dose for dogs, also depending upon concentration, was 25 to 99 mg/kg and for monkeys 3.9 to 15.5 mg/kg.
In contrast to the delayed death observed in rats after oral administration, lethality in rats, dogs and monkeys after intravenous injection occurred within minutes after injection. When sublethal amounts were injected, central nervous system depression with concomitant behavioral changes similar to those observed after oral doses were observed. However, their onset was more rapid and the intensity of effect more severe with anaesthesia, and convulsions noted after injection. The monkeys and dogs that survived the intravenous injection of THC recovered completely within five to nine days.
The only consistent pathological changes were noted in the animals which succumbed. Pulmonary changes including hemorrhage, edema, emphysema and generalized congestion were found and death resulted from respiratory arrest and subsequent cardiac failure. The investigators presumed one mechanism possibly accounting for these findings was due to the concentration of the THC solution and its insolubility in water. Presumably, when these highly concentrated solutions mixed with the blood, the THC precipitated out of solution. The precipitated foreign material then formed aggregates (or emboli) that were filtered out in the lung capillaries causing a physical blockage of pulmonary blood flow.
Subsequently, intravenous studies were repeated using Delta 9 THC emulsified in a sesame oil-Tween 80-saline vehicle at 15 mg/ml or 40 mg/ml. The emulsions were administered at a uniform rate of 2 ml/15 sec. Doses administered were 1, 4, 16, 64, 92,128, 192 and 256 mg/kg. All monkeys injected with 92 mg/kg or less survived and completely recovered from all effects with two to four days. All monkeys injected with 128 mg/kg or more succumbed within 30 minutes for all but one (180 minutes).
Histopathological changes found in the lungs of the deceased monkeys were like those described after the, previous intravenous experiment. All the monkeys that died exhibited severe respiratory depression and bradycardia within five minutes after the injection. Respiratory arrest and subsequent cardiac failure occurred within minutes. Behavioral changes preceding death were salivation, prostration, coma and tremors.
Behavioral and physiological changes described clinically in the surviving monkeys followed a consistent developmental sequence and were roughly dose related in severity and duration. Onset was 15 minutes following injection and duration was up to 48 hours. Huddled posture and lethargy were the most persistent changes. Constipation, anorexia and weight loss were noted. Hypothermia, bradycardia and decreased respiratory rate generally were maximal two to six hours post injection. Tremors with motion but not at rest were believed to be caused by peripheral muscle inadequacy.
In summary, enormous doses of Delta 9 THC, All THC and concentrated marihuana extract ingested by mouth were unable to produce death or organ pathology in large mammals but did produce fatalities in smaller rodents due to profound central nervous system depression.
The non-fatal consumption of 3000 mg/kg A THC by the dog and monkey would be comparable to a 154-pound human eating approximately 46 pounds (21 kilograms) of 1%-marihuana or 10 pounds of 5% hashish at one time. In addition, 92 mg/kg THC intravenously produced no fatalities in monkeys. These doses would be comparable to a 154-pound human smoking at one time almost three pounds (1.28 kg) of 1%-marihuana or 250,000 times the usual smoked dose and over a million times the minimal effective dose assuming 50% destruction of the THC by smoking.
Thus, evidence from animal studies and human case reports appears to indicate that the ratio of lethal dose to effective dose is quite large. This ratio is much more favorable than that of many other common psychoactive agents including alcohol and barbiturates (Phillips et al. 1971, Brill et al. 1970).
PHYSIOLOGICAL EFFECTS
Much research has been reported on the effect of single doses of marihuana or THC on a wide variety of indices of physiologic function in animals. Most animalt studies involved large doses a-rid produced profound changes similar in nature but less in magnitude than those described in the previous paragraphs. These have been comprehensively reviewed elsewhere (Secretary HEW 1972, Forney, 1971; Secretary HEW, 1971) and should be consulted if more detailed information is required.
Similarly, much research has been done in man. As discussed in the previous section on factors influencing the psychopharmacological effect in man, an acute dose-response relationship has been clearly defined over a dose range relevant to human usage patterns for these effects. Thus, with increasing dose, the larger the effect on the index being observed and the longer the effect persists. However, there is a wide variation between individuals' responses but each individual is quite consistent.
The most consistent physiological sign is an increased pulse rate (Mendelson et al., 1972; Johnson and Domino, 1971; Renault et al., 1971; Galanter et al., 1972; Domino, 1970; Hollister et al., 1968 Manno et al., 1970; Mayor's Committee 1944; Waskow et al., 1970; Isbell and Jasinski, 1969; Meyer et al., 1971; Weil et al., 1968; Jones and Stone, 1970; Clark and Nakashima, 1968). This does not appear to be a direct drug effect on the heart (Manno et al., 1970). Instead, the drug appears to cause complex changes in the autonomic nerves regulating heart rate. Thus, Kiplinger et al. (1971) demonstrated that the increase produced by marihuana in heart rate is prevented by pretreatment with a Beta-sympathetic nervous system blocking agent, propranolol. A comparable increase rate was produced by treatment with isoprotemol, a Beta-sympathetic like drug. One subject developed an abnormal bigeminal rhythm after both marihuana and isoproternol.
Renault et al. (1971) noted a consistent effect of marihuana on the cardiac rhythm which also produced an increased heart rate. The effect was the suppression of the normal sinus arrhythmia usually produced by respiration. Respiration usually produces a slowing of heart rate mediated by the vagal parasympathetic nerve supply. This depression of normal vagal tone was further evidenced by the absence of heart rate slowing during forced expiration against a closed glotis (valsalva maneuver). This effect seemed to wax and wane over several minutes producing alternate periods of rapid and slowed heart rate.
Both autonomic nervous systems seem to be affected by marihuana; the sympathetic is stimulated while the parasympathetic is inhibited.
Kiplinger et al. (1971) clearly demonstrated that the amount of increase in _pulse rate was directly related to the dose of THC administered as did Renault et al. (1971) and Johnson and Domino (1971) over a wide range of doses. Both experienced and inexperienced marihuana smokers demonstrated increases regardless of the subjective state described. Tachycardia is noted rapidly and reaches a peak about 15 to 20 minutes after finishing smoking. The pulse rate returns to normal within one to one-and-a-half hours.
Other than the one report of bigeminy (Kiplinger et al., 1971), little or no alteration of normal heart rhythm were noted by electrocardiogram (Isbell et al., 1967; Mayor's Committee, 1944) other than sinus tachycardia (Mendelson et al., 1972). Johnson and Domino (1971) noted premature ventricular contractions in a few of their subjects, but they felt this effect was more likely produced by the smoking itself rather than by the drug.
Conjunctival injection, reddening of the eyes due to increased prominence of the conjunctival blood vessel and dilation of the scleral vessels, (Hepler et al., 1971; Kiplinger, et al., 1971) is another highly consistent occurrence (Mendelson et al., 1972, Allentuck and Bowman, 1942; Ames, 1958; Hollister, et al., 1968; Isbell et al., 1967; Manno et al., 1970; Waskow et al., 1979; Weil et al., 1968) produced by orally ingested and smoked al., 1968). This finding is produced by orally ingested and smoked marihuana (or THC). And thus the effect must be a direct drug effect and not caused by irritation from smoke (Perez-Reyes and Lipton, 1971). Kiplinger et al. (1971) noted that this finding was dose-related although it develops slowly reaching a maximum about one hour after smoking.
Reported effects on blood pressure are inconsistent. Some investigators find lowered pressure (Hollister et al., 1968; Isbell et al., 1967; Waskow, et al., 1970) while others report a slight increase (Johnson and Domino, 1971; Domino, 1970; Mayor's Committee, 1944) and still others report increases and decreases (Mendelson et al., 1972; Perez-Reyes et al., 1971).
Preliminary results of a carefully performed study of the cardiovascular effects (Weiss, 1971) demonstrated orthostatic, hypotension in the erect position and hypertension when supine.
Little or no effect has been demonstrated in humans on a wide variety of parameters investigated. Body temperature is unchanged (Mendelson et al., 1971; Hollister et al., 1968; Isbell et al., 1967; Brooks, 1896) as is respiratory rate (Domino, 1970; Isbell et al., 1967; Weil et al., 1968), lung vital capacity and acute bronchospasni (Mendelson et O., 1972) and basal metabolism (Mayor's Committee, 1944).
Several studies (Mendelson et al., 1972; Mayor's Committee, 1944; Personal Communication, 1970) have examined changes in blood cells and blood chemistry. No acute effects were demonstrated on red blood cell number, or structure; differential and total white blood cell count; platelet count; reticulocyte, count; serum electrolyte concentrations; calcium and phosphorous serum levels; liver function tests; uric acid concentration; type or quantity of serum proteins. Although increased frequency of urination is often reported, increased urine volume has not been demonstrated (Ames, 1958; Mayor's Committee, 1944) and no alteration of kidney function identified (Personal Communication, 1970; Hollister et al., 1968; Mayor's Committee, 194-4; Mendelson et al. 1972).
Reports of increased hunger, especially for sweets (Allentuck and Bowman, 1942; Ames, 1958; Manno et al., 1970; Mayor's Committee, 1944), have focused attention on blood sugar and food intake. No consistent significant change in blood sugar has been demonstrated (Dornbush and Freedman, 1971; Hollister, 1971; Hollister et al., 1968; Isbell et al., 1967; Manno et -al., 1970; Personal Communication, 1970; Weil et al., 1968) with some investigators finding decreases (Beringer et al., 1932; Lindemann, 1933-1934), others finding increases (Manno, 1970; Mayor"s Committee, 1944), still others finding both increases and decreases (Miras, 1965).
Podolsky (1971) found that although fasting blood glucose was unchanged by smoking marihuana, higher 30 and 60 minute glucose levels were noted after a standard dose of glucose. No corresponding alteration in insulin or growth hormone levels was demonstrated.
Hollister and Gillespie (1970) found an increased total food intake when the drug was administered after breakfast but not after an overnight fast. Half the subjects reported subjective increased hunger. Subjects' free fatty acid levels and blood glucose remained unchanged while the placebo controls' free fatty acid values decreased. Another study suggested increased appetite and food intake but was without adequate controls (Personal Communication, 1970).
An investigation of physiological parameters of stress after marihuana (Hollister, 1969; Hollister et al., 1970) revealed only a minimal increase in white blood cells and a minimal decrease in cosinophils but no changes in serotonin, cortisol level and urinary catecholamines. However, another investigator (Chopra, 1969) demonstrated increased catecholamine excretion especially those from the adrenal medulla. 
Hepler and Frank (1971) and Frank et, al(1971) have carefully studied ophthalmological changes produced by marihuana. Swelling of the eyelids (Ames, 1958), ptosis (Isbell et al., 1967), photophobia and nystagmus (Allentuck and Bowman, 1942) and dilated, sluggish reacting pupils (Mayer-Gross et al., 1960; Mayor's Committee, 1944) were all mentioned in earlier discussions but were not demonstrated (Hepler et al., 1971).
Findings which were quantifiable (Hepler et al., 1971) were a slight pupillary constriction with normal responsiveness to light and accommodation and an increase in glare recovery time. No change was evident on near and far visual acuity, fundiscopic exam, visual field acuity and depth and color perception. However, a decrease in tear secretion and an increase in conjunctival injection was demonstrated.
Hepler and Frank (1971) reported an average of about 25% decrease in the intraocular pressure of most normal subjects after smoking marihuana. A preliminary trial in one patient with glaucoma demonstrated similar findings (Frank, 1971).
No objective impairment of improvement invisual acuity or brightness perception (Caldwell et al., 1970; Caldwell et al., 1969) nor effect on depth perception and duration of after image (Clark and Nakashima, 1968) was noted in other studies.
Neurological examinations have consistently revealed no major abnormalities during marihuana intoxication. (Mayor's Committee, 1944; Rodin and Domino, 1970; Rodin et al., 1970; Personal Communication, 1970). Subjects often report muscle weakness. Minimal decreased leg, hand and finger maximum muscle strength have been demonstrated objectively (Fere, 1901; Hollister et al., 1968; Mayor's Committee, 1944). However, electromyography was reported to be normal (Personal Communication, 1970
A slightly increased briskness in the knee jerk has been detected (Domino, 1971 - Rodin and Domino, 1970) while no change in threshold or elicitation of deep tendon reflexes is usually, reported (Hollister et al., 1968; Isbell et al., 1967).
Incoordination, fine tremor and ataxia are often experienced by the user (Ames, 1958; Beringer et al., 1932; Clark et al., 1970; Mayor's Committee, 1944). The presence of a fine tremor and decrements in hand steadiness and static body equilibrium leave been demonstrated with refined measuring devices when they are not grossly observable (Manno et al., 1970; Mayor's Committee, 1944; Mendelson et al., 1972). Kiplinger et al. (1971) using sensitive apparatus demonstrated these fine hand tremors and changes in body equilibrium are also dose related.
Cranial nerve function and somatic sensation have not been significantly impaired or improved. Subjective reports of increased auditory sensitivity contributing to greater esthetic appreciation of music (Winick, 1960) have been generally unconfirmed in objective tests of auditory acuity and pitch, frequency or intensity or threshold discrimination (Aldrich, 1944; Caldwell et al., 1970; Caldwell et al., 1969; Clark and Nakashima 1968; Mayor's Committee, 1944; Meyers and Caldwell, 1969). Objective improvement in auditory acuity in several subjects was noted (Walton, 1938; Williams et al., 1946).
Similarly, improvement in visual acuity and discrimination and altered depth perception reported by users has been unconfirmed objectively (Caldwell et al., 1970; Caldwell et al., 1969; Clark and Nakashima, 1968; Mayor's Committee, 1944; Hollister and Gillespie, 1970; Jones and Stone, 1970; Frank et al., 1971).
A slight improvement in vibratory sensation (Rodin and Domino, 1970), no change in touch or two-point discrimination (Rodin and Domino, 1970; Williams et al., 1946) nor olfactory and gustatory senses (Williams et al., 1946) have been demonstrated. Decreased sensitivity to pain has been objectively demonstrated (Personal Communication, 1970) which corroborates its past therapeutic use as an analgesic.
One of the most frequently reported subjective effects of marihuana intoxication is a distortion of time sense (Tart, 1971). Actual elapsed time is overestimated or perceived as being longer than actual clock time. Thus, present events are perceived as prolonged when intoxicated and isolated from the past and future. They are in the "hereand-now" (Melges et al., 1971). Many have confirmed this experimentally (Ames, 19,58; Clark et al., 1970; Mendelson et al., 1972; Dornbush and Freeman, 1971; Hollister and Gillespie, 1970; Weil et al., 1968; Williams et al., 1946). The over-estimate is much greater during periods lit which the subject is performing a task than for unfilled time, and the error is (greater as the time period is longer (Clark et al., 1970).
Melges et al. (1971) have demonstrated that marihuana intoxication induces temporal distortions with a greater concentration on the present and a shortening of span of awareness into the past and future. They believe that under the drug's influence, as the, subject becomes less able to integrate past, present and future, his awareness becomes more concentrated on present events. These present events are experienced as prolonged or timeless because they no longer appear to the intoxicated individual as transitions from the past to the future.
Melges and Bowlby (1969) have described habitual marihuana smokers who specifically use the drug to achieve the "here-and-now" orientation. These smokers claim this focus on the present permits them to be more open to immediate experience while being less troubled by past and future concerns. This focus may also explain the belief that perceptions during intoxications are both unexpected and never experienced previously.
The effect of intoxication on the resting electroencephalogram are still unclear but generally have been minimal, inconsistent and within normal limits. In early studies (Wikler and Lloyd, 1945; Williams et al., 1946) a decrease in alpha activity was noted. More recently (Ames, 1958) noted a delayed alpha increase with concomitant increases in beta and theta activity. Rodin and Domino (1971) reported a slight shift toward slower alpha frequencies.
Three other studies (Jones and Stone, 1970; Hollister et al., 1971; Rickles et al., 1970), failed to find consistent changes but noted increased alpha frequency, increased synchronization and occasional paroxysmal activity. These effects were ascribed to relaxation and drowsiness.
Two investigators (Chopra, 1935; Miras, 1969) reported decreased fast activity and other variable effects. Most recently, Volavka et al. (1971) and Fink et al. (1971), reported a significant rapid onset effect occurring during the five-minute smoking period and of short duration (less than 30 minutes) in continuously alert individuals. The principal changes detected by computer analysis were a dose related increase in percent alpha time and an associated reduction in theta and beta hands.
Roth et al. (1972), demonstrated that auditory evoked responses were decreased in amplitude by marihuana and THC particularly during the first few minutes of stimulation. These results may indicate that the intoxicated individual may receive external auditory stimuli differently during the intoxication period.
The prominent and frequently reported sedative effects of marihuana and the dreamlike states occurring during intoxication directed several investigators to study the effects of marihuana on sleep. Fragmentary data from one sleep laboratory (Pivik et al., 1969) indicated decreased rapideye-movement (REM) sleep time. Another sleep lab (Rickles et al., 1970), in preliminary work demonstrated an increase in REM sleep time. Fink et al. (1971) noted that EEG defined sleep (stages one and two) were dose dependent but THC did not act like a classical sedative. The occurrence of EEG sleep was much more frequent in the placebo and low dose (10 mg THC) conditions than in the high dose condition (20 mg THC). 
Mendelson et al. (1972) noticed an increased amount of total sleep as well as an increase in discrete episodes of sleep related to marihuana smoking. These findings correlate well with questionnaire data (Tart, 1970) indicating that at moderate doses, users found it easier to induce sleep and that sleep was considered to be more refreshing, while at higher doses both aspects were impaired. 
In summary, marihuana containing Delta-9-THC is a pharmacologically active drug with minimal acute physiological effects at the low to moderate doses used by man.
Based on its few consistently observed physiological effects, marihuana is a rather unexciting compound of negligible acute physiological toxicity at the usual doses consumed by man. The subjective state characteristically described by the intoxicated user is far more interesting to both the user and the scientist than the objective one observed by the investigator.
EFFECTS ON MENTATION AND PSYCHOMOTOR PERFORMANCE
Characteristically, intoxication with psychoactive materials effect psychomotor and mental functions. It is apparent from the subjective assertions of users and a wide range of experimental studies that marihuana is no exception (Clark and Nakashima , 1968; Clark et al., 1970; Dornbush and Freedman, 1971; Hollister and Gillespie, 1970; Manno et al., 1970; Mayor's Committee, 1944; McGlothlin et al., 1971; Melges et al., 1970; Meyer et al., 1971; Weil and Zinberg, 1969; Weil et al., 1968; Volavka et al., 1971; Galanter et al., 1972; Kiplinger et al., 1971; Mendelson et al., 1972; Dornbush et al., 1971).
Psychomotor tasks which have been tested include tapping speed, handwriting and free-hand writing and free handdrawing, simple and complex reaction time, pursuit rotor and tracking tasks and continuous performance tests. Cognitive tasks frequently tested are simple arithmetic problems, serial addition or subtraction, fine judgment tasks, 'digit-symbol substitution test, digit-code memory, reading comprehension, speech or verbal out-put, forward and backward digit spans, goal directed complex serial subtractions and additions to reach a set end sum, and short-term or immediate memory functions.
In general, Kiplinger et al. (1971) have clearly demonstrated that the degree of impairment is dose related and varies in degree during the period of intoxication exerting its maximal effect at the peak intoxication.
Naive subjects commonly demonstrate greater decrement in performance than experienced users but report less subjective effect (Weil et al., 1968). Experienced users appear to better compensate to the effect of the drug especially for ordinary performance at lower doses (Clark and Nakashima, 1968; Clark et al., 1970; Crancer et al., 1969; Jones and Stone, 1970; Meyer et al., 1971; Weil and Zinberg, 1969; Jones, 1971; Mendelson et al., 1972). Performance of simple or familiar tasks (i.e. simple reaction time) during intoxication is minimally effected. However, on unfamiliar or complex tasks (i.e., complex reaction time), performance decrements occur (Weil and Zinberg, 1969; Dornbush et al., 1971; Moskowitz et al., 1970).
Performance decrements are further enhanced when verbal tasks are performed during delayed auditory feedback (Kiplinger et al., 1971). Also marked individual differences in performance are noted between similar subjects. (Clark and Nakashima, 1968; Clark et al., 1970; Manno et al., 1970; Kiplinger et al., 1971). A cyclical waxing and waning of the intensity of the intoxication and concomitant performance occurs periodically (Clark et al., 1970; Melges et al., 1970).
Finally, when subjects concentrate on the task being performed at "normal social high," objective evidence of intoxication is not apparent and the individual may perform better than when drug free (Rodin and Domino, 1970; Mendelson et al., 1972).
Obviously, these observations raise practical doubts regarding the intoxicated individuals' ability to function at jobs requiring memory, concentration, and organization of thinking.
THE INTOXICATED MENTAL STATE
Several investigators have suggested that shortterm memory is the mental function most significantly affected by marihuana and contributes to the subtle alterations of mental functioning noted. Generally an impairment of recent or short term memory is demonstrated (Abel, 1970,1971; Dornbush et al., 1971; Menges, 1970-71; Tinklenberg, 1970; Clark et al., 1970; Weil et al., 1968). Thus, mental tasks requiring immediate information acquisition (Abel, 1971) and/or retrieval (Weil et al., 1968) are effected.
Abel (1971) recently showed that marihuana blocks the acquisition process involved in the storage of new interferes with the retrieval of already stored information. Decrements are produced in decisions requiring recent memory or sustained alertness (Clark et al., 1970) ; conversation (Well et al., 1968) ; calculations, or reading which requires retention, coordinating and indexing sequential information termed temporal disintegration (Melges et al., 1970, 1971).
Melges eta]. (1970, 1971) theorizes that episodic impairment of immediate memory produces voids which are filled with perceptions and thoughts extraneous to the organized mental processes. He suggests that this leads to temporal disintegration producing a fragmented and disorganized temporal experience in which past and future time frames are blurred and the present is experienced as prolonged or boundless. Thus, depersonalization occurs as the individual experiences himself temporally in a strange and unreal manner during marihuana intoxication.
UNPLEASANT REACTIONS: "TOO STONED" AND "NOVICE-ANXIETY" 
These substantial cognitive and psychomotor effects are probably responsible for many of the acute adverse reactions to marihuana. One, of the most common is the heavy, drugged feeling where the individual feels mentally and physically sluggish so that every motion and thought seems to require extreme effort (Smith and Mehl, 1970). This probably reflects impaired cognitive function and psychomotor retardation from getting "too stoned." This most frequently occurs after oral ingestion of a large dose of drugs or in inexperienced smokers who have, not learned to selftitrate their dose to achieve the desired high.
In these instances, depression, anxiety, fatigue, short-term memory loss, dizziness, nausea, incoordination, palpitations are experienced as generalized discomfort, and ill-being.
"Novice anxiety reactions" or panic reactions account for a majority of acute toxic reactions to marihuana (Baker and Lucas, 1969; Baker-Bates, 1935; Gaskill, 1945; Grossman, 1969; Persyko, 1970; Bialos, 1970; Sonnenreich and Goes, 1962; Sigg, 1963; Dally, 1967; Hamaker, 1891; Marten, 1969; Smith and Mehl, 1970; Walton, 1938).
When dosage, set and setting are optimal the distortion of self (depersonalization) and temporal disintegration (timelessness of the present moment) common to marihuana intoxication is recognized by the individual as time-limited and drug-induced. It is usually experienced as pleasurable. But, if dose, set and setting are not optimal the experience may cause the intoxicated individual to fear that loss of his identify and self control may not end or that he is dying or losing, his mind. Acute, anxiety or panic results (Mel et al., 1970).
Non-drug factors of set and setting play a most important role in these, reactions. Of course, the great variability of individuals makes the effect of marihuana on any specific individual rather unpredictable.
The large majority of these anxiety reactions occur in novices who have intense underlying anxiety surrounding marihuana use such as fears of arrest, of disruption of family and occupational relations and of possible physical and mental dangers. Also, individuals with relatively rigid personality structures, whose values are more in line with those of the "straight"society and have little desire for new and different experiences, appear to experience these, anxiety reactions much more frequently than those, individuals who are members of the "counterculture" (Smith and Mehl, 1970).
In addition, simple episodes of neurotic depression may be observed in these, same types of individuals during periods of unusual psychological stress (Well, 1970). Both of these types of reactions are transient and abate as the drug effects wear off over a few hours. Treatment should consist of gentle but authoritative. reassurance that nothing is seriously wrong and that the drug effects will wear off and the individual will feel normal" again (Smith and Mehl, 1970; Well, 1970).
ACUTE PSYCHOSES
Rare cases of full-blown acute psychotic episodes precipitated by marihuana use are reported in individuals with histories of mental disorder, with marginal psychological adjustments or with poorly developed personality structures and ego defenses (Talbott, 1968; Heiman, 1968; Kaplan, 1971; Pernot, 1969; Keeler, 1968; Defer and Diehl, 1968; Wurniser et al., 1969; Allentuck and Bowman, 1942; Bromberg, 1939; Bromberg, 1934; Curtis and Wolfe, 1939; Hughes et al., 1970; Isbell et al., 1967; Keup , 1970; Keeler, 1967; Talbott and Teague, 1969 Mayor's Committee, 1944).
Marihuana intoxication may hinder the ability of these, individuals to maintain structural defenses to existing stresses, or, alternatively produce a keener awareness of personality problems or existing stresses (Smith, 1968). Psychotherapy and antipsychotic medications are useful in controlling and preventing this reaction (Weil, 1970).
Exceptionally rare reports from North America of nonspecific toxic psychosis or actite brain syndrome have occurred after extremely high drug dose consumption, although such reports are, more common in the eastern countries. These conditions are self-limited and clear spontaneously as the drug effect abates (Weil et al., 1968; Bartolucei et al. 1969 Ames, 1958; Isbell et al., 1967; Mayor's Committee, 1944; Williams et al., 1946).
Finally, marihuana intoxication may trigger delayed anxiety reactions or psychotic episodes in a small percentage of persons who have prior experience with hallucinogenic drugs (Ungerleider et al., 1968; Ungerleider, 1969; Weil et al., 1968; Favazza and Domino, 1969).
In summary, the acute psychomotor-cognitive effects of marihuana intoxication are, interesting academically to gain understanding of normal and abnormal mental function. Also, for practically determining the danger-risk factor for the individual including determination of his functional level personally, vocationally and socially in this society. The effect on personal-social-vocational function is highly individualized and difficult to predict at present.
Although reports of anxiety attacks and psychotic episodes are more frequent as marihuana use spreads, they are still exceedingly rare and their incidence appears to be decreasing as use becomes more acceptable to more diverse populations. For example, during the nine-year period of 1961 to 1969, out of 701,057 admissions to Los Angeles County Hospital, located in a, city with very high marihuana use, only three patients required hospitalization for psychic sequelae of marihuana smoking (Lundberg, et al., 1971). 
In contrast, many cases are being seen in Vietnam soldiers where a extremely potent material is available and daily stresses are high, but, these probably represent only a small fraction of marihuana, users (Talbott and Teague, 1969; Talbott, 1968; Heiman, 1968).
During the, academic year 1968 and 1969, eight students were seen in the mental hygiene division of a private Eastern University student population (8,500) with acute anxiety reactions (Bialos, 1970). The frequency of marihuana-associated acute adverse, anxiety reactions requiring attention at Boston University Student Health Service (student population 20,000) is between five and seven yearly (Pillard, 1970).
In a recent survey of newly admitted patients to a large mental hospital, marihuana was the direct cause of the hospitalization in only 0.9 per thousand admissions (Keup, 1970).
PERSISTENT EFFECTS AFTER ACUTE DOSE
Investigators have not noted persistent effects after smoking marihuana for periods of more than three to five hours (Fink et al., 1971; Weil et al., 1968; Pillard, 1970).
Users report only minimal hangover effects (Mayor's Committee, 1944; Haines and Green, 1970; McGlothlin et al., 1971) after very heavy use. Feelings of lassitude and heaviness of the head, lethargy, irritability, headaches and loss of concentration are reported especially when associated with lack of sleep (Chopra and Chopra, 1939; Indian Hemp, 1893). This may be related to preliminary data (Rickles et al., 1970) suggesting a subtle increase in REM sleep time primarily seen in the last one-third of the night in individuals who smoked one to two cigarettes per day usually at night for at least a year.
EFFECTS OF MARIHUANA USE ON CONCOMITANT BEHAVIOR
Mendelson et al. (1972), under contract to the Commission, analyzed the effects on behavior of acute marihuana intoxication on an extensive variety of assessine nts including a simple operant task, mood states, individual and group observations before, during and after smoking and clinical psychological evaluations.
Sleep-inducing properties were confirmed. Increased amounts of total sleep were observed in both number and length of shorter and longer blocks of consecutive hours of sleep related to marihuana smoking.
Examination of mood assessments prior, during and after marihuana smoking indicates that the acute effects were a reduction of negative moods (anxiety, hostility, and guilt-shame) and an increase in the positive moods (carefreeness and friendliness). Examinations of the mood prior to smoking revealed that the subjects tended to smoke marihuana when they reported generally positive moods. The effect of the drug was to increase this positive mood. One paradoxical finding was that the subjects also reported feeling more depressed after smoking.
Acute effects of marihuana on cognitive and motor functions were studied with a battery of tests sensitive to brain function (Halstead Category Test, Tactile Performance Test, Seashore Rhythm Test, Finger Tapping Test, Trail Making Test and the Weschler Adult Intelligence Scale). No alterations in performance as a result of acute intake of marihuana were noted in any of these.
The acute effect of marihuana smoking on social behavior was investigated, by observing the individual and his interaction in small groups. The data indicated very strongly that marihuana smoking, in addition to being a subjective drug experience, is also a social activity around which verbal interaction and other types of social behavior are centered.
Although marihuana smoking tended to be, a group activity, subjects did not always engage in verbal communication while smoking. Subjects often were observed withdrawing from the social interaction and then participating in some type of noncommunicative passive activity, such as watching television, listening to music, reading or staring at objects or people. This decrement in total interaction appeared to be a drug effect.
Heavy marihuana users tended to be more withdrawn than the intermittent users, often listening to the stereo and focusing on the personal effects of the drug. The intermittent users tended to watch television which provided group entertainment, thus enhancing the social effects of the drug.
Verbal interaction in formal task-oriented discussion groups diminished when several group members were simultaneously intoxicated. How-ever, groups engaged in problem-solving tasks performed more efficiently because less suggestions and discussion ensued before proposing a workable solution. The groups tended to become more convivial and less task-oriented although none failed to arrive, at the goal. Marihuana did not appear to increase hostility during these sessions and furthermore tended to change the nature of hostile communication from direct criticism to indirect sarcasm.
Assessment of risk-taking behavior revealed that under the influence of marihuana, users tend to become more conservative in the decision making.
In summary, it appears that marihuana does exert subtle effects on measurable components of social behavior and interaction.



Effects of Short-Term or Subacute Use



ANIMAL STUDIES (PRECLINICAL)
Studies have only begun in this area in the last 10 years. Subacute toxicity studies in rats involving 30 daily intraperitoneal injections of up to 30 mg/kg THC were recently reported by Phillips et al. (1971). No fatalities were observed. Total body and organ weight (rains were significantly retarded over the period. However, no significant differences in organ histology were detected although in a few animals there were suggestions of change in liver and testicular cells. An interesting phenomena also observed was a suggestion of increased sensitivity to effects of Delta 9 THC occurring after two weeks of daily treatment.
Thompson et al. (1971) under contract to NIMH studied the toxicity in rats treated daily for seven, 28, 91 and then 119 days with oral Delta 9 THC, A" THC and crude marihuana extract at doses from 50 to 500 mg/kg. The findings were generally similar for all three preparations although A" effect was greater than All THC which in turn was greater than CME.
A bimodal pattern of behavorial toxicity was exhibited by the cannabinoids for all time periods of dosing ranging from five to 119 days. Initially, a dose-related generalized central nervous system depression was noted. This was characterized by huddled posture, inactivity, drowsiness, slow movements, unkempt appearance, loss of appetite, wide stance, constipation, weight loss, depressed respiration and heart rate and fall in body temperature. Tolerance gradually developed to the initial depressant effects starting after two to five doses and continued at different rates for different parameters.
Concomitant to the development of tolerance, rats exhibited progressively more hyperactivity, manifesting increased exploratory behavior, grooming and motor activity. The daily duration of the altered behavior progressively shortened. Tolerance to the hyperactivity was not seen in the rats. Later, in the experimental period, the rats became hyper-irritable and exhibited fighting behavior, especially at lower doses. Additionally, tremors and later chronic convulsions occurred in significant numbers of rats.
The onset and frequency of chronic convulsions were dose-related and the severity increased as the duration of dosage was extended. Cumulative toxicity, as evidenced by increased mortality, was observed in the rats but most deaths and maximal toxicity (central depression) occurred 36 to 72 hours following first treatment. Drug dose-related histopathological changes in all treated rats (in addition to decreased body and organ weight gains) were hypocellularity of the spleen and bone marrow, vacuolization of the adrenal gland and degeneration of the testes (seminiferous tubules) or ovarian stronia. Extended doses from five to119 days were not significantly more toxic except to the adrenals. No evidence of abstinence syndromes were noted upon abrupt cessation of these doses.
Similar behavorial and clinical findings were observed in monkeys given 50-500 mg oral Delta 9 THC, All THC and equivalent CME for up to 91 days. Cumulative toxicity was less severe and all monkeys survived the initial moderately severe central nervous system depression. Tolerance to the depression occurred and the monkeys returned to their undrugged behavior. Mild hyperactivity was noted only in several of the median dosed animals.
Three of 28 monkeys studied became moribund on days 10, 14 and 16 respectively. These were sacrificed and the only histopathology seen was severe hemorrhagic and probably drug-related enterocolitis. The bone marrow and kidney changes seen probably were due to severe electrolyte imbalance resulting from the intestinal lesion. The thymus lesion is consistent with stress due to this electrolyte imbalance. Pancreatic atrophy was due to weight changes. Eight additional monkeys were sacrificed at 28 days in fair-to-good condition and no histopathology was demonstrable. Several other monkeys had bloody diarrhea, but recovered spontaneously without demonstrable histopathology.
The remaining 17 monkeys were all in fair-to good condition at 28 days and hyperactivity was no longer observed. They were treated at the same dose for an additional 63 days. Tolerance to the central depression continued to develop so that the effects lasted only one to two hours at 91 days. No additional monkey fatalities were recorded -and the remaining 17 monkeys were normal histopathological at autopsy. Urine and ophthalmological examinations were all within normal limits. Hematological and blood chemical changes after 28 and 91 days were minor and little affected in the surviving monkeys.
Thus, a. minimal toxicity in monkeys, either physical or behavorial, is evident after 91 daily doses orally of enormous amounts of Delta 9 THC. However, significant cumulative toxicity, primarily a generalized central nervous system depression, is evident in the first few days but tolerance rapidly develops to these effects. A dose-related hemorrhagic enterocolitis occurred which may lead to electrolyte imbalance and death in a few monkeys. This probably is a direct irritative phenomena.
Again, the enormous daily doses of THC that were administered to these animals cannot, be compared to the daily doses used in man even by the heaviest users.
The effects were observed of 28 daily administrations to monkeys of intravenous Delta 9 THC in sesame oil-Tween 80-saline vehicle at doses of 5, 15 and 45 mg/kg. Behavioral, clinical, hematological and hemochemical changes were similar for monkeys given single or repeated injections. However, the duration was extended in the 28-day groups and tolerance gradually developed. Delayed death indicative of cumulative toxicity occured on days eight and 19 in two of four animals given the largest dose.
Histopathological changes, noted in the two animals which succumbed and in one of the highdose monkeys, were acute hemorrhagic pneumonia resembling the finding in the single-intravenous studies at doses of 128 mg/kg or greater. Additionally in the repeated dose study, edema, ulceration and fibrosis at the injection sites probably contributed to minor hematological and hemachemical alterations.
In summary, the 1972 Marihuana and Health Report to the Congress from the Secretary of HEW noted that these doses were employed in rodents and mammals to test the limits of toxicity. The doses are much higher than those used by man and the routes of administration substantially dif ferent. These studies have shown that the margin of safety between the lethal dose and the pharmacologically active doses of Delta 8 and All THC and crude marihuana extract is large. Consequently, it has been determined that these compounds could be safely administered to man for Phase I and early Phase II clinical studies (Secretary of HEW, Feb. 11, 1972, p. 158-160).
HUMAN EXPERIMENTS (CLINICAL)
Only a few investigators have studied the subacute administration of marihuana to man. Marihuana cigarettes of unknown potency were made available to 34 military prisoners in Panama by Siler et al. (1933). The mean daily consumption was five cigarettes (range one to 20). The usual behavior effects associated with marihuana use were noted. No ill effects were observed nor abstinence syndrome seen.
Williams et al. (1946) made available marihuana cigarettes of unknown potency to six prisoner addicts who were experienced marihuana users in the Public Health Service Lexington Hospital. The subjects were permitted to freely consume the drug in any quantity desired. The number of cigarettes consumed increased only slightly over a 39-day period. The daily range was from nine to 26 per day with a mean of 17. Only minimal evidence of tolerance was seen. There was no evidence of physical dependence; that is, no observable abstinence, syndrome was observed after abrupt termination of the drug.
In general, the following observations were made on these subjects: daily rectal temperature increased slightly; pulse, rate increased for three weeks, then returned to normal; no change was noted in respiratory rate, coordination, or rote memory ; increase was noted in sleep and body weight while caloric intake initially increased then progressively decreased; mild confusion was observed; general intelligence tests were slightly impaired while psychomotor tests were performed faster but less accurately; EEG showed inconsistent changes but returned to normal five days after cessation; and mood was euphoric for several days followed by general lassisitude and indifference.
In a recent uncontrolled preliminary study (Personal Communication, 1970), marihuana extract was administered daily to eight terminal cancer patients from four to 13 days (mean 8.5 days). Daily doses were purposefully raised by the investigator from 7.5 mg (mean daily dose 19.8 mg THC). The total dose per individual patient averaged 168 mg with a range from 75-210 mgs.
Euphoria was experienced by all eight subjects and one had a transient anxiety episode at a high dose. Three subjects demonstrated decreased-opiate analgesic needs indicating an analgesic-effect of the drug. Five subjects reported improved appetite and five, of six tested, demonstrated objective improvement in depression on Back scale. No new changes were seen in physiological parameters, neurological status, blood cell and chemistry values or urine examination. During the period of drug effect, drowsiness was common but not lethargy, lassitude or indifference. In fact, all became more active on the ward. No evidence of abstinence symptoms were seen after abrupt discontinuation of the drug.
Volavka et a]. (1971) in preliminary experiments administered two marihuana cigarettes daily (13 mg Delta 9 THC) to four detoxified heroin addicts. Pleasant effects peaked during the second week and then leveled off. Prominent dysphoric effects and depressive reactions with paranoid thoughts appeared during the third to sixth days and persisted causing cessation of the study by one subject after 10 days and after 17 days by another. The other two subjects completed the entire planned 22 days.
Again no abstinence syndrome was seen and the dysphoric symptoms disappeared within five days after the last dose. Consistent electroencephalogram changes developed in three of four subjects indicating increased synchronization. Their EEG changes first appeared immediately after smoking.
In two of the f our subjects they were detectable, in the presmoking records after days 12 and eight, and did not begin to subside until 48 hours after the last dose in two subjects and persisted for the entire 72 hours follow-up in a third subject.
Fink et al. (1971) subsequently studied five medical and graduate students who had been almost daily marihuana smokers in college and were currently weekend smokers. Each subject smoked under laboratory conditions one marihuana cigarette containing 14 mg of THC each morning daily for 21 days.
No subject reported any adverse effects from smoking. The subjects were generally able to conduct their usual daily activities including jobs. However, they reported they did not function completely up to par during the several hour duration of the acute drug effect. There were no effects which persisted for more than three to five hours and cumulative effects were not noted day to day. No persistent decrements were seen in behavior, mental status, EEG, heart, rate, short-term memory, or psychomotor function tests. In sum, daily marihuana smoking for 21 days was well tolerated by well-adjusted graduate students.
Mendelson et al. (1972) performed a Commission-sponsored study of the biological and behavioral concomitants of 21 days repeated doses of marihuana. Subjects were individuals whose life style, activities, values and attributes were more characteristic of the unconventional youthful subculture than most of their peers in the general population. Their mean age was 23. Based on I.Q. testing they were superior intellectually although they had completed, on the average, two-and-a half years of college. Their job histories were rather erratic and characteristic of a pattern of itinerant living. Their family background was a middle or lower-middle socioeconomic status. In addition alcohol use was infrequent while use of drugs, especially hallucinogens and amphetamines, was significant.
Two groups of 10 subjects each were investigated over separate 31-day periods of confinement on a comfortably furnished research ward equipped with an array of recreational materials. A large, open yard was available for outdoor recreational activities. The research period was divided into three periods: a pre-drug period of five days during which the subjects were drug free; a, subsequent 21-day period when marihuana, could be earned by performing a, work-contingent operant task, then purchased and smoked on a free-choice basis; and a five-day post-drug period without access to marihuana.
All attempts were made to not interfere in any way with performance of the operant task or free choice marihuana smoking although the subjects were under constant observation. A vast array of behavioral and biological assessments were made during the experimental period to determine any effect of repeat doses of marihuana over this time.
Two groups of subjects, studied separately, differed primarily in the frequency of marihuana smoking over the past year. Both groups had averaged about five years of marihuana use (range two to 17 years). The first group studied, referred to as the "casual" users by the authors, reported an average frequency of marihuana use, of 7.7 occasions per month (range three to 15 occasions). The second group studied, referred to as the "heavy" users by the authors, reported almost daily use of marihuana (average 33 sessions per month; range 20+ to 75, including one substitute subject to fill the group who only smoked about 10 times a month). 
During the first 20 days of the smoking period, the casual group's consumption averaged three cigarettes daily (individual average was one-half to six) while that of the heavy users averaged six-and-a-half cigarettes daily (individual average three to eight-and-a-half). Both groups demonstrated a, progressive trend toward increased daily consumption during the experiment. Close examination of the consumption patterns for individual subjects showed that the trend toward increased use occurred in the subjects who were initially the heaviest users. Several subjects who were initially the least frequent users did not increase their use of marihuana over the course of the study.
Subjects in both groups tended to smoke practically all of each cigarette including the butt. Each cigarette contained about 20 mg- Delta 9 THC. Therefore, the heavy users average daily intake was 130 mg of THC or a total of almost, Joni- -grams of THC over the 21-day period. The casual users average intake was slightly less than half this amount.
No abstinence syndrome or physical dependence was observed after abrupt termination of smoking. Signs of mild to moderate psychological dependence. were possibly seen in the heavy group but no evidence of psychological dependence was seen in the casual users.
No consistent clinically significant physiological or biochemical changes were demonstrated during or after the period of repeated use of marihuana.
Urinalysis, complete blood counts, cell morphologies and differentials, and blood chemistry determinations (calcium, phosphorous, glucose, blood urea nitrogen, uric acid, cholesterol, total protein, albumen, total bilirubin, alkaline phosphatase, lactic dehydrogenase, and serum glutamic oxalacetic transaminase) were unaffected.
Weight gain occurred in all but one subject. Maximal gain was seen during the marihuana smoking period. The subjects were not judged to be clinically malnourished prior to the experiment.
Normal body temperature was not altered. No significant change, in pulmonary function (decreased. vital capacity or acute broncho spasm) was observed during the marihuana smoking period.
Variable inconsistent changes in upright blood pressure were noted. Effects on pulse rate were related only to acute drug administration and were more pronounced during the initial smoking phases. This suggests that tolerance developed to drug-induced tachycardia. No significant electrocardiographic changes were observed. Marihuana smoking had no apparent effect on exercise related cardiac vascular function.
Physical examinations revealed only the development of persistent conjunctival injection, lateral gaze nystagmus and fine, finger tremors. These findings were believed to be acute drug effects and of no clinical significance. No signs of neurological abnormality were observed. No cumulative effect of marihuana to cause, impairment of cognitive function was noted on a battery of tests sensitive to organic brain function.
An increased amount of sleep in both shorter and longer blocks of consecutive hours was observed. Also an increase in the number of discrete episodes of sleep, especially one to three hour episodes also occurred during the marihuana use period. Reappearance of pre-drug pattern was seen during the post-drug period. This reversion appeared to begin toward the end of the drug period which may be indicative of tolerance, to the acute depressant-like effects of marihuana.
Generally, performances on short-term memory, psychomotor skills and time estimation suggests that repeated marihuana smoking had no discernible effect on the ability to improve performance with practice on these measures. Tolerance appeared to develop to the acute decrement in performance on these measures. On the time estimation task, a tendency appeared for the subjects to increasingly overcompensate for the acute drug effect with repeated testing in the nonintoxicated state.
Both casual and heavy users had a marked decrement in total social interaction during the first portion of the marihuana smoking period. Total interaction of the casual subjects continued to diminish subsequently. Heavy users subsequently tended to exceed presmoking levels of interaction indicating they accommodated to the depressant effects of repeat doses of marihuana.
Both groups became progressively more convivial and less task-oriented in group discussions. They offered less suggestions in problem-solving tasks but continued to efficiently solve the problem.
Casual users reported general relative increases in negative daily moods and decreases in positive daily moods during the course of the study. The trend began with the onset of smoking and persisted through the post-smoking period. This trend could be a sequelae of repeated marihuana use or related to non-drug variables (set and setting).
The heavy users did not evidence this trend toward relative increases in dysphoric mood until the post-smoking period. Again this may be related to repeated marihuana use, reflect psychological dependence or be related to set and setting variables, such as boredom and tension associated with the prolonged study period.
Finally, repeated use of marihuana over the 21day period did not decrease motivation to engage in a variety of social and goal-directed behaviors. Almost without exception, every subject earned the maximum number of points every day throughout all non-drug and drug periods. No consistent alteration in pattern of work could be related to repeated marihuana use. Subjects often performed very high work output while they were smoking marihuana and experiencing the maximum drug effects.
Repeated marihuana use, did not decrease subject's motivation to complete the study. Nor was any noticeable effect observed on interest and participation in a variety of personal activities, such as, writing, reading literature, keeping up with current national and world events, and participation in both athletic and esthetic endeavors.


Effects of Long-Term Cannabis Use



Patterns of marihuana use in Western countries, particularly the United States are primarily long term (two t o 10 years). Additionally, Western investigators have been able to observe those who use marihuana at most, daily and more often, moderately or intermittently. Consequently, observed effects are rare. Knowledge is incomplete but certain trends appear to be emerging in regard to American usage patterns.
The relevance of Eastern reports of heavy hashish use is uncertain. Nutrition, disease prevalence and quality of medical care impose limits on transferring Eastern observations to Western conditions of use.
DEPENDENCE AND TOLERANCE
Neither severe physical dependence, nor prominent withdrawal symptoms after abrupt termination of very heavy usage is suggested by some overseas experience (Charen and Perelman, 1946; Fraser, 1949; Ludlow, 1857, Marcovitz and Myers, 1944; Siler et al., 1933; Walton, 1938). Other studies, however, suggest marked psychological dependence from heavy use producing compulsive drug taking in very heavy users (Indian Hemp, 1893; Chopra and Chopra, 1957; Bouquet, 1944; Lambo, 1965).
Psychosomatic abstinence syndromes often reported were physical weakness, intellectual apathy, loss of appetite, flatulence, constipation, insomnia, fatigue, abdominal cramps and nervousness, restlessness, and headache. For most heavy users the syndrome of anxiety and restlessness seem to be comparable to that observed when a, heavy tobacco smoking American attempts to quit smoking.
However, the psychological dependence appears to be severe as evidenced by the f act that one group of subjects were unable to cease their habitual use although the frequency of use, was only eight to 12 times per month (Soueif, 1967). This psychological dependence may have made some users claim physical dependence so that the government did not terminate dispensing them their drug. Studies in the United States using must lower doses for shorter periods of time have revealed little if any evidence of psychological dependence (Bromberg, 1934 Mayors Committee, 1944; Williams et al., 1946).
Tolerance to the subjective and depressant effects of the drug (discussed in an earlier section) does probably occur in man, with heavy use. Thus, increasingly larger and more frequent doses become necessary to experience the desired effects.
Several investigators have recently studied the question of physiological and psychological dependence to Delta 9 THC in monkeys using intravenous self-injection techniques.
Deneau and Kaymakcalan (1971) demonstrated that no monkey initiated self-administration over a three-week period when given the opportunity to self-inject a behaviorly effective dose of 100 micrograms per kilogram of Delta 9 THC in a Tween solution. The researchers subsequently administered to these monkeys this dose every six hours. Tolerance developed to the behavioral effects within a few days. Dose administered was progressively increased up to 400 micrograms per kilogram over the course of a month. When the injections were abruptly discontinued, all six monkeys showed after twelve hours, behavioral and physiological changes described by the researchers as mild abstinence signs. Two of the six monkeys then initiated and maintained for several weeks the self-administration of THC.
The investigators believe these findings are evidence for mild psychological and physiological dependence on THC. However, vehicle controls were not included in the research design. Thus, the abstinence signs and subsequent behavior may possibly be accounted for by the biological effects in of the Tween vehicle.
Harris et al. (1972) utilized several procedures to maximize the possible conditions necessary for developing self-injection in monkeys. These procedures included: spontaneous Delta 9 THC self administration with no previous training to the technique; self-administration of A' THC after training, with cocaine alone and a mixture of cocaine and Delta 9 THC. Doses utilized ranged from 20 to 500 micrograms per kilogram suspended in polyvinylpyrrolidone. In all cases, monkeys failed to self -administer Delta 9 THC.
The researchers conclude that A' THC lacks the reinforcing effects of psychomotor stimulants and depressants which monkeys readily self infuse with no auxiliary incentives. Also Delta 9 THC lacks a reinforcing function even for monkeys that are well-trained with cocaine and have experienced several days of rather large quantities of Delta 9 THC during the early pleases of extinction of the cocaine reinforced response.
Finally, the results demonstrate that a two week period of exposure to Al THC (in a mixed solution with cocaine) does not result in the degree of homeostatic imbalance which occurs with morphine, ethanol, barbiturates and sometimes the amphetamines which accounts for the continued self-administration of these drugs.
PHYSIOLOGICAL EFFECTS
Permanent congestion of the transverse ciliary vessels of the eye and accompanying yellow discoloration is the only physical effect firmly linked to long-term marihuana use (Ames, 1958; Chopra, and Chopra, 1957; Dhunjibhoy, 1928). Although there are several suspected or reported effects, none has been conclusively demonstrated in a valid study. Some (Chopra and Chopra, 1939; Indian Hemp, 1893) claim that bronchitis, asthma and other respiratory problems may be produced by chronic and excessive use of potent compounds in India. Eastern smoking, preparations are often a mixture of tobacco and hashish.
Indian users reportedly exhibit digestive tract abnormalities, weight loss and disturbed sleep (Chopra and Chopra, 1939; Soueif, 1967). However, the contributing factors of poor living conditions, malnutrition and prevalence of communicable disease could not easily be separated.
A high percentage of heavy Moroccan users have developed obliterative arteritis of the lower extremities (Sterne, 1960) possibly related to the occurrence of tropic foot ulcers (Ganja -foot) (Miras, 1965). The progression of this abnormality is claimed to parallel prolonged use of the drugs.
Mendelson et al. (1972) were unable to demonstrate clinically significant abnormalities in the extensive battery of tests performed which could be attributed purely to the subjects long-term use of marihuana. No histories were obtained of neurological, hepatic, renal, pulmonary, cardiac, gastrointestinal, (renitourinary, or nutritional disorders. No history of psychotic illness was given.
All subjects were Judged to be in normal mental, health by psychiatric interview and psychological tests (MMPI and Edwards Personality Preference Inventory). Three subjects were felt to be neurotic.
Pre-drug complete physical exams, chest X-ray, electrocardiogram, urinalysis, complete blood count and blood chemistry profile did not demonstrate, any clinically significant abnormalities. No subject showed evidence of poor nutrition.
Pulmonary vital capacity and one second forced expiratory volume were reduced in 12 of the 20 subjects initially. These changes were not correlated with either current cigarette smoking or f requency or duration of marihuana smoking. Histories of past cigarette use, past patterns of marihuana use and past or present contact with environmental air pollutants were inadequate to attempt to account for these pulmonary findings.
Many of the subjects were in fair to poor physical condition as judged by a cardiac exercise tolerance test.
Four of the 20 subjects' initial performance on a battery of cognitive functions tests was poorer than would have been predicted by high average to superior I.Q. scores and educational backgrounds. One of the casual subjects demonstrated improvement with retesting consistent with good brain function. Thus, behavioral impairment was present in three subjects.
Whether the impairment is related to prior drug histories, particularly the excessive use of LSD by the two heavy users, cannot be ascertained. For the casual users, nothing in the case histories possibly elucidated the reason for relatively poor performance based on the exceptionally high I.Q., 139 and 128.
Many Western investigators have suggested that smoking hashish or marihuana may possibly cause bronchitis, asthma or rhinopharyngitis (Bloomquist, 1967; Waldman, 1970; Tylden and Wild, 1967; Schwartz, 1969).
Tenant et al. (1971) described bronchitis, sinusitis, asthma and rhinopharyngitis in 22 American soldiers in Germany who smoked daily enormous quantities (100 grams or more) of hashish for six to 15 months. These conditions, believed to be caused by irritation of the respiratory tract by hashish smoke, seemed to improve, with diminished hashish use.
Twenty-one of the subjects were tobacco cigarette, smokers and occasionally smoked hashish rolled in a tobacco cigarette. Nine patients had symptomatic bronchitis. Five of these subjects underwent pulmonary function tests while consuming their usual daily amount of hashish and again three days after discontinuing use. A mild obstructive pulmonary deficit was demonstrated which was at least partially corrected with diminished hashish intake. Hashish contributed to rbinopharyngitis in 12 of the patients and this effect was not allergic in origin. Urticaria, acne, diarrhea and gastrointestinal cramps were less frequent complaints. Extensive hemotological and hentochemical studies including liver function tests were performed and were within normal limits.
Mann et a]. (1970, 1971) and Finley (1971) studied the effect of marihuana smoking on the pulmonary function of eight non-cigarette smoking marihuana smokers (20-27 years old). Marihuana smoking history was defined in marihuana cigarette-years, that is, one marihuana cigarette daily for one year or the equivalent over a longer or shorter period. The mean marihuana cigarette years for the group was 11 and the range from 2.5 to 26. Three of the marihuana users also used hashish. Chest X-ray, comprehensive spironietry deterinitiations, lung volumes and carbon monoxide diffusion studies were observed and retested with prednisone. Pulmonary functions were essentially normal for all of the non-cigarette smoking marihuana smokers and non-smoking controls.
These investigators were able to distinguish differences in quantity and structure and function in pulmonary macrophages and minor material between marihuana smokers and nonsmokers. In tobacco smokers more marked changes were noted. These changes do not indicate a diminution in defensive capacity of these cells.
Kew et al. (1969) has suggested a possible hepatotoxic effect of marihuana. right persons who smoked marihuana for two to eight years, at least six times a week, evidenced mild liver dysfunction by liver function tests and liver biopsy. Several of the patients admitted to the use of alcohol and oral amphetamines but denied use of intravenous drugs. The authors concluded that the findings were not unequivocally due to marihuana.
Hochman and Brill (1971) noted abnormal liver function tests in 10 of 50 frequent marihuana users. However, all admitted to long-term, regular and heavy use of alcohol. When these subjects abstained from alcohol for one month but continued their usual marihuana usage, evidence of disturbed liver function cleared in nine out of 10 subjects.
Recently, Liskow et al. (1971) reported the appearance of an anaphylactoid reaction in a 29year-old woman after smoking marihuana for the first time. Skin tests were positive for an allergy to marihuana, constituents. Allergy to marihuana, especially in areas of the country where it grows wild, may be more common than generally believed.
Campbell et al. (1971) presented evidence of ventricular dilatation consistent with cerebral atrophy by air encephalography in 10 young males (average age 22) with histories of consistent marihuana use for three to 11 years as well as less frequent use of LSD and amphetamines. The first four of the patients had been referred originally for neurological investigation of behavioral change, memory loss or headache. The remaining six subjects were selected from patients tinder treatment for drug abuse because of their long history of marihuana use and concomitant neurological and behavioral symptoms.
However, the patients showed personality behavioral and mental disorders, as well as histories of head trauma and psychomotor or grand mal epilepsy that are commonly associated with ventriculographic changes. Also alcoholism can be associated with these findings. Additionally, the authors compared their subjects ventriculograms with those of normal young adults originally referred for loss of consciousness, syncope and headache without subsequent development of neurological illness.
Thus, the authors demonstrated dilation of the third ventricle, of the frontal or temporal horn, or of the trigone of the lateral ventricle. All of these are commonly associated with personality and mental disorders such as these patients shelved. However, whether these changes are caused by marihuana is not proven because no specific neuropathological cause for the cerebral atrophy was identified. Further carefully designed studies are required to clarify this finding.
The LaGuardia Report (Mayor's Committee, 1944) indicated no damage to the cardiovascular, digestive, respiratory and central nervous system, nor the liver, kidney or blood in individuals who had used from two to 18 cigarettes of unknown potency (average seven) for a period of two-and a-half to 10 years (average eight). However, this study was not up to modern standards as it lacked double-blind precautions and placebo controls and adequate statistical analysis of the data. Bias was present in reporting. Small numbers of prisoners were used as subjects.
Another less comprehensive American study of 310 individuals who used marihuana on the average of seven years was performed on soldiers (Freedman & Rockmore, 1946). It did not demonstrate any evidence of physical or mental deterioration.
Another team of investigators (Meyer et al., 1971; Mirin et al., 1970) examined a group of 10 male marihuana users (average age 25) who had consumed the drug about 20 to 30 times a month for all average of 4.4 years (one-half to five year range) and had smoked daily for three of the 4.4 years. Heavy use was correlated with psychological dependence, search for insight or meaningful experience, multi-drug use, poor work adjustment, diminished goal directed activity, decreased ability to master new problems, poor social adjustment and poorly established heterosexual relationship. No physical or neurological or psychiatric abnormalities were noted in their work-up.
Indeed, numerous American investigators have not reported abnormalities in baseline, examinations of their experimental subjects who have various patterns of marihuana use from very infrequent to many times a day.
GENETICS AND BIRTH DEFECTS
Much concern about possible effects on the unborn generations has arisen because of marihuana's use by persons in their reproductive years. Presently, most studies are preliminary.
There are three isolated case reports in man (Gelehrter, 1970; Carakiishansky et al., 1969; Heelit et al., 1968) of birth defects in mail in the offspring of parents who had used marihuana and LSD. However, due to their complex gestational histories and the high level of birth defects seen in a "normal" population, a causal relationship cannot be attributed to cannabis or anything else. At present, there is no substantial evidence indicating that marihuana at the dose commonly used is a teratogen in man.
Marihuana has been implicated as a teratogen in animals by several groups at high doses. One study (Miras, 1965) showed reduced fertility in rats impregnated after being fed a diet containing marihuana extract for several months. However, the offspring were normal. The reduced fertility may be related to the finding of marked decrease rate of cellular division, but without chromosomal damage, -when Delta 9 or All THC is added to white blood cell cultures (Neu et al., 1969 Martin, 1969).
Dorrance et al. (1970) and Gilmore et al. (1970) detected no significant difference in lymphocyte chromosomes in groups of users and nonusers. No significant differences were, found in lymphocyte chromosomes between heavy, long-term. Jamaican ganja users and matched nonusers. (Rubin and Comitas, 1972)
Pregnant mice injected with cannabis resin on day six of gestation caused stunted but not malformed offspring. Fetal reabsorption occurred when the dose was given on days one to six (Persand and Ellington, 1967). A second experiment using rats injected on days one to six produced a high frequency of malformed progeny. Another investigator (Geber, 1969; Geber and Schramm, 1969) demonstrated congenital malformations in fetal hamsters and rabbits after large multiple doses of cannabis extract.
Another group (Pace et al., 1971) have administered a wide range of dosages of Delta 8 and Delta 9 THC and marihuana extract by subcutaneous, intraperitoneal and intravenous routes at varying intervals pre- and post-conception to rats, hamsters and rabbits. Delta 9 THC up to 200 mg/kg in variety of dose schedules produced reduced average litter size and stunted pups at high doses but no birth defects. A low incidence of abnormalities occurred in rats and rabbits with marihuana extract, but a high incidence of neonatal deaths was observed apparently due to inadequate material lactation.
Studies with radioactive labeled THC (Idanpaaiini-Heikkila et al., 1969) indicated that it did cross the placenta in high concentrations early in gestation during the developmentally labile phase.
These studies suggest that Delta 9 THC itself is not a teratogen. Instead, perhaps some unidentified substance or substances in the plant extract may be causing the teratogenic effect noted by this group and others when injected. It is uncertain whether this theoretical substance(s) volatilizes during smoking or enters the pulmonary vasculature (Pace et al., 1971).
Consequently, the following FDA label required of many currently prescribed psychoactive drugs warning about use in Pregnant women and women of childbearing age, appeals indicated. "Safe use of the drug during pregnancy and lactation has not been established; therefore, in administering the drug to Pregnant patients, nursing mothers, or women of childbearing potential, the potential benefits must be weighed against the possible hazards. Animal reproduction studies have yielded inconclusive results. . . . There have been clinical reports of congenital malformation associated with the use of this drug, but a causal relationship has not been confirmed."
ORGANIC BRAIN DAMAGE
Deterioration of mental functioning allegedly due to long-term use of marihuana can be subdivided into four major categories: organic brain damage, mental illness-psychosis, amotivational syndrome, and recurrent-pnuenomenia. As with alcoholism, it is quite often impossible to distinguish whether the described effects result from drug use or represent personality traits or changes which would have been present without the drug use.
When marihuana consumption was irregular, mental deterioration was not evidenced (Freedman and Rockmore, 1946) in 310 users with an average history of seven years of use. Sixty-seven heavy users in New York showed no evidence of dementia attributable to drug use although they did have underlying personality disorders. Another investigation (Mayor's Committee, 1944) of individuals who used a daily average of seven marihuana cigarettes (two to 18 range) for average of eight years (two-and-a-half to 16 range) showed no evidence of brain damage or mental deterioration.
Reports from India (Chopra, 1935; Chopra, 1940; Chopra and Chopra, 1939; Chopra, Chopra, and Chopra, 1942) relate minor impairment of judgment and memory, limited self -neglect and insomnia, when potent preparations are consumed regularly in large amounts for many years. No evidence for mental deterioration or brain damage has been noted.
Miras (1967) has described a Greek population of heavy hashish smokers who appear as outcasts from the community after 15 to 20 years of heavy hashish use. They appear mentally sluggish and depressed. They are reported to exhibit laziness, psychic instability, amorality and apparent lack of drive and ambition. Their speech and behavior has been described as -peculiar. Some degree of responsibility is retained in that some do work to cover their living and drug purchasing expenses. Some of them are still quite intelligent. Memory is not deteriorated except during the intoxication. They appear overly suspicious. Samples of their electroencephalograms were believed to demonstrate abnormalities.
However, Miras believes that this effect is related to the quantity and frequency of hashish use. He describes three categories of long-term hashish users. Type A uses low doses intermittently and is socially and mentally unaffected. Type B1 uses low doses daily and no interference is caused in function. Type B 2 uses high doses daily causing dependence and performance decrements. Type C uses very high doses daily allegedly causing mental deterioration and abnormal behavior described above. Fink and Dornbush (1971) are currently intensively studying this population. The results will be described in a later section.
Non-differentiated psychosis noted in foreign populations may also be included within this diagnostic category. These will be discussed with the psychosis.
PSYCHOSIS
The alleged connection between mental illness and cannabis derives from Africa, the Middle East and India. These areas are currently developing economically and scientifically, but for many years medical care and especially psychiatric care were given low priority. Many chronic illnesses still persist in these countries which may affect mental functioning. Furthermore, well-trained psychiatrists and methodologists are very rare in mental hospitals in these countries. Consequently, the findings of earlier studies are questionable due to lack of controls, biased sampling and poor data collection and failure to account for variables like nutrition, living standard, cultural factors and socioeconomic status.
India's mental institutions were widely quoted to support the, connection between excessive cannabis consumption and insanity. The Indian Hemp Commission performed a thorough and objective investigation of this question, although methodologically it was not up to modern standards. The Commission was unconvinced of the reliability of hospital statistics, where often the diagnosis was not made by a psychiatrist but by a referring policeman.
Therefore, the Commission examined all admissions to Indian mental hospitals for one year. They found that cannabis rise could not be considered a factor in more than seven to 13% of all cases of both acute and chronic psychosis.
Chopra et al. (1942) carefully performed the same examination of admission to Indian mental hospitals from 1928 through 1939 when cannabis use was extremely high. They found 600 cases of acute and chronic psychosis which could be traced to cannabis use. Other reports from India have produced varying estimates of the incidence of cannabis psychosis (Peebles and Mann, 1914; Chopra, 1971; Dhunjibhoy, 1930 Evens, 1904). In Egypt 27% to 33% of mental hospital admissions were cannabis related (Ireland, 1893; Warnock, 1903).
Benabud (1957) reported that cannabis users comprised 68% of all mental hospital admissions in Morocco but only 25% of these admissions could be called cannabis psychosis. Watt (1936 and 1961) reported that 2% to 3% of mental hospital admissions in South Africa were due to the use of dagga (cannabis).
Boroffka (1966) and Asuni (1964) reported that 14% of psychiatric admissions in Nigeria used cannabis. Toxic psychosis accounted for half of these and cannabis was felt to aggravate underlying schizophrenia in the remainder.
Several statistical studies from other countries including Jamaica, Colombia, Algeria, Panama and Tunisia support this type of data (Prince et al., 1970; Beaubrun, 1971 Allentuck and Bowman, 1942; Bouquet, 1951; Chevers, 1870; Defer and Dielil, 1968; Fraser, 1949; Freedman and Rockmore, 1946; Porst, 1942; Siler et al., 1933; Reales-Aroyco, 1953; Medical Staff, 1938).
Very little information is available on the prevalence of psychosis in the overall population of cannabis users. Chopra and Chopra (1939) classified 2% of the ganja and charas smokers and 0.5% of the bhang drinkers in their sample of 1,200 as psychotic.
Roland and Teste (1958) estimated that no more than 0.5% of kif (cannabis) smokers in Morocco suffer from recurrent mental conditions.
Prince et al. (1970), in a study in Jamaica, noted that about 20 patients per year are admitted to mental or general hospitals with acute psychotic reactions allegedly precipitated by ganja. In one general and one mental hospital the, ganja smokers comprised 20% of the psychiatric admissions. Furthermore, the percentage of heavy ganja smokers in the community was significantly higher than 20%. Thus, a larger percentage of psychiatric admissions were, derived from non-ganja smokers in a comparable lower socioeconomic segment of the population.
This finding contrasts with the 68% prevalence of cannabis use among psychiatric admissions reported by Roland and Teste (1958) which is considerably higher than the prevalence of cannabis use in the general population of Morocco.
Studies based on several hundred cases indicate that the large majority of individuals hospitalized in mental institutions for "cannabis psychosis" have suffered acute toxic psychoses associated with a sharp toxic overdose or massive excesses among habitual users. Occasional smokers and moderate habitual users seldom had psychotic reactions and then only when there were substantial predisposing factors.
The acute clinical picture seen in these delirium with confusion, disorientation, terror, and subsequent amnesia is that of a severe exogenous psychosis. It does not typically involve the type of thought disorder characteristic of schizophrenia. Short recovery times ranging from a few days to six weeks are uniformly reported in sharp contrast to the lengthy recovery period of functional psychoses (Chopra et al., 1942; Roland, and Teste, 1958; Defer and Diehl, 1968; Beaubrun , 1971; Stringaris, 1939).
Consequently, the psychiatric literature on cannabis-induced chronic psychosis is quite confused. In general, it appears that cannabis use probably produces a specific psychosis, but this must be quite rare, since the prevalence of psychosis in heavy cannabis users, world-wide, is only doubtfully higher than the prevalence in general populations (Murphy, 1963). However, incidence and prevalence data for these countries on psychosis of users and non-users of cannabis does not exist.
A Morroccan investigator, Christozov (1965), studied 140 chronic heavy hashish users hospitalized in a mental hospital. Their behavior was characterized by a confusional state of consciousness, an impulsivity, an irresponsible attitude, and an instability of mood and character. The patients were often psychotic with persistent hallucinations. Intellectual functions were reduced in over half the cases although this was related to a low intellect prior to drug use. Electroencephalography showed no specific changes. In addition, it was noted that half of the patients were also alcoholics.
The majority of the patients were, sedated and showed a rapid improvement, allowing them to be discharged and be employed, Although it appeared that these characteristics are reversible, the patient often returned to heavy drug use again causing return of the syndrome.
Thus, the existence of a more long lasting cannabis-related psychosis is poorly defined. Some evidence indicates the existence, of a, quite rare slow-recovery, residual cannabis-psychosis following heavy chronic use. Patients often exhibit schizophrenic-like withdrawal, mental confusion and mild residual hallucinations; but there is little tendency for the, symptoms to become organized or proliferate. The symptoms develop gradually and then subside gradually before proceeding to full-blown psychotic symptoms. These may produce gradual psychic deterioration in the habitual excessive user after prolonged periods of time. Several authors theorized that the chronic psychosis consists of recurrent acute attacks with gradual deterioration in habitual excessive users (Roland and Teste, 1958; Chopra, et al., 1942; Stringaris, 1939; Sigg , 1963).
Most investigators, therefore, find it exceedingly difficult to distinguish a psychosis due to cannabis from other acute and chronic psychoses because, few, if any symptoms, are uniquely found in it and not observed in other psychoses. Often the diagnosis of cannabis psychosis is made because of the history of heavy marihuana or hashish use. Several have suggested that a characteristic cannabis psychosis does not exist and that marihuana will not produce a psychosis in a well-integrated, stable person (Allentuck and Bowman, 1942; Reales-Aroyco, 1953).
In addition, alcohol often played a part in producing the mental derangement (Medical Staff, 1938; Porst, 1942). Most data refers to any form of psychosis in marihuana users; not specifically cannabis psychosis.
Although it is fairly well-established that cannabis use attracts the mentally unstable, the prevalence of major mental disorder among cannabis users appears to be little if any higher than that in the general population. Therefore, true cannabis psychosis must be earlier, very rare or it must substitute for other forms of psychosis. Perhaps, cannabis use alternatively is protecting some less stable individuals from a psychosis (Murphy, 1963).
Because of these many difficulties, the role of cannabis use in acute and especially chronic psychoses in these countries is impossible to determine with certainty.
Finally, the Eastern literature often mentions the existence of a characteristic psychic degeneration among older habitues after prolonged excessive use (Chopra et al., 1942; Christozov, 1965; Indian Hemp Commission, 1893; Roland and Teste, 1958; Stringaris, 1939; Warnock, 1903). They are frequently described as showing a single minded, carefree state, such as "Kif-happy vagabonds."
Soueif (1967) administered psychomotor and cognitive performance tests to imprisoned hashish users and non-hashish users in Egypt. Preliminary results indicate that, on most of the tests, the hashish sample scored 10% to 20% below the control, and differences were larger for those with higher educational levels. These results do not necessarily indicate a causal relationship. Assessment of the significance of these findings must await further description of the samples utilized.
Experience in the U.S. and Western Europe has not involved a level of marihuana use comparable to the above-mentioned countries. Consequently, the associated chronic psychotic disturbances have not been seen.

In Western countries, Bromberg (1939) and Allentuck and Bowman (1952) reported on acute psychotic episodes with clear-cut onset during the marihuana intoxication. Most symptoms cleared within a few days although several had a, prolonged illness. These rare acute psychotic episodes, discussed earlier, have been described recently by a variety of authors in scattered countries (Smith, 1968; Weil, 1970; Bialos, 1970; Keeler, 1967; Milman, 1971; Pesyko, 1970 Kaplan, 1971; Prince et al., 1970; Baker and Lucas, 1969; Grossman, 1969; Beaubrim, 1971; Spencer, 1970).
Some of these reported cases are quite transient and clear rapidly with support of others and may be more like acute panic reaction than psychosis. Still others appear to fit the picture of transient toxic psychosis.
A few cases of marihuana psychosis reported by Kaplan (1971) recovered very slowly after extensive psychotherapy. However, the high incidence of schizophrenia and borderline states described in these patients and their families may indicate that marihuana use merely aggravated or precipitated an underlying psychosis in these individuals.
George (1970) reported a case in Britain in which an acute episode of confusion, disorientation, hallucination, anxiety, paranoia, agitation and memory loss related to cannabis use was followed by a more chronic schizophrenic-like syndrome with thought disorder, incongruous affect and hallucinations. This individual was experiencing considerable financial and marital stress prior to these two separate acute episodes. The chronic condition eventually responded to psychotherapy.
Bernhardson. (1969) reported aggravation by cannabis of schizophrenic conditions in several Scandinavian patients. Perna (1969) reported a case in which marihuana appeared to aggravate an extended psychosis for which the patient had required psychiatric treatment prior to the use of marihuana.
Keup (1970) reported 14 cases of prolonged psychotic symptoms requiring hospitalization associated with the use of marihuana. He noted evidence for the existence of a, high level of psychopathology in many of them which predated their marihuana use.
Kolansky and Moore (1971) in a widely publicized report of cases of individuals ages 13-to-24 has claimed profound adverse psychological effects from smoking marihuana two or more times a week.
Of 38 individuals reported, all had decompensated personalities, eight had psychoses (four attempted suicide) and 13, according to the authors became sexually promiscuous due to marihuana. These clinical impressions were, all based on, at most, a few interviews with the, individuals who were referred to these psychiatrists for consultation for problems (including one-third by legal authorities after arrest for possession of marihuana).
Unfortunately, the authors made sweeping generalizations to all young adolescent marihuana users from this biased and non-representative sample. No attempt was made to interview other young marihuana users who have not been referred for psychiatric help, and the high prevalence of promiscuity and psychopathology in comparable adolescent populations was totally disregarded. In addition, case histories of previous mental health were obtained introspectively from the patient, their families or the referral source.
Thus, it is impossible, to state unequivocally, as the authors do, that since marihuana use and psychiatric problems occurred at the same time the former is causative of the latter.
Several authors have reported acute toxic psychosis following marihuana use by soldiers in Vietnam (Talbott and Teague, 1969; Colbach and Crowe, 1970, Bey and Zecchinelli, 1971).
All these cases represented transient reactions and cleared rapidly with treatment. In many cases, personality disorders or borderline personality states appeared to be predisposing factors in the development of the psychotic state. Often revealed were problems of identify diffusion, ego weakness, low self-esteem and inability to form close interpersonal relationships. Also the stressful conditions of the setting in which the drug was used deserves emphasis.
Halikas et. al. (1971, 1972) performed intensive psychiatric interviews on a population of 100 regular marihuana users and a control group of 50 of their non-using or casually using friends. Half of each group met the criteria for some psychiatric diagnosis. Psychiatric illness and antisocial behavior most often preceded marihuana use.
Some attempts have been made to estimate the incidence, of psychosis and other adverse reactions to marihuana in Western countries. Obviously, such estimates depend on how these reactions are defined-one questionnaire study of 2,700 psychiatrists, psychologists, internists and general practitioners in the Los Angeles area reported 1,887 "adverse reactions" to marihuana in an 18-month period (Ungerleider et al., 1968). Adverse reactions were not defined by the authors in the survey. Those reported ranged from mildly unpleasant parental objections to use to severe anxiety or acute psychosis.
Keeler (1967) reported on "adverse reactions" to marihuana (paranoid feelings, etc.) which are limited to the immediate period of intoxication. These phenomena occasionally occur in such a light proportion of regular users that they are of little interest in the present discussion, e.g., 80% of users report they sometimes have paranoid reactions during the marihuana intoxication (Tart, 1970).
Other estimates have been based on hospital admissions in which marihuana use was the recognized precipitating cause. Lundberg et al. (1971) reviewed the admission records for the Los Angeles County General Hospital for the period 1961-1969 and found marihuana use was listed as the reason for admission in only nine out of 700,000 cases, and five of these were for intravenous injections.
Keup (1970) reports that 0.9 per 1,000 of the 1968 admissions to a Brooklyn psychiatric hospital were directly related to cannabis use, and in another 1.9 per 1,000 it was found to be a contributory factor.
In 1966, psychiatric hospitals in England listed 82 admissions for which cannabis use was considered a factor (Baker and Lucas, 1969) in 1967, the number was 140 (George, 1970). For the 1966 data, further analysis revealed that eight of the 82 cases were acute psychotic reactions to cannabis, 20 were related to "cannabis addiction as a way of life," and cannabis could not be established as a definite factor in the remainder (Baker and Lucas, 1969).
Colbach and Crowe (1971) estimate that among a population of 45,000 U.S. soldiers in Vietnam in 1969, some 40 to 50 per month were hospitalized for psychiatric reasons and about five of these were associated with (usually heavy) marihuana use.
Among college populations, Pillard (1970) estimates five to seven marihuana-associated anxiety reactions are, seen per year by the Boston University Health Service which cares for a student population of 20,000; and Bialos (1970) reported 11 cases during a one-year period (1968-1969) for a student population of 8,500.
If it is assumed that about one-third of the Vietnam and college populations are using marihuana to some degree, the annual incidence of hospitalized cases in Vietnam would be about four per 1,000 users; the rate for student-health cases, 0.3 to 1.3 per 1,000 users.
The 1972 Secretary of Health, Education and Welfare's report on Marihuana and Health prepared by the National Institute of Mental Health noted in summary that marihuana can clearly precipitate certain less serious adverse psychiatric reactions, such as simple depression and panic, particularly in inexperienced users.
In these reactions, non-drug factors may be the most important determinants. Psychotic episodes may also be precipitated in persons with a preexisting borderline personality or psychotic disorder or those persons under excessively stressful conditions. These acute psychoses appear to share considerable clinical similarities with the acute toxic psychoses noted in the Eastern literature. Both these psychoses resemble an acute brain syndrome in that they occur primarily after heavier than usual usage and are self-limited and short-lived after the drug is removed from the body.
Some reports describing a prolonged psychotic course after an initial acute episode cannot rule out the role of pre-existing psychopathology. At the present time evidence that marihuana is a suf ficient or contributory cause of chronic psychosis is weak and rests primarily on temporal association. This issue may be clarified by extensive epidemiological and controlled clinical studies. (Secretary, HEW, 1972)

AMOTIVATIONAL SYNDROME
Another type of possible mental deterioration or subtle personality and behavioral changes associated with heavy long-term cannabis use is the amotivational syndrome.
This syndrome has been described world-wide in its extreme form when the most potent preparations are, used (Miras, 1967; Chopra. and Chopra, 1957; Chopra et aL, 1942; Christozov, 1965; Indian Hemp, 1893; Benabud, 1957; Warnock, 1903). Its most extreme form depicts a loss of interest in virtually all activities other than cannabis use. The resultant lethargy social and personal deterioration and drug preoccupation may be comparable to the skid row alcoholics' state.
Benabud (1957) describes the occurrence of this syndrome in individuals chronically intoxicated with hashish. These individuals are unlikely to show conventional levels of motivation. Also the time required to obtain and consume enough drug to maintain this state is not likely to leave much time for other pursuits. The passive user tends to lose interest in work and other long-term goals.
The question of whether there exists a significant causal as opposed to an associative or correlational relationship, only attracted attention when the traditionally achievement-oriented Western youth adopted cannabis use. The traits of passivity or amotivation are commonly described among heavy cannabis user throughout the world.
A number of Eastern authors have expressed the opinion that this is a result of organicity from chronic cannabis use in large amounts, without objective studies being performed.
Recently the term has been used to describe the behavior of numbers of young Americans who are for a variety of reasons dropping out of school, refusing to prepare themselves for traditional adult roles and smoking marihuana.
This type of social maladjustment is not comparable in magnitude to that described in other cultures. However, the individual may lose the desire to work, to compete, to face challenges. Old interests and concerns are lost and the individual's life, becomes centered around his compulsive drug use. In addition, the individual may ignore personal hygiene, experience loss of sex drive and avoid social interaction (Mirin et al., 1970; Smith, 1968).
West (1970) and McGlothlin and West (1968) have described a clinical syndrome as a result of observations of regular marihuana users for four years. Their clinical impressions are that these individuals show subtle changes in personality over time which might represent an organic syndrome. These include diminished drive, lessened ambitious decreased motivation, apathy, shortened attention span, loss of effectiveness, introversion, magical thinking, derealization and depersonalization, decreased capacity to carry out complex plans or prepare realistically for the future, a peculiar fragmentation in flow of thought, and a progressive loss of insight.
Another psychiatrist, Powelson (1971), has also concluded on the basis of over five years clinical experience with drug users at the University of California, Berkeley, that the effects of marihuana are cumulative. He, feels that after a period of prolonged use a disorder of thinking characterized by a lack of coherence and a pathological thinking process results.
These disturbing findings are being reported more frequently, especially in adolescent and young-adult groups. Recently, tentative and preliminary data (Francois et al., 1970; White et al., 1970) has been presented on a group of 19 hospitalized 14-to-20-year-old patients with behavioral disorders who had used marihuana and other drugs heavily.
In addition to "amotivation," they showed primitive and magical modes of thought and low frustration tolerance. Subtle EEG patterns were detected although this finding is not uncommon in adolescents with behavior problems.
The researchers are presently carrying out a study in non-hospitalized adolescents without behavioral disorders who have similar patterns of drug use in order to clarify their findings.
Kornhaber (1971) believes that at least twice daily marihuana use for a year, in a 13-to-18-yearold population, has a deleterious effect upon the developing adolescent. The intoxicated state facilitates a regression from logical-mathematical thought processes to a more primitive conceptual mode of fantasy and magical thinking and impairs learning ability and judgment by decreasing attention and concentration. Thus, the developing youth turns away from reality toward fantasy and from structure and activity to passive dependency.
Kornhaber suggests that marihuana facilitates the development of normal adolescent turmoil into a pathological state. However, he feels that the existence of the syndrome depends partially on the individual's vulnerability to the drug influence.
A possibly milder variation of this syndrome has been clinically observed by Scher (1970) in individuals in the 20-to-30 age group who have used marihuana daily for five years while apparently functioning normally in society with good jobs, often creative ones. These individuals begin to experience a vague sense of functioning at reduced efficiency level. Thus, the disabilities experienced are personal and internal ,and constitute a vague neurotic depressive-like syndrome,.
In addition to the methodological problems of (Establishing causative as opposed to associative relationships, it is also very difficult to obtain a sample of heavy cannabis users in the West who have not had substantial experience, with other drugs, especially the strong hallucinogens.
Koridiaber (1971) has described a sample of 50 adolescent psychiatric patients who used marihuana daily and also took other drugs. He concluded that marihuana exercised a "chronic, tranquilizing, psychomotor-depressant effect" among these patients, and facilitated regression, fantasy and magical thinking. School performance, participation in sports, and personal hygiene also declined. He reported improvement in school performance, mood and the underlying depressive symptoms for many patients four to six weeks after discontinuing marihuana use.
Given there is a fairly strong tendency for heavy cannabis users to be passive and apathetic, to emphasize the present over the future, and to choose fantasy over rationality, there are several ways by which this relationship might come about (McGlothlin, 1972).
First,, persons who already exhibit these, traits may simply be attracted to the use of cannabis. Sociologists tend to favor this explanation, arguing that the relationship between cannabis use and various behavioral indicators is not causal, but simply one manifestation of a general pattern of youthful deviance or rebellion (Goode, 1970).
Utilizing a large sample, Johnson (1971) found that marihuana use is associated with impaired school performance and several forms of deviance; however, other indicators such as premarital sex and high school truancy predicted the dependent variable as well or better. Tobacco and alcohol use were nearly as good predictors as marihuana.
A second related explanation is that the illegal. context in which the drug is taken forces the adoption of a nonconforming life style. The users is thus further alienated from the dominant culture through his close ties with the cannabis-using group.
Third, cannabis use and associated activities may largely substitute for other interests. The individual may focus so much of his time and energy on cannabis that he has little time for other endeavors.
Fourth, heavy cannabis use may act pharmacologically to produce a chronic tranquilized state. Although the acute phase of intoxication is relatively short, there is some evidence of a lethargic hangover effect (Haines & Green, 1976).
Fifth, personality and behavior changes may result through the routine process of learning via exposure. If an impressionable youth spends a great deal of his time in the world of cannabis intoxication, he may learn to think in a similar manner when not intoxicated. In particular, he may learn to choose the drug fantasy as an alternative to solving personal problems and facing adult responsibility.
A related explanation is that cannabis acts as a catalyst, creating a condition which facilitates change, providing other necessary conditions are present. Cannabis, along with the strong hallucinogens, produces a kind of mind-loosening effect in which mechanisms providing structure and stability to perception of self-image, environment, time sense,, etc., are temporarily suspended.
The, more frequent users welcome this effect and report utilizing the loosening effect of the drug to achieve further personality change in the direction of less conformity and more spontaneity, that is. the "hang-loose ethic" (Suchman, 1968; Simmons and Winograd, 1966).
In addition, the cannabis intoxication produces a heightened suggestibility which likely makes the user more amenable to adopting the attitudes and values of the subculture in which the drug is taken. At a minimum, it may be concluded that the effects of cannabis can reinforce and provide a rationalization for previously existing tendencies.
Finally it is possible that chronic cannabis use can result in organicity (Soueif, 1967).
In summary, if cannabis use produces personality and behavior changes via one or more of the above mechanisms, the extent of such changes is likely to be strongly related to the amount consumed and the age of the user. According to evidence found in Western literature, frequent use may be quite disruptive during the formative years of adolescence.
On the other hand, the Eastern literature indicates that, although the very heavy user (200 mg. THC or more per day) is largely incapacitated, manual laborers often function adequately while consuming amounts containing 30 to 50 mg. THC per day (Roland and Teste, 1958; Chopra and Chopra, 1939). Similarly, many musicians and entertainers in the United States have lived productive lives while using marihuana (Winick, 1960).

RECURRENT PHENOMENON
Another poorly understood phenomenon is the spontaneous recurrence of all or part of the drug intoxicated state (somatic and visual sensations) when not under the influence of the drug. This phenomenon has been called a "flashback" when it occurs spontaneously or "a contact high" when it occurs in the presence of others who are intoxicated.
Flashbacks have been reported with marihuana use alone. However, these occurrences are apparently predominant in marihuana users, who have taken hallucinogenic drugs previously. These marihuana, users occasionally find that marihuana highs change for them after their hallucinogenic. experiences. For example, a simple hallucination experienced previously may reoccur while high on marihuana.
These flashbacks may be interpreted as pleasant, even desired experiences by some but unwelcome and disturbing to others. The recurrences are benign in most individuals and tend to disappear as the hallucinogenic experience recedes in time (Keeler, 1967; Smith, 1968; Weil, 1970; Bialos, 1970; Blumenfield, 1970).
Truly vivid experiences which recapture most of the elements of the original experience are extremely rare (Smith and Meld, 1970). More often they resemble an anxiety state occurring after an unpleasant high or the recurrence of a new perceptual awareness gained while high. It is difficult to differentiate these recurrences from the not uncommon deja vu phenomenon in which a person has the illusion that a perceived situation has occurred before. These recurrences are intermittent and usually occur within a few days to weeks following the use of marihuana.
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