Joseph A. Califano, Jr.
Chairman and President
The National Center on Addiction and
Substance Abuse At Columbia University
on release of
Non-Medical Marijuana: Rite of
Passage or Russian Roulette?
For certain individuals with AIDS and the 15 percent of chemotherapy patients whose nausea is not relieved by currently available medicines, marijuana may have some medicinal value. That is something to be determined by the research and clinical trials that the Institute of Medicine (IOM) recommended in its report, Marijuana and Medicine: Assessing the Science Base, issued earlier this year. The risks and benefits of marijuana as medicine are matters for physicians, scientists, the National Institutes of Health, and the Food and Drug Administration. Because smoked marijuana is a carcinogen and adversely affects the immune system, the IOM stressed the importance of developing an alternative delivery system, such as an aerosol using synthetic cannabinoids rather than the whole plant, and disapproved any use of smoked marijuana except by the terminally ill and those in extremis with chronic diseases, and even then only under tightly controlled circumstances.
For America's children and teens, marijuana is a dangerous drug. The extent of the danger and the most effective way to keep our youngsters from using this drug are matters for teens, parents, schools, churches, communities and public policy makers.
Marijuana's potential as medicine, as the IOM report noted, has nothing to do with whether the drug should be made more widely available or its possession, cultivation and distribution should be legalized for the general population. That is the subject of this paper, with special emphasis on the implications for children of legalization or decriminalization. Now that we know a child who gets through age 21 without smoking, using marijuana or any other illegal drug, or abusing alcohol is virtually certain never to do so, a key measure of any drug policy should be how well it helps achieve that objective.
Recent discussions of marijuana policy have failed to make this key distinction between marijuana as medicine and marijuana as recreation. President Lyndon Johnson used to say that the problem with the Democratic party was that the politicians want to be intellectuals and the intellectuals want to be politicians. Marijuana discussions suffer an analogous problem: too many politicians want to play scientist and too many scientists want to play politician. Marijuana legalization proponents like to play doctor and prescribe marijuana by political referendum. Many opponents of decriminalizing or legalizing marijuana also like to play physician, opposing scientific inquiry to determine whether the drug might have any medicinal value. Medical marijuana should not be the nose under the tent leading to the drug's general legalization (as some proponents hope) any more than the medical use of cocaine and opiates has been regarded as an opening move in the direction of general use.
This paper on non-medical marijuana deals with the impact of decriminalization or legalization on the general use of marijuana, the dangers to health and well-being of our citizens that such use presents, how best to deal with those dangers and the ramifications of such radical changes in policy on marijuana smoking by the nation's children and teens.
The potential of marijuana as a dangerous drug for our children, as a gateway to other drug use, and as a signal of trouble is a matter of the most serious concern for American parents. And there's plenty to justify such parental concern:
Smoking marijuana, in and of itself, is especially dangerous for teens. The drug can impair short term memory, ability to concentrate and motor skills at a time when these are particularly important to children developing and learning in school. Marijuana can stunt the intellectual, emotional and psychological development of adolescents. In some ways, marijuana combines the adverse health effects of both our currently legal drugs: the intoxication of alcohol with the lung damage of tobacco. Nine percent of those who ever use marijuana become dependent on it. In 1996 (the latest year for which numbers are available), more than 195,000 individuals entered treatment for marijuana; 62 percent (more than 120,000) of whom are under age 25, 45 percent (nearly 88,000) are teens or younger. There are more teens and children in treatment for marijuana than for any other substance including alcohol.
Statistically speaking, marijuana stands convicted as a gateway drug. Twelve- to 17-year-olds who smoke marijuana are 85 times more likely to use cocaine than those who do not. Among teens who report no other problem behaviors, those who used cigarettes, alcohol and marijuana at least once in the past month are almost 17 times likelier to use another drug like cocaine, heroin or LSD. To appreciate the power of these statistical relationships, remember that the 1964 Surgeon General's report on Smoking and Health found a nine to ten times greater risk of lung cancer among smokers; the early results of the Framingham heart study found individuals with high cholesterol two to four times likelier to get heart disease; and the Selikoff study found that workers exposed to asbestos were five times likelier to get lung cancer.
Biomedical and scientific studies are beginning to unearth the reason for this tight statistical relationship between use of marijuana and other drugs. Recent studies at universities in California, Italy and Spain reveal that marijuana affects levels of dopamine (the substance that gives pleasure) in the brain in a manner similar to heroin and cocaine (as well as nicotine and alcohol). While scientists have not yet uncovered the smoking gun, they have certainly found the trigger finger. Proponents of decriminalization and legalization argue that so long as there is not conclusive proof of the gateway relationship, we should not worry about it. But parents who mistake the absence of proof for the proof of absence are playing Russian roulette with their children's lives. Although most kids who use marijuana will not move on to heroin and cocaine, teens who use marijuana are far more likely to get into harder drugs than teens who don't. Remember, most cigarette smokers will not get lung cancer; less than 20 percent will.
Decriminalization for all ages of possession of small amounts of marijuana (e.g., an ounce, enough for 40 to 50 joints) or legalization of use, cultivation and distribution of the drug will increase use by adolescents.
We've been there, done that.
In the early 1960s a few hundred thousand individuals had smoked marijuana. Decriminalization, more lenient laws, and lax enforcement of existing state and federal laws opened the way for an enormous surge in use that peaked in 1979 when 30 million Americans smoked marijuana.
Decriminalization or legalization of marijuana only for adults will increase use by minors.
We've been there, done that, too.
The sale of two legal recreational drugs, alcohol and tobacco, is prohibited for those under 18 (for tobacco) and under 21 (for alcohol). Use of these drugs by adolescents far exceeds their use of marijuana which is illegal for all regardless of age. Of high school tenth graders (usually 15 to 16 years old), nearly 28 percent have smoked cigarettes and 39 percent have used alcohol in the past month--in contrast, 19 percent have smoked marijuana. Among younger students, use of alcohol and nicotine is also substantially higher than marijuana use. Of eighth graders, 23 percent drank and 19 percent smoked during the past month--in contrast, 10 percent have smoked marijuana.
This CASA White Paper, Non-Medical Marijuana: Rite of Passage or Russian Roulette?, makes clear that decriminalization or legalization of the drug would certainly increase use among the nation's teens and children. In a society that looks to government to protect it from unsafe cars and toys--and that recognizes that the availability of guns increases likelihood of their use--it is hard to understand why anyone would take actions likely to make this drug more readily available to our children.
Clearly, there ought to be a law. For teens, laws prohibiting the possession, distribution and cultivation of marijuana send a clear signal that smoking pot is dangerous and a conduct that society strongly disapproves.
This is not to say that all drug policies and laws on the books make sense. Laws that prescribe mandatory sentences for possession of small amounts of marijuana are overkill. In general, mandatory sentences, especially those requiring drug and alcohol abusers and addicts to serve their entire sentence, are counterproductive. We need all the carrots and sticks we can muster to help these individuals shake their habit. Mandatory sentences take away any potential that an early release might hold as an incentive for such an inmate to enter treatment. Such sentences also remove the leverage that parole offers to get recently released inmates to continue treatment and aftercare or face a return to prison.
Mandatory sentences are particularly insidious where teens convicted of possession of marijuana are concerned. In such cases, prosecutors and judges should be given wide discretion in order to encourage the teen to stop using the drug. The best chance of achieving that objective is to permit prosecutors and judges to set a punishment proportionate to the offense, for they are positioned to know what sanctions and opportunities are most likely to get the youngster back on track. The early results from the drug courts attest to the value of giving judges and prosecutors wide discretion in dealing with defendants.
At bottom, we must all recognize that the most important influences on children and teens are parents, relatives, friends, teachers, coaches, clergy and community. It is across the kitchen table, in the school yard, church pew and neighborhood that the problem of teen drug use will be resolved. Those who most influence teens--parents, friends, teachers, coaches, clergy--are helped by the clear signal that laws prohibiting possession, distribution and cultivation of marijuana send. Such laws provide support outside the home for the guidance that teens receive from their parents inside the home. As the IOM report on medical marijuana and a host of work sponsored by the National Institute on Drug Abuse of the National Institutes of Health indicate, smoking marijuana is a decidedly dangerous pastime for anyone, just on the basis of its adverse health implications.
Teen experimentation with marijuana should not be considered a casual rite of passage. Teens who smoke marijuana are playing a dangerous game of Russian Roulette. Most kids who smoke pot will not move on to cocaine, heroin and acid, but those who do smoke it greatly hike the odds that they will use harder drugs. Not all kids who smoke pot will become dependent on the drug, but nine percent will. Not all kids who smoke pot will go into drug treatment to try and shake the habit, but nearly 88,000 of the 195,000 individuals undergoing such treatment are teens and children and more teens and children are in treatment for marijuana than for any other drug, including alcohol. Not all kids who experiment will become regular users or pot heads but the only sure way to avoid that is not to smoke marijuana. Not all kids who smoke marijuana will so severely impair their short term memory and ability to concentrate that they will fail in school, drop out or seriously arrest their intellectual development, but many will. Not all teens who get high on marijuana will be involved in a crippling or killing auto accident, but getting high greatly increases the dangers of driving and getting high is the reason teens (and adults) smoke pot. Society, through its laws and customs, has an obligation to do all it can to support parents and others who understand that smoking marijuana is not a rite of passage, but a very decidedly dangerous game of Russian Roulette.
As this CASA White Paper demonstrates, there is more than enough evidence that decriminalization or legalization of marijuana would greatly increase the danger that our children would use this drug. That is reason enough to reject any such course of action. The one thing our teens--and our society--do not need is a third legal drug.
John Demers, a recent magna cum laude graduate of Harvard Law School, did the heavy lifting and led the research effort on this White Paper. Dr. Herbert Kleber, CASA's Executive Vice President and Medical Director, William Foster, Ph.D., CASA's Senior Vice President and Chief Operating Officer and I reviewed and edited it. Others have read it and made suggestions. But, as always, CASA is responsible for its content.