Reprinted from Journal of American Medical Association 204 (June 24, 1968): 1181-82, with the permission of the publisher.
After careful appraisal of available information concerning marihuana (cannabis) and its components, and their derivatives, analogues and isomers, the Council on Mental Health and the Committee on Alcoholism and Drug Dependence of the American Medical Association and the Committee on Problems of Drug Dependence of the National Research Council, National Academy of Sciences, have reached the following conclusions:
Cannabis is a dangerous drug and as such is a public health concern.
For centuries, the hemp plant (cannabis) has been used extensively and in various forms as an intoxicant in Asia, Africa, South America, and elsewhere. With few exceptions, organized societies consider such use undesirable and therefore a drug problem, and have imposed legal and social sanctions on the user and the distributor.
Some of the components of the natural resins obtained from the hemp plant are powerful psychoactive agents; hence the resins themselves may be. In dogs and monkeys, they have produced complete anesthesia of several days' duration with quantities of less than 10 mg/kg.
Although dose-response curves are not so accurately defined in man, the orders of potency on a weight (milligram) basis are greater than those for many other powerful psychoactive agents, such as the barbiturates. They are markedly greater than those for alcohol. In India, where weak decoctions are used as a beverage, the government prohibits charas, the potent resin, even for use in folk medicine. In many countries where chronic heavy use of cannabis occurs, such as Egypt, Morocco, and Algeria, it has a marked effect of reducing the social productivity of a significant number of persons.
The fact that no physical dependence develops with cannabis does not mean it is an innocuous drug. Many stimulants are dangerous psychoactive substances although they do not cause physical dependence.
Legalization of marihuana would create a serious abuse problem in the United States.
The current use of cannabis in the United States contrasts sharply with its use in other parts of the world. In this country, the pattern of use is Arimarily intermittent and of the "spree" type, and much of it consists of experimentation by teenagers and young adults. Further, hemp grown in the United States is not commonly of high potency and "street" samples sometimes are heavily adulterated with inert materials.
With intermittent and casual use of comparatively weak preparations, the medical hazard is not so great, although even such use when it produces intoxication can give rise to disorders of behavior with serious consequences to the individual and to society.
And, while it is true that now only a small proportion of marihuana users in the United States are chronic users and can be said to be strongly psychologically dependent on the drug, their numbers, both actual and potential, are large enough to be of public health concern.
If all controls on marihuana were eliminated, potent preparations probably would dominate the legal market, even as they are now beginning to appear on the illicit market. If the potency of the drug were legally controlled, predictably there would be a market for the more powerful illegal forms.
When advocates of legalizing marihuana claim that it is less harmful than alcohol, they are actually comparing the relatively insignificant effects of marihuana at the lower end of the dose-response curve with the effects of alcohol at the toxicity end of the curve—i.e., the "spree" use of marihuana vs. acute or chronic "poisoning" with alcohol. If they compared both drugs at the upper end of the curve, they would see that the effects on the individual and society are highly deleterious in both cases.
Admittedly, if alcohol could be removed from the reach of alcoholics, one of the larger medical and social problems could be solved. But to make the active preparations of cannabis generally available would solve nothing. Instead, it would create a comparable problem of major proportions.
That some marihuana users are now psychologically dependent, that nearly all users become intoxicated, and that more potent forms of cannabis could lead to even more serious medical and social consequences—these facts argue for the retention of legal sanctions.
Penalties for violations of the marihuana laws are often harsh and unrealistic.
Persons violating federal law with respect to possession of marihuana are subject to penalties of from 2 to 10 years imprisonment for the first offense, 5 to 20 years for the second offense, and 10 to 40 years for additional offenses. Suspension of sentence, probation, and parole are allowed only for the first offense. Many of the state laws provide fOr comparable penalties. With respect to sale, penalties are even more severe.
Laws should provide for penalties in such a fashion that the courts would have sufficient discretion to enable them to deal flexibly with violators. There are various degrees of both possession and sale. Possession ranges from the youngster who has one or two marihuana cigarettes to an individual who has a substantial quantity. Sale may range from the transfer of a single cigarette to the disposition of several kilograms of the drug.
While persons should not be allowed to become involved with marihuana with impunity, legislators, law enforcement officials, and the courts should differentiate in the handling of the occasional user, the frequent user, the chronic user, the person sharing his drug with another, and the dealer who sells for a profit.
Of particular concern is the youthful experimenter who, by incurring a criminal record through a single thoughtless act, places his future career in jeopardy. The lives of many young people are being needlessly damaged.
For those persons who are chronic users of the drug, and are psychologically dependent on it, general medical and psychiatric treatment, plus social rehabilitative services, should be made readily available. Such persons should not be treated punitively for their drug abuse alone any more than are persons dependent on other drugs, such as narcotics or alcohol.
Furthermore, if the purpose of imposing penalties is to deter acts which might injure the individual and disrupt society, then equitable penalties, insofar as they enhance respect for the law, can contribute to effective prevention.
Additional research on marihuana should be encouraged.
Only recently has an active hallucinogenic principle of cannabis been exactly identified and synthesized. Sufficient time has not elapsed to obtain a substantial body of pharmacologic and clinical evidence concerning its effects. There are no carefully controlled clinical studies of long-time effects of cannabis on the central nervous or other organ systems. These and other considerations point to the importance of ongoing research in this area.
It must be emphasized, however, that the issue which faces the United States today is not whether we know all there is to know about marihuana scientifically. Obviously every effort should be made to correct the deficiencies in our knowledge. The issue is whether we can ignore the experiences and observations established over centuries of heavy use of ,hemp preparations in various societies. A current solution to the problem does not relate to what is not known, but to those facts which are known about cannabis and its preparations. There is extensive experience in its use in all of its forms, including the effects of the potent natural resins which contain the active biological principles.
Educational programs with respect to marihuana should be directed to all segments of the population.
Educational material, based on scientific knowledge, should point out the nature of marihuana and the effects of its use. Such material should be an integral part of a total educational program on drug abuse.
Primary and secondary schools, as well as colleges and universities, should establish such programs.
The communications media should disseminate authoritative information to the general public.
Physicians, as professional practitioners and concerned members of the community, should call attention frequently and forcibly to the problems of drug abuse and drug dependence.
An informed citizenry, in the final analysis, is the most effective deterrent of all.