Reprinted from Psychiatric Opinion 5 (October 1968): 9-15, with the permission of the publisher.
What opportunities have you had of obtaining information regarding the matters connected with hemp drugs in regard to which your answers are framed? What classes and what proportion of the people eat, drink, or smoke hemp drugs, and in what localities? Is the use of these drugs on the increase, or decrease? What proportion of the consumers are: (a) habitual moderate; (b) habitual excessive; (c) occasional moderate; (d) occasional excessive consumers? To what extent is the consumption of each of these drugs practiced in solitude or in company? Is there a tendency for the moderate habit to develop into the excessive? If not beneficial, do you consider the moderate use to be harmless? Give reasons for your answer. Does the habitual moderate use produce any noxious effects— physical, mental, or moral? Do you think the cultivation of the hemp plant should be in any way controlled; would this be feasible; if so, indicate the method by which such control could be exercised? Would it be feasible to prohibit the use of these drugs; would the drug be consumed illicitly; how could the prohibition be enforced; would the prohibitions be followed by recourse to alcohol or other drugs?
Thus began the inquiry of the Indian Hemp Drugs Commission carried out by the British in 1893-94 to determine whether there was a cannabis problem and how it could best be dealt with. In 1968 we need to ask ourselves why passion, extremism, ignorance, and irrationality have come to be substituted in regard to marijuana (and other matters) for the above objectivity and reason. Why have many physicians and other professionals allied themselves with drug policemen and politicians in criminalizing our youth and in talking about marijuana as though it were more dangerous than any other phenomenon in our society including cancer, guns, or the hydrogen bomb?
To understand the use of any drug, whether aspirin, penicillin, or alcohol, one must look at the full context of drugs, including the full range of psychoactive or mind-altering drugs (alcohol, nicotine, barbiturates, amphetamines, LSD, narcotics, tranquilizers, and many others, in addition to marijuana). Even more important is to recognize drug usage as a symptom or barometer of a society which is in many ways sick, hypocritical, primitive, and underdeveloped; a society which is drug-ridden, crime-ridden, and myth-ridden.
The "problem" of marijuana is taken for granted by most laymen and professionals and consists of a vague conglomerate of fear-inducing impressions, or paranoia, including the concepts of "dope fiend" (with marijuana at the least being a stepping-stone to this evil state), "sexual excesses," assassination, psychosis, crime, dropping out, and general immorality. As with most things the truth is far more complex. What is deviant, abnormal, sick, or criminal is not handed down by God but rather is arbitrarily and subjectively defined for each culture and society by certain moral entrepreneurs or rule makers, in this case, narcotic police (especially the Federal Bureau of Narcotics), medical bureaucrats, politicians, and the mass media.
With marijuana, alcohol, or any other drug, it is important to differentiate short-term effects and long-term effects, average doses and large doses, use and abuse, and other dimensions which are customarily glossed over. Abuse of drugs involves excessive use to an extent that it impairs an individual's health or social or vocational adjustment. Documented cases of drug abuse involving marijuana are few and short-lived, but the situation can best be put in perspective by discussing a concept dear to the hearts of drug extremists, "hard" drugs.
Although the American Medical Association and the National Research Council recently saw fit to issue a special statement to the effect that marijuana is a "dangerous drug," the committee members (who for the most part have had no research or clinical experience with marijuana in either natural or pathological settings) would have been more accurate and honest if they had said that marijuana, like all drugs including aspirin and alcohol, can be dangerous depending on how it is used, for what purposes, and by whom. Even those who have been rescued from well-deserved obscurity (and who make a good living from the marijuana demonology) now admit that it is not a narcotic despite the false classification of the laws and that it does not produce addiction (physical dependency). However, the latest one-dimensional oversimplification is the stress on psychological dependence or habituation. Under this concept, a person becomes so accustomed to something from regular use that he feels restless or uncomfortable when the agent is no longer available. Psychological dependence can occur with marijuana just as it can and often does with caffeine, nicotine, alcohol, and with such things as television or one's spouse. Habituation to anything will divert a certain amount of time, energy, and money, but fortunately it does not always impair an individual's functioning. The real significance of habituation must always be determined for each person within the full context of his life.
The major definitions of "hardness" would certainly include death, damage to body organs, mental illness, addiction, and accidents. Thus, without minimizing in any way the seriousness of a bad LSD trip, amphetamine psychosis, or heroin addiction, the doctor, policeman, and politician should be giving the highest priority to reducing and eliminating the use and abuse of alcohol and tobacco. Most people reluctantly acknowledge the millions of deaths and disabilities resulting from cigarette smoking, but few seem aware of America's 6,000,000 alcoholics with their cirrhosis of the liver (the 6th leading cause of death in America), addiction, job loss, family disruption, and mental illness (including chronic brain damage which accounts for 20 percent of those in state mental hospitals). Fifty percent of those in prison for murder, robbery, theft and rape committed these crimes after taking alcohol and 50-70 percent of the 53,000 deaths and 2,500,000 serious injuries on the highways each year are associated with alcohol consumption. To say the least, physicians and other professionals who have preoccupied themselves with marijuana, LSD, or narcotics have been hypocritical and have helped the drug policemen in their systematic efforts to delude the public and aggrandize their agencies. As a final example, heroin—which has been made the foundation of the drug demonology—is "hard" in the sense of liability to induce physical dependency, but it is "softer" than alcohol or tobacco in that it produces no irreversible physical damage to body organs, even with many years of heavy daily use.
No drug is harmless, and no drug is inherently desirable, necessary or life-enhancing.
Surely marijuana is the most remarkable chemical substance ever known if it has even a fraction of the properties attributed to it by various self-appointed experts. It is said to produce both sexual "excesses" and decreased interest in sex; violence and passivity; radicalism and dropping-out; heroin addiction and LSD use; psychosis and consciousness-expansion. Actually, the effects of any mind-altering drug (assuming a moderate or average dose) depend mainly on the personality and character structure of the user, including their moods, attitudes and expectations, all interacting with the pharmacological properties of the drug and the socio-cultural setting in which the drug is consumed. This principle is best illustrated by the most common mind-altering drug experience in our society, the cocktail party or other group "turn-on" with alcohol. People of similar ages and backgrounds consume the same quantities of the drug and behave in markedly different ways, ranging through passivity or drowsiness, aggressiveness or violence, amorousness or overt sexual behavior, euphoria or gloominess. Happily, there is no drug, including marijuana, which will magically transform an otherwise conforming, well-adjusted normal person into a licentious, violent psychotic; and, unhappily, there is no drug, including marijuana, which will transform mediocrity and ignorance into productive genius.
Pharmacologically, tetrahydrocannabinol, the active principle of the (female) cannabis sativa plant variously referred to as marijuana, ganja, kif, hashish, charas, bhang, etc., now appears to have a mixed sedative-stimulant effect on the central nervous system and mind. Some prefer to refer to it by nonspecific and often emotional terms—intoxicant, psychedelic, hallucinogen, etc.—which help to confuse rather than to illuminate. Some of its properties (keeping in mind the broad principle of mind-altering drug effects enunciated above) are similar to depressant drugs such as alcohol, barbiturates, and morphine, while others are similar to stimulants such as caffeine and amphetamines.
Historically, cannabis derivatives or products have been used for at least 5,000 years, and it is presently used by an estimated 250,000,000 people in North America, South America, the West Indies, Europe, Africa, and Asia, second in popularity only to alcohol, a drug which has been aggressively manufactured, distributed, advertised and "pushed" by those liking and profiting from that drug.
Conservatively it seems likely that at least 5,000,000 Americans are users of marijuana, often referred to as pot, grass or weed. The tens of thousands of arrests and the seizures of large quantities of the plant are only the top of the iceberg, since it is estimated that in the United States 15-20 percent of college students and 20-40 percent of urban high school students use or have used it. Many more have experimented with it in the past, including 10 percent of a recent representative sample of adults surveyed in the San Francisco metropolitan area. As significant as the numbers involved is the spread to all socio-economic classes and occupational groups. Surveys I have conducted over the past year show that in one large urban school district 18 percent of 7th grade boys and 12 percent of the girls have used marijuana. In the 12th grade, 41 percent of the boys and 43 percent of the girls have used the drug, the majority with some regularity.
Obviously, pot is now, just as alcohol and tobacco are now, for a large proportion of the young and for increasing numbers of the older generations.
Many types of bias have contributed to the ignorance, confusion and hysteria about marijuana. Generalizing from laboratory or pathological experience to the natural situation; from the results or consequences of another drug such as heroin; or from the pronouncements of the Federal Bureau of Narcotics (recently re-organized and renamed the Bureau of Narcotics and Dangerous Drugs) are the most common sources of error. There is a notable absence of logic, rationality and statistical reasoning.
Why are so many people, young and old, seeking out old and new drugs, legally and illegally? Certainly it reflects widespread alienation, with growing numbers of individuals finding school, jobs, and leisure-time pursuits lacking in meaning and significance. There is reaction and over-reaction to decades of lies and distortions about drugs and about other important subjects, and there are communication and credibility gaps which accompany the generation gap. The role models of the young—their parents and other "mature" adults—consistently utilize mind-altering drugs whenever they socialize, relax, or seek pleasure. The alcoholic beverage, tobacco, and over-the-counter "sedative" industries spend millions of dollars every single day in advertising and promoting drug usage, stressing such lures as youthfulness, sexual pleasure and happiness. Our society has been taught, and has gullibly accepted, that it is natural, harmless and beneficial to place a dried plant leaf (tobacco) in one's mouth, ignite it, and inhale and exhale the resulting smoke. It should not be surprising that this practice has carried over to marijuana smoking, but it should emphasize the interdependency of the different drug problems and the necessity for a combined approach. Peer group and conformist pressures constitute another contributing cause, along with the absence of drug education and of more constructive alternatives to drug use. Then there is the criminogenic effect of the extreme drug laws. Sociologists have long recognized that to label "vice" illegal, deviant, or abnormal actually makes it far more interesting and attractive to many people, particularly those who see themselves as being disaffiliated from, or in revolt against, the establishment, as do most of our youth.
When we discuss and react to marijuana, we respond to a symbol of the chasm between young and old, between open and closed minds, between libertarian and authoritarian mentalities. Politicians have loved the subject; the more one succeeds in foisting the marijuana menace on the public, the less one needs to talk about alcohol, racism, poverty, war and other far more serious matters, the discussion of which in any depth might result in loss of votes, decreased income, or worst of all, unpopularity. The drug laws have an important scapegoating and anti-intellectual function in our society, being used to attack youth and other minorities, dissent, and nonconformity.
Early in this century we had widespread (but much less than now) use of alcohol and of tonics containing opium and/or alcohol. The concept of addiction was not yet delineated, and no survey or statistical data exists to substantiate the claims of drug policemen and their medical allies that "1 in 400" Americans were "addicts." Whatever the former prevalence of use, despite increasingly severe criminal penalties for users and distributors, more people are using more drugs (including more potentially-dangerous ones) than ever before. We see, then, that the present system is "soft on drugs," an appellation frequently misdirected against modern reformers in much the same way that political dissenters are often labeled as traitors or Communists. What the current laws are "hard on" is not marijuana, but rather human beings, and the time is long overdue for us to redirect our focus and our priorities despite intimidation and harassment by those benefiting from the status quo.
Those who have been influenced by the 12th century tale of a group of assassins (actually religious fanatics seeking to free their country) who were said to have used marijuana (hashish, etymologically derived from the Arabic for assassin) should take comfort from the fact that mind-altering drugs don't work that way, and that from the findings of scholars, these men actually were influenced by wine and beautiful women.
There is another sacred cow of the marijuana demonology which I call the stepping-stone theory. Like the domino theory of foreign policy, this rests upon a very insubstantial foundation. Basically it states that even if marijuana isn't actually a combination of arsenic and the H-bomb, it is necessary to devote vast resources to spying upon, entrapping and jailing the young who use it, so that we can save them from stepping up to heroin (sometimes in recent years shifted to LSD). Even if there were some causal relationship, which there clearly is not, between smoking or eating marijuana and becoming a heroin addict, the proper approach would be education and rehabilitation, not expulsion from school, a criminal record, and training in real crime and homosexuality in one of our prisons. In any case there is an inverse relationship, for as marijuana use has increased astronomically, the use of and addiction to heroin has declined. Even Anslinger, the author of most of our current stereotypes and policies, in presenting his anecdotal and hysterical accounts of marijuana's dangers to a respectful Congress in 1937, stated in response to a question that there was no relationship between marijuana and heroin. The philosopher David Hume and others have pointed out that just because one thing follows another in sequence does not show causality. If one asks about mind-altering drug usage in its full and proper context in talking with heroin addicts, one finds that the first drugs used (and illegally in the early teens) were alcohol and tobacco. Some of these individuals then later used marijuana, and some, a small minority even a decade ago, later used heroin. The bare statement that 50-70 percent of heroin addicts used marijuana may impress the untrained and uncritical, but in reality it is meaningless and a non sequitur. The limited association between the two drugs was a direct consequence of misguided laws which, as another of their criminogenic effects, drove the two together in the black market traffic as they were made profitable to the purveyors of vice.
The real marijuana problem is the law and its fanatical enforcement. Police, bureaucrats, politicians, and the mass media define the drug for society as being far more interesting, important, and desirable than it actually is. Since most discussions are polarized in terms of the criminalization of anyone even remotely associated with marijuana (including in many states anyone in a room or building where any amount of the drug is present), few individuals ever get around to talking about specific and constructive alternatives. Legalization of pot, for most people, seems to mean something analagous to what we have done with tobacco and alcohol, i.e., making them essentially uncontrolled and overavailable, while many individuals and many governments profit from their widespread use and abuse.
The first major responsibility of the professional should be to help communicate to the public and its "leaders" that the present system has been notably unsuccessful and dangerously harmful and that we can be much more selective and sophisticated in our policies by concentrating the criminal law on antisocial behavior, on real crime (increasing dramatically in our cities), and on large-scale trafficking in disapproved drugs.
The major reform in which I have been involved nationally is to take the drug user and possessor (whether of alcohol, tobacco, marijuana, LSD, or heroin) entirely out of the criminal law, recognizing such use and possession as a public health and sociological matter. It is as barbaric and inhumane to manufacture criminals out of drug users as it was to put the mentally ill in dungeons and burn witches at the stake. It is also unsuccessful and expensive. If we were to consistently and completely enforce our present drug laws, schools would be depopulated and our unjailed youth decimated overnight, particularly in regard to the illegal use of alcohol and tobacco with marijuana a distant third in extent of use. Unfortunately, there are those in our society who would like to do just that with marijuana, while hypocritically ignoring the other drugs despite the real health and social problems stemming from their use.
The issue is not how harmful or harmless marijuana is, or may be found to be (if the blocking of research by the narcotics agencies can be overcome by professional outcry); rather it is how to deal with the situation in a constructive and humane manner. No amount of research will show the drug to be as dangerous as a number of agents already widely disseminated in our society.
Truth, rationality, and concern for human welfare are ideally qualities to be provided by the professions, particularly medicine, even when something or somebody considered to be evil is involved. I would hope that most of the readers of this article will subscribe to the following statement, first circulated at the 1967 meeting of the American Sociological Association, and signed among others by Professors Alfred Linde-smith, Howard Becker, and the writer:
We, the undersigned medical and social scientists having national and international experience with the problems and challenges of marijuana use, wish to indicate our agreement that the present extreme laws imposing criminal penalties on users of marijuana require drastic and immediate reform through judicial and legislative action. Social and legal policies in the United States regarding this substance should recognize possession or use as a sociological and public health matter, removing this from the criminal law and reserving such criminal penalites solely for antisocial behavior and if necessary, illicit manufacture and distribution. Present marijuana laws were based almost entirely on self-serving, hearsay testimony presented in an artificially created climate of emotionalism and failed to reflect or consider scientific knowledge or thinking. Such legislative action in the 1930's has defeated the purposes for which it was supposedly intended and has brought about far more extensive drug use, and has done far more social and individual harm than marijuana itself. Clinical and social research, which is practically nonexistent at the present time due to current repressive policies of narcotics agencies, should be urgently accelerated and broadened. State and national conferences of true experts in the pharmacological, psychological, sociological, and other aspects of marijuana use, should be convened in the near future to provide guidelines to government for future policies of regulation and control.
An ideal program for reducing the use of mind-altering drugs should deal with all of them and should involve physicians and all other professionals. Such a program should include the law reforms mentioned above.
A total ban on advertising and/or promotion of any of these drugs. Higher taxation.
Prominent, unequivocal labeling of alcohol and tobacco as to their multiple dangers and higher taxation of the sale and purchase of these substances.
Treatment by private practitioners and special clinics of the drug abuser (alcoholic, chronic tobacco smoker, heroin addict, amphetamine psychotic, LSD bad tripper, barbiturate addict, etc.).
Full-scale educational programs beginning in elementary school, and extending on to adults, to present facts about all of the drugs in one context and to demythologize and desensationalize them.
Developing better role models for the young.
Attacking the roots of the multiple drug problems—i.e., bureaucratization, poverty, racism, disease, boredom, inadequate family associations, and in general, the low quality of American life.
To do nothing or to uphold the status quo is to be part of the problem, and perhaps to authenticate the words of T. S. Eliot, "The line down the middle of the road is yellow."
Let us remember, as doctors and as men, other words from the Book of Job:
From out of the city the dying groan, and the soul of the wounded cries for help.