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Chapter 5 - Physicians on Marijuana Use PDF Print E-mail
Written by Erich Goode   
Tuesday, 08 March 2011 00:00

Chapter 5 - Physicians on Marijuana Use


Introductory Remarks

A sociologist of knowledge seeks to explicate whether and to what extent man's social surroundings influence his intellectual efforts. Adopting this perspective toward the sentiments of the various disputants in the marijuana controversy, we are alerted to the possibility that attitudes about, and orientations toward, the use of marijuana, as well as what effects it has, and whether these effects are good or bad, may be at least in part traceable to a specific kind of role one plays, or status one has, in society. It would seem highly peculiar if, somehow, doctors were exempt from the generalization that ideas have a powerful existential referent, that individuals are compellingly influenced by their social locations and interactions. We expect, therefore, that the ideas of physicians in the sphere of marijuana use are influenced by, and can be traced partly to, their social contexts. (This is a testable proposition, not an axiom beyond the reach of empirical investigation.) The question which remains, therefore, is what is the nature of the social expectations, demands, and sentiments related to the position of physician in American society, and what is their articulation with regard to marijuana use.
Physicians act not only as individuals; they also act as representatives. Unlike intellectuals, writers, and professors, their clients comprise everyone, all classes and groups in society. In their hands is entrusted the health of the social body. They are burdened (or blessed, depending on one's point of view) with the responsibility of protecting the well-being of society at large, and therefore are under a pressure to act in a manner that society defines as responsible and mature. The physician knows that when he speaks, many listen. His favored position disinclines him to a radical direction.[1] His prestige and power are a mixed blessing, because whatever he says will be taken seriously. He is highly visible, and he is expected to make sober and responsible pronouncements. The physician and the intellectual, although equally well educated, informed, and occupying roughly the same social class position, differ markedly in their accountability to a constituency, and thus usually differ radically on crucial issues. The question, therefore, becomes not so much: "What is the opinion of the medical profession, trained in the scientific technique and objective about anything affecting the human body, on the dangers of this drug, marijuana?" It is, rather: "What sorts of responses toward marijuana use might be expected from a group of individuals who are highly respected and affluent members of their community, geared to social functions of a distinctly protective nature, and responsible to a public?" I would predict that the responses of doctors regarding marijuana use would not be much different from individuals in positions much like theirs: bankers, politicians, attorneys, executives, judges. Their attitudes, I maintain, stem less from their medical knowledge than from their social position in society.
The position of medical men is a conservative posture, if we understand that as having the implication of "conserving" the status quo—protecting society from any possible danger. The basic thrust of such a position is that any substance has potential dangers that have to be thoroughly examined before it can be released to the unsuspecting public. It is far better, this line of reasoning goes, to restrict access to an innocuous drug than to permit access to one which is truly dangerous. The parallel between marijuana and thalidomide—inadequately tested and prematurely marketed—is obvious and sobering. The physician's stance, then, is paternalistic; certain decisions have to be made for the public, who, without expertise, cannot possibly decide on the danger or safety of a drug, unaided by those whose responsibility it is to perform that very task. As Henry Brill, physician, professor of medicine and hospital director, wrote: "All drugs are guilty until proven innocent."[2]
A guiding principle in this analysis is the specialness of the physician's orientation toward marijuana and its use.[3] I intend "specialness" to bear two distinct but interrelated meanings. First, that physicians' attitudes toward marijuana, as with everyone else, are largely "nonrational," not simply untrue or false in a scientific sense, but that their stance is a possible one out of several competing versions, and that all of these versions "surpass experience," that is, are based on attitudes that are sentiments and values which cannot be either supported or refuted scientifically. It follows from these expectations of society that the physician will act in a manner society defines as "responsible," that is, he will make essentially protective pronouncements.
Let us assume something true that is false, namely that it has been established scientifically that the statistical chance of experiencing a "psychotic episode" while under the influence of marijuana is one in a thousand—or even one in a million. This is, we will assume, a fact on which all observers agree. (It is not, of course.) The manner in which the physician makes his decision, that is, to be "responsible," will lead him to decide that this is too great a price for society to pay for the luxury of allowing a small freedom, and therefore marijuana use ought to be prohibited. Someone with a different set of values would make the decision in a very different way. The civil libertarian would say that the incidence of danger is sufficiently small to offset the larger threat to society's freedom to smoke marijuana. Both may agree on the facts, but it is the sentiments, even among the physicians, that ultimately decide.
The ideas of physicians are "special" in a second sense as well: doctors have been successful in defining the nature of reality for the rest of society in a vast number of areas. They have been successful in claiming that they alone are competent to interpret the reality of marijuana, and that their version of the drug's actions is the only legitimate, valid, and objective one. They have managed, that is, to establish epistemological hegemony. Their position enables their special version of the nature of the drug and its use to be regarded by others as neutral, impartial, and objectively true, and all other versions to be biased and based on special interest pleading. The physician is seen as transcending the accidental and irrational prejudices that blind others. In the area of drug use, physicians are "instant experts," knowledgeable and unbiased.
Since most members of society are not aware of professional and scientific distinctions, they will make little effort to seek out the word of those physicians who are most qualified to speak and write on marijuana, that is, those physicians who have actually done studies themselves, or who have closely read such studies. In fact, it might very well be disadvantageous to publicize the views of those physicians who are best-informed on the effects of marijuana, because they will present a more complex view, one which does not square with official morality. The contrary, in fact, will be true: the public will encourage those physicians whose views are most hostile to marijuana use which, almost inevitably, will be those physicians who are least informed on the subject. As a general rule, doctors whose writings on marijuana indicate dubiousness concerning its dangers are more likely to have done original research. Those physicians who are most stalwartly against its use, and whose writings indicate a strong feeling that clear dangers attend its use, are more likely to be without any systematic research experience on the drug's use, have no real contact at all with users, or be acquainted with them only as patients. (Patients who smoke pot and who visit doctors, especially psychiatrists, in connection with their drug use are, as we might expect, radically different from the average user—as are individuals who visit psychiatrists for any reason.)
It is not only the characteristics of the physician that would enable us to predict the role he would take vis-à-vis marijuana use. We must also look to the tie-in between the doctor's role and the cultural values of American society that generate his concern. It has become a cliché that American civilization still retains many strong traces of a Puritan ethic. Not all clichés are completely wrong; this one has at least a grain of truth. One axiom in the Puritan ideology is that pleasure must not be achieved without suffering. In fact, much of the machinery of Calvinist culture was devoted to making that axiom a self-fulfilling prophecy. Through guilt, ridicule, and punishment, the pleasure-seeker was made to suffer. We consider our age more enlightened. We have lost faith in many of the stigmata that once indicated sin. We no longer believe that it is possible, by outward sign, to "tell" if a girl has been deflowered, and we no longer counsel the adolescent boy against masturbation for fear of insanity or pimples. Yet we have not entirely moved away from this form of reasoning. With regard to marijuana use, we still take seriously the notion that the user must pay for his evil deed. No one is permitted to experience great pleasure without suffering a corresponding pain—a kind of moral Newton's Third Law. This is one of the reasons why alcohol is such a perfect American intoxicating beverage: getting drunk has its price. (There are, of course, historical reasons as well for liquor's acceptance.) It is, however, puzzling to the American cultural mainstream that anyone could enjoy cannabis without suffering any misery. It is necessary, therefore, for the cultural apparatus to construct a pathology explanation on marijuana use. A search must be made for signs of mental and bodily suffering that the marijuana smoker experiences as a consequence of his use. In the vastness and diversity of the many experiences that users have, at least some pathological traces may be dredged up. By searching for and emphasizing these traces, we have satisfied our need for discrediting marijuana use, and have done so in a manner that specifically calls forth the efforts of physicians to verify our cultural sentiments.
It follows that marijuana use will be viewed as a medical matter. And that it is a matter for physicians' attention. It might be presumed that physicians' word is sought on marijuana use because it is a medical matter. The sociologist looks at the issue differently. That marijuana use is a medical matter is an imputation, not a fact. It is because society has already adopted the pathology or "disease" model on marijuana use that it seems reasonable to infer that marijuana use, therefore, is a medical matter. But the prior imputation was necessary to see it that way in the first place.
The central point of this book, explained in detail in the chapter on "the politics of reality," is that we all view reality selectively. We notice that which verifies our own point of view, and ignore that which does not. We accept a "world taken for granted," and an exposure to contrary worlds does little to shake our faith in our own. Moreover, when our version of what is real and true is threatened, we marshall pseudoevidence to support this version. Facts used in arguments are rhetorical rather than experimental. Societies whose values do or would oppose a given activity face a tactical problem: how to make a condemnation of that activity seem reasonable and rational? A rationale must be provided, and a personnel whose word is respected must provide that rationale. Thus, by generating statements from physicians, society is utilizing a valuable ideological resource. The antimarijuana lobby will therefore court and win the sympathies of doctors whose word on cannabis is largely negative. Society is searching for verification of an already held ideological position, not for some abstract notion which idealistic philosophers once called "truth." (We all assume that we have truth on our side.) So that the pathology position will be crystallized out of the magma of society's needs and expectations, out of the social and cultural position of physicians, their self-conception —partly growing out of society's conception of them—as preservers of society's psychic and bodily equilibrium, and as experts on anything having to do with what is defined as a health matter. It is these pressures that generate the concern of physicians regarding marijuana, and not any particular expertise they might have.[4]
In lieu of actually doing a survey, it is necessary to examine the writings of physicians on marijuana. However, to use these written statements to characterize the dominant medical view on cannabis use it would be necessary to resolve at least one difficulty first. There is the question of the typicality of published and widely disseminated statements, as opposed to the actual sentiments and actions of the vast bulk of doctors who do not write on marijuana. Those who wish to spread their views by publishing them might, for instance, be those who feel most strongly involved—both for and against; they might be "moral entrepreneurs," to use Howard Becker's phrase. Yet, in spite of the possibly nonrandom sentiment expressed in physicians' printed statements on marijuana, we must also remember that these are the views that tend to have the greatest impact. The American Medical Association makes an official pronouncement, reported by major newspapers and magazines, which means that a position is congealed and more easily utilized in the continuing debate. Published statements take on a life of their own. Although the question of whether or not physicians' published statements are typical is an empirical question, and not one on which we have an answer, nonetheless, the basic thrust of these statements is overwhelmingly negative, largely cast in the form of a pathology model,[5] and used by the antipot lobby to verify its own position. Thus, although we will encounter some diversity of orientations regarding drug and drug use, it is possible to discern a relatively consistent ideology, both in "official" and in working day-to-day terms. In the remainder of this chapter I intend to elaborate on the mainstream medical position on marijuana use. This position is made up of a number of separate elements. Let us examine each element.

 

Drug Abuse

In the typical medical view, marijuana use is by definition "abuse." Drugs are taken for therapeutic purposes, to alleviate pain, to aid adjustment, to cure a disease, and must be prescribed by a physician. Marijuana has no known or recognized, professionally legitimated role whatsoever. The human body operates best, in the absence of a pathology, without drugs. Drugs are unnecessary without illness. The purpose of getting high is seen by this view as illegitimate. All use of marijuana is abuse; all use of drugs outside of a medical context is in and of itself the misuse of the purposes for which drugs were designed. The AMA writes: "... drug abuse [is] taking drugs without professional advice or direction."[6]

Marijuana is hallucinogenic and has no medical use or indication.... Feelings of being "high" or "down" may be experienced. Thought processes may be disturbed. Time, space, distance and sound may be distorted. Confusion and disorientation can result from its use. Reflexes are slowed. Marijuana does not produce physical addiction, but it does produce significant dependence. And it has been known to produce psychosis. With this description of the effects of its use and the total lack of any medical indication for its use, medically it must be stated that any use of marijuana is the misuse of a drug.[7]


The damning constituent of marijuana, like all "recreational" drugs, is that it is used to get high; the normal state is seen as desirable—the state of intoxication, pathological. The use of a drug to get high is abuse of that drug: "There is no such thing as use without abuse in intoxicating substances."[8]
In an essay in what is widely considered the bible of clinical pharmacology, the following is a definition of drug abuse (of which marijuana abuse is discussed as an instance; a distinction is made between obsolete "Therapeutic Uses" and current "Patterns of Abuse"):

In this chapter, the term "drug abuse" will be used in its broadest sense, to refer to use, usually by self-administration, of any drug in a manner that deviates from the approved medical or social patterns within a given culture. So defined, the term rightfully includes the "misuse" of a wide spectrum of drugs.... However, attention will be directed to the abuse of drugs that produce changes in mood and behavior.[9]

 

Etiology of Drug Use

In terms of the etiology of marijuana use, physicians may generally be found within the orbit of the personality theory of causality. Now, no psychologist or psychiatrist would dispute the contention that sociological factors play a decisive role in marijuana use. Clearly, a milieu wherein marijuana is totally lacking, or in which its use is savagely condemned, is not likely to generate many marijuana smokers, regardless of the psychological predisposition of the individuals within that ambiance. Yet, at the same time, a theory of marijuana use set forth by a psychologist, psychiatrist, or physician, will look and sound very different from one delineated by a sociologist. Doctors will tend to emphasize individual and motivational factors in the etiology of marijuana use. It is necessary, therefore, according to this perspective, to understand the individual's life history, particularly his early family relations, if we are to understand why an individual does as he does, particularly if he challenges the established social order—as, to some degree, his use of marijuana does. An individual of a certain family background will be predisposed to specific certain kinds of behavior.
More than merely being generated to a considerable degree by personality factors, physicians (following psychologists and psychiatrists) often see marijuana use as being at least to some degree generated by pathological or abnormal motives. Sometimes this is seen as a general process; marijuana use, like all illicit, deviant, and illegal drug use, represents a form of neurosis, however mild: "The willingness of a person to take drugs may represent a defect of a superego functioning in itself."[10] It is, of course, necessary to specify the degree of drug involvement. Most physicians will not view occasional or experimental use in the same light as frequent, habitual, or "chronic" marijuana use. Probably we can make a safe generalization about the relative role of the factors we are discussing: the heavier and the more frequent the use of marijuana, the greater the likelihood that most doctors (as well as psychiatrists and personality oriented psychologists) will view its etiology as personality-based, as well as pathological in nature, and its user to some degree neurotic; the less frequent and regular the use of marijuana, the greater the likelihood that the cause will be located in accidental and sociological factors, and the lower the likelihood of being able to draw any inferences about the functioning of the user's psyche. This qualification is essential.


Probably the commonest view of marijuana use within the medical profession is that it is a clumsy and misplaced effort to cope with many of one's most pressing and seemingly insoluble problems. Drug use is not, of course, logically or meaningfully related to the problem, but is, rather, a kind of symbolic buffer serving to mitigate it by avoiding it, or by substituting new and sometimes more serious ones. Feelings of inadequacy, for instance, are said to be powerful forces in precipitating drug use.

An individual who feels inadequate or perhaps perverted sees in drugs a way out of himself and into a totally new body and mind. For some a drug does give temporary surcease from feelings of inferiority, but for most it provides only numbness and moderate relief from anxiety, with no true or constant feeling of strength or superiority. Often this search for a new self is what leads to escalation and a frantic search for new drugs which may lead to addiction.[11]


Occasionally, this notion of inadequacy is further pinpointed to sexual inadequacy. One prominent physician, analyzing a case history, writes: "Tom began to smoke marijuana and to gamble. He also suffered from impotence. Tom's need for marijuana and gambling was to help him overcompensate for his physical and mental inferiorities. He was underweight, had only a grade school education and suffered from the fear of organ-inferiority, called a 'small penis complex.'"[12] Another physician concurs: "I know of several cases where males would use marijuana to overcome feelings of sexual inadequacy. Their marijuana use ceased after psychiatric treatment."[13]


Sexual failure may be seen as a manifestation of a general inadequacy; marijuana use is seen as a kind of smoke-screen for the real issues. It becomes a means of avoiding responsibility, of concealing one's failures and inadequacies, of "copping out" of life:

Individuals who have a significant dependency on marijuana and use it chronically report a decrease of sexual drive and interest. A reduction in frequency of intercourse and increased difficulty becoming sexually aroused occurs with the chronic user. However, there is usually a concomitant decrease in aggressive strivings and motivation and an impoverishment of emotional involvement. These changes are generally true for the chronic alcoholic, the chronic amphetamine or barbiturate user. Marijuana dependency is a symptom and the person who avoids experiencing parts of himself through the chronic use of drugs, is usually lonely and frightened of impersonal contact prior to drug use. Some of the diminished sexual activity of the marijuana dependent individual is part of his general withdrawal from emotional contacts with other human beings. The temporary gratification of drug-induced feelings are preferred to the gratification of interpersonal closeness which involves the risks and vicissitudes of real emotional intimacy.[14]


Rebellion is another common component in many medical conceptions of marijuana use, especially as applied to high school and college students. Some doctors feel that the use of the drug represents a symbolic rejection of parental values, a desire to shock one's elders, to aggress against them for real or imagined hurts, to use the drug as a weapon in the parent-child struggle:

The reason why drugs have so strong an appeal to the adolescent are several. The reason most commonly cited is rebellion, and this probably is a factor of importance in most instances. Children begin at fourteen to gain satisfaction from doing the opposite of what is expected. This is a way of retaliating against parents for years of what is now felt to have been unjustified subjugation.... Anything that is disapproved of by adults begins to have a certain allure.... Drugs are clearly beyond the pale in the eyes of both parents and legal authorities, and thus have a particularly strong appeal. A lot of the mystique that is part of the drug taking experience is directly related to the satisfaction the participants gain from realizing how horrified their parents would be to know what was going on. The secrecy surrounding meetings, the colorful slang words, the underworld affiliations make it all seem very naughty.[15]


The intrinsic appeals of the drug itself, its specific effects, the nature of the marijuana high, are overshadowed by its symbolic appeal as both indication of and further cause of rebellion:

Smoking marijuana has become almost an emblem of alienation. The alienated student realizes that the use of "pot" mortifies his parents and enrages authorities....[Marijuana] has become a rallying cause for students, a challenge to adults and a potent catalyst for widening the gap between generations.[16]

 

Marijuana as a Dangerous Drug

The doctors feel that the drug is prohibited for a reason. It is a dangerous drug, and because it is a dangerous drug, it is (and should be) prohibited: "Certain drugs because of known characteristics are classified as dangerous drugs."[17] They take, in other words, a "rationalist" position that men who make such decisions for society respond rationally and logically to a real and present danger. Medical bodies (like the legal structure of societies as a whole) do not authorize marijuana use; they disapprove of its use because there is enough evidence to be able to decide on the drug's dangers—or there is enough indication that it might be thought of as dangerous. "... those of us who oppose legalization are... implacable in insisting that all cannabis preparations are potentially dangerous. The potential dangers, to our minds, are severe."[18] As a result, "... there is overwhelming consensus that this drug [marijuana] should not be legalized, and no responsible medical body in the world supports such action."[19]
Marijuana, then, according to the medical profession, is a "dangerous drug." The question, therefore, is: In what specific ways does the medical profession see its use as dangerous? Opinion is not unanimous on the questions of what, precisely, the effects are whether certain effects represent, in fact, a clear danger, and to what extent the danger appears. Nonetheless, the differences within the profession should not be exaggerated.

 

PSYCHOLOGICAL DEPENDENCY

Without question the danger most commonly seen by physicians and psychiatrists in marijuana is its power to engender a kind of psychological dependence in the user. No observer of the drug scene attributes to marijuana the power of physiological addiction; instead, psychological dependence is imputed. "Drug dependence is a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis."[20] Each drug has its characteristic syndrome, and each must be designated with its own specific title; we are interested in "drug dependence of the cannabis type." Marijuana, then, produces a psychic dependency in the user which impels him to the continued and frequent use of that specific drug—a dependency that is similar in important respects to actual physical addiction.
Marijuana smokers hold the lack of physiological addiction of their drug of choice to be a powerful scoring point in its favor; many physicians, on the other hand, see this point as trivial in view of the parallels between addiction and dependency. The dimension of interest to us is not whether the impelling force is chemical or psychological, but whether the user persists in his use of a substance which physicians have defined as noxious, whose use constitutes "abuse." Thus, a person is defined as being dependent on the basis of whether use of a drug is continued over a period of time, and is ruled undesirable by drug experts. The imputation of undesirability is necessary to the definition, since the repeated administration of crepe suzette[21] is not labeled "dependency"—even though it can occur with the same frequency and with the same degree of disruption in one's life. The fact that a withdrawal syndrome does not appear upon abstinence is outside the focus of this definition; the telling point is that the drug is capable of producing dependency.

It has... been customary to distinguish between drugs that are habit-forming and drugs that are addicting... the present writer, however, fails to perceive any value at all in this distinction.... Hence, it would be quite correct to use the terms habit-forming and addicting synonymously and to refer to common habit-forming drugs as addictive in nature.[22]


The troika of abuse, pathological etiology, and dependence combine forces to pull in the same direction. He who tries marijuana is impelled by the same motivational syndrome which may lead to abuse and, ultimately, dependence; the three concepts are seen as part of the same pattern.

The chronic user develops a psychological dependence which in view of today's knowledge, is the prime detrimental factor. This dependence soon causes him to lose control of his use of the drug because the psychological factors which drew him to try it in the first place now precipitate a pattern of chronic, compulsive abuse. At this point the user is just as "hooked" as are the persons we used to call addicts.[23]


The fact that, supposedly, marijuana use enlarges the sphere of one's freedom, by broadening the field of the choice of one's actions, can, ironically, have the opposite long-range effect, according to dominant medical views. Dependency limits one's possibilities for acting; by being dependent on a drug, one has severely limited his freedom, although to have taken that drug in the first place meant greater freedom. No physician has presented this dilemma more strikingly than a nonphysician, Seymour Fiddle, a social worker who coined the term "existentialist drugs" to capture this contradiction. Existentialist drugs are those a man takes to enact his fullest human potential, to test the limits of his ability to act, just to see how much he can do and be and still retain his essential humanness—but ends by so severely shrinking his possibilities that he is able ultimately to act out only a single role, virtually identical for everyone: that of street junkie.[24] Thus, we chance upon a paradox: man takes drugs to be free, only to discover that he is enslaved by them. The Fiddle argument, then, would hold the freedom issue to be irrelevant, since drugs are a dead-end trap which ultimately kill off all freedom of action. Drugs produce, in the end, even more narrowly restricted one-dimensional men. As to whether marijuana properly belongs in this category is an empirical question, and cannot be assumed in the first place, but the fact that physicians commonly hold it to be a drug of dependence demonstrates that they do believe that it can in fact act in this manner.

 

PANIC STATES AND PSYCHOTIC EPISODES

Cannabis opponents consider the psychotomimetic quality of the drug another potential danger. Physicians and psychiatrists, especially, feel that marijuana is capable of precipitating powerful, though temporary, psychotic episodes—or, more generally, disturbing psychic adverse reactions. There are, of course, problems with this view; to mention only three: (1) What constitutes such a reaction and how do we define an "adverse effect" of marijuana? (2) How extensively does it occur? (3) Under what conditions does it occur?
The smoker, under the influence of the drug, is held to be subject at times to confusion, panic, disorientation, fear, and hallucinations —a schizophrenic break with reality. This point of view holds that this state—ranging from a simple amused befuddlement all the way to a full-blown outbreak of transient psychosis—"can" happen and "does" happen. The fact that it has occurred with at least some modest degree of frequency is, in the eyes of many health figures, powerful damaging evidence that the drug is, or can be, dangerous and harmful.
While physicians are adamant about the existence of these episodes and their attendant dangers, smokers are equally as vociferous in denying to the drug such diabolical powers. Donald Louria writes: "The evidence on panic seems so clear that to deny its existence indicates either abysmal ignorance of the facts or intentional intellectual dishonesty."[25] Yet, writers supporting use of the weed minimize and often dismiss outright its madness-inducing potential. Their claim is that if marijuana can induce psychosis, then the causal sequence posited has nothing intrinsically to do with the effects of the drug itself. Rosevear, for instance, writes: "... a broken shoelace may also be used as a parallel for precipitating psychosis."[26]


Those who seek psychiatric and medical help as a result of an untoward reaction to marijuana are far from typical of potheads, or the mental state of the characteristic marijuana intoxication. The average smoker has probably never seen any evidence of an untoward reaction of any seriousness—so that he denies its existence completely It is difficult to deny that marijuana can potentiate panic or a psychotomimetic experience, given the "right" person and setting. To assert, however, that such reactions are typical, widespread, common, or even more than merely occasional is, I think, entirely incorrect, since, by all accounts, extreme psychosis-like reactions to the drug are extremely rare. Even the staunchest opponents of the drug are careful to point out that they are of relatively infrequent occurrence. The Medical Society of the County of New York informs us that cannabis "is an unpredictable drug and is potentially harmful even in its mildest form. Even occasional use can produce (although rarely) acute panic, severe intoxication, or an acute toxic psychosis."[27] A pair of physicians, reporting on panic reactions in Vietnam, inform us that at the extreme of the continuum, cannabis is capable of touching off in some individuals "a frank schizophrenic-like psychosis," but, at the same time, are careful to point out that "smoking marijuana for most persons is a pleasant, nonthreatening, and ego-syntonic experience."[28]


Work by physicians on cannabis psychosis breaks down into clinical[29] and laboratory[30] research. In general, clinical work must, of necessity, be unsystematic since it is impossible to detect the degree to which the patients who come to a physician for problems connected (or unconnected) with their drug use are in any way representative of users in general. It is impossible to know just what it means when a number of marijuana-using patients show up in a physician's office. How typical are their experiences? What universe of individuals are they supposed to represent? How widespread are their complaints? What role does marijuana play in their problems? Clinical work can answer none of these troublesome but central questions. But clinical reports do have the advantage that they describe people in real-life situations. Laboratory work suffers from the opposite problem. Although it is systematic, the laboratory situation is artificial and outside the marijuana-using situation in which the smoker actually conducts his activities. Although this qualification in no way invalidates either form of research, it should be kept in mind when generalizations from clinical and laboratory situations are made to the use-patterns of the typical marijuana smoker in real-life situations.
The complexity of the issue increases when we consider the relative potency of the various cannabis preparations. Hashish, as we know, is more powerful than the varieties of marijuana commonly available in the United States. Although heavily used in the Orient, it is less commonly, but increasingly, consumed in America.[31] Many of the differences between the gloominess of the findings of many studies conducted on hashish and charas users in North Africa, the Middle East, India, and Greece, and the relative lack of mental pathology associated with use in the United States, can be attributed to the strength of the drugs available. Marijuana grown in the United States is weak; and even Mexican varieties generally lack the strength of their Oriental sisters. The fear, therefore, is that were marijuana to be legalized, it would be impossible and irrational to disallow hashish. "If all controls on marijuana 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."[32] Thus, could it be that hashish, were it freely available to Americans, would produce many of the symptoms described in the Eastern studies?

... no amount of qualification can obscure the fact that marijuana can produce psychotic reactions (this is a simple medical fact) and that a psychotic state can release violence and precipitate criminal behavior. This is not to say that it will in every case but that it can and has. Because of the relative mildness of Mexican and American varieties of cannabis we have seen very little of this kind of cannabis-induced reaction. But with the coming of hashish, we can look for more instances of psychosis and violence as a result of a cannabis use.[33]

 

MOTOR INCOORDINATION

A third reason why physicians consider marijuana dangerous and not to be legalized or made freely available is that it supposedly deteriorates one's motor coordination, rendering the handling of a machine, particularly an automobile, hazardous. The fear is that the current slaughter on the highways of America—partly due to drunken driving—will increase dramatically with the increase in marijuana use. The assumptions underlying this supposition are that marijuana use characteristically leads to intoxication; that intoxicated marijuana smokers are likely to drive; and that one's ability to drive is, in fact, impaired by the use of marijuana. These are all, of course, empirically verifiable (or refutable) propositions, and cannot be assumed. But whether true or false, this line of reasoning will be encountered frequently in antimarijuana arguments: "The muscular incoordination and the distortion of space and time perception commonly associated with marijuana use are potentially hazardous since the drug adversely affects one's ability to drive an automobile or perform other skilled tasks."[34] More dramatically, the marijuana smoker, intoxicated, "may enter a motor vehicle and with "teashades (dark glasses worn because of the dilated pupils) over his handicapped eyes and with impaired reflexes he may plow through a crowd of pedestrians."[35]
Not only is there the fear that widespread use of cannabis will increase the highway death toll, but since there is no reliable or valid test at the moment for determining whether the driver is high on marijuana, there are, therefore, no possible social control mechanisms for preventing an accident before it happens. Since effective tests exist for alcohol, physicians hold that this makes marijuana a more dangerous drug than liquor, at least in this respect. "With marijuana, there are currently no adequate methods for measuring the drug either in the blood or urine.... Under such conditions, the thought of legalizing the drug and inflicting marijuana-intoxicated drivers on the public seems abhorrent."[36]

 

LOSS OF AMBITION AND PRODUCTIVITY

A common concern among members of the medical profession is that marijuana—particularly at the heavier levels of use—will produce lethargy, leading to a loss of goals and a draining off of potential adolescent talent into frivolous and shiftless activities. One physician speculates whether marijuana might be America's "new brain drain."[37] The AMA states that frequent use "has a marked effect of reducing the social productivity of a significant number of persons,"[38] and that as use increases, "nonproductivity" becomes "more pronounced and widespread."[39]

As the abuse pattern grows, the chronic user develops inertia, lethargy and indifference. Even if he does not have psychotic or pseudopsychotic episodes or begin a criminal or violent existence, he becomes a blight to society. He "indulges" in self-neglect. And even though he may give the excuse that he uses the drug because it enlarges his understanding of himself, it is the drug experience, not his personal development, which is his principal interest.[40]


Physicians with academic responsibilities particularly see a negative impact of marijuana use on achievement and motivation. Dana Farnsworth, director of Harvard's health services, writes: "... the use of marijuana does entail risk. In fact, we find it to be harmful in many ways and to lack counterbalancing beneficial effects. Many students continue to think it is beneficial even when their grades go down and while other signs of decrease in responsible and effective behavior become apparent."[41] Harvard's class of 1970 was issued a leaflet which contained a warning by the Dean of the College, which read, in part: "... if a student is stupid enough to misuse his time here fooling around with illegal and dangerous drugs, our view is that he should leave college and make room for people prepared to take good advantage of the college opportunity."[42] The message was that learning and drug use are incompatible. However, the amount of marijuana smoking and the degree of involvement with the marijuana subculture are not specified. Since possibly close to a majority of all individuals who have smoked marijuana at least once do so no more than a dozen times in all there is no reason to suppose that marijuana smoking should have any effect on the ambition of the average smoker. The problem, as the doctors realize, is with the frequent user. It is entirely possible that heavy involvement in marijuana use (as with nearly any nonacademic activity, from heroin addiction to athletics) leads to academic nonproductivity. It is difficult to say whether or not this is due directly to the action of the drug itself. Involvement with a subculture whose values include a disdain for work probably contributes more to the putative "nonproductivity" than the soporific effect of the drug.

 

THE EFFECT ON THE ADOLESCENT PERSONALITY

It would be naive of marijuana legalization enthusiasts to think that the average age of first smoking the weed would not drop if their demands were somehow realized, in spite of any potential age restrictions—think of the facility with which adolescents obtain cigarettes and liquor. I suspect that if the antimarijuana arguments carry any weight at all, the noxious effects of the drug will be aggravated among the very young. And even if the promarijuana arguments turn out to substantially sound, that is, that the effects on a well-integrated, fully developed adult personality are either beneficial (within agreed-upon definitions) or negligible, the impact on adolescent and pre-adolescent children (taking eighteen as a rough demarcation line) is a matter to be investigated separately. It is a legitimate question to raise as to the influence of marijuana on the young. The following questions might present themselves as heretofore unanswered requests for much-needed information:

  1. Are adolescents able to assimilate and integrate the insights of a novel and offbeat perspective into a rewarding day-to-day existence in society?
  2. Will they be able to avoid making the drug the focus of their lives, a complete raison d'être?
  3. How aware will adolescents be of the distinction between situations in which marijuana is relatively harmless (such as with friends, or watching a film), and those where it may be dangerous (such as, perhaps, in stressful situations )?


Physicians are acutely aware of the potential damaging effects of the drug on the adolescent personality. (In fact, even many nonmedical observers who take a relatively tolerant view of marijuana use in general are concerned about its possible impact on the young.)[43] The Director of the National Institute of Mental Health, a physician, writes:

One needs to be particularly concerned about the potential effect of a reality distorting agent on the future psychological development of the adolescent user. We know that normal adolescence is a time of great psychological turmoil. Patterns of coping with reality developed during the teenage period are significant in determining adult behavior. Persistent use of an agent which serves to ward off reality during this critical development period is likely to compromise seriously the future ability of the individual to make an adequate adjustment to a complex society.[44]

 

THE USE OF MORE POTENT DRUGS

Finally, some physicians oppose marijuana use on the sequential grounds that it leads to the use of more powerful, truly dangerous and addicting drugs. At one time, heroin was the primary concern of society, but within the past six years, it has had to share society's concern with LSD. Physicians have absorbed a good deal of sociological thinking and generally deny that there is an actual pharmacological link between marijuana use and the use of LSD and heroin. Being high does not make one crave another, progressively more potent, drug. As Dr. Brill says, there is no connection between marijuana and other drugs "in the laboratory," but the association "in the street" is undoubtedly marked.[45] The pusher line of reasoning as to progressive drug use is sometimes cited: "... marijuana is frequently the precursor to the taking of truly addictive drugs. Those who traffic in it often push other more dangerous substances."[46]
Another argument is that the reason for the progression from marijuana to either heroin or LSD is experiential: marijuana use leads one into patterns of behavior which make more serious involvement likely. The less potent drug acts as a kind of "decompression chamber" gradually allowing the user to get used to increasingly more serious drug use, getting used to it bit by bit.

There is nothing about marijuana which compels an individual to become involved with other more potent drugs. Marijuana use, however, is often an individual's initiation into the world of illicit drug use. Having entered that world—having broken the law—he may become immersed in the drug subculture and in sequential form progress to abuse of a variety of other drugs, including amphetamines LSD, amphetamines, and heroin.... Marijuana does not in any way mandate use of other drugs, but it may be the beginning of the road at the end of which lies either LSD or heroin.... [If] certain individuals... did not begin with marijuana, they would never get around to using the more potent and dangerous drugs.[47]

 

THE ALCOHOL-MARIJUANA COMPARISON

As we stated earlier, marijuana's supporters take seriously the argument concerning the relative dangers inherent in marijuana and alcohol usage; physicians, on the whole, are not so impressed, and tend to dismiss it as irrelevant.
As we said in the last chapter, potheads draw the conclusion from a comparison of marijuana with alcohol that marijuana is unfairly discriminated against; the laws represent a double standard, just as if there were laws permitting one social group to do something and prohibiting another from doing the same thing. If alcohol (which is toxic, lethal, and dangerous) is legal—then why not pot? Marijuana is certainly no more dangerous than alcohol. Why aren't both allowed?
The medical answer to this argument is basically that it is irrelevant. Physicians rarely attribute marijuana with a more dangerous temperament than alcohol. The disagreement is far less on the facts than on the conclusion to be drawn from the facts. Potheads will say that alcohol is far more dangerous than pot, which is relatively innocuous, while doctors will say that pot is no more dangerous than alcohol—both of which are dangerous drugs. Yet this is a matter of emphasis only. Even were marijuana smokers to grant the medical argument, the disagreement concerning the implications of this position would still be rampant. Dr. Bloomquist, author of an antimarijuana book, in testimony before the California Senate Public Health and Safety Committee, when asked a question on the relative dangers of the two drugs, replied: "I would almost have to equate the two of them."[48] And Donald Louria wrote: "Surely alcohol itself is a dangerous drug. Indeed, marijuana's dangers... seem no greater than the documented deleterious effects of alcohol. If the question before us were a national referendum to decide whether we would use... either alcohol or marijuana, I might personally vote for marijuana—but that is not the question"[49] Physicians say that the damage to society following the legalization and widespread usage of marijuana would only be additive to the harm inflicted by alcohol. Whatever thousand deaths traceable to alcohol we actually experience now would be increased by a considerable number if marijuana restrictions were removed.

... the existence of alcoholism and skid rows is not an argument in favor of cannabis but one against it. If alcohol has ruined six million lives in this country, how can it possibly be an argument for permitting cannabis to do the same, or worse? Logic compels those who argue against alcohol to excuse cannabis to take another stand: they should be arguing for the control of alcohol and the elimination of its evils, not for the extension of those or similar evils to a wider segment of society.

The attack on alcohol implicitly acknowledges the evils of cannabis and goes on to urge that we let two wrongs make a right.... legalization of cannabis will in no way alleviate the problems of alcoholism but is very likely to add problems of another sort.... one drug is as socially and personally disruptive as the other. The question is whether we, as a nation, can afford a second drug catastrophe.[50]

 

A Minority Opinion

Although mainstream medical opinion holds marijuana to be damaging, potentially dangerous and, on the whole undesirable, a minority of doctors demure. We have claimed that the dominant view of physicians is that marijuana is a dangerous drug, capable of causing adverse psychic reactions and psychotic episodes. Yet David E. Smith, physician, toxicologist, pharmacologist, and director of the Haight-Ashbury Medical Clinic in the midst of a heavy drug-using population, writes that he has never seen a "primary psychosis" among his 30,ooo patients, and, outside the clinic, he says that he has witnessed only three cases of marijuana-induced psychosis—"extreme paranoid reactions characterized by fear of arrest and discovery."[51]


I have stated that most physicians dismiss the pothead's point that marijuana is less dangerous than alcohol as irrelevant. Yet, Joel Fort, a physician, claims that alcohol is the most dangerous of all drugs currently available in America, whether legally or illegally. He has developed a scheme characterizing dimensions of drug "hardness," i.e., dangerousness. Fort's feeling is that any impartial observer will arrive at least the following list of dimensions of hardness: addiction (or psychic dependency), insanity, tissue damage, violence, and death. Thus, some drugs may be hard in one way, but not in other ways. Fort claims that alcohol scores high on all of these dimensions; barbiturates and the amphetamines are also extremely hard as well. Marijuana, says Fort, is probably the least hard of the drugs available in today's pharmacopoeia. The fact that a truly dangerous drug (alcohol) is legal and freely available, while the possession of a far less dangerous drug (marijuana) is severely penalized, is patently absurd, according to Fort.[52]


Andrew T. Weil and Norman E. Zinberg, both physicians, after detailed controlled tests on subjects high on marijuana, concluded that the drug is relatively safe, and its effects, mild.[53] James M. Dille and Martin D. Haykin—pharmacologist and psychiatrist respectively, and both physicians—along with several nonphysicians, minimize the drug's deleterious effects on simulated driving performance.[54] And Tod H. Mikuriya, director of the San Francisco Psychiatric Medical Clinic, in a pamphlet entitled "Thinking About Using Pot," refuses to persuade readers not to use marijuana; he rejects the contention that marijuana leads to heroin and states, with regard to psychosis, that "marijuana is exceedingly safe."[55] His advice to those who "choose to turn on" concerns understanding how to use marijuana wisely. What is more, Mikuriya employs marijuana in his therapy. In treating alcoholics, one of his recommendations is that they give up alcohol, in his view the more destructive drug, for pot, which is far less damaging. It is obvious that this doctor disagrees with the majority view on at least two points: (1) marijuana no longer has any therapeutic value, and its use constitutes "abuse," and (2) it is a dangerous drug whose use should be avoided.
Another medical figure, Dr. Eugene Schoenfeld, writes a column syndicated by a number of "underground" (and invariably pro-pot) newspapers, such as The East Village Other. His stance is usually skeptical concerning the putative dangers of marijuana. One piece attacked the AMA's June 1968 statements condemning marijuana use, "Marihuana and Society." The critique is replete with such phrases as "the AMA... has chosen ... to ignore... ," "casting itself into the role of prophet the Council demonstrates its lack of familiarity with the current American marihuana situation by the following statement ... ," "contrary to all known evidence, the AMA statement denies...." The review concludes with the claims: ". .. the scientific judgment of the AMA will now be looked upon with some suspicion by the millions of American marijuana users ... the AMA would certainly be surprised by the great numbers of medical students and young residents who chronically use marijuana with no observable detriment to their physical or mental well-being."[56]
It is clear, then, that some physicians do not accept the dominant current medical views concerning marijuana. They underplay its dangers and hold that smoking pot is less a medical matter than a social and political question. Medically, they say, there is relatively little problem with marijuana. It is important to recognize that this is a minority opinion. Yet it is also interesting to speculate on some of the roots of this "different drummer" opinion. Probably the safest bet on the characteristics of the minority physicians has to do with age: the younger the doctor, the greater the likelihood that he will minimize its dangers; the older the doctor, the more danger he will see in pot smoking. Because of this generational difference, it is entirely possible that a tolerant attitude in the medical profession toward cannabis use will become increasingly common and may, in time, become the reigning sentiment. That day, in any case, will be a long time in coming.
It is also possible that doctors engaged in research will be more tolerant than those who have more extensive patient responsibilities. Issues of welfare and security will become predominant when others are in one's care, and decisions will be inclined in a conservative and protective direction. Risk will be minimized. Moreover, when one's actions and decisions are constantly scrutinized by one's clients, one feels pressure to conform to the stereotype of the responsible, judicious, reliable physician. The greater the accountability to a public, the more that the physician will perceive dangers in marijuana. (It may also be that doctors who decide to do client-oriented work are more conservative and cautious to begin with than the research-oriented physician.) The more independent the physician is—"safe" from retaliation and free of accountability—the less danger he will see in marijuana use.
Third, the possibility exists that the positive correlation between the quality of one's college and tolerance for marijuana use also applies to medical schools. We found this relationship with students in general; it seems natural to assume that it would hold up for physicians specifically. What is distinctive about the more highly rated schools, whether medical or otherwise, is that the student lives in an ambiance of experimentation, of greater tolerance for diversity and deviance and ambiguity. The better schools offer a richer, more complex view of the universe. It is not that better medical schools offer a more advanced technical training. It is that the more highly rated the school, the more daring the intellectual environment, the greater the willingness to diverge from conventional opinion, the more attuned both faculty and students will be to avant-garde cultural themes which presage later dominant modes of thinking and acting. Whatever the virtues or drawbacks of marijuana, it is clear that it shares a place with other developments which are thought to be fashionable among those who consider themselves (and who are also so considered by others),[57] progressive, knowledgeable, and ahead of their time. This is, in any case, speculation. Yet is capable of being tested empirically. Anyone interested in the appeal of marijuana has to consider this side of its attraction.
As a qualification, it must be stated that the attitudes of many physicians are in flux, in large part moving in the direction of a decreased severity of criticism of marijuana. Many doctors are becoming aware of the vastness of the phenomenon of use, as well as the predominance of relatively infrequent users in the ranks of potsmokers. Data on the effects of use are beginning to refute many of the classic antimarijuana arguments, and physicians sufficiently respect the empirical tradition to be influenced by this. Many influential medical figures have shifted their position from the "pathology" model outlined in this chapter to one which minimizes pot's actual or potential danger. Dr. Stanley Yolles, for instance, Director of the National Institute of Mental Health, cited earlier in this chapter as typifying some aspects of the antipot pathology argument, has made recent statements to the Senate Judiciary Subcommittee on Juvenile Delinquency which minimized marijuana's medical dangers; his statements were summarized in an article written by himself entitled: "Pot Is Painted Too Black."[58] It may very well be, then, that the medical profession is moving in the direction of a more "soft" stand on the dangers represented by marijuana.
If polled, the vast majority of physicians in America would certainly oppose the relegalization of marijuana possession.[59] However, nearly all medical commentators admit that the marijuana laws are unnecessarily harsh. Very few will support the present legal structure. Although nonmedical figures who do—principally the police—invoke medical opinion on pot to shore up their own position, utilizing the pathology argument in regard to use, they do not mention the doctors' opposition to the laws as they are presently written. Their conclusions on the justness of the present legal structure is made contrary to medical opposition to it.

 

N O T E S

n    1. The prestige of physicians is higher than that of any other widely held occupation. See Robert W. Hodge, Paul M. Seigel, and Peter H. Rossi, "Occupational Prestige in the United States," in Reinhard Bendix and Seymour Martin Lipset, eds., Class, Status and Power, 2nd ed. (New York: Free Press, 1966), pp. 322-334. (back)
2. Henry Brill, "Drugs and Drug Users: Some Perspectives," in Drugs on the Campus: An Assessment, The Saratoga Springs Conference of Colleges and Universities of New York State (Sponsored by the New York State Narcotics Addiction Control Commission, Saratoga Springs, New York, October 25 to 27, 1967), p. 49. (back)
3. The literature on the "specialness" of the medical view of reality—as the term is defined here—particularly regarding psychosis, is among the most impressive and exciting in the entire field of sociology. For examples of sociological lines of attack on the medical view see Thomas Scheff, Being Mentally Ill (Chicago: Aldine, 1966); R. D. Laing, The Politics of Experience (New York: Ballantine, 1968); Thomas Szasz, The Myth of Mental Illness (London: Secker and Warburg, 1962). (It should be noted that both Laing and Szasz are themselves physicians.) For the process of the dynamics of constructing this reality in the patient relationship, see Thomas Scheff, "Negotiating Reality: Notes on Power in the Assessment of Responsibility," Social Problems 16 (Summer 1968): 3-17. (back)
4. The sword cuts two ways, however. Physicians who have conducted research on marijuana use may also be employed as rhetorical devices by the pro-pot lobby. In fact the scientific method may be employed as a rhetorical device for the purpose of convincing the opposition. As many of the arguments of the antimarijuana side fail to be substantiated empirically, the scientific rhetoric will tend to be invoked correspondingly less, but will become increasingly emphasized by the opposition. (back)
5. This concept of the disease or pathology model is precisely equivalent to what Dr. Norman Zinberg independently calls a "medical model" on marijuana use. (back)
6. American Medical Association, Committee on Alcoholism and Drug Dependence Council on Mental Health, "The Crutch That Cripples: Drug Dependence," pamphlet (Chicago: AMA, 1968), p. 2. For some reason, a small but vigorous contingent of marijuana supporters maintain that the drug may actually be therapeutic. For instance, in the vast and decidedly promarijuana anthology, The Marihuana Papers, edited by David Solomon, several articles were included which dealt specifically with marijuana's healing powers in some regard or another. A physician-psychiatrist, Harry Chramoy Hermon, is licensed to employ cannabis in his therapy. See Hermon, "Preliminary Observations on the Use of Marihuana in Psychotherapy," The Marijuana Review , no. 3 (June-August 1969), 14-17. (back)
7. E. D. Mattmiller, "Social Values, American Youth, and Drug Use" (Paper presented to COTA, January 22, 1968), p. 5 (my emphasis, in part). (back)
8. Brill, op. cit., p. 52. (back)
9. Jerome H. Jaffe, "Drug Addiction and Drug Abuse," in Louis S. Goodman and Alfred Gilman, eds. The Pharmacological Basis of Therapeutics, 3rd ed. (New York: Macmillan, 1965), p. 285. (back)
10. Paul Jay Fink Morris J. Goldman, and Irwin Lyons, Recent Trends in Substance Abuse," The international Journal of the Addictions, 2 (Spring 1967): 150. (back)
11. Graham B. Blaine, Jr., Youth and the Hazards of Affluence (New York: Harper Colophon, 1967), p. 68. (back)
12. Frank S. Caprio, Variations in Lovemaking (New York: Richlee Publications, 68), p. 166. (back)
13. Duke Fisher, "Marijuana and Sex" (Paper presented to the National Symposium on Psychedelic Drugs and Marijuana, April 1l, 1968), p. 3. (back)
14. Ibid. (back)
15. Blaine, op. cit., pp. 67-68. Blaine qualifies his assertion by distinguishing the "hard core" user, who would be impelled to drugs in the absence of the rebellion motive, and the "experimenter," for whom parental rejection is a strong impetus to sporadic and eventually discontinued use of drugs. (back)
16. Seymour L. Halleck, "Psychiatric Treatment of the Alienated College Student," American Journal of Psychiatry 124 (November 1967): 642-650. (back)
17. Mattmiller, op. cit. (back)
18. Donald B. Louria, The Drug Scene (New York: McGraw-Hill, 1968), p. 101. (back)
19. Henry Brill, "Why Not Pot Now? Some Questions and Answers About Marijuana," Psychiatric Opinion 5, no. 5 (October 1968): 19. (back)
20. Nathan B. Eddy et al., "Drug Dependence: Its Significance and Characteristics," Bulletin of the World Health Organization 32 (1965): 721. (back)
21. The parallel with agents of which society approves was made by Eliot Freidson, in "Ending Campus Incidents," Letter to the Editor, Trans-action 5, no. 8 (July-August 1968): 75. Freidson writes, with regard to the terms psychic addiction and habituation: "What does this term mean? It means that the drug is pleasurable, as is wine, smoked sturgeon poetry, comfortable chairs, and Trans-action. Once people use it and like it, they will tend to continue to do so if they can. But they can get along without it if they must, which is why it cannot be called physically addictive." (back)
22. David Ausubel, Drug Addiction (New York: Random House, 1958), pp. 9-10. (back)
23. Edward R. Bloomquist, "Marijuana: Social Benefit or Social Detriment?" California Medicine 106 (May 1967): 352. (back)
24. Seymour Fiddle, Portraits From a Shooting Gallery (New York: Harper & Row, 67), pp. 3-20. (back)
25. Louria, op. cit., p. 103. (back)
26. John Rosevear, Pot: A Handbook of Marihuana (New Hyde Park, N. Y.: University Books, 1967), p. 90. (back)
27. The Medical Society of the County of New York, "The Dangerous Drug Problem—II," New York Medicine 24 (January 1968), p. 4 (my emphasis). (back)
28. John A. Talbott and James W. Teague, "Marihuana Psychosis: Acute Toxic Psychosis Associated with Cannabis Derivatives," The Journal of the American Medical Association 210 (October 13, 1969): 299. (back)
29. For some representative clinical work by physicians on the use of marijuana, see Martin H. Keeler, "Adverse Reaction to Marihuana," The American Journal of Psychiatry 124 (November 1967): 674-677; Doris H. Milman, "The Role of Marihuana in Patterns of Drug Abuse by Adolescents," The Journal of Pediatrics 74 (February 1969): 283-29c, Aaron H. Esman et al., "Drug Use by Adolescents: Some Valuative and Technical Implications," The Psychoanalytic Forum 2 (Winter 1967): 339 353, Leon Wurmser, Leon Levin, and Arlene Lewis, "Chronic Paranoid Symptoms and Thought Disorders in Users of Marihuana and LSD as Observed in Psychotherapy," unpublished manuscript (Baltimore: Sinai Hospital 1969). (back)
30. The most well-known of the cannabis laboratory experiments are those conducted in the Addiction Research Center in Lexington, Kentucky. (Actually, THC is used, not natural marijuana.) See Harris Isbell et al., "Effects of (-)A9-Trans-Tetrahydrocannabinol in Man," Psychopharmacologia 1l (1967): 184-188, and Harris Isbell and D. R. Jasinski, "A Comparison of LSD-25 with (-)A9-Trans-Tetrahydrocannabinol (THC) and Attempted Cross Tolerance between LSD and THC," Psychopharmacologia 14 (1969): 115-123. See also Reese T. Jones and George C. Stone, "Psychological Studies of Marijuana and Alcohol in Man" (Paper presented at the 125th Annual Meeting of the American Psychiatric Association, Bal Harbour, Fla., May 1969). (back)
31. The use of hashish in America is, as we stated earlier, increasing rapidly certainly much faster than the use of the less potent cannabis preparations. As a rough indication of this trend, consider the fact that more hashish was seized by the United States Customs in the year 1967-1968 than in the previous twenty years combined. See The New York Times, September 19, 1968: The California police in 1968 seized over seven thousand grams of hashish, whereas none was recorded as having been seized in 1967. (In neither year was a category for hashish provided on the official police forms.) See State of California, Department of Justice, Bureau of Criminal Statistics, Drug Arrests and Dispositions in California, 1968 (Sacramento, 1969), pp. 40-41. In 1969, this tendency was further accelerated by the "Great Marijuana Drought" caused by increased federal vigilance in reducing the quantity of Mexican marijuana entering the country. Thus, hashish, which comes from Asia, was more in demand and imported in far greater volume than previously. And, of course, used with greater frequency. (back)
32. American Medical Association, Council on Mental Health, "Marihuana and Society," The Journal of the American Medical Association 204, no. 13 (June 24, 1968): 1181. (back)
33. Edward R. Bloomquist, Marijuana (Beverly Hills, Calif.: Glencoe Press, 1968) p. 102. For some of the Oriental studies on marijuana use referred to, see Ahmed Benabud, "Psycho-Pathological Aspects of the Cannabis Situation in Morocco: Statistical Data for 1956," United Nations Bulletin on Narcotics 9, no. 4 (October-December 1957): 1-16; Ram Nath Chopra, Gurbakhsh Singh Chopra, and Ismir C. Chopra "Cannabis Sativa in Relation to Mental Diseases and Crime in India," Indian Journal of Medical Research 30 (January 1942): 155-171; Ram Nath Chopra and Gurbakhsh Singh Chopra, The Present Position of Hemp-Drug Addiction in India, Indian research Memoirs, no. 31 (July 1939); Constandinos J. Miras, "Report of the U. C. L. A. Seminar," in Kenneth Eells, ed., Pot (Pasadena, Calif.: California Institute of Technology, October 1968), pp. 69-77
It should be made clear that the validity of many of these studies has been severely called into question. For instance, in the Leis-Weiss trials in Boston during 1967, conducted by Joseph Oteri, it was revealed that the Benabud data were collected at a time when there was not a single certified psychiatrist in the entire nation of Morocco, the admitting diagnosis cards were filled out by French clerks, who recorded the opinions of the police who brought in the suspect. The transcript of the court proceedings in which Oteri reveals these facts is to be published in book form by Bobbs-Merrill. (back)
34. Stanley F. Yolles, "Recent Research on LSD, Marihuana and Other Dangerous Drugs" (Statement Before the Subcommittee on Juvenile Delinquency of the Committee on the Judiciary, United States Senate, March 6, 1968). Statement published in pamphlet form by the National Clearinghouse for Mental Health Information, United States Department of Health, Education and Welfare, National Institute of Mental Health. (back)
35. Bloomquist, "Marijuana: Social Benefit or Social Detriment?" p. 348. It should be noted that dark glasses may be worn because the user thinks that his pupils are dilated, but not "because of the dilated pupils," because, as we shall see in the chapter on the effects of marijuana, the pupils do not become dilated. (back)
36. Louria, op. cit., pp. 107, 108. (back)
37. Brill, "Why Not Pot Now?" p. 21. (back)
38. American Medical Association, "Marihuana and Society," p. 1181. (back)
39. AMA, "Marihuana Thing," Editorial, Journal of the American Medical Association 204, no. 13 (June 24, 1968). (back)
40. Bloomquist, "Marijuana: Social Benefit or Social Detriment?" p. 352. (back)
41. Dana Farnsworth, "The Drug Problem Among Young People," The West Virginia Medical Journal 63 (December 1967): 434. (back)
42. J. U. Monro, unpublished memorandum to the Harvard class of 1970 April 13, 1967. (back)
43. William Simon and John H. Gagnon, "Children of the Drug Age," Saturday Review, September 21, 1968, pp. 76-78. (back)
44. Yolles, op. cit. (back)
45. Brill, "Why Not Pot Now?" and "Drugs and Drug Users." (back)
46. Blaine, op. cit., p. 74. (back)
47. Louria, op. cit., pp. 110-111. (back)
48. Edward R. Bloomquist, Testimony, in Hearings on Marijuana Laws Before the California Public Health and Safety Committee (Los Angeles, October 18, 1967, afternoon session), transcript, p.43. (back)
49 Louria op. cit., p. 115. (back)
50. Actually, Bloomquist misses the point here somewhat. Potheads do not say that marijuana is as dangerous as alcohol—and that both are dangerous—and therefore marijuana ought to be legalized. They say that alcohol is dangerous and legal, while pot is not dangerous, but illegal, and legalizing marijuana would reduce the seriousness of the drug problem, because more pot and less alcohol would be consumed. See Bloomquist Marijuana, pp. 85, 86. (back)
51. David E. Smith, "Acute and Chronic Toxicity of Marijuana," Journal of Psychedelic Drugs 2, no. 1 (Fall 1968): 41. (back)
52. Of Fort's many publications, perhaps the most relevant to these points is "A World View of Marijuana: Has the World Gone to Pot?" Journal of Psychedelic Drugs 2, no. 1 (Fall 1968): 1-14. See also "Pot: A Rational Approach," Playboy, October 1969, pp. 131, 154, 216, et seq., in which Fort argues for the legalization of marijuana. See also The Pleasure Seekers (Indianapolis: Bobbs-Merrill, 1969). (back)
53. Andrew T. Weil, Norman E. Zinberg, and Judith M. Nelsen, "Clinical and Psychological Effects of Marihuana in Man," Science 162, no. 3859 (December 13, 1968): 1234-1242; Zinberg and Weil, "Cannabis: The First Controlled Experiment," New Society/ (January 19, 1969): 84-86; Zinberg and Weil, "The Effects of Marijuana on Human Beings," The New York Times Magazine, May 11, 1969, pp. 28-29, 79, et seq.; Weil, "Marihuana," Letter to the Editor, Science 163, no. 3872 (March 14, 1969): 5 (back)
54. Alfred Crancer, Jr., James M. Dille, Jack Delay, Tean E. Wallace, and Martin D. Haykin, "A Comparison of the Effects of Marihuana and Alcohol on Simulated Driving Performance," Science 164, no. 3881 (May 16, 1969): 851-854. (back)
55. Tod H. Mikuriya and Kathleen E. Goss, "Thinking About Using Pot" (San Francisco: The San Francisco Psychiatric Mental Clinic, 1969), p. 24. (back)
56. Eugene Schoenfeld, "Hip-pocrates," The East Village Other 3, no. 36 (August 9, 68): pp. 6, 16. (back)
57. I am not making the claim that marijuana is inherently part of an intellectual avant-garde movement. At certain times and places, it may be looked upon as reactionary. It is just that today, in America, it is so considered. We also do not say that it is only among those who consider themselves in the historical vanguard that marijuana will appeal; it is just that those who do think this way will be more likely to try marijuana than those who do not. (back)
58. Stanley F. Yolles, "Pot Is Painted too Black," The Washington Post, September 21, 1969, p. C4. Compare this later statement with those made in the National Clearinghouse for Mental Health Information, NIMH pamphlet, published in part in the March 7, 1968 issue of The New York Times, p. 26, and the article "Before Your Kid Tries Drugs," The New York Times Magazine, November 17, 1968, pp. 124, et seq. (back)
59. In an actual mail-in questionnaire study by a physician of the attitudes of psychiatrists and physicians in the New York area on the legalization of marijuana, it was found that the large majority (about 60 percent) said that they were against legalization. Only a quarter were for it. See Wolfram Keup, "The Legal Status of Marihuana (A Psychiatric Poll)," Diseases of the Nervous System 30 (August 1969): 517-523. (Another way of looking at these figures, however, is that there is far from unanimous agreement within the medical and psychiatric professions on the status of marijuana.)

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