Cannabis in North America has much more symbolic meaning than just that of a drug alone. It has many meanings, some of which strike fear into the hearts of middle- and upper-middle-class persons. There have been many questionnaires distributed among high school, junior high school, and college students to determine the extent of teen-age drug use. The validity of many of these questionnaires is open to serious doubt because of the illegal nature of the drug-taking behavior, for the use and possession of cannabis are either felony or misdemeanour offense. Despite these questionnaire's, the incidence of cannabis use remains largely unknown. Young people who have not used drugs often say they have because of the tremendous peer-group pressure in some sectors of our society at age 12 or 13 years to take drugs. Other young people who have used and are using the drug are afraid of what would happen if their parents found out or the police became aware of this activity. Thus, they say they have not used drugs, and the incidence figures remain obscure.

Our study dealt with a population of students in their senior year of medical school. A questionnaire was designed by the Canadian members of the research team in an attempt to assess attitudes toward cannabis as well as the incidence of cannabis use (in comparison to the use of some other psychotropic drugs) among the target populations, as one segment of our culture. The questionnaire was administered by a member of the senior class of a Canadian medical school in the province of Ontario and by a member of the senior class in a United States medical school in California. The questionnaire was deliberately designed not to include a complete survey of all drugs of misuse such as solvents, "strong" hallucinogens, "hard" narcotics, and the "uppers and downers" (amphetamines and barbiturates). We strongly believe that, if honest attitudinal and incidence data can be ascertained and presented in a non-hysterical way, there will exist a firm foundation for future research into the risk factor of marihuana.

 

Method and Results

 

A short questionnaire was distributed to the two selected classes of medical students who filled it out on the spot. They were instructed to complete the questionnaire individually without discussing it with their peers. The answers were collected so as to ensure anonymity.

 

In the Ontario sample (0) there were 185 .students in the class; 150 were present on the day are questionnaire was distributed, and 149 responses were returned and represented an approximate uniform distribution according to standing in the class. In the California sample (C) there were 113 students in the class; 86 questionnaires were distributed, 85 were returned. The students responding were approximately uniformly distributed by academic standing.

 

On the questionnaire, "cannabis" was defined as "intended to include marihuana, hashish, and related products derived from the hemp plant." Respondents were advised: "Mark down the number of the one choice that most closely represents your opinion."

Two questions were designed to elicit attitudes about "risk factor" in moderate use of cannabis (one to three cigarettes, shared, about once a week). The responses are shown in Table 1.

Approximately the same pattern of distribution was noted in the two samples. In both' groups, the vast majority believed that physical health would not be significantly affected by moderate use as defined, and no students picked either the extreme negative or positive response choices. More respondents, in both samples, thought that moderate cannabis use would affect mental health than thought it would affect physical health, but the majority thought that there would be no significant change in the mental health of a moderate user.

 

The students were asked about their reaction when a patient discloses occasional use of cannabis in a routine medical history. Responses indicated that none of the students would praise the patient and encourage him to use cannabis more frequently, and very few (2`'; in the 0 sample) would reassure him about the relative safety of cannabis and suggest that he continue using the drug. The majority (52"; in the 0 sample and 89" in the C sample) would elect to make no comment about the matter. However, 46'; in the 0 sample would point out the possible dangers associated with cannabis and urge the patient to stop using it, whereas only I ri in the C sample would take such action. Only one student (0 sample), in addition to pointing out the dangers of using cannabis, would also notify the police

authorities. The fact that only of the students in the California school would urge a, patient to stop using cannabis seems to indicate a more permissive attitude on the part of the California students compared to that of the Ontario students. This finding will be borne out in sections to follow.

 

In response to questions designed to elicit attitudes about cannabis and the law, very few expressed the belief that the drug should be distributed free or made readily available like soft drinks. Also, very few expressed satisfaction with existing legislation. The vast majority (93'.'; in the 0 sample and 99C4 in the C sample) believed that present legislation regarding cannabis possession and distribution is too severe.

 

Most of the respondents, particularly in the California group, were of the opinion that cannabis should be taxed and controlled like alcohol.

 

When asked if they would recognize cannabis by sight, 37`; of the Ontario students and fir'( of the California students answered "Yes." On the other hand, 59'; of the Ontario students and 87ri of the California students expressed the belief that they would recognize cannabis by smell when it is burning. Respondents asked later to elaborate on these di fferences offered t& explanation that they were unsure of cannabis on visual examination alone, and that a substitute similar in appearance could readily be made. A few stated that they had been exposed to cannabis only under poor lighting conditions and when it had already been rolled into a cigarette. In any case, the difference between the Canadian and the American samples in ability to recognize cannabis by smell was striking.

 

The final section of the questionnaire polled the students about their own use of caffeine (coffee, tea), alcoholic beverages, nicotine (cigarettes, pipe, cigars), and cannabis. The results are shown in Table 2.

 

The results for caffeine, alcoholic beverages, and nicotine were parallel in the two groups. However; a substantial difference in experience with cannabis is evident. The vast majority of the California medical students have used cannabis at least once, and 41'; currently use it at least monthly whereas less than half of the Canadian students have had such experience and only 13% report monthly or more frequent use. This again seems to indicate a different attitude among the American students.