I began to study marijuana in 1967. By the time I had completed the research which formed the basis for a book, I had become convinced that cannabis was considerably less harmful than tobacco and alcohol, the most commonly used legal drugs.

At that time I naively believed that once people understood that marijuana was much less harmful than drugs that were already legal, they would come to favor legalization. In 1971, I confidently predicted that cannabis would be legalized within the decade for people over 21. I had not yet learned that there is something very special about illicit drugs. If they don't always make the drug user behave irrationally, they certainly cause many non-users to behave that way. Instead of making marijuana legally available to people 21 years of age or more, we have continued to criminalize many millions of Americans and to arrest approximately 400,000 (about the same number who die from the effects of tobacco) mostly young people on marijuana charges each year. What's more, the political climate has deteriorated, particularly over the past few years, to the point where it is difficult to discuss marijuana openly and freely. Surreptitious smokers of the 60s and early 70s who became more open toward the mid-70s had to go back into their closets during the Reagan years.

I will give two further pieces of evidence for this climate of psychopharmacological McCarthyism. The first is mandatory drug testing. Many of you will remember that one product of the McCarthyite climate of the 50s was the loyalty oath. Hardly anyone really believed that forced loyalty oaths would enhance national security, but people who refused to take such oaths nevertheless risked losing their jobs and reputations. Today we are witnessing the imposition of a kind of chemical loyalty oath. Mandatory, often random testing of urine samples for the presence of illicit drugs is increasingly demanded as a condition of employment. People who test positive may be fired, or if they want to keep their jobs, may be involuntarily assigned to drug counseling or "employee assistance" programs.

All this is of little use in preventing or treating drug abuse. In the case of cannabis, for example, the test requires analysis of the urine for a breakdown product or metabolite of tetrahydrocannabinol called 9-carboxy-THC. It is assumed that anyone with THC metabolites in his or her urine uses marijuana, and anyone without it doesn't. But clever or well-in-structed marijuana users can easily defeat the test by chemically altering their urine or substituting someone else's urine. And even if the urine sample has not been altered, the available tests are far from perfect. Most programs start with immunoassays, which are cheap but inaccurate, missing THC metabolites that are there and finding them when they are not there. So urine that tests positive on immunoassays is now being subjected to more accurate and far more expensive techniques such as gas chromatography-mass spectroscopy (GC/MS). However, used in this sequence, GC/MS of course does nothing to detect false negatives. Furthermore, it is fallible because of laboratory error and passive exposure to marijuana smoke.

Even if there were an infallible test, it would be of little use in preventing or treating genuine drug abuse. The presence of cannabis metabolites in the urine bears no established relationship to drug effects on the brain. It tells us nothing about when the drug was used, how much was used, or what effects it had or has. Marijuana metabolites remain in the urine for days after a single exposure and weeks after a long-term user stops. Like loyalty oaths imposed on government employees, urine testing for marijuana is useless for its ostensible purpose. It is little more than shotgun harassment designed to impose an outward conformity to certain dominant social passions and prejudices.

My second example of psychopharmacological McCarthyism is the response to a publication in the May issue of the American Psychologist. Two psychologists at the University of California, Berkeley, followed 101 children from the age of 5 to 18, in a scientifically
rigorous longitudinal study. They were interested in the relation between psychological characteristics and drug use. Their data demonstrated that adolescents who had engaged in some drug experimentation (primarily with marijuana) were the best adjusted in the group. Adolescents who used drugs frequently "were maladjusted, showing a distinct personality syndrome marked by interpersonal alienation, poor impulse control, and manifest emotional distress. Adolescents who had never experimented with any drug were relatively anxious, emotionally constricted, and lacking in social skills.

Psychological differences between frequent drug users, experimenters, and abstainers could be traced to the earliest years of childhood and related to the quality of their parenting. The findings indicate that (a) problem drug use is a symptom, not a cause, of personal and social maladjustment, and (b) the meaning of drug use can be understood only in the context of an individual's personality structure and developmental history." The study suggests that current efforts at drug prevention are misguided to the extent that they focus on symptoms rather than on the psychological syndrome underlying drug abuse.

The hue and cry began immediately. The director of a San Francisco drug prevention program said that it was irresponsible for the researchers to report that "dabbling with drugs was 'not necessarily catastrophic' for some youths and may simply be a part of normal adolescent experimentation." A physician who directs the adolescent recovery center of a metropolitan hospital asked, "What does this do to the kids who made a commitment to be abstinent? Now they're being told they're a bunch of dorks and geeks. You can imagine how much more peer pressure is going to be put on them." An article in the PRIDE Quarterly Summer 1990 stated: 'Based on the experiences of only 101 subjects, all living in San Francisco, the study drew national attention due to its outrageous conclusion." The article went on to say, "Unfortunately, the permissive thinking which surfaced in the California study will continue to exist in the United States until truly effective drug education reaches beyond the elementary classroom. However, too few educators themselves have seen the latest discoveries about the health consequences of drug use." I am reminded of Soviet party-line criticism of science which led to the phenomenon known as Lysenkoism.

Despite the hysteria, large numbers of Americans continue to use cannabis regularly. What was once considered primarily a youthful indulgence or an expression of youthful rebellion is now a common adult practice. Millions have smoked marijuana for years, and most of them will continue to smoke it for the rest of their lives. They are convinced that they are harming no one else and not harming themselves as much as cigarette smokers or alcohol drinkers. Many, if not most, believe that marijuana enhances their lives.

Like Marihuana Reconsidered itself, the public discussion of marijuana has focused almost exclusively on its potential harmfulness. In more than two decades of research, I have read and heard little about the value of cannabis. There has been some interest in its medical potential, but far less than there would be if any other drug had revealed a similar therapeutic promise. There are many reasons for this. One is that new drugs are developed and promoted by drug companies. The capital needed to take a drug from shelf chemical to pharmaceutical product is as much as $100 million. Needless to say, only substances which can be patented will attract this kind of investment. Cannabis and its cannabinol and cannabidiol derivatives cannot be patented because they are natural substances.

Furthermore, the government's intense antipathy has blocked medical use of cannabis for years. If legal, political, and social pressures have hindered the due recognition of the medical uses of cannabis, they have made it almost impossible to acknowledge publicly its non-medical virtues. In my twenty years of lecturing and writing about cannabis, I have until now never felt free to speak about this matter. It seems to be implicitly understood that that would be improper for an academic. To discuss what is good and useful about this substance is to risk being seen as the "Timothy Leary of pot." I have felt the disapproval and even censure of colleagues merely for arguing that marijuana is not as dangerous as alcohol and tobacco. On this subject attitudes in academia reflect the erroneous common wisdom.

The authorities who want to reduce the demand for cannabis have very little idea why that demand is so powerful and persistent. As Bob Dylan says to Mr. Jones in his famous song, "Something is happening here, but you don't know what it is." If they did know, they might be less concerned about diminishing the demand and less sanguine about the value of punitive legislation. Our society must make informed decisions based on the fact that tens of millions of its citizens use cannabis. It is important for us to know why those citizens not only like to use the substance, but in many cases believe that it has enhanced their lives.

The best way to learn about cannabis is to let users speak for themselves. In the last few months I have met two artists and a scientist who believe that the use of cannabis is important to their work. The first is a man in his mid-40s who consulted me because, as he said on the telephone, he had a "problem" concerning marijuana. He is a happily married man, the father of two children, who decided about 10 years ago that he was sufficiently successful as a painter to give up an ancillary job. He was able to make his living as a painter until eight months ago, when he was forced to give up the use of cannabis because of its illegality.* Before this, his successful painting routine had been as follows: he would take two tokes (puffs) of marijuana when he started to paint and another two tokes every two hours as long as he continued to work. He never took more than that. An ounce of cannabis would last him six or seven weeks. He describes the effect as follows: "With it, I get eager, motivated, even excited to paint. My mind focuses
on one thing to accomplish at a time. I'm clear of negative thoughts and able to see instantly colors and shapes rather than a subject. I can now see the beauty in something I may have thought of as mundane or boring. My thoughts now seem to be of how precious time is and making the best use of every moment. This leads to greater accomplishments during the day which makes me feel content, satisfied, even happy; self-confidence grows and I want to go after something with a greater challenge."

Since being compelled to cease the use of marijuana, he finds that he sits "for hours before the canvas, unable to accomplish anything. I may look at one painting for an average of 200 hours, and I find myself full of self-doubt and lack of confidence. I may work for weeks on something, only to cover it up later. I waste time, I have no motivation, I get depressed." This man has not produced a saleable painting for eight months and his financial situation is desperate. All his technical skills are intact, but he cannot produce paintings of the same caliber that he sold so readily before.

The second artist who finds cannabis important to his work writes as follows: "Marijuana has over the years served as a creative stimulant to my work as a performer and to my more occasional inspirations as a composer. For me, marijuana is a creative stimulant; almost all my finished choral pieces and songs have been composed partly or wholly under the influence: melodic and rhythmic ideas may just pop into my head during relaxed and happy moments, "points of creative release" one might say. The work of forming these seminal ideas into a whole composition, for me who am not prolific, then takes place over an ensuing period: a few days to a few years (in the latter extreme, intermittently, of course). As a performer, I have certainly gained insights into the inner meaning of the musical masterpieces which I play. Practicing new repertoire while intoxicated by marijuana is not a very good nor productive habit: the keen mental concentration of learning notes is not aided and abetted. But once a piece is fluently learned, my understanding of what it means as an entirety is often enhanced. A usual practice day for me is to work in the morning with a few cups of coffee in me. In the late afternoon I often have a little workout in the gym, and this renews me and gets the adrenaline flowing so I can come back to the piano, have a bit of marijuana, and practice very enjoyably and productively for one or two hours. I never try to perform in public when stoned, but as it is well known that marijuana can enhance the pleasure of listening to many kinds of music, I often listen after having smoked some marijuana. And so do many others who I know and have known over the years. WGBH-TV has produced a special on Satchmo, in which his lifelong affection for marijuana is not kept from the viewers. He found it both an inspiration for his music and a balm against life's trials. It seems to work the same way for me; it's one of my best friends, though, as I mentioned earlier, I wish for a better way to partake than by smoking it — pills, cookies, fudge, or whatever."

The scientist, like the two artists, has been using cannabis for years, and he too believes that it contributes to his work: "As a scientist I have spent literally years training the analytical side of my mind — to be suspicious of my data, to look for order of magnitude arguments to test the reasonableness of my results, to use lateral thinking to try to arrive at the same conclusions by alternative means. This has been an active process of mental discipline: idealizing physical situations, making assumptions to reduce the system to something solvable, and applying logic to determine the outcome.

"What has often been neglected in concentrating on only those things I have chosen to think about is an awareness of the wider perspective and significance of the work and the sense of personal wonder which led me into the field to begin with. There have also been many times when the answer to some question was right before me but I was unable to see the "forest for the trees." This is partly due to the same training which enables me to work through complicated analytical problems: in order to concentrate on those pertinent aspects which I have included in the model I will deliberately omit distractions which might perhaps hold the key. This is particularly true of working with computers, which have no tolerance for vague suggestions that perhaps something of importance has been left out of the equations, but will happily spit out results with an apparent accuracy of many decimal digits.

"If it were possible, say through yoga for example, for me to turn off the rational side of my mind and think creatively (and randomly) for short time periods, to reverse the training temporarily and see my work in a different light, then it would probably be as productive as getting high (although perhaps not as pleasant). Part of the neccesity for getting high is the human habit of going over old ground and seeing what you believe to be there rather than what actually exists (the same reason why it is almost impossible to proofread one's own writing).

"Obviously it is inefficient for me to try to pursue these new ideas while high, because I am too easily distracted and my analytical capabilities are unquestionably impaired; instead I enjoy the relaxation and keep notebooks recording my unchanneled thoughts in lists and outlines. I would state flatly that both aspects of getting high, namely relaxation and observation of subtle details of problems which I overlook at other times, have been valuable contributions to my work."

As you will have noticed, my informants do not identify themselves. How can we expect people to share these experiences openly in the present atmosphere? The government's newest legal assault includes a fine of up to $10,000 for possession of a single marijuana cigarette. Yet fear of the law is probably less important than fear of the consequences of being seen as irresponsible and deviant. When homosexuals started to come out of the closet a decade ago, many people were surprised to learn that they were not sick, antisocial, or in other ways "different" aside from their sexual orientation. It was an effective way to reduce this form of bigotry. So, too, cannabis users may eventually have to provide the public with an opportunity to test stereotypes against reality. They too are targets of bigotry and may have to adopt the same strategy in their struggle against it.

* I cannot provide more details because it would compromise his anonymity.

Lester Grinspoon, M.D., Harvard Medical School, Cam-bridge, MA.