* Acknowledgement is expressed by the authors to Donald R. Jasinski, M.D., of the Addiction Research Center, Lexington, Ky., for his helpful comments and advice.

Reprinted from Federal Probation 32 (September 1968): 8-15, with the permission of the publisher.

 

Marihuana smoking is a topic of considerable public interest in the United States. One may observe a growing controversy of spirited opinion ranging from the view that marihuana is beneficial and should be legalized, to warnings that catastrophic harm is the direct consequence of marihuana use. In this controversy, the abuse of known information about marihuana may be as important an issue as the abuse of the drug itself. Dr. J. D. Reichard's review of marihuana knowledge in his article for Federal Probation, October—December 1946, was primarily intended to dispel many of the myths of that time which had come to be associated with the drug. Similarly, this review is intended to provide a contemporary perspective of marihuana use within the broader drug abuse situation that will have practical use for probation and parole officers. *

 

The term marihuana refers to any part of the hemp plant (Cannabis Sativa) or its extract which is pharmacologically active in man. A resin obtained from the flowering tops of the female plant contains most of the active ingredients. This resin, known as "hashish" in Arab countries, is far more potent than the dried leaves and flowering shoots. The potency of the active ingredients of the cannabis plant vary with the region of growth. In the United States, the horticultural conditions are generally unfavorable for the production of high resin content.' Common names for cannabis include: bhang, ganja, charas (India); kif (Morocco); dagga (South Africa); anascha (Russia); maconha (Brazil) ; tea, pot, sticks, grass, joints, reefers (U.S. slang).2

 

While marihuana may be taken orally, as a tea, a confection, or even whole, in this country it is primarily smoked. Absorption is more rapid by the latter route, intoxicating effects appearing shortly after smoking begins.3 Most investigators have agreed that the effects of marihuana are due to tetrahydrocannabinols. Although physiologically active substances had previously been extracted, a substance of known chemical structure has only recently been isolated and evaluated under laboratory conditions.' Differences in the potency of drug samples and the inadequate methods of laboratory analysis have contributed to the present confusion concerning the effects of marihuana use. Thus, the voluminous literature on marihuana is difficult to evaluate, almost as though'one were comparing the effects of wine and whiskey, or beer and gin, without considering alcohol content or amount of consumption. Marihuana, for the most part, has yet to receive the more thorough pharmacological evaluation given to drugs of accepted medical use.

 

EFFECTS IN MAN

 

The effects of a drug depend in part on the dose. The smoking of marihuana is a process in which the active ingredient is taken in small portions with each inhalation. The experienced user thereby has a greater opportunity to achieve a "controlled" high than with drugs customarily taken in a single dose such as the ingestion of LSD or the "shooting" of opiates into the vein.

 

Acute physical symptoms frequently include conjunctival vascular injection, dryness of the mouth and pharynx, irritation of the throat, increased sensitivity to light, sound, touch, and pain stimuli, and such changes in the autonomic nervous system as increase in pulse, blood pressure, and tendon reflexes. Ataxia, the impaired ability to coordinate voluntary muscular movements, may also occur. Appetite is often stimulated. There is no evidence that marihuana increases sexual potency. There are as yet no recognized lasting ill effects directly attributed to the brief use of marihuana nor has a death been reported in this country due to overdosage.5

 

The mental changes following marihuana use are variable and depend in part upon the expectations and prior drug experience of the user and the social setting at the time of use; thus, the meaning of the experience is largely socially acquired.6 Marihuana is primarily classified as a hallucinogen even though intoxication may include both early stimulant and later depressant effects. A decreased sense of fatigue, relaxation, and increased self-confidence has been described. There may be a distortion of affect toward omnipotency and a perception of "insight" rarely shared by the unintoxicated. The individual is often garrulous, giggly, and talk is disconnected. Associated with a period of euphoria, or well-being, there may be distortions of time, space, color, and other sensory perception with increased dosage.

 

Depersonalization, the perception of the physical body as not self, has been described with use. While this distortion might be expected to increase the likelihood of self-injury, we know of no documentation to confirm this expectation.

 

Increased suggestibility, decreased judgment, and change of affect may be followed by depression and sleep. There may also be delusions, hallucinations, suspiciousness, panic, and fear of death. Violent or aggressive behavior is unusual. While occasional persons may be especially sensitive to even small doses, with the result that a psychotic-like state is produced, there is recent evidence that almost all persons are so affected with sufficient dosage.? A puzzling observance is that many of the persons who have had frightening episodes in their marihuana experience wish to repeat it.8

 

In summary, the acute effects of marihuana smoking commonly include a euphoric state accompanied by motor excitation and mental confusion. These reactions are often followed by a period of dreaminess, depression, and sleep. The wide variety of individual reactions appears to be more closely related to personality differences (including expectations and emotional arousal) and the cultural setting of use than to any specific property of the drug itself. Recognizing this variability, one user remarked that "every person has the dream he deserves."

 

Even though there are an estimated 200 million users worldwide,9 predominantly in Africa and Asia, the long-term effects of marihuana use have not been sufficiently studied to permit valid generalization. While physical deterioration, lethargy, and social degradation have been observed among the chronic cannabis users of India and Africa, it has not been established that the deleterious effects were not related to inadequate nutrition, disease, subcultural norms, or other influences.

 

No research has been done in the United States to establish the presence or absence of a chronic marihuana syndrome. Thus, the absence of a well-defined chronic syndrome among cannabis users at the present time does not establish that marihuana is safe. The extent of long-term ill effects may be determined by the duration and frequency of use, and the potency of the drug abused. The absence of a well-defined chronic syndrome in the United States might be accounted for by restricted availability of the drug, the practice of smoking only to a "controlled" high, or other factors.

 

Though repeated use of cannabis seems to attract the emotionally unstable, there is presently no adequate evidence that it causes permanent mental disorders. More sophisticated studies will eventually reveal whether marihuana causes changes in the chromosomal patterns (as recently reported with respect to LSD), or other subtle physical changes.

 

MEDICAL USE

 

There is no presently accepted medical use for marihuana." In this regard, marihuana differs from the opiate drugs in that the latter are extensively used to alleviate pain. Marihuana may have some effect as a tonic, diuretic, antibiotic, anticonvulsant, sedative, and pain reliever, but none of these properties is of sufficiently demonstrated effect or reliability to compare favorably with other available drugs. We believe marihuana deserves further experimental investigation.

 

IS MARIHUANA ADDICTING?

 

This question generally leads to confusion because there is a discrepancy between the medical, legal, and social definitions of addiction. One can more meaningfully discuss this question of addiction if certain basic drug effects are understood. To consider first the medical viewpoint, a chart has been prepared to provide the reader with a framework for identifying psychoactive drug types and noting their addictive properties (see page 16).

 

Drug addiction is commonly described medically with respect to the three properties of tolerance, physical dependence, and psychological habituation."

 

Tolerance is the decreased effect produced with repeated use of a drug, with the result that the original effect can only be obtained by repeatedly increasing the dose. Thus, an opiate addict may require a dose which is several hundred times the normal therapeutic measure in order to achieve a "high." Similarly, he might be immune to the toxic effect of a large dose of opiates which would be sufficient to kill a nontolerant person, such as you or me.

 

Physical dependence refers to an altered physiological state in which absence of the drug from the body causes illness. In the addicts' language, he has a "habit," or is "hooked." There is a characteristic "withdrawal sickness" for each class of drugs. The two groups of drugs that unequivocally produce physical dependence are the narcotics (opiates) and sedative-hypnotics (barbiturates, minor tranquilizers, and alcohol).12

 

The opiate drugs give rise to a withdrawal sickness resembling influenza with diarrhea, cramps, sweating, muscle aches, and so on, but this sickness infrequently results in death. Sudden alcohol or barbiturate withdrawal is medically more dangerous in that hallucinations, convulsions, and death are not uncommon. With medical supervision, withdrawal from addicting drugs is generally safe and withdrawal symptoms are markedly reduced. At the National Institute of Mental Health Clinical Research Center at Lexington, Ky., the withdrawal period from opiate drugs is usually accomplished within 10 days; alcohol and barbiturates often require a longer period of withdrawal.13

 

Psychological dependence (or habituation) refers to a persistent need or craving for a drug, or the conditions associated with its use. Tobacco and coffee are familiar examples of habituation. In the case of "hard narcotics" (the opiate drugs) habituation is marked and accounts, in part, for the relapse of opiate addicts following hospitalization.

 

Thus, a medical definition of an addicted person is one who will experience withdrawal sickness without the drug, tends to increase the dose as tolerance develops, and has a compelling desire to continue use of the drug. With respect to marihuana, use does not produce physical dependence and rapid tolerance has not been observed.14 Medically, then, marihuana is best described as habit forming rather than addicting.

 

Recently the World Health Organization 15 has attempted to resolve the confusion often associated with the words "addiction" and "habituation" by replacing these terms with "drug dependence" of a specified type—as "morphine type," or "amphetamine type." In this classification, habitual marihuana use is referred to as "drug dependence of the cannabis type."

 

Social definitions of drug addiction have included consideration of whether use of a drug is detrimental to the individual or to society. Legal definitions vary according to local, state, or federal jurisdiction. Marihuana is often included in such definitions of addiction.16

 

IS MARIHUANA DANGEROUS?

 

Unfortunately this question frequently is answered with an impassioned, unqualified "yes" or "no." Marihuana is a pharmacologically potent drug. It is an intoxicant. Small doses may precipitate psychosis in the susceptible person." Yet, advocates are of the opinion that marihuana intoxification is a beneficial experience for most users.

 

We believe that danger exists less in drugs themselves than in their misdirected use—in the "misuser." Danger, then, must be considered with regard to the individual user as well as the larger social and cultural system of which he is a part. False expectations about the properties of a drug or the need for which it is taken constitute an important part of the danger liability. Few drugs score so high as marihuana on unsubstantiated claims attributed to the drug and misguided expectations by the user. Popular myths abound and these are associated with the reported effects of marihuana use itself. Stripped of its folklore, the layman's picture of marihuana might be considerably changed.

 

 

DOES MARIHUANA LEAD TO CRIME?

 

The possession or sale of marihuana is a criminal offense in the United States." Thus, the use of marihuana, in fact, makes one a lawbreaker.

 

Beyond this, the question arises as to whether marihuana use is associated with other types of criminal behavior. Does the violation of marihuana laws predispose or compel an individual to commit other illegal acts, or does this illicit behavior have no further consequences?

 

There is no evidence to suggest that marihuana, or any drug, has a direct causal relationship with criminal behavior in the sense that its use invariably compels an individual to commit criminal acts. The relationship is more complex as the behavioral consequences depend upon the age and sex of the user, his mental state and associates, his socioeconomic status, and the extent of his involvement in and identification with drug abuse as a way of life. In the last instance, it is obviously one thing to experiment with marihuana smoking once or twice and quite another thing to habitually use the drug, actively proselyte for initiates, or sell marihuana for profit.

 

Habitual use of marihuana is often associated with other illicit acts. First, many persons who are otherwise delinquent or criminal may also smoke marihuana. Second, marihuana use is often pursued in a hedonistic peer-group setting in which laws are violated. Third, use of more dangerous drugs is frequently preceded by the use of marihuana.19 On the other hand, use of marihuana is not necessarily associated with other illicit acts and the extent to which occasional users go on to the use of more dangerous drugs or become involved in criminal activity is unknown.

 

Available evidence suggests that marihuana use in the United States is a type of behavior which is often associated with criminal activity.20 Although most juvenile delinquents do not go on to become professional criminals, most professional criminals have been delinquents. The question remains, then, as to how many marihuana smokers are involved in a transitory episode of delinquency and how many become enmeshed and committed to a drug oriented way of life.

 

DOES MARIHUANA USE LEAD TO OPIATE ADDICTION?

 

We do not know the percent of marihuana users who do not abuse other drugs. We do know that 70 percent of 2,213 opiate addicts admitted to the U.S. Public Health Service Hospitals at Lexington and Fort Worth during 1965 reported a history of marihuana use. From interviews with 337 of these patients, it was found that the dominant sequence of events was marihuana smoking followed by opiate use.21

 

Although marihuana use is neither a necessary nor sufficient condition for opiate addiction, it may be a contributory influence. The self-administration of one illicit drug predisposes the user to try other drugs, especially when this is done in a group setting for hedonistic purposes. Thus, it is not uncommon for the neophyte to be introduced to both marihuana and heroin by the same group of friends:

 

Case No. 211.—The very first time he tried drugs, it was marihuana. It happened one night . . he was going out with a couple of friends to a party. One of them got hold of some cigarettes and they decided to try it. At first, he didn't get any "kicks" out of it, but the others seemed so excited, he decided to keep trying it. After that first night they would get together mostly on weekends and smoke marihuana. About 3 months later he tried heroin. (Year of Onset: 1958.)

 

Case No. 147.—The subject had his first experience with marihuana at age 22 while in New York City after his discharge from the Army.

 

He said he was living in a neighborhood where most of the kids were using marihuana. He was going around with this crowd until one night he decided to try it himself. They went up to one of the fellow's rooms and smoked marihuana. He went on using marihuana almost every day for a couple of months before he used heroin. He used heroin with the same crowd. He said that two of the fellows were heroin addicts, and they were also selling. (Year of Onset: 1954.) 22

 

What is not known at present is the long-term effects of continual marihuana use upon the persons who use this drug and who do not graduate to hard narcotics. What will happen to the college student who becomes a daily marihuana user? Is the solitary user different from the more common peer-group abuser? Does continued marihuana use lead to an alienated and nihilistic orientation to life, to hippie deviancy? Is it of no consequence? Or, conversely, does alienation lead to marihuana use?

 

IS MARIHUANA USE INCREASING?

 

It appears that marihuana use has increased in the United States considerably during the past 30 years, and particularly during the past several years. With respect to marihuana use among opiate addicts, the evidence suggests that this has increased markedly. The absence of reference to marihuana use in 1928 23 and the finding in 1937 24 that only a few Lexington patients had used marihuana before opiates seem significant when contrasted with the dominant pattern of marihuana use followed by opiate abuse reported in recent years.25

 

Newspaper and magazine reports suggest that marihuana use has markedly increased among high school and college students. Although these journalistic accounts cannot be utilized to estimate the extent of marihuana use (incidence rates), police arrest figures for marihuana offenses 26 and clinical reports from school health authorities support the observation, as do verbal reports of increasing use of marihuana by America's youth. The extent of this increase is unknown.

 

CREATIVITY AND MARIHUANA

 

There appears to be considerable curiosity and an increase in marihuana use among college students. Some users even claim to be striving for Truth. The issue of creativity and marihuana use is such an important and current one that we would like to elaborate our views in this regard.

 

Some persons "give witness" to creative insights and a new found purpose and zeal in life following drug use. Many users even become "marihuana missionaries." Consider these "natural laws" of a leading missionary, Timothy Leary: 27

 

I. Thou shalt not alter the consciousness of thy fellow man.

II. Thou shalt not prevent thy fellow man from altering his own consciousness.

 

Leary claims he did not invent these commandments:

 

They are revealed to me by my nervous system, by ancient, cellular counsel.. . . Ask your DNA code. I urge you to memorize these two commandments. . . . Nothing less than the future of our species depends' upon our understanding of and obedience to these two natural laws.28

 

The assertion that marihuana is a mind expander, that it "turns on" creativity, may well turn out to be an insidious liability. While there is some foundation for the view that marihuana produces a feeling of creativity, this is quite different from creativity.29 For example, musicians perceive that they do better when high, but the available evidence suggests just the reverse.30 If artists' and musicians' fame were dependent upon marihuana-inspired creativity, our belief is that they would for the most part remain unrecognized, save possibly to an audience intoxicated with marihuana.

 

The ordinary creative process in society, as found in literature, art, music, and science has been viewed as consisting of four stages." (1) A stage of preparation often requiring years of effort in the acquisition of technical skills. (2) A stage of frustration characterized by rising emotionality, restlessness, feelings of inferiority, neurosis, and even abandonment of the problem for other activities in the sheer defense of emotional balance. (3) A stage, or moment, of insight accompanied by a flood of ideas, almost hallucinatory vividness of thought and feelings of exaltation. (4) A stage of verification, or confirmation, in which the new found "insight" is checked against external realities and exaggeration and overstatement are modified.

 

Supposing marihuana does cause a feeling which mimics the period of insight of Stage 3 without the genuine work and time required in the creative process. We might then predict that the marihuana user will wish to repeat the pleasant experience for hedonistic purposes, but woe to his attempt to communicate to others the value of drug induced "creative insight."

 

We believe marihuana may uncover longings for omnipotency and success as well as provide a false sense of self-confidence. This is illustrated in the following recorded experience of an intoxicated person who believed he was creating a great novel:

 

"I'm giving you the thoughts; slap them down, we'll make a fortune and go whacks. We'll make a million.... Take down everything that is significant—with an accent on the cant—Immanuel Kent was a wise man, and I'm a wise man; I am wise, because I'm wise." In spite of all the gabble concerning the volume that was to bring fame and fortune, not even one line was dictated by the inspired author. In fact he never got beyond the title: "Wise is God; God is Wise." 32

 

This feeling of accomplishment and superiority was noted in a study of 35 confirmed marihuana users who were failures in the Army.33 They were referred during World War II for medical treatment because of inadequate performance of their duties. Nonetheless, many of them felt themselves "superior" to their fellow soldiers. In this regard, the following account of the 35 subjects' thoughts and attitudes is pertinent:

 

The rest of the world, the "squares," allowed themselves to be limited to the earth, whereas they [the marihuana users] could transcend it. In this they take on the traditional attitude of the creative artist or the "Bohemian" but without the need of even making a pretense of creating. They themselves are the supreme creation, and they do not feel any need to justify their existence by soiling their hands with work. They repeatedly state, "I don't go for work," or "I wasn't cut out for work."

 

There were repeated statements that marihuana improved their health, increased their strength, enhanced their sexual potency and gave them feelings of power over women and over other challenging situations."

 

In short, the use of marihuana seemed to enhance their self-image and make them unconcerned with the real world and its dangers.

 

Some observers report that the use of hallucinogens by college students leads them to feel superior to their professors and to regard examinations as beneath them; the outcome may be that they become college dropouts. Says Leary:

 

The new cult of visionaries. They turn on, tune in, and often drop out of the academic, professional and other games-playing roles they have been assigned. They do not drop out of life, but probe more deeply into it, toward personal and social realignments characterized by loving detachment from materialistic goals.35

 

Those who preach that marihuana promotes insight might be opening a Pandora's Box with regard to creativity. We believe this would be especially so if the user has the illusion that marihuana will be a substitute for adequate preparation and the frustrations often associated with the creative process. The assertion that marihuana causes a user to "tune in" and "turn on" a creative experience is no more justified than the statement that marihuana leads one to "fade out" and "turn off" with respect to recognizable creative accomplishment.

 

The majority of persons of recognized creativity deny the value as well as the use of drugs to assist their creativity.36 While it is true that some persons do attribute their creativity to drug use, it also appears that such persons have studiously prepared themselves and have been creative before the use of drugs.

 

IS MARIHUANA LESS HARMFUL THAN ALCOHOL AND SHOULD MARIHUANA BE LEGALIZED?

 

Is marihuana less harmful to the individual and to society than alcohol? Should marihuana be legalized? Arguments have been advanced that the answer to both questions is "yes." 37 While this might be the case, we believe sufficient data for such a decision is lacking.

 

Let us not forget that alcoholism afflicts over 5 million people in the United States and it is one of our most enigmatic social problems. The widespread use and abuse of alcohol is a reality. While we cannot easily change existing folkways and mores concerning the consumption of alcohol, we may have a greater degree of freedom to wisely legislate policy on marihuana.

 

There has been extensive controversy as to whether the existing legal code pertaining to marihuana use should be changed. Differing views on this subject have been presented by others.38

 

WHAT METHODS OF PREVENTION ARE EFFECTIVE?

 

This question is often asked. We must say that know-how in prevention is lacking. Most efforts have been directed at the established user with such methods as limiting drug supply, heavy penalties, and long probation for offenders." Unfortunately, insufficient effort has been directed toward the development of methods which would promote more informed opinion among potential drug users. While many states require drug education by law, organized programs are the exception with the result that mass media reports based on personal impressions often go unchallenged as expert opinion.

 

The last point suggests a potential role for the probation officer. Open discussions and forums with active student participation have promise if accurate scientific information is made available.4° The probation officer, if he is well informed, could be a key person to stimulate such activities and assist as a resource person. General principles of education to follow include the avoidance of preaching and an effort to present information objectively. The World Health Organization has suggested that education improperly done may stimulate rather than prevent abuse." One local health educator reported that "after being scared in a high school assembly program about the evils of narcotics, four girls took up marihuana smoking the following day." 42

 

There are the beginnings of a comprehensive health education curriculum for use in public schools.43 In this approach, marihuana smoking is recognized as a symptom rather than an illness and will be related to the greater drug abuse problem, as well as to the problems of school dropouts, suicide, venereal disease, out-of-wedlock pregnancy, homosexuality, delinquency, and even boredom and unhappiness.

 

SUMMARY

 

To recapitulate, the danger liability of marihuana with respect to our society is largely unknown. A danger does exist, however, in that individuals with personality problems often are attracted to abuse of drugs. Frequent reasons given by users for beginning are thrills, boredom, desire for a change, to be one of the gang, curiosity, or because it's illegal. It seems to us that the use of any drug to satisfy transitory needs in an effort to relieve the immediate discomforts of life is a poor substitute for facing reality and building a durable and meaningful way of life.