At present the most hotly debated question concern-ing marijuana is the effect of the drug upon the health of its users. This issue is extremely complex for several reasons. As pointed out in Chapter III, not only does the laboratory research in this area leave a large number of questions unresolved, but the effects of any one use of this drug are so much a function of the personality and mood of the user, the social setting, and the dosage of the drug used that predictions of the drug's effects become especially complex. Moreover, both the illegality of marijuana and its relative newness in Western society leave an unusually large range of uncertainty with respect to the consequences of long-term use.

On the other hand, it should be realized that, whether or not hann to the user is a sufficient reason to criminalize a drug, it is one of the weaker reasons. In our society, we have a tradition of free-dom and autonomy that holds that a competent adult may under-take a wide range of actions in which he may damage himself. The fact that such damage may lead him to become a public charge may justify some types of preventive action, but such action is generally taken only where the need is most clear. This justification for our marijuana laws is very different from those based on the alleged empirical facts that the drug causes aggressive crime against innocent members of society, or that it causes heroin addiction and hence the numerous property crimes necessary to support an expensive drug habit. The harm-to-the-user argument, even granting its factual premise, has no great obvious force. In Anglo-American law, protecting the individual from himself has clearly been the exception rather than the rule.

The Acute Effects of Marijuana Use

In order to make meaningful statements about the effects of marijuana upon its users, we must first discriminate between the acute effects—the effects while the user is actually under the influence of the drug—and the chronic effects—the more long-term effects upon the user, independent of whether he is using the drug at the time of observation. Since we have already discussed the ordinary acute effects of marijuana in Chapter III, we will begin here with the "pathological" acute effects.

This picture presented in Chapter III of normal marijuana use as producing a sleepy, happy "high" is, at least at first glance, hard to reconcile with the warnings of law-enforcement officials and drug educators that "in sufficient dosage the properties of marijuana can cause psychotic reactions in almost any individual"' and that the dangers of marijuana "include the precipitation of psy-chotic episodes during which the user becomes mentally unbalanced for varying periods of time."2

The Marijuana Psychosis

It turns out, however, that these warnings rely in great part upon the work of Dr. Harris Isbell and his co-workers at the U.S. Public Health Service Hospital in Lexington, Kentucky, who report that:

It has long been known that marijuana and hashish can cause psychotic reactions, but usually such reactions were ascribed to individual idiosyncrasies, rather than being usual or common re-actions to the drug. The data in these experiments, however, definitely indicate that the psychosomimetic effects of delta 1-THC are dependent on dosage and that sufficiently high doses can cause psychotic reactions in almost any individual.3

The key words in Dr. Isbell's statement are "sufficiently high doses," and herein lies the major difference between the experi-mentally induced psychoses and the reactions described under the heading of ordinary use. Isbell, in his study, used THC. He began with a dose that averages to about 1.8 milligrams for a 160-pound person.4 At this dose level he reported that the most common response was a euphoric mood, with the subjects feeling happy, gay, relaxed, and silly.5 At this dosage no hallucinations or psychotic symptoms were noted. With a dose four times as large, however, hallucinations began to occur, and with eight times the initial dose, the majority of subjects began to experience delusions and hallucinations, and several showed psychotic effects.6

There is a problem comparing the dose rates used by Isbell with those of other experimenters. At least if one believes the various' tests used to determine the quantity of THC in the vegetable matter used by Clark, Jones, and Weil, it would appear that even Isbell's high, psychosis-producing dose was well within the ranges used to investigate normal use in the other laboratories.

It is possible—though not likely—that the atypical nature of Isbell's experimental sample, "former opiate addicts, serving sentences for violations of the United States Narcotics Laws," accounts for the difference. It will be noted shortly that a similar, if less extreme, methodological problem was the main defect alleged in the Journal of the American Medical Association attack on the investigation of the La Guardia Committee. It is also possible that the determinations made by the other experimenters of the THC content of the vegetable matter they used included large amounts of much less active forms of the drug than the delta 1 used by Isbell —though there is some experimental evidence to contradict this; it is possible that another, as yet unknown, ingredient in marijuana partially counteracts the effects of THC; and finally it is most likely that the usual method of determining the amount of THC in marijuana is simply not very accurate. Nonetheless, it is clear that the high-dose phenomena reported by Isbell are a consequence of dosages that are not generally taken in ordinary use.

Assuming then that Isbell's lowest dose approximated normal use, the most we can conclude from his work on the ability of marijuana to produce "psychotic reactions in almost any individual" is that this will happen at more than eight times the normal dose of the drug. Although the analogy to alcohol in this respect per-haps is not completely accurate, one might well question the relevance of data on that drug if it were based on what happened on sixteen martinis. Assuming no other factors such as unconsciousness or death intervened, such an enormous dose of alcohol—like one of marijuana—would literally poison the brain. For the most part this "toxic reaction" would be temporary, but so long as the bloodstream contained large quantities of such psychoactive substances the brain would be affected, producing symptoms similar to those often seen in psychotics.

The La Guardia Committee. Another often-cited example of the ability of marijuana to produce psychotic episodes Is drawn from the investigations undertaken for what subsequently has been called the La Guardia Committee Report.7 Since this report has come under considerable attack, it may be valuable to examine the way the committee conducted its business. It is not clear with whom the idea originated for a "blue ribbon" committee to investigate the problem of marijuana. The first public mention of it occurred in 1939, when the mayor of New York, Fiorello H. La Guardia, asked the New York Academy of Medicine for information on the use and effects of marijuana, a "newly described" drug that at the time was receiving a great deal of publicity.8 The Academy of Medicine's Committee on Public Health Relations appointed a nine-man subcommittee to investigate the literature and discuss the matter with interested government officials, such as those in law enforcement and education.° The subcommittee decided that the information available was too scanty for them to reach any con-clusions and recommended that a special group be established to study the matter carefully, both from the medical and from the sociological viewpoint» In response to this recommendation Mayor La Guardia appointed a fifteen-man committee, consisting of two Ph.D.s and thirteen M.D.s. This committee included the nine members of the initial study subcommittee plus the Commissioner of Hospitals, the Director of the Psychiatric Division of the Department of Hospitals, and the First Deputy Commissioner of Correc-tions» The committee began its work in 1939 and issued its report five years later.

Almost immediately, the La Guardia Commission came under strenuous attack for minimizing the dangers of marijuana. The Journal of the American Medical Association editorialized:

The value of the conclusions is destroyed by the fact that the experiments were conducted on 77 confined criminals. Prisoners were obliged to be content with the quantities of drug administered. Antisocial behavior could not have been noticed, as they were prisoners. At liberty some of them would have given free rein to their inclinations and would probably not have stopped at the dose producing "the pleasurable principle." . . .

The book states unqualifiedly to the public that the use of this narcotic does not lead to physical, mental or moral degenera-ticon and that permanent deleterious effects from its continued use were not observed on 77 prisoners. This statement has already done great damage to the cause of law enforcement. Public officials will do well to disregard this unscientific, uncritical study, and continue to regard marijuana as a menace wherever it is purveyed.12

Attackers of the report as a whole, however, have often cited one part of the La Guardia Commission's investigation as evidence of the dangers of marijuana. One of the major investigations undertaken for the La Guardia report---and the only one referred to in the Journal editorial—was a month-long study of seventy-seven prisoners imprisoned for various criminal offenses13; members of this group, on 150 different occasions, drank a marijuana concentrate of undetermined potency." During these experiments there were nine reactions that the report described as "psychotic episodes."13

Although these nine reactions are typically given as a major experimental finding on the dangers of the marijuana psychosis," there are several aspects of the experiment that make this a less persuasive interpretation. First, although the potency of the material was not known in terms of the amount of THC present, it was known that the minimum effective dose of the concentrate was two cc17 Since the doses producing the psychotic effect ranged from three to eight times this amount, it is likely that they were very large doses.18 Second, an examination of the nine reported "psychotic episodes" shows that six were "toxic reactions" very much like those obtained by Isbell. They were characterized by disorientation and anxiety but lasted only as long as the drug was in the subject's system.19 They were, in short, the marijuana equivalent of a good drunk.

In only three cases was the psychosis longer-lasting than this effect." The commission concluded that in one of these, an "acute confusional state," the user was an epileptic who was subject to such "fits" once or twice every two months. The tie-in with marijuana in this case was that the drug was the only known factor that precipitated the attack. The second involved a heroin addict who was diagnosed as having "a psychosis due to drugs and other exogenous poisons (morphine and heroin)," and the third was, in the words of the commission, "a fairly typical example of what was termed a prison psychosis" that struck the subject two weeks after the marijuana use.21

Finally, it is important to note that the La Guardia Commis-sion itself, after the completion of its investigating, did not take these marijuana psychoses seriously. Indeed, the Commissioner of Corrections of New York, who provided the information concerning the prisoners used for the experiment, commented that

I am indeed surprised that we had so little trouble with our volunteers upon completion of this study and sojourn at the hospital and the few psychotic episodes that occurred are exactly what we would expect in the whole group without considering the ad-ministration and effects of excessive doses of marijuana.22

On the other hand, one cannot deny that some psychotic episodes are caused by marijuana use outside the laboratory. In the United States there are several reports of adverse reactions to marijuana, other than those that involve the experimental administration of an overdose of the drug.

"Adverse" Reactions to Marijuana Use. Probably the most widely cited report of such reactions to "normal" marijuana use is that of Martin Keeler, a psychiatrist at the University of North Carolina School of Medicine. Dr. Keeler, in the American Journal of Psychiatry, reported eleven "adverse" reactions to marijuana.23 Of these, nine involved some type of fear, ranging from one subject who "had become intensely anxious and apprehensive without any idea of what she was afraid of," all the way to two who had a very specific—and perhaps not completely irrational—anxiety that "the police might raid the house."24 Indeed, when one looks at Keeler's account of such "adverse reactions" one is struck not only by the relatively small number reported, considering that they arose in a large university community, but also by their relative mildness.

Compare Dr. Keeler's report with the description given by Chopra from the Indian experience:

The individual looks confused and excited, and has bright, shining eyes which are almost always heavily congested. He shouts, vociferates, signs, walks quickly up and down or around his cell, and shakes the door out of its fastenings. If at liberty, he is violent, aggressive, and may run amock.25

By contrast, all Dr. Keeler's reactions involve is the kind of tempo-rary fear and anxiety that marijuana-users occasionally experience and have learned to combat merely by waiting until it goes away. In none of the eleven cases related by Keeler was hospitalization required for the effects of marijuana and, indeed, according to Keeler:

all but two of the eleven individuals reporting adverse reactions considered the benefits (in terms of positive pleasure, enhanced sensitivity, insight, etc.) to outweigh the unfortunate aspects and plan to continue use of the drug.25

In addition to the eleven cases Keeler reports as adverse reactions, there were four patients who had become schizophrenic subsequent to the use of marijuana, LSD, and amphetamines. Although Dr. Keeler does not include these four cases in his sample of eleven adverse reactions, he does conclude:

It is the clinical impression of the author that this dissolution of ordinary adaptive and defensive psychological structure that oc-curs during the marijuana reaction is potentially dangerous for individuals with a predisposition to schizophrenia.27

We will discuss this aspect of the problem at pp. 175-76.

Blum's Data. Perhaps the most complete picture of the ad-verse acute effects of marijuana outside the laboratory, at least in the student culture, has come from the work of Richard Blum.28 In his chapter entitled "Bad Outcomes," he lists what users in the five colleges studied reported as the unfortunate effects of various ldnds of drug use. Since alcohol is not only the most common drug used on the campuses but also the one most similar in its use-pattern to marijuana, it is interesting to compare the "bad outcomes" of Marijuana use with those of the use of alcohol. For this purpose we set out a table taken from Blum's data.

In a number of areas Blum gives no comparison figures because the responses as to one drug or the other showing the ill effect were negligible. Thus there is no alcohol comparison to the two percent of marijuana-users who reported bad dreams, and no marijuana comparison to the eleven percent of alcohol-users who reported unconsciousness, the eight percent who reported fights, or the three percent who reported receiving a traffic ticket or moving violation, which they regarded as due to the influence of a drug.2'

Despite the fact that, at least according to Blum's data, the acute effects of marijuana in the student culture seem less serious than those of alcohol, we must note several caveats here. First, the marijuana-users may have attempted to put their drug in a good light, though there is no evidence that in fact they did so. Second, Blum does not compare the frequency of the marijuana-users' drug use with that of the alcohol-users. If the marijuana-users used their drug less often than did the alcohol-users, Blum's figures might understate the bad outcomes per use of marijuana. On the other hand, one might argue that this did not matter. If marijuana were used less often by its users, even though it was widely available, that would be an indication that the drug could more easily be used in moderation, thus perhaps restoring to significance the differential figures between marijuana and alcohol. Finally, Blum's data unfortunately were collected just before the great increase in marijuana use which in a two-year period rose from twenty-one to sixty-nine percent at one of the campuses he studied. As a result, significant changes may have taken place in the types of student using 'marijuana—though whether this would tend to increase or decrease the number of bad outcomes is hard to say.

In any event, Blum's data gathered from the student users are at least partially confirmed by the university records. Although university record-keeping in the area of student discipline does not appear fo be very good, and as Blum states, "the schools differed considerably in the kind and detail of records kept,"" he was able to draw certain conclusions. While alcohol-users were never more than five times as numerous as marijuana-users:

drug cases [including alcohol] of any sort comprise from 5 to 75% of disciplinary cases and alcohol related violations exceed viola-tions involving any other drugs by a factor of at least ten. That is, there are at least ten students identified as rule violators in cases involving alcohol use for every case involving another drug.31

The Frequency of the Marijuana Psychosis. The implication of Blum's data is clear: serious reactions beyond a severe but brief anxiety are not at all common in the college student culture. And Blum's data are not the only information we have on the rarity of the marijuana psychosis. Miss Barbara Durham, at the time a Stanford law student and presently an Assistant District Attorney

in Seattle, sampled "the opinion and experience of doctors and heads of clinics in the areas where there is heavy marijuana use, such as the San Francisco Bay Area."32 She reported:

An attempt has been made to contact the doctors and clinics most likely to have encountered examples of abnormal behavior caused by marijuana. The institutions involved were the Student Health Centers at Stanford University and the University of California at Berkeley, the University of California Medical Center and Clinic in the Haight-Ashbury district, the San Francisco General Hospital, and the Stanford-Palo Alto Hospital. At the risk of making the rest of this section anti-climactic, it is impressive to find not a single case of marijuana-induced psychosis reported from any of these facilities.

Perhaps the single most surprising figure was that given by the Haight-Ashbury Clinic, the most likely of the group to encounter marijuana reactions. An administrator of the Clinic, Al Rose, stated that out of 30,000 admissions in the 10 months since the Clinic opened in June, 1967, not one case of marijuana psychosis was seen. Dr. Rose did cite one case of mild anxiety reaction in a young man thought to be brought on by smoking marijuana, but added that in that case, the boy was discharged within half an hour after calming him down a bit, but did not require any medication (tranquilizers, etc.).

It might be pointed out here that most of the doctorecon-tacted acknowledged the existence of unpleasant reactions to marijuana in some people [but stated that they are] generally thought to be rare nonetheless. These reactions usually take the form of anxiety and mild paranoid reactions. They are not what could properly be described as psychotic episodes and almost without exception disappear within an hour or so, when sleepiness takes over. The fact that only one such case appeared at the Haight-Ashbury Clinic would indicate it is an atypical reaction.

Figures recently released by the Immediate Psychiatric Aid Center at San Francisco General Hospital showed that although some 5,000 patients had been admitted with drug-induced psy-chotic symptoms over the past year, not one [was admitted as a direct consequence of marijuana use].33

A recent study of hospital admissions to the University of Southern California Medical Center dramatically confirms this information.34 Among the admissions during a one-year period were three marijuana-induced psychiatric cases. "All three patients were teenagers, two with acute intoxication and one with a headache after marijuana ingestion. All were discharged within three days." On the other hand, in the same period thirty-five hospital admissions were traceable to Doriden, sixteen to Sleepeze, and similar numbers to various other freely available psychoactive agents. In addition, in only one month there were 140 hospital admissions and eleven fatalities traceable in whole or in part to barbiturate use.

Further corroboration for this is provided by the personal experience of those working with patients. A psychiatrist at Los Angeles' Neuropsychiatric Institute reported:

In an effort to accumulate patients with complaints referable to Cannabis, we discovered that they are practically non-existent. I have personal experience with only one patient who gave his dependence on marijuana as a presenting complaint and he subsequently proved to be a chronic schizophrenic whose illness antedated his use of marijuana.35

Dr. David Smith, head of the Haight-Ashbury Clinic and assistant clinical professor of toxicology at the University of California Medical School, reports:

I have seen three cases of marijuana-induced psychosis and the individuals (2 doctors and 1 newspaper reporter) involved were remarkably similar. They were all successful members of the establishment, in their middle thirties, and were using marijuana for the first time in "far out" environments. All had extreme paranoid reactions characterized by fear of arrest and discovery, and two of three were hospitalized in private hospitals under a "non-drug" psychiatric diagnosis."

Reports of marijuana-induced psychoses in the past medical literature are by no means so uncommon as this. Probably there are two major reasons why. First, there is today an increasing recogni-tion of the severe problem of diagnosis. For instance, according to Prof. James A. Paulsen, Psychiatrist-in-Chief at the Stanford Student Health Center, a young Stanford student was taken to the Student Health Center a few years ago for what appeared to be a psychotic condition. The young man had smoked marijuana off and on for the previous two weeks, and accordingly his condition was diagnosed initially as a marijuana psychosis. After treatment by a family psychiatrist and rest at home for several months, the student returned to Stanford and several months later was returned to the Health Center suffering from a similar psychotic epi-sode. Since, in the interim, so far as could be determined, he had. smoked no marijuana, a more careful investigation was made. The Student Health Service concluded that the youth had been prepsychotic for several years and that his marijuana smoking had been, in the words of Dr. Paulsen, "at very most a catalyst and more probably, coincidental to the psychotic episode.'"37

The second reason why reports of psychoses due to marijuana have fallen off so much in recent years is probably related to society's greater familiarity with the drug. Professor Howard Becker, writing in the Journal of Health and Social Behavior, makes it clear why such an effect is expectable.88 Becker points ,out that psychoactive drugs often have a wide variety of effects on percep-tion consciousness and mood. The drug-user, however, tends to single out one or a very few of these drug effects and ignore all the others. The "recreational" drugs, such as marijuana and alco-hol, are no exception to this rule. Since they are taken in part because they change one's perceptions of the world and of li'imself, or because they produce pleasurable states, these are their most commonly noted effects.

Becker points out, however, that an

inexperienced user has certain unusual subjective experiences which he may or may not attribute to having taken the drug . . . he may see or hear things in a way that he suspects is quite differ-ent from the way others see and hear them. . . . In any society whose culture contains notions of sanity and insanity the person who finds his subjective state altered in the way described may think that he has become insane . . . that he has lost his grip on reality, his control of himself, and in fact gone crazy.39

So long as the user defines these changes as being merely temporary, they are not terribly frightening. However, the less familiar he is with the effects of the drug, the more likely he is to consider the changes long-lasting, which then becomes a very serious matter indeed. It is easy then to see how a panic reaction can develop. But unlike the usual toxic reaction from an overdose, the panic reaction may last far beyond the period that the drug is affecting the system biochemically. In this way a full-blown psychosis can develop, indirectly from the action of the drug, but more directly from the extreme anxiety over the drug's effect.

Such a mechanism might well explain the two most significant observations about the psychotic reaction to marijuana use. First, it explains why marijuana psychoses, when they occur, tend to afflict middle-aged novice users who are "up-tight" and especially conscious of the consequences of loss of their mental powers; and, second, it explains why marijuana psychoses are so rare today. At one time, before an elaborate culture had developed and before it became common to be initiated into marijuana use by experienced users in a quiet and relaxed group setting, the beginning users of marijuana might well interpret their experiences as terrifying. However, marijuana use is common today and most users are not par-ticularly frightened by the drug. Even if, because of an unexpected overdose, they begin to suffer a toxic psychosis, they know enough not to panic and to "groove on it" until it goes away. As a result, one would expect just what has occurred—that such panic reac-tions 'and their attendant psychoses would cease to be associated with marijuana in any significant numbers. It is interesting to note in passing that this mechanism explains at least some of the very large number of psychotic reactions to LSD. Not only is LSD far more likely to produce bizarre mental effects than marijuana, but it has developed among its users far less of a culture and expecta-tion that can act as a reassuring element to prevent panic reactions.

Marijuana and Hallucinations

This comparison between marijuana and LSD is related to another of the alleged acute dangers of marijuana use. It has been pointed out that "marijuana may produce all of the hallucinogenic effects of which LSD is capable."40 The implication of this statement thit marijuana is as dangerous as LSD is not only clearly untrue, it is dangerous. The most likely effect of such statements, rather than scaring off young users of marijuana, would be to convince them that it is not a much more serious step to use LSD. The fact is, however, that, so far as we know, the capacity of LSD to produce hallucinations has very little to do with the many serious dangers of that drug. Indeed, many substances that involve comparatively little danger are quite effective in producing hallucinations. In the words of Dr. Frederick H. Meyers, professor of pharmacology at the University of California Medical Center:

An additional area of confusion or controversy is introduced when marijuana is characterized as a "mild hallucinogen." The effect referred to is better described as a dreamy state with an increased tendency to fantasize and to accept suggestion. Such a dreamy, hypnogogic state can be induced with almost any one of the seda-tives or anesthetics under favorable conditions. The use of nitrous oxide to produce such a state was described by Humphry Davy almost as soon as he isolated the gas. The Pentothal interview or the recent use of PCP (Peace Pill) are additional examples, and a transcient "hallucinatory" state has also been described during the therapeutic use of chlordiazepoxide (Librium).41

Moreover, although it is true that marijuana can produce hal-lucinations, there is evidence that it very rarely is taken in such quantities as to do so. According to Dr. David Smith of the Haight-Ashbury Clinic, hallucinations are a phenomenon only of an over-dose of marijuana.42 "Normal" use of that drug does not produce hallucinations and, indeed, users very rarely take the drug fos that purpose. If it is hallucinations they want, they are not likely to use marijuana at all, but rather LSD or one of the drugs akin to it. However, this subject is in need of further research, since this in-formation conflicts with Blum's data showing eight percent of the marijuana-users reporting hallucinations on at least one occasion.

In any event, the capacity of a drug to produce hallucinations would not seem to be very important in and of itself. Except insofar as they lead to panic reactions or occur during the driving of an automobile (a problem that will be discussed in Chapter VIII), transient drug-induced hallucinations harm neither the user nor anyone else.

The Unpredictability of Marijuana Effects

Entirely apart from any specific acute effect of marijuana, advocates of marijuana prohibition typically point out that the effects of the drug are unpredictable. According to Matthew O'Connor, chief of the Bureau of Narcotic Enforcement of California's Department of Justice, "unlike the person who downs two martinis in a controlled situation the person 'turning on' has released an un-guessed quantity of uncontrolled drug in his nervous system."43

This was put in greater detail by the Chief Counsel of the United States Bureau of Narcotics and Dangerous Drugs, Donald E. Miller, who stated:

A psychoactive drug such as marijuana does different things to different people, and even to the same person, depending on ex-ternal and internal circumstances. Environmental and psycho-logical factors, mood, disposition, attitude, suggestion, expectancy, motivation, and any abnormal behavioral patterns will determine the drug's effects. As stated by J. H. Jaffe, "The subjective effects [of marijuana] are exquisitely dependent, not only on the per-sonality of the user, but also on the dose, the routine of ad-ministration, and the specific circumstances in which the drug is used."44

There is no doubt that marijuana's effects are less controllable than those of many other commonly used drugs. Partly, of course, this is due to the fact that society cannot require standardization of a prohibited product or control the potency of an illegal drug. This is simply one of the costs of the criminalization of marijuana—very much as the substitution of wood alcohol for whiskey was one of the costs of Prohibition. There are other reasons for the variabil-ity of marijuana's effects. First of all, THC appears to deteriorate with exposure to air, and therefore the amount the marijuana-user takes into his system will vary depending upon the age of the material he is smoking. And even when one corrects for the quan-tity of active ingredient taken in, as pointed out in Chapter III, the effects of marijuana are especially dependent upon the user's set and setting.

Despite this, arguments for the criminalization of marijuana based on the unpredictability of its effects remain unpersuasive. Except insofar as these unpredictable effects cause injury to others or damage to the user, it is hard to see why society should have any concern with them. Of course, if a drug's effects were too un-predictable it would probably fall out of favor with its users. The fact is, however, that in most cases the unpredictability of mari-juana's effects involves the range between a mild anxiety and de-pression, and a cheerful, laughing euphoria.

The Chronic Effects of Marijuana Use

We have thus far discussed the acute effects of mari-juana. By and large today, with the exception of the problem of automobile driving to be discussed in Chapter VIII, these are relied on less and less to support the criminalization of marijuana. The argument has in great part shifted to the major area of uncertainty regarding marijuana—the chronic effects of the drug. Unlike the acute effects, which can be measured in the laboratory and, more importantly, can be gauged under American conditions from inter-views with users and from reports of psychotic breaks, arrests, and the like, the chronic effects are very difficult to determine. First of all, it is very difficult to conduct studies among long-term users which make allowance for such factors as socioeconomic status, psychiatric instability, and the effects of other drugs; secondly, in the United States, among the most studied middle-class popula-tions, marijuana use has not as yet continued long enough 'to have produced a representative sample of chronic users; and finally, the fact that the use of marijuana is illegal makes it extremely dif-ficult if not impossible to do the kind of follow-up studies of users that would be most valuable.

Marijuana and Physical Damage

Essentially all the allegations as to the chronic effects of marijuana involve mental damage. So far as physical damage is concerned, there are only two allegations, both of which have been made only in the most tentative and hesitant manner. In fact, as to both alleged dangers, liver damage and birth defects, the evidence falls so far short of proof it can hardly be regarded as even suggestive. With respect to liver damage, probably the major study examined twelve marijuana-users, six of whom also used pep pills "when these were available," and all of whom were "high" four nights and two days a week. "Eight of the subjects showed evidence of a mild liver dysfunction."45

So far as birth defects are concerned, the possible causes may be divided into chromosomal dama0 and interference with the development of the embryo. The first of these issues is much more commonly raised in relation to LSD, where some workers have reported damage to chromosomes," and others have found none.41

In the case of marijuana, the evidence as to chromosomal damage is even weaker than that involving LSD, one published study showing that marijuana does not cause such damage to the cells of the rat."48And, in any event, such substances in common use as caffeine and aspirin have been reported to cause chromosomal damage.

As for its effect on the developing embryo, the evidence on marijuana is equally weak. Injections of the drug into pregnant animals have produced malformed young in hamsters and rabbits" but not in mice." Injection, however, is such an artificial method of administration of the drug that this tells us next to nothing about the effect of smoking or even eating the drug. Nonetheless, the mechanics of tissue differentiation in fetal development are so little understood that unless there is a very good reason, pregnant women, especially in the first three months, should not use any drug. This includes not only marijuana, but also antibiotics, to-bacco, and aspirin.51 Presently there is no indication that marijuana is more dangerous in this respect than any of these.52

Marijuana and Drug Dependence

Most of the allegations as to the chronic mental effects of marijuana center about two areas.53 First, it is asserted that pro-longed ,use of marijuana causes drug dependence; and second, that it causes various types of mental deterioration. As to the first of these alleged effects, there was at one time a strong debate as to whether marijuana produced physical dependence, or addiction, as do the opiates and, to a lesser extent, alcohol. The essence of physical dependence is the onset of certain physical symptoms such as stomach cramps and nausea when the addict is deprived of his drug. When such symptoms occur to those addicted to opiates such as heroin or morphine, they are referred to as withdrawal symptoms. When they occur in persons addicted to alcohol, they are called delirium tremens, or the "D.T.'s."

Marijuana and Physical Dependence

Probably the most important reason why many people believe marijuana is addicting is that, as a legal matter, the drug is generally classed with the opiates as a narcotic drug. In fact, this classification was a historical accident, in which it was assumed that mari-juana was nonaddicting. In 1932, the National Conference of Commissioners on Uniform State Laws, a private semiofficial body that proposes a wide variety of uniform, comparatively noncontro-versial laws for enactment by the states, was considering amend-ment of its Uniform Narcotic Drug Act. At that time the Federal Bureau of Narcotics was not itself eager to regulate marijuana and hence its representative suggested that an optional clause should be included criminalizing marijuana. This, then, could be enacted by any state that felt it had a marijuana problem. Since, however, the Uniform Narcotic Drug Act would then include marijuana and, more important, cocaine, neither of which was a narcotic, it was proposed to define all the drugs as "habit-forming" and rename the act the Uniform Habit-Forming Drug Act. A delegate? however, objected:

MR. SCOTT: It occurs to me that some of the other members, like myself, would like to hear from the Chairman why we have substituted the expression "habit-forming" for the heretofore uni-versally used word, "narcotic." . . .

I have this question in mind because I notice that you have taken the trouble to suggest that we hereafter cite this act as the Uniform Habit-Forming Drug Act. I know that a lot of legisla-tures are going to get the idea if they read something about a Habit-Forming Drug Act, they are going to be afraid that you are going to take away our sal hepatica and our various headache cures, and a lot of other things, whereas there is a universal antipathy to the use of narcotics. I am wondering if we are not really going to lose something if we substitute habit-forming for narcotic.54

The delegates acceded to this objection and, as a result, mari-juana was classed as a narcotic--and still is in the great majority of states that have adopted the Uniform Narcotic Drug Act.

In the medical literature, probably the closest approximations to reports of addiction to marijuana are found in three studies of marijuana use among soldiers during World War II. The first two studies involve American soldiers, and the third is a British report of addiction among Indian troops. In the first of these, "The Marijuana Addict in the Army," Marcovitz and Meyers reported that they regard marijuana's addictive potential as somewhere between that of alcohol and that of morphine. According to these authors:

Previous studies have insisted that marijuana addicts show no physiologic withdrawal symptoms such as characterize morphine addicts. However, in our cases the psychologic aspect of the with-drawal seems of extreme importance. When marijuana addicts are separated from their source of supply, they manifest anxiety, restlessness, irritability or even a state of depression with suicidal phantasies, sometimes self-mutilating actions or actual suicidal attempts.55

In the second study, Charen and Perelman, though referring throughout to their sample of users as marijuana "addicts," likened the users' attitude toward marijuana to that of the "tobacco addict."58 Finally, Frazer in a short note in Lancet described nine soldiers who were "marijuana addicts" and who went into psychotic states shortly after being unable to procure the drug.57 Frazer noted, however, that "the proportion of marijuana addicts who developed this illness was comparatively small."58

On the other hand, the author of what is probably the most complete review of the literature concluded that at least the American "addicts were merely playing strongly on the nuisance value of their alleged addiction,"59 and that
it should be remembered that the subjects of the Marcovitz and Charen teams would be inclined to paint a bad picture of their dependency on cannabis in the hope of receiving army discharge. . . .60

Other commentators have concluded that this view of the two papers is probably an understatement and that the "marijuana addicts" had expertly "conned" their doctors. It is not clear that this is so. The marijuana-users were a subsample of those hospitalized for various psychiatric complaints. They were overwhelmingly Negroes (thirty-four out of thirty-five in the Marcovitz study and fifty-five out of sixty in the Charen study), and although they did not like the army, they had been delinquent in civilian life as well. On the other hand, reading the information they gave their doctors, one is struck by its exaggerated character. Thus according to Charen:

We were told of the eating of feces, of the swallowing of leukor-rheal discharges, of other activities in which individuals vied with each other to see who could commit the most disgusting acts. All sorts of perversions, both homosexual and heterosexual, were staged. "Nothing seems wrong any more," one of the patients commented. "You see lots of queer things going on that you never dreamed existed." Marcovitz and Meyers in "The Marijuana Addict in the Army" give an excellent description of such parties. . . .61

And a sample of the Marcovitz and Meyers case histories shows that the doctors did, in each case, recommend discharge.

It would seem that, so far as physical dependence is con-cerned, the absence of tolerance to marijuana use, if confirmed, would clinch the matter.62 So far as we know, all drugs that are addictive show the phenomenon of tolerance; that is, as one be-comes an experienced user he must increase his dose in order to obtain the same effect. In alcohol this is referred to as "learning to hold one's liquor." Among marijuana-users, as mentioned in Chapter III, the reverse effect seems to be noted. Regardless of the reason for this, a lack of tolerance refutes the notion of an addictive potential. Though many drugs that produce a marked tolerance are not physically addicting, we know of no drug with-out tolerance that is addicting.

Marijuana and Psychological Dependence

Recently it has been admitted by law-enforcement officials that marijuana is not physically addicting.°3 It is said, however, that marijuana is habituating, that although the drug does not cause physical dependence, it does cause psychological dependence.°4 The problem with analyzing this type of argument is that, while the concept of addiction is relatively specific and subject to careful definition, the concept of psychological dependence, or habituation, often merely reflects the common-sense observation that people who like a drug will continue to use it if they can—so long as they continue to like its effects. The World Health Organization has defined the difference between addiction and habituation:

Drug Addiction is a state of periodic or chronic intoxication pro-duced by the repeated consumption of a drug (natural or syn-thetic). Its characteristics include:

(1) an overpowering desire or need (compulsion) to continue the drug and to obtain it by any means;
(2) a tendency to increase the dose;
(3) a psychic (psychological) and generally a physical dependence on the effects of the drug;
(4) a detrimental effect on the individual and on society. Drug Habituation (or habit) is a condition resulting from the repeated consumption of a drug. Its characteristics include:
(1) a desire (but not a compulsion) to continue taking the drug for the sense of improved well-being which it engenders;
(2) little or no tendency to increase the dose;
(3) some degree of psychic dependence on the effect of the drug, but absence of physical dependence and hence of an ab-stinence syndrome;
(4) detrimental effects, if any, primarily on the individual.85

As might be expected, such definitions of psychological dependence have been treated with some mirth by many of those seriously interested in the problem. Thus Professor Leslie Wilkins, acting dean of the School of Criminology of the University of California, has Natirized this concept of dependence by pointing out the "pain-ful symptoms" he experienced when deprived of his automobile,°6 while another author wrote of his father's dependence upon the Sunday New York Times.67

Psychological dependence is hardly uncommon. It is difficult to think of a better description than that of Ishmael in Moby Dick:

Whenever I find myself growing grim about the mouth; whenever it is damp, drizzly November in my soul; whenever I find myself involuntarily pausing before coffin warehouses, and bringing up the rear of every funeral I meet; and especially whenever . . . it requires a strong moral principle to prevent me from deliberately stepping into the street, and methodically knocking people's hats off—then, I account it high time to get to sea as soon as I can.68

The question, of course, is just how habituating marijuana really is. The Bureau of Narcotics and Dangerous Drugs has strongly implied that the distinction between addiction and marijuana dependence is unimportant, and that the two types of craving are of equal strength.

From a medical standpoint, this distinction cannot be overlooked, but it assumes less importance when considering the practical social dangers of the drug. Dr. David P. Ausubel, in his book,

Drug Addiction, noted that chronic users of marihuana will go to great lengths to insure that they will not be without the drug. Deprivation, he says, may result in "anxiety, restlessness, irritabil-ity, or even a state of depression with suicidal fantasies, sometimes self-mutilating actions, or actual suicidal attempts." Other re-searchers have also observed that, from a psychiatric point of view, marihuana dependence is but little different from narcotic addiction.69

The government, however, took a very different position in attempting to justify Operation Intercept as a method of pricing marijuana out of the market. According to an interview with Deputy Attorney General Richard Kleindienst:

... the administration would like to make marijuana smoking as expensive as using heroin. Few youths would experiment with it at that price, he reasoned.

Would marijuana users turn to street crime—as heroin addicts usually do--to obtain the higher priced drug?

"Since marijuana is not addictive, we don't think that our students and young people will resort to crime in order to get.it," Kleindienst replied.70

Actually it is the Deputy Attorney General, not his subordi-nate agency, who is correct. We lcnow, for instance, that it seems easier for most marijuana-users to give up marijuana than for cigarette-smokers to give up tobacco, which is strongly habituat-ing. It is easier for most marijuana-users to give up their drug than it is for many drinkers to give up alcohol, which is not only strongly habituating but also, when used excessively over long periods of time, actually addicting. Dr. J. M. Watt's observation that marijuana does not "establish a strong craving as in tobacco smoking and indulgence in alcohol,"71 is partially confirmed by Dr. Donald Louria's statement that between two and five percent of marijuana-users become "pot heads."72 Although most authori-ties in the field would place their estimate of marijuana's de-pendence-producing potential below that of Dr. Louria's, even that figure is less than half the dependency rate for alcohol and even further below that for tobacco.

Certainly one cannot argue from this that marijuana is not in some sense habit-forming. First of all, it is likely that prolonged heavy use of marijuana concentrates such as hashish, especiallyunder the conditions prevalent in non-Western countries, does lead to a very strong drug habit. Moreover, even under American con-ditions marijuana use may become a habit—as can the use of coffee, cola drinks, or several other types of beverage. On the other hand, in evaluating the strength of the marijuana habit, we should realize that most users do not use the drug on a regular basis, and among those who do, the great majority do not use it as much as twice a week. Moreover, many students have smoked the drug on a somewhat regular basis while away at college and have then returned home and ceased smoking it, either because they were afraid of discovery by parents or because the drug was unavailable in their home area. Their behavior indicates that what-ever the strength of the habit, it can be broken in most cases with-out much inconvenience.

Of course, there are certain patterns of marijuana consumption that do raise an inference of strong psychological dependence. One &curs where, upon the user's discovery of marijuana, he smokes it quite heavily—two or three cigarettes a night on most nights.73 In this case, marijuana occupies a very important position in the user's life. He generally proclaims its virtues and devotes a sizable fraction of his waking hours to contemplating his subsequent use, thinking about his previous use, or actually being under the influence of the drug. Typically this type of use pattern disappears in a month or two, and the user either gives up the drug entirely, reverts to a social use on a once- or twice-a-week basis, or, as we will discuss in the next chapter, may take up the use of stronger drugs.

The heavy use of marijuana is not, however, confined to this type of user. There are a small number of users who for consider-able periods use the drug several times daily so that they are almost continuously under its influence. Two facts about such abusive use, however, are extremely interesting.

First, they are extremely rare. One study, by G. Lewis Scott, then a Stanford law student and now an attorney for the Los Angeles Public Defender's Office, specifically looked for such abusive marijuana-users and found only a handful." On the Stan-ford campus, despite the widespread use and availability of the drug, Scott was able to discover only one person who was in the extremely heavy-use category (though there must have been some others who were not found) ; and according to Dr. Roger Smith, there are very few even in the high drug-using Haight-Ashbury population who use marijuana in such quantity that, if taken alone, it would seriously interfere with their functioning in society.75

The second interesting fact about heavy and continuous use of marijuana is that though it is hardly conducive to efficient func-tioning in society, it is not nearly as disabling as one would expect. Two of the users Scott found were full-time students—one an undergraduate at Stanford and one a law student at the University of California—whose grades, though perhaps well below their capa-bilities, were nonetheless well within the satisfactory range.

Probably the best way to get a feeling for the life-style of the heavy and continuous marijuana-user is to read Scott's description of one of his subjects:

The first impression one has of Bill is of leanness and strength. He stands six feet two and weighs 190 pounds, all muscle, no fat. He moves, as expected, with grace and coordination, but appears to be brooding when in repose. He graduated from Yale with honors in English, earned five varsity letters, attended one semester at the Harvard Business School, and then refused to follow the way the arrow was pointing. Having dropped out, in Establishment terms, he is now a San Francisco mailman who smokes marijuana, talks politics, and reads philosophy, all continually.

Bill's family background is a mixture of the NCAA wrestling championship and Dr. Norman Vincent Peale. His father died of a heart attack at the age of forty-five while trying to prove that he was still as tough in the ring as he was at twenty-two when he was king of the NCAA. His mother, when she can reach Bill, sends him signed copies of Peale's book, inscribed "Get a hold of yourself, Bill, I know you can [signed] Norman Vincent Peale." His mother donates half her income from the estate to Peale, and exhorts Bill to make his father proud and become a "go-getter," not a "do-gooder"—Willy Loman in wrestling tights.

Bill comes from a wealthy suburb of Chicago, and while at high school was a leader, both as a student and as an athlete. Colleges drooled over him. His father, who went to Penn State University, wanted Bill to go to Yale because it "opened all the doors to business," and would tolerate from Bill no silly arrogance about Harvard or Oberlin. Although Yale was a little "pink," it was still the best. Bill is almost mute about his child-hood; he mentions only his father's temper and his mother's simpering religion.

When Bill's father died, Bill dropped out of Yale for a year and joined the Marine Corps for six months of active duty. He hated it. When his discharge papers came at the end of the six months, they were summarily burned. He rants about the military much more emotionally than about anything else, but the ranting serves as catharsis.

He went to the Harvard Business School because he could not figure out what else to do, but after one semester he knew he had made the wrong choice: "It was not creative enough." After that, he first went to see his mother, who was apparently sick, but, he says, she was only trying to trap him at home. Then he tended bar for a while in New Orleans and there received his introduction to marijuana. After being turned down by the philosophy department at the University of California at Berkeley, he decided to come to California anyway. He worked for a while as a house cleaner in Berkeley, saved his money, and began study-ing the Oriental mystics. He claims that after three years of study he still knows very little: "You have to break out of the mold of Western logic and see and feel."

He lives in a small apartment in San Francisco--living room, kitchen, bedroom, bath. The furniture is second-hand but clean, comfortable, and sturdy. He refinished the coffee table himself after buying it in a used furniture store, and it looks new. An enormous number of books stand in neat stacks along two walls. Many are standard works of literature, philosophy, and politics, but a great many are on Oriental philosophy. He has an expensive record player and radio, and the hundred or so record albums reflect a taste for both classical and folk music. A reproduction of a Miro painting on one wall faces a Klee reproduction on the other. Everything is clean—the sink, the tables, the floor, even the windows. In a word, the apartment looks as though a very orderly, very neat, very intellectual college student lives in it.

Bill's morning is like any working man's except for one thing: his first act in the morning is to light the "joint" he has rolled the previous night before going to bed. He takes a few drags and then carefully puts it out. He showers and shaves, and after putting on inexpensive but clean clothes, he relights and finishes the joint. During a large breakfast, he reads the newspaper or finishes a chapter in a book he started the night before. He then washes the dishes, makes his bed, and, with precision, rolls two more joints. A common morning in his apartment, but the sweet, pungent smell of marijuana lingers after Bill leaves.

His job is routine, and he does it without really thinking, but because he is slightly "stoned," he sees the sunlight on a building, the shadows in an alley, or hears the sound of a car in a different way than he did when stoned yesterday. About noon the marijuana starts to wear off and he ducks behind a building for a little more; he eats a big lunch and finishes the joint after lunch. The second joint is smoked during the afternoon.

If you were to follow Bill around on his job, it would be difficult if not impossible to discover if he was stoned. He walks steadily and talks coherently—he controls his high. Two things might give him away: he looks a little blank in the eyes and he tends to stare at a bird, a tree, a crack in the sidewalk a bit too long. Just for a second, he is not quite there.

Bill is between girl friends at the moment. If he werg not, his routine would be slightly altered both morning and evening because she would probably be living at his apartment, and he would talk to her before making plans for the evening. But almost every evening, Bill eats at home or at a friend's apartment. There is no need to eat out because both he and his well-fed circle of friends are, almost to a person, excellent cooks.

The nights of the week for Bill are almost equally divided among going to the movies, reading, and talking politics with friends. Bill is not faced with a dilemma over television programs since he does not own a television set. The one constant in every evening, however, is marijuana—never less than one but never more than three joints. . . .76

For at least some users, however, dependence on marijuana can be a very serious problem. When one is dependent on an intoxi-cant he will often use it at inappropriate times. For adults, except for the very few, like Bill, who use the drug during working hours, this may not be serious since their evenings are generally their own. But for school-age children, dependence on marijuana may lead to missed homework assignments, failure in schoolwork, and a general attitude that one can escape the difficult problems of growing up by retreat into a drug-induced euphoria. This latter effect may be most significant. Adolescence is a period of painful adjustment and of developing a whole new set of responses to the challenges of maturity. Use of a drug that allows one to avoid these problems can leave the adolescent half grown up and with-out sufficient "coping mechanisms."

Some cases of marijuana dependence of this type have been reported, though as yet only informally. Perhaps, however, because of the illegal nature of the activity, young people are not seeking medical help or physicians are not widely discussing the problem. A not too different clinical entity—dependence on watching tele-vision to escape one's problems—has been reported to be fairly widespread,77 and it is likely that marijuana dependence will become at least as great a problem among the young. We should not, how-ever, conclude that every use of marijuana by one of tender years is a precursor of marijuana dependence. Such use is to be dis-couraged as much as possible, since it involves both a relatively high risk and a user not mature enough to judge for himself whether to take it. Nonetheless, even in areas of heavy marijuana use, use of alcohol by preteens is still considerably greater than that of marijuana.78 Just as alcohol is occasionally used by those in thek early teens without producing dependence, it is likely that the sizable majority of even the very young smokers of marijuana will escape without serious damage—though the fact that they are willing at that age to use any drug is, in itself, ominous.

Finally, we should realize that in itself the capacity of a drug (or for that matter anything else) to produce dependence is at most a very weak reason to criminalize it. Even if we assume, as we do throughout this chapter, that harm to the user of a drug is a proper reason for criminalization, dependence on a drug, without any other ill-effects, involves the most attenuated type of harm to the user. Of course, if the drug causing the dependence causes addi-tional harm to the user (as it may to the adolescent) or to others, the fact that the user will find it difficult to stop use may be a factor aggravating the danger of the drug use. Otherwise, however, dependence on a drug (or television, sailing, or a host of other activities) is harmful only because it interferes with the Platonic virtue of free will or the Puritan virtue of self-control. It is hard to see, however, how either of these types of interference, in itself, provides any justification for criminalizing any substance.

Marijuana and Mental Illness

After drug dependence, the most commonly ascribed chronic danger of marijuana use is some kind of mental deterioration. Men-tal deterioration is an especially vague term, so for the purposes of this discussion it will be helpful to divide the issue into three cate-gories: mental illness, brain damage, and the amotivational syn-drome. For the most part, the allegations of a connection between marijuana and mental illness, like those of a connection between marijuana and violence, are based upon studies made in under-developed countries. For the same reasons, moreover, one cannot place much reliance in them. The fact is that the nations they orig-inate in are underdeveloped scientifically as well as economically.

In addition, much of this work is fairly difficult to interpret—in great part because a requirement of internal consistency does not seem to be applied so rigidly as in Western science. Thus, as quoted by several representatives of the Bureau of Narcotics and Dangerous Drugs, the Chopras, reporting on the Indian experience, assert that

Acute mental derangements due to cannabis drugs are marked by extreme vehemence of the mania.... If at liberty, he is violent, aggressive, and may run amock. These symptoms are not so pro-nounced in other forms of mania. Instances are on record where the patient in this state of excitement got hold of a weapon and committed murder without any reason or provocation.79

We should, however, note that elsewhere in the same article they seem to reach a conclusion that at least points in the opposite direction:

So far as pre-meditated crime is concerned, particularly that of a violent nature, the role of hemp drugs is quite distinctive. In some cases they not only do not lead to it but actually act as deterrents. We have already remarked that one of the important actions of these drugs is to quieten and stupefy the individual so that there is no tendency to violence, as is not infrequently met with in cases of alcoholic intoxication. The result of continued and excessive use of these drugs in our experience is to make the individual timid rather than to lead him to commit crimes of a violent nature.80

Moreover, even if the foreign literature is accepted at face value, the conditions in the countries that report widespread marijuana abuse are so different from those in the United States that it is hard to draw from them any conclusions relevant to this nation. By and large, they are cultures that do not use alcohol, and hence a high proportion of those people who have psychological com-pulsions to disable themselves through drug abuse are more likely to do so with easily available marijuana derivatives. More important, perhaps, is the fact that the populations of the non-Western countries studied live under conditions very different from our own. It is perhaps no coincidence that those nations with a marijuana problem also have high rates of unemployment and malnutrition. The effects of the drug on ill-fed individuals who have nothing better to do than to remain intoxicated are very different from the effects of the drug upon persons, even in the same country, who are better nourished and less socially demoralized. And it is, of course, this latter group that much more nearly approximates the typical American users.

On the other hand, since the foreign experience is so often cited in discussing the chronic effects of marijuana, it will be valuable to examine it to see just what it does—and does not—show.

The Indian Hemp Drugs Commission. Certainly the most careful and scientific study in any of the non-Westem cultures was that of.the Indian Hemp Drugs Commission. Inasmuch as it was an essentially Western scientific study operating upon a non-Western culture, there are many reasons to pay careful attention to its conclusions. And despite the fact that its methodology is not up to modem standards, no other study of marijuana to date has matched it in care and thoroughness. In India, at the time of the commission investigation, it was very much the common impression that consumption of hemp drugs (marijuana and its concentrates), especially to excess, produced insanity. In addition to the popular impression, statistics from Indian mental institutions had been relied on widely, not only in public discussions but also in scientific treatises and journals, to support the connection between hemp drugs and mental illness.

Looking at the matter afresh, the commission decided that the popular impression was not probative because "the unscientific popular mind rushes at conclusions and naturally seizes on that fact of the case that lies most on the surface."81 Moreover "an intoxicant would naturally be more readily accepted than other phys-ical causes because some of its effects as seen in ordinary life are very similar to the symptoms of insanity.82

Furthermore, as the commission pointed out, the superin-tendents of mental hospitals in India had reinforced the popular conception because they saw only those patients who were mentally ill and had no idea as to "the vast majority of cases" where no such illness was manifested by similar drug-users. (This has been analogized by an American psychiatrist to examining the incidence of tobacco use in a mental hospital and concluding that it was a substantial factor in causing mental illness.83) As a result, the commission, in order to make its own determination, was forced to examine carefully the statistics from India's mental hospitals.

The first thing the commission noted was that, even in England, there often was great difficulty in determining the cause of any particular case of insanity. In both England and India, there were enormous variations not only in the methods of diagnosis but also in the relative frequencies of different diagnoses from hospital to hospital. The commission discovered that, typically, the diagnoses made by the Indian mental hospitals were taken from the "descriptive role" that was sent to the asylum at the time the patient was delivered. It turned out that this descriptive role was not, in general, filled out by a psychiatrist or even a doctor but rather by the policeman or by the magistrate who had committed the patient. In some of the cases, indeed, it turned out that the police had been merely writing down "the statements of the lunatic himself, the man being at the time insane." Since neither the police nor the magistrates had the training or the inclination to make an accurate diagnosis, a diagnosis of insanity due to excess use of hemp drugs was used where no other obvious cause appeared—though at least one witness stated that in many of the cases it could just as well have been attributed to the catchall European diagnosis of insanity traceable to blows on the head.

After a complete examination of the sources of the hospital statistics, the commission, with what seems, considering the provocation, to be exceptional restraint, commented:

It may well seem extraordinary that statistics based on such absolutely untrustworthy material should have been submitted year after year in the asylum reports. It is extraordinary and cannot be fully justified.84

As a result of the unreliability of the hospital statistics, the commission attempted to make its own diagnosis of all of the admissions to Indian mental hospitals in one year, 1892. Among the 1,344 admissions, the commission found only ninety-eight where hemp drugs could be considered to be a factor, and in only sixty-one of these was there no other factor whose involvement seemed to be more significant than that of the drug. Moreover, even as to these the commission could not "say that the use of hemp drugs was in all the sole cause of insanity or indeed any part of the cause." First, there were difficulties in getting all of the necessary information, which might in some cases have revealed other causes of insanity than the drug use; second, there were no typichl features or symptomatology of "hemp insanity" that al-lowed diagnosis to be made, "unless perhaps it was the shorter duration of the madness"; and, finally, the problem of determining whether the excessive use of hemp drugs was a symptom of the insanity rather than a cause was completely intractable. As a result, the commission felt, one might look with suspicion on any diagnosis in any case of insanity caused by excessive drug use.

That, however, did not mean that the "hemp insanity" was impossible. It was merely not proven. The commission therefore concluded, as much in keeping with popular beliefs as the evidence before it permitted:

In respect to the alleged mental effects of the drugs, the Commission have come to the conclusion that the moderate use of hemp drugs produces no injurious effects on the mind. It may indeed be accepted that in the case of specially marked neurotic diathesis, even the moderate use may produce mental injury. For the slightest mental stimulation or excitement may have that effect in such cases. But putting aside these quite exceptional cases, the moderate use of these drugs produces no mental injury. It is otherwise with the excessive use. Excessive use indicates and in-tensifies mental instability. It tends to weaken the mind. It may even lead to insanity. It Has been said by Dr. Blanford that "two factors only are necessary for the causation of insanity, which are complementary, heredity and stress. Both enter into every case: the stronger the influence of one factor, the less of the other factor is requisite to produce the result. Insanity, therefore, needs for its production a certain instability of nerve tissue and the incidence of a certain disturbance." It appears that the excessive use of hemp drugs may, especially in cases where there is any weakness or hereditary predisposition, induce insanity. It has been shown that the effect of hemp drugs in this respect has hitherto been greatly exaggerated, but that they do sometimes produce insanity seems beyond question.85

The Chopra and Chopra Study. Though merely ranking any one of the other non-Westem studies as second to that of the Indian Hemp Drugs Commission tends to obscure great differences in their thoughtfulness and care, it is probable that the next most reliable study is that of Chopra and Chopra.86 The Chopras report that, by examining the inmates of "all the important Indian mental hospitals between 1928 and 1939," they were able to eliminate "all doubtful cases" and collect "reliable data concerning 600 cases of insanity attributable to cannabis drug. . ."87 Unfortunately their evidence is somewhat less clear than this, since they have further divided the six hundred cases into four hundred "unmixed cases in which the cannabis habit was found to be the only illicitable cause of insanity," and two hundred mixed cases in which "other factors such as heredity, predisposition, indulgence, and other intoxicants . . . such as alcohol, datura and opium were also involved."88

Perhaps the most striking thing about the Chopras' data is that in a huge country, where some types of cannabis are ingested and other types smoked in the form of hashish, only six hundred admissions to mental institutions were unambiguously traceable to marijuana—and in one-third of these, other data makes the "unambiguity" most doubtful.89 Moreover, even the cases that seem medically unambiguous are complicated by the fact that, as the Chopras point out,

the social disfavor and boycott of the addicts in certain parts of the country where the use of cannabis is not common makes it difficult for them to lead a normal life which may bring about unfavorable changes in their character and gradual mental and moral deterioration.90

And when one also considers the Chopras' remark that habitual use of cannabis drugs impoverishes the addict, whose income is generally small, so that he spends a large portion of his meager earnings on the dope and in consequence has very little money to obtain the daily necessities of life . . .91

it is hard to argue that even chronic overuse of marijuana is demonstrably a major cause of insanity in India.

The Benabud Study. After the Chopras' data, the most widely quoted report on the dangers of marijuana is a study by Dr. Ahmed Benabud of over 1,200 persons admitted in 1956 to a large mental institution in Morocco." Benabud admits, to begin with, that there are certain serious statistical problems in examining the population of this hospital as a cross section of Moroccan mental patients. First, certain regions

send only dangerous anti-social cases . . . [others] are only just beginning to use the hospital services . . . [and Casablanca] uses the same criteria for admission . . . as in a French town.93

Nonetheless, Benabud divides the cannabis psychoses into a bewildering variety of pathologies. Thus, he includes "cannabis psycho-ses," "psychoses with cannabis element," "cannabis psycho-ses with toxic infectious elements," and "pure cannabis psy-choses." In addition he sets out tables on "syphilitic infection associated with cannabis intoxication" and "alcoholism and can-nabis addiction."" Overall, Benabud concludes that of those ad-mitted to the hospital sixty-eight percent were marijuana smokers." In somewhat under a fifth of these "the intoxicant [had] no effects on the clinical aspect or on the development of the case."" Bena-bud has divided the remaining four-fifths of the marijuana smokers into those characterized as "psychoses with cannabis element [in which] the psychopathic pattern is predominant"" and those of acute, residual, and deficiency syndromes. In both cases Benabud subdivides his categories further into categories" where the mari-juana use is aggravated by alcoholism, schizophrenia, epilepsy, and so forth. However, nowhere in Benabud's paper can one find a figure approximating the Chopras' irreducible minimum of six hundred (or perhaps four hundred) where the psychoses were solely due to marijuana use.

Moreover, the probability that Benabud's study might apply to American conditions is considerably reduced by his observation that one of the factors facilitating his research work is that:

most of the patients being penniless, and therefore mentally back-ward owing to a lack of education and the crippling worries of hard life, live in a world without many complexities. Reactions to the toxic effects of cannabis addiction will consequently be of little variety and the symptomatology is generally restricted.99

Cannabis psychoses, according to Benabud, occur overwhelmingly among the "neoproletariat" of displaced slum-dwellers "who, for the most part are Berbers with scanty means in small jobs which are uncertain and changing, wretched food and housing, who, more-over, have no future to look forward to.""° In conditions somewhat more favorable, however, marijuana is not nearly so destructive. Benabud points out that although

kif [a marijuana preparation less concentrated than hashish but somewhat stronger than that typically used in the United States] addiction is widespread in the country districts it is mainly found among moderate smokers who smoke only. at work in order to keep up their spirits or as a relaxation. . . .iot

Benabud adds that, as the country saying goes, "a little kif warms, a lot burns"1" and that "addiction in the country dis-tricts . . . though endemic, has far fewer psychopathological consequences."103

There is yet another reason to be cautious in accepting Bena-bud's data. According to a communication published in the Inter-national Journal of Addictions, the mental hospital that gave rise to his study had a professional staff of one psychiatrist and four physicians to care for its two thousand patients. At least as of the time of the communication, it had neither of its quota of two psychiatric social workers and the daily per-patient expenditure including professional and nonprofessional staff was $1.20. More-over, as pointed out by the writer of the communication, American psychiatrist Tod H. Mikuriya, it was not only the shortage of pro-fessional staff that made diagnosis uncertain:

Usual laboratory studies beyond routine blood count, urinalysis, and chest X-ray were unavailable. An EEG machine was acquired only last year. Post-mortem examinations were and are rarely performed because of adverse attitudes within the Moslem community.104

The Wootton report discussing the foreign studies somewhat charitably states:

There have been reports, particularly from experienced ob-servers in the Middle and Far East, which suggest that very heavy long-term consumption may produce a syndrome of in-creasing mental and physical deterioration to the point where the subject is tremulous, ailing and socially incompetent. This syn-drome may be punctuated on occasions with outbursts of violent behavior. It is fair to say, however, that no reliable observations of such a syndrome have been made in the Western World, and that from the Eastern reports available to us it is not possible to form a judgment on whether such behavior is directly attributable to cannabistaking.105

An American Study. In the United States there are a num-ber of studies that picture chronic marijuana use as a cause of men-tal illness. Typical of these is a recent one entitled "The Role of MarijUana in Patterns of Drug Abuse by Adolescents," by Dr. Doris H. Milman of the Department of Pediatrics, State University of New York, Downstate Medical Center.'" Despite its title, the major thrust of Dr. Milman's work is that "Marijuana, as used by young people with unstable personalities, is capable of precipitating acute psSIchoses, {and] may contribute to the production of chronic psychoses. . . ."1" An examination of this paper shows that it is based entirely on a study of eleven young middle- and upper-class marijuana-users, all of whom had been diagnosed as having either acute or chronic schizophrenia.

An examination of the entire sample, however, casts doubts on the causation issue in each case. One of the eleven subjects apparently had suffered an acute panic reaction to marijuana use, though it is hard to conclude that this caused his schizophrenia:

This boy had intermittent psychiatric treatment over a period of many years beginning at age eight. . . . The diagnosis established in a consultation at age eleven was personality disorder character-ized by passive aggression and emotional instability. He had a single experience with marijuana at a party immediately following which he became "panicky, disoriented and immobilized." He remained depressed and withdrawn and disoriented for a week and then gradually recovered. . . . He never again used drugs.108

Moreover, although Dr. Milman reports that another six of the eleven had become chronically schizophrenic "after a variable period of drug use," this subgroup had received psychiatric exam-inations before using marijuana and had been diagnosed as having "personality disorders." The final group of four patients, who had not been examined previous to their drug use, all were diagnosed afterward as suffering from chronic schizophrenia. Dr. Milman concludes that in these cases, drug use was a causative factor in the mental illness because of what to other observers might appear a non sequitur:

The fact that psychiatric consultation was not sought [before drug use] suggests that drugs contributed in significant measure to impaired functioning; [and second] this hypothesis is further supported by the fact that the parents sought consultation because of problems other than drugs and were in fact unaware that their children were using drugs.109

One can read Dr. Milman's paper again and again to attempt to find some persuasive reason to believe that the marijuana use caused the schizophrenia in any of the cases. First of all, the change in diagnosis from "personality disorder" to schizophrenia in the six users who had previously been examined is not probative. Psy-chiatrists typically hesitate to diagnose schizophrenic adolescents as schizophrenics until they have reached a certain age—Rrefer-ring, as in Dr. Milman's sample, a diagnosis such as "personality disorder."

There are several additional methodological problems in con-cluding causation in Dr. Milman's sample. According to her report, all eleven youths had basic psychodynamic problems such as sexual muddy and inadequacy; and, as the Indian Hemp Drugs Commis-sion pointed out, drug use by those who are fighting for mental stability can often be mistaken as a cause of the instability. More-over, attributing causation of the mental illness to marijuana use is further weakened by the fact that ten out of the eleven (all but the sufferer from the acute psychosis) had used multiple drugs such as LSD, amphetamines, and heroin. And finally the nature of schizo-phrenia is still so little understood today that there is no scientific proof (or even good reasons to believe) that drug use of any kind can cause the chronic form of this disease. In short, until these methodological problems are solved, this study, like many others, will remain merely a collection of histories of very disturbed young people who happen to have used marijuana.

Marijuana and Brain Damage

For the most part today, the allegations of law-enforcement officials are not that marijuana use causes mental illness but rather that it causes long-run mental deterioration—brain damage. Thus Matthew O'Connor of the Califomia Narcotics Bureau states:

Continued use of Marijuana over a long period (approximately ten years) brings about a general condition and appearance of being inebriated. The person has difficulty keeping a trend of thought, frequently misunderstands others in conversation, and over-dramatizes a minor point of discussion to inordinate propor-lions. In essence, the user becomes lethargic, self-negligent, and generally "Rummy" or "Punch Drunk." There are persistent re-ports from Africa and India reflecting possible mental disorders, attendant to continued and over-indulgence in Cannabis.110

The Bouquet Study. Again the primary reliance is placed upon foreign studies, probably the most cited of which is that of Bouquet on the Tunisian experience.111 Unlike Benabud, Bouquet asserts that marijuana smokers "scarcely ever attain a condition of dementia: it is not in mental asylums that they are to be found but in the riff-raff of professional beggars, vagabonds and thieves.”112 Assuming that Bouquet is describing a genuine drug effect and not merely the way members of his society treat a certain type of drug-user, his picture is somewhat reminiscent of our own chronic alcoholic, though his "liff-raff" are perhaps less seriously disabled. Bouquet, however, cites no figures to give us any indication of the extent of this syndrome, as a percentage either of the nation or of the marijuana-using population. Moreover, the relevance of Bouquet's findings is greatly reduced by three of his own observations: (1) that the most serious chronic effects are due to prolonged use of hashish and "only exceptionally [to] the smoking of chopped hemp" such as is predominantly used in the United States; (2) that hashish-users "do little or no work, take insufficient nourishment and live in deplorable hygienic conditions"; and (3) that they often mix their marijuana preparations with henbane or datura, both of which are extremely toxic.113

Indeed, Bouquet points out that

Hemp smokers are to be found who have been addicted to this vice for many years (thirty, forty or fifty) and who, apart from a certain obvious mental instability, show no signs of physical troubles, seem to have preserved normal health, and continue to follow their occupations. But in all these cases the individuals had managed to regulate and restrict their drug consumption. A few daily pipes of kif are merely an agreeable weakness, enough to induce the condition of euphoria and well-being which they desire. They can rest content with that.114

It is most likely that this type of chronic effect of marijuana—though perhaps atypical in Tunisia—would be the American pattern.

Finally, the presence of grossly debilitating chronic effects from prolonged marijuana use, even among the more serious abusers, is rendered less likely by Bouquet's complaint about the difficulty of diagnosing the marijuana "addict." Marijuana addicts are treated for a host of other complaints—including broncho-pulmonary afflictions, enterogastric ailments, and "syphilitic le-sions, which are quite common."115

During their time in hospital nothing is learned, as a rule, of their addiction; firstly because they themselves do not reveal it, and secondly because the subordinate nursing staff, although in permanent contact with them, consists of natives, who attach no importance to the vice and do not report it. Moreover, the labora-tory tests so far carried out do not reveal any special signs pointing to cannabis addiction. . . .

Another reason why the detection of this class of addict is difficult is that they do not show any of those withdrawal symp-toms which are so characteristic in the case of opium addicts and consumers of manufactured drugs that they cannot pass unnoticed.

Thus it is extremely difficult to discover such addicts, unless they give themselves away by some reprehensible act during, or as a result of, a bout of cannabis intoxication, or are caught red-handed holding or consuming a prohibited drug.116

The Miras Announcement. The other of the foreign "studies" most often cited on this issue is one that attracted a great deal of attention in the United States a few years ago. Dr. Constantine Miras of the University of Athens was widely quoted in American newspapers as saying:

I can recognize a chronic marijuana user from the way he walks, talks and acts. . . . You begin to see the personality changes that typify the long time user, the slowed speech, the lethargy, the lowered inhibitions and the loss of morality.117

The newspaper stories were based on a paper prepared for a seminar at the department of pharmacology at UCLA. In it Dr. Miras wrote,

In Greece heavy hashish smokers after 15 to 20 years are usually out of the community. This is due to laziness, psychic instability, amorality and loss of drive and ambition. They have rather apa-bhetic faces of a grayish yellow color.... They all look much older for their age, are slim and in very poor health. They speak and move very slowly in a peculiar way.118

Miras' description of the heavy hashish-user is strikingly like that of the American skid-row alcoholic. It is impossible, however, to tell from Dr. Miras' paper, which presents no supporting data or methodology, whether these are merely the heavy hashish-users who have come to his attention and what percentage of the hashish-using population they represent.

Subsequently, in June of 1968 at the Rutgers Conference on Drug Abuse Dr. Miras protested that he had been misquoted and that in fact he had been describing a very particular kind of exces-sive hashish-user. These hashish-users, he said, constituted only a minority of the long-term marijuana-using population and used the drug so that it very badly affected their position in society.

It is, of course, by no means clear that the mental disturbance was an effect of the excessive hashish use, rather than the reverse. And even if we could be confident that there was no underlying pathology, the effect of the Greek penal law, which makes hashish use seriously criminal, would render it very difficult to separate the effect of the drug from the effect of the social consequences to the user.

The Problem of Determining Brain Damage. Despite the foreign studies' failure to show that long-term marijuana use causes mental deterioration, it is impossible to conclude that they exonerate the drug. The fact is that on this issue the studies done in underdeveloped countries are of especially little help either way. It is interesting, however, that, in devoting so much attention to at-tempting to show that heavy use of the drug causes mental de-terioration, they seem to agree that long-term moderate use of the drug is not harmful.

The marijuana-user, however, can take little comfort from this, since the issue of long-term mental damage is a subtle one in which the lack of highly sophisticated methodology might be cru-cial. Nonetheless, it may be of some significance that by far the most reliable information we have from a non-Western area indi-cates that even there, the long-range effects of marijuana are not very serious. The Indian Hemp Drugs Commission, it should be remembered, found neither mental or moral injury from, long-term moderate use of marijuana preparations considerably stronger than those typically used in the United States today.

Moreover, though the matter is hardly settled, there is a cer-tain amount of evidence that indicates—though it certainly does not prove—that the chronic effects of marijuana, in this countryi are not so serious as has been alleged. First, the La Guardia Commit-tee not only found no permanent long-range effects of marijuana use but stated flatly that "there is definite evidence in this study that the marijuana users . . . [for up to 16 years] had suffered no physical or mental deterioration as a result of use of the drug.”119

Second, the largest study of use by military personnel, that reported by Freedman and Rockmore in 1946, examined 310 marijuana-users whose average length of use was just over seven years, and concluded that

if the continued use of the drug has a deteriorating effect on an individual, it was not observed in the clinical examination, the focus of which was the total personality development.120

Third, the Wootton report agreed with the view that the "long-term consumption of cannabis in moderate doses has no harmful ef-fects.”1.21 And fourth, students of the subject frequently come upon long-term marijuana-users, such as the California high-school principal who had used the drug daily for over fifteen years122 and who apparently have suffered no gross ill effects from the drug.

Of course, this type of information is very weak proof that marijuana causes no long-term mental deterioration. The problem of determining the long-range harm, especially the mental harm, due to any substance is an extremely difficult one. First of all, in the case of drugs, unless the harm is so gross as to be noticeable in a very high percentage of users, it may be attributable to any of the many other variables such as arrest, poverty, or malnutrition that are often associated with drug use. Moreover, unless the type of deterioration is an unusual one, the chances are that the same symptoms—or ones so closely like it that we cannot at this time differentiate between them—are shown by many non-drug-users. Tobacco, for instance, was widely used in our society under the impression that it was essentially harmless, only to later be revealed as causing gross long-term physical harm to a substantial per-centage of its users. Where the use involves the even more subtle question of brain damage it is not surprising that there is no clear evidence either way.

The problem of making determinations of brain damage is further complicated by several factors. First of all, such diagnoses of brain damage are not objective in the sense that X-rays objec-tively determine fractured bones and chemical tests determine ab-normal blood sugar. In most cases, diagnoses of brain damage, for obvious reasons, are made on the basis of behavior on certain psychological tests rather than through observation of physical damage to the brain. Indeed, brain damage is in many cases more of a postulate to explain certain unusual responses on various batteries of tests than a documented fact. In cases of all but the most gross damage, psychologists have to deduce from certain types and patterns of responses on these tests that the brain must be damaged, the damage in other ways—including autopsy—being completely unobservable.

Not only is the diagnosis of subtle brain damage often dif-ficult to make, with considerable variation in results among dif-ferent methods of testing, but, even more significantly for our purposes, brain damage of the type we might expect from drug use is hardly uncommon in our society. We as yet do not know what percentage of non-drug-users in our society have varying degrees of brain damage, but a figure of ten or fifteen percent would not be an unreasonable one. Indeed, it is possible to argue that brain damage, in terms of the death of brain cells without their replace-ment, is an inevitable consequence of aging with or without drug use, and that the process often begins to be noticeable by the age of twenty-five and continues throughout life.

Finally, the issue is complicated by the fact that substances whose capacity to cause brain damage has been far better documented than that of marijuana by no means produce such damage in every user. Alcohol, which is widely conceded to produce brain damage in long-term heavy users (and probably even in moderate users), has been used in enormous quantities over long periods by many famous people without any observable harm. And while the fact is that many long-term marijuana-users exhibit no sign of brain damage, all this proves is that for reasons as yet not under-stood these particular users have not been observably damaged. This, of course, may mean only either that they have been so subtly damaged that it is not yet observable or that they are atypical and that other users may nonetheless have suffered long-range damage.

One would think, therefore, that the only way to determine this issue would be to undertake a careful study of long-term marijuana-users to determine whether the incidence of subtle,brain damage among them is any higher than in a similar group chosen from the nonusing population. The difficulties of such a study, how-ever—even aside from the problems of diagnosis—are formidable.

First of all, the very illegality of marijuana makes it difficult to find enough long-term users who are willing to be sufficiently open about their violation of law. Second, those marijuana-users in whom one would most expect to find observable brain damage-- the extremely heavy users—very often also use other drugs that are considerably more likely than marijuana to cause brain damage, thus depriving us of the group which could be most likely to shed light on the damage caused by excessive use of marijuana. Third, we have the methodological problem that made so difficult the much simpler determination of the involvement of marijuana in mental illness. It is hardly unreasonable to expect that someone who was already brain damaged and having perhaps greater trouble adjusting to the world would seek out intoxicants and seda-tives in an attempt to alleviate his anxieties. As a result, even if one were to find that a large number of people who have brain damage have used marijuana or, for that matter, any other drug, the issue of causation would hardly be settled.

In short, based on today's knowledge it is hard to argue with any degree of certainty that marijuana use can or cannot cause long-term subtle brain damage. The fact that (as we will see in Chapter VIII) alcohol use and, according to several respected authorities, the overuse of sedatives and tranquilizers can cause brain damage makes this an expectable effect of marijuana as well—though it is of note that the two major reasons why alcohol produces long-term damage do not apply to marijuana. Neither is marijuana very toxic itself, nor does it supply calories and hence become a substitute for more nutritious food. And although it does seem to be true that long-term heavy users of hashish in some underdeveloped countries form a class of social dropouts not too unlike the alcoholic inhabitants of our own skid rows, it is not easy to det6rmine the relevance of this to the American experience. We must remember that in other countries a far stronger form of marijuana is used; it apparently is often "cut" with considerably more dangerous drugs such as datura; and most important, these cultures have much greater problems of malnutrition, unemploy-ment, afid social disorganization than does this country, all of which could be expected to intensify the deteriorating effect of any form of drug use.

In short, all we can say at the present is, first, that if mari-juana use does cause mental deterioration it has not yet been noted in any careful look at the problem; second, that whatever damage the drug does cause must be fairly subtle at least as compared to the easily observable and fairly gross effects of long-term alcohol abuse; and finally, with reference to the calls for "more research" before any changes are made in the law, if one wished to be abso-lutely certain that marijuana—or for that matter patent medicines, contraceptive pills, aspirin, or literally hundreds of other substances freely used in our society—did not cause subtle long-term brain damage, the task would take at least a generation.

Nor apparently can we stop with abuse of substances if we are truly concerned with eliminating the possible causes of brain dam-age in our society. One member of Congress, at least, believes we must look considerably further than this. As Representative James B. Utt (Rep., Calif.) puts it:

The Beatles, and their mimicking rock-and-rollers, use the Pav-lovian techniques to produce artificial neuroses in our young people. Extensive experiments in hypnosis and rhythm have shown how rock and roll music leads to a destruction of the normal inhibitory mechanism of the cerebral cortex and permits easy acceptance of immorality and disregard of all moral norms.123

The Amotivational Syndrome

One final alleged chronic effect of marijuana use is what is called the amotivational syndrome. The argument here is not that the long-term marijuana-user becomes mentally ill or suffers brain damage, but that for some not yet understood reason he simply loses interest in everything worthwhile and drops out of society. This picture, typically associated with the hippie, and more often said to be a consequence of LSD use, is becoming one of the more widely alleged dangers of marijuana. One guidebook for educators warns that "Marijuana may lead to extreme lethargy, self, neglect and preoccupation with the use of marijuana to a degree that pre-cludes constructive activity. 19124

A popular book on the topic refers to the experience of in-vestigators in the Middle East and Africa who had completed

a more thorough documentation on the lethargy which cabnabis produced; the wasteful man-hours lost; the personalities destroyed as the user sat immobile in his doorway, his only interest that of obtaining enough [marijuana] to maintain that state. One re-searcher speaks of a typical smoker useless to himself and society, emaciated, filthy, so wrapped up in his cannabis inspired dreams he only aroused himself when his wife brought him bits of food
and forced him to eat.125

Moreover, after the six-day Middle Eastern war of 1967, it was reported that,

Israeli mop-up crews picked up a ton of hashish abandoned in the Sinai Peninsula by the retreating Egyptian soldiers. How much its presence had to do with the lack of will to fight among the Egyptian army forces is a matter of conjecture?"

It is hard to evaluate this type of argument. Certainly, there does seem to be an alarming number of young people dropping out of our society, and this has come most to public attention during the sudden increase in marijuana use of the past few years. On the other hand, the causes given not only by the dropouts but also by those psychiatrists and sociologists who have examined the situa-tion do not include marijuana use. They are things such as the affluence of a younger generation that permits larger numbers of nonproductive lives, the rapid pace of social change, a sense of disillusionment with our society's approach to racial and inter-national matters, and a host of other reasons one could name. It is no doubt true that the great bulk of the dropouts have used mari-juana. The problem with concluding anything from this is that it reverses the cause and effect. One of the very first ways a young person could demonstrate his estrangement from society was to break a revered societal law that he regarded as foolish, and hence smoke marijuana. It should be noted that Bill, the constant mari-juana-user described on pp. 164-67, was well on his way to be-coming a dropout before he first used marijuana.

Moreover if drug use is to blame for the amotivational syn-dromel the likelihood is that the effective drug is not marijuana but LSD. At least those hippies whom one can point to as exem-plifying the American version of the amovitational syndrome attrib-ute their loss of interest in "making it" to their LSD rather than their marijuana experiences. Finally, and most important, we should not be prepared to accept any hypothesis of causation until some mechanism can be postulated that is consistent with the facts we know. So far as the amotivational syndrome is concerned the only attempt to do this relies not on any published scientific work but upon the authority of Sports Illustrated magazine. Dr. Edward Bloomquist, in his book Marijuana, relying on this authority com-pares marijuana use to life on the island of Bora Bora:

[In Sports Illustrated] Coles Phinizy says "because they are both beautiful and bountiful, many of the small Polynesian islands that litter the South Pacific are dangerous places. At first sight of such beguiling shores, too many men fall in love and jump ship, foolishly believing that they have found a paradise where the mangoes are never wormy and worrying is against the law. . . .

"The man who goes to paradise to spend the rest of his days quite often finds after only a month that his senses are surfeited and starting to decay. The hibiscus and the dancing colors of the lagoon fade and are wasted on the eye. In time even the mango loses its taste and only the worm remains. Although none of the island songs mentions it, it is a fact that paradise has a sneaky way of turning a complex man into a discontented vegetable."

If overexposure to an excess of natural beauty can do this, when the mind is presumably operating normally, it can certainly be argued that overstimulation of one's sensory faculties by psycho-toxic drugs can do at least the same, if not worse. The effect with drugs, however, is likely to be quicker and more lasting.127

Of course, the problem with this argument is that it applies, if at all, only to the very small minority of users who spend all their time on the "tropical island" of marijuana. For even the heavy users short of this, the analogy is closer to a commuter from the island to the United States. Whatever his other problems, it is unlikely that he would suffer from "an excess of natural beauty."

The effort to link the amotivational syndrome with mari-juana sometimes reaches even more absurd lengths. One labora-tory researcher announced (fortunately informally) that ,he had produced the amotivational syndrome in a cat by feeding it a marijuana extract. The animal indubitably did just sit in a corner of its cage and did not appear interested in anything. Other scien-tists examining it offered the possibility that the animal simply had been made sick by the overdose—which was truly enormous. This view received strong corroboration when the poor beast died a few days later.

The AMA-NRC Committee Report

If the effects of cannabis, so far as we know them, are so comparatively innocuous, one might well ask why the drafts-men of the joint report by the Council of Mental Health and the Committee on Alcoholism and Drug Dependence of the American Medical Association, and the Committee on Problems of Drug Dependence of the National Research Council, have labeled the drug as "dangerous."128 Actually a reading of the widely quoted report shows that its description of the dangers of marijuana is extremely vague. The total description of the dangers of the drug is set out under the first two headings (the other three demand lowered penalties, more research, and better education) :

After careful appraisal of available information concerning mari-huana (cannabis) and its components, and their derivatives, ana-logues and isomers, the Council on Mental Health and the Committee on Alcoholism and Drug Dependence of the American Medical Association and the Committee on Problems of Drug Dependence of the National Research Council, National Academy of Sciences, have reached the following conclusions:

1. Cannabis is a dangerous drug and as such is a public health concern.

For centuries, the hemp plant (cannabis) has been used exten-sively and in various forms as an intoxicant in Asia, Africa, South America, and elsewhere. With few exceptions, organized societies consider such use undesirable and therefore a drug problem, and have imposed legal and social sanctions on the user and the distributor.

Some of the components of the natural resins obtained from the heinp plant are powerful psychoactive agents; hence the resins themselves may be. In dogs and monkeys, they have produced complete anesthesia of several days' duration with quantities of less than 10 mg/kg.

Although dose-response curves are not so accurately defined in man,' the orders of potency on a weight (milligram) basis are greater than those for many other powerful psychoactive agents, such as the barbiturates. They are markedly greater than those for alcohol. In India, where weak decoctions are used as a beverage, the government prohibits charas, the potent resin, even for use in folk medicine. In many countries where chronic heavy use of cannabis occurs, such as Egypt, Morocco, and Algeria, it has a marked effect of reducing the social productivity of a significant number of persons.

The fact that no physical dependence develops with cannabis does not mean it is an innocuous drug. Many stimulants are dangerous psychoactive substances although they do not cause physical dependence.

2. Legalization of marihuana would create a serious abuse problem in the 'United States.

The current use of cannabis in the United States contrasts sharply with its use in other parts of the world. In this country, the pattern of use is primarily intermittent and of the "spree" type, and much of it consists of experimentation by teenagers and young adults. Further, hemp grown in the United States is not commonly of high potency and "street" samples sometimes are heavily adulter-ated with inert materials.

With intermittent and casual use of comparatively weak prepara-tions, the medical hazard is not so great, although even such use when it produces intoxication can give rise to disorders of behavior with serious consequences to the individual and to society.

And, while it is true that now only a small proportion of mari-huana users in the United States are chronic users and can be said to be strongly psychologically dependent on the drug, their numbers, both actual and potential, are large enough to be of public health concern.

If all controls on marihuana 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.

When advocates of legalizing marihuana claim that it is less harmful than alcohol, they are actually comparing the relatively insignificant effects of marihuana at the lower end of the dose-response curve with the effects of alcohol at the toxicity end of the curve—i.e., the "spree" use of marihuana vs. acute or chronic "poisoning" with alcohol. If they compared both driiis at the upper end of the curve, they would see that the effects on the indi-vidual and society are highly deleterious in both cases.

Admittedly, if alcohol could be removed from the reach of alco-holics, one of the larger medical and social problems could be solved. But to make the active preparations of cannabis generally available would solve nothing. Instead, it would create a com-parable problem of major proportions.

That some marihuana users are now psychologically dependent, that nearly all users become intoxicated, and that more potent forms of cannabis could lead to even more serious medical and social consequences—these facts argue for the retention of legal
sanctions.129

Aside from pointing out that other nations have criminalized marijuana and pound for pound the drug is more powerful than many other drugs, the first heading is hardly informative. The second heading consists primarily of predictions as to the social effects of changes in the marijuana laws. We will discuss these issues in Chapter IX, but in passing we should note that these social predictions are not only much more complex than the medical scientists have indicated but, in all probability, the doctors are simply wrong.

Of course, the physicians who authored the statement are in some sense correct in considering marijuana dangerous. To some extent the drug is dangerous. Its acute effects, like those of all psychoactive agents, including alcohol, involve some danger of psychiatric disturbance—especially to the adolescent and preadoles-cent user. And, although there is no evidence that chronic effects as gross as those reported in foreign countries will appear under American conditions, the effect of the drug may well be to dimin-ish initiative and impair the performance of the habitual excessive user—though, as long as such persons are self-selected, this effect may be extremely difficult to separate out from any psychological predispositions.

The problem is that the standards of dangerousness that the draftsmen of the AMA-NRC report have used do not take into account the difference between prescribing for the welfare of an individual patient and recommending a course of action for society. In the former case one may tell a patient not to take even slight risks where no benefits are seen in his drug use. And, if one dis-counts pleasure and does not recognize any "medical" benefit in the reduction of anxiety and strain that at least some users say comes from occasional moderate marijuana use, the issue is easy. However, one cannot conclude from this any answer to the far more complex question of whether the state should incur the social costs of making people do what is felt—even correctly—to be good for them.

For this purpose we must weigh not only the benefits of sup-pressing marijuana use but the social costs of attempting to do so as well. The fact that marijuana might be dangerous in the medical sense and yet, unlike heroin or LSD, not be so dangerous as to justify the costs of criminalizing it, has been recognized by the principal draftsman of the AMA-NRC committee report, Dr. Dana Farnsworth, who has elsewhere suggested that not only a first but a second conviction of marijuana possession should be punishable only by a small fine.13° It is a reflection of one's view of the seriousness of a disease to determine that the cure is worse than the disease.

Moreover, granting that marijuana is dangerous, we should realize several other things to place this information in context. First, we should further realize that marijuana is by no means the only drug widely used in our society that can be considered dan-gerous. Consider this description of the dangers of aspirin:

Aspirin has effects on almost every major system in the organism. . . .

In statistics reporting hospital admissions classified as result-ing from drug-induced disturbances, aspirin is often the most fre-quent cause. "Salicylate poisoning can result in death and the drug should not be viewed as a harmless household remedy. The toxicity of the salicylates is underestimated by both the laity and physicians." There were 5700 poison cases in Florida in 1966, of which 418 were reported by the four hospitals in Pinellas County. Of these 418, 199 were cases of poisoning from internal medicine and 92 were from aspirin.

At excessively high dosage levels or as result of individual idiosyncrasy, acute poisoning may occur. Headache, dizziness, ringing in the ears, difficulty in hearing, dimness of vision, mental confusion, lassitude, drowsiness, sweating, thirst, nausea, vomit-ing, and occasionally diarrhea may occur. As poisoning pro-gresses, central stimulation is replaced by depression, stupor, and coma, followed by respiratory collapse and convulsions. Salicylate poisoning is considered an acute medical emergency and death may result even when all recommended procedures are followed. In persons with hypersensitivity to aspirin, skin rashes, asthma, swelling of the eyelids, tongue, lips, face, and intestinal tract are not uncommon. Asthma constitutes the chief manifestation and may result in death. Aspirin may cause mild hemolytic anemia in individuals with certain blood deficiencies.131

And if it is argued that aspirin has "medical" uses, we should realize that at least two other nonmedical drugs are freely used in our society—tobacco and alcohol. The dangers of cigarette smoking are not completely comparable to those of marijuana, since (except for the far stronger habituating effect of tobacco) cigarette smoking seems to lead only to physical harm. Nonetheless, it is hard to believe that any rational person looking at the social cost of cigarette smoking in terms of lives cut short and family heads disabled, could consider that cost to be less than the social cost of the marijuana use presently seen in the United States—aside, of course, from the costs of our criminalizing the drug.

The case of alcohol is much more obviously comparable to that of marijuana because of the similarity of their use patterns and psychoactive effect. In view of the frequency with which this comparison is made in the literature and in discussions of the marijuana laws, a rather careful examination of its many facets will repay the effort. This we will undertake in Chapter VIII, but for our present purpose, we can note here that it is very hard to make a case that, in terms of danger to its user or to society, mari-juana is any more dangerous than alcohol.

In short, even though one agrees that marijuana is in some sense a dangerous drug, one must acknowledge that our society tolerates many dangerous drugs and all sorts of dangerous imple-ments that are not drugs. Thus, the number of people drowned in swimming pools each year (750 in 1969)132 is far greater than the number who die from any illegal drug use other than that of heroin. And yet we would reject without hesitation any attempt to forbid the building and maintenance of swimming pools—even though.they are primarily justified as pure pleasure. So far as drugs are concerned, there seems to be a certain quantum of danger to the user that we are willing to tolerate rather than suffer the costs of criminalization. It is the thrust of this chapter that the dangers of marijuana to its users lie well within this range.

Summary

To make meaningful statements about the effect of marijuana upon the health of its users, we must differentiate be-tween the acute and the chronic effects of the drug. Acute effects are here confined to "pathological" effects of an immediate use of marijuana, the "ordinary" acute effects having been discussed in Chapter III.

Aside from the question of automobile driving, which will be discussed in Chapter VIII, three basic arguments have been made that the acute effect of marijuana use is a major danger of the drug: (1) that in sufficient dosage marijuana can cause psychotic reactions in almost any user; (2) that marijuana may produce hal-lucinogenic effects; and (3) that the acute effects of marijuana are unpredictable. Each of these arguments is, in a sense, irrelevant to the proper treatment of marijuana by the law. For instance, studies purporting to show that marijuana causes psychotic reactions suffer from two main faults: (1) they rely in great part on laboratory studies that use considerably higher doses of the drug than does ordinary use; and, (2) the "psychoses," if any, are temporary, generally lasting no longer than the presence of marijuana in the individual's system. They are, in short, the marijuana equivalent of a good drunk.

Longer-lasting psychoses are not unknown, but they are today extremely rare--certainly far less frequent than injuries from aspirin.

The argument that marijuana may produce hallucinogenic effects attempts to link marijuana with the dangers of drugs such as LSD. This ignores the fact that: (1) marijuana is pharma-cologically a very different drug from LSD; (2) the social use and expectations regarding marijuana and LSD are entirely differ-ent; (3) many substances have hallucinogenic effects, but that this by no means implies that they involve the serious danger of LSD; and (4) marijuana is rarely taken in quantities large enough to produce hallucinations.

Finally, apart from any specific dangers of marijuana, there is the argument that the effect of the drug is unpredictable. Such unpredictability is due, in large part, to the illegality of the drug, since its strength cannot be standardized. More significantly, except insofar as it does harm to the individual user or to others, unpre-dictability is not a rational reason for the prohibition of a drug.

The arguments as to the acute effects are falling out ot favor today and are being supplanted by those relating to the major area of uncertainty regarding marijuana—the chronic effects. These center on four areas: (1) that use of the drug causes drug depen-dence; (2) that it causes mental ilhiess; (3) that it causes brain damage; and (4) that it causes an amotivational syndrome.

Despite the fact that marijuana is legally classified as a "nar-cotic," the accompanying belief that the drug must be addicting is untrue. It is reasonably clear that marijuana, unlike the opiates such as heroin, is not addicting. Most arguments along this line today concern habituation to the drug, rather than addiction. Abusive use of marijuana undeniably does exist, resulting in the individual's elevating its use to a position of primary importance in his life and creating a strong psychological need for the drug. When this occurs in the very young it can be a very serious inter-ference with normal development. However, it appears that for the great majority of American users, marijuana is easier to give up than tobacco or alcohol. Finally, insofar as the argument for dependence holds, it is a weak one, for without any other attend-ant evil, its harm is merely that it interferes with self-control and free will.

The next alleged danger of chronic marijuana use relies in great part upon foreign studies linking marijuana use with mental illness. A major problem with these studies is that they may not be transferable to the United States, where the contributing factors to mental illness such as the economic and social conditions are so very different. An even greater problem of relating mental ill-ness to the use of marijuana, both in foreign and domestic studies, is the difficulty of establishing a cause-effect relationship. Not only is there difficulty in determining the cause of almost any case of mental illness, but the problem of determining whether the excessive use of marijuana was a symptom of the mental illness rather than a cause is completely intractable.

For the most part today, the allegations are not that long-term marijuana use causes mental illness but rather that it causes another type of mental deterioration—brain damage. Primary reliance again is placed upon foreign studies, but these suffer from great methodological difficulties and, in fact, seem to agree that moderate use of the drug is not harmful. The most reliable foreign study, that of the Indian Hemp Drugs Commission, as well as recent studies in the United States, indicate the long-range effects of most marijuana use are not serious. The effects of long-term heavy use of marijuana are in great part not lmown. A major reason for this is that the methodological difficulties in the studies that purport to find serious damage are so significant that one simply cannot tell. In addition, the problem of determining the long-range mental harm due to any substance is an extremely difficult one.

The same problems prevent our concluding that there is any connection between marijuana and what is called the atnotivational, or dropout, syndrome. There is certainly no probative evidence that marijuana use is any more than one of the signs of an alien-ation from our society—an alienation that is shared by those who drop out.

On the other hand, medical groups that have denounced ma-rijuana as a dangerous drug are not completely wrong. To some extent, of course, the drug is dangerous. Its acute effects, like those of all psychoactive agents, including alcohol, involve some danger of psychiatric disturbance. In some cases, the drug may well dimin-ish initiative and impair the performance of the habitual excessive user.

The real problem today is recognizing the difference between prescribing for the welfare of an individual patient and recom-mending a course of action for society. For the latter purpose, we must weigh not only the benefits of suppressing marijuana use, but the social costs of attempting to do so as well. It would seem that to make these social costs bearable marijuana would have to be vastly more harmful to the user than the evidence indicates.

NOTES

1. Miller, Donald E., "The Problems of the Prosecutor in the Mari-juana Controversy," paper presented to the National District At-torneys Association Conference at New Orleans, Mar. 16, 1968, citing H. Isbell and others, Studies of Tetrahydrocannabinol, Feb., 1967.
2. The Dangers of Marijuana . . . Facts You Should Know, 'bureau of Narcotics and Dangerous Drugs (Washington: U. S. Govern-ment Printing Office, 1968), p. 5.
3. Isbell, Studies of Tetrahydrocannabinol, p. 4844.
4. Ibid., p. 4838.
5. Ibid.
6. Ibid., p. 4842.
7. Mayor's Committee on Marijuana, The Marijuana Problem in the City of New York (Lancaster, Pa.: Cattell, 1944).
8. Ibid., p. v.
9. Ibid., p. ix.
10. Ibid., pp. ix–x.
11. Ibid., p. x.
12. Journal of the American Medical Association, Vol. 127, April 28, 1945, p. 1129.
13. Mayor's Committee, op. cit., p. 30.
14. Ibid., p. 38.
15. Ibid., p. 45.
16. See Louria, Donald B., The Drug Scene (New York: McGraw-Hill, 1968), p. 105.
17. Mayor's Committee, op. cit., p. 32.
18. Ibid.
19. Ibid., p. 46.
20. Ibid., p. 48.
21. Ibid., p. 51.
22. Ibid.
23. Keeler, Martin H., "Adverse Reaction to Marihuana," American Journal of Psychiatry,Vol. CXXIV, Nov., 1967, p. 128.
24. Ibid., p. 675.
25. Chopra, I. C., and Chopra, R. N., "The Use of Cannabis Drugs in India," United Nations Bulletin on Narcotics, Vol. IX, No. 1, Jan.- Mar., 1957, p. 23.
26. Keeler, op. cit., p. 677.
27. Ibid.
28. Blum, Richard H., Students and Drugs (San Francisco: Jossey-Bass, 1969).
29. Ibid., pp. 149,151.
30. Ibid., p. 97.
31. Ibid., p. 154.
32. Durham, B., "The Marijuana Psychosis" (1968).
33. Ibid., pp. 20-21.
34. Communication from Verhoven, Michael, and Lundberg, George V., M.D., New England Journal of Medicine, Vol. 281, No. 16, Oct. 16,1969, p. 909. See also letter from George V. Lundberg, dated Dec. 24,1969.
35. Ciesla, Thomas, "The Marijuana Problem, A Brief Review" (1968), p. 11.
36. Smith, David E., "Acute and Chronic Toxicity of Marijuana," Journal of Psychedelic Drugs, Vol. II, No. 1, Fall, 1968, p. 41.
37. See Durham, op. cit., p. 22.
38. Becker, Howard, "History, Culture and Subjective Experience: An Exploration of the Social Bases of Drug-Induced Experiences," Journal of Health and Social Behavior, Vol. VIII, Sept., 1967, p. 163.
39. Ibid., p. 166.
40. Miller, op. cit., p. 8, citing Donald B. Louria, M.D., Nightmare Drugs (New York: Pocket Books, 1966), p. 32.
41. Meyers, Frederick H., "Pharmacologic Effects of Marijuana," Journal of Psychedelic Drugs, Vol. II, No. 1, Fall, 1968, p. 33.
42. Smith, op. cit., p. 40.
43. San Francisco Chronicle, Aug. 15,1967, p. 5.
44. Miller, op. cit., p. 13.
45. Kew, M. C., Bersohn, I., and Siew, S., "Possible Hepatoxicity of Cannabis," The Lancet, Mar. 15,1969, pp. 578-79.
46. Skakkeback, N. E., Philip, J., and Rafaelsen, O. J., Science, Vol. 160,1968, p. 1246.
47. Jagiello, G., and Polani, P. E., Cytogenetics, Vol. 8,1969, p. 136.
48. "Medical Research in the Caribbean," British Medical Journal, June 7,1969, p. 628.
49. Geber, William F., and Schramm, Lee C., Toxicology and Applied Pharmacology, Vol. 14,1969, p. 276.
50. Persaud, T. V. N., and Ellington, A. C., "Cannabis in Early Preg-nancy," The Lancet, Dec. 16,1967, p. 1306.
51. "Cannabis-Yet Another Teratogen?" British Medical Journal, Vol. I, Mar. 29,1969, p. 797.
52. See generally for the problems in methodology McGlothlin, William H. "LSD: Effect Upon Human Pregnancy" (1969).
53. See generally, Jaffe, J. H., "Drug Addiction and Drug Abuse," in The Pharmacological Basis of Therapeutics, L. Goodman and A. Gilman, eds., 3d ed. (New York: Macmillan, 1965), p. 300.
54. Transcript, National Conference of Commissioners on Uniform State Laws, 43rd Annual Meeting, 1932, pp. 51-52.
55. Marcovitz, E., and Meyers, H. J., "The Marijuana Addict in the Army," War Medicine, Vol. VI, 1944, p. 388.
56. Charen, S., and Perelman, L., "Personality Studies of Marijuana Addicts," American Journal of Psychiatry, V ol. CII, 1946, p. 679.
57. Fraser, J. D., "Withdrawal Symptoms in Cannabis Indica Addicts," The Lancet, V ol. II, 1949, pp. 747-48.
58. Ibid.
59. Murphy, H. B. M., "The Cannabis Habit: A Review of Recent Psychiatric Literature," United Nations Bulletin on Narcotics, Vol. XV, 1963, p. 17.
60. Ibid.
61. Charen and Perelman, op. cit., p. 677.
62. See Chapter III, pp. 64-66.
63. Miller, op. cit., p. 6.
64. Ibid.
65. Joachimoglu, G., "Natural and Smoked Hashish," in Hashish: Its Chemistry and Pharmacology, Wolstenholme and Knight, eds. (Boston: Little, Brown, 1965), pp. 4-5; and see Eddy, N., and others, "Drug Dependence, Its Significance and Characteristics," Bulletin of the World Health Organization, Vol. 32,1965, pp. 721- 23.
66. Wilkins, L., summarized in Singlon, D., Psychosocial Aspects of Drug Taking (London: Pergamon Press, 1965), p. 9.
67. Mandel, J., The Stepping-Stone Theory (Chicago: Aldine, sched-uled for publication after 1970).
68. Melville, Herman, Moby Dick (New York: E. P. Dutton, 1950), P. 3.
69. The Dangers of Marijuana . . . Facts You Should Know, p. 11.
70. San Francisco Chronicle, Sept. 14,1969, p. 1.
71. Watt, J. M., in Hashish: Its Chemistry and Pharmacology, p. 54.
72. Louria, op. cit., p. 108.
73. See Wilcox, J., "Marijuana Use Patterns at Stanford" (1969).
74. See Scott, G. L., "The Heavy Use of Marijuana" (1968).
The Dangers of Marijuana Use 197
75. Letter from Dr. Roger Smith, Jan. 23,1970.
76. Scott, op. cit., pp. 10-15.
77. See Pearlen, E. G., "Social and Personal Stress and Escape Tele-vision Viewing," Public Opinion Quarterly, Vol. 232, 1959, pp. 255-59; Television and Radio, Tyler, Poyntz, ed., Vol. 33, No. 6, The Reference Shelf (New York: H. W. Wilson, 1961), p. 43.
78. See, e.g., Five Mind Altering Drugs, Research and Statistics Sec-tion, Department of Public Health and Welfare, San Mateo County, Calif. (1969). Cf. pp. 11-13 with pp. 19-21.
79. Chopra and Chopra, op. cit., p. 23.
80. Ibid., p. 25.
81. Report of the Indian Hemp Drugs Commission, 1893-94 (re-printed, Silver Springs, Md.: Thomas Jefferson Publishing Co., 1969), p. 225.
82. Ibid.
83. Mikuriya, T. H., "Communications," International Journal of the Addictions, Vol. 3, No. 2, Fall, 1968, p. 398.
84. Report of the Indian Hemp Drugs Commission, p. 236.
85. Ibid., p. 264.
86. Chopra and Chopra, op. cit., p. 23.
87. Ibid.
88. Ibid., p. 24.
89. Ibid.
90. Ibid., p. 25.
91. Ibid.
92. Benabud, A., "Psycho-pathological Aspects of the Cannabis Situa-tion in Morocco; Statistical Data for 1956," United Nations Bul-letin on Narcotics, Vol. IX, Oct.-Dec., 1957, p. 1.
93. Ibid., p. 5.
94. Ibid., pp. 13-16.
95. Ibid., p. 4.,
96. Ibid., p. 15.
97. Ibid.
98. Ibid.
99. Ibid., p. 5.
100. Ibid., p. 6.
101. Ibid.
102. Ibid.
103. Ibid.
104. Mikuriya, op. cit., p. 398.
105. "Cannabis," Report by the Advisory Committee on Drug De-pendence, London, 1968, p. 7.
106. Milman, Doris H., "The Role of Marijuana in Patterns of Drug Abuse by Adolescents," The Journal of Pediatrics, Vol. 74, No. 2, Feb., 1969, pp. 283-90.
107. Ibid., p. 283.
108. Ibid., p. 287.
109. Ibid., p. 285.
110. O'Connor, Matthew, "A Police View of School Drug Users," presentation to Institute on Non-narcotic Drug Abuse, May, 1967 (Southern Illinois University), p. 20.
111. Bouquet, J., "Cannabis," United Nations Bulletin on Narcotics, Vol. IX, 1951, pp. 22-45.
112. Ibid., p. 28.
113. Ibid.
114. Ibid.
115. Ibid.
116. Ibid., p. 35.
117. Los Angeles Times, Sept. 18,1967, p. 1.
118. Miras, C. J., Marijuana and Hashish, Athens, Feb., 1968.
119. Mayor's Committee, op. cit., p. 141.
120. Freedman, Harry L., and Rockmore, Myron J., "Marijuana A Factor in Personality Evaluation and Assay Maladjustment, Part II," Journal of Clinical Psychopathology, Vol. 8,1946, p. 233.
121. "Cannabis," Report by the Advisory Committee, p. 7.
122. Wegars, D., "The Lesson for Today Has to do with Pot," San Francisco Chronicle, Nov. 3,1967, p. 3.
123. "This World," San Francisco Chronicle, Mar. 30,1969, p. 2.
124. Drug Abuse: Escape to Nowhere (Philadelphia: Smith, Kline and French Laboratories, 1967), p. 39.
125. Ousler, Will, Marijuana: The Facts: The Truth (New York: Paul S. Eriksson, Inc., 1968), p. 28.
126. Ibid., pp. 28-29.
127. Bloomquist, Edward R., Marijuana (Beverly Hills: GlencoQ Press, 1968), p. 70.
128. "Marijuana and Society," statement by Council on Mental Health and Committee on Alcoholism and Drug Dependence of the American Medical Association, reprinted in the Journal of the American Medical Association, June 23,1968, p. 91.
129. Ibid.
130. Letter from Dr. Dana Farnsworth, Mar. 21,1968.
131. Nowlis, Helen H., Drugs on the College Campus (Garden City, N.Y.: Doubleday, 1969), p. 108.
132. See San Francisco Chronicle, Aug. 10,1969, p. 30.