Several jurisdictions in the U.S. have taken steps toward decriminalizing marijuana possession for personal use or when prescribed by a physician for medicinal purposes. Other jurisdictions have pending ballot initiatives or legislative bills proposing such changes in the law.
The Board of Directors of the National Association of Drug Court Professionals (NADCP) has determined that it is essential for drug court practitioners to be fully and objectively informed about the effects of marijuana on their participants and the public at-large. This document briefly reviews the scientific evidence concerning the effects of marijuana.

Incarceration for Marijuana Possession

It is exceedingly rare to be incarcerated in the U.S. for the use or possession of marijuana. According to the National Center on Addiction & Substance Abuse at Columbia University (CASA, 2010), less than 1 percent (0.9%) of jail and prison inmates in the U.S. were incarcerated for marijuana possession as their sole offense.
Excluding jail detainees who may be held pending booking or release on bond, the rates are even lower. Prison inmates sentenced for marijuana possession account for 0.7 percent of state prisoners and 0.8 percent of federal prisoners (see Table). And, considering that many of those prisoners pled down from more serious charges, the true incarceration rate for marijuana possession can only be described as negligible.
State Prisoners Federal Prisoners
Marijuana offense only 1.6% N.R.
Marijuana possession only 0.7% 0.8%
First-time marijuana possession 0.3% N.R.

Source: Office of National Drug Control Policy, Who’s Really in Prison for Marijuana? [NCJ #204299] (citing BJS, 1999, Substance abuse and treatment, state and federal prisoners, 1997 [NCJ #172871]; U.S. Sentencing Commission, 2001 Sourcebook of Federal Sentencing Statistics). N.R. = not reported. 2

Addiction Potential

By the early 1990’s, the scientific community had concluded from rigorous laboratory and epidemiological studies that marijuana is physiologically and psychologically addictive. Every drug of abuse has what is called a dependence liability, which refers to the statistical probability that a person who uses that drug for nonmedical purposes will develop a compulsive addiction. Based upon several nationwide epidemiological studies, marijuana’s dependence liability has been reliably determined to be 8 to 10 percent (Anthony et al., 1994; Brook et al., 2008; Budney & Moore, 2002; Kandel et al., 1997; Munsey, 2010; Wagner & Anthony, 2002). This means that one out of every 10 to 12 people who use marijuana will become addicted to the drug.
Importantly, the dependence liability of any drug increases with more frequent usage. Individuals who have used marijuana at least five times have a 20 to 30 percent likelihood of becoming addicted to the drug, and those who use it regularly have a 40 percent likelihood of becoming addicted (Budney & Moore, 2002).
The hallmark feature of physical addiction is the experience of uncomfortable or painful withdrawal symptoms whenever levels of the substance decline in the bloodstream. This is, in part, what drives addicts to continue abusing drugs or alcohol despite suffering severe negative medical, legal and interpersonal consequences. Carefully controlled, rigorous laboratory studies have proven beyond further dispute that marijuana addiction is associated with a clinically significant withdrawal syndrome. When marijuana-addicted individuals stop using the drug, they experience symptoms of irritability, anger, cravings, decreased appetite, insomnia, interpersonal hypersensitivity, yawning and/or fatigue (Budney et al., 2001; Preuss et al., 2010). In fact, the features and severity of the marijuana withdrawal syndrome are virtually indistinguishable from those of nicotine (cigarette) withdrawal.
A second hallmark feature of addiction is psychosocial dysfunction resulting from repeated use of the substance. The most commonly diagnosed symptoms of psychosocial dysfunction among marijuana addicts include persistent procrastination, bad or guilty feelings, low productivity, low self-confidence, interpersonal or family conflicts, memory problems and financial difficulties (Budney & Moore, 2002; NIDA, 2005). This constellation of symptoms has been collectively referred to as an “amotivational syndrome” (e.g., Hubbard et al., 1999) because marijuana abusers tend to be characteristically languid and often achieve considerably below their true intellectual potentials.
Based on this substantial body of empirical research, the American Psychiatric Association (APA) has long recognized cannabis dependence as a valid and reliable psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is the official psychiatric diagnostic classification system in the U.S. A diagnosis of cannabis dependence has been continuously included in the 3rd and 4th editions of the DSM since 1980 (APA, 1980, 1987, 1994, 2000). In the soon-to-be published 5th edition of the DSM, a cannabis withdrawal syndrome will now also be officially recognized as part of the diagnostic criteria for cannabis dependence.

Medical Harm

In many respects, smoked marijuana has the potential to be as, or more, harmful than cigarettes. Although marijuana does not contain nicotine, it does contain 50 to 70 percent more carcinogenic compounds, including tar, than cigarettes (NIDA, 2005; Hubbard et al., 1999). Marijuana also produces high levels of a particular enzyme which converts certain hydrocarbons into their carcinogenic or malignant forms (NIDA, 2005).
Although gram for gram, marijuana smoke is clearly more carcinogenic than cigarette smoke, it is difficult to predict whether actual incidence rates of induced cancers are likely to be as high as they are for cigarettes. On one hand, cannabis smokers tend to use the drug on fewer occasions than cigarette smokers. On the other hand, they typically inhale larger amounts of the drug per occasion, hold the smoke in their lungs for longer intervals of time, and are unlikely to employ filters. This makes it difficult to compare the predicted magnitudes of the harms. The best estimate from the National Institutes of Health (NIH) is that a person who smokes five marijuana cigarettes per week is likely to be inhaling as many cancer-causing chemicals as one who smokes a full pack of cigarettes every day.1
See U.S. Dept. of Justice, Drug Enforcement Administration, Exposing the myth of medical marijuana: The facts. Available at http://www.justice.gov/dea/ongoing/marijuanap.html.
Like nicotine, cannabis increases heart rate, alters blood pressure, can induce tachycardia (rapid or irregular heartbeat), increases myocardial (heart) stress, decreases oxygen levels in the circulatory system, and exacerbates angina (Hubbard et al., 1999). As a result, a person’s risk of a heart attack is increased four-fold during the first hour after smoking marijuana (NIDA, 2005).
There is no question that regular marijuana use is associated with a wide spectrum of chronic respiratory ailments. A nationally representative study of 6,728 adults found heavy marijuana use to be substantially associated with chronic bronchitis, coughing on most days, wheezing, abnormal chest sounds and increased phlegm (Moore et al., 2005).
Marijuana has undisputed negative effects on cognitive functioning, including memory, learning and motor coordination. These negative effects persist long after the period of acute intoxication, averaging approximately 30 days of residual cognitive impairment (Bolla et al., 2002; NIDA, 2005; Pope et al., 2001). This means that individuals are apt to wrongly believe they are capable of performing critical tasks, such as driving a car, operating heavy machinery, caring for children or solving work-related intellectual problems, when in fact they may be performing in the mildly to moderately impaired range of functioning.
Like any drug, marijuana’s negative effects tend to be most pronounced in elderly persons, individuals with chronic medical illnesses, and those with compromised immune systems. This is of particular concern given that marijuana is being specifically touted for “medicinal” use by elderly patients, cancer patients, and those with immunodeficiency
syndromes such as HIV/AIDS (e.g., Munsey, 2010). Rather than benefiting such individuals, marijuana has the serious potential to further suppress or compromise their immune systems and exacerbate the disease process (NIDA, 2005).

Medicinal Effects

Marijuana is a “Schedule I” drug according to the Drug Enforcement Administration (DEA), meaning it has a high abuse potential and no recognized medical indication. However, the Food and Drug Administration (FDA) has approved a particular ingredient within marijuana (THC) in a non-smoked form for certain medical indications, such as for treatment of nausea, vomiting and poor appetite. Recent studies have also supported its use in treating chronic neuropathic pain (e.g., Munsey, 2010).
To date, research indicates that oral THC (when administered at adequate doses) is as effective as smoked marijuana in achieving these therapeutic effects (e.g., Munsey, 2010). Anecdotal testimonials are the only evidence favoring smoked marijuana over oral THC for therapeutic purposes. Further research is called for to determine whether other compounds within marijuana might have medicinal properties as well, but at this juncture any such indications are purely experimental and speculative.
Regardless, smoked marijuana could no more be considered a “medication” than cigarettes or alcohol. Although cigarettes and alcohol have undeniable effects that many people may find palliative (such as alleviating short-term stress), they are very “dirty” drugs. This means they contain dozens, if not hundreds, of other physiologically active compounds which are irrelevant to their palliative effects and may actually work at cross-purposes against those effects. For example, many people believe alcohol and nicotine lower their stress level, but in fact these drugs are proven to increase anxiety, lower stress tolerance and exacerbate insomnia over the longer term. These drugs are also associated with a host of serious medical conditions, including cancer, heart disease, liver disease and respiratory illnesses. For these reasons, physicians would rarely, if ever, “prescribe” these drugs to treat a medical condition.
More research is needed to isolate the potential therapeutic effects of specific compounds within marijuana, and to determine how to administer those compounds in a manner that is medically safe and does not threaten to cause heart, lung and other diseases. Administering the “dirty” form of the drug would never be a legitimate medical end-goal.

Impact on Crime

Two recent meta-analyses (advanced statistical procedures) have concluded that marijuana use during adolescence or young adulthood significantly predicts later involvement in criminal activity and criminal arrests (Bennett et al., 2008; Pedersen & Skardhamar, 2010). The risk of criminal involvement was determined to be between 1.5 and 3.0 times greater for cannabis users than for non-users. 5 The results suggest that, all else being equal, cannabis users are at a statistically increased risk for associating with antisocial individuals, engaging in illegal conduct, and eventually getting a criminal record.

Conclusion

Marijuana is an intoxicating and addictive drug that poses serious medical risks akin to those of nicotine and alcohol. Although some physicians may consider it to have palliative indications, no national or regional medical or scientific organization recognizes marijuana as a medicine in its raw or smoked form.
If marijuana becomes decriminalized or legalized in a given jurisdiction, this does not necessarily require drug court practitioners to abide its usage by their participants. The courts have long recognized restrictions on the use of a legal intoxicating substance (i.e., alcohol) to be a reasonable condition of bond or probation where the offender has a history of illicit drug involvement. If there is a rational basis for believing cannabis use could threaten public safety or prevent the offender from returning to court for adjudication, appellate courts are likely to uphold such restrictions in the drug court context.
Individuals who have a valid medical prescription for marijuana present a more challenging issue, but one that is probably also not insurmountable. Under such circumstances, the judge might subpoena the prescribing physician to testify or respond to written inquiries about the medical justification for the prescription. In addition, the court may be authorized by the rules of evidence or rules of criminal procedure to engage an independent medical expert to review the case and offer a medical recommendation or opinion. Having a Board-certified addiction psychiatrist on hand to advise the drug court judge may provide probative evidence about whether a particular marijuana prescription is medically necessary or indicated.
It remains an open question what degree of deference appellate courts are likely to give to the conclusions of a treating physician. In the absence of clear precedent, the best course of action is to develop a factual record and make a particularized decision in each case about the medical necessity for the prescription and the rationale for restricting marijuana usage during the term of criminal justice supervision.
If judges make these decisions based on a reasonable interpretation of medical evidence presented by qualified experts, it seems unlikely that drug courts — which were specifically designed to treat seriously addicted individuals — could not restrict access to an intoxicating and addictive drug as a condition of criminal justice supervision.

About NADCP

It takes innovation, teamwork and strong judicial leadership to achieve success when addressing drug-using offenders in a community. That’s why since 1994 the National Association of Drug Court Professionals (NADCP) has worked tirelessly at the national, state and local level to create and enhance Drug Courts, which use a combination of accountability and treatment to compel and support drug-using offenders to change their lives.
Now an international movement, Drug Courts are the shining example of what works in the justice system. Today, there are over 2,400 Drug Courts operating in the U.S., and another thirteen countries have implemented the model. Drug Courts are widely applied to adult criminal cases, juvenile delinquency and truancy cases, and family court cases involving parents at risk of losing custody of their children due to substance abuse.
Drug Court improves communities by successfully getting offenders clean and sober and stopping drug-related crime, reuniting broken families, intervening with juveniles before they embark on a debilitating life of addiction and crime, and reducing impaired driving.
In the 20 years since the first Drug Court was founded in Miami/Dade County, Florida, more research has been published on the effects of Drug Courts than on virtually all other criminal justice programs combined. The scientific community has put Drug Courts under a microscope and concluded that Drug Courts significantly reduce drug abuse and crime and do so at far less expense than any other justice strategy.
Such success has empowered NADCP to champion new generations of the Drug Court model. These include Veterans Treatment Courts, Reentry Courts, and Mental Health Courts, among others. Veterans Treatment Courts, for example, link critical services and provide the structure needed for veterans who are involved in the justice system due to substance abuse or mental illness to resume life after combat. Reentry Courts assist individuals leaving our nation’s jails and prisons to succeed on probation or parole and avoid a recurrence of drug abuse and
Today, the award-winning NADCP is the premier national membership, training, and advocacy organization for the Drug Court model, representing over 27,000 multi-disciplinary justice professionals and community leaders. NADCP hosts the largest annual training conference on drugs and crime in the nation and provides 130 training and technical assistance events each year through its professional service branches, the National Drug Court Institute, the National Center for DWI Courts and the National Veterans Treatment Court Clearinghouse. NADCP publishes numerous scholastic and practical publications critical to the growth and fidelity of the Drug Court model and works tirelessly in the media, on Capitol Hill, and in state legislatures to improve the response of the American justice system to substance-abusing and mentally ill offenders through policy, legislation, and appropriations.
For more information please visit us on the web at www.AllRise.org.

Source: National Association of Drug Court Professionals. Sept. 2010

In 1996 a ballot initiative in California was approved (Prop. 215, and its successor SB420), which allowed for a smoked (!) leaf of unknown chemical composition, unregulated doses of psychoactive ingredients and hundreds of other potentially hazardous chemicals, to treat serious medical conditions, including “AIDS, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, persistent muscle spasms, seizures, epilepsy, severe nausea, any
other chronic or persistent medical symptom that substantially limits the ability of the person to conduct major life activities”. Prop 215 passage had nation-wide ramifications and set off a cascade of ballot initiatives in other states, including Montana.

A. MARIJUANA AS MEDICINE

1. The most obvious objection to Prop 215 is the use of smoking as a delivery system for drugs, after a 40 year national campaign to end smoking.
2. The second objection is the poor quality or no evidence for marijuana’s safety and efficacy in treating a myriad of diseases listed in the ballot initiatives

A few years after Prop 215 passed in California, Governor G. Davis
funnelled millions of dollars into medical marijuana research, to seek validation,
after the fact, for these “ballot-approved” medical claims. After a decade of funding, this California Center for Medicinal Cannabis Research has issued 24 publications.
Only 3/24 reports focus specifically on clinical studies to examine the effectiveness of marijuana in treating diseases listed in the ballot initiative. Only one medical condition is explored, neuropathic pain in AIDS patients. Intriguingly, recruited subjects were required to be experienced marijuana smokers and all subjects were maintained on other painkillers, but the manuscripts do not report any details on other painkillers. In the majority of observational studies published on the “therapeutic” effects of smoked marijuana, there is no reporting of side effects (e.g. intoxication, cognitive impairment, etc), information that the FDA considers essential for FDA approval. These include whether marijuana produced a feeling of “high” (“euphoria”), being impaired, feeling sedated and showing cognitive impairment in objective tests of learning, speed recall, attention.
As for the other medical indications for marijuana, five major clinical trials were discontinued because the investigators could not recruit enough patients, despite extensive advertising, to study marijuana effectiveness for relief of cancer pain, muscle spasticity, multiple sclerosis, severe nausea and vomiting, neuropathic pain. The intent to investigate was present, but candidate patients refused to enroll. It raises significant questions as to why 16 of the remaining research projects did not address the core reason for the state funding, whether marijuana is effective in all the medical conditions and indications specified in 215 and SB420.
3. The third objection, of national significance, is that ballot initiatives
circumvent stringent Federal FDA standards, a direct threat and challenge to
our elaborate, technical- and evidence-based, national drug approval system.
FDA standards have protected Americans from fraudulent, dangerous or ineffective drugs for decades, with an approval system, although imperfect, that is among the most rigorous in the world. Consider the wise FDA response to ballot initiatives for the sham cancer treatment laetrile, their denial of thalidomide approval and a myriad of other drugs deemed unsafe and unacceptable by rigorous standards. Circumvention of FDA approval by a ballot initiative is a dangerous precedent, a slippery slope that can create chaos in the evidence-based approval process for medicines.

B. FDA REQUIREMENTS

The FDA requires that a drug:
a. is a pure compound
b. its chemistry, manufacturing, and composition of matter are tightly
controlled so that each batch is identical
c. its production methods are validated
d. its shelf life is known and can be dated to protect patients from a degraded chemical
e. its microbiology is known (batches of chemicals contaminated with bacteria are rejected)
f. its pharmacology and toxicology in animals is known
g. its rate of entry, bioavailability, toxicology are known
h. its dose response, efficacy, safety are known
i. its side effect profile is documented.
j. after approval, requires case reports and safety updates to be submitted to the FDA for ongoing evaluation.

Ballot initiatives for alleged treatments erode this carefully constructed process
and lead to compromised quality of our nation’s medications.
The FDA ruling on marijuana as medicine is given below. It has not changed. Marijuana is listed in schedule I of the Controlled Substances Act (CSA), the most restrictive schedule.

• The Drug Enforcement Administration (DEA), which administers the CSA, continues to support that placement and FDA concurred because marijuana met the three criteria for placement in Schedule I under 21 U.S.C. 812(b)(1)
• Marijuana has a high potential for abuse has no currently accepted medical use in treatment in the United States
• Lacks accepted safety for use under medical supervision.
• There is sound evidence that smoked marijuana is harmful.
• A past evaluation by HHS agencies, FDA, SAMHSA and NIDA, concluded that no
sound scientific studies supported medical use of marijuana for treatment in the
United States
• No animal or human data supported the safety or efficacy of marijuana for general medical use.
• There are alternative FDA-approved medications in existence for treatment of
many of the proposed uses of smoked marijuana
• A growing number of states have passed voter referenda (or legislative actions)
making smoked marijuana available for a variety of medical conditions upon a
doctor’s recommendation.
• These measures are inconsistent with efforts to ensure that medications undergo the rigorous scientific scrutiny of the FDA approval process and are proven safe and effective under the standards of the FD&C Act.
• Accordingly, FDA, as the federal agency responsible for reviewing the safety and efficacy of drugs, DEA as the federal agency charged with enforcing the CSA, and the Office of National Drug Control Policy, as the federal coordinator of drug control policy, do not support the use of smoked marijuana for medical purposes.

C. THE PRACTICE OF MEDICINE IS IMPACTED BY MARIJUANA AS MEDICINE BALLOT INITIATIVES.

Medicine increasingly is evidence-based but marijuana has no academic presence in medical training or scholarship.

Contrary to good medical practice, there is no requirement:

a. to issue a prescription (only a recommendation)
b. extract medical history
c. give a detailed medical exam
d. discuss long term treatment, effects or follow-up
e. provide informed consent
f. consult with other physicians
g. keep proper records that support recommending marijuana instead of safe
approved alternatives
h. have a good faith relationship with a patient rather than a “marijuana mill”
i. be able to identify substance abusers or the addicted.
j. Forewarn patients on maintaining control of their product

Contrary to regulations governing pharmacies, dispensaries have:
k. no product liability
l. no product regulation
m. no chain of custody
n. no accountability
o. no pharmacists trained in drug-drug interactions of appropriate dose
measures and requirements

Summary.
Over the past 150 years the US moved rapidly away from plants as medicines to
purified products, for obvious reasons: the composition of a plant is unknown, the composition of its thousands of constituents are uncontrolled and the long term effects of each of these chemicals, alone or together on body, brain, behavior are unknown. At the time these ballots passed and presently, marijuana’s scientific record was not sufficient to fulfill FDA’s rigorous standards of safety, efficacy, consistent dosing and side effect profile. The evidence for smoked marijuana as a safe and effective treatment for over 12 diseases
(e.g. glaucoma, Alzheimer’s disease), including the myriad forms of chronic pain that respond to different class of drugs does not begin to meet professional and FDA standards.
D. RESTRICTIVE MARIJUANA LAWS ARE DRIVEN PRIMARILY BY PERSONAL AND PUBLIC CONSIDERATIONS.

Maintaining restrictions on marijuana are more compelling than ever, as marijuana potency and availability soar, in parallel with escalating scientific evidence of marijuana’s adverse consequences.

Acute effects of marijuana on brain function.
Unlike opioids, marijuana is not likely to cause death by overdose but it resides in Schedule I because of its high abuse liability, and no medical indications – essentially because it adversely disturbs brain function and biology. A Saturday night marijuana binge is intoxicating in the short term, but it can also produce residual cognitive deficits (on learning and memory) for several days. (Marijuana
research protocols generally wait at least 5-30 days for marijuana to clear, before measuring long term residual cognitive effects). These deficits are readily quantified, are exaggerated in schizophrenics, and refute advocacy for marijuana treatment of Alzheimer’s disease. Who is compromised by marijuana? The student in class who can’t focus, the construction worker at risk for injury, the unemployed who is less likely to find work, the poor, the high school drop-out, the criminal. It is unacceptable for soldiers, airline pilots, nuclear power plant operators, federal workers to test positive for marijuana.
Should it be acceptable for teachers, day care providers, construction workers, students, machine operators, miners, parents, or drivers? A 2009 National Highway Traffic Safety Administration (NHTSA) report showed that more
people are driving on weekend nights under the influence of marijuana (8.3%) than alcohol (2.2%). Emergency department mentions of marijuana in the US have increased from 281,619 to 374,435 during 2004-2008, in parallel with linear increases in marijuana potency and marijuana addiction.

Enduring effects: marijuana addiction.
Marijuana is addictive in about 9-10% of users and progression to addiction reportedly is more rapid than progression to nicotine addiction. Abstinence in the heavily addicted unmasks physical and psychological neuroadaptation, manifest by an unnerving withdrawal syndrome. Nation-wide, more
people harbor a medical (DSM-IV) diagnosis of marijuana abuse/addiction than any other illicit drug and more youth are DSM-IV positive for marijuana than for alcohol, as a percentage of users. Extrapolating from national statistics, an average cost for addiction treatment is $4,000 for ambulatory care and at least four times that amount for residential care. This can add billions of dollars for marijuana treatment needs nationally.
Marijuana and youth.
There is no reasonable evidence that marijuana sold for “medical
purposes” will prevent diversion to young adolescents. Our abysmal failure at preventing youth cigarette smoking or alcohol consumption should be our intuitive guide. Youthful users of marijuana are at particular risk. The addiction rates of marijuana are 6-fold higher in young adolescents who initiate marijuana use at age 14 or younger. Early onset of marijuana use is also associated with addiction to other drugs in adulthood, including alcohol and heroin. Some have speculated that genetics, cigarettes smoking, social
environment, poverty, child abuse, psychiatric conditions confer this higher risk in the young. But how to explain that adolescent rats exposed to the most active constituent of marijuana, delta-9-tetrahydrocannabinol or THC, only during adolescence, seek heroin at higher rates after they mature into adults compared with matched controls, and display a fundamental change in brain opioid systems long after their last dose? Social, environmental, poverty, child abuse, psychiatric conditions do not apply to inbred rats – the drug alone alters the trajectory of brain and behavioral development.

Marijuana use and neuropsychiatric disorders.
In nine population studies of more than 75,000 people from seven different countries, early marijuana use was found to be associated with an average two-fold higher risk for later-onset psychosis and schizophrenia. The influential medical journal Lancet, which declared in 1995 that “The smoking of cannabis, even long term, is not harmful to health.” changed this conclusion in 2007, by stating that “Research published since 1995, including the systematic review in
this issue, leads us now to conclude that cannabis use could increase the risk of psychotic illness… governments would do well to invest in sustained and effective education campaigns on the risks to health of taking cannabis.” A current debate is being waged on whether to revise comparative risk assessment in the Global Burden of Disease (GBD) to include the attribution of psychosis to marijuana use. Degenhardt et al argue that the risk assessment should be included because the evidence is as good as that for many other risk
factors in the GBD. Some scientists have estimated that marijuana contributes about 8% to new cases of schizophrenia. If this estimate is accurate, unfettered marijuana access in California conceivably would add 25,000+ cases of schizophrenia, with an estimated cost of caring for this cohort for 30 years in excess of $6 billion (based on a low estimate of $8,000/per patient/year).

Long term heavy marijuana use.
Heavy daily marijuana use across protracted periods can exert harmful effects on brain tissue and mental health. Brain imaging of long-term heavy marijuana users has shown exposure-related structural abnormalities in brain regions critical for learning, memory and emotional responses, with changes associated
with impaired verbal memory and other symptoms. Abnormal brain size and brain circuitry of adolescent marijuana users have also been recently documented. Compromised academic performance, school drop-out, and a host of other adverse consequences are elevated in high school or college students who use marijuana. Accurate price tags for these lost educational and employment opportunities don’t exist, but at the very least, they
should weigh heavily on the citizens’ conscience. Peripheral health is also affected, as marijuana use is associated with increased risks for bronchitis, compromised pulmonary function, precancerous lung changes, cardiovascular events, problematic pregnancies, teratogenic and hormonal effects.
Despite this evidence, 2009 was a banner year for marijuana use in our nation. Compared with 2008, 1.5 million more marijuana users were added to the ranks in 2009. The steady decline in marijuana use among youth over the past 6 years was reversed in 2009.
Marijuana use among 12-17 year olds increased by over 7%, with a 14% increase among boys, and a 13% increase among college students. Expanding acceptance of medical marijuana and proliferating availability conceivably are driving reduced perception of harm and a pivotal rise in use.

Authors’ Biography: Bertha K. Madras is a Professor of Psychobiology in the Department of Psychiatry at Harvard Medical School and former Deputy Director for Demand Reduction in the White House Office of National Drug Control Policy.

Source: Sent to Drugwatch International Feb.2 2011

Marijuana used for medical purposes has the same long term effect on the user as marijuana used for recreation. Marijuana use can cause impairment of short-term memory, attention, motor skills, reaction time, and the organization and integration of complex information. Marijuana use alters perceptions and creates time distortion and can cause drowsiness and lethargy. Heavy marijuana use can cause apathy, decreased motivation, and impair cognitive performance and can cause mental health problems. Employees who use marijuana off-duty are still effected by it. Impaired cognition that can cause lapses in judgement can remain for a long period. Memory defects can last as long as six weeks. See: Abbie Crites-Leoni, Medicinal Use of Marijuana: Is the Debate a Smoke Screen for Movement Toward Legalization? 19 J. Legal Med. 273, 280 (1998) (citing Schwartz, et al., Short- Term Memory Impairment in Cannabis-Dependent Adolescents, 143 Am. J. Dis. Child. 1214 (1989)

Employers may be liable for the actions of employee who use marijuana especially those employees in safety sensitive positions. The more chronic the use of “medical” marijuana the higher the risk.

VIOLATIONS OF FEDERAL LAW

Will employers have to accommodate marijuana use that violates federal law? Marijuana, remains illegal under federal law because of its “high potential for abuse,” its lack of any “currently accepted medical use in treatment in the United States,” and its “lack of accepted safety for use … under medical supervision.”Gonzales v. Raich, 545 U.S. 1 (2005); United States v. Oakland Cannabis Buyers’ Cooperative, 532 U.S. 483 (2001)

IF THIS BILL PASSES “MEDICAL” MARIJUANA WILL RESULT IN MORE MARIJUANA USE AMONG EMPLOYEES

As consumers we all pay for lost productivity and job-related accidents in the final costs of the produced goods and higher insurance premiums due to workplace accidents. Drug using employees are not as safe. They are 3.6 times more likely to be involved in a work-related accident than their non-using employee, and 5 times more likely to file workers’ compensation claims. As many as 50% of all workers’ compensation claims may involve substance abuse.[ EN1]

The U.S. Postal Service did a study that showed that substance abusers have 55% more accidents, experience 85% more on-the-job injuries, and have a 78% higher rate of absenteeism when compared to non-substance abusing employees.[ EN2] A report by the National Safety Council claimed that 80% of those injured in serious drug-related work accidents are not the drug using employees, but innocent employees and others.[ EN3]

Drug using employees commit workplace crimes. There is a very significant statistical correlation between drug use and criminal conduct.[ EN4]

Substance abuse also causes:

Domestic and financial difficulties for employees;

Poor judgment in employment decision making;

Potential embarrassment to the employer as a result of off-duty conduct, which may be publicized, including criminal charges, diversion of supervisory and managerial time;

Damage to company property; and

Time devoted to discipline and grievance matters.[EN5]

While the studies vary somewhat, it is clear that there is substantial substance abuse in the workplace and it has a powerful negative impact on our economy and productivity. The increased use of “medical” marijuana will magnify all these problems.

References

[EN1] Current, The Truth About Drug Testing: Answers to the Questions Everyone Is Asking, p. 3 (1st Ed., Fort Lauderdale, FL, 1998).

[EN2] “Pre-employment Drug Testing: Association with EAP, Disciplinary, and Medical Claims Information” U.S. Postal Service, Personnel Research and Development Branch, Office of Selection and Evaluation, July 1992.

[EN3] Wisotsky, The Ideology of Drug Testing [Ideology of Drug Testing], 11 Nova L Rev 763, 768 (1987).

[EN4] See Stewart, Proof Positive of Drug Link to Crime, Wall St J, May 28, 1987, at 26, col 3.

[EN5]Alcohol & Drugs in the Workplace: Costs, Control and Controversies, A BNA Special Report [Costs, Control and Controversies], 7 (Bureau of National Affairs, Washington, D.C. 1986)

Source: Attorney David Evans in email to Drug Free America Foundation June 2010

Two NIDA-funded studies identify health risks that  underscore the importance of curbing marijuana abuse.

BY PATRICK ZICKLER, NIDA Notes Contributing Writer                             

A large new epidemiological study suggests that marijuana smoke can cause the same types of respiratory damage as tobacco smoke. Significant associations between marijuana smoking and a variety of respiratory diseases also have been confirmed by an extensive review of clinical literature.

MONITORING THE EFFECTS OF TOBACCO AND MARIJUANA

Dr. Brent Moore and colleagues at Yale University, the National Cancer Institute, and the University of Vermont evaluated data from a nationally representative sample of 6,728 adults. Their analysis indicated that a history of more than 100 lifetime episodes of smoking marijuana, with at least one episode in the past month, increased an individual’s risk of chronic bronchitis, coughing on most days, wheezing, chest sounds without a cold, and increased phlegm.

“The most significant difference between tobacco smoke and marijuana smoke is their principal active ingredients—nicotine in tobacco and delta-9-tetrahydrocannabinol (THC) in marijuana. Beyond that, marijuana contains at least as much tar and half again as many carcinogens as smoke from conventional tobacco,” says Dr. Moore. “Quitting marijuana smoking may benefit respiratory health as much as quitting cigarettes, in addition to the clear and considerable health, psychological, and social benefits of no longer abusing an illicit drug.”

The information Dr. Moore and his colleagues analyzed was gathered through the third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994. Participants included 4,789 nonsmokers of either tobacco or marijuana; 1,525 smokers of tobacco but not marijuana; 320 smokers of both marijuana and tobacco; and 94 who smoked marijuana only. On average, marijuana abusers had smoked the drug on 10 of the preceding 30 days, with 16 percent reporting daily or almost daily smoking. Tobacco smokers consumed roughly the same number of cigarettes—averaging 19.2 per day—whether or not they also smoked marijuana. Survey participants answered questions about their experiences of a range of respiratory symptoms and were examined for signs of respiratory abnormalities.

The researchers concluded that tobacco smokers who also smoked marijuana had a higher prevalence of most respiratory symptoms than tobacco-only smokers. Compared with tobacco-only smokers, however, those who also smoked marijuana were less likely to have had pneumonia during the previous year or to show spirometric evidence of obstructive pulmonary disorder. Commenting on this finding, Dr. Moore says that it is important to note that the marijuana smokers in the sample were significantly younger (average age 31.2 years) than the tobacco smokers (average age 41.5 years). “The marijuana-related respiratory effects correspond to a relatively young population, and NHANES III did not ask participants older than age 59 about drug use,” he adds. “It is likely that respiratory effects will be higher in older marijuana smokers, and, because of the high prevalence of tobacco use among marijuana smokers, there appears to be an increased risk for illness due to cumulative effects of smoking both drugs.”

MARIJUANA’S LONG-TERM PULMONARY EFFECTS

Further evidence of marijuana’s respiratory toxicity emerged from a study conducted by Dr. Donald Tashkin at the University of California, Los Angeles. Dr. Tashkin conducted an extensive review of clinical and epidemiological research to determine the extent to which chronic marijuana smoking might lead to long-term pulmonary effects and diseases similar to those caused by tobacco. Unlike the NHANES III data examined by Dr. Moore, the studies evaluated by Dr. Tashkin made it possible to assess a possible association between marijuana smoking and respiratory cancers.

The results of animal and cell culture studies are mixed with respect to the carcinogenic effects of THC, some studies showing that THC promotes lung cancer growth and others showing an anti-tumoral effect on a variety of malignancies. Although the results of epidemiological studies are also mixed, a large, recently completed case-control study has failed to find a direct link between marijuana use (including heavy use) and lung, throat, or other head and neck cancers. “Nevertheless, there is evidence that suggests precarcinogenic effects in respiratory tissue,” Dr. Tashkin says. “Biopsies of bronchial tissue provide evidence that regular marijuana smoking injures airway epithelial cells, leading to dysregulation of bronchial epithelial cell growth and eventually to possible malignant changes.” Moreover, he adds, because marijuana smokers typically hold their breath four times as long as tobacco smokers after inhaling, marijuana smoking deposits significantly more tar and known carcinogens within the tar, such as polycyclic aromatic hydrocarbons, in the airways. In addition to precancerous changes, Dr. Tashkin found that marijuana smoking is associated with a range of damaging pulmonary effects, including inhibition of the tumor-killing and bactericidal activity of alveolar macrophages, the primary immune cells within the lung.

Taken together, Dr. Tashkin’s survey of clinical and epidemiological studies and Dr. Moore’s assessment of self-reported and clinically observed effects provide an extensive catalog of respiratory and pulmonary damage associated with marijuana smoking. Smokers are subject to:

·         Coughing and phlegm production on most days;

·         Wheezing and other chest sounds;

·         Acute and chronic bronchitis;

·         Injury to airway tissue, including edema (swelling), increased vascularity, and increased mucus secretion;    

·         Impaired function of immune system components (alveolar macrophages) in the lungs.

Moore, B.A., et al. Respiratory effects of marijuana and tobacco use in a U.S. sample. Journal of General Internal Medicine 20(1):33-37, 2005. [Full Text]

Tashkin, D.P. Smoked marijuana as a cause of lung injury. Monaldi Archives for Chest Disease 63(2):93-100, 2005. [Abstract]

Hashibe, M., et al. Marijuana use and aerodigestive tract cancers: a population-based case control study. Cancer Epidemiology, Biomarkers & Prevention (In Press).

Source:NIDA Notes > Vol. 21, No. 1  Oct.2006

 

 

 

 

MINNESOTA COUNTY ATTORNEYS ASSOCIATION

POLICY POSITION

OPPOSING THE MEDICAL USE OF MARIJUANA IN MINNESOTA

Adopted February 16, 2007

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The Minnesota County Attorneys Association (hereafter MCAA) strongly opposes any efforts to use marijuana for medical purposes within the State of Minnesota currently under consideration in the Minnesota Legislature in Senate File No. 345 and House File No. 655 (hereafter S.F. 345). Prosecutors are not alone in our opposition to this proposal. Legalizing marijuana for medicinal uses is also opposed by the Minnesota Sheriff’s Association, the Minnesota Chiefs of Police Association, the National District Attorneys Association, and the U.S. Drug Enforcement Administration. The reasons for the strong opposition to this proposal by these law enforcement organizations are many and are set forth in outline form below.

I. Marijuana is an Addictive Drug That Poses Significant Health Consequences, Even to a Person Using it for “Medical Reasons.”

• Marijuana is an addictive drug that poses significant health consequences to its users, including those who may be using it for medical purposes.
- Marijuana has been proven to be a psychologically addictive drug. Scientists at the National Institute of Drug Abuse have demonstrated that laboratory animals will self administer THC in doses equivalent to those used by humans who smoke marijuana.
- Persons using marijuana, even for medicinal purposes, suffer withdrawal symptoms when use is stopped, such as restlessness, loss of appetite, trouble with sleeping, weight loss and shaky hands.
• The short-term effects of marijuana use include: memory loss, distorted perception, trouble with thinking and problem solving, loss of motor skills, decrease in muscle strength, increased heart rate, and anxiety.
• Long-term use of marijuana may increase the risks of chronic cough, bronchitis, and emphysema, as well as cancer of the head, neck, and lungs.
• Studies have shown smoking marijuana causes a variety of health problems, including cancer, respiratory problems, loss of motor skills, and increased heart rate. It damages the immune system by impairing the ability of T-cells to fight off infections, demonstrating that marijuana can do more harm than good in people with already compromised immune systems.
- Marijuana is a significant health hazard which contains 50-70 percent more carcinogenic hydrocarbons than does tobacco smoke. Using marijuana may promote cancer of the respiratory tract and disrupt the immune system.
- Marijuana contains more than 400 chemicals, including the harmful substances found in tobacco smoke. Smoking one marijuana cigarette deposits almost four times more tar into the lungs than a filtered tobacco cigarette.
- According to the National Institute of Health, studies show that someone who smokes five joints per week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.
- Smoked marijuana has also been associated with an increased risk of the same respiratory symptoms as tobacco, including coughing, phlegm production, chronic bronchitis, shortness of breath and wheezing. Because cannabis plants are contaminated with a range of fungal spores, smoking marijuana may also increase the risk of respiratory exposure by infectious organisms (i.e., molds and fungi).
- In a 2003 study, researchers in England found that smoking marijuana for even less than six years causes a marked deterioration in lung function. The study suggests that marijuana use may rob the body of antioxidants that protect cells against damage that can lead to heart disease and cancer.
- Smoking marijuana also weakens the immune system and raises the risk of lung infections. A Columbia University study found that a control group smoking a single marijuana cigarette every other day for a year had a white-blood-cell count that was 39 percent lower than normal, thus damaging the immune system and making the user far more susceptible to infection and sickness.
• Harvard University researchers report that the risk of a heart attack is five times higher than usual in the hour after smoking marijuana.
- Marijuana can cause the heart rate, normally 70 to 80 beats per minute, to increase by 20 to 50 beats per minute or, in some cases, even to double.
• According to two studies, marijuana use narrows arteries in the brain, “similar to patients with high blood pressure and dementia,” and may explain why memory tests are difficult for marijuana users. In addition, “chronic consumers of cannabis lose molecules called CB1 receptors in the brain’s arteries,” leading to blood flow problems in the brain which can cause memory loss, attention deficits, and impaired learning ability.
• The British Medical Journal recently reported: “Cannabis use is associated with an increased risk of developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration.”
- Dr Andrew Campbell, a member of the New South Wales (Australia) Mental Health Review Tribunal, published a study in 2005 which revealed that four out of five individuals with schizophrenia were regular cannabis users when they were teenagers. Between 75-80 percent of the patients involved in the study used cannabis habitually between the ages of 12 and 21.
- A laboratory-controlled study by Yale University scientists, published in 2004, found that THC “transiently induced a range of schizophrenia-like effects in healthy people.
• According to several recent studies, marijuana use has been linked with depression and suicidal thoughts, in addition to schizophrenia. These studies report that weekly marijuana use among teens doubles the risk of developing depression and triples the incidence of suicidal thoughts.
- Marijuana users have more suicidal thoughts and are four times more likely to report symptoms of depression than people who never used the drug.
• Carleton University researchers published a study in 2005 showing that current marijuana users who smoke at least five “joints” per week did significantly worse than non-users when tested on neurocognition tests such as processing speed, memory, and overall IQ.
• Mentions of marijuana use in emergency room visits in this country have risen 176 percent since 1994, surpassing those of heroin. In 2001, marijuana was a contributing factor in more than 110,000 emergency department visits in the United States.
• Users can become dependent on marijuana to the point they must seek treatment to stop abusing it. In 1999, more than 200,000 Americans entered substance abuse treatment primarily for marijuana abuse and dependence.

II. Marijuana Does Not Have Any Proven Medical Value and it is Not Supported for Medicinal Use by Many Prominent National Health Organizations.

Before considering the enactment of this proposed statute, the Legislature is urged to look closely at the medical facts behind this issue. These include:

• Scientific research has not demonstrated that smoked marijuana is helpful as medicine.
• Major medical and health organizations, as well as the clear majority of nationally recognized experts in the fields of medicine, science and scientific research, have concluded that smoking marijuana is not a safe and effective medicine. These organizations include: The American Medical Association, the American Cancer Society, the National Sclerosis Association, the American Glaucoma Association, the American Academy of Ophthalmology, the National Eye Institute, and the National Cancer Institute.
• The American Medical Association (AMA) has rejected pleas to endorse marijuana as a medicine, and instead has urged that marijuana remain a prohibited, Schedule I controlled substance (although it does support further studies, especially those aimed at delivering a “smoke-free inhaled delivery system for marijuana or . . . (THC) to reduce the health hazards associated with the combustion and inhalation of marijuana.”)
• The American Cancer Society “does not advocate inhaling smoke, nor the legalization of marijuana” (although the organization does support carefully controlled clinical studies for alternative delivery methods, specifically a THC skin patch) .
• The American Academy of Pediatrics (AAP) opposes the legalization of marijuana because it believes that “[a]ny change in the legal status of marijuana, even if limited to adults,” [which would include its use for medical purposes] “could affect the prevalence of use among adolescents.” (Similar to the AMA, the AAP supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana.)

- The AAP asserted that with regard to marijuana use, “from a public health perspective, even a small increase in use, whether attributable to increased availability or decreased perception of risk, would have significant ramifications.”
• The National Multiple Sclerosis Society (NMSS) states that studies done “have not provided convincing evidence that marijuana benefits people with MS,” and thus marijuana is not a recommended treatment. Furthermore, the NMSS warns that the “long-term use of marijuana may be associated with significant serious side effects.”
• A recent study by the Mayo Clinic, showed THC to be less effective than standard treatments in helping cancer patients regain lost appetites.
• The British Medical Association (BMA) has also voiced extreme concern that down-grading the criminal status of marijuana would “mislead” the public into believing that the drug is safe. [The same holds true in reference to legalizing the use of marijuana for medical purposes.]
- The BMA maintains that marijuana “has been linked to greater risk of heart disease, lung cancer, bronchitis and emphysema.” The 2004 Deputy Chairman of the BMA’s Board of Science said that “[t]he public must be made aware of the harmful effects we know result from smoking this drug.”
• Even the 1999 landmark study of The Institute of Medicine (IOM) which reviewed the supposed medical properties of marijuana (a study often cited by “medical” marijuana advocates) clearly discounts the notion that smoked marijuana is or can become “medicine.” A close review of the IOM study reveals the following:
- While the principal investigators in the IOM study found that the active compounds in marijuana may have medicinal potential for some ailments (the IOM found “… potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation.” ) They pointed out that “[t]he effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications [than smoked marijuana].”
- The IOM study concluded that, at best, there in only anecdotal information on the medical benefits of smoked marijuana for some ailments, such as muscle spasticity. For other ailments, such as epilepsy and glaucoma, the study found no evidence of medical value and did not endorse further research.
- The principal investigators of the IOM study explicitly stated that using smoked marijuana in clinical trials “should not be designed to develop it as a licensed drug, but should be a stepping stone to the development of new, safe delivery systems of cannabinoids.”
- The IOM study explained that “smoked marijuana . . . is a crude THC delivery system that also delivers harmful substances.” In addition, “plants contain a variable mixture of biologically active compounds and cannot be expected to provide a precisely defined drug effect.” Therefore, the study concluded that “there is little future in smoked marijuana as a medically approved medication.”

• The Food and Drug Administration and the U.S. Public Health Service have rejected smoking crude marijuana as a medicine. (It is important to note that the Food and Drug Administration (FDA) has never approved medications that are smoked.) This is because not only is it difficult if not impossible to administer safe and regulated dosages of medicine in a smoked form, the harmful chemicals and carcinogens that are by-products of smoking create an entirely new set of health problems.

III. There Already Exists a Legalized Form of “Medical Marijuana” in our Country – It’s Called Marinol (and other approved drugs exist as well to treat these diseases).

• Marinol is an approved pharmaceutical product that is widely available through a doctor’s prescription. It comes in the form of a pill (which can accurately regulate the dose of THC delivered, unlike smoked marijuana), and it is also being studied by researchers for suitability by other delivery methods, such as an inhaler or a patch. The active ingredient of Marinol is synthetic THC, which is the main active chemical found within marijuana. However, unlike marijuana which also contains more than 400 different chemicals (including most of the cancer-causing chemicals found in tobacco smoke), Marinol delivers therapeutic doses of THC in a manner that has been studied and approved by the medical community and the Food and Drug Administration.
• There is, therefore, no medical need to substitute a dangerous and addictive drug like marijuana for an approved prescriptive drug like Marinol that can provide a synthetic form of THC treatment with safe and controlled amounts to assist patients suffering from nausea, vomiting associated with chemo therapy and the loss of appetite associated with AIDS, two of the recognized and approved uses of Marinol.
• Numerous other approved drugs exist to treat the medical problems for which medical use of marijuana would be authorized under S.F. 345. A list of over 20 such medications is set forth in footnote 51 of this document.

IV. Marijuana’s Use As A Medicine Is Contrary to Federal Law as Upheld by Federal Court Decisions (including the U.S. Supreme Court).

• The Federal Controlled Substance Act (CSA) was enacted in 1970 as part of the Comprehensive Drug Abuse Prevention and Control Act. The CSA classifies drugs under five categories (Schedule I–V) based upon their level of danger and acceptance for medical use (among other criteria).
• Schedule I consists of the most restricted drugs under federal law – drugs which have a high potential for abuse, a lack of any accepted medical use, and an absence of any accepted safety criteria for use in medically supervised treatment.
• Marijuana is classified as a Schedule I drug, the manufacture, distribution or possession of which is a federal crime. Manufacture, distribution or possession of marijuana is also a state crime in Minnesota (except possession of small quantities of less than 1.5 oz., which is classified as a petty misdemeanor) .
• States have no authority to change the federal classifications of controlled substances under the CSA (including marijuana) under the Supremacy Clause of the United States Constitution.
• Federal Courts have consistently upheld the classification of marijuana as a Schedule I controlled substance and the fact that marijuana is a dangerous drug with no accepted medical use.
- In 1994, a U.S. Court of Appeals upheld a decision of the Administrator of the Drug Enforcement Administration, who declined to reschedule marijuana from Schedule I to Schedule II of the Controlled Substance Act, finding that marijuana was a drug with “high potential for abuse” which has “no currently accepted medical use in treatment in the United States” and that “there is a lack of accepted safety for use of the drug . . . under medical supervision.”
- The U.S. Court of Appeals found that the DEA Administrator properly relied upon “the testimony of numerous experts that marijuana’s medicinal value has never been proven in sound scientific studies,” noting that physicians supporting use of marijuana for medical purposes (in testimony before an Administrative Hearing Officer) were basing their opinions on “anecdotal evidence, on stories . . . heard from patients, and on . . . impressions about the drug.”
• The most recent and important federal court case on this topic is a 2005 decision of the United States Supreme Court in Gonzales v. Angel, et al., which upheld the authority of federal authorities to enforce federal laws prohibiting the use of marijuana in California for medical purposes as authorized under California law.
- In this decision, the U.S. Supreme Court affirmed that Congress has the authority to regulate controlled substances and “to prohibit entirely the possession or use of substances listed in Schedule I” (including marijuana), except as part of a strictly controlled research project.
• Congress has done just that through passage of the CSA under which marijuana has been designated as a Schedule I drug. In other words, marijuana has been deemed by federal regulation to be an extremely dangerous drug with no general acceptance for medical use.
• If S.F. 345 is passed, it will be in direct conflict with federal law and the U.S. Supreme Court has clearly indicated in Gonzales v. Angel, et al., that federal law takes precedence under the Supremacy Clause of the United States Constitution.
- Consequently, those granted authority to lawfully produce and use marijuana for medical purposes under state law (if S.F. 345 is enacted) will still be committing a federal crime.
• Also, as pointed out by the U.S. Supreme Court in Gonzales v. Angel, et al., legalizing marijuana use for medicinal purposes will clearly lead to increases in the marijuana supply, greater use of marijuana by non-patients and more criminal activity under state law. (See Section VII below for a more specific discussion of this issue.)
• The Minnesota Legislature should not substitute its judgment for that of Congress and the Administrators of the U.S. Drug Enforcement Administration (hereafter DEA) and the Federal Drug Administration (hereafter FDA) as to the fact that marijuana has no general acceptance for medical use and as to defining what is the appropriate way to deliver safe medications to our citizens.
• It is not sound public policy to enact state laws which encourage law abiding citizens to commit federal crimes.

V. Marijuana is a Dangerous Drug that is Associated with Crime and Violence.

• Research shows a link between frequent marijuana use and increased violent behavior.
- Young people who use marijuana weekly are nearly four times more likely than nonusers to engage in violence.
• A large percentage of those arrested for crimes test positive for marijuana. Nationwide, 40 percent of adult males tested positive for marijuana at the time of their arrest.
- Of adult males arrested in the United States for all crimes, 40 percent tested positive for marijuana at the time of their arrest, according to the Director of the U.S. Drug Enforcement Administration.

• In 2003, 3.1 million Americans aged 12 or older used marijuana daily or almost daily in the past year. Of those daily marijuana users, nearly two-thirds “used at least one other illicit drug in the past 12 months.”
- More than half (53.3 percent) of daily marijuana users were also dependent on or abused alcohol or another illicit drug compared to those who were nonusers or used marijuana less than daily.
• There is a strong correlation between drug use and crime. Drug use affects the user’s behavior. In 1997, illicit drug users were:
- approximately 16 times more likely than nonusers to report being arrested for larceny or theft;
- more than 14 times more likely to be arrested for driving under the influence, drunkenness, or liquor law violations; and
- more than 9 times more likely to be arrested on assault charges.

VI. Marijuana is Far More Powerful Today Than it Was 30 Years Ago and it Serves as a Gateway to the Use of Other Illegal Drugs.

• Marijuana is much stronger now than it was decades ago. According to data from the Potency Monitoring Project at the University of Mississippi, the tetrahydrocannabinol (THC) content of commercial-grade marijuana rose from an average of 3.71 percent in 1985 to an average of 5.57 percent in 1998. The average THC content of U.S. produced sinsemilla increased 3.2 percent in 1977 to 12.8 percent in 1997.
- The average THC levels in marijuana in the past two decades has increased form 6 percent to more than 13 percent, with some samples containing THC levels of up to 33 percent (which is far higher than the 1 percent potency levels in marijuana used in the mid-1970’s).
• Marijuana is a gateway drug to the use of other illegal drugs like methamphetamine, heroin and cocaine. Long-term studies of students who use drugs show that very few young people use other illegal drugs without first trying marijuana. The use of marijuana often lowers inhibitions about drug use and exposes users to a culture that encourages the use of other drugs.

• Studies show that of the people who have ever used marijuana, those who started early are more likely to have other problems later on. For example, adults who were early marijuana users were found to be:
- 8 times more likely to have used cocaine.
- 15 times more likely to have used heroin,
- 5 times more likely to develop a need for treatment of abuse or dependence on any drug.
• The Journal of the American Medical Association reported a study of more than 300 sets of same-sex twins. The study found that marijuana-using twins were four times more likely than their siblings to use cocaine and crack cocaine, and five times more likely to use hallucinogens such as LSD.
• The study by Columbia University’s National Center on Addiction and Substance Abuse offers further support for the fact that teens who use marijuana at least once a month are 13 times more likely than other teens to use another drug like cocaine, heroin, or methamphetamine and are almost 26 times more likely than those teens who have never used marijuana to use another illegal drug.
- Other studies show that twelve to seventeen year olds who smoke marijuana are 85 times more likely to use cocaine than those who do not. Sixty percent of adolescents who use marijuana before age 15 will later use cocaine. These correlations are many times higher than the initial relationships found between smoking and lung cancer in the 1964 Surgeon General’s report (nine to ten times higher).
• Health care workers, legal counsel, police and judges indicate that marijuana is a typical precursor to methamphetamine use. For example, Nancy Kneeland, a substance abuse counselor in Idaho, pointed out that “In almost all cases meth users began with alcohol and pot.”

VII. Legalizing Marijuana for Medical Purposes Will Lead to Increased Use of Marijuana By Other Persons, Increased Crime and the Perception that Marijuana is Harmless.
• It is foolish to think that there will be no additional use of marijuana occurring as a result of legalizing its use for medicinal purposes under S.F. 345. First of all there will be no practical way to enforce the law to ensure that marijuana obtained from medical purposes is not used by other persons, including children. Anecdotal information received from prosecutors in other states where similar legislation has been enacted indicates that this is exactly what will occur.
• Under S.F. 345, no person would be subject to arrest or prosecution “for constructive possession, conspiracy, aiding and abetting, being an accessory, or any other criminal offense for being in the presence or vicinity of the medical use.” Consequently, there will be no way to ensure that those who obtain marijuana for a medical purpose will not share it with other persons.
• If this legislation is enacted, it will authorize persons to lawfully grow and sell marijuana. Because marijuana is a widely used illegal substance, incentives will exist for some unscrupulous persons involved in the sale or distribution of “legal marijuana” to steal and distribute the substance for illegal uses.
• Institutions, which are lawfully producing marijuana if this legislation is enacted, would also become easy targets for thieves looking to break in and steal “legally produced” marijuana for illegal distribution purposes.
• It is important to note that the U.S. Supreme Court in its 2005 decision in Gonzales v. Angel, et al., specifically acknowledged that adverse impacts of increasing crime and illegal marijuana use will result from the passage of state laws similar to S.F. 345. In Gonzales, the majority of the U.S. Supreme Court made the following conclusions:
- “The exemption for cultivation by patients and caregivers can only increase the supply of marijuana in the [state] market.”
- “The likelihood that all such production will promptly terminate when patients’ medical needs during their convalescence seems remote, whereas the danger that excesses will satisfy some of the admittedly enormous demand for recreational use seems obvious.”
- “[T]he [fact that the] national and international narcotics trade has thrived in the face of vigorous criminal enforcement efforts suggests that no small number of unscrupulous people will make use of the . . . [state] exemptions to serve their commercial ends whenever it is feasible to do so.”
• Legalizing marijuana for medical purposes will lead many to conclude that the drug is in fact safe.
- In states where the issue of legalizing marijuana for medical purposes has been put on the ballot for voters to decide, well-financed and organized campaigns spearheaded by pro-marijuana legalization groups have contributed to the misperception that marijuana is harmless.
- According to the Office of National Drug Policy, these campaigns are led not by medical professionals or patients-rights groups, but by pro-drug donors and organizations in a cynical attempt to exploit the suffering of sick people.
- This misperception that marijuana is harmless is perhaps most prevalent among teens where it has led to a 140 percent increase in marijuana use among high school seniors from 1994-95.
- The mortal danger of thinking that marijuana is “medicine” was graphically illustrated by a story from California. In the spring of 2004, Irma Perez was “in the thrills of her first experience with the drug ecstasy” when, after taking one ecstasy tablet, she became ill and told friends that she felt like she was “going to die.” Two teenage acquaintances did not seek medical care and instead tried to get Perez to smoke marijuana. When it failed due to her seizures, the friends tried to force feed marijuana leaves to her, “apparently because [they] knew that drug is sometimes used to treat cancer patients.” Irma Perez lost consciousness and died a few days later when she was taken off life support. She was 14 years old.
• Legalizing marijuana for medical purposes will lead to the perception that marijuana is harmless, will result in increased use of it for illegal purposes, and will result in more crime (see Section IV above), endangering our youth and the safety of all citizens in our state.

VIII. Legalizing the Use of Marijuana for Medicinal Purposes Will Increase Dangers Associated With Impaired Driving.

Driving under the influence of marijuana can dramatically impact the safety of citizens within our state as indicated by the following:
• Smoking marijuana impairs the judgment of the smoker and increases the risk of accidents. Many car accidents are caused by drivers using marijuana. In fact, some say just as many as those caused by drivers under the influence of alcohol.
• Marijuana affects many skills required for safe driving: alertness, the ability to concentrate, coordination, and reaction time. These effects can last up to 24 hours after smoking marijuana. Marijuana use can also make it difficult to judge distances and react to signals and signs on the road.
• A roadside study of reckless drivers in Tennessee found that 33 percent of all subjects who were not under the influence of alcohol and who were tested for drugs at the scene of their arrest tested positive for marijuana.
• In a 2003 Canadian study, one in five students admitted to driving within an hour of using marijuana.
• In a 1990 report, the National Transportation Safety Board studied 182 fatal truck accidents and found that just as many of the accidents were caused by drivers using marijuana as were caused by alcohol – 12.5 percent in each case.

Some of the documented consequences of marijuana impaired driving across America include the following:
- The driver of a charter bus, whose 1999 accident resulted in the death of 22 people, had been fired from bus companies in 1989 and 1996 because he tested positive for marijuana four times. A federal investigator confirmed a report that the driver “tested positive for marijuana when he was hospitalized Sunday after the bus veered off a highway and plunged into an embankment.”
- In April 2002, four children and the driver of a van died when the van hit a concrete bridge abutment after veering off the freeway. Investigators reported that the children nicknamed the driver “Smokey” because he regularly smoked marijuana. The driver was found at the crash scene with marijuana in his pocket.
- A former nurse’s aide was convicted in 2003 of murder and sentenced to 50 years in prison for hitting a homeless man with her car and driving home with his mangled body “lodged in the windshield.” The incident happened after a night of drinking and taking drugs, including marijuana. After arriving home, the woman parked her car, with the man still ledged in the windshield, and left him there until he died.
- In April 2005, an eight year old boy was killed when he was run over by an unlicensed 16 year old driver who police believed had been smoking marijuana just before the accident.
- In 2001, George Lynard was convicted of driving with marijuana in his bloodstream, causing a head-on collision that killed a 73 year old man and a 69 year old woman. Lynard appealed this conviction because he allegedly had a “valid prescription” for marijuana. A Nevada judge agreed with Lynard and granted him a new trial. The case has been appealed to the Nevada Supreme Court.
- Duane Baehler, 47, of Tulsa, Oklahoma was “involved in a fiery crash that killed his teenage son” in 2003. Police reported that Baehler had methamphetamine, cocaine and marijuana in his system at the time of the accident.

IX. Summary

For all of the reasons outlined above, legalizing marijuana for medicinal purposes is not in the interests of protecting the public safety of Minnesota’s citizens, nor is it in the best interest of persons who suffer from the types of chronic or debilitating diseases or medical conditions specified in S.F. 345. Marijuana is a dangerous addictive drug that poses significant health risks to those who use it. Legalizing marijuana for “medicinal use” will only increase the access of both youth and adults to marijuana, which will not only increase the likelihood of violent behavior but will often lead to experimentation with other even more dangerous illegal drugs. As noted by the Office of National Drug Control Policy;

“Even if smoking marijuana makes people “feel better”, that is not enough to call it a medicine. If that were the case, tobacco cigarettes could be called medicine because they are often said to make people feel better. For that matter, heroin certainly makes people “feel better” (at least initially), but no one would suggest using heroin to treat a sick person.”

The bottom line is that at the present time, there is no proven medicinal value in using marijuana to treat illnesses or disease and, in fact, a legal form of THC, which can be controlled for its strength and which delivers none of the harmful side effects of smoking marijuana already exists for use through a doctor’s prescription.

Marijuana use, even by those using it for medicinal purposes, is significantly harmful to the body. Smoking pot delivers three to five times the amount of tars and carbon monoxide into the body as does smoking cigarettes and it also damages pulmonary immunity and impairs oxygen diffusion. We agree with the Office of National Drug Control Policy, that it is hard to understand how changes such as these could be good for someone dying of cancer or AIDS.

Perhaps most importantly of all, as a prohibited Schedule I controlled substance under the Federal Controlled Substance Act (CSA), the manufacture, distribution or possession of marijuana is a federal crime. The Minnesota Legislature should not substitute its judgment for that of Congress and the Administrators of the U.S. Drug Enforcement Administration and the Federal Drug Administration as to the fact that marijuana is a dangerous drug with no accepted medical use and as to determining what is the appropriate way to deliver safe medications to our citizens. It is not sound public policy to enact state laws which encourage law abiding citizens to commit federal crimes.

It is for all these reasons that the MCAA strongly opposes the adoption of the law in Minnesota which would legalize the use of marijuana for medicinal purposes. This opposition is shared by associations representing our law enforcement partners within Minnesota.

Bertha K. Madras, Ph.D., Deputy Director, Demand Reduction, Office of National Drug Control Policy

This is the second in a series of articles on how specific drugs affect the brain and body.

The brain drain
Myths that downplay the risks associated with drug use permeate youth culture and are embraced to rationalize experimentation with addictive drugs. Scientific evidence can help educators and parents de-bunk these dangerous myths.
Adolescents and young adults are the principal age groups using addictive drugs and are at the greatest risk for experiencing adverse consequences as a result of the early introduction of drugs into their brains. Early drug use can compromise academic achievement, school attendance, homework, participation in extracurricular activities, and school behavior. Drug use at a young age is also associated with addiction, violence, accidents, delinquency, criminal activity, and even death. As with any major public health problem, the inability to predict which young people will suffer detrimental, potentially life-threatening consequences from drug use is itself a reason to engage in widespread prevention efforts.
The brain has approximately one hundred billion nerve cells, with each cell producing 10,000 or more “wires” that connect with other cells. A critical component of brain development is accurate “wiring.” Imaging technologies that compare adolescent brains with those of adults have shown that the “wiring” of the adolescent brain is still immature, compared to the adult brain. Exposure to drugs before brain maturation may affect brain development, interfering with the wiring and circuitry of the brain in much the same way as a computer technician can damage a circuit board by zapping it with electrical jolts during the assembly process.
In the short term, a single dose of a drug can result in poor performance in a school or sports activity, accidents, violence, unplanned risky behavior, and the risk of overdosing. It can trigger repeated drug use, which is associated with serious health consequences, loss of desire to fulfill obligations, truancy, disorderly conduct, and social or family problems. Repeated drug use can also lead to addiction. Studies show that the earlier an adolescent begins using drugs, the more likely he or she will be to develop a substance abuse problem or become addicted to substances. Conversely, if an individual does not start using drugs during the teen years, he or she is less likely to initiate or develop a substance abuse problem later in life.
Statistics make a compelling case for focusing on preventing youth drug use. In 2006, among persons with substance dependence or abuse, the percentage dependent on or abusing illicit drugs was much higher in the 12-17 age group (57.4 percent) than among 18- to 25-year-olds (36.9 percent) or adults age 26 or older (24.1 percent), according to the 2007 National Survey on Drug Use and Health (NSDUH). One hundred eighty-one thousand youth (12-17 year-olds) received treatment for alcohol or illicit drugs (NSDUH 2007). Although prevention is a key to interrupting the progression to addiction, deterring marijuana use and prescription-drug misuse is particularly challenging because of the myths associated with these drugs.
Myth No. 1: Marijuana is a ‘soft’ drug
Marijuana use should not be considered a rite of passage. It is neither a “soft” drug nor a safe drug. The effects of marijuana can last up to 24 hours after administration, continuing to compromise reflexes, cognitive ability, and other brain functions. Driving while under the influence of marijuana is dangerous, as the use of this drug can impair motor function, concentration, and perception, thereby increasing the likelihood of road accidents. According to the 2006 Monitoring the Future study, the percentage of high school students who reported driving under the influence of marijuana (10.6 percent) was nearly as high as the percentage of those driving under the influence of alcohol (12.4 percent).
Accumulating evidence makes a forceful case for abstention from marijuana use. One study found that high school students who abstained from marijuana functioned better than occasional or frequent users during high school and during the transition to adulthood. During high school, abstainers fared better than experimenters and frequent users of marijuana on the basis of school engagement, deviant behavior, family and peer relations, and mental health. They were more likely to do homework and get better grades. When they turned 23, abstainers were twice as likely to graduate from college and much less likely to steal or to sell illicit drugs.
A long-term analysis of marijuana potency funded by the National Institute on Drug Abuse (NIDA) reveals that the strength of marijuana has increased substantially over the past two decades. Today, marijuana is more potent than ever before, and this elevated potency may be leading to an increase in teen marijuana treatment admissions and a rise in the number of marijuana-related emergency room episodes.

These worrisome results add to the growing body of evidence that the effects of youth marijuana use may endure into adulthood. Adolescents who used marijuana are twice as likely to use illicit drugs when they become young adults. In fact, in one study, individuals of twin pairs who used marijuana by age 17 had 2.1 to 5.2 times higher risk of other drug use (cocaine, heroin), alcohol dependence, and drug abuse/dependence than their co-twin who did not use before the age of 17.
Experiments with animals seem to corroborate these findings. Animals, which were not subject to environmental stressors, were exposed to the active ingredient of marijuana during adolescence. They were given a drug-free period and then, as adults, were given access to heroin. After maturation into adulthood, the early-exposed animals consumed higher amounts of heroin and showed greater heroin-seeking behavior than the non-exposed group. The effects of early exposure to marijuana were not restricted to behavior: components of the system in the brain that modulates pain and pleasure were changed in the animals’ adult brains, after exposure during adolescence.
Collectively, these findings suggest that marijuana, introduced during adolescence, may influence the biology of the brain, promote drug-seeking behavior, and affect social function during the transition to adulthood.
How addictive is marijuana, and how realistic is the perception that it is a “soft” drug? The 2007 NSDUH reported that in 2006, among adults aged 18 or older who first tried marijuana at age 14 or younger, 12.9 percent were classified with illicit drug dependence or abuse, a considerably higher number than the percentage (2.2 percent) who had first used marijuana at age 18 or older. Marijuana also ranked first as the most reported illicit drug resulting in abuse/dependence.
Early, frequent use of marijuana may be an independent risk factor for psychosis—even if use precedes the onset of schizophrenia or another form of psychosis. Marijuana may induce acute psychotic symptoms in vulnerable people and a persistent psychosis in some individuals who have not had prior signs of psychosis. Marijuana may also exacerbate psychosis in people with symptoms of schizophrenia, and these effects can persist after the drug is cleared from the body.
As with other addictive drugs, heavy marijuana use has many health and social consequences. Heavy marijuana use into adulthood creates an expanding set of health risks, including exercise-induced heart pain and reduced lung function, as well as objective and self-reports of adverse social consequences. During pregnancy, heavy marijuana use can lead to impaired fetal growth and development.
Myth No. 2: Prescription drugs used for psychoactive effects are safer than “street drugs”
Several classes of controlled prescription drugs—medications prescribed by doctors for legitimate medical purposes—have abuse and addiction potential. These include opioids prescribed for the management of pain, drugs to treat attentional problems and anxiety, and drugs to promote sleep. These drugs are safe and effective when used according to doctors’ prescriptions and advice. Abuse or non-medical use of prescription drugs is the use of drugs not prescribed for the individual, use of drugs solely for the experience or feelings they cause, or use of drugs for which the intended person has made false or inaccurate claims to obtain them.
A disturbing trend emerged last year, when NSDUH reported that first-time non-medical users of prescription drugs now equal first time users of marijuana and that misuse of prescription drugs among 12- and 13-year-olds exceeds marijuana use. The misuse of opioid pain killers is of particular concern because of the large number of users, the high addictive potential, and the potential to induce overdose or death.
Also of concern is that approximately 598,542 visits to emergency departments during 2005 involved the non-medical use of prescription drugs or over-the-counter medication or dietary supplements, with the majority involving multiple drugs (Drug Abuse Warning Network, 2005).
There are many factors contributing to the increased misuse of prescription drugs. There is a perception among young people that prescription drugs are safer than illicit street drugs. Moreover, many teens are not aware of the consequences of prescription drug misuse. Prescription drugs are also more easily attainable from friends and family.
There are indications that long-term misuse of pain medications can lead to addiction, and that intravenous use of this class of drugs places a person at increased risk of HIV and other infectious diseases. Additionally, because many of the prescription drugs that are abused share similarities with illicit drugs in the way they act on the brain, it is probable that some of the harmful consequences will be the same.
It is important for adults to recognize this growing problem and to help young people understand the risks of using prescription drugs non-medically. When used properly, under the supervision of a doctor, prescription drugs can be safe and effective. Used improperly, however, they can have serious consequences.
Preventing initiation and identifying problem use
Using marijuana or misusing prescription drugs in any amount is not safe. Scientists, educators, counselors, community coalitions, prevention experts, and others are working to expose dangerous drug myths and to increase awareness of the adverse physical, mental, emotional, and behavioral changes that can be associated with these substances. Testing students for drug use may help prevent initiation and identify drug users at an early stage, before a dependency sets in, thereby protecting adolescents and their fragile brains from the harmful effects of drug-using behavior.
A complete list of citations for this article is available at www.randomstudentdrugtesting.org

Source: Strategies for Success, Isssue 2 Vol.1 Fall 2007

The campaign to legitimize what is called “medical” marijuana is based on two propositions: that science views marijuana as medicine, and that DEA targets sick and dying people using the drug. Neither proposition is true. Smoked marijuana has not withstood the rigors of science – it is not medicine and it is not safe. DEA targets criminals engaged in cultivation and trafficking, not the sick and dying. No state has legalized the trafficking of marijuana, including the twelve states that have decriminalized certain marijuana use.

SMOKED MARIJUANA IS NOT MEDICINE
There is no consensus of medical evidence that smoking marijuana helps patients. Congress enacted laws against marijuana in 1970 based in part on its conclusion that marijuana has no scientifically proven medical value. The Food and Drug Administration (FDA) is the federal agency responsible for approving drugs as safe and effective medicine based on valid scientific data. FDA has not approved smoked marijuana for any condition or disease. The FDA noted that “there is currently sound evidence that smoked marijuana is harmful,” and “that no sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use.” 2
In 2001, the Supreme Court affirmed Congress’s 1970 judgment about marijuana in United States v. Oakland Cannabis Buyers’ Cooperative et al., 532 U.S. 438 (2001), which held that, given the absence of medical usefulness, medical necessity is not a defense to marijuana prosecution. Furthermore, in Gonzales v. Raich, 125 S.Ct. 2195 (2005), the Supreme Court reaffirmed that the authority of Congress to regulate the use of potentially harmful substances through the federal Controlled Substances Act includes the authority to regulate marijuana of a purely intrastate character, regardless of a state law purporting to authorize “medical” use of marijuana.
The DEA and the federal government are not alone in viewing smoked marijuana as having no documented medical value. Voices in the medical community likewise do not accept smoked marijuana as medicine:
The American Medical Association has rejected pleas to endorse marijuana as medicine, and instead has urged that marijuana remain a prohibited, Schedule I controlled substance, at least until more research is done. 3

• The American Cancer Society “does not advocate inhaling smoke, nor the legalization of marijuana,” although the organization does support carefully controlled clinical studies for alternative delivery methods, specifically a THC skin patch. 4

• The American Academy of Pediatrics (AAP) believes that “[a]ny change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.” While it supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana, it opposes the legalization of marijuana. 5

• The National Multiple Sclerosis Society (NMSS) states that studies done to date “have not provided convincing evidence that marijuana benefits people with MS,” and thus marijuana is not a recommended treatment. Furthermore, the NMSS warns that the “long-term use of marijuana may be associated with significant serious side effects.” 6

• The British Medical Association (BMA) voiced extreme concern that down-grading the criminal status of marijuana would “mislead” the public into believing that the drug is safe. The BMA maintains that marijuana “has been linked to greater risk of heart disease, lung cancer, bronchitis and emphysema.” 7 The 2004 Deputy Chairman of the BMA’s Board of Science said that “[t]he public must be made aware of the harmful effects we know result from smoking this drug.”8

• The American Academy of Pediatrics asserted that with regard to marijuana use, “from a public health perspective, even a small increase in use, whether attributable to increased availability or decreased perception of risk, would have significant ramifications.” 9
In 1999, The Institute of Medicine (IOM) released a landmark study reviewing the supposed medical properties of marijuana. The study is frequently cited by “medical” marijuana advocates, but in fact severely undermines their arguments.
After release of the IOM study, the principal investigators cautioned that the active compounds in marijuana may have medicinal potential and therefore should be researched further. However, the study concluded that “there is little future in smoked marijuana as a medically approved medication.” 10

• For some ailments, the IOM found “…potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation.” 11 However, it pointed out that “[t]he effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications [than smoked marijuana].”12

• The study concluded that, at best, there is only anecdotal information on the medical benefits of smoked marijuana for some ailments, such as muscle spasticity. For other ailments, such as epilepsy and glaucoma, the study found no evidence of medical value and did not endorse further research. 13

• The IOM study explained that “smoked marijuana . . . is a crude THC delivery system that also delivers harmful substances.” In addition, “plants contain a variable mixture of biologically active compounds and cannot be expected to provide a precisely defined drug effect.” Therefore, the study concluded that “there is little future in smoked marijuana as a medically approved medication.” 14

• The principal investigators explicitly stated that using smoked marijuana in clinical trials “should not be designed to develop it as a licensed drug, but should be a stepping stone to the development of new, safe delivery systems of cannabinoids.” 15
Thus, even scientists and researchers who believe that certain active ingredients in marijuana may have potential medicinal value openly discount the notion that smoked marijuana is or can become “medicine.” DEA has approved and will continue to approve research into whether THC has any medicinal use. As of May 8, 2006, DEA had registered every one of the 163 researchers who requested to use marijuana in studies and who met Department of Health and Human Services standards. 16
One of those researchers, The Center for Medicinal Cannabis Research (CMCR), conducts studies “to ascertain the general medical safety and efficacy of cannabis and cannabis products and examine alternative forms of cannabis administration.”17 The CMCR currently has 11 on-going studies involving marijuana and the efficacy of cannabis and cannabis compounds as they relate to medical conditions such as HIV, cancer pain, MS, and nausea.18
At present, however, the clear weight of the evidence is that smoked marijuana is harmful. No matter what medical condition has been studied, other drugs already approved by the FDA, such as Marinol – a pill form of synthetic THC – have been proven to be safer and more effective than smoked marijuana.
MARIJUANA IS DANGEROUS TO THE USER AND OTHERS
Legalization of marijuana, no matter how it begins, will come at the expense of our children and public safety. It will create dependency and treatment issues, and open the door to use of other drugs, impaired health, delinquent behavior, and drugged drivers. This is not the marijuana of the 1970′s; today’s marijuana is far more powerful. Average THC levels of seized marijuana rose from less than one per cent in the mid-1970′s to a national average of over eight per cent in 2004. 19
And the potency of “B.C. Bud” is roughly twice the national average – ranging from 15 per cent to as high as 25 per cent THC content.20
Dependency and Treatment:
o Adolescents are at highest risk for marijuana addiction, as they are “three times more likely than adults to develop dependency.” 21
This is borne out by the fact that treatment admission rates for adolescents reporting marijuana as the primary substance of abuse increased from 32 to 65 per cent between 1993 and 2003.22 More young people ages 12-17 entered treatment in 2003 for marijuana dependency than for alcohol and all other illegal drugs combined.23

• “Research shows that use of [marijuana] can lead to dependence. Some heavy users of marijuana develop withdrawal symptoms when they have not used the drug for a period of time. Marijuana use, in fact, is often associated with behavior that meets the criteria for substance dependence established by the American Psychiatric Association.” 24

• Of the 19.1 million Americans aged 12 or older who used illicit drugs in the past 30 days in 2004, 14.6 million used marijuana, making it the most commonly used illicit drug in 2004. 25

• Among all ages, marijuana was the most common illicit drug responsible for treatment admissions in 2003, accounting for 15 per cent of all admissions — outdistancing heroin, the next most prevalent cause. 26

• In 2003, 20 per cent (185,239) of the 919,833 adults admitted to treatment for illegal drug abuse cited marijuana as their primary drug of abuse.27
Marijuana as a Precursor to Abuse of Other Drugs:
o Marijuana is a frequent precursor to the use of more dangerous drugs, and signals a significantly enhanced likelihood of drug problems in adult life. The Journal of the American Medical Association reported, based on a study of 300 sets of twins, “that marijuana-using twins were four times more likely than their siblings to use cocaine and crack cocaine, and five times more likely to use hallucinogens such as LSD.” 28
• Long-term studies on patterns of drug usage among young people show that very few of them use other drugs without first starting with marijuana. For example, one study found that among adults (age 26 and older) who had used cocaine, 62 per cent had initiated marijuana use before age 15. By contrast, less than one per cent of adults who never tried marijuana went on to use cocaine. 29

• Columbia University’s National Center on Addiction and Substance Abuse reports that teens who used marijuana at least once in the last month are 13 times likelier than other teens to use another drug like cocaine, heroin, or methamphetamine, and almost 26 times likelier than those teens who have never used marijuana to use another drug. 30

• Marijuana use in early adolescence is particularly ominous. Adults who were early marijuana users were found to be five times more likely to become dependent on any drug, eight times more likely to use cocaine in the future, and fifteen times more likely to use heroin later in life. 31

• In 2003, 3.1 million Americans aged 12 or older used marijuana daily or almost daily in the past year. Of those daily marijuana users, nearly two-thirds “used at least one other illicit drug in the past 12 months.” More than half (53.3 per cent) of daily marijuana users were also dependent on or abused alcohol or another illicit drug compared to those who were nonusers or used marijuana less than daily. 32

• Healthcare workers, legal counsel, police and judges indicate that marijuana is a typical precursor to methamphetamine. For instance, Nancy Kneeland, a substance abuse counselor in Idaho, pointed out that “in almost all cases meth users began with alcohol and pot.” 33
Mental and Physical Health Issues Related to Marijuana:
John Walters, Director of the Office of National Drug Control Policy, Charles G. Curie, Administrator of the Substance Abuse and Mental Health Services Administration, and experts and scientists from leading mental health organizations joined together in May 005 to warn parents about the mental health dangers marijuana poses to teens. According to several recent studies, marijuana use has been linked with depression and suicidal thoughts, in addition to schizophrenia. These studies report that weekly marijuana use among teens doubles the risk of developing depression and triples the incidence of suicidal thoughts. 34

• Dr. Andrew Campbell, a member of the New South Wales (Australia) Mental Health Review Tribunal, published a study in 2005 which revealed that four out of five individuals with schizophrenia were regular cannabis users when they were teenagers. Between 75-80 per cent of the patients involved in the study used cannabis habitually between the ages of 12 and 21. 35 In addition, a laboratory-controlled study by Yale scientists, published in 2004, found that THC “transiently induced a range of schizophrenia-like effects in healthy people.”36

• Smoked marijuana has also been associated with an increased risk of the same respiratory symptoms as tobacco, including coughing, phlegm production, chronic bronchitis, shortness of breath and wheezing. Because cannabis plants are contaminated with a range of fungal spores, smoking marijuana may also increase the risk of respiratory exposure by infectious organisms (i.e., molds and fungi). 37

• Marijuana takes the risks of tobacco and raises them: marijuana smoke contains more than 400 chemicals and increases the risk of serious health consequences, including lung damage. 38

• According to two studies, marijuana use narrows arteries in the brain, “similar to patients with high blood pressure and dementia,” and may explain why memory tests are difficult for marijuana users. In addition, “chronic consumers of cannabis lose molecules called CB1 receptors in the brain’s arteries,” leading to blood flow problems in the brain which can cause memory loss, attention deficits, and impaired learning ability. 39

• Carleton University researchers published a study in 2005 showing that current marijuana users who smoke at least five “joints” per week did significantly worse than non-users when tested on neurocognition tests such as processing speed, memory, and overall IQ. 40

Delinquent Behaviors and Drugged Driving:
o In 2002, the percentage of young people engaging in delinquent behaviors “rose with [the] increasing frequency of marijuana use.” For example, according to a National Survey on Drug Use and Health (NSDUH) report, 42.2 per cent of youths who smoked marijuana 300 or more days per year and 37.1 per cent of those who did so 50-99 days took part in serious fighting at school or work. Only 18.2 per cent of those who did not use marijuana in the past year engaged in serious fighting. 41

• A large shock trauma unit conducting an ongoing study found that 17 per cent (one in six) of crash victims tested positive for marijuana. The rates were slightly higher for crash victims under the age of eighteen, 19 per cent of whom tested positive for marijuana. 42

• In a study of high school classes in 2000 and 2001, about 28,000 seniors each year admitted that they were in at least one accident after using marijuana. 43

• Approximately 15 per cent of teens reported driving under the influence of marijuana. This is almost equal to the percentage of teens who reported driving under the influence of alcohol (16 per cent). 44

• A study of motorists pulled over for reckless driving showed that, among those who were not impaired by alcohol, 45 per cent tested positive for marijuana. 45

• The National Highway Traffic Safety Administration (NHTSA) has found that marijuana significantly impairs one’s ability to safely operate a motor vehicle. According to its report, “[e]pidemiology data from road traffic arrests and fatalities indicate that after alcohol, marijuana is the most frequently detected psychoactive substance among driving populations.” Problems reported include: decreased car handling performance, inability to maintain headway, impaired time and distance estimation, increased reaction times, sleepiness, lack of motor coordination, and impaired sustained vigilance. 46
Some of the consequences of marijuana-impaired driving are startling:
The driver of a charter bus, whose 1999 accident resulted in the death of 22 people, had been fired from bus companies in 1989 and 1996 because he tested positive for marijuana four times. A federal investigator confirmed a report that the driver “tested positive for marijuana when he was hospitalized Sunday after the bus veered off a highway and plunged into an embankment.” 47

• In April 2002, four children and the driver of a van died when the van hit a concrete bridge abutment after veering off the freeway. Investigators reported that the children nicknamed the driver “Smokey” because he regularly smoked marijuana. The driver was found at the crash scene with marijuana in his pocket. 48

• A former nurse’s aide was convicted in 2003 of murder and sentenced to 50 years in prison for hitting a homeless man with her car and driving home with his mangled body “lodged in the windshield.” The incident happened after a night of drinking and taking drugs, including marijuana. After arriving home, the woman parked her car, with the man still lodged in the windshield, and left him there until he died. 49

• In April 2005, an eight year-old boy was killed when he was run over by an unlicensed 16 year-old driver who police believed had been smoking marijuana just before the accident. 50

• In 2001, George Lynard was convicted of driving with marijuana in his bloodstream, causing a head-on collision that killed a 73 year-old man and a 69 year-old woman. Lynard appealed this conviction because he allegedly had a “valid prescription” for marijuana. A Nevada judge agreed with Lynard and granted him a new trial. 51 The case has been appealed to the Nevada Supreme Court.52

• Duane Baehler, 47, of Tulsa, Okalahoma was “involved in a fiery crash that killed his teenage son” in 2003. Police reported that Baehler had methamphetamine, cocaine and marijuana in his system at the time of the accident. 53
Marijuana also creates hazards that are not always predictable. In August 2004, two Philadelphia firefighters died battling a fire that started because of tangled wires and lamps used to grow marijuana in a basement closet. 54

MARIJUANA AND INCARCERATION
Federal marijuana investigations and prosecutions usually involve hundreds of pounds of marijuana. Few defendants are incarcerated in federal prison for simple possession of marijuana.
o In 2001, there were 24,299 offenders sentenced in federal court on drug charges. Of those, only 2.3 per cent (186 people) were sentenced for simple possession. 55
In addition, it is important to recognize that many inmates were initially charged with more serious crimes but negotiated reduced charges to simple possession through plea agreements.56

• According to the latest survey data in a 2005 ONDCP study, marijuana accounted for 13 per cent of all state drug offenders in 1997, and of the inmates convicted of marijuana offenses, only 0.7 per cent were incarcerated for marijuana possession alone. 57
THE FOREIGN EXPERIENCE
The Netherlands
o Due to international pressure on permissive Dutch cannabis policy and domestic complaints over the spread of marijuana “coffee shops,” the government of the Netherlands has reconsidered its legalization measures. After marijuana became normalized, consumption nearly tripled – from 15 per cent to 44 per cent – among 18 to 20 year-old Dutch youth. 58
As a result of stricter local government policies, the number of cannabis “coffeehouses” in the Netherlands was reduced – from 1,179 in 199759 to 737 in 2004, a 37 per cent decrease in 7 years.60

• About 70 per cent of Dutch towns have a zero-tolerance policy toward cannabis cafes.61

• In August 2004, after local governments began clamping down on cannabis “coffeehouses” seven years earlier, the government of the Netherlands formally announced a shift in its cannabis policy through the United National International Narcotics Control Board (INCB). According to “an inter-ministerial policy paper on cannabis, the government acknowledged that ‘cannabis is not harmless’ – neither for the abusers, nor for the community.” Netherlands intends to reduce the number of coffee shops (especially those near border areas and schools), closely monitor drug tourism, and implement an action plan to discourage cannabis use. This public policy change brings the Netherlands “closer towards full compliance with the international drug control treaties with regard to cannabis.” 62

• Dr. Ernest Bunning, formerly with Holland’s Ministry of Health and a principal proponent of that country’s liberal drug philosophy, has acknowledged that, “there are young people who abuse soft drugs . . . particularly those that have a high THC [content]. The place that cannabis takes in their lives becomes so dominant they don’t have space for the other important things in life. They crawl out of bed in the morning, grab a joint, don’t work, smoke another joint. They don’t know what to do with their lives.” 63
Switzerland
Liberalization of marijuana laws in Switzerland has likewise produced damaging results. After liberalization, Switzerland became a magnet for drug users from many other countries. In 1987, Zurich permitted drug use and sales in a part of the city called Platzpitz, dubbed “Needle Park.” By 1992, the number of regular drug users at the park reportedly swelled from a “few hundred at the outset in 1987 to about 20,000.” The area around the park became crime-ridden, forcing closure of the park. The experiment has since been terminated. 64
Canada:
After a large decline in the 1980s, marijuana use among teens increased during the 1990s as young people became “confused about the state of federal pot law” in the wake of an aggressive decriminalization campaign, according to a special adviser to Health Canada’s Director General of drug strategy. Several Canadian drug surveys show that marijuana use among Canadian youth has steadily climbed to surpass its 26-year peak, rising to 29.6 per cent of youth in grades 7-12 in 2003. 65
United Kingdom:
In March 2005, British Home Secretary Charles Clarke took the unprecedented step of calling “for a rethink on Labour’s legal downgrading of cannabis” from a Class B to a Class C substance. Mr. Clarke requested that the Advisory Council on the Misuse of Drugs complete a new report, taking into account recent studies showing a link between cannabis and psychosis and also considering the more potent cannabis referred to as “skunk.” 66

• In 2005, during a general election speech to concerned parents, British Prime Minister Tony Blair noted that medical evidence increasingly suggests that cannabis is not as harmless as people think and warned parents that young people who smoke cannabis could move on to harder drugs. 67
THE LEGALIZATION LOBBY
The proposition that smoked marijuana is “medicine” is, in sum, false – trickery used by those promoting wholesale legalization. When a statute dramatically reducing penalties for “medical” marijuana took effect in Maryland in October 2003, a defense attorney noted that “there are a whole bunch of people who like marijuana who can now try to use this defense.” The attorney observed that lawyers would be “neglecting their clients if they did not try to find out what ‘physical, emotional or psychological’” condition could be enlisted to develop a defense to justify a defendant’s using the drug. “Sometimes people are self-medicating without even realizing it,’” he said. 68

Ed Rosenthal, senior editor of High Times, a pro-drug magazine, once revealed the legalizer strategy behind the “medical” marijuana movement. While addressing an effort to seek public sympathy for glaucoma patients, he said, “I have to tell you that I also use marijuana medically. I have a latent glaucoma which has never been diagnosed. The reason why it’s never been diagnosed is because I’ve been treating it.” He continued, “I have to be honest, there is another reason why I do use marijuana . . . and that is because I like to get high. Marijuana is fun.” 69

• A few billionaires-not broad grassroots support-started and sustain the “medical” marijuana and drug legalization movements in the United States. Without their money and influence, the drug legalization movement would shrivel. According to National Families in Action, four individuals – George Soros, Peter Lewis, George Zimmer and John Sperling – contributed $1,510,000 to the effort to pass a “medical” marijuana law in California in 1996, a sum representing nearly 60 per cent of the total contributions. 70

• In 2000, The New York Times interviewed Ethan Nadelmann, Director of the Lindesmith Center. Responding to criticism that the medical marijuana issue is a stalking horse for drug legalization, Mr. Nadelmann stated: “Will it help lead toward marijuana legalization? . . . I hope so.” 71

• In 2004, Alaska voters faced a ballot initiative that would have made it legal for adults age 21 and older to possess, grow, buy, or give away marijuana. The measure also called for state regulation and taxation of the drug. The campaign was funded almost entirely by the Washington, D.C.-based Marijuana Policy Project, which provided “almost all” the $857,000 taken in by the pro-marijuana campaign. Fortunately, Alaskan voters rejected the initiative. 72

• In October 2005, Denver voters passed Initiative 100 decriminalizing marijuana based on incomplete and misleading campaign advertisements put forth by the Safer Alternative For Enjoyable Recreation (SAFER). A Denver City Councilman complained that the group used the slogan “Make Denver SAFER” on billboards and campaign signs to mislead the voters into thinking that the initiative supported increased police staffing. Indeed, the Denver voters were never informed of the initiative’s true intent to decriminalize marijuana. 73

• The legalization movement is not simply a harmless academic exercise. The mortal danger of thinking that marijuana is “medicine” was graphically illustrated by a story from California. In the spring of 2004, Irma Perez was “in the throes of her first experience with the drug ecstasy” when, after taking one ecstasy tablet, she became ill and told friends that she felt like she was “going to die.” Two teenage acquaintances did not seek medical care and instead tried to get Perez to smoke marijuana. When that failed due to her seizures, the friends tried to force-feed marijuana leaves to her, “apparently because they knew that drug is sometimes used to treat cancer patients.” Irma Perez lost consciousness and died a few days later when she was taken off life support. She was 14 years old. 74
STILL, THERE’S GOOD NEWS
Continued Declines in Marijuana Use among Youth
In 2005, the Monitoring the Future (MTF) survey recorded an overall 19.1 per cent decrease in current use of illegal drugs between 2001 and 2005, edging the nation closer to its five-year goal of a 25 per cent reduction in illicit drug use in 2006. Specific to marijuana, the 2005 MTF survey showed:
Between 2001 and 2005, marijuana use dropped in all three categories: lifetime (13%), past year (15%) and 30-day use (19%). Current marijuana use decreased 28 per cent among 8th graders (from 9.2% to 6.6%), and 23 per cent among 10th graders (from 19.8 per cent to 15.2%). 75
Increased Eradication
As of September 20, 2005, DEA’s Domestic Cannabis Eradication/Suppression Program supported the eradication of 3,054,336 plants in the top seven marijuana producing states (California, Hawaii, Kentucky, Oregon, Tennessee, Washington and West Virginia). This is an increase of 315,628 eradicated plants over the previous year. 76

• For the 2005 eradication season, a total of 5 million marijuana plants have been eradicated across the United States. This is a one million plant increase over last year. The Departments of Agriculture and Interior combined have eradicated an estimated 1.2 million plants during this 2005 eradication season. 77
APPENDIX A
Acronyms used in “The DEA Position on Marijuana”
AAP American Academy of Pediatrics
ACS American Cancer Society
AMA American Medical Association
BBC British Broadcasting Company
B.C. Bud British Columbia Bud
BMA British Medical Association
CB1 Cannabinoid Receptor 1: one of two receptors in the brain’s endocannabinoid (EC) system associated with the intake of food and tobacco dependency.
CMCR Center for Medicinal Cannabis Research
DASIS Drug and Alcohol Services Information System
DEA Drug Enforcement Administration
FDA Food and Drug Administration
HIV Human Immunodeficiency Virus
INCB International Narcotics Control Board
IOM Institute of Medicine
IOP Intraocular Pressure
LSD Diethylamide-Lysergic Acid
MS Multiple Sclerosis
NHTSA National Highway Traffic Safety Administration
NIDA National Institute on Drug Abuse
NMSS National Multiple Sclerosis Society
NORML National Organization for the Reform of Marijuana Laws
NSDUH National Survey of Drug Use and Health
ONDCP Office of National Drug Control Policy
TEDS Treatment Episode Data Set
THC Tetrahydrocannabinol

ENDNOTES
1 As of April 2006, the eleven states that have decriminalized certain marijuana use are Arizona, Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Rhode Island, Vermont, and Washington. In addition, Maryland has enacted legislation that recognizes a “medical marijuana” defense
2 “Inter-Agency Advisory Regarding Claims That Smoked Marijuana Is a Medicine.” U.S. Food and Drug Administration, April 20, 2006. <

http://www.fda.gov/bbs/topics/NEWS/2006/NEW01362.html>.

3 “Policy H-95.952 ‘Medical Marijuana.’” American Medical Association. See also, American Medical Association, Featured Council on Scientific Affairs. “Medical Marijuana (A-01).” June 2001. In 2001, the AMA updated their policy regarding medical marijuana reflecting the results of this study. It should be noted that a few medical organizations have offered limited support to the concept of “medical” marijuana. For example, the American Academy of Family Physicians has said that it opposes the use of marijuana “except under medical supervision and control, for specific medical indications.” Largely at the urging of one activist – a lobbyist and former Board member of NORML – the American Nurses Association has endorsed “medical” marijuana under “appropriate prescriber supervision,” and the American Academy of HIV Medicine, a group of about 1,800 members founded in 2000, has taken the view that marijuana should not only be made available for “medical” use, but should be excluded altogether as a Schedule I drug
4 “Experts: Pot Smoking Is Not Best Choice to Treat Chemo Side-Effects.” American Cancer Society. 22 May 2001.

http://www.cancer.org/docroot/NWS/content/update/NWS_1_1xU_

Experts__Pot_Smoking_Is_Not_Best_Choice_to_Treat_Chemo_Side_Effects.asp
(9 March 2005).
5 Committee on Substance Abuse and Committee on Adolescence. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics Vol. 113, No. 6 (6 June 2004): 1825-1826. See also, Joffe, Alain, MD, MPH, and Yancy, Samuel, MD. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics Vol. 113, No. 6 (6 June 2004): e632-e638h.
6 National MS Society. “Information Sourcebook.” National MS Society. December 2004. <
www.nationalmssociety.org/pdf/sourcebook/marijuana.pdf> (1 April 2005).
7 “Doctors’ Fears at Cannabis Change.” BBC News. 21 January 2004.
8 Manchester Online. “Doctors Support Drive Against Cannabis.”
Manchester News. 21 January 2004. <

http://www.manchesteronline.co.uk/

news/s/78/78826_doctors_support_drive_against_cannabis.html> (25 March 2005).
9 Joffe, Alain, MD, MPH, Yancy, Samuel W., MD, the Committee on Substance Abuse and the Committee on Adolescence, Technical Report: “Legalization of Marijuana: Potential Impact on Youth”, American Academy of Pediatrics, 6 June 2004.
10 Institute of Medicine. “Marijuana and Medicine: Assessing the Science Base.” (1999). Summary. <
http://www.nap.edu/html/marimed> (12 April 2005).
11 Id.
12 Institute of Medicine. “Marijuana and Medicine: Assessing the Science Base.” (1999). Executive Summary. <
http://www.nap.edu/html/marimed> (11 January 2006).
13 Institute of Medicine. “Marijuana and Medicine: Assessing the Science Base.” (1999). Summary. <
http://www.nap.edu/html/marimed> (11 January 2006).
14 Institute of Medicine. “Marijuana and Medicine: Assessing the Science Base.” (1999). Summary. <
http://www.nap.edu/html/marimed> (11 January 2006).
15 Benson, John A., Jr. and Watson, Stanley J., Jr. “Strike a Balance in the Marijuana Debate.” The Standard-Times. 13 April 1999.
16 DEA, Office of Diversion Control. 8 May 2006.
17 “CMCR Mission Statement.” Center for Medicinal Cannabis Research. <
http://www.cmcr.ucsd.edu/geninfo/mission.htm> (3 February 2005).
18 DEA, Office of Diversion Control. 6 January 2006.
19 Marijuana Potency Monitoring Project. “Quarterly Report #87.” Marijuana Potency Monitoring Project. 8 November 2004.
20 “BC Bud: Growth of the Canadian Marijuana Trade.” Drug Enforcement Administration, Intelligence Division. December 2000.
21 “Teens at High Risk for Pot Addiction.” The Seattle Post-Intelligencer. 6 January 2004.
22 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS) 1993-2003: National Admissions to Substance Abuse Treatment Services. November 2005, Table 5.1b. <
http://wwwdasis.samhsa.gov/teds03/teds_2003_rpt.pdf> (12 January 2006).
23 Id.
24 “Marijuana Myths & Facts: The Truth Behind 10 Popular Misperceptions.” Office of National Drug Control Policy. <
http://www.whitehousedrugpolicy.gov/publications/marijuana_myths_facts/index.html> (12 January 2006).
25 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Overview of Findings from 2004 National Survey on Drug Use and Health. September 2005.
26 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS) 1993-2003: National Admissions to Substance Abuse Treatment Services. November 2005. Page 74; Table 2.1b. <
http://wwwdasis.samhsa.gov/teds03/teds_2003_rpt.pdf> (12 January 2006).
27 Id., Tables 2.1a and 5.1a. There were 284,361 primary marijuana admissions in 2003, with 99,122 of those being juvenile marijuana admissions, meaning that there were 185,239 adult marijuana admissions.
28 “What Americans Need to Know about Marijuana.” Office of National Drug Control Policy. October 2003.
29 Gfroerer, Joseph C., et al. “Initiation of Marijuana Use: Trends, Patterns and Implications.” Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. July 2002. Page 71.
30 “Non-Medical Marijuana II: Rite of Passage or Russian Roulette?” CASA Reports. April 2004. Chapter V, Page 15.
31 “What Americans Need to Know about Marijuana,” 9.
32 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. “Daily Marijuana Users.” The NSDUH Report. 26 November 2004.
33 Furber, Matt. “Threat of Meth-’the Devil’s Drug’-increases.” Idaho Mountain Express and Guide. 28 December 2005.
34 “Drug Abuse; Drug Czar, Others Warn Parents that Teen Marijuana Use can Lead to Depression.” Life Science Weekly. 31 May 2005.
35 Kearney, Simon. “Cannabis is Worst Drug for Psychosis.” The Australian. 21 November 2005.
36 Curtis, John. “Study Suggests Marijuana Induces Temporary Schizophrenia-Like Effects.” Yale Medicine. Fall/Winter 2004.
37 “Marijuana Associated with Same Respiratory Symptoms as Tobacco,” YALE News Release. 13 January 2005. <
http://www.yale.edu/opa/newsr/05-01-13-01.all.htm> (14 January 2005). See also, “Marijuana Causes Same Respiratory Symptoms as Tobacco,” January 13, 2005, 14WFIE.com.
38 “What Americans Need to Know about Marijuana,” page 9.
39 “Marijuana Affects Brain Long-Term, Study Finds.” Reuters. 8 February 2005. See also: “Marijuana Affects Blood Vessels.” BBC News. 8 February 2005; “Marijuana Affects Blood Flow to Brain.” The Chicago Sun-Times. 8 February 2005; Querna, Elizabeth. “Pot Head.” US News & World Report. 8 February 2005.
40 “Neurotoxicology; Neurocognitive Effects of Chronic Marijuana Use Characterized.” Health & Medicine Week. 16 May 2005.
41 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Sciences. “Marijuana Use and Delinquent Behaviors Among Youths.” The NSDUH Report. 9 January 2004.
42 “Drugged Driving Poses Serious Safety Risk to Teens; Campaign to Urge Teens to ‘Steer Clear of Pot’ During National Drunk and Drugged Driving (3D) Prevention Month.” PR Newswire. 2 December 2004.
43 O’Malley, Patrick and Johnston, Lloyd. “Unsafe Driving by High School Seniors: National Trends from 1976 to 2001 in Tickets and Accidents After Use of Alcohol, Marijuana and Other Illegal Drugs.” Journal of Studies on Alcohol. May 2003.
44 Id.
45 “White House Drug Czar Launches Campaign to Stop Drugged Driving.” Office of National Drug Control Policy Press Release. 19 November 2002.
46 Couper, Fiona, J., Ph.D., page 11.
47 Orange County Register. “Nation: Drug Test Positive for Driver in Deadly Crash.” Orange County Register. 14 May 1999.
48 Edmondson, Aimee. “Drug Tests Required of Child Care Drivers – Fatal Crash Stirs Change; Many Already Test Positive.” The Commercial Appeal. 2 July 2003.
49 McDonald, Melody and Boyd, Deanna. “Jury Gives Mallard 50 Years for Murder; Victim’s Son Forgives but Says ‘Restitution is Still Required.’” Fort Worth Star Telegram. 28 June 2003.
50 “Boy, 8, Who Was Struck While Riding Bike Dies.” The Dallas Morning News. 25 April 2005.
51 “Lastest News in Brief from Northern Nevada.” The Associated Press State & Local Wire. 30 April 2005.
52 Washoe County District Attorney’s Office. 6 January 2006.
53 The Associated Press. “Police: Driver in Fatal Crash had Drugs in System.” The Associated Press. 1 June 2003.
54 The Associated Press. “Murder Charges Filed in Blaze that Killed Two Firefighters.” The Associated Press. 21 August 2004.
55 Office of National Drug Control Policy. “Who’s Really in Prison for Marijuana?” May 2005. Page 22.
56 “Marijuana Myths & Facts.” Page 22.
57 “Who’s Really in Prison for Marijuana? Page 20.
58 “What Americans Need to Know about Marijuana,” ONDCP, Page 10.
59 Dutch Health, Welfare and Sports Ministry Report. 23 April 2004.
60 INTRAVAL Bureau for Research & Consultancy. “Coffeeshops in the Netherlands 2004.” Dutch Ministry of Justice. June 2005. <

http://www.intraval.nl/en/b/b45.html>.

61 Id.
62 International Narcotics Control Board. “INCB Welcomes ‘Crucial and Significant Change in Dutch Cannabis Policy.’” United Nations Information Service. 2 March 2005. The action plan to discourage cannabis use includes elements such as drug prevention campaigns, mass-media anti-drugs campaign, increased treatment efforts to cannabis users, and encouragement of administrative and criminal law enforcement efforts. See also: “International Narcotics Control Board Annual Report Focuses on Need to Integrate Drug Demand, Supply Strategies.” SOC/NAR/924 Press Release. 3 February 2005. <
http://www.un.org/News/Press/docs/2005/socnar924.doc.htm> (18 March 2005); “Press Briefing by International Narcotics Control Board.” 3 January 2005. (18 March 2005).
63 Collins, Larry. “Holland’s Half-Baked Drug Experiment.” Foreign Affairs Vol. 73, No. 3. May-June 1999: Pages 87-88.
64 Cohen, Roger. “Amid Growing Crime, Zurich Closes a Park it Reserved for Drug Addicts.” The New York Times. 11 February 1992.
65 Adlaf, Edward M. and Paglia-Boak, Angela, Center for Addiction and Mental Health, Drug Use Among Ontario Students, 1977-2005, CAMH Research Document Series No. 16. The study does not contain data on marijuana use among 12th graders prior to 1999. See also: Canadian Addiction Survey, Highlights (November 2004) and Detailed Report (March 2005), produced by Health Canada and the Canadian Executive Council on Addictions; Youth and Marijuana Quantitative Research’ 2003 Final Report, Health Canada; Tibbetts, Janice and Rogers, Dave. “Marijuana Tops Tobacco Among Teens, Survey Says: Youth Cannabis Use Hits 25-Year Peak,” The Ottawa Citizen, 29 October 2003.
66 Koster, Olinka, Doughty, Steve, and Wright, Stephen. “Cannabis Climbdown.” Daily Mail (London). 19 March 2005. See also. Revill, Jo, and Bright, Martin. “Cannabis: the Questions that Remain Unanswered.” The Observer. 20 March 2005; Steele, John and Helm, Toby. “Clarke Reviews “Too Soft” Law on Cannabis.” The Daily Telegraph (London). 19 March 2005; Brown, Colin. “Clarke Orders Review of Blunkett Move to Downgrade Cannabis.” The Independent (London). 19 March 2005.
67 “Blair’s ‘Concern’ on Cannabis.” The Irish Times. 4 May 2005. See also, Russell, Ben. “Election 2005: Blair Rules Out National Insurance Rise.” The Independent (London). 4 May 2005.
68 Craig, Tim. “Md. Starts to Allow Marijuana Court Plea; Penalty Can be Cut for Medicinal Use.” The Washington Post. 1 October 2003, sec B.
69 From a videotape recording of Mr. Rosenthal’s speech, as shown in “Medical Marijuana: A Smoke Screen.”
70 “A Guide to Drug Related State Ballot Initiatives.” National Families in Action. 23 April 2002. <
http://www.nationalfamilies.org/guide/california215.html> (31 March 2005).
71 Wren, Christopher S. “Small But Forceful Coalition Works to Counter U.S. War on Drugs.” The New York Times, 2 January 2000.
72 Brant, Tataboline. “Marijuana Campaign Draws in $857,000.” The Anchorage Daily News. 30 October 2004.
73 Gathright, Alan. “Pot Backers Can’t Stoke Hickenlooper.” Rocky Mountain News. 27 October 2005.
74 Stannard, Matthew B. “Ecstasy Victim Told Friends She Felt Like She Was Going to Die.” The San Francisco Chronicle, 4 May 2004. The Chronicle reported that Ms. Perez was given ibuprofen and “possibly marijuana,” but DEA has confirmed that the drug given to her was indeed marijuana.
75 Monitoring the Future, 2005. Supplemented by information from the Office of National Drug Control Policy press release on the 2005 MTF Survey, December 19, 2005.)
76 DEA Domestic Cannabis Eradication/Suppression Program, 2005 eradication season.
77 Id.
Source: DrugWatch International January 2010