Introduction to the 1994 classic reprint of Marihuana
(first published by Harvard University press in 1971)
ON FURTHER RECONSIDERATION by Lester Grinspoon M.D.
I first became interested in cannabis when its use increased explosively in the 1960s. At that time I had no doubt that it was a very harmful drug that was unfortunately being used by more and more foolish young people who would not listen to or could not believe or understand the warnings about its dangers. When I began to study marihuana in 1967, my aim was to define scientifically the nature and degree of those dangers. But as I reviewed the scientific, medical, and lay literature, my views began to change. I came to understand that I, like so many other people in this country, had been misinformed and misled. There was little empirical evidence to support my beliefs about the dangers of marihuana. By the time I had completed the research that formed the basis for the book, originally published in 1971, I was convinced that cannabis was far less harmful than I had believed. The book's title, Marihuana Reconsidered, reflected that change in view.
After three years of research on cannabis, I concluded that not only was it much less harmful than alcohol or tobacco, but also that no harm it might cause was nearly as serious as the damage attributable to the annual arrest of 400,000 mostly young people on marihuana charges. I naively believed that once people understood that marihuana was much less harmful than drugs already legal, the laws against it would be repealed. I confidently predicted that cannabis would be legalized for adult use within the decade. I had not yet learned that there is something peculiar about illicit drugs: if they don't always make the drug user behave irrationally, they certainly cause many nonusers to behave that way. Instead of making marihuana legally available to adults, we have continued to criminalize many millions of Americans. Hundreds of thousands of mostly young people are arrested on marihuana charges each year, and the political climate has now deteriorated so severely that it has become difficult to discuss marihuana openly and freely. It could almost be said that there is a climate of psychopharmacological McCarthyism.
In the years following publication of Marihuana Reconsidered, it became increasingly clear that there were no valid scientific reasons for the ban on marihuana. The Anslinger-era notions on which the 1937 Marijuana Tax Act was based - that marihuana caused violent crime, "sexual excess" (whatever that is), and addiction, and that it served as a "stepping-stone" to "harder drugs," had been thoroughly discredited. Since these arguments were no longer plausible, groups opposed to liberalization of the marihuana laws now began to talk about "new research" supposedly proving that marihuana caused other kinds of harm. It was in this atmosphere that the federal government provided greatly expanded support, largely through the National Institute on Drug Abuse, for studies designed to uncover new health hazards. Thus, we heard in the early '70s that marihuana destroyed brain cells, caused psychoses, lowered testosterone levels and sperm counts, led to breast development in adolescent males, damaged memory and intellectual functions, compromised the immune system, and caused chromosome breakage, genetic damage, and birth defects. The publication of these findings followed a typical pattern. Each one would be reported in front-page stories with alarmist commentary. Then, over the next few months or years, investigators would report that the finding could not be replicated. When this contradictory evidence was reported at all, the story would usually appear as a short item in the back pages. The public was often left with the impression that the existence of the latest health hazard had been scientifically demonstrated.
By 1977 enough genuine new knowledge had accumulated to justify a second edition of Marihuana Reconsidered with a new chapter in which James B. Bakalar and I reviewed research and social developments over the intervening six years. Undeterred by the failure of my prediction in 1971 that marihuana would be legalized within the decade, we concluded the second edition with the following words: “Whatever the cultural conditions that have made it possible, there is no doubt that the discussion about marihuana has become more sensible. We are gradually becoming conscious of the irrationality of classifying this drug as one with high abuse potential and no medical value. If the trend continues, it is likely that within a decade, marihuana will be sold in the United States as a legal intoxicant."
We had reason to be optimistic at that time, three years before Ronald Reagan was elected President. In 1971 the National Commission on Marijuana and Drug Abuse, appointed by President Nixon, had recommended eliminating penalties for possession of marihuana for personal use and casual nonprofit transfers for small amounts. In 1973 Oregon had become the first state to decriminalize marihuana, making possession of less than an ounce a civil offense penalized by a small fine. In 1975 Alaska had eliminated all penalties for private possession and cultivation of less than four ounces. President Carter had endorsed decriminalization, as had the American Medical Association, the American Psychiatric Association, the American Bar Association, and the National Council of Churches. By 1977, most states had reduced simple possession to a misdemeanor, and by 1980 eleven states had actively decriminalized possession.
Unfortunately, this trend did not continue. The marihuana reform movement peaked in the late 1970s. In 1978 Dr. Peter Bourne, the White House drug advisor who had helped President Carter move toward reform, resigned and was replaced by Lee Dogoloff, a hardliner. In that same year the proportion of the population favoring marihuana legalization began to fall from its 1977 high of 28%; today it has dropped to 15%. Under President Reagan the government instituted a program of "zero tolerance." By 1983 it was spraying the dangerous insecticide Paraquat on domestic marihuana crops and using military methods to uproot cannabis plants and arrest their growers in northern California.
In 1987 a Supreme Court nominee had to withdraw under pressure because he had smoked marihuana as a law professor. In 1989, under President Bush, the federal government began Operation Green Merchant; it confiscated lists of people who had ordered indoor plant growing equipment and raided their homes. The Bush administration also worked hard to persuade Alaska to recriminalize marihuana possession, and succeeded in 1990. That same year Congress passed a bill calling for federal transportation funds to be withheld from states refusing a six-month suspension of the automobile licenses of people convicted of marihuana possession.
It is important to remember that these increasingly harsh government measures (and the growing hysteria of anti-marihuana citizen's groups) did not reflect any new knowledge about the dangers of this drug. The quarter of a century since the publication of the first edition of Marihuana Reconsidered has produced remarkably little laboratory, sociological, or epidemiological evidence of serious health or social problems caused by marihuana. The present attitude of the government and anti-marihuana crusaders bears the same relationship to reality that the film "Reefer Madness" bore in 1936. But the dissonance is even more striking now, because we know so much more. Since 1971 millions of dollars have been spent to study the dangers of cannabis, and this vast research enterprise has completely failed to provide a scientific basis for prohibition. Although evidence against the toxicity continues to accumulate, the government persists in escalating its war on cannabis users. To justify this policy (usually with the Drug Enforcement Administration (DEA) as its voice) it distorts, stretches, and truncates research findings to an extent worthy of Procrustes.
The government's commitment to gross exaggeration of the harmfulness of cannabis has made it necessary to deny the drug's medical usefulness in the face of overwhelming evidence. In 1991 the DEA was inundated with requests for marihuana from people with AIDS. In response, James 0. Mason, head of the Public Health Service, announced that the compassionate IND program, which had helped a handful of patients to use marihuana legally as a medicine, would be suspended. He explained that this program undercut the administration's opposition to the use of illegal drugs: "If it is perceived that the Public Health Service is going around giving marihuana to folks, there would be a perception that this stuff can't be so bad," Mason said. "It gives a bad signal. I don't mind doing that if there is no other way of helping these people .... But there is not a shred of evidence that smoking marihuana assists a person with AIDS."
In 1971 I pointed out that since marihuana had been used by so many people all over the world for so many thousands of years with so little evidence of significant toxic effects, the discovery of some previously unknown serious health hazard was unlikely. I suggested that the emphasis in cannabis research should be shifted to its medical uses and its potential as a tool to advance our understanding of brain function. Although few resources have been committed to either of these fields, there have been compelling developments in both.
In 1990 researchers discovered receptors in the brain stimulated by THC. This exciting discovery implied that the body produces it own version of cannabinoids for one or more useful purposes. The first of these cannabinoid-like neurotransmitters was identified in 1992 and named anandamide (ananda is the Sanscrit word for bliss). Cannabinoid receptor sites occur not only in the lower brain but also in the cerebral cortex, which governs higher thinking, and in the hippocampus, which is a locus of memory. These discoveries raise some interesting questions. Could the distribution of anandamide receptor sites in the higher brain explain why so many cannabis users claim that the drug enhances some mental activities, including creativity and fluidity of associations? Do these receptor sites play a role in marihuana's capacity to alter the subjective experience of time? What about the subtle enhancement of perception and the capacity to experience the physical world with some of the freshness and excitement of childhood? Perhaps further research on these receptors, which may not be limited to the brain alone, will also promote a better understanding of the remarkable versatility of cannabis.
Despite conditions that deter medical researchers, medical applications of cannabis have seen considerable progress since 1971 under the most unusual and difficult of circumstances. New drugs are generally escorted over the complicated federal regulatory obstacle course by pharmaceutical companies, which devote vast resources to the task of taking a chemical with therapeutic potential and transforming it into a marketable property. For many reasons, including the fact that patent protection is impossible, no drug company is ever likely to undertake this effort on behalf of cannabis. Furthermore, the United States government has been steadfast in its opposition to recognizing the medical utility of cannabis. Yet ever larger numbers of people are using marihuana medically.
Several developments have greatly increased interest in cannabis as a medicine. In the early 1970s many people noticed that cannabis could relieve the intense nausea and vomiting induced by cancer chemotherapeutic substances, which were then new. Marijuana often proved to be more effective than legal anti-nauseants. At about the same time it was discovered that marihuana reliably lowered the pressure on the optic nerve in people suffering from open-angle glaucoma; many patients learned, mostly from one another, that cannabis was more effective than conventional medications in retarding the loss of vision caused by this disorder. In the mid-1980s people with AIDS discovered that cannabis relieved the nausea caused by their illness or by the medications taken to counteract it. In addition, cannabis often improved their appetite and enabled them to stop losing or even to gain weight. Like most medical users of cannabis, AIDS patients have found that smoked marihuana is more effective than the synthetic THC (Marinol) that was made legally available as a prescription drug in 1985.
The effort to make cannabis itself available as a prescription drug was initiated in 1972 by the National Organization for the Reform of Marijuana Laws and worked its way through the legal system with excruciating slowness. In 1986 the administrator of the DEA finally announced that he would hold the public hearings ordered by the courts seven years before. Those hearings, which began in 1986 and lasted two years, involved many witnesses, including both patients and doctors, and thousands of pages of documentation. The DEA's own Administrative Law Judge, Francis J. Young, reviewed the evidence and rendered his decision in 1988. Young said that approval by a "significant minority" of physicians was enough to meet the standard of "currently accepted medical use in treatment in the United States" established by the Controlled Substances Act for a Schedule II (prescription) drug. He added that "marihuana, in its natural form, is one of the safest therapeutically active substances known to man.... One must reasonably conclude that there is accepted safety for use of marihuana under medical supervision. To conclude otherwise, on the record, would be unreasonable, arbitrary, and capricious." Young went on to recommend "that the Administrator [of the DEA] conclude that the marihuana plant considered as a whole has a currently accepted medical use in treatment in the United States, that there is no lack of accepted safety for use of it under medical supervision, and that it may be lawfully transmitted from Schedule I to Schedule II."
The DEA disregarded the opinion of its own Administrative Law Judge and refused to reschedule marihuana. As the agency's lawyer remarked, "The judge seems to hang his hat on what he calls a respectable minority of physicians. What percent are you talking about? One half of one percent? One quarter of one percent?" DEA Administrator John Lawn went further, calling claims for the medical utility of marihuana a "dangerous and cruel hoax." In the last twenty years, as the medical potential of cannabis has become increasingly clear, I have witnessed the growing frustration of patients who cannot obtain it legally. The United States government must accept responsibility for the unnecessary suffering produced by a policy that can only be described as ignorant and cruel, and for forcing its citizens to engage in criminal activity. Despite government obstructionism, many patients have learned to use marihuana therapeutically and many more are discovering its benefits. Unfortunately, they have to endure the anxiety imposed by the threat of arrest and their feelings about breaking the law, and they are compelled to pay exorbitant street prices for a medicine that should be quite inexpensive. [fn 1 For a detailed account of the growing place of cannabis in the treatment of a variety of disorders, see Lester Grinspoon and James B. Bakalar, Marijuana, the Forbidden Medicine (New Haven: Yale University Press, 1993).
Re-reading Marihuana Reconsidered now, I find that some chapters, such as those on chemistry, pharmacology, and medical uses, are out of date. Some of the ideas expressed in the book now seem a little quaint to me as well. The tone is more conservative than it would be if I were to undertake the same task today. Although I still believe that marihuana is not harmless, I am convinced that it is one of the least dangerous, if not the least dangerous, of all psychoactive drugs, legal or illegal, recreational or medicinal.
Another impression I have in re-reading the book is a certain neglect of uses of marihuana that are neither strictly medical nor strictly recreational. I wrote in 1971 that "My intention is to present a reasonably accurate and comprehensive account of the drug and its properties and to put into perspective its dangers and utilities." At that time, largely because of my own ignorance, "utilities" referred only to medicine. Experience over the last twenty years had compelled me to take much more seriously the claims of those who believe that cannabis has useful properties that cannot be described as medical.
For example, I no longer doubt that marihuana can be an intellectual stimulant. It can help the user to penetrate conceptual boundaries, promote fluidity of associations, and enhance insight and creativity. Some people find it so useful in gaining new perspectives or seeing problems from a different vantage point that they smoke it in preparation for intellectual work. I suspect that these people have learned to make use of the alteration in consciousness produced by cannabis. Other ways in which cannabis is useful probably have less to do with learning. It can enhance the appreciation of food, music, sexual activity, natural beauty, and other sensual experiences. Under the right conditions and in the right settings, it can promote emotional intimacy. For almost everyone it has the capacity to induce a deep and salutary laughter.
Perhaps in part because so many Americans have discovered for themselves that marihuana is both relatively benign and remarkably useful, moral consensus about the evil of cannabis is uncertain and shallow. The authorities pretend that eliminating cannabis traffic is like eliminating slavery or piracy, or eradicating smallpox or malaria. The official view is that everything possible has to be done to prevent everyone from ever using marihuana. But there is also an informal lore of marihuana use that is far more tolerant. Many of the millions of cannabis users in this country not only disobey the drug laws but feel a principled lack of respect for them. They do not conceal their bitter resentment of laws that render them criminals. They believe that many people have been deceived by their government, and they have come to doubt that the "authorities" understand much about either the deleterious or the useful properties of the drug. This undercurrent of ambivalence and resistance in public attitudes towards marihuana laws leaves room for the possibility of change, especially since the costs of prohibition are all so high and rising. At the present time more than 300,000 people a year are arrested on marihuana charges, contributing to the clogging of courts and overcrowding of prisons.
Besides the measurable billions wasted on prohibition, there are costs more difficult to quantify. One of them is lost credibility of government. Young people who discover that the authorities have been lying about cannabis become cynical about their pronouncements on other drugs and disdainful of their commitment to justice. Another frightful cost of prohibition is the erosion of civil liberties. The use of informers and entrapment, mandatory urine testing, unwarranted searches and seizures, and violations of the Posse Comitatus Act (which outlaws the use of military forces for civilian law enforcement) are becoming more common. It is increasingly clear that our society cannot be both drug-free and free.
It is also clear that the realities of human need are incompatible with the demand for a legally enforceable distinction between medicine and all other uses of cannabis. Marijuana simply does not conform to the conceptual boundaries established by twentieth-century institutions. It enhances many pleasures and it has many potential medical uses, but even these two categories are not the only relevant ones. The kind of therapy often used to ease everyday discomforts does not fit any such scheme. In many cases what lay people do in prescribing marihuana for themselves is not very different from what physicians do when they provide prescriptions for psychoactive or other drugs. The only workable way of realizing the full potential of this remarkable substance, including its full medical potential, is to free it from the present dual set of regulations - those that control prescription drugs in general and the special criminal laws that control psychoactive substances. These mutually reinforcing laws establish a set of social categories that strangle its uniquely multifaceted potential. The only way out is to cut the knot by giving marihuana the same status as alcohol -- legalizing it for adults for all uses and removing it entirely from the medical and criminal control systems.
Given my record as a prophet, it may be foolhardy for me to make any further predictions about the fate of marihuana. Yet I still believe that eventually the people of the United States and the world will recognize the individual and social benefits of this drug and the enormous cost of the present prohibition. One day, I hope, we will look back and wonder why our societies were so perverse as to treat cannabis as they did for the greater part of the twentieth century.