Intended for healthcare professionals

Rapid response to:

Education And Debate For and against

Cannabis control: costs outweigh the benefitsForAgainst

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7329.105 (Published 12 January 2002) Cite this as: BMJ 2002;324:105

Rapid Response:

Re: Risks of legalising cannabis underestimated

For the sake of brevity, I will refer readers to my previous message
for references on points already covered.

Raabe: Wodak, et al. conveniently ignore the mounting evidence of the
harmful effects of cannabis.

In truth, the reform crowd has published more peer-reviewed health
information on cannabis than the people who support this policy. In fact,
the publication of the full text of this information was one of the key
parts of the strategy for reform.(1)

Raabe: Cannabis is much stronger than it was in previous years.

Very strong forms of marijuana (e.g., hashish) have been available
since the dawn of recorded history. They are nothing
new.(2)(3)(4)(5)(6)(7) It should be noted that some proponents of
marijuana prohibition sometimes claim that modern marijuana is fifty times
stronger than marijuana of yore. When the US DEA first started tracking
potency in the 1970s, the average potency was in the range of about 3
percent. If modern marijuana was fifty times stronger, that would make a
marijuana plant 150 percent THC. In other words, every pound of plant
contains 1.5 pounds of THC. Apparently, it is such a remarkable plant that
it can defy the laws of physics.

While underground producers looking to make money have done some
amazing things with plant breeding, that high-powered stuff just doesn't
seem to sell as well as the more moderate commercial grades. The reason is
pretty the much the same as the reason why beer and wine outsell 190 proof
rum. (On the scale of toxicity, it is clear that 190 proof rum is far more
dangerous than the most potent marijuana -- by many orders of magnitude.)

Raabe: Cannabis causes cancer:

If what Dr. Raabe says is completely correct, then marijuana poses
about the same risk as tobacco cigars so the penalties should be about the
same.(1) However, the best medical research to date doesn't seem to
support the idea that casual cannabis use is a major health threat to most
people.(8)

It should also be mentioned that giving yourself cancer from bad
habits is certainly undesireable but, except in the case of marijuana, it
doesn't seem to constitute a criminal offense.

Raabe: Adverse effects of maternal cannabis smoking:

Pregnant women should avoid recreational drugs. That's a no-brainer.
But, if any drug is going to be outlawed because of its hazard to
newborns, that drug is alcohol.

The implications of prohibition in this case are particularly
disturbing. Let's suppose that we find a pregnant women who is smoking
cannabis. Would Dr. Raabe suggest that we throw her in prison as the best
method of protecting her health and the healh of her baby? Or would we
achieve better results overall with other, non-criminal approaches?

Raabe: Evidence is mounting that Cannabis is more addictive than
previously thought:

We have had several thousand years of history to establish the
behavioral effects of cannabis. According to the US National Institute on
Drug Abuse,cannabis is about as addictive as caffeine, and far less
addictive than either alcohol or tobacco.(9)

Raabe: Adverse affects on mental health: The "amotivational syndrome"

There really isn't much evidence for the "amotivational
syndrome".(10)

Even if we assumed it was true then it should be noted that, except
in the case of marijuana, lacking motivation -- to whatever degree -- does
not constitute a criminal offense. It should also be noted that throwing
someone in prison for being lazy isn't likely to be a good solution to the
problem, anyway.

Raabe: Adverse affects on mental health: 15 Percent of users reported
psychotic symptoms following use.

Compared to what extent of alcohol users who have experienced
psychotic or otherwise unpleasant symptoms? Once again, if this was a
reason for prohibition, the best place to start would be with alcohol.

Raabe: Adverse affects on mental health: Schizophrenia

People with mental disorders such as schizophrenia should not take
recreational drugs. That's another no-brainer that applies equally well to
alcohol as it does to marijuana. Alcohol is bad for people with all sorts
of mental and physical conditions -- far worse than marijuana in nearly
all cases. That doesn't mean that alcohol prohibition is a good idea.(1)

Raabe: Adverse affects on mental health: Adoption of an anti-
conventional lifestyle.

Once again, adoption of an anti-conventional lifestyle (i.e., they
don't live like the rest of us) seems to be a crime only in the case of
marijuana. If it was a crime, one can only imagine the percentage of the
UK population that might be jailed for being "anti-conventional". As some
observers have noted, this problem (assuming it is a problem at all) is
probably exacerbated by the fact that many young people try cannabis and
discover that their government has been grossly lying to them about its
effects.

Raabe: Adverse effect of cannabis on driving and piloting skills:

Nobody that I know of has recommended that people should be allowed
to drive or pilot a plane while impaired on anything. Even if the laws
were changed, there would be no change regarding operating motor vehicles
while one is intoxicated. The sum of the evidence shows that the effects
of marijuana are far less than the effects of alcohol(1) so, if this was a
good reason for prohibition, then forget cannabis -- alcohol should be
outlawed immediately.

Raabe: Association between cannabis use and violent crime:

This argument was covered in my previous response to Colin Drummond.
In short, alcohol is the only drug with any real connection to drug-
induced violence.(1) It should also be noted that Dr. Raabe claims, all in
the same essay, that marijuana induces violence while, at the same time,
it makes people lazy. This is one remarkable drug, indeed.

Raabe: Cannabis – the “gateway drug”:

I keep hoping that some day this idea will be forgotten forever and
relegated to the category of similar ideas like the medieval practice of
bloodletting. With the knowledge currently available on the subject, I
can't help feeling embarrassed for anyone who brings it up.

First, there is no drug that, when taken, will give someone a craving
for a completely different drug they have never had. That is the stuff of
magic, not medical science. If there is any "gateway" effect, it is not
due to the pharmacological properties of cannabis.

Second, the argument that is most commonly given to support the idea
is the fact that many addicts of other drugs "started" with marijuana. The
truth is that more of them "start" with alcohol and tobacco. Even if this
idea was true, it does not establish causality at all. The simplest
explanation is that people who engage in one risky behavior often engage
in others. If you find someone whose behavior is so risky that they inject
black market heroin, then chances are they have done every risky thing
they could think of before that -- marijuana just being one more item on a
long list.

The idea itself is perhaps the best current example of the logical
fallacy of "post hoc ergo propter hoc." Anyone who makes the argument will
fail any college freshman class in logic, and I could only hope that the
BMJ would never publish any research that makes this fundamental error.

But, let's examine the history of this particular myth so we can
understand how it arose:

The idea that one small sin leads to greater ones is an old one. In
the early days before the prohibition laws they believed that such things
as "piecing between meals" and "eating Mexicanized food" would lead one to
a drunkard's grave.(11) Eating spicy food will inevitably lead one to
crave more exciting sensations -- real Mexican food, the "hard stuff" -
which will, in turn, lead to drug abuse and destruction. Yes, it's funny,
but some people still believe it.

In the 1920s, marijuana was outlawed in some of the northeastern
states because of the fear that heroin addiction would lead to the use of
marijuana -- exactly the opposite of what the US Federal Government would
like you to believe today.(1)

In 1937, when marijuana was outlawed at the national level, Harry
Anslinger, then head of the Federal Bureau of Narcotics, was asked
specifically if there was any connection between marijuana and heroin. He
replied specifically that there was no connection at all. (12)

In 1944, the LaGuardia Committee report confirmed Anslinger's
testimony -- there was no connection between marijuana and heroin.(13)

In 1951, the story changed. Harry Anslinger was testifying before
Congress for the Boggs Act, asking for more money and agents to enforce
the marijuana laws. Unfortunately for Mr. Anslinger, the head of the US
Federal addiction research program testified just before him and said that
all of the reasons that had been given to outlaw marijuana in 1937 were
completely wrong. Anslinger, left with no justification for his request
for more money and agents, argued that that marijuana is the
certain stepping stone to heroin.(14) In doing so, he directly
contradicted his own testimony from fourteen years earlier, as well as the
sum of the research at the time. There never was any evidence for it then,
and there hasn't been any since. Regardless, it has been the justification
for US marijuana policy (and, by extension, world marijuana policy) ever
since.

The best explanation for the "gateway" effect is "the legal status of
marijuana makes it a gateway drug".(15) In other words, it is prohibition
itself -- which places both marijuana and harder drugs in the same black
market -- that accounts for the "gateway" effect. Those who support
prohibition try to use this argument to justify the policy that caused the
problem in the first place.

Raabe: Decriminalising cannabis is likely to lead to increased use,
especially among the most vulnerable group of regular users and is likely
to lead to increased use among children:

This isn't really supported by the evidence. Alcohol prohibition was
followed by a huge increase in alcohol consumption and related problems,
especially among children.(1) The single biggest cause of drug epidemics
among children is hysterical anti-drug campaigns.(1) The surveys of
availability of drugs to children show close to 90 percent of all twelfth-
graders have reported that marijuana is "fairly easy" or "very easy" to
get for the last decade.(16)

Raabe: Legalizing cannabis sends the wrong signal:

The sum of the historical evidence on cannabis shows that the laws
were based on racism, ignorance, and nonsense, and they do more harm than
good.(1) These laws currently send the message that we are bent on
punishing people even when they have done no harm to anyone but
themselves. Continuing them shows that we aren't smart enough to recognize
the obvious mistakes of the past and correct them.

Kids are smart enough to recognize that -- especially when they have
been busted for pot themselves -- and that doesn't encourage respect for
the law. Changing the laws would recognize the obvious lunacy of these
laws from the very beginning (1) and the fact that the laws currently do
more harm than good.(17)

References:

1) See my response to Colin Drummond, at:
http://bmj.com/cgi/eletters/324/7329/105#18816

2) Marijuana - The First Twelve Thousand Years - Ernest L. Abel, 1980
- http://druglibrary.org/schaffer/hemp/history/first12000/abel.htm

3) Chapter 53 - Marijuana in the Old Word, from the Consumers Union
Report on Licit and Illicit Drugs by Edward M. Brecher and the Editors of
Consumer Reports Magazine, 1972 -
http://druglibrary.org/schaffer/Library/studies/cu/cu53.html

4) The Tale of Two Hashish-Eaters, from 1001 Arabian Nights -
http://druglibrary.org/schaffer/hemp/arab1.htm

5) The Tale of the Hashish Eater -- From "The Tale of King Omar bin
al-Nu'uman and his Sons Sarrkan and Zau al-Makan", *The Book of the
Thousand Nights and a Night* 142-143, Translated by Richard F. Burton. -
http://druglibrary.org/schaffer/hemp/history/hasheater.htm

6) On Indications of the Hachish-Vice in the Old Testament, By C.
Creighton, M.D.
From: JANUS, Archives internationales pour l'Histoire de la Medecine et la
Geographie Medicale, Huitieme Annee, 1903, p. 241-246 -
http://druglibrary.org/schaffer/hemp/history/hashot.htm

7) History of the Intoxicant Use, Marihuana: A Signal of
Misunderstanding, The Report of the US National Commission on Marihuana
And Drug Abuse, 1972 -
http://druglibrary.org/schaffer/Library/studies/nc/nc1b.htm

8) Marijuana use and mortality.- Sidney S., et. al. American Journal
of Public Health. 87(4):585-90, 1997 Apr. -
http://druglibrary.org/crl/aging/sidney-01.html

9) Rankings of Addictive Qualities by Dr. Jack E. Henningfield of the
National Institute on Drug Abuse and Dr. Neal L. Benowitz of the
University of California at San Francisco -
http://druglibrary.org/schaffer/library/basicfax.htm#q5

10) II. The Probable Health Effects of Cannabis Use, WHO Project on
Health Implications of Cannabis Use: A Comparative Appraisal of the Health
and Psychological Consequences of Alcohol, Cannabis, Nicotine and Opiate
Use, 1995 -
http://druglibrary.org/schaffer/hemp/general/who-probable.htm

11) Themes in Chemical Prohibition, By William L. White, From: Drugs
in Perspective, National Institute on Drug Abuse, 1979 -
http://druglibrary.org/schaffer/History/ticp.html

12) Testimony of Harry Anslinger, Director of the Federal Bureau of
Narcotics, in the transcripts of the congressional hearings for the
Marihuana Tax Act, 1937 at
http://druglibrary.org/schaffer/hemp/taxact/taxact.htm

13) The Marihuana Problem in the City of New York, Mayor's Committee
on Marihuana, by the New York Academy of Medicine, City of New York, 1944.
- http://druglibrary.org/schaffer/Library/studies/lag/lagmenu.htm

14) History of the Non-Medical Use of Drugs in the United States, by
Professor Charles Whitebread, a speech before the California Judges
Conference, 1995 - http://www.druglibrary.org/schaffer/History/whiteb1.htm

15) 3. First, Do No Harm: Consequences of Marijuana Use and Abuse,
from Marijuana and Medicine, Assessing the Science Base, National Academy
of Sciences, 1999 - http://books.nap.edu/html/marimed/ch3.html

16) Figure 2 - Marijuana: Trends in Annual Use, Risk, Disapproval,
and Availability, Eighth, Tenth, and Twelfth Graders - from Monitoring the
Future - http://monitoringthefuture.org/data/01data/fig01_2.pdf

17) Runciman R. Drugs and the law: report of the independent inquiry
into the Misuse of Drugs Act 1971. London: Police Federation, 1999. -
http://druglibrary.org/schaffer/Library/studies/runciman/default.htm

Competing Interests: None

Competing interests: No competing interests

18 January 2002
Clifford A. Schaffer
Director, DRCNet Online Library of Drug Policy
Agua Dulce, CA 91350