HomeMy WebLinkAboutCOM 0639.005 2008-2010
~
~
The Honorable Guy Enriques, Chair
And Members I
Committee on Public Works & Intergovernmental Relations
Hawai'i County Council
25 Aupuni Street
Hilo, HI 96720
(')
00
c()
~~
.....(-......;:1-.,:
"..'...J
_%
Sj;; ~-n
Z ~~
rn
,.... r-",
v' 1..ki
~"<;r;o>~
January 5, 2010
--0 --::~
:3 ,.;:."...,
rr"l
J: C"i
.......'
N
I-"
Re: Testimony in Opposition to Resolution No. 281-09
Dear Committee Chair Enrilues and Members: .
The Office of the prosecutiJg Attorney for the County of Hawaii is opposed to the passage of
this resolution.
Resolution No. 281-09 would create a policy statement for the County Council that increases the
availability of drugs, specifitally marijuana, on the Big Island and creates additional problems
for our commimities and laJ enforcement. These problems would range from more marijuana
being available to our youth to organized crime and other related crimes.
The Office of the Prosecuting Attorney's Comprehensive Strategy on Juvenile Justice has
identified the availability of ' drugs as a significant risk factor to our youth. More young people
enter treatment centers with la primary diagnosis of marijuana dependence than for all other illicit
drugs combined according t6 the Department of Health and Human Services. DHHS Pub. No.
(SMA) 02-3727, 2002. CuJ.ently 62 percent of teens in drug treatment are dependent on
marIJuana.
Next to alcohol, marijuana is the most abused drug among young people. Young people are also
starting to use these drugs atlan earlier age and it is showing up more frequently in the schools. I
received a call from a Department of Education Principal on the Big Island requesting assistance
with an incident involving tHe sale of marijuana on campus by 10 year old boys. This is
especially disturbing since rrlarijuana use has been shown to be three times more addictive
amoung adolescents than adong adults. The decimalization of marijuana for adults would lead to
a greater prevalence among ldolescents. Thus the American Academy of Pediatrics opposes the
legalization of marijuana. I
Marijuana is illegal, harmful~ addictive, dangerous, and is a destructive force in our community.
The passage of this resolutioh would exacerbate. the challenges already facing our community.
There are many examples of lot her communities that are living through the scourge of drug
addiction to know this is not the right path to follow.
&at.. No. ~3lf.$".
~f.Tol ..P/~~
Ref. Data JAN. 5 ._
~
The Honorable Guy Emiques, Chair
And Members
Committee on Public Works & Intergovernmental Relations
Page -2-
Re: Testimony in-Opposition to Resolution No. 281-0'9
I urge the Council to deny tliis resolution for the reason that it is the wrong policy for this County
and State.
Sincerely yours,
-~ ~
J~ .~J;AA I
Prosecuting Attorney
Attachments
EXECUTIVE OFFICE OF THE PRESIIlEN'T
OFFICE or NATIONAL DReG CONTROL POLICY
Washington, D.C. 20503
Marijuana LegalizatioD; A NOD-Starter
IoNDCP Director R. GiI Kerlikowske
October 23, 2009
The Department of Justice earolier this week issued guidelines for Federal prosecutors regarding
laws authorizing the use of mkijuana for medical purposes. This prompted a flurry of news
reports, analysis and commentary, some arguing that the guidelines could be read as the Federal
government's tacit approval of "medical" marijuana. Advocates of marijuana legalization tried
to cast the guidelines as a vict6ry, portraying them as a step toward full legalization. Neither of
these analyses is correct.
Marijuana legalization, for any purpose, remains a non-starter in the Obama Administration. It is
not something that the President and I discuss; it isn't even on.the agenda. Attorney General
Holder issued very clear guidJlines to u.s. Attorneys about the appropriate use of Federal
resources. He did not open thJ door to legalization.
Regarding state ballot initiati~eS concerning "medical" marijuana, I believe that medical
questions are best decided not I by popular vote, but by science. The Food and Drug
Administration (FDA), which studies and approves all medicines in the United States, has made
very clear that the raw marijuana plant is not medicine, and any state considering medical
marijuana should look very ca'refully at what has happened in California.
Legalization is being sold as Jeing a cure to ending violence in Mexico, as a cure to state budget
problems, as a cure to health ~roblems. The American public should be skeptical of anyone
selling one solution as a cure for every single problem. Legalized, regulated drugs are not a
panacea-pharmaceutical dru~ in this cOlmtry are tightly regulated and government controlled,
yet we know they cause untold damage to those who abuse them.
To test the idea oflegalizing ld taxing marijuana, we only need to look at already legal dmgs-
alcohol and tobacco. We kno~ that the taxes collected on these substances pale in comparison to
the social and health care costs related to their widespread use.
I
I
In a little over three months, ~y office will deliver to President Obama a National Dmg Control
Strategy that will strike a balailce between public health and public safety, recognizing that
reducing demand through a community-wide approach is critical to our success. Legalization
would only thwart our efforts and increase the economic and social costs tllat result from greater
drug acceptance and use.
-R. Gil Kerlikowske
REFERENCES:
1. The NHSDA Report, Marijuana Use Among Youth, July 19,2002
2. Rodriguez de Fonseca, F et al. Activation of corticotrophin-releasing factor in
the limbic system during cannabinoid withdrawl. Science. 276(5321): 2050-
2064, 1997-
3. National Highway Traffic Safety Administration (NHTSA) Notes. Marijuana
and alcohol combined severely impede driving performance. Annals of
Emergency Medicine. 35:398-400,2000.
4. Gfroerer, JC and Wu, LT. Initiation of marijuana use, trends, patterns and
implications. Analytic Series: A-17, DHHS publication No. SMA 02-3711.
Rockville, MD: Substance Abuse and Mental Health'Services Administration,
2002.
5. DSM-IV
6. Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Trreatment Episode Date Set 1992-2000; National
Admissions to Substance Abuse Treatment Services. DASIS Series: S-17,
DHHS Pub. No. (SMA) 02-3727, 2002.
7. Tashkin, DP. Pulmonary complications of smoked substance abuse. Western
Journal of Medicine. 152(5): 525-530, 1990
8. Office of National Drug Control Policy letter dated 10/23/09.
iA"
mH
..:.:........:.d.:..:.....:..:._.'.......
. ..--... -....
. ". ..
. The Truth Behind
1 0 Popular Misperceplions,
OFFICE OF NATIONAL DRUG CONTROL POLICY
TABLE OF CONTENTS
Introduction.............................................................................. 1
Myth #1: Marijuana is harmless .......................................... 3
Myth #2: Marijuana is not addictive .......................~........... 7
Myth #3: Marijuana is not as harmful to your health
as tobacco.. ........ ... .............. ......... ..... .............. ...... 9
Myth #4: Marijuana makes you mellow:............................ 10
Myth #5: Mat.ijuana is used to treat cancer and
othdr diseases....... ..................:.. ............ ........ ...... 11
Myth #6: MJjuana is not as popular as MDMA (Ecstasy)
I
or other drugs among teens today...................... 13
I
Myth #7: IfI buy marijuana, I'm not hurting
I
anyone else ..................... ............ ........................ 14
I
Myth #8: My kids won't be exposed to marijuana. ............ 17
Myth #9: TheLs not much parents can do to stop their
kids from experimenting with marijuana........... 19
Myth #10: The government sends otherwise innocent
pe~ple to prison for casual marijuana use......... 21
Conclusion.............................................................................. 23
I
Glossary.................................................................................. 25
I
References...... ............................ ........... .................................. 27
INTRODUCTION
. ,. ',' '." .,- ". '" ;.i'::'-
Marijuana is the most widely used illicit drug in the United States.
According to the National Survey on Drug Use and Health (formerly
called the National Household Survey on Drug Abuse), 95 million
Americans age 12 and older have tried "pot" at least once, and three out
of every four illicit-drug users reported using marijuana within the
previous 30 days.!
Use of marijuana has adverse health, safety, social, academic,
I
economic, and behavioral consequences. And yet, astonishingly, many
people view the drug as "harmless." The widespread perception of
marijuana as a benign natural herb seriously detracts from the most basic
message our society needs to deliver: It is not OK for anyone--especially
young people-to use this or any other illicit drug.
Marijuana became popular among the general youth population in
the 1960s. Back then, many people who would become the parents and
grandparents of teenage kids today smoked marijuana without
significant adverse effects, so now
they may see no harm in its use.
But most of the marijuana
available today is considerably
more potent than the "weed" of
the Woodstock era, and its users
tend to be younger than those of
past generations. Since the late
1"9605, the average age of
marijuana users has dropped from
around 19 to just over 17. People are also lighting up at an earlier age.
Fewer than half of those using marijuana for the fIrst time in the late
19605 were under 18. By 2001, however, the proportion ofunder-18
initiates had increased to about two-thirds (67 percent).2
Today's young people live in a world vastly different from that of
their parents and grandparents. Kids these days, for instance, are
bombarded constantly with pro-drug messages in print, on screen, and
on CD. They also have easy access to the Internet, which abounds with
sites promoting the wonders of marijuana, offering kits for beating drug
tests, and, in some cases, advertising pot for sale. Meanwhile, the
Use of marijuana and
other drugs usually
peaks in the late teens
and early twenties, then
declines in later yeats.77
I
preval~nce of higher potency marijuana, measured by levels of the
chemical delra-9-tetrahydrocannabinol (THC), is increasing. Average
THC levels rose from less than 1 percent in the mid-1970s to more
than 6 percent in 2002. Sinsemilla potency increased in the past two
decades from ,6 percent to more than 13 percent, with some samples
containing THC levels of up to 33 percent.3
Many people who worry about the dangers of heroin or cocaine are
less concerned about marijuana, or they consider experimentation with
pot an adolescent rite of passage. Such attitudes have given rise to a
number of mYths in the popular culture. Movies, magazines, and other
media commonly show glamorous images and gratuitous use of
marijuana, trivializing the risks and ignoring any negative
consequences. At the same time, special-interest groups proclaim that
smoked marijuana is not only harmless, it's actually good medicine.
Marijuana Myths & Facts looks at 10 popular misperceptions about
marijuana and, using the latest research findings and statistical
information, explains why they are wrong. The booklet describes the
dangers of marijuana and why it is important for society to send a
clear, consistent, and credible message to young people about the
seriousness of the threat.
IS harmless.
Marijuana harms in many ways, and kids are the most vulnerable to
its damaging effects. Use of the drug can lead to significant health,
safety, social, and learning or behavioral problems, especially for young
users. Making matters worse is the fact that the marijuana available
today is more potent than ever.
Short-term effects of marijuana use include memory loss, distorted
perception, trouble with thinking and problem-solving, and anxiety.
Students who use marijuana may find it hard to 1earn,4 thus jeopardizing
their ability to achieve their full potential.
COGNITIVE IMPAIRMENT
That marijuana can cause problems with concentration and thinking
has been shown in research funded by the National Institute on Drug
Abuse (NIDA), the
federal agency that brings
the power of science to
bear on drug abuse and
addiction. A NIDA-
funded study at McLean
Hospital in Belmont,
Massachusetts, is part of
the growing body of
research documenting
cognitive impairment
among heavy marijuana users.5 The study found that college students
who used marijuana regularly had impaired skills related to attention,
memory, and learning 24 hours after they last used the drug.
Another study, conducted at the University of Iowa College of
Medicine, found that people who used marijuana frequently (7 or more
YoUlhs with an average grade
ofD>of'belo1N were more than
4 times as likely to have used
marijuana in the past year as
youthS who reported an
average grade of A.78
times weekly for an extended period) showed deficits in mathematical
_ 1
skills and verqal expression, as well as selective impairments in
memory-retri~val processes.6 These findings clearly have significant
I
implications for young people, since reductions in cognitive function
can lead to pdor performance in school.
Other imp1airments observed in frequent marijuana users involve
sensory and Jme perception and coordinated movement, suggesting
use of the druk can adversely affect driving and sports performance.7
Effects such is these may be especially problematic during teens' peak
learning years! when their brains are still developing.
I
MENTAL HEALTH PROBLEMS
";"""'('::':'~';:;-}4"!/::;i~'-;':::';"""'}\:;'''::}<;~.r&~:<I'::'il~~:+.'-;';.~''''r ","".~~el~:~~;':;.::"""':"h'.,",~}:,.~o:,:,.,."_: '~:'?-:,,;,:.;,c,,',.;, n"" "_<'_~__":':.',
Smoking marijuana leads to changes in the brain similar to those
caused by coctne, heroin, and alcohol. 8 All of these drugs disrupt the
flow of chemibal neurotransmitters, and all have specific receptor sites
in the brain tHat have been linked to feelings of pleasure and, over
time, addictiob. Cannabinoid receptors are affected by THC, the active
ingredient in tbarijuana, and many of these sites are found in the parts
of the brain tHat influence pleasure, memory, thought, concentration,
sensory and tilne perception, and coordinated movement.9
Particularl~ for young people, marijuana use can lead to increased
anxiety, panic attacks, depression, and other mental health problems.
One study lin~ed social withdrawal, anxiety, depression, attention
problems, andlthoughts of suicide in adolescents with past-year
marijuana usef Other research shows that kids age 12 to 17 who
smoke marijua,na weekly are three times more likely than non-users to
have thoughts labout committing suicide.ll A recently published
longitudinal study showed that use of cannabis increased the risk of
major depressi~n fourfold, and researchers in Sweden found a link
between marij-t'Jana use and an increased risk of developing
schizophrenia. j2
According to the American Society of Addiction Medicine,
addiction and psychiatric disorders often occUr together. The latest
National Surv~y on Drug Use and Health reported that adults who use
illicit drugs were more than twice as likely to have serious mental
illness as aduld who did not use an illicit drug.lJ
I
I
Researchers conducting a longitudinal study of psychiatric disorders
and substance use (including alcohol, marijuana, and other illicit drugs)
have suggested several possible links between the two: 1) people may
use drugs to feel better and alleviate symptoms of a mental disorder; 2)
the use of the drug and the disorder share certain biological, social, or
other risk factors; or 3) use of the drug can lead to anxiety, depression,
or other disorders.14
TRAFFIC SAFETY
Marijuana also harms when it contributes to auto crashes or other
incidents that injure or kill, a problem that is especially prevalent
among young people. In a study reported by the National Highway
Traffic Safety Administration, even a moderate dose of marijuana was
shown to impair driving performance. The study measured reaction
time and how often drivers checked the rear-view mirror, side streets,
and the relative speed of other vehicles. IS
Another study looked at data concerning shock-trauma patients
who had been involved in traffic crashes. The researchers found that 15
percent of the trauma patients who were injured while driving a car or
motorcycle had been smoking marijuana, and another 17 percent had
both THe and alcohol in their blood.16 Statistics such as these are
particularly troubling in light of recent survey results indicating that
almost 36 million people age 12 or older drove under the influence of
alcohol, marijuana, or another illicit drug in the past year.li
LONG- TERIVI.C~N~EQUENCES
.. . -,-L;~i":',_,:::ii<: ;;,,<'- ::,,~,::;,c,,' ....,. "-"_':""'~~"~'",
The consequences of marijuana use can last long after the drug's
effects have worn off. Studies show that early use of marijuana is
strongly associated with later use of other illicit drugs and with a
greater risk of illicit drug dependence or abuse.18 In fact, an analysis of
data from the National Household Survey on Drug Abuse showed that
the age of initiation for marijuana use was the most important
predictor oflater need for drug treatment.19
Regular marijuana use has been shown to be associated with other
long-te~m problems, including poor academic performance,2o poor job
performance ahd increased absences from work,21 cognitive deficits,22
and lung damdge.23 Marijuana use is also associated with a number of
I
risky sexual behaviors, including having multiple sex partners,24
initiating sex ar an early age/5 and failing to use condoms consistently.26
not: addictive.
I t was once believed that marijuana was not addictive; many people
still believe this to be the case. But recent research shows that use of
the drug can indeed 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 in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV). Considered the standard reference for
health professionals who make psychiatric diagnoses, the DSM
contains information about all mental disorders for children and adults.
As described in the DSM, the criteria for substance dependence
i!1clude tolerance (needing more of the substance to achieve the same
effects, or diminished effect with the same amount of the substance);
withdrawal symptoms; using a drug even in the presence of adverse
effects; and giving up social, occupational, or recreational activities
because of substance use.27 According to the 2002 National Survey on
Drug Use and Health, 4.3 million Americans were classified with
dependence on or abuse of marijuana. That figure represents 1.8
percent of the total U.S. population and 60.3 percent of those classified
as individuals who abuse or are dependent on illicit drugs.28
The desire for marijuana exerts a powerful pull on those who use it,
and this desire, coupled with withdrawal symptoms, can make it hard
for long-term smokers to stop using the drug. Users trying to quit
often report irritability, anxiety, and difficulty sleeping.29 On
psychological tests they also display increased aggression, which peaks
approximately one week after they last used the drug. 30
Many people use marijuana compulsively even though it interferes
with family, school, work, and recreational activities. What makes this
all the more disturbing is that marijuana use has been shown to be
. ,
I
three times more likely to lead to dependence among adolescents than
,
among adultsf Research indicates that the earlier kids start using
marijuana, the more likely they are to become dependent on this or
other illicit d~gs later in life.32
I
TR~l\IOOENTI;l~OOJ~~IONS ..... . .., .'
: '. ., w,;;,,,,'i>.,":' c,: ;' ",.':' ".'" "'. ."; "'i, :':';~'-;'''':''';; ;:-_.:"}~,;:,:;; .:. .'_' . : _ . '.-:,_ . : ~.~,. j;', .,'" ,
M~re teen~ e~'t~r treatment each year with a primary diagnosis of
m~ijuana dep~ndence than for all other illicit drugs combined.33
Currently, 62 ~ercent of teens in drug treatment are dependent on
marijuana.34. I
The proportion of admissions for primary marijuana abuse
increased frod 6 percent in 1992 to 15 percent of admissions to
I
treatment in 2000.35 Almost half (47 percent) of the people admitted
for marijuana were under 20
years old, and many of them
started smoking pot at a very
early age. Of those admitted
for treatment for primary
marijuana dependence, 56
percent had first used the drug
by age 14, and 26 percent had
begun by age 12.36
The earlier kids start
usingmarijpana, the more
..... . "< ..' ....1' .... ...... .' ..'
.Iikel!...th~~: aretoi.~ecome
dep.endenr'Oh'lhls'ot'other
illicit drilg~.laler in Iife/9
n. ....... not.. as:, harmful
Health as:'tobacco.
Although some people think of marijuana as a benign natural herb,
the drug actually contains many of the same cancer-causing chemicals
found in tobacco. Puff for puff, the amount of tar inhaled and the level
of carbon monoxide absorbed
by those who smoke marijuana,
regardless ofTHC content, are
three to five times greater than
among tobacco smokers.37
Consequently, people who
use marijuana on a regular basis
often have the same breathing problems as tobacco users, such as
chronic coughing and wheezing, more frequent acute chest illnesses,
and a tendency toward obstructed airways. And because respiratory
problems can affect athletic performance, smoking marijuana may be
particularly harmful to kids involved in sports.
Researchers at the University of California, Los Angeles, have
determined that marijuana smoking can cause potentially serious
damage to the respiratory system at a relatively early age. Moreover, in
a review of research on the health effects of marijuana use, the
researchers cited findings that show "the daily smoking of relatively
small amounts of marijuana (3 to 4 joints) has at least a comparable, if
not greater effect" on the respiratory system than the smoking of more
than 20 tobacco cigarettes.38
Recently, scientists in England produced further evidence linking
marijuana use to respiratory problems in young people. A research
team at the University of Birmingham found that regular use of
marijuana, even for less than six years, causes a marked deterioration in
lung function. These findings, the study concludes, "may have serious
long-term implications for what is currently regarded as a relatively
'harmless' recreational habit."39
Regular use 01 marijuana
appears to be at least as
damaging as regular use
01 tobacco.8o
:tyI:I1iju,~~Il'1j~kes you mellow.
i
Not alwal. Research shows that kids who use marijuana weekly are
nearly four tikes more likely than non-users to report they engage in
I
violent behavior. One study found that young people who had used
marijuana in !he past year were more likely than non-users to report
aggressive beAavior. According to that study, incidences of physically
attacking peo~le, stealing, and destroying property increased in
proportion to the number of days marijuana was smoked in the past
, year. Users were also twice as
likely as non-users to report they
disobey at school and destroy
their own things.40
In another study, researchers
looking into the relationship
between ten illicit drugs and
eight criminal offenses found that
a greater frequency of marijuana
use was associated with a greater
likelihood to commit weapons
offenses; except for alcohol, none of the other drugs showed such a
connection. That study, published in the Journal of Addictive Diseases in
2001, also foukd a link between marijuana use and the commission of
attempted horhicide and reckless endangerment offenses.41
, '.
, . I "
J .,
One stUdY found that
, .1
people who had used
, I
mariiuana in .thepasl
year lwere Inore likely
; I . ". . .
than i non-users to report
.1' . .
aggressive behavior.81
.. ."--"...,,.. --- - .
rlJ rials used to treat
cancer and other diseases.
Under the Comprehensive Drug Abuse Prevention and Control
Act of 1970, marijuana was established as a Schedule I controlled
substance. In other words, it is a dangerous drug that has no
recognized medical value.
Whether marijuana can provide relief for people with certain
medical conditions, including cancer, is a subject of intense national
debate. It is true that THC, the primary active chemical in marijuana,
can be useful for treating some medical problems. Synthetic THC is
the main ingredient in Marinol@, an FDA-approved medication used
to control nausea in cancer chemotherapy patients and to stimulate
appetite in people with AIDS. Marinol, a legal and safe version of
medical marijuana, has been available by prescription since 1985.
However, marijuana as a smoked product has never proven to be
medically beneficial and, in fact, is much more likely to harm one's
health; marijuana smoke is a crude THC delivery syStem that also
sends many harmful substances into the body. In 1999, the Institute of
Medicine (10M) published a review of the available scientific evidence
in an effort to assess the potential health benefits of marijuana and its
constituent cannabinoids. The review concluded that smoking
marijuana is not recommended for any long-term medical use, and a
subsequent 10M report declared, "marijuana is not a modern
medicine."42
Clinical trials of smoked marijuana for therapy are underway
through the National Institutes of Health, a major provider of funding
for research on the potential medical uses of marijuana. Meanwhile,
the best available evidence points to the conclusion that the adv:erse
effects of marijuana smoke on the respiratory system would almost
certainly offset any possible benefit.
,
I
Some sta~es have removed criminal penalties for possessing
marij~ana fol "medical" use, adding fuel to the debate about using
I
smoked marijuana to reduce suffering. Residents in those states have
voted to charlge the marijuana policy in the mistaken belief that the
....uu___jl . ben~~ts of smoked
Marijuana as a smoked marl!Uana exceed those
',' ,...i I.... .. . proVided byTHC alone. A
product ha~ never proven to number of organizations
~~\W~~i~~"i!:~~~~fiCialand,. are pushing to make
i~<realiw,':iS<I'I1U~hI110re likely marijuana available for
loharntone'S<health. medicinal purposes,43 but
! . this campaign is regarded
by many public-health
experts as a veiled effort to legalize the drug. .
Moreover,l medicines are not approved in this country by popular
vote. Before any drugs can be released for public use they must
undergo rigoJous clinical trials to demonstrate they are both safe and
effective, andlthen be approved by the Food and Drug Administration.
Our investment and confidence in medical science will be seriously
undermined rr we do not defend the proven process by which
medicines are brought to market.
as ~~S(E~~~~~0otr~her
drugs among teens today.
Recent survey data show that about 15 million people-6.2 percent
of the U.S. pOfmlation--are current marijuana users,44 and that nearly a
third of them (4.8 million people) used the drug on 20 or more days in
the past month.45 Among kids age 12 to 17, more than rn:o million
(8.2 percent) reported past-
month marijuana use. By
contrast, fewer than 250,000
young people (1 percent)
reported past-month use of
hallucinogens, and of that
number, only half (124,000)
had used MDMA.46
The 2003 Monitoring the Future Study showed that marijuana is
not only popular today, it has been the most widely used illicit drug
among high school seniors for the entire 29 years of the study.47
Meanwhile, Ecstasy use among American teens appears to be declining
after record increases. Between 2001 and 2003, past-month use of
MDMA among students in the three grades surveyed dropped by
more than half, from 1.8 percent to 0.7 percent (8th grade), 2.6 percent
to 1.1 percent (10th grade), and 2.8 percent to 1.3 percent (12th
grade).48
In a recent survey, more
than two million kids age
12 to 17 reported past.
month. marijuana use.82
Lifetime prevalence (ever used) rates for students in the 8th, 10th, and 12th
grades in 2003:49
i
i ' , " ,
,- If,1 bm.y Il1afijuaga, I'm not
hurting anyone else.
Think J. Despite its reputation" the herb of peace and love-
I
and despite claims that smoking pot is a victimless crime-marijuana
and violence gJ hand in hand. Marijuana trafficking is a big, violent
business, whet~er the plants are grown on foreign soil or cultivated in
I
b"ements. batards. and farms in the United States.'"
VIOLENCE AT HOME
The trade l domestically grown marijuana often turns violent
when dealers h~ve conflicts or when growers feel their crops are
threatened. But drug criminals are not the only ones threatened by the
violence of the lmarijuana trade.
Much of the marijuana produced in America is grown on public
lands, includin~ our national forests and parks-areas set aside to
I preserve wildlife habitats,
'--"', provide playgrounds for our
Even, SUPPOjers of the children and serve as natural
lega'izalion, and medical refuges ior recreation.51
marijuana' .movements Traffickers grow their crops in
agre~t~~I.;kiqS'ShOUld: these areas bec~use the land is
, 'tli:.;,<~:<illlr' II " "'83 ' free and accesslble, crop
no ,,' Je usmgl ',' e ',' rug. ownership is hard to document,
.N_..N and because growers are
immune to asset forfeiture laws. Law enforcement officials report that
.. I ki tho fi
many marIjUana growers, see ng to protect elr crops rom
busybodies andlrival "pot pirates;' surround their plots with crude
booby traps, induding fishhooks dangling at eye level, bear traps, punji
sticks, and rat t~aps rigged with shotgun shells.52
Most of the/marijuana on Americas public lands is grown in the
vast national forests of California, where more than 540,000 plants
were seized or eradicated on land managed by the US. Forest Service
in 2003 alone. This figure does not include the 309,000 marijuana
plants taken from Forest Service land in other states/3 nor does it take
into account the hundreds of thousands of plants removed from land
managed by other government agencies. For example, in 2003 more
than 134,000 marijuana plants were seized or eradicated from areas in
California administered by the US. Department of the Interior's
Bureau of Land Management.54
According to officers with the Forest Service and other agencies,
many of California's illegal marijuana fields are controlled not by
peace-loving flower children but by employees of Mexican drug-
trafficking organizations carrying high-powered assault weapons.
During the growing season, the officers say, the cartels smuggle
hundreds of undocumented Mexican nationals into the US. to work
the fields, bringing with them pesticides, equipment, and guns.
Hunters, campers, and others have been threatened at gunpoint or
fired upon after stumbling into these illegal gardens.55
A DANGEROUS IMPORT
It is commonly believed that most marijuana smoked in the United
States is also grown in this country. In truth, smuggled marijuana-
whether brought in from Mexico, other Latin America source areas, or
from Canada-accounts for most of the pot available in America..S6
Drug traffickers often use violence in the effort to get their product
to the U.S. market. Criminal groups operating from Mexico, many of
them linked to torture, executions, and other acts of violence, have
transported and distributed thousands of tons of marijuana and other
drugs throughout the United States since the 1970s.57
While some would argue that problems such as these would be
solved by simply legalizing marijuana, it's important to remember that
the drug is illegal because it causes harm-physical, social, behavioral,
and academic-especially to young users. Even most people who
support legalization agree that kids should not be using marijuana.58
MARIJD.ANA ,~.~RTS FAMILIES AND COMMUNITIES
.~ . 'f"
Marijuana harms more than just those who use the drug. It also
hurts the babi~s born to users. It hurts teen users who betray the trust
of their parenJs, and it hurts the parents who are confused and
I .
dismayed by their kids' use.
Marijuana luso hurts communities when users commit crimes or
cause crashes 6n the highway. A roadside study of ;eckless drivers in
Tennessee fouhd that 33 percent of all subjects who were not under the
influence of albohol, and who were tested for drugs at the scene of
their arrest, te~ted positive for marijuana.59 In a 2003 Canadian study,
one in five stuaents admitted to driving within an hour of using
marijuana.60 I .
Marijuana also harms society by causing lost productivity in
I .
business, limiting educational attainment, and by contributing to
illnesses and iJjuries that put further strain on the health care system.
My ki~~ won't be exposed
to marIJuana.
It's an unfortunate fact: If kids want marijuana, they can find it.
More than half (55 percent) of youths age 12 to 17 responding to the
National Survey on Drug Use and Health in 2002 reported that
marijuana would be easy to
obtain. The survey indicated
that most marijuana users got
the drug from a friend, and
that almost nine percent of
youths who bought marijuana
did so inside a school
building.61 Moreover, nearly 17
percent of the young people
surveyed said they had been approached by someone selling drugs in
the past month.62 In the 2000 survey, more than a quarter of 12- to 17-
year-olds (26.6 percent) reported that drug-selling occurs frequently in
their neighborhoods.63
Kids are also exposed to a relentless barrage of marijuana messages
in the popular culture-in the music they listen to, the movies they
watch, and the magazines they read. And then there's the Internet, a
crowded landscape of pro-marijuana and drug legalization Web sites.
More often than not, the culture glamorizes or trivializes marijuana use
and fails to show the serious harm it can cause.
The easy availability of marijuana has been a concern for years.
Since the Monitoring the Future Survey began in 1975, most high
school seniors said they could obtain the drug fairly easily or very
easily.64 Fortunately, non-use remains the norm, but an alarming
number of young people have at least experimented with marijuana.
The 2001 Youth Risk Behavior Surveillance System survey found that
42 percent of all high school students nationwide had used marijuana
at some time in their lives.65 A report based on that survey revealed
More often than not, the
culture glamorizes or
trivializes marijuana use
and fails to portray the
harm it can cause.
that fr~m 1999 to 2001, the number of 9th graders reporting current
. marijuana use I more than doubled, increasing from 9.5 percent to 19.4
I .
percen t. 66 I
Marijuana juse is in some ways like a contagious disease, spreading
from "infected" individuals to others around them. And those most
I
susceptible to its harmful influence are young people. Analysis of data
from the Natibnal Household Survey on Drug Ab~se reveals that kids
I
with friends who used marijuana were themselves more than 30 times
as likely to ha~e used marijuana in the past month. Kids were also nine
times more l~ely to have used marijuana in the past month if they
I
knew adults who used the drug.67
I
NOT JUST AN INNER-CITY PROBLEM
"'~":':*i:'WE"':t(di>~~ttW,:~:iht:'n::i;':~",:?~:,;;,~-,~:,:",f~'>p,:!t';i{~~-:;-:"',,;',~~'-~?,":i;._:::':'c;,:,,::-:."r'''_''') -". _ . r;~;~ ':.( ~,:~~,.; :,p,,~ ' ',' ,',-~
I
Some people have the impression that kids in the inner city are
those most likbly to get involved with drugs. Research shows, however,
that marijuanal use among youth in cities, rural areas, and the suburbs
is roughly the ~ame, and that use rates are similar regardless of
population dedsity. For example, annual prevalence rates of marijuana
I
use among 10th graders are 28 percent in non-urban areas, 29 percent
in large metro~olitan statistical areas, and 32 percent in other
metropolitan Jeas.68
There's n()t.much par~nts
can d<F)ii~t(Jst0p theIr kids from
experimenting with marijuana.
Many people are surprised to learn that parents are the most
powerful influence on their children when it comes to drugs. By
staying involved, knoWing what their kids. are doing, and setting limits
with clear rules and consequences, parents can increase the chances
their kids will stay drug free. Research shows that appropriate parental
monitoring can reduce future
drug use even. among
adolescents who may be prone
to marijuana use, such as those
who are rebellious, cannot
control their emotions, and
experience internal distress.69
In a government survey of
youth ages 12 to 17, almost 90
percent of the respondents
thought their parents would
strongly disapprove of their
By staving ,involved,
knowing what their kids
are doing, and setting
limits with clear rules and
consequel1lces, parenls can
increase the chances their
kids will slav drug free.
trying marijuana once or twice.
The report, from the National Household Survey on Drug Abuse, also
showed that the rate of past-month marijuana use was lower among
kids who believed their parents would disapprove. In 2000, for
example, 27 percent of young people who believed that their parents
did not strongly disapprove of marijuana use reported past-month use
of an illicit drug. For kids who thought their parents did disapprove,
the use rate was only 4.9 percent.70 As these numbers make clear,
parents' attitudes and actions have a profound influence on their
children's drug-using behavior.
PARENTAL IN,VDLVEMENT
'0Kid;":h:<i~a.rn'abo~~"ilie risks of drugs from their parents or
I
caregivers are less likely to use drugs than kids who do not. 71 Parents
can create situ~tions that help them connect with their children and
stay involved ih their lives. Experts suggest that parents try to be home
with their kidJ after school, if possible, because evidence indicates that
the riskiest tiJe for kids with regard to drug involvement is between
the hours of 3lp.m. and 6 p.m. Parents who can't be home with their
children shouln consider enrolling them in after-school programs,
sports, or othe} activities, or arrange for a trusted adult to oversee
them} ; al . I fi f: ili' . . . . . . h
t s so Important or am es to partiCIpate In actIVltIes suc as
eating meals t6gether; holding meetings in which each person gets a
chance to talk;land establishing regular routines of doing something
special (like taking a walk) that allow parents to talk to their kids.
Opening chanhels of communication between parents and children, as
well as betweeh families and the greater community, gives young
people greater bonfidence and helps them make healthy choices.
: The g~yer~ment sends::
otf1.erWlselnnocent people to
prison for casual marijuana use.
On the contrary, it is extremely rare for anyone, particularly fIrst-
time offenders, to get sent to prison just for possessing a small amount
of marijuana. In most states, possession of an ounce or less of pot is a
misdemeanor offense, and some states have gone so far as to
downgrade simple possession
of marijuana to a civil
offense akin to a traffic
violation.
The numbers speak for
themselves. In 1997,
according to the U.S.
Department of Justice's
Bureau ofJustice Statistics
(BJS), only 1.6 percent of
the state inmate population
had been convicted of a
marijuana-only crime,
including trafficking. An
even smaller percentage of state inmates were imprisoned with
marijuana possession as the only charge (0.7 percent). And only 0.3
percent of those imprisoned just for marijuana possession were fIrst-
time offenders.72
More recent estimates from the BJS show that at midyear 2002,
approximately 8,400 state prisoners were serving time for possessing
marijuana in any amount. Fewer than half of that group, or about
3,600 inmates, were incarcerated on a first offense.73 In other words, of
the more than 1.2 million people doing time in state prisons across
America,74 only a small fraction were first-time offenders sentenced
just for marijuana possession. And again, this figure includes
possession of any amount.
Many inmates ultimately
sentenced for marijuana
possession were initially
charged with more serious
crimes but were able to
negotiate reduced charges
or lighter sentences
'thrOugh plea agreements
with prosecutors.
On the fei:ierallevel, prosecutors focus largely on traffickers,
kingpins, an~ other major drug criminals, so federal marijuana cases
often involve:hundreds of pounds of the drug. Cases involving smaller
amounts are typically handled on the state level. This is part of the
reason why h~dly anyone ends up in federal prison for simple
possession oflmarijuana. The fact is, of all drug defendants sentenced
in federal court for marijuana offenses in 2001, the vast majority were
convicted odrafficking. Only 2.3 percent-186 people-were
sentenced forl simple possession, and of the 174 for whom sentencing
information is known, just 63 actually served time behind bars.75
It's impodant to point out that many inmates ultimately sentenced
for marijuanal possession were initially charged with more serious
crimes but wJre able to negotiate reduced charges or lighter sentences
through plea ~greements with prosecutors. Therefore, the 2.3 percent
figure for sim~le-possession defendants may give an inflated
impression ofj the true number, since it also includes those inmates who
pled down from more serious charges.
The goal Jf drug laws is not merely to punish, but to reduce drug
I
use and help keep people from harming themselves and others with
this destructiJe behavior. In recent years, with the introduction of drug
courts and sidmar programs, there has been a shift within the U.S.
criminal justiJe system toward providing treatment rather than
incarceration for drug users and non-violent offenders with addiction
I
problems. Today, in fact, the criminal justice system is the largest
I
source of referral to drug treatment programs.76
GQNCtUSIQ,N ..
The clutter of messages about marijuana in the popular culture
creates an atmosphere of confusion and sends kids mixed signals about
the drug. But what should be clear is that no responsible person thinks
young people should use marijuana. Kids can learn the truth about
marijuana at www.freevibe.com.
Parents can help keep their children away from marijuana by letting
them know its dangers, and by monitoring their activities and staying
involved in their lives. For more information and useful tips about
talking to kids about marijuana, visit www.theantidrug.com. Both of
these Web sites are supported by the Office of National Drug Control
Policy.
Schools and communities can also play an important role by
providing activities that keep kids interested and involved in healthy,
drug-free programs.
If you want to help dispel rnisperceptions and spread the truth
about marijuana to. help kids grow up drug-free, you can:
. Educate yourself about the dangers of marijuana and
keep up with scientific research into its harmful
effects. For a wealth of good information, visit the
Web site for the National Institute on Drug Abuse at
http://www.nida.nih.gov
. Help kids in trouble with marijuana get into drug
treatment programs
. Be an advocate for better, more informed drugged-
driving laws
. Support after-school programs and get involved in
local anti-drug coalitions
. Stay informed about the marijuana laws in your state, and
take a stand against changes in legislation that would increase
the drug's availability in your community
I
. Support efforts to launch a student drug-testing
program in your local schools
. See ;'What You Need to Know About Drug Testing in
Schc;>ols," available by calling 800-666-3332 and online at
http://www.whitehousedrugpolicy.gov/pdf/ dru~testing. pdf
! .
. To l~arn more about drug and alcohol abuse, visit the
Sub~tance Abuse & Mental Health Services
Adniinistration's National Clearinghouse for Alcohol
I .
and iDrug Information at http://www.health.org/ or
I
call its 24- hour hotline: 1-800-729-6686 or 1-800-
788J2800
GlOSSA~Y
Addiction: A chronic, relapsing disease, characterized by compulsive
drug-seeking and use, and by neurochemical and molecular changes in
the brain.
Anxiety: Apprehension, tension, or uneasiness from anticipation of
danger, the source of which is largely unknown or unrecognized.t
Cannabinoid receptors: Sites on nerve cells in the brain to which
THC attaches, affecting the way those cells work. Cannabinoid
receptors are abundant in parts of the brain that regulate movement,
coordination, learning and memory, higher cognitive functions such as
judgment, and pleasure.
Cognitive deficits: Difficulties in reasoning, judgment, intuition and
memory, or a lack of awareness and insight.
Dependence: Often called physical dependence, an adaptive
physiological state that occurs with regular drug use and results in a
withdrawal syndrome when drug use is stopped.
Depression: A psychiatric disorder characterized by feelings of
sadness, hopelessness, guilt, changes in appetite, low energy, and
difficulty concentrating.
Longitudinal study: A study in which the same group of individuals is
interviewed at intervals over a period of time.
Neurotransmitter: A chemical produced by specialized cells called
neurons in the brain and body to transmit messages to other neurons.
t Shahrokh, NC, and Hales, RE. American Psychiatric Glossary, Eighth
Edition. Washington, DC. American Psychiatric Publishing Inc., 2003.
Schizophrenia: A chronic, severe, and disabling brain disease
characterized ~y illogical patterns of thinking, delusions, and
hallucinations.
Sinsemilla: From the Spanish for "seedless." Sinsemilla, a higher
potency marijJana, contains only the leaves and buds of the
unpollinated fJmale cannabis plant, where THe is ~ost concentrated.
THe: Delta-LetrahYdrocannabinO!, the main active ingredient in
marijuana and the chemical that acts on the brain to produce the
drug's effects.
Withdrawal: Symptoms that occur after use of a drug is reduced or
stopped.
REF~RE"CES
."...~..:.: -. ,. ::: :: : ~ ." -, - - ," ';,".:'.' -.-' ;: ~ '". -',-.-
1 National Survey on Drug Use and Health 2002: National Findings.
Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration (SAMHSA), 2003.
2 Trends in Initiation of Substance Use, Substance Abuse and Mental Health
Services Administration, based on the 2002 National Survey on Drug
Use and Health. SAMHSA, 2003.
3 Marijuana Potency Monitoring Project, report No. 83. University of
Mississippi, 2003.
4 Pope, HG and Yurelun-Todd, D. The residual cognitive effects of heavy
marijuana use in college students. Journal of the American Medical
Association. 275(7): 521-527, 1996.
SPope, HG and Yurelun-Todd, D. The residual cognitive effects of heavy
marijuana use in college students. Journal of the American Medical
Association. 275(7): 521-527,1996.
6 Block, RI and Ghoneim, MM. Effects of chronic marijuana use on human
cognition. Psychopharmacology. 110(1-2):219-228, 1993.
7 Herkenham, M et al. Cannabinoid receptor localization in the brain.
Proceedings of the National Academy of Sciences of the United States of
America. 87: 1932-1936, 1990.
Mathew, RJ; Wilson, WH; Turkington, TG; and Coleman, RE. Cerebellar
activity and disturbed time sense after THC. Brain Research. 797(2):
183-189,1998.
8 Rodriguez de Fonseca, F et al. Activation of corticotrophin-releasing factor
in the limbic system during cannabinoid withdrawal. Science. 276(5321):
2050-2064,1997.
Diana, M et al. Mesolimbic dopaminergic decline after cannabinoid
withdrawal. Proceedings of the National Academy of Sciences of the United
States of America. 95 (17): 10269-10273, 1998.
9 Herkenham, M et al. Cannabinoid receptor localization in the brain.
- I
Proceedings oJ( the National Academy of Sciences of the United States of
America. 87:1932-1936, 1990.
'" Bwok, JS " .J Th, off", of ",!y madju,", 0'" on 1at" anxi,ty and
depressive sybptoms. NYS Psychologist. 35-39, 2001.
I
Green, BE and Ritter, C. Marijuana use and depression. Journal of Health
and Social Bkhavior. 41(1):40-49,2000.
Brook,JS et al.[Longitudinal study of co-occurring psychiatric disorders and
substance use. Journal of the Academy of Child and Adolescent Psychiatry.
37:322-330,1998.
11 Greenblatt, J. tdolescent self-reported behaviors and their association with
marijuana use. Based on data from the National Household Survey on
Drug Abuse, 1994-1996 SAMHSA, 1998.
12 Bovasso, GB. <Cannabis abuse as a risk factor for depressive symptoms.
AmericanJou~nal ofPsychiatlY, 158:2033-2037,2001.
Rey, J and Tenlant, C. Cannabis and Mental Health (letter). British Medical
I .
Journal 325:1183-1184; 1212-1213, 2002.
I
Zammit, S et al. Self reported cannabis use as a risk factor for schizophrenia
in Swedish 40nscripts of 1969: historical cohort study. British Medical
Journal 325:1199-1201, 2002.
"Nation,] so,."l on Drug U" and H,,]th 2002. SAMHSA, 2003.
14 Brook, JS et J Logitudinal study of co-occurring psychiatric disorders and
substance us~. Journal of the American Academy of Child and Adolescent
Prychiatry. 3r22-330, 1998.
15 National Highway Traffic Safety Administration (NHTSA) Notes.
Marijuana add alcohol combined severely impede driving performance.
Annals of Em~rgency Medicine. 35:398-400,2000.
I
16 Soderstrom, CA et al. Marijuana and other drug use among automobile and
motorcycle dfivers treated at a trauma center. Accident Analysis and
Prevention. 25: 131-135,1995.
17 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies, National Survey on Drug Use and Health, 2002.
18 Gfroerer, JC and Wu, LT. Initiation of marijuana use: trends, patterns and
implications. Analytic Series: A-17, DHHS Publication No. SMA 02-
3711. Rockville,MD: Substance Abuse and Mef.ltal Health Services
Administration, 2002.
19 Gfroerer, JC and Epstein, JF. Marijuana initiates and their impact on future
drug abuse treatment need. Drug and Alcohol Dependence. 54(3): 229-237,
1999.
20 The National Household Survey on Drug Abuse (NHSDA) Report:
Marijuana use among youths. Based on data from the 2000 NHSDA
SAMHSA,2002.
21 Lehman, WE and Simpson, DD. Employee substance use and on-the-job
behaviors. Journal of Applied Psychology. 77(3):309-321,1992.
22 Bolla, KI; Brown, K; Eldreth, D; Tate, K; and Cadet, JL. Dose-related
neurocognitive effects of marijuana use. Neurology. 59(9):1337-1343,
2002.
23 A Smoking Gun: The Impact of Cannabis Smoking on Respiratory Health.
The British Lung Foundation, 2002.
24 Valois, RF et al. Relationship between number of sexual intercourse partners
and selected health risk behaviors among public high school adolescents.
Journal of Adolescent Health. 25(5): 328-335, 1999.
Guo, J; Chung, IJ; Hill, KG; Hawkins, JD; Catalano, RF; and Abbott, RD.
Developmental relationships between adolescent substance use and risky
sexual behavior in young adulthood. Journal of Adolescent Health. 31(4):
354- 362, 2002.
Graves, KL and Leigh, BC. The relationship of substance use to sexual
activity among young adults in the United States. Family Planning
Perspectives. 27:18-22, 1995.
Staton, M et al. Risky sex behavior and substance use among young adults.
Health and Social Work. 24(2): 147-154, 1999.
Whitaker, DJ; Miller, KS; and Clark, LF. Reconceptualizing adolescent
sexUal beh4vior: Beyond did they or didn't they? Family Planning
Perspective}. 32(3): 111-117, 2000.
I
Brook, JS; Baika, EB; and Whiteman, M. The risks for late adolescence of
early adole~cent marijuana use. AmericanJournal of Public Health. 89(10):
1549-1554t 1999.
25 Rosembaum, E and Kandel, DB. Early onset of adolescent sexual behavior
and drug involvement.]ournalof Marriage and the Family. 52: 783-798,
1990.
26 Guo, J; Chung, IJ; Hill, KG; Hawkins, JD; Catalano, RF; and Abbott, RD.
Developmehtal relationships between adolescent,substance use and risky
sexual beha00r in young adulthood. Journal of Adolescent Health. 31(4):
354-362,2002.
I
Brook, JS; Balka, EB; and Whiteman, M. The risks for late adolescence of
early adole~cent marijuana use. American Joumal of Public Health. 89(10):
1549-1554[1999.
I
Hingson, RV\) et al. Beliefs about AIDS, use of alcohol and drugs, and
unprotected sex among Massachusetts adolescents. American Journal of
I
Public Health. 80(3):295-299,1990.
n DSM-rv-TJ Amon,,,, P'J'<hi,tri, fu,oci,tion, 2000.
I '
· N ,tion'! SUley of Dmg U" ",d H"lth 2002. SAMHSA, 2003.
29 Haney, M et aI. Abstinence symptoms following smoked marijuana in
I
humans. Psychopharmacology. 141:395-404, 1999.
, I '
30 Kouri, EM; Pope, HG; and Lukas, SE. Changes in aggressive behavior
during withfu.awal from long-term marijuana use. Psychopharmacology. 143:
'" I
-,02-308,1999.
31 Cannabis Youth Treatment Randomized Field Experiment, preliminary
report. U.S. Department of Health and Human Services, 2002.
32 Gfroerer, JC and Epstein, JE Marijuana initiates and their impact on future
drug abuse treatment need. Drug and Alcohol Dependence. 54(3):229-237,
1999.
Anthony, JCand Petronis, KR. Early-onset drug use and risk of later drug
problems. Drug and Alcohol Dependence, 40: 9-15, 1995.
Grant, BF and Dawson, DA, Age of onset of drug use and its association
with DSM-IV drug abuse and dependence: Results from the National
Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse,
10: 163-173,1998.
33 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Treatment Episode Data Set 1992-2000; National
Admissions to Substance Abuse Treatment Services. DASIS Series: S-17,
DHHS Pub. No. (SMA) 02-3727,2002.
34 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Treatment Episode Data Set 1992-2000; National
Admissions to Substance Abuse Treatment Services. DASIS Series: S-17,
DHHS Pub. No. (SMA) 02-3727,2002.
35 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Treatment Episode Data Set 1992-2000; National
Admissions to Substance Abuse Treatment Services. DASIS Series: S-17,
DHHS Pub. No. (SMA) 02-3727,2002.
36 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Treatment Episode Data Set 1992-2000; National
Admissions to Substance Abuse Treatment Services. DASIS Series: S-17,
DHHS Pub. No. (SMA) 02-3727, 2002.
37 Wu! TC et al. Pulmonary hazards of smoking marijuana as compared with
tobacco. New EnglandJournal of Medicine. 318(6):347-351, 1988.
38 Tashkin, DP. Pulmonary complications of smoked substance abuse. Western
Jou~nal of Medicine. 152(5):525-530, 1990.
Roth, MD etl al. Airway inflammation in young marijuana and tobacco
smokers. 4merican Journal of Respiratory Critical Care Medicine.
157(3):928-937, 1998.
Wu, TC et all Pulmonary hazards of smoking marijuana as compared with
tObacco'lew EnglandJournal of Medicine. Vol. 318(6):347-351, 1988.
39 Nuttall, .SL; ~aczi, JL; ::"1anney, S; Thorpe, GJ:f; ~endall, ~J. Effects of
smoking and cannabIs use on markers of oXIdatlve stress m exhaled
breath conHensate. Division of Medical Sciences, University of
Birminghab, Birmingham, UK, 2003.
40 Greenblatt, J. Adolescent self-reported behaviors and their association with
marijuana use. Substance Abuse and Mental Health Services
AdministrJtion (SAMHSA). Based on data from the National
I
Household Survey on Drug Abuse, 1994-1996, 1998.
I
41 Friedman, AS; Glassman, K; Terras, A. Violent behavior as related to use of
marijuana kd other drugs.fournal of Addictive Diseases. 20:49-70, 200l.
., M"iju,", ,j Modicin" A,""ing tho Scion", B"o, Divi,ion of
Neurosciedce and Behavioral Health, Institute of Medicine, 1999.
431)1e National Organization for the Reform of Marijuana Laws
Home page: http://www.norml.org/
Medicf Use: http://no~ml.org/index.cfm?Group_ID=5441#f4
Marijuana Policy Project
Home Ipage: http://www.mpp.org/
Medical Marijuana Briefing Paper 2003
http://Www.mpp.org/medicine.html
I
The Medical Marijuana Mission
http://~.themarijuanamission.com/
The Americ~ Medical Marijuana Medical Association
http:// ~ericanmarijuana.org/
WolMen's Alliance for Medical Marijuana
http://www.wamm.org/
44 National Survey on Drug Use and Health 2002, Substance Abuse and
Mental Health Services Administration, 2003.
45 National Survey on Drug Use and Health 2002. Substance Abuse and
Mental Health Services Administration, 2003.
46 National Survey on Drug Use and Health 2002. Substance Abuse and
Mental Health Services Administration, 2003.
47 National Institute on Drug Abuse, 2003 Monitoring the Future Data
Tables, Table 4: Long-Term Trends in Lifetime Prevalence of Use of
Various Drugs for Twelfth Graders.
http://monitoringthefuture.org/ datal03datalpr03t4. pdf
411 University of Michigan, 2003 Monitoring the Future press release,
December 19,2003.
http:// monitoringthefuture.orgl pressreleases/03 drugpr. pdf
http://monitoringthefuture.org/ datal03datalpr03t2. pdf
49 National Institute on Drug Abuse, 2003 Monitoring the Future Data
Tables, Table 1: Trends in Lifetime Prevalence of Use of Various Drugs for
Eighth, Tenth, and Twelfth Graders.
http://www.monitoringthefuture.org/ datal 03datalpr03t1. pdf
50 Intelligence Brief: National Drug Threat Assessment, Marijuana Update,
August 2002, Document ID: 2002-J0403-002.
http://www.usdoj.gov/ndidpubs1/1335/
Atlanta High Intensity Drug Trafficking Area, Office of National Drug
Control Policy.
National Drug Intelligence Center, Massachusetts Drug Threat Assessment
(Apri12001); Texas Drug Threat Assessment (October 2003); Oklahoma
Drug Threat Assessment (October 2002), Washington Drug Threat
Assessment (February 2003).
51 Intelligence B1ief: National Drug Threat Assessment, Marijuana Update;
August 200Q, Document ID: 2002-J0403-002.
http://~.usdoj .gov/ndidpubs 1/1335/
I
52 Intelligence Blef: National Drug Threat Assessment, Marijuana Update,
I
August 200Q, Document ID: 2002- J0403-002.
http://~.usdoj.gov/ndidpubs1/1335/
National DruJ Intelligence Center, Oklahoma Drug Threat Assessment
(October 2(02), Washington Drug Threat Assessment (February 2003).
Marijuana Erldication, Santa Barbara County (CA) Sheriff's Department
I
press release, August 18,2003.
I .
53 Unpublished data from the U.S. Forest Service.
I
54 Unpublished data from the U.S. Department of the Interior's Bureau of
I
Land Management.
55 National DruJ Intelligence Center, Massachusetts Drug Threat Assessment
Ap~il 2001. I
Annex E, California State Threat Assessment FY 2004, Drug Enforcement
Administration.
U.S. Forest Sekce and Bureau of Land Management.
" Drug T"ffiokt in tho Unitod Stat". U.S. Deportmont ofju,tic" Drug
Enforcement! Administration, 2001.
I
Intelligence Br.ief: National Drug Threat Assessment, Marijuana Update,
I .
August 2002, Document ID: 2002-J0403-002.
http://Jww.usdoj .gov/ndidpubs 1/1335/
57 Drug Trafficking in the United States, U.S. Department of Justice, Drug
Enforcement Administration, 2001. '
Organized Crime and Terrorist Activity in Mexico, 1999-2002, a report
prepared under an interagency agreement by the federal research division,
Library of Congress, February 2003.
http://www.1oc. gov/ rrl frd/ pdf-flles/OrgCrime_Mexico. pdf
National Drug Intelligence Center, California-Southern District Drug
Threat Assessment, December 2000.
Drug Intelligence Brief, Mexico: Country Brief, DEA Intelligence Division,
International Strategic Support Section, Mexico/C. America Unit, DEA-
02035, July 2002.
Mexican Marijuana in the United States, Drug Intelligence Brief. Drug
Enforcement Administration Intelligence Division, DEA-99025,
September 1999.
58 For example: "Walters is correct in suggesting that marijuana, like other
drugs, is not for kids, n Keith Stroup, founder and executive director of the
National Organization for the Reform of Marijuana Laws (NORML),
and Paul Aimentano, NORML senior policy analyst, in Letters to the
Editor, The Washington Post, May 4, 2002, in response to "The Myth of
'Harmless' Marijuana," by ONDCP Director John Walters, The
Washington Post, May 1, 2002.
"Cannabis consumption is for adults only. It is irresponsible to provide
cannabis to children," Principles of Responsible Cannabis Use, the National
Organization for the Reform of Marijuana Laws (April 11, 2003;
www.norml.org).
59 Brookoff, D et al. Testing Reckless drivers for cocaine and marijuana. New
EnglandJournalofMedicine. 331:518-522, 1994.
http:// content.nejm.org/ cgil contentlabstractl331/8/518
60 Adlaf, et al. Drinking, cannabis use and driving among Ontario students.
Canadian Medical Association Journal. 168, March 2003.
http://www.cmaj.ca/cgil contentlfull/168/5/ 565
61 Results from the 2002National Survey on Drug Use and Health: National
Finiling"jffioe of Applioo Studi", SAMHSA DHHS, 2003.
62 National Suryy on Drug Use and Health 2002. SAMHSA, 2003. Detailed
Tables: Table 3.1B, Perceived Risk and Availability of Drugs, by Age
Group.
63 The National Household Survey on Drug Abuse (NH5DA) Report:
Neighborhoed Characteristics and Youth Marijuana Use. Department of
Health and Human Services, Substance Abuse and Mental Health
Services Adbinistration, Office of Applied Studies, January' 4, 2002.
"Nation,] I"'tilte on Dmg Abu,", 2003 Monito,ing the FUMe Data
Tables, Tabl~ 13: Long-Term Trends in Perceived Availability of Drugs by
I
Twelfth Graders.
http://kw.moni toringthefuture.orgl datal03datal pr03t 13. pdf
" Gmnb,wn, J j, aI. Youth Ri,k Behavioe Sun>eillanee-U nited Stat", 2001.
Surveillance 'su:nmaries, June 28, 2002, MMWR 2002. 51 (No. 5S-4): 1-64.
" Gmnb,wn, J j, ,]., Youth Ri,k Beh,vioe Sun>eillanee-United Stat", 2001.
I
Surveillance Summaries, June 28, 2002. MMWR2002; 51(No. SS-4): 1-64.
CDC UTobaccb, Alcohol and Other Drug Use Among High School
I
Students-United States," MMWR 40 (45) (1990): 776-84.
I
67 The National Household Survey on Drug Abuse (NHSDA) Report:
Obtaining Jarijuana easy for youths. Department of Health and Human
Services, SuHstance Abuse and Mental Health Services Administration,
Office of Ap~lied Studies, August 31, 200l.
68 Monitoring thl Future, National Survey Results on Drug Use, 1975-2002.
Department 'of Health and Human Services, Public Health Service,
National Institutes of Health, 2002.
http:// rboni toringthefuture.orgl pubsl monographs/vol1_2002. pdf
Pulse Check.: TJends in Drug Abuse, January-June 2001 Reporting
Period, Exec~tive Office of the President, Office of National Drug
Control Polidy, 2001.
69 Marijuana: Facts Parents Need to Know. National Institute on Drug Abuse
(NIDA), revised November 1998.
70 The National Household Survey on Drug Abuse (NHSDA) Report:
Parental disapproval of youths' substance abuse. Department of Health
and Human Services, Substance Abuse and Mental Health Services
Administration: Based on data from the 2000 NHSDA, 2002.
71 National Center on Addiction and Substance Abuse at Columbia
University. 1999 CASA National Survey of American Attitudes on
Substance Abuse V: Back to School: Teens and Their Parents, 1999.
72 Unpublished BJS estimates based on the 1997 Survey of Inmates in State
and Federal Correctional Facilities, National Archive of Criminal Justice
Data. For a public-use copy of the survey data, see
http://www.icpsr.umich.edulNACJD/SISFCF /index.html
73 Ibid.
Prison and Jail Inmates at Midyear 2002, Bureau of Justice Statistics
Bulletin, Apri12003, NCJ 198877.
http://www.ojp.usdoj.govlbjs/pub/pdf/pjim02. pdf
7' Prisoners in 2002. Bureau of Justice Statistics, July 2003, NCJ 200248.
http://www.ojp.usdoj.govlbjsl pub/pdf/p02. pdf
75 U.S. Sentencing Commission's 2001 Sourcebook of Federal Sentencing
Statistics. Table 33: Primary Drug Type of Offenders Sentenced Under
Each Drug Guideline, Fiscal Year 200l.
http://www.ussc.gov/ANNRPT/2001/SBTOC01.htm
http://www. ussc.gov/ ANNRPT /2001/table33. pdf
Unpublished figures from the U.S. Sentencing Commission, 2001 Dataflie;
USSCFYOl.
76 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. Treatment Episode Data Set 1992-2000; Table 3.4:
Admissions by primary substance of abuse, according to type of service,
source of referral to treatment, and planned use of methodone.
http://wwwdasis.samhsa.gov/tedsOO/3.4.htm
n Marijuana: Facts Parents Need to Know. NIDA, 1998.
"Tho ~SDj Roport, Marijuana U" Among Youth. July 19, 2002.
" Gfrocr, Je ank Ep,";n, JF. Marijuana m;bat" and thou ;mpact on future
drug abuse treatment need. Drug and Alcohol Dependence. 54(3):229-237,
1999.
Anthony,JC and Petronis, KR. Early..,onset drug use and risk oflater drug
I
problems. Drug and Alcohol Dependence, 40: 9-15, 1995.
Grant, BF an~ Dawson, DA, Age of onset of drug use and its association
I
with DSM-IV drug abuse and dependence: Results from the. National
Longitudirlal Alcohol Epidemiologic Survey. journal of Substance Abuse,
I
10: 163-17(3,1998.
I
80 Tashkin, DP. Pulmonary complications of smoked substance abuse. Western
journalof~eduine. 152(5):525-530, 1990.
Roth, MD et lal. Airway inflammation in young marijuana and tobacco
smokers. Akericanjournal of Respiratory Critical Care Medicine. 157(3):
I .
928-937,1998.
· Greenblatt, J. Lo,o"ont ,dh,!,ortod bohavio" and thou ",,,,ciabon with
marijuana Jse. Substance Abuse and Mental Health Services
Administration (SAMHSA). Based on data from the National
Household Survey on Drug Abuse, 1994-1996, 1998.
82 National Survey on Drug Use and Health 2002. Substance Abuse and
Mental Hellth Services Administration, 2003.
83 For example: "Walters is correct in suggesting that marijuana, like other drugs,
is not for kids," Keith Stroup, founder and executive director of the National
Organization for the Reform of Marijuana Laws (NORML), and Paul
Armentano, NORML senior policy analyst, in Letters to the Editor, The
Washingtoll Post, May 4, 2002, in response to "The Myth of , Harmless'
Marijuana," by ONDCP Director John Walters, The Washington Post,
May 1, 2002.
"Cannabis consumption is for adults only. It is irresponsible to provide cannabis
to children," Principles of Responsible Cannabis Use, the National
Organization for the Reform of Marijuana Laws (Aprilll, 2003;
www.norml.org)
HOW TO ORDER
This documenl is ~vailable online at www.whitehousedrugpolicy.gov.
I
Additional copies may be obtained from the ONDCP Drug Policy
I
Information Clearinghouse by calling 1-800-666-3332, Of by sending
il 'd @' , '
an e-ma to on cp nCjfs.org.
~
P EJ) I AT R I C S'
I
Legaliz~tion of Marijuana: Potential Impact on Youth
Alain Joffe, W. Samuel Yancy and the Committee on Substance Abuse and
Committee on Adolescence
Pediatrics 2004; 113 ;e632-e63 8
DOl: 1 0.1 ~42/peds.1l3.6.e632
The online version 0fthis article, along with updated information' and services, is
I located on the World Wide Web at:
http://ivv\vw.pediatrics.org/cgi/content/full/113/6/e632
PEDIATRICS is the offibial journal of the American Academy of Pediatrics. A monthly
publication, it has been Hublished continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the 1j\merican Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, q0007. Copyright ~ 2004 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005: Online ISSN: 1098-4275.
I
American Academy of Pediatrics
DEDlc~n:D TO THE HEALTH OF ALL CHILDREN"
Downloaded from "\.V\v"\.\'.pediatrics.org by on December 23,2009
I
I
I
i
I
I
I
I
I
AMERICAN ACADEMY OF PEDIATRICS
TECHNICAL REPORT
Alain Joffe, MD, MPH, and W. Samuel Yancy, MD, the Committee on Substance Abuse
and Committee on Adolescence
Legalization of Marijuana: Potential Impact on Youth
I
ABSTRACT. This technical repdrt provides historical
perspectives and comparisons of ~arious approaches to
the legal status of marijuana to <!jd in.forming public
policy. Information on the impact that decriminalization
and legalization of marijuana coul~ have on adolescents,
in addition to concerns surrounding medicinal use of
marijuana, are also addressed in this report. Recommen-
dations are included in the ~ccompanying policy
statement. Pediatrics 2004;113:e~32-e638. URL: http:
//www.pediatrics.org/cgilcontent/fu11l113/6/e632; mari-
juana, legalization, substance abu$e, decriminalization.
i
ABBREVIATIONS. AAP, American Aca'demy of Pediatrics; 10M,
Institute of Medicine. I
I
BACKGROUND
I
Over the last 40 years, th~ legal status of mar-
ijuana has been debated vigorously. Propo-
nents of policies that wbuld permit individ-
ual possession of small amount~ of marijuana argue
that it is a safe drug and tha!t criminal sanctions
against personal use and pos~ession represent at
worst excessively harsh and at blest unnecessary pen-
alties. Echoing these sentiments! editors of The Lancet
have concluded that "cannabis wer se is not a hazard
to society but driving it furthe'r underground may
well be."l Advocates for legalihtion also point out
that the morbidity, mortality, ahd economic costs to
society associated with alcoholl and tobacco use in
the United States dwarf those associated with mari-
juana use. I
Those opposing liberalizati0n of current laws
counter that marijuana is not ~ benign drug, espe-
cially in light of new psychoph~rmacologic informa-
tion demonstrating that mariju~na shares many fea-
tures with other illicit drugs. Tli.ey also contend that
legalization or decriminalizatioh of personal use of
marijuana likely would trigger ~ substantial increase
. in use, with foreseeable increa~es in the social, eco-
nomic, and health costs.
Most recently, the debate has focused on the med-
ical use of marijuana (that is, the use of smoked
marijuana to treat a variety of medical conditions).
Eight states (Alaska, Arizona, California, Colorado,
Maine, Nevada, Oregon, andl Washington) have
The guidance in this report does not indicaJ an exclusive course of treat-
ment or serve as a standard of medical care. Variations, taking into account
individual circumstances, may be appropriatk.
PEDIATRICS (ISSN 00314005). Copyright <d 2004 by the American Acad-
emy of Pediatrics.
passed ballot initiatives that provide for medical use
of marijuana under certain circumstances; one other
state (Hawaii) has enacted state legislation permit-
ting medical marijuana use? The federal government
has opposed vigorously any efforts to permit physi-
cians to prescribe marijuana for medical purposes, an
approach characterized by the former editor of the
New England Journal of Medicine as "misguided,
heavy-handed, and inhumane."3
Controversy regarding inarijuana is not limited to
the United States. Australia has decriminalized the
use of marijuana in some territories, and Canada4 as
well as Switzerland and other European countries5
are reconsidering their approach to marijuana. How-
ever, the most widely publicized approach to regu-
lation of marijuana is that of The Netherlands. Under
a complex system of "law-on-the-books" and "law-
in-action," Dutch law permits personal use of mari-
juana but outlaws possession.6
Pediatricians, too, are not of one mind in their
views regarding the legal status of marijuana. In a
periodic survey of fellows of the American Academy
of Pediatrics (AAP) conducted in 1995/ only a mi-
nority (18%) favored legalization, and 26% believed
that possession or sale should be a felony; 31% felt
that marijuana should be available by prescription
for medical purposes to a certain class of patients,
and 24% believed that marijuana should remain ille-
gal but penalties for personal possession should be
reduced or eliminated.
Since the periodic survey was conducted, much
more has been learned about the psychopharmaco-
logic properties of marijuana. Scientists have dem-
onstrated that the emotional stress caused by with-
drawal from marijuana is linked to corticotropin-
releasing factor, the same brain chemical that has
been linked to anxiety and stress during opiate, al-
cohol, and cocaine withdrawal.8 Others report that
tetrahydrocannabinol, the active ingredient in mari-
juana, stimulates release of dopamine in the me-
solimbic area of the brain, the same neurochemical
process that reinforces dependence on other addic-
tive drugs.9 Current scientific information about
marijuana has been summarized in the AAP policy
statement "Marijuana: A Continuing Concern for Pe-
diatricians."lo Some of the significant neuropharma-
cologic, cognitive, behavioral, and somatic conse-
quences of acute and long-term marijuana use are
well known and include negative effects on short-
PEDIATRICS Vol. 113 No: 6 Ju,ne 2004 .. htm:/ /www.p~diatrics.oJ:g/cgi/content/full/113/6/e632
Downloaded from ,,,v'i,".pedlatncs.org'by on Decetnber 23,200"-
I .
e632
term memory, concentration, at~ention span, motiva-
tion, and problem solving, which clearly interfere
with learning; adverse effects O~l coordination, judg-
ment, reaction time, and trackin'g ability, which con-
tribute substantially to unintenfional deaths and in-
juries among adolescents (espec~ally those associated
with. motor vehicles); and negative health effects
with repeated use similar to effects seen with smok-
ing tobacco. Three recent studiesll-13 demonstrate an
association between marijuana I use and the subse-
quent development of mental health problems; how-
ever, a small study of 56 mon6zygotic cotwins dis-
cordant for marijuana use didl not find any such
associations.14 I
DEFINITION OF 'FERMS
There are 3 general policy perkpeCtives concerning
the status of marijuana in the Uh.ited States: prohibi-
tion, decriminalization, and legMization. Prohibition
describes current federal policy toward marijuana
use, which seeks to minimize orj prevent use of mar-
ijuana with strong legal sanctions and aggressive
interdiction of supply routes. D~criminalization and
depenalization (used interchangeably in this report)
refer to the elimination, reduction, and/or nonen-
forcement of penalties for the s~le, purchase, or pos-
session of marijuana although stch activities remain
illegal. Under decriminalization! penalties for use or
distribution are at least possible theoretically, and
advertising would be banned. Lkgalization, one step
beyond decriminalization, wduld fundamentally us AND INTERNATIONAL EXPERIENCES WITH
change the status of marijuan~ in society. It is an MARIJUANA LEGALIZATION AND
acknowledgment that the goverh.ment has no funda- DEPENALIZATION
mental interest in an individJal's use of a drug, Because to our knowledge no country has com-
although it may still seek to regulate its sale, distri- pletely legalized the sale, possession, and advertising
bution, use, and advertisement to safeguard the pub- of marijuana, there are no studies that examine the
lic's health. Such is the case withlalcohol and tobacco. effect of legalization on marijuana use by young
Of the 3 approaches, only the prohibitionist ap- people. Hence, we examine data on adolescents' use
proach has reducing or limiting drug use as its ex- of marijuana in states and countries that have, to a
plicit goal. I greater or lesser extent, decriminalized use and pos-
session of this drug.
HISTORICAL PERSPECTIVES qN DRUG POLICIES Analyzing data from the annual Monitoring the
IN THE UNITED SIfATES Future survey, Johnston et aF9 condudedthat de-
Important perspectives on ho\v changing the sta- criminalization of marijuana in a number of states
tus of marijuana could affect usk by adolescents can from 1975 to 1980 apparently had no effect on high
be gleaned from an examinatidm of this country's school students' beliefs and attitudes about mari-
experience with drugs over the last 200 years. During juana or on their use of the drug during those years.
the 19th century, opiate drugs Were legal and widely In contrast, Chaloupka et al,2o analyzing data from
available. Opium use was dommon, especi~lly the 1992-1994 Monitoring the Future surveys, found
among middle-class white woken.15 Use of mor- that /lyouths living in decriminalized states are sig-
phine also was extensive, and lieroin was marketed nificantly more likely to report currently using mar-
as a /lsedative for coughs./I Codine, which routinely ijuana and may consume more frequently./I
was added to patent medicines land beverages, also There are several possible explanations for these
was legal; it was prized for its local anesthetic effect disparate findings. Although the study by Johnston
and its ability to counteract the !effects of morphine. et al did not find any effect of decriminalization,
The national opiate addiction rate increased from baseline marijuana use was higher in states that
0.72 per 1000 in 1840 to 4.59 p~r 1000 in the 1890s, changed their laws compared with states that did
thereafter beginning a sustained decline.16(p2S) not, although the subsequent rate of increase in all
Another wave of drug use began in the mid-1960s states was the same. It is possible that the higher
as enforcement of marijuana lats by police became baseline rates of use in the states that decriminalized
lax and adolescent and laypers~n perceptions of the marijuana use may have reflected a more lax or
risk of regular use declined. Officials from the US tolerant approach to marijuana use before decrimi-
Drug Enforcement Agency expJessed the view that nalization. Hence, decriminalization would not have
the fight against marijuana detr~cted from the more resulted in any significant lessening of enforcement,
I htto:llwww.pediatrics.prg/cgi/content/full/113/6/e632 e633
Downloaded from 'V\v,v.pedi'atrics.org by on December23, 2'009
I
important work of combating heroin use.16(p174)
Drug incarcerations per 1000 arrests began to drop in
1960 and remained low through 1979. The Carter
administration (1977-1981) proposed removing
criminal sanctions for possessing small amounts of
marijuana.16(P175) In 1975, 6% of high school seniors
reported using marijuana daily during the previous
30 days. By 1978, the same year during which per-
ceived risk of regular use of marijuana reached its
lowest point ever, 10.7% of high school seniors re-
ported using the drug dailyP
Drug use in America tends to follow cycles, often
with one generation having to relearn the experi-
ences of previous ones. Ninety years after the first
cocaine epidemic, cocaine use began to increase in
the 1970s and escalated substantially from 1980 to
1995. Because it had been so long since the previous
epidemic, cocaine was perceived to be a safe drug. In
a chapter on cocaine in the 1980 edition of a promi-
nent textbook of psychiatry, the authors wrote: /lIf it
is used no more than two or three times a week,
cocaine creates no serious problems./lIS In 1977, 10%
of 18- to 25-year-olds had used cocaine; that propor-
tion doubled to 20% in 1979. By 1985, one third of 18-
to 25-year-olds had used cocaine, as had 17.3% of
12th graders.15 Only with subsequent widespread
publicity about the health risks and addictive prop-
erties of cocaine and the epidemic of crack cocaine
did cocaine use among young people begin to wane.
and the observed rate of ;ncreJ would pamlle] but
not exceed changes in the stat~s that did not alter
their laws. Also, because the Monitoring the Future
survey is administered in schobls, any effect of de-
criminalization on marijuana c~se by out-of-school
youth (who typically have higher levels of drug
use21) would not have been reflected.
An additional explanation is provided by a recent
analysis of marijuana decrimin~lization laws in the
United States by Pacula et a1.22l1ihey found that some
states that are viewed as having decriminalized mar-
ijuana use have in fact retained a first-time marijuana
offense as a criminal offense. In Jddition, many states
that are characterized as not h~ving decriminalized
laws pertaining to marijuana Jse specify firsHime
marijuana possession offenses a~ noncriminal. These
same authors found that YOuthlliVing in states that
lowered offenses for marijuana possession to below
the felony level were more likely to report use of
marijuana in the past month.22!
Several territories in Australia have decriminal-
ized use of marijuana. Studie$ comparing use in
these territories with use in thos~ that did not reduce
penalties found no appreciable ~ifferences in use.23,24
The most widely scrutinized large-scale change in
the legal status of marijuana oc'curred in The Neth-
erlands. Dutch policy regarding! decriminalization is
very complex. Use of illegal c!irugs per se is not
punishable by law, but posses~ion for use is; drug
dealing also is considered a fel'ony.25 Theoretically,
one can be imprisoned for up td 1 month for posses-
sion of 5 g or less of cannabi~, and promotion of
marijuana through advertisemehts is forbidden also.
From 1984 to 1996, the period Iduring which Dutch
prosecution of marijuana-related offenses became
virtually nonexistent, marijuanA use increased con-
sistently and substantially until I 1992 while decreas-
ing or remaining stable in other countries.26,27
Among 18- to 20-year-olds, thel proportion who re-
ported ever having used marijt1ana increased from
15% to 44%, and the proportion/who reported using
it within the previous 30 days in~reased from 8.5% to
18.5%. Use among adolescents in the United States
decreased steadily from 1979 t:o 1992. In Norway,
which also forbids the sale otl marijuana, use re-
mained constant until 1992 and then increased. Use
remained steady or decreased in Catalunya (Spain),
Stockholm, Hamburg, and Dentnark during this pe-
riod. These figures strongly suggest that marijuana
use was influenced by changes in Dutch policy dur-
ing this period. However, the Ur\.ited States and Nor-
way (Oslo) also experienced increases in use of mar-
ijuana from 1992 to 1996, and thus it is difficult to
attribute any change in use amohg Dutch youth after
1992 to the country's drug polidies.
The 1999 European School SJrrvey Project on Al-
cohol and Drugs, specifically d~veloped to provide
data on European drug use cdmparable with that
obtained by the Monitoring the' Future surveys, re-
vealed that the proportion of I adolescents in The
Netherlands who reported ever having used mari-
juana (28%) was substantially lo~er than that of 10th
graders in the United States (41%). However, the
I
e634 LEGAUZATION OF MARITUANA: POTENTIAL IMPACT ON YOUTH
Downloaded from -.....\v-..v.pediatncs.org by on December 23,2009
I
European survey also indicated that Dutch use was
higher than any other European country except Ire-
land, the United Kingdom, France, and the Czech
Republic.2s
MEDICAL MARIJUANA
Considerable anecdotal evidence suggests that
marijuana may be effective in treating a number of
medical conditions. This perspective has been an
important force behind efforts to change the legal
status of marijuana. Marijuana has been touted as
ameliorating chemotherapy-induced nausea, wast-
ing and anorexia associated with AIDS, intraocular
pressure in glaucoma, and muscle spasticity arising
from such conditions as multiple sclerosis. Two com-
prehensive reviews evaluating the scientific basis for
these claims, one conducted by the Institute of Med-
icine (10M) and the other by the American Medical
Association, have been published recently.29,30 Both
reports acknowledge the lack of rigorous data to
support the use of smoked marijuana as medicine
while calling for additional research into the medical
use of cannabinoids, especially those that could be
delivered rapidly in a smoke-free manner. The 10M
report noted that marijuana smoke delivers "harmful
substances" as well as tetrahydrocannabinol to the
body and that marijuana "plants cannot be expected
to provide a precisely defined drug effect." "For
these reasons," the 10M report concluded, "there is
very little future in smoked marijuana as a medically
approved medication. If there is any future in can-
nabinoid development, it lies with agents of more
certain, not less certain, composition."
POTENTIAL EFFECT OF DECRIMINALIZATION OR
LEGALIZATION ON US ADOLESCENTS
Although efforts to legalize marijuana are focused
solely on adults (no one is proposing that use or
possession of marijuana by adolescents should be
legalized), any change in its legal status could none-
theless have an effect on adolescents. Alcohol (illegal
for those under 21 years of age) and tobacco products
(illegal under 18 years of age) are nonetheless the
psychoactive substances most widely abused by ad-
olescents. During 2003, 47.5% of 12th graders re-
ported using alcohol in the past 30 days and 24.4%
reported smoking cigarettes in the past 30 days.31
Legalization of marijuana could result in advertis-
ing campaigns for its use, some of which might be
directed toward adolescents. Control measures to
prevent advertising to young people, as recent expe-
rience demonstrates, may be difficult to implement.
As revealed during the course of the Comprehensive
Tobacco Settlement negotiations, tobacco companies
systematically have marketed their products to
young people even while disavowing any efforts to
do so. Even after the Comprehensive Tobacco Settle-
ment was implemented (which prohibited any
youth-oriented advertising), tobacco companies con-
tinued marketing to young people. A recent study
noted that cigarette advertising in youth-oriented
magazines increased by $54 million after the Tobacco
Master Settlement Agreement.32 Another study
showed that advertising of youth brands of ciga-
.
rettes (defined as those smoked by >5% of 8th, 10th,
and 12th graders in 1998) in y~lUth-oriented maga-
zines increased from 1995 to 2800, as did expendi-
tures for adult brands in yo~th-oriented maga-
zines.33 The Supreme Court r~cently struck down
several Massachusetts regulatiohs aimed at protect-
ing schoolchildren from tobaccol advertising (includ-
ing bans on tobacco ads within (lOOO feet of a school
or playground). liThe state's interest in preventing
underage tobacco use is substahtial and even com-
pelling, but it is no less true that the sale and use of
tobacco by adults is a legal activity," wrote Justice
Sandra Day O'Connor for the rhajority. She contin-
ued, ". '. . tobacco retailers and 'manufacturers have
an interest in conveying truth:ft.h information about
their products to adults, and ddults have a corre-
I
sponding interest in receiving truthful information
about tobacco products."34 Pres~mably, these same
interests in regard to advertising! for marijuana prod-
ucts also would be protected. I
DiFranza35 has demonstrated that both the states
and the federal government are pood y enforcing the
Synar Amendment, which requires states to control
the sale of tobacco products to tHose younger than 18
years. Legalization of marijuan~ for adults but not
adolescents would necessitate additional law en-
forcement burdens on a system that currently is not
meeting its regulatory obligations.
Similarly, the alcoholic-beverage industry contin-
ues to portray drinking in terms that clearly appeal
to young people. Drinking is associated with being
sexy, popular, and fun and as an ideal means to
"break the ice" in social settings.36 These portrayals
are extremely enticing to adolescents, who are in the
process of developing their own identities as well as
refining their social skills. One can speculate that
distributors of marijuana quickly would recognize
the profitability of portraying marijuana in a similar
manner (thereby maximizing sales), all the while
protesting that their marketing attempts seek only to
induce adults to change brands.
How adolescents would perceive a change in the
legal status of marijuana, even if only for adults, also
is difficult to determine. However, recent studies
have shown that prevalence of adolescent marijuana
use is inversely proportional to the perceived risk
associated with use (Fig 1).37 The proportion of 12th
graders who reported using marijuana in the past 30
days peaked in 1978 and again in 1997, exactly the
years in which the perceived risk of regular use was
at its lowest.
Some research suggests that legal sanctions may
50
100
AVAILABILITY
-----"'/"'-..-_-~ ----------------------.
'-....--------------- /
--~
40
90
80
- ~ - -....
/ "' ,
I \ RISK\
\
30
\.
LlJ , "-
Cf) ,
~ , \ ~ -', - .........
./ ,/-
20 \ USE /
. \. I
\
/
I
'76 '78 '80 '82
I
USE: % using once or
more in p~st 30 days
(on left-hand scale)
I
Source: Johnston LD, o'Mllley PM, Bachman JG. Monitoring the Future: National Survey Results on Drug Use, ,
1975-2002. Vol 1: Secondal-y School Students. Bethesda. MD: National Institute on Drug Abuse; 2003
Fig 1. Marijuana: trends in perceived atailability, perceived risk of regular use, and prevalence of use in past 30 days for 12th grad-
ers I '
10 '--
o
, I I
70 ::u
(j)
60 ^
Qo
)>
50 <
)>
r
)>
40 OJ
r
=i
30 -<
20
.J 10
,
I I
1 I I I I I
o
'84 '86 '88 '90 '92
RISK: % saying great risk
of harm in regular use
(on right-hand scale)
'94 '96 '98 'DO '02
AVAILABILITY: % saying fairly
easy or very easy to get
(on right-hand scale)
I
: htto:/ /www.pediatrics.prg/cgi/content/full/113 / 6 / e632
Dowri.loaded from "\'vw"\'v.pedi'atrics.org by on DecembeY23, 2009
,
I
,
e635
influence the initial decision J use drugs and that
this influence diminishes as drug use by individuals
progresses.38 If so, it is the ~oungest adolescents
(those who have not yet tried marijuana or are in the
experimentation phase) who wduld be affected most
by changes in marijuana laws. Age at first use is, in
turn, a risk factor for problem 1lse in the future.39
Moral development in childten and adolescents
assumes a developmental traj~ctory. E~rly. adoles-
cents have a concrete approach ~o moralIty: laws are
obeyed to avoid punishment. ts such, young ado-
lescents would be most susceptible to the deterrent
effects of drug laws. This detertent effect could dis-
appear or lessen with legalizatiop of marijuana. Once
adolescents gain the ability to think abstractly, chal-
lenges to the apparent hypocrisy of lido as I say, not
as I do" can be anticipated. I
Parental drug use is an important influence on
adolescents' drug use.40 Recerit data indicate that
easy household access to illicit ~ubstances is associ-
ated with greater risk of marijukna use among both
younger and older adolescents.!41 Some adults may
choose not to use marijuana (ho;Wever they may feel
about the law), because the potential risk of criminal
sanctions outweighs any percei{,ed benefit from us-
ing the drug. With the demis~ of legal sanctions
against use, some parents may choose to begin using
marijuana, acting as an impo~tant new source of
exposure for their adolescents. Parental use of mari-
juana in the last year is associat~d with their adoles-
cent's use during the same peripd.42
Availability of marijuana, which might increase if
the drug were legalized, clearl~ has been shown to
affect adolescents' use. Adolescents who have been
offered marijuana are 7 times thore likely to use it SUMMARY
than are those who have not be~n offered marijuana. Several recent studies concerning American ado-
Similarly, those who report that/marijUana is easy to lescents, the Dutch experience with decriminaliza-
get are approximately 2.5 times more likely to use it tion (from 1984 to 1992), and the relationship be-
than those who consider it hard to get.43 tween cheaper marijuana and use by adolescents
Marijuana is cheap and easy tb produce; if it were suggest that decriminalization increases marijuana
legalized, its price likely wouldldecrease below cur- use by adolescents. Because no country has legalized
rent levels. Work by Pacula et al44 in the United use of marijuana outright, there are no studies avail-
States and Williams45 in AuStralia demonstrates able to evaluate the potential effect of legalization in
clearly that a decrease in the p,rice of marijuana is the United States. Legalization of marijuana could
associated with a significant inbrease in the preva- decrease adolescents' perceptions of the risk of use
lence of use among adolescentsl and increase their exposure to this drug. Further-
Some advocates for the legalization of marijuana more, data concerning adolescents' use of the 2 drugs
argue that it is safer than alcoh61. They suggest that that are legal for adults (alcohol and tobacco) suggest
increased use of marijuana by young people might strongly that legalization of marijuana would have a
have a positive effect if some adolescents switched negative effect on youth. Alcohol and tobacco are the
from alcohol to marijuana (a sub~titution effect). This drugs most widely abused by adolescents, although
theory cannot be supported by recent studies on their sale to adolescents (younger than 18 years for
adolescent marijuana and alcoh;ol use that incorpo- tobacco and younger than 21 years for alcohol) is
rated the price of marijuana int0 the analysis. These illegal. Research demonstrates that manufacturers of
studies conclude that an increas~ in use of marijuana alcohol and tobacco market their products to young
by adolescents would result in Ian increased use of people, and the recent Supreme Court decision and
alcohol (ie, that the 2 drugs are economic comple- experience with the Synar Amendment suggest that,
ments).46 I if marijuana were legalized, restrictions on the sale
From a public health perspective, even a small and advertising of the substance to young people
increase in use, whether attriUutable to increased would prove daunting. Finally, two in-depth reviews
availability or decreased percewtion of risk, would of medical marijuana conclude that future research
have significant ramifications. For example, if only should focus on the medical use of cannabinoids, not
an additional 1 % of 15- to 19-ye~r-olds in the United smoked marijuana.
I
LEGALIZATION OF MARITUANA: POTENTIAL IMPACT ON YOUTH
Downroaded from ,YW,\ .pedlatncs.org by on December 23,2009
I
i
e636
States began using marijuana, there would be ap-
proximately 190 000 new users.47
COMPARISONS BETWEEN MARIJUANA,
ALCOHOL, AND TOBACCO
Proponents of legalization of marijuana argue that
in terms of costs to society, both financial and health-
related, alcohol and tobacco cause far more harm
than does marijuana. They argue that classifying a
relatively benign drug (marijuana) as schedule I and
vigorously prosecuting its sale and possession while
permitting the legal use of substances that cause far
more damage are inconsistent and illogical practices
or policies. That alcohol and tobacco cause far more
harm in our society than marijuana is undeniable,
but it does not follow logically that yet a third
addictive psychoactive drug (marijuana) should be
legalized. Many of the harms associated with alcohol
and tobacco use stem from the widespread accept-
ability, availability, and use of these substa_nces.
Still other harms result from lax enforcement ot cur-
rent laws regulating their use or sale, especially to
underage youth. Rather than legalizing marijuana,
an equally compelling approach would be vigor-
ously enforcing current regulations regarding sale
and use of alcohol and tobacco products to minimize
health-related problems attributable to their con-
sumption. Recent examples include lowering the
blood alcohol concentration that defines whether an
individual is driving while intoxicated to 0.08
mg/dL (0.02 mg/dL for youth), limiting or banning
smoking in public places, and banning cigarette ad-
vertisements targeted toward young people.
I
Recommendations from the AAP are included in
the accompanying policy state~ent.48
I
COMMITTEE ON SUBSTANCE ABUSE, 2001-2002
Edward A. Jacobs, MD, Chairperson
Alain Joffe, MD, MPH
John R. Knight, MD
John Kulig, MD, MPH
Peter D. Rogers, MD, MPH
Janet F. Williams, MD
LIAISON
Deborah Simkin, MD
American Academy of Child and Adolescent
Psychiatry
STAFF
Karen S. Smith
COMMITTEE ON ADOLESCENCE, 2001-2002
David W. Kaplan, MD, MPH, Chairperson
Angela Diaz, MD I
Ronald A. Feinstein, MD
Martin M. Fisher, MD I
Jonathan D. Klein, MD, MPH
Ellen S. Rome, MD, MPI8:
W. Samuel Yancy, MD
LIAISONS
Ann J. Davis, MD
American College of Obstetricians and
Gynecologists I
Glen Pearson, MD
American Academy of Child and Adolescent
Psychiatry I
Jean-Yves Frappier, MD
Canadian Paediatric Society
STAFF
Karen S. Smith
REFERENCES
I
1. Deglamorising cannabis [editorial]. Lancet. 1995,346:1241
2. National Drug IntelIigence Center. Marij~ana. National Drug Threat As-
sessment 2003. Johnstown, PA: National ~rug Intelligence Center; 2003.
Available at: www.usdoj.gov/ndic/pubs3/3300/marijuan.htm.Ac-
cessed February 4, 2004 I
3. Kassirer JP. Federal foolishness and marijuana. N Engl J Med.
1997,336:366-367
4. Canada Senate. Cannabis: Our Position for,! Canadian Public Policy. Report
of the Senate Special Committee on Illegal Drugs. Available at:
www.medicalmarihuana.ca/pdfiles / sehatesummary. pdf. Accessed
February 4, 2004 I
5. Katz G. Europe loosens its pot laws. Roll Stone. 2002,(899-900):55-57
6. SilVIS J. Enforcmg drug laws in The Nethi'rlands. In: Leuw E, Marshall
IH, eds. Between Prohibition and Legalization. The Dutch Experiment in
Drug Policy. Amsterdam, The Netherlands: Kugler Publications; 1994:
41-58 I
7. Amencan Academy of Pediatrics, Division of Child Health Research.
AAP Periodic Survey of Fellows No. 31: IssJes Surrounding Drug Legaliza-
tion. Elk Grove Village, IL: American Addemy of Pediatrics; 1995
8. Rodriguez de Fonseca F, Carrera MR, Nkvarro M, Koob GF, Weiss F.
Activation of corticotropin-releasing fact6r in the limbic system during
cannabinoid withdrawal. Science. 1997,276:2050-2054
9. Tanda G, Pontieri FE, Di Chiara G. Cann~binoid and heroin activation
of mesolimbic dopamine transmission bYla common 11-1 opioid receptor
mechanism. Science. 1997,276:2048-2050
10. American Academy of Pediatrics, Committee on Substance Abuse.
Marijuana: a continuing concern folr pediatricians. Pediatrics.
1999,104:982-985 . I
11. Patton Ge, Coffey C, Carlin JB, Degenliardt L, Lynskey M, HalI W.
Cannabis use and mental health in yourlg people: cohort study. BMJ.
2002,325:1195-1198
12. . Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G. Self reported
cannabis use as a risk factor for schizophrenia in Swedish conscripts of
1969: historical cohort study. BMJ. 2002,325:1199-1203
13. Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE.
Cannabis use in adolescence and risk for adult psychosis: longitudinal
prospective study. BMJ. 2002,325:1212-1213
14. Eisen SA, Chantarujikapong S, Xian X, et aI. Does marijuana use have
residual effects on self-reported health measures, socio-demographics
and quality of life? A monozygotic co-twin control study in men.
Addiction. 2002,97:1137-1144
15. Jonnes J. Hep-Cats, Narcs, and Pipe Dreams: A History of America's Ro-
mance With Illegal Drugs. New York, NY: Scribner; 1996
16. Courtwright DT. Dark Paradise: A History of Opiate Addiction in America.
Cambridge, MA: Harvard University Press; 2001
17. Johnston LD, O'MalIey PM, Bachman JG. Monitoring the Future: National
Survey Results on Drug Abuse, 1975-2001. Volume I: Secondary School
Students. Bethesda, MD: National Institute on Drug Abuse, Department
of Health and Human Services; 2002. NIH Publication No. 02-5106.
Available at: www.monitoringthefuture.org/pubs/monographs/
volL2001.pdf. Accessed May 13, 2003
18. Grinspoon L, Bakalar JE. Drug dependence: nonnarcotic agents. In:
Kaplan HL, Freedman AM, Sadock B1, eds. Comprehensive Textbook of
Psychiatry. 3rd ed. Baltimore, MD: Williams & Wilkins; 1980:1621
19. Johnston LD, O'Malley PM, Bachman JG. Marijuana Decriminalization:
The Impact on Youth 1975-1980. Monitoring the Future Occasional Paper
No. 13. Ann Arbor, MI: Institute for Social Research, University of
Michigan; 1981
20. Chaloupka FJ, Pacula RL, FarrelIy Me, Johnston LD, O'MalIey PM. Do
Higher Cigarette Prices Encourage Youth to Use Marijuana? NBER Working
Paper No. w6939. Cambridge, MA: National Bureau of Economic
Research; 1999. Available at: www.nber.org/papers/w6939. Accessed
May 7, 2003
21. Swaim Re, Beauvais F, Chavez EL, Oetting ER. The effect of school
dropout rates on estimates of adolescent substance abuse among three
racial/ethnic groups. Am J Public Health. 1997,87:51-55
22. Pacula RL, Chriqui IF, King J. Marijuana Decriminalization: What Does it
Mean in the United States? Available at: www.impacteen.org/
generalarea..PDFs/ mjdecriminaLpaculaJ uly2002. pdf. Accessed January
27, 2004
23. DonnelIy N, HalI W, Christie P. The effects of partial decriminalisation
on cannabis use in South Australia, 1985 to 1993. Aust J Public Health.
1995,19:281-287
24. McGeorge J, Aitken CK. Effects of cannabis decriminalization in the
Australian Capital Territory on university students' pattern of use. J
Drug Issues. 1997,27:785-793
25. Korf DJ. Dutch Treat: Formal Control and Illicit Drug Use in The Nether-
lands. Amsterdam, The Netherlands: Thesis Publishers; 1995
26. MacCoun R, Reuter P. Interpreting Dutch cannabis policy: reasoning by
analogy in the legalization debate. Science. 1997,278:47-52
27. MacCoun R, Reuter P. Evaluating alternative cannabis regimes. Br J
Psychiatry. 2001,178:123-128
28. State University of New York at Albany. Press Release February 20,
2001. Available at: http://monitoringthefuture.org/pubs/
espad.pr.pdf. Accessed December 17, 2003
29. Institute of Medicine. Introduction. In: Joy JE, Watson SJ, Benson JA,
eds. Marijuana and Medicine: Assessing the Science Base. Washington, DC:
National Academies Press; 1999:13-31
30. American Medical Association. Medical Marijuana. Report of the Council
on Scientific Affairs (A-01). Chicago, IL: American Medical Association;
2001. Available at: www.ama-assn.org/ama/pub/article/2036-
4971.htmL Accessed May 7, 2003
31. Johnston LD, O'Malley PM, Bachman JG. Table 2: Trends in annual and
30-day prevalence of use of various drugs for eighth, tenth, and twelfth
graders. Available at: www.monitoringthefuture.org/data/03data/
pr03t2. pdf. Accessed January 27, 2004
32. Center for Substance Abuse Research. Cigarette advertisements in
youth magazines increased by $54 million after Tobacco Master Settle-
ment Agreement. In: CESAR Fax. VoL 9. College Park, MD: Center for
Substance Abuse Research, University of Maryland; 2000. Available at:
www.cesar.umd.edu/cesar/cesarfax/voI9/9-26.pdf. Accessed May 7,
2003
33. King C III, Siegel M. The Master Settlement Agreement with the tobacco
industry and cigarette advertising in magazines. N Engl J Med.
2001,345:504 -511
34. Lorillard Tobacco Company v Reilly. 218 F3d 30 (US Supreme Court 2001)
35. DiFranza JR. State and federal compliance with the Synar Amendment:
federal fiscal year 1998. Arch Pediatr Adolesc Med. 2001,155:572-578
htto://www.pediatrics.org/cgi/content/full/113/6/e632
Downloaded from >V\v'.v.pedi'atric.s.org by on December23, 2009
I
e637
36 A~'" $B, Rkh M. Con<=~'= '" ,ml 00 fu. h~l'" 01 "'ol~
cents. Adolesc Med. 2001,12:389-409 I
37. Johnston LD, O'Malley PM, Bachman JG. ^1onitoring the Future National
Survey Results on Drug Use, 1975-2002. Volume I: Secondary School Stu-
dents. Bethesda, MD: National Institute dn Drug Abuse; 2003. NIH
Publication No. 03-5375 I
38. MacCoun RJ. Drugs and the law: a psychological analysis of drug
prohibition. Psychol Bull. 1993,113:497-5121
39. Hawkins JD. Risk and protective factors and their implications for
preventive interventions for the health care professional. In: Schyd-
lower M, ed. Substance Abuse: A Guide for He!rlth Professionals. 2nd ed. Elk
Grove Village, IL: American Academy of ~ediatrics; 2002: 1-19
40. Hawkins JD, Catalano RF, Miller JY. RisK and protective factors for
alcohol and other drug problems in adoleJcence and early adulthood:
implications for substance abuse p~evention. Psychol Bull.
1992,112:64-105 I
41. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from
harm. Findings from the National LonginJdinal Study on Adolescent
Health. JAMA. 1997,278:82~832 I
42. Kandel DB, Griesler PC, Lee G, Davies M,. Schaffren C. Parental Influ-
ences on Adolescent Marijuana Use and the Bapy Boom Generation: Findings
From the 1979-1996 Household Surveys on Drug Abuse. Rockville, MD:
Office of Applied Studies, Substance Abuseland Mental Health Services
Administration, Department of Health and Human Services; 2001.
Available at: www.SAMHSA.gov/OAS/NHSDA/BabyBoom/
cover.htm. Accessed May 7, 2003 I
43. Lane J, Gerstein D, Huang L, Wright D. R,iskand Protective Factors for
Adolescent Drug Use: Findings From the 1997 National Household Survey on
Drug Abuse. Rockville, MD: Office of Applied Studies, Substance Abuse
and Mental Health Services Administration, Department of Health and
Human Services; 2001. Available at www.samhsa.gov/oas/NHSDA/
NAC97/Table_oLContents.htm. Accessed May 7, 2003
44. Pacula RL, Grossman M, Chaloupka FJ, O'Malley PM, Johnston LD,
Farrelly MC Marijuana and youth. In: Gruber J, ed. Risky Behavior
Among Youths. An Economic Analysis. Chicago, IL: University of Chicago
Press; 2001 :271-326
45. Williams J. The effects of price and policy on marijuana use: what can
be learned from the Australian experience? Health Economics [serial
online). Available at: www3.interscience.wiley.com/cgi-bin/abstract/
103520930/START. Accessed May 13, 2003
46. Hall W, Pacula RL. Cannabis Use and DePendence: Public Health and Public
Policy. Victoria, Australia: Cambridge University Press; 2003
47. Census 2000 supplementary survey profile for United States. Available
at: www.census.gov/acs/www/Products/Profiles/Single/2002!
ACS/Tabular /010/01000US1.htm. Accessed May 13, 2003
48. American Academy of Pediatrics, Committee on Substance Abuse and
Committee on Adolescence. Policy statement: legalization of marijuana:
potential impact on youth. Pediatrics. 2004,113:1825-1826
All technical reports from the American Academy of Pediatrics
automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or beftJre that time.
e638
I
I
I
I
LEGALIZATION OF MARIruANA: POTENTIAL IMPACT ON YOUTH
Dowriroaded from ,>\\v'>v.pedlatncs.org by on December 23,2009
I
I
I
Legaliz~tion of Marijuana: Potential Impact on Youth
Alain Joffe, W. Samuel Yancy and the Committee on Substance Abuse and
Committee on Adolescence
Pediatrics 2004; 113;e632-e638
Updated Information
& Services
Citations
including high-resolution figures, can be found at:
http://wvvw. pediatrics.org!cgi/content!full!l13!6!e63 2
This article cites 21 articles, 14 of which you can access for free
at:
http:!hN\vw.pediatrics.org/cgi/content!full!113!6!e632#BIBL
This article has been cited by 1 HighWire-hosted articles:
http://v...v'/w. pediatrics. org!cgi! content/full/I 13 !6!e63 2#otherarticl
es
References
Subspecialty Collections
This article, along with others on similar topics, appears in the
following collection(s):
Therapeutics & Toxicology
http://wvvw.pediatrics.org/cgi/collection/therapeutics_and _ toxico
logy
Information about reproducing this article in parts (figures,
tables) or in its entirety can be found online at:
http://v...ww. pediatrics. org!misc/Permissions. shtml
Information about ordering reprints can be found online:
http://wvv'w . pecti atrics. org/m isc!reprints. shtmI
Permissions & Licensing
Reprints
American Academy of Pediatrics
I
DEDICATED TO THE HEALTH OF ALL CHILDREN"
Downloaded from "V\vw.pediatrics.org by on December 23,2009
I