Marijuana: It's a Hard Drug

By Joseph A. Califano Jr.

This fall citizens of the District of Columbia and some states will
consider proposals to make marijuana available for a variety of
ailments. Before following the Pied Pipers of medical marijuana,
voters should take into account recent research which reveals some
sharp edges of smoking pot that undermine its popular status as a
"soft" drug and underscore the need for a major biomedical research
program.

This year the National Center on Addiction and Substance Abuse at
Columbia University (CASA) for the first time established the
statistical relationship between use of tobacco, alcohol and marijuana
in and of themselves and use of harder drugs such as cocaine,
heroin and acid. (Virtually all teens who smoke marijuana also smoke
nicotine cigarettes and drink alcohol.)

Examining data from the U.S. Centers for Disease Control and
Prevention's 1995 Youth Risk Behavior Survey of 11,000 ninth through
12thgraders, CASA isolated teen use of these gateway drugs from other
problem behaviors, such as fighting, drunk driving, truancy,
promiscuous sexual activity, carrying a weapon and attempting suicide.
The correlations are compelling:

Among teens who report no other problem behaviors, those who drank and
smoked cigarettes at least once in the past month are 30 times
likelier to smoke marijuana than those who didn't.

Among teens with no other problem behaviors, those who used
cigarettes, alcohol and marijuana at least once in the past month are
almost 17 times likelier to use another drug like cocaine, heroin or
acid.

Though only statistical, those relationships are powerful. For
perspective, remember that in 1964 the first Surgeon General's Report
on smoking and health found a nine to 10 times greater risk of lung
cancer among smokers, and the early results of the Framingham heart
study found that individuals with high cholesterol were two to four
times likelier to suffer heart disease. Most who smoke marijuana do
not move on to other drugs, just as most who smoke cigarettes do not
get lung cancer; but both kinds of smokers enormously increase their
risks. And those risks rise with teen use: The earlier and more often
an individual uses marijuana, the likelier that individual is to use
cocaine.

Recent biomedical research suggests the reasons why. Studies in Italy
reveal that marijuana affects levels of dopamine (the substance that
gives pleasure) in the brain in a manner similar to heroin. Gaetana
DiChiara, who led this work at the University of Cagliari, indicates
that marijuana may prime the brain to seek substances such as heroin
and cocaine that act in a similar way. Studies in the United States
have found that nicotine and cocaine also affect dopamine levels.

While psychological dependence on marijuana has been widely
recognized, the drug's potential for physical addiction is only
recently becoming clear. A team at Scripps Research Institute in
California and Cumplutense University in Madrid found that rats
subjected to immediate cannabis withdrawal exhibited changes in
behavior similar to those seen after withdrawal of cocaine, alcohol
and opiates. Science magazine called this "the first neurological
basis for a marijuana withdrawal syndrome, and one with a strong
emotional component that is shared by other drugs." Dr. Alan Leshner,
the Director of the National Institute on Drug Abuse, estimates that
more than 100,000 individuals are in treatment because of marijuana
use. Most are believed to be teenagers.

We have known for some time that marijuana can damage ability to
concentrate, shortterm memory and motor skills when teens most need
these attributes, when they are learning in school and developing
rapidly. Now a body of work indicts marijuana as physically addictive
and demonstrates that teens who play with the fire of cigarettes,
alcohol and marijuana increase the danger that they will get burned by
the flames of heroin, cocaine and acid. These findings make a strong
case to start calling marijuana what it is: a hard drug, one that can
bring serious harm to children and ruin their lives. While this
reality should not preclude the drug's use as medicine if scientific
studies confirm its safety and efficacy, it should condition smoking
pot for medical purposes on appropriate Food and Drug Administration
findings of safety and efficacy and temper any rush to practice
medicine by political referendum.

The statistical link between smoking pot and using heroin, cocaine and
acid, the indications that marijuana acts on dopamine levels in the
brain in a manner similar to harder drugs and nicotine, and mounting
evidence of marijuana's addictive power present a convincing case for
a billiondollarayear investment to move biomedical research on
substance abuse and addiction into the big leagues at the National
Institutes of Health, along with heart disease, cancer and AIDS. Such
an investment is essential for more effective prevention and treatment
and greater understanding of the risks and benefits of any medical
potential marijuana might have.

The writer is president of the National Center on Addiction and
Substance Abuse at Columbia University. He was secretary of health,
education and welfare from 1977 to 1979.

(c)Copyright 1997 The Washington Post Company