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DOCUMENT RESUME ED 066 675 CG 007 337 AUTHOR Petersen, Robert C., Ed. TITLE Marihuana and Health; Second Annual Report to Congress from The Secretary of Health, Education, and Welfare. INSTITUTION Health Services and Mental Health Administration (DHEW), Bethesda, Md.; National Institutes of Health (DHEW), Bethesda, Md. SPONS AGENCY Department of Health, Education, and Welfare, Washington, D.C. PUB DATE 72 NOTE 280p. EDRS PRICE MF-$0.65 HC-$9.87 DESCRIPTORS *Drug Abuse; Drug Addiction; Drug Legislation; Foreign Culture; *Health; *Marihuana; *Narcotics; Research ABSTRACT This report studies the effects of marihuana on the individual's physical and psychological health, as well as the effects of cannibas use on the society. A major purpose of this report is to serve as an up-to-date compendium of scientific information bearing on issue of marihuana and health. In order to make the report maximally useful to the technically trained as well as to the layman, findings are reported in technical as well as in more everyday language. The report attempts to carefully describe the strengths and limitations of the work that has been done in this area. The authors of the report state that with the increase of our knowledge of marihuana and its effects, we have become increasingly capable of better designing research so as to more adequately answer the many questions that its use poses in American society. This report emphasizes the more recent findings and their significance in the light of our past knowledge. (Author/WS) MARIHUANA AND HEALTH SECOND ANNUAL REPORT TO CONGRESS from The Secretary of Health, Education, and Welfare U.S DEPARTMENT OF HEALTH. EDUCATION & WELFARE OFFICE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO. DUCED EXACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIG INATING IT POINTS OF VIEW OR OPIN IONS STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDU CATION POSITION OR POLICY 1972 1 TABLE OF CONTENTS Acknowledgments 2 I. Introduction 3 II. Summary 8 III. Extent, Patterns and Social Context of Use in the United States 31 IV. Marihuana Use in Other Countries 54 V. The Material and Analytic Methodology 133 VI. Preclinical Research in Animals 157 VII. Tolerance 189 VIII. Effects in Man 199 IX. Therapeutic Uses of Cannabis 259 X. Future Research Directions 269 ror sae by the flaperfutendent of Documents, Eke. Clonnunant Prbitley Offloo, Wublagton, D.C. 2002 2 ACKNOWLEDGMENTS The preparation of a report of this type would be impossible without the willing cooperation of the many members of the scientific commun- ity who have generously made available reports of their current marihuana research. Their comments and assistance are gratefully acknowledged. Scientists of the National Institute of Mental Health who have had the primary responsibility for preparing each of the sections of this report are: Dr. Monique Braude - Sections on the material, analytic methodology, preclinical studies in animals, pharmacological aspects of tolerance. Miss Eleanor Carroll - Section on cannabis use abroad and the historical portion of the section on therapeutic uses of cannabis. Dr. Alan Ramsey - Section on the Effects in Man, viz: acute physical toxicity, chronic physical effects, genetic & birth defects, and psychiatric illness and contemporary aspects of therapeutic use. Dr. Louise Richards - Section on Extent, Patterns and Social Context of Use in the United States. Dr. Jean Paul Smith - Discussion of impurities and adulterants in the section on the Material and Analytic Methodology. Dr. Stephen Szara - Section on the Effects in Man, viz: the active ingredient, route of administration, metabolism, subjective, physiological and biochemical aspects, intellectual & psychomotor effects. Dr. Robert C. Petersen edited and coordinated the preparation of the report in addition to preparing the introduction, summary and section on future research directions. 3 3 I. INTRODUCTION 4 4 INTRODUCTION This marks the second in a series of reports prepared in accordance with the "Marnuana and Health Reporting Act" (Title V of P.L. 91-296). Under this act the Secretary of Health, Education and Welfare has the responsibility to submit annual reports to the Congress on the health consequences of marihuana use. "Health consequences" for the purposes of this report include not only the effects of the drug on the indivi- dual's physical and psychological health, but also the effects of cannabis use on the society. Our knowledge of marihuana has significantly increased during the past year. A serious problem in evaluating research in a socially controversial area such as this is the ever present temptation for many to over generalize far beyond what the research warrants. Each new finding is eagerly sought after and the limitations of any single study are too often overlooked. There are two important difficulties in the interpretation of much drug research. One is that drugs as investigated in the laboratory are not used under the same conditions as are to be found in illicit social use. Under more typical 1.1.7e conditions marihuana may be used along with other drugs and 5 the social context of use may profoundly alter the 1,-,avidual's response. When cannabis use is studied in cultures that are different in many ways from our own, the implications of use may be quite different from that in American society. For example, the performance demands made by an agrarian society like that of rural Jamaica are quite different from those made by a modern, industrial society. Each of the various research approaches has both advantages and disadvantages. The limitations of each is to some extent compensated for by the strengths of the others. When the obser- vations derived from clinical observations, systematic laboratory research and cross cultural observation all converge toward a common conclusion, we can have far greater confidence than that possible based on a single study. The dilemma posed by present and future marihuana use in our society can only partially be resolved by scientific evidence. The issues profoundly involve questions of values, social custom, legal controls and our often inconsistent view of recreational drug use including that of alcohol and tobacco. These larger issues are appropriately the concern of all segments of society and are currently being considered by 6 many other groups including a Presidential Commission. We have attempted throughout the report to limit ourselves to those issues on which a scientific judgment is possible leaving examination of other, equally important, social, political and economic aspects of use to others. A major purpose of this report is to serve as an up-to-date compendium of scientific information bearing on the issue of marihuana and health. In order to make the report maximally useful to the technically trained as well as to the layman we have reported findings both technically and, wherever possible, in more everyday language. Because of the tendency for many reports to overgeneralize conclusions based on single studies, we have attempted to describe carefully the strengths and limitations of the work that has been done. With the increase in our knowledge of marihuana and its effects we have become increasingly capable of better designing research so as to more adequately answer the many questions its use poses in American society. This year's report emphasizes the more recent findings and their signi- ficance in the light of our past knowledge. 7 7 Sources of Information An unusually wide variety of sources of information have been used in the preparation of this report.These have ranged from published and unpublished reports from scientists to information supplied about local marihuana use by our embassies abroad. In addition to reports from the scientific literature, much of the report is based on formal and informal reports from grantees of the National Institute of Mental Health and researchers who have been supplied with marihuana and related materials by the Institute. They in turn have been generous in sharing their often quite preliminary findings with us. Reports given at various national and international symposia and conferences on cannabis have been carefully reviewed. There has been extensive discussion with researchers in other parts of the world so as to make maximal use of research that is being done abroad as well as within our own country. Reports from relevant government commissions both here and abroad have been reviewed for scientific content and their Observations integrated with those of other scientific reports. In order to provide at least a partial picture of the diversity of overseas use patterns of cannabis an attempt has been made to bring together informationon such use from a diversity of sources. r B II. SUMMARY 5 9 9 SUMMARY During the year since submission to the Congress of the first annual report on Marihuana and Health our knowledge of this complex issue has been significantly advanced in almost all aspects. We have a far better picture of the extent of present usage in the United States, of the basic nature of the material, and much of the essential basic research on short-term effects in animal and man has been done.Well controlled studies of more extensive human use in a laboratory setting are underway and two overseas studies of long-term, chronic users are nearing completion. Nevertheless even as the extent of the problem has grown so has our awareness of its complexity and of the difficulties of studying it. In this summary of the second annual report we will attempt to describe the present state of our knowledge, to summarize the progress made in the past year and to again translate the disparate and neces- sarily technical data into as reasonable an answer as possible to the question: What are the health implications of marihuana use for the American people? Despite the advances of the past year any simple answer to this disarmingly simple question is not likely to be possible now or in the near future.

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