The war on marijuana: The transformation of the war on drugs in the 1990s

As the "war on drugs" enters the latter half of its third decade since being forged into the American lexicon by President Ronald Reagan, the public has grown more skeptical of the current strategy and has proven to be receptive to a broader consideration of alternatives to incarceration. This has been the case most notably with marijuana offenses, where the policy discussion has shifted in some localities to one of decriminalization or de-prioritizing law enforcement resources dedicated to pursuing possession offenses. Despite the increased profile surrounding marijuana policy in recent years, there remains a significant degree of misunderstanding regarding the current strategy, both in terms of how resources are being allocated and to what eventual gain.

Methods:

Previous studies have analyzed drug offenses as a general category, but there has yet to be a single study that has focused specifically on marijuana offenders at all stages of the system. This report analyzes multiple sources of data for the period 1990–2002 from each of the critical points in the criminal justice system, from arrest through court processing and into the correctional system, to create an overall portrait of this country's strategy in dealing with marijuana use.

Results:

The study found that since 1990, the primary focus of the war on drugs has shifted to low-level marijuana offenses. During the study period, 82% of the increase in drug arrests nationally (450,000) was for marijuana offenses, and virtually all of that increase was in possession offenses. Of the nearly 700,000 arrests in 2002, 88% were for possession. Only 1 in 18 of these arrests results in a felony conviction, with the rest either being dismissed or adjudicated as a misdemeanor, meaning that a substantial amount of resources, roughly $4 billion per year for marijuana alone, is being dedicated to minor offenses.

Conclusion:

The results of this study suggest that law enforcement resources are not being effectively allocated to offenses which are most costly to society. The financial and personnel investment in marijuana offenses, at all points in the criminal justice system, diverts funds away from other crime types, thereby representing a questionable policy choice.

The War on Marijuana: The Transformation of the War on Drugs in the 1990s

Federal law enforcement is targeted effectively at convicting major drug traffickers and punishing them with longer lockups in prison. 1
-John Ashcroft, Former United States Attorney General

Background

Despite decades of discussion and intense media coverage, there remains considerable confusion regarding how the criminal justice system treats marijuana offenders. This misunderstanding has catalyzed a contentious debate that has been characterized by disagreements about the appropriate legal status of marijuana, the suitable level of punishment, and the most effective distribution of institutional resources to address marijuana use. This has been coupled with a fundamental difference of opinion about the true dangers that marijuana use poses to American society. In light of international developments in which a number of countries have reduced punishment for marijuana use, as well as the growth in the domestic decriminalization movement culminating in local ballot initiatives and proposals to amend state law, the struggle over the appropriate criminal justice response to marijuana has become a key policy concern.
Drug war advocates such as John Walters and former Attorney General John Ashcroft have frequently remarked that the current criminal justice approach to drug abuse represents an efficient use of resources. Walters, the head of the Office of National Drug Control Policy, has lamented that persons who claim that prisons are full of low-level drug offenders are incorrect and have misinformed the debate on drug policy 2.
In order to provide a framework for assessing the role of marijuana enforcement in the criminal justice system, we have conducted a national analysis of marijuana offenders for the period of 1990 to 2002. This includes an assessment of trends in arrest, sentencing, and incarceration, along with an evaluation of the impact of these developments on marijuana price and availability, and the use of crime control resources. Our analysis indicates that the "war on drugs" in the 1990s was, essentially, a "war on marijuana."
Key findings include:
▪ Of the 450,000 increase in drug arrests during the period 1990–2002, 82% of the growth was for marijuana, and 79% was for marijuana possession alone;
▪ Marijuana arrests now constitute nearly half (45%) of the 1.5 million drug arrests annually;
▪ Few marijuana arrests are for serious offending: of the 734,000 marijuana arrests in 2000, only 41,000 (6%) resulted in a felony conviction;
▪ Marijuana arrests increased by 113% between 1990 and 2002, while overall arrests decreased by 3%;
▪ New York City experienced an 882% growth in marijuana arrests, including an increase of 2,461% for possession offenses;
▪ African Americans are disproportionately affected by marijuana arrests, representing 14% of marijuana users in the general population, but 30% of arrests;
▪ One-third of persons convicted for a marijuana felony in state court are sentenced to prison;
▪ One in four persons in prison for a marijuana offense – an estimated 6,600 persons – can be classified as a low-level offender;
▪ An estimated $4 billion is spent annually on the arrest, prosecution and incarceration of marijuana offenders.
The findings in this report call for a national discussion regarding the zealous prosecution of marijuana use and its consequences for allocation of criminal justice resources and public safety. Law enforcement has focused disproportionately on low-level possession charges as a result of the nation's lack of a thoughtful strategy about how best to address the consequences of marijuana use. Consequently, police spend a significant amount of time arresting marijuana users, many of whom do not merit being charged in court. This diverts efforts away from more significant criminal activity while having no appreciable impact on marijuana cost, availability, or use. As state and federal resources become more limited, a rational consideration of the most efficient way to address marijuana use is critical; this discussion should take place outside the realm of political rhetoric. The findings in this study can inform that conversation with sound, empirical analysis of more than a decade's worth of data on the criminal justice system's treatment of marijuana offenders.

Law enforcement and marijuana

As seen in Figure 1, from 1990 to 2002, drug arrests nationally increased by 41%, from 1,089,500 to 1,538,800. During this time, the total number of marijuana arrests more than doubled from 327,000 to 697,000, an increase of 113%. All non-marijuana drug arrests increased by only 10%. The percentage of arrests for all offenses comprised of marijuana more than doubled from 2.3% in 1990 to 5.1% in 2002.

Figure 1

Drug Arrest Trends – 1990 to 2002

Drug Arrest Trends – 1990 to 2002.

This significant expansion of the drug war was fueled almost entirely by a focus on marijuana. Of the 450,000 increase in arrests for drugs, 82.4% was solely from marijuana arrests, and 78.7% from marijuana possession arrests.
Since 1990, there have been 6.2 million arrests for marijuana possession and an additional 1 million for marijuana trafficking. As of 2002, marijuana arrests comprised 45% of all drug arrests, and of these, possession arrests constituted 88% of all marijuana arrests. While marijuana trafficking arrests declined as a proportion of all drug arrests during this period (from 6.1% in 1990 to 5.4% in 2002), the proportion for marijuana possession increased by two-thirds (24% in 1990 to 40% in 2002).
As seen in Figure 3, overall arrests declined by 3% from 1990 to 2002, while marijuana arrests rose by 113%. The incongruent arrest patterns between marijuana and other criminal offenses require further analysis to understand the trends at work. Overall Index I crimes, defined as the most serious and costly to society, dropped by 24% during this period, a time when the United States was experiencing the lowest crime rates since the 1970s 3.

Figure 3

Growth in Arrests – 1990 to 2002

Growth in Arrests – 1990 to 2002.

From a policy perspective, for this growth to be tenable, one must assume that marijuana use and marijuana market trends ran counter to all national crime trends, including patterns in overall drug arrests. As this is rather unlikely, this growth is probably better understood as the result of selective enforcement decisions. There is no indication from national drug survey data that a dramatic decrease in the use of other drugs led to law enforcement agencies shifting resources to marijuana 4. Indeed, there was a slight increase in the use of all illicit drugs by adult users between 1992 and 2001 (5.9% to 6.6%) 5. Over that same period, emergency room admissions for heroin continued to increase 6. Thus, there are no explicit indications of dramatic shifts in drug use that might explain the law enforcement trend toward marijuana enforcement in the 1990s.
An examination of historical drug arrest patterns illustrates the role of policy decisions in shaping the trends of the 1990s. As seen in Figure 4, in 1982, marijuana comprised 72% of all drug arrests. At that point, the "war on drugs" began in earnest and there was a shift in the distribution of arrests for drug abuse violations. By 1992, marijuana arrests made up only 28% of all drug arrests. During that same period, the proportion of cocaine and heroin arrests increased from 13% to 55%.

Figure 4

Trends in Drug Enforcement – 1982 to 2002*

Trends in Drug Enforcement – 1982 to 2002*. * = Chart adapted from data in Pastore, AL and Maguire, K (Eds.): Sourcebook of Criminal Justice Statistics 2001. United States Department of Justice, Bureau of Justice Statistics, Washington, DC: USGPO, 2002. (Table 4.29). Additional data obtained from Crime in the United States, 2001 (Table 4.1) and Crime in the United States, 2002 (Table 4.1). Washington, DC: Federal Bureau of Investigation.

However, over the course of the 1990s a tangible shift toward arrest patterns of the early 1980s began to reemerge. Law enforcement agencies arrested fewer people for cocaine and heroin offenses and began to arrest more people for marijuana possession and sale. By 1996, marijuana had once again surpassed heroin and cocaine as the primary drug of arrest, a gap which has widened since then. Early pursuit of the "war on drugs" targeted heroin and cocaine (drugs deemed to be hard, costly, or dangerous), but the current manifestation of the drug war, from the law enforcement perspective, is targeted disproportionately at marijuana use.

Impact on marijuana use

What impact has the practice of increased arrest for marijuana offenses had on rates of use, ease of purchase, and price? Higher trafficking arrests theoretically should reduce supply and increase marijuana costs, and an increase in possession arrests should, if general deterrence theory applies, reduce use through heightened probability of apprehension. However, since 1992, real price has fallen by 16% while potency has increased by 53% 7. From 1990 to 2002, daily use of marijuana by high school seniors nearly tripled from 2.2% to 6%. Notably, the current 6% level is the same as the level in 1975 8. One study suggests that the rapid increase in low-level arrests, many of which result in dismissals or misdemeanor convictions, reinforces a perception that a person can "get away with it" 9. Consequently, the frequent use of marijuana arrests provides little of the deterrent effect necessary to put pressure on the market exchange.
Thus, after 30 years of aggressively pursuing marijuana, arrests have grown at a rapid rate while use patterns fluctuate, but remain near the same level. In 1990, 84.4% of high-school seniors responded that it was fairly easy or very easy to get marijuana. Despite a record number of arrests, this figure actually increased slightly over the 12-year period of the study to 87.2%, near 1975 levels 10.
The continued ease with which users obtain marijuana calls into question the wisdom of the national investment of increased law enforcement targeting marijuana users. Recent research suggests that raising the price of marijuana has a significant impact on its use; however, law enforcement has not succeeded in raising prices 11. Figure 5 illustrates the growth of marijuana arrests plotted alongside the average annual cost for marijuana by the gram 12. Marijuana prices are measured at 2000 values to allow for comparison. In all three categories of marijuana distribution, costs have dropped consistently since 1991.

Figure 5

Trends in Marijuana Pricing and Law Enforcement – 1990 to 2000

Trends in Marijuana Pricing and Law Enforcement – 1990 to 2000.

Despite a 113% increase in marijuana arrests, almost exclusively for possession, marijuana costs have decreased, and purity increased as have use and perceived availability. If increased law enforcement and an expanded use of arrests were successful in restricting the supply of marijuana, then an increase in its price would be expected. Instead, marijuana prices fell continuously during the 1990s even as marijuana arrests reached unprecedented levels. This trend suggests that the growth in marijuana arrests in the 1990s has had no measurable impact on price, access, or availability.
The drug war has been predicated on arresting high-ranking narco-traffickers, as the opening quote by former Attorney General Ashcroft illustrates. However, the data indicate that this has not been the practice. During the 1990s the focus of law enforcement has been on low-level marijuana offenders. In fact, some law enforcement officials acknowledge that they target low-level offenders as part of a larger strategy known as "quality of life," or order maintenance, policing. This approach emphasizes the use of police officers to stop and frisk pedestrians under the assumption that such encounters will deter people from carrying contraband. In practice, this approach often targets low-level offenses as a means of identifying more substantial criminal behavior. Former New York City Police Commissioner Howard Safir remarked, in defense of this strategy, " [o]ur plan is to attack it on all levels. We're not just going after the major traffickers; we're gonna harass the little guys on a daily basis" 13.
This approach has had a disproportionate impact on the African American community. According to data from the National Survey on Drug Use and Health for 2002, approximately 74% of regular marijuana users (those who have used within the past month) are non-Hispanic whites and 14% are black, rates that are similar to lifetime use patterns as well (76% white and 11% black) 14. But these figures contrast sharply with arrest rates. While blacks make up approximately 14% of marijuana users in the general population, they are 30% of those arrested for marijuana violations.
Enforcement policy decisions are one potential explanatory factor for the disparity in arrest by race. A Maryland study on marijuana enforcement observed that police officers knew where to go if they wished to make an easy drug arrest, and suggested that they could do so whenever they wished in certain neighborhoods 15. These neighborhoods are those where drug use and selling is most likely to be in public spaces, allowing for easy apprehension. Research by criminologist Alfred Blumstein supports this point, observing that disproportionate arrest rates are due to "a more dense police presence where blacks reside" 16.

The cost to law enforcement

The growth of marijuana arrests results in substantial costs for law enforcement. Since 1991, the domestic law enforcement component of the federal drug control budget has increased from $4.6 billion (or 42% of the federal drug control budget) to $9.5 billion (or 51% of the federal drug control budget) in 2002 17. This increase of $4.9 billion (107%) has occurred during a period when most of the growth in drug arrests has been for marijuana.
Of the total law enforcement budget for 2001 of $72.4 billion, we estimate that $2.1 billion, or 2.9% of the entire law enforcement budget nationally, is spent on marijuana arrests. Of this, approximately $430 million is spent on marijuana trafficking and $1.7 billion on marijuana possession arrests 18.

Law enforcement resource allocation

In addition to cost, a significant consequence of these tactics includes reduced law enforcement attention to other criminal behavior. Law enforcement resources come from a finite pool of funding in the general revenue fund. It is the responsibility of the legislature to determine how these resources will be allocated (law enforcement, corrections, education, roads, etc.). If the role of law enforcement is to be expanded, there are three options available to accomplish this: 1) increase the size of the common pool (raise taxes); 2) alter the distribution within the common pool (draw monies away from a different program and direct additional funding towards law enforcement); or 3) alter the approach of law enforcement patterns (practice selective enforcement of offenses).
Economists Rasmussen and Benson believe that the latter is the most likely solution. " [I]ndividual police officers and police departments as a whole must decide which laws to attempt to enforce and how rigorously" 19. Increased resources directed towards a specific type of offense, such as drugs, lead inevitably to a decrease in resources dedicated to another offense. Law enforcement resource allocation is a zero-sum game, and any difference in appropriation is likely to manifest itself in delayed response times. "As drug crimes receive more attention from police ... the queues for other offenses must move slower as fewer resources are allocated to them" 20. This is of particular concern in light of recent developments which indicate that many cities and municipalities are losing police officers in response to budgetary constraints 21.
Benson, Rasmussen and Kim find support for this hypothesis. Looking at data from Florida, they conclude that every additional drug arrest leads to an increase of 0.7 Index (serious) crimes 22. The authors surmise that increased law enforcement of drug offenses has a dual effect: it directs resources away from the pursuit of Index crimes, and it may drive potential economically motivated drug offenders into non-drug crimes (some of which may be more dangerous or costly to society) where law enforcement attention is not as greatly concentrated. A quasi-replication of that study using more recent data from Florida found that a one percent increase in drug arrests would lead to a .18% increase in Index crime 23. The impact of the war on drugs on the enforcement of other crimes has been demonstrated elsewhere. A study of New York State law enforcement data found that an increase in drug arrests for sale and possession led to a significant increase in assaults, robberies, burglaries, and larcenies 24. Moreover, a 10% increase in marijuana sale arrests led to 880 additional larcenies statewide 25.
The shift in the 1990s towards more aggressive policing of marijuana may have siphoned law enforcement resources away from certain Index crimes. Rasmussen and Benson suggest that not only is this a possible scenario, but that there are institutional incentives in place that encourage the pursuit of drug crimes. Civil asset forfeiture, which permits law enforcement agencies to seize all or a portion of property obtained during a drug investigation, creates an incentive for administrators to dedicate more resources to drug enforcement. " [L]aw enforcement agencies focus resources on enforcement of drug laws because of the financial gains for the agencies arising from forfeitures" 26. Indeed, a recent analysis of arrest patterns in police departments that are permitted to retain a portion of seized assets discovered that this policy resulted in an increase of drug arrests by 18%, and drug arrests as a portion of all arrests by 20% 27.

Marijuana enforcement at the local level

The geographical variation in marijuana arrest patterns at the local level illustrates the critical role of discretion in defining a law enforcement agency's policy. Table 1 provides the number of arrests in 1990 and 2002 in the nation's ten largest counties as well as ten other large counties chosen for their geographic distribution, taken from the Uniform Crime Report 28.

Table 1

Marijuana Arrests-Large U.S. Counties – 1990 and 2002****

County

1990 Sale

2002 Sale

% Growth

1990 Poss.

2002 Poss.

% Growth

1990 Total

2002 Total

% Growth

Los Angeles (CA)

6,708

2,868

-57

5,638

12,929

129

12,346

15,797

28

Cook (IL)*

8,974

N/A

N/A

1,597

N/A

N/A

10,571

N/A

N/A

Harris (TX)

68

38

-44

1,593

7,174

349

1,661

7,212

334

Maricopa (AZ)

563

462

-18

3,529

6,194

76

4, s092

6,656

63

Orange (CA)

636

579

-9

3,128

6,466

107

3,764

7,045

87

San Diego (CA)

1,588

756

-52

3,162

4,950

57

4,750

5,706

20

Miami-Dade (FL)*

1,279

N/A

N/A

3,926

N/A

N/A

5,205

N/A

N/A

Dallas (TX)

174

260

49

2,483

2,992

20

2,657

3,252

22

Wayne (MI)

182

223

23

1,009

2,357

134

1,191

2,580

117

King (WA)

94

187

99

639

3,608

465

733

3,795

418

Philadelphia (PA)

468

2,449

423

358

3,774

954

826

6,223

653

Middlesex (MA)

93

233

151

676

1,274

88

769

1,507

96

Cuyahoga (OH)

161

141

-12

732

1,032

41

893

1,173

31

Clark (NV)

9

560

6,122

98

3,472

3,443

107

4,032

3,668

Hennepin (MN)

25

467

1768

739

1,184

60

764

1,651

116

St. Louis (MO)

106

126

19

617

1,625

163

723

1,751

142

Fairfax (VA)

53

18

-66

383

258

-33

436

276

-37

Milwaukee (WI)

363

840

131

1,542

2,228

44

1,905

3,068

61

Shelby (TN)

34

584

1,618

91

1,790

1,867

125

2,374

1,799

Fulton (GA)

314

776

147

2,750

3,757

37

3,064

4,533

48

**** – Cook County, Illinois and Miami-Dade County, Florida did not provide marijuana arrest statistics to the Uniform Crime Report in 2002.

Several key findings can be identified from these figures:
• Every major county except for Fairfax, Virginia experienced an increase in marijuana arrests between 1990 and 2002;
• The growth rates in marijuana arrests in the top 10 counties ranged from 20% (San Diego, CA) to 418% (King, WA);
• In 1990, 11 of the 20 counties in our sample had more than 1,000 marijuana arrests; in 2002, all but one had more than 1,000 marijuana arrests.
A number of counties had very few arrests in 1990, so the growth these counties experienced produced astronomical increases. Eight counties more than doubled their marijuana arrests between 1990 and 2002, with some increasing five- and ten-fold. In addition to the near uniform patterns of growth, the other noteworthy trend was the consistent growth in arrests for possession. In nearly every county in the sample, the growth rate for possession arrests far exceeded that for sales or manufacturing. Despite the similarities, there are variations in the degree of growth, and there are also a number of counties that experienced a decline in some types of marijuana arrests. In the ten most populous counties, the growth in arrests ranged from 20% (San Diego) to 418% (King, WA). This variation was affected by the size of the county and the degree to which each had been pursuing marijuana violations in 1990 versus 2002. It also underscores the importance of individual policymakers and practitioners making decisions that shift the emphasis in enforcement policy. Short of a localized, rapid increase in marijuana sales and use, for a county to experience the size of growth witnessed in Clark (Nevada), Shelby (Tennessee), or most of the counties in this sample, a tangible modification of marijuana arrest policies is the most likely cause. As a means of demonstrating this point, we examine the trends in marijuana arrest patterns in New York City and discuss the impact of contemporaneous political developments.

Marijuana at the city level

Examining city level arrest patterns is an instructive approach to provide context to national level trends. In the case of New York City, the 1990s represented a profound shift in policing strategy that resulted in an exponential growth in marijuana arrests. Although the experience in New York City may not be representative of developments across the country, it is an example of the ways in which the decisions of local officials played a role in the national increase in marijuana arrests.
Prior to the election of Mayor Rudolph Giuliani in 1994, the New York City Police Department applied a low-key approach towards marijuana use and distribution. Marijuana offenses were usually treated with a fine issued in the form of a citation, and in many cases individuals were not required to report to court, but were permitted to handle the ticket in the same fashion as a traffic summons. The election of Mayor Giuliani, with a promise of addressing "quality of life" issues 29 in New York City, and the subsequent appointment of William Bratton as police commissioner, ushered in a new era of policing in the city.
Shifting away from the "community policing" model of the previous Dinkins administration, Commissioner Bratton implemented a strategy of "zero tolerance" policing. Grounded in the philosophy of "broken windows," zero tolerance policing is characterized by aggressive policing of traditionally ignored, minor offenses. If left unchecked, according to supporters of this approach, this allows an element of criminality to take root in a community, leading to more serious criminal behavior. New York police officers increased their use of stop-and-frisk searches in an effort to crack down on public nuisance offenses. In 1997, a New York Police Department unit of 433 officers performed stop-and-frisk searches on about 45,000 people 30. In the process of targeting public-nuisance issues, the Department also began a revitalized pursuit of marijuana offenders.
The new policing strategy was crafted to target violations of public order, and to increase the overall risk of apprehension for all offenses. By casting as wide a net as possible, the police sought to increase the likelihood of apprehending more substantial criminal offenders. Supporters of this approach contend that increasing the probability of arrest provides a deterrent effect to persons carrying weapons or illegal drugs on the street.
The way in which law enforcement implements this policy is through increased use of the "stop-and-frisk" technique. "A 'stop' intervention provides an occasion for the police to have contact with persons presumably involved in low-level criminality" without meeting the evidentiary burden necessary to make an arrest, while providing a pretense for further investigation 31. One New York Police official described the approach: " [y]our open beer lets me check your ID. Now I can radio the precinct for outstanding warrants or parole violations. Maybe I bump against that bulge in your belt; with probable cause, I can frisk you" 32. A legal "stop" may result in nothing more than a verification that an individual was engaged in legal behavior. But it also may result in an arrest for a low-level offense, or, and this is the reason cited by supporters, it may result in the identification of more serious criminal behavior.
Such an approach is more intrusive than conventional policing and increases the likelihood that persons will face arrest for low-level violations, such as marijuana use, that may have been ignored in the past. Moreover, opponents contend that this aggressive approach results in racially discriminatory arrest patterns and is tantamount to police harassment. The growth in the use of the "stop-and-frisk" technique in New York City in the 1990s unquestionably was partly responsible for the increase in the number of low-level marijuana arrests during that period. The discretion that police officers have in initiating a stop is evidenced by the fact that less than one-third of all encounters are the result of a person meeting the description of a suspect for a crime 33. An analysis of more than 175,000 "stop-and-frisk" encounters during a 15-month period in 1998 and 1999 indicated that African Americans and Hispanics were substantially more likely to be stopped by the police, and this difference could not be explained by legal factors such as criminality or overall crime rates 34.
As Figure 7 illustrates, the increased use of "stop-and-frisk" encounters produced a dramatic rise in marijuana arrests, most of which focused on use rather than trafficking. In 1990, there were 5,116 arrests for marijuana offenses, of which 34.5% (1,766) were for possession. By 2002, marijuana arrests had increased by 882%, totaling more than 50,000. Of those, 90% (45,227) were for possession offenses, representing an increase of more than 2400%. In contrast, total arrests for all offenses were up only 8%. Arrests for violent crimes dropped 33% and felony drug crimes dropped 39%. Not surprisingly, misdemeanor drug arrests increased by 143%, driven by growth in marijuana arrests. If the growth in marijuana possession arrests is removed from the equation, overall drug arrests in New York City would have dropped by nearly 15,000. This trend should come as little surprise, as some experts suggest a byproduct of order maintenance policing will be an increase in arrests for low-level offenses 35.

Figure 7

Marijuana Arrests in New York City – 1990 to 2002***

Marijuana Arrests in New York City – 1990 to 2002***. *** = Data from the New York State Division of Criminal Justice Services, Computerized Criminal History System.

Nationally, the proportion of marijuana arrests from New York City also grew exponentially. In 1990, 1.6% of all marijuana arrests nationally occurred in New York City; that figure more than quadrupled to 7.2% by 2002. The proportion of possession arrests from New York City grew ten-fold, from 0.7% to 7.4% of national arrests. This translates into more than 12% of the growth in national marijuana arrests between 1990 and 2002. While New York City represents approximately 3% of the nation's population and 2.1% of the nation's total arrests, more than 7% of all marijuana arrests in the entire country in 2002 occurred in New York City. These figures indicate a citywide policy that, in the process of executing a zero-tolerance policing model, has demonstrably shifted towards the targeting of marijuana users for arrest.

Alternative enforcement strategies: domestic and international

Although not all large American cities were experiencing as significant an upward turn in marijuana arrests as in New York City, the country was moving in that direction on a national scale. Domestically the rapid growth in marijuana arrests has led to a number of situations in which local officials have succumbed to the overwhelming increase in workload and have responded by demanding a change in practice. In 2000, local district attorneys in Texas declined to accept low-level drug prosecutions from federal agencies because they could not keep up with the number of arrests 36. One district attorney noted, "We wanted to do our share of fighting the war on drugs. But now it's too much" 37.
In Syracuse, the proportion of resources dedicated to drug enforcement raised concern with the city's auditor. The auditor's report to the mayor noted that drug-related arrests "exceeded arrests for assaults, disturbances, and larcenies combined," and that arrests for marijuana comprised nearly one-third of all drug arrests 38. City Auditor Minchin G. Lewis expressed concern that the department's emphasis on pursuing drug use had unintended consequences for the community and was an inefficient use of law enforcement resources. Lewis recommended that the Common Council of Syracuse conduct a survey of neighborhood residents and identify the level to which residents are concerned with drug related incidents. "Devoting so many taxpayer resources in an effort to eliminate the distribution of drugs could be a significant misappropriation of resources if the primary concern is not drug use" 39.
In Chicago, similar concerns have been raised, this time in a report submitted by a city police sergeant 40. Sergeant Thomas Donegan noted that the vast majority (over 90%) of marijuana arrests in Chicago were dismissed or dropped, leading him to question why law enforcement agents were dedicating significant resources to pursue marijuana when approximately nine of ten cases will not result in a conviction. Donegan recommended the use of fines rather than arrest for marijuana use, a proposal endorsed by Chicago Mayor Richard M. Daley.
These concerns of practitioners are translating into reform measures at the ballot box. In the late 1990s, Arizona passed Proposition 200, which among other reforms, explicitly noted that drug use was to be treated as a health problem, with monies dedicated to treatment and education rather than incarceration. More recently, Proposition 36 in California created a protocol to divert low-level drug offenders into treatment rather than prison. In Seattle, the passage of Initiative 75 reduced marijuana for adult personal use to the lowest law enforcement priority, estimated to be saving tens of thousands of dollars in state prison and local jail costs. In addition to the numerous state initiatives in the past few years permitting the use of marijuana for medical purposes, there have also been efforts to reform the response to recreational use.
In the 2004 election, a number of state and local initiatives addressed the need for change in the manner in which law enforcement treats marijuana use 41. In Oakland, California, Measure Z, which was passed with 64% of the vote, will "make investigation, arrest, prosecution, and imprisonment for private adult cannabis offenses the lowest law enforcement priority ..." In Columbia, Missouri, 61% of voters supported reforms to the current criminal code that will reduce the punishment for possession to a $250 fine and keep marijuana cases in municipal court. This legislation resembles approaches employed in Ann Arbor, Michigan and Madison, Wisconsin.
In addition to these domestic changes, there have also been similar developments abroad. In May of 2004, Russia decriminalized the possession of small amounts of narcotics, including marijuana. Canada continues to debate decriminalization of marijuana, but in June of 2003, Toronto Police Chief Julian Fantino declared that he had instructed his officers to discontinue making arrests for simple possession of marijuana 42. In response to the developments in Toronto, the head of the provincial association of police chiefs suggested to all law enforcement in Ontario to "use discretion in situations that involve the simple possession of marijuana" 43.
England has also been experimenting with decriminalization. In August of 2001, the police commissioner in Brixton announced that the police would no longer be making arrests for personal possession of marijuana, as a result of the police and courts being overrun with marijuana related arrests. In Brixton, about 90% of all drug arrests are for possession and about 75% of those possession arrests are for marijuana 44. By the summer of 2002, it was announced that all of Britain would be decriminalizing personal amounts of marijuana 45. Former Home Secretary David Blunkett stressed that the decriminalization of marijuana did not equate to decriminalization of all behaviors related to the use of marijuana. "Where cannabis possession is linked to aggravated behavior that threatens public order, the police will retain the power of arrest," while noting that this policy will permit Britain to "concentrate [our] efforts on the drugs that cause the most harm ..." 46.
The common thread in these developments has been a response by officials to the significant amount of time and resources that law enforcement officials dedicate to the pursuit of marijuana offenses. Dissatisfaction with the pursuit of the war on drugs has led a number of the nation's leading policing administrators to call for reform. A 2004 survey of 300 chiefs of police indicated that two-thirds of respondents believed that the response by law enforcement to drug use and sale had been unsuccessful 47. Three-quarters of police chiefs believe that the resource gap for the enforcement of drug laws is more significant than with any other criminal or public safety requirements 48. For these reasons, 84% of chiefs of police felt that there need to be changes implemented in the way drug laws are enforced 49.

Assessing the increase in marijuana arrests

During the period after the beginning of the modern "drug war," a measurable shift in drug enforcement strategy could be identified. As seen previously in Figure 4, at the beginning of the 1980s, nearly three-quarters of all drug arrests were for marijuana; by the end of the decade that percentage had dropped to one-third. But by the early 1990s, drug enforcement relative to other arrests began to diminish. Rasmussen and Benson observe that between 1989 and 1990, the ratio of drug arrests to Index I crime arrests dropped by 24% 50. This led the authors to conclude that the "drug war" was winding down relative to general law enforcement trends, or at least shifting the way that it was being pursued.
With the benefit of hindsight, fourteen years later it is clear that the drug war did not wind down. However, a closer examination of the growth in drug arrests indicates that there was a kernel of truth to the Rasmussen and Benson prediction about the abatement of drug enforcement. The 1990s ushered in a fundamental change in the way the drug war was pursued. As the crack cocaine market began to constrict in urban areas and the use of cocaine, heroin, and other substances remained flat, the category of primary drug abuse violation arrests skewed significantly towards marijuana, and particularly possession. Of the nearly one-half million increase in drug abuse violations between 1990 and 2002, 79% was for marijuana possession.
The precipitous growth of marijuana possession arrests is striking in the context of declining overall crime rates and stability in other drug abuse violations, as well as general use patterns nationally. Moreover, the growth in marijuana possession arrests beginning in the early 1990s was incongruous with the initial justification of the war on drugs in the 1980s, which stressed cocaine and heroin as targeted substances.
Marijuana arrests may have increased during the 1990s as a function of structural changes in criminal behavior and law enforcement strategies that increased the likelihood of marijuana arrests within the pre-existing routines of law enforcement officers. By the early 1990s, drug abuse arrests were leveling off and overall crime rates were decreasing as well. Beginning in 1992, violent and property crime would begin a sustained reduction for the longest duration in 30 years. During that same period, President Clinton was spearheading a movement to place 100,000 more police officers on the streets as a means of combating crime. The decade of the 1990s was characterized by these two trends: rapidly decreasing violent and property crime (beginning prior to the implementation of the national growth in police officers) and a rapid increase in law enforcement manpower.
These two trends may have combined to increase the probability of arrest for marijuana offenses. Law enforcement agencies prioritize their labor allocation; if serious crime is an entrenched problem in a given area, minor violations are likely to receive less attention. However, as the degree of serious crime diminishes, law enforcement agents are likely to turn their attention to nuisance crimes such as prostitution and petty drug crimes. The growth in stop-and-frisk searches in New York City is an example of this shift in practice. Therefore, as violent and property crime dropped through the 1990s, the growing ranks of law enforcement officers were more likely to pay attention to minor crimes such as marijuana possession, which would drive up arrest rates 51.
There has been little study of the method in which law enforcement agents respond to marijuana possession, but a Maryland study is instructive regarding the manner in which many marijuana arrests occur 52. The authors of this study found that the rise in marijuana arrests during the 1990s in Maryland was not the result of a conscious policy shift, as in New York City; rather, it was the result of traffic stops and patrols in neighborhoods that the officers knew were "drug hot spots" 53. The authors concluded that " [m]any of these arrests are not targeted at marijuana possession itself but are incidental to traffic stops, drug enforcement more generally, disorderly conduct and other patrol activities" 54. They pointed out that general use patterns of marijuana in different Maryland counties was not a predictor of marijuana arrests.
The results from Maryland suggest that the growth in marijuana arrests was not the result of an upper-level directive; rather, it may simply be the product of an aggregation of law enforcement officers making more arrests while in the process of their daily patrol routine.
In the case of New York City, it is apparent that the growth in marijuana arrests was the result of the use of zero tolerance policing, and particularly, an increase in "stop-and-frisk" encounters. This approach primarily resulted in possession arrests and, as we will demonstrate in the next section, most of these were dismissed. Given the substantial law enforcement investment in such cases, the question is whether using stops for low-level offenses as a pretense for detecting more serious criminality is an effective approach to public safety. It clearly is not the most efficient, as evidenced in an Attorney General report concluding that only one out of every nine stops resulted in an arrest for any type of crime 55. While there is no definitive analysis of the New York crime decline to date, most observers believe that the interplay of a number of variables was responsible. These include solid economic development, a dwindling crack cocaine market, demographic changes, and sophisticated computer technology that increased police response times 56.

Marijuana and the court system

Given the dramatic growth in marijuana arrests, it is instructive to examine how these cases have been handled by the court system. The primary source for national level sentencing data is the National Judicial Reporting Program, which issues a biennial survey of felony sentences in state courts 57. We collected NJRP data from 1990 and 2000, analyzing the processing of marijuana offenders in the state court system 58. Perhaps surprisingly considering the growth in the arrest rate, state court systems did not experience any rapid increase in marijuana offenders being sentenced for a felony offense. The proportion of all persons sentenced for a marijuana felony in state courts in 2000 was 3.6%, which is 39% higher than the proportion in 1990 (2.6%), but far below the 113% growth in arrests during this period. The key findings of the court analysis are the following:

• System dismisses large number of arrestees, likely misdemeanors

The state sentencing figures in 2000 indicate a similar pattern as in 1990, suggesting that pre-trial dismissals and the fact that most arrests were for low-level misdemeanors dramatically mediated the shift in law enforcement treatment of marijuana over the decade. For example, in 2000 there were 734,000 marijuana arrests and approximately 41,000 felony convictions in state and federal courts 59. Thus, only 1 of every 18 arrests results in some type of felony sentence.
Considering the significant growth in arrests during this period and the relative stasis in felony sentences for marijuana in the state court system, it is apparent that the vast majority of the more than 700,000 arrests for marijuana in 2000 are for misdemeanors, or are dismissed for one or more of a variety of reasons.

• Of those convicted of a felony, one-half to two-thirds sentenced to incarceration

In 2000, persons convicted of felony marijuana offenses were likely to be incarcerated. Half (51%) of the convictions for possession led to a prison or jail term, as did two-thirds (63%) of the trafficking convictions. Overall, one-third of all felony marijuana convictions resulted in a prison term of at least one year. This rate was the same for both marijuana trafficking and possession, raising questions regarding the charging phase of the proceedings that will be discussed later. As seen in Table 2, the distribution of persons sentenced to prison for trafficking and possession is similar, with the only dramatic departure in the use of probation and fines for persons sentenced for a marijuana trafficking felony.

Table 2

Felony State Sentences for Marijuana Convictions – 1990 and 2000

PRISON

JAIL

PROBATION

1990

2000

1990

2000

1990

2000

Possession

30%

32%

22%

19%

48%

49%

Trafficking

31%

33%

42%

30%

27%

37%

Conventional wisdom suggests that individuals sentenced to prison for possession are repeat offenders with significant criminal histories. Although this may be true of many sentences, some states mandate incarceration even for some types of first-time marijuana possession. In Alabama, a 2004 report by the state's sentencing commission found that 328 people were sentenced to prison for marijuana possession, and only one-third were repeat offenders 60.
The rates for jail and probation sentences were relatively stable across time, although the proportion of persons sentenced to jail for marijuana trafficking dropped by nearly one-third while the proportion sentenced to probation increased by 37%.

• Average sentence length upwards of two years

Recent data on sentence length indicates that persons sentenced for a marijuana felony are likely to face sentences in the range of the national average for aggravated assault. In 2000, the average sentence for a person convicted of aggravated assault in a state court and sentenced to incarceration (prison or jail) was 37 months (median = 16 months), while the average sentence for persons sentenced to probation for a felony was 40 months (median = 36 months) 61. An analysis of those figures for persons sentenced for marijuana felonies indicate a similar sentencing range. The average sentence for persons convicted of a marijuana felony in state court in 2000 was 28 months (median = 12 months) for incarceration and 40 months (median = 36 months) for probation 62.
Separated by type of marijuana offense, we find that possession cases actually result in more severe sentences than trafficking. Persons sentenced for trafficking received an average of 27 months (median = 9 months) incarceration, while those sentenced to probation received 39 months (median = 36 months). For possession, the incarceration average was 31 months (median = 16 months) and the probation average was 42 months (median = 36 months).
A potential explanation for marijuana possession cases receiving longer sentences, in general, than convictions for sale is due to the inclusion of "possession with intent to distribute" cases 63. Whereas trafficking convictions require face-to-face purchases (frequently multiple purchases) by law enforcement in order to build a case of a criminal drug enterprise, possession with intent to distribute cases are based solely on the quantity of drugs found at the time of arrest. For example, if law enforcement agents exercise a warrant and enter a home to find a significant quantity of marijuana (more than deemed reflective of personal use) coupled with paraphernalia indicative of marijuana distribution, this evidence will likely be sufficient to merit a prosecutor pursuing a charge of possession with intent to distribute. Since the agents do not have evidence of a continuing criminal enterprise, a prosecutor is unlikely to seek a trafficking charge, which is more burdensome to prove. Because most trafficking cases are comprised of multiple purchases, any single charge for possession with intent to distribute will potentially elicit higher quantities of marijuana as well as the associated distribution paraphernalia than a typical series of face-to-face purchases by a law enforcement agent building a trafficking case.
The relatively stable patterns in state court conviction data, in light of the growth in arrests, raises questions about the allocation of law enforcement resources during the 1990s. While the numbers of arrests have more than doubled, making marijuana the single most pursued offense by American law enforcement agents, overall felony convictions have increased only modestly during the decade. Further, there is no discernable increase in the severity of marijuana offenses, since similar proportions are being sentenced to prison as in the past. Therefore, it appears that the court system is expending resources processing, dismissing, and filtering the increasing wave of marijuana arrestees. We estimate that 3.6% ($1.36 billion) of the national judicial and legal budget for 2001 ($37.8 billion) was spent on the court processing of marijuana offenders 64. The fact that the upward trend in arrests is not reflected in felony conviction data suggests that the quality of arrests has diminished greatly. It is reasonable to surmise that the growth in marijuana arrests, which are primarily for possession, is laden with misdemeanor charges and cases that are dismissed by the prosecuting authority. From a policy standpoint, the question is whether this is an efficient use of law enforcement and court system resources.

Marijuana in a city court system: a case study

There have been serious policy implications for criminal justice resources as a result of this shift in resources towards marijuana arrests. In New York City the increase in arrests due to the Giuliani-Bratton model of zero tolerance policing inundated the court system with marijuana cases. The number of arrests for marijuana increased 882% between 1990 and 2002, with an increase of 739% since Giuliani was elected in 1994, including a 1,877% increase in possession arrests 65. This contributed to a backup of the court system to such a degree that by 1999 the number of overall cases dismissed because the deadline for a "speedy trial" had passed was up 20% from 1993 66.
The disproportionate impact of possession arrests translates into court dispositions as well, as seen in Figures 9 and 10. In 1994, three of every five (61%) dispositions for marijuana in New York City courts were for sales offenses. By 2002, that figure had dropped to one of nine (11%). Overall, possession dispositions increased 1576% while conviction rates for sales dropped by one-third. All of the growth in marijuana possession dispositions was in the area of misdemeanor offenses. While lower court (misdemeanor) dispositions increased more than 17-fold, upper court (felony) dispositions for possession dropped 31%.

Figure 9

Marijuana Offense Dispositions by Type – New York City, 1994

Marijuana Offense Dispositions by Type – New York City, 1994.

Figure 10

Marijuana Offense Dispositions by Type – New York City, 2002

Marijuana Offense Dispositions by Type – New York City, 2002.

Meanwhile, the pattern in dispositions for sales offenses remained relatively flat. Lower court dispositions grew by 5% while the number of upper court dispositions was too low to arrive at any accurate statistical conclusions. The impact of zero tolerance policing on the judicial system is immediately evident upon examining New York City court data: a more than six-fold increase in marijuana dispositions, with a 15-fold increase in possession dispositions. The majority of this growth was from cases which the prosecution decided not to proceed with charging, indicated by a 23-fold increase in marijuana cases dismissed in lower court.
Although these cases did not require the level of resources accorded a full trial, there was a need to allocate court resources to address even those cases that were dismissed. Court staff time, processing costs, judge and attorney hours and other resources need to be dedicated even in cases that result in dismissal. This includes resources dedicated to arrest and processing by the police department followed by arraignment in the court system. By the time a case is dismissed, in addition to the arresting officer(s) and administrative staff necessary to process the defendant, the prosecutor's office and the office of the judge will also be involved. This comes at significant financial cost to the city as well as placing an additional burden upon an already stressed court system.

Marijuana and the correctional system

The endpoint in the criminal justice system is corrections, where persons sentenced to supervision are either incarcerated in prison or jail, or in the community on probation or parole. Based on current prison population counts, we estimate that there are 27,900 persons in state and federal prison serving a sentence for which a marijuana violation is the controlling (or most serious) offense 67. This translates to a national estimated loss of more than $600 million per year 68. Twenty-three percent of marijuana offenders are incarcerated for a possession offense, 15% for possession with intent to distribute, and 59% for trafficking. Of the total, 40% are incarcerated for the first time, 48% are recidivists with no current or prior violent offense history, and 12% are recidivists with a past violent offense in their criminal history.
This initial analysis raises questions about the severity of offenders incarcerated in state and federal prisons for marijuana offenses. Nearly 90% have no history of a violent offense. However, violent offenses are not the only measure of a person's risk to society. Many officials assert that prison sentences for marijuana are imposed for high level offenses. In order to address this question, we analyzed the data from the Survey of Inmates on offender role in a drug enterprise.
The Inmate Survey asks respondents to report their activity in the drug trade. Although self-report data suffers from some inherent biases, it is a much better indicator of individual level drug involvement because, unlike the controlling offense, it is not impacted by pre-trial discretion and negotiations regarding charging level (as discussed in the section on court processes). We define drug activity as high-level if the individual has been involved in "importing," "manufacturing," "money laundering" or "distribution to other sellers." We estimate that 48% of marijuana offenders in state and federal prison were engaged in high-level drug activity prior to their arrest. Federal marijuana offenders participated in high-level activity at a higher rate (65%) than state prisoners (40%).
Using reported activity response as an indicator, there is reason to question the assertion that only serious marijuana distributors are incarcerated in prison. In fact, the data strongly indicate that a significant number of marijuana offenders are in prison for playing a low-level role in the drug market. We can see this by identifying only those persons in state or federal prison on a first-time offense, who had not played a role of importer, manufacturer, or distributor of marijuana, and who did not involve a weapon in their offense 69. Table 5 illustrates that when these characteristics are taken into consideration, there are still 6,600 (24%) marijuana offenders in prison for a low-level offense. Based upon these criteria, we conclude that at least one in four persons in prison for a marijuana offense can be classified as a low-level offender.

Table 5

Marijuana Offenders in State and Federal Prison

Total Marijuana Offenders in Prison

27,900 (100%)

Total First-Time Marijuana Offenders in Prison

11,200 (40%)

No weapon

10,400 (37%)

No weapon, No importation

8,500 (30%)

No weapon, No importation, No manufacturing

8,700 (30%)

No weapon, No importation, No manufacturing, No laundering

8,300 (30%)

No weapon, No importation, No manufacturing, No laundering, No distribution

6,600 (24%)

In addition to persons serving a sentence in state or federal prison for a marijuana offense, there are a greater number of people on probation or parole or in jail. Although data for these populations is not available at the same level of detail as for persons in prison, we were able to create estimates of the number of people on probation or sentenced to jail for a marijuana offense using data from the National Judicial Reporting Program. Based on sentencing patterns in 2000, we estimate in 2003 that 36,000 people were on probation for a marijuana offense and an additional 4,600 were in jail serving a sentence for marijuana. These jail numbers do not include pre-trial detainees awaiting court proceedings. Thus, with half of the nearly 700,000 persons in jail awaiting trial, we estimate that the number of those persons who have been charged with a marijuana offense will equal or exceed the 4,600 people that have been sentenced.
Based on the available data for prison, jail, and probation, we estimate that over 68,000 people are under correctional supervision for a marijuana offense. While there are no data regarding the proportion of persons on parole for a marijuana offense, it is likely that this group would raise the total number of persons under supervision to more than 75,000. In addition, there are an unknown number of persons in prison due to a probation or parole violation for a non-marijuana offense who have had their supervision revoked after testing positive for marijuana.

Discussion and recommendations

It is apparent that despite a rapidly evolving national dialogue around marijuana use and a renewed discussion of alternatives to arrest and incarceration, during the 1990s the law enforcement community pursued marijuana offenses with a renewed vigor. Arrests for possession came to dominate nearly all of the growth in drug arrests during the period studied. Assertions that "nobody" goes to prison for marijuana are misguided and over-simplify the policy issue. Modest numbers of persons serving time in prison for a marijuana offense does not necessarily mean that the country is effectively calibrating its resources to address marijuana use.
Narrowly focusing on people incarcerated in state and federal prison for marijuana offenses diverts the lens of analysis from the real target: low-level marijuana users. These persons have disproportionately been targeted by the war on drugs in the 1990s. Increased arrests and frequent use of probation and suspended sentences may give the appearance that the correctional system has been calibrated properly to only incarcerate the most severe offenders, but a discussion of resource allocation demands that we also consider the growth of persons with an arrest and felony conviction record as a result of this policy. Such persons face many of the same challenges and obstacles as people who have been incarcerated. These include a denial of federal financial aid for higher education, lack of access to federal aid such as food stamps, denial of entry to public housing, and a prohibition on the right to vote, in some states for life. In addition to the institutional hurdles, there remain informal barriers for persons with a felony conviction, such as the difficulty to compete for employment with a criminal record. All of these critical issues are a cost of the drug war and exist equally whether one spends time in prison or serves a sentence in the community.
Moreover, there are important policy questions regarding the growth of marijuana arrests and the impact on law enforcement and court processing resources. As states continue to struggle under budgetary constraints, the wisdom of making nearly 700,000 marijuana arrests annually, the majority of which will be dismissed or processed as misdemeanors, is called into question. Proponents of public order, or "broken windows" policing, maintain that these arrests are symbolic and serve to maintain order, which leads to the suppression of more dangerous crime. However, this is a contentious point, and more than twenty years after the philosophy was put forth by James Q. Wilson and George Kelling, there remains no empirical validation of its truth. Criminologist Ralph Taylor notes that "initial incivilities contribute to later changes in some serious crimes ... [b]ut the contributions are neither as sizable as anticipated, nor as consistent ... 70.
What is empirically evident is that the growth in marijuana arrests over the 1990s has not led to a decrease in use or availability, nor an increase in cost. Meanwhile, billions are being spent nationally on the apprehension and processing of marijuana arrestees with no demonstrable impact on the use of marijuana itself, or any general reduction in other criminal behavior. Our analysis of criminal justice processing of marijuana use over the 1990s suggests that the contemporary approach is apportioning resources inefficiently at each stage of the system. In order to address issues of marijuana and the criminal justice system in a more effective manner, policymakers and practitioners should consider the following recommendations.

Law enforcement

Prioritize arrest policies

As has become policy in jurisdictions such as Seattle and Oakland, law enforcement agencies should categorize enforcement of marijuana possession as a low priority so as to conserve police resources for more serious offenses.

Eliminate marijuana enforcement as a means of "broken windows" policing

Marijuana arrests in some cities have been justified on the premise that arresting people for marijuana possession disrupts other, potentially more serious, behaviors. Such strategies result in substantially increased numbers of low-level marijuana arrests, with little evidence that they are actually effective in suppressing other criminal behaviors. Further, they contribute to the mistrust of law enforcement, particularly in communities of color that have been disproportionately targeted by such practices.

Courts

Exercise prosecutorial discretion to divert cases from the court system

Few marijuana possession arrests result in any significant jail or prison time, yet they are cumulatively quite costly to the court system through the engagement of prosecutors, defense counsel, judges, and probation officers. Prosecutors should use their discretion in appropriate cases to drop charges and/or utilize community resources at the earliest possible stage of court proceedings in order to effect outcomes that represent a reasonable allocation of resources.

Exercise prosecutorial discretion to reduce the number of felony convictions

In most states felony drug convictions carry a set of collateral consequences in addition to whatever punishment is directly imposed. These may include a ban on receipt of welfare benefits, prohibition on living in public housing, loss of student loans, and loss of the right to vote. These punishments place additional burdens on ex-offenders attempting to reenter the community. Therefore, to the extent that the interests of justice can be served through a misdemeanor conviction rather than a felony, prosecutors should use their charging discretion to pursue such outcomes.

Policy

Encourage debate on marijuana policy

National debate on drug issues has too often been characterized by "soundbites" that distort the policy issues under consideration. In the case of marijuana, proposals for decriminalization represent an alternative approach to current policy. Consideration of such options should be addressed in the context of the findings of this report, including the substantial criminal justice and social costs involved in the large-scale prosecution of marijuana offenders. National debate on marijuana policy, and drug policy generally, should be focused on the most effective ways of addressing substance abuse and the most efficient allocation of law enforcement resources.

Federal government should respect local decisions

For the period of the war on drugs, federal funding – currently $19 billion a year – has been allocated in a 2:1 ratio of enforcement to treatment/prevention 71. These priorities have resulted in a bloated prison population, with high proportions of low-level offenders. The Federal government should defer to local governments to develop their own approaches to marijuana use and respect the choices of state, county, and city policymakers. Federal funding should not be tied to a locality's decision to address marijuana use in only one fashion, namely law enforcement; rather, it should also encourage and adequately fund alternative strategies. A number of cities have raised concerns about the emphatic prosecution of marijuana as putting undue stress upon law enforcement resources, culminating in calls for and implementations of policy changes. The federal government should recognize these developments, and respect the choices of communities and local government agencies.

Figure 2

Marijuana as a Proportion of Growth in Drug Arrests – 1990 to 2002

Marijuana as a Proportion of Growth in Drug Arrests – 1990 to 2002.

Figure 6

Federal Drug Control Budget – 1991 to 2002**

Federal Drug Control Budget – 1991 to 2002**. ** = Chart adapted from Pastore and Maguire, Table 1.12.

Figure 8

Growth in Arrests in New York City – 1990 to 2002

Growth in Arrests in New York City – 1990 to 2002.

Table 3

Average Felony Sentence (months) in State Court – 2000

All Offenses

Aggravated Assault

Marijuana

Marijuana Possession

Marijuana Trafficking

Prison/Jail

36 (16)*

37 (16)

28 (12)

31 (16)

27 (9)

Probation

38 (36)

40 (36)

40 (36)

42 (36)

39 (36)

*Median in parentheses

Table 4

Criminal History of Marijuana Offenders

First-Timers

Recidivist/Non-Violent

Recidivist/Violent

40%

48%

12%

Drug Cases, Sentences Up Sharply Since 1984

Cooper
G

Washington Post
A02
August 20, 2001

12462241

The Christian Science Monitor Breakfast

Walters
JP

The Christian Science Monitor
March 13, 2002.

Index I crimes, generally considered the most serious crimes, are comprised of murder and non-negligent manslaughter, forcible rape, robbery, aggravated assault, burglary, larceny-theft, motor vehicle theft, and arson

Substance Abuse and Mental Health Services Administration

Results from the 2002 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NHSDA Series H-22, DHHS Publication No. SMA 03-3836)
Rockville, MD
2003

Substance Abuse and Mental Health Services Administration

2001 National Survey on Drug Use and Health
2002
Chapter 9.2

Substance Abuse and Mental Health Services Administration

Heroin – Changes in How It Is Used, 1992–2002
Rockville, MD
2004

Marijuana and Youth. Working Paper No. 7703

Pacula
RL

Grossman
M

Chaloupka
FJ

O'Malley
PM

Johnston
LD

Farrelly
MC

Cambridge, MA: National Bureau of Economic Research
2000
28

Monitoring the Future: National Survey Results on Drug Use, 1975–2003. Volume I: Secondary School Students

Johnston
LD

O'Malley
PM

Bachman
JG

Schulenberg
JE

(NIH Publication No. 04-5507). Bethesda, MD: National Institute on Drug Abuse. Table 5-4
2004

Analyzing Illicit Drug Markets When Dealers Act With Limited Rationality

Caulkins
J

MacCoun
R

The Law and Economics of Irrational Behavior
Palo Alto, CA: Stanford University Press
Parisi F, Smith VL
2005
315
338

Johnston

Table 9-6

Individual Behaviors and Substance Use: The Role of Price

Grossman
M

Working Paper No. 10948
Cambridge, MA: National Bureau of Economic Research
2004

The Price of Illicit Drugs: 1981 through the Second Quarter of 2000

Office of National Drug Control Policy

Table 9
Washington, DC: Office of National Drug Control Policy; Office of Programs, Budget, Research and Evaluations
2001

NYPD View: New Procedures Credited with Crime Drop

Ward
J

American City and County
1997
112
28
31

Substance Abuse and Mental Health Services Administration

Overview of Findings from the 2002 National Survey on Drug Use and Health. (Office of Applied Studies, HHDSA Series H-21, DHHS Publication No. SMA 03-3774). Rockville, MD. Table 1.31A
2003

Assessing the Crack-Down on Marijuana in Maryland. [unpublished manuscript]

Reuter
P

Hirschfield
P

Davies
C

2003

Racial Disproportionality of U.S. Prison Population Revisited

Blumstein
A

University of Colorado Law Review
1993
64
743
760

Pastore and Maguire, Table 1.12

The Budgetary Implications of Marijuana Legalization in Massachusetts

The formula to calculate these estimates is adapted from the Miron JA

[unpublished manuscript]; Miron creates cost estimates by analyzing the overall budget for each category (policing, courts, and corrections) and the proportion of arrests, convictions, and incarceration that is composed of marijuana offenses
2003

Rasmussen
DW

Benson
BL

The Economic Anatomy of a Drug War: Criminal Justice in the Commons
Rowman and Littlefield
Lanham, MD
1994

Ibid

36
7

Police, Fire Departments See Shortages Across USA

Hall
M

USA Today
November 29, 2004.

Deterrence and Public Policy: Trade-Offs in the Allocation of Police Resources

Benson
BL

Rasmussen
DW

Kim
I

International Review of Law and Economics
1998
18
77
100

10.1016/S0144-8188(97)00059-8

The Impact of Drug Enforcement on Crime: An Investigation of the Opportunity Cost of Police Resources

Benson
BL

Leburn
IS

Rasmussen
DW

Journal of Drug Issues
2001
31
989
1006

Drug Enforcement and Crime: Recent Evidence from New York State

Shepard
EM

Blackley
R

Social Science Quarterly, forthcoming. The authors note that an increase in drug possession arrests does not have a significant impact on assaults
2005
86

Ibid

Rasmussen

Benson

135

Entrepreneurial Police and Drug Enforcement Policy

Mast
BD

Benson
BL

Rasmussen
DW

Public Choice
2000
104
285
308

10.1023/A:1005183918319

New York City counties were excluded because we analyze the city data in the following section

The symbolic targets being the ''squeegee men'' who aggressively pursued washing car windows at city street corners, but homeless people, panhandlers, street merchants, and marijuana smokers were also targeted

Policing Disorder: Can We Reduce Serious Crime by Punishing Petty Offenses

Spitzer
E

cited in Harcourt
BE

Boston Review
2002

Office of the Attorney General, New York State: The New York City Police Department's ''Stop and Frisk'' Practices: A Report to the People of the State of New York from the Office of the Attorney General
1999
57

One Good Apple

Pooley
E

Time, as quoted in Karmen, A: New York Murder Mystery: The True Story Behind the Crime Crash of the 1990s
New York: New York University Press
2000
55
56
1996, Jan 15:

Office of the Attorney General, New York State
122
[Footnote 30]

Ibid

93
94

Ruth
H

Reitz
KR

The Challenge of Crime: Rethinking Our Response
Cambridge, MA: Harvard University Press
2003

District Attorneys in Texas Say They Can't Prosecute Drug Cases Assigned by Federal Agents; They Get the Cases of Those Caught at Border with Smaller Amounts; Number of Arrests Has Soared

Associated Press

St. Louis Post-Dispatch
A10
May 7, 2000

Ibid

City of Syracuse, Department of Audit

Report on the Syracuse Police Department Activity for the Year Ended June 30, 2002
Lewis, City Auditor
Minchin G
December 29, 2003

Ibid

A Change in Marijuana Prosecution Eyed: Chcago Considers Bid to Issue Fines in Certain Cases

Ferkenhoff
E

Boston Globe
September 26, 2004.

A state-by-state list of initiatives that were on local and state ballots for the 2004 election is available online from Alternet. Marijuana Reform to Tap Grassroots

Armentano
P

http://www.alternet.org/drugreporter/19441/
Accessed September 8, 2004.

Ontario Backs Off Pot Arrests

Brown
B

Buffalo News
A1
June 8, 2003.

Ibid

Britain's Cannabis 'Safe Haven': Police in London's Gritty Brixton Neighbourhood are Losing the War on Drugs, so the Police Chief is Experimenting with not Enforcing Marijuana Laws

Manasek
J

Ottawa Citizen, News
A1
August 5, 2001

Britain to Stop Arresting Most Private Users of Marijuana

Hoge
W

The New York Times Section A
3
July 11, 2002.

Ibid

Peter
D

Hart Research Associates, Inc

Drugs and Crime Across America: Police Chiefs Speak Out. A National Survey Among Chiefs of Police
Washington, DC: Drug Strategies and Police Foundation
2004

Ibid

Ibid

Rasmussen

Benson

146

For an example of how the reduction in crime has altered policing patterns, see: Policing a City Where Streets Are Less Mean

Wilson
M

The New York Times
August 8, 2004.

Reuter

Ibid

13
15

Ibid

2

Op. cit., Office of the Attorney General, New York State

Reflecting on the Subject: A Critique of the Social Influence Conception of Deterrence, the Broken Windows Theory, and Order-Maintenance Policing New York Style

Harcourt
B

Michigan Law Review
1998
97
291
389

NATIONAL JUDICIAL REPORTING PROGRAM, 1990: [UNITED STATES] [Computer File]. Compiled by U.S. Department of Commerce, Bureau of the Census. 2nd ICPSR ed. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [producer and distributor], 2000; and U.S. Department of Justice, Bureau of Justice Statistics. NATIONAL JUDICIAL REPORTING PROGRAM, 2000: [UNITED STATES] [Computer File]. Compiled by U.S. Department of Commerce, Bureau of the Census. 2nd ICPSR ed. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [producer and distributor]

U.S. Department of Justice, Bureau of Justice Statistics

2003

The most recent year available is 2000

[UNITED STATES] [Computer File]. Compiled by U.S. Department of Commerce, Bureau of the Census. 2nd ICPSR ed. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [producer and distributor], 2003. Federal data from United States Sentencing Commission

State-level data extracted from U.S. Department of Justice, Bureau of Justice Statistics. NATIONAL JUDICIAL REPORTING PROGRAM

2000 Sourcebook of Federal Sentencing Statistics, Table 33
2000

The Alabama Sentencing Commission

2004 Annual Report: Recommendations for Reform of Alabama's Criminal Justice System
2004

Durose
mr

Langan
PA

Felony Sentences in State Courts, 2000
Washington, DC: Bureau of Justice Statistics. NCJ 198821
2003

The figures calculated for this study use the same indicator variables as the Bureau of Justice Statistics study in an effort to permit comparison. The mean and median refer to the maximum sentence length in which the offense under discussion is the most serious

This pattern of longer average sentences for possession cases is mirrored in the federal system for all drugs, not simply marijuana

See Note 20 for discussion of methodology

Data from the New York State Division of Criminal Justice Services, Computerized Criminal History System

Crackdown on Minor Offenses Swamps New York City Courts

Rohde
d

The New York Times ; Section A
1
February 2, 1999

Harrison
PM

Beck
AJ

This estimate is based on current population counts from Prisoners in 2003. Washington, DC: Bureau of Justice Statistics. NCJ 205335; 2004. The proportion of marijuana offenders was calculated using data from: U.S. Dept. of Justice, Bureau of Justice Statistics, and the U.S. Dept. of Justice, Federal Bureau of Prisons. SURVEY OF INMATES IN STATE AND FEDERAL CORRECTIONAL FACILITIES, 1997. [Computer File]. Compiled by U.S. Dept. of Commerce, Bureau of the Census. ICPSR ed. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [producer and distributor]
2000

This estimate calculated using an average annual per inmate cost of $22, 000

This cohort is based on criteria used in Kingpins or Mules: An Analysis of Drug Offenders Incarcerated in Federal and State Prisons

Sevigny
EL

Caulkins
JP

Criminology & Public Policy. Low-level drug offenders are defined as having "no current or prior violence in their records, no involvement in sophisticated criminal activity and no prior commitment." An individual engaged in sophisticated criminal activity is "a principal figure or prime motivator in the criminal organization or activity, including an individual who acted alone or directed the illicit activities of a criminal organization." See Dept. of Justice, An Analysis of Non-Violent Drug Offenders with Minimal Criminal Histories, 1994. (p. 2, 6)
2004
3
401
434

'Broken Windows' or Incivilities Thesis

Taylor
RB

Encyclopedia of Law Enforcement
Thousand Oaks, CA: Sage Publications
LE Sullivan (Editor-in-Chief)
2005
1
34
(Volume 1: Encyclopedia of State and Local Law Enforcement, M. Rosen, editor)

Enforcement includes domestic law enforcement, as discussed on pages 9–10, as well as international interdiction and supply reduction

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Vaporizers

From Wikipedia, the free encyclopedia:
A '''vaporizer''' (or '''vapouriser''') is a device used to release the active ingredients of plant material, commonly cannabis (Marijuana), or tobacco, or to release therapeutic compounds from herbs (phyto-inhalation. Vaporizing is an alternative to Cannabis smoking. Rather than Combustion, burning the herb, which produces numerous harmful by-products; a vaporizer heats the material, to ideally 180°C (356°F), so that the active compounds contained in the plant melt and phase into an aromatic vapor, not smoke. This vapor ideally contains reduced amounts of particulate matter (tar (tobacco residue)|tar]]) and carcinogens such as [[carbon monoxide]]. Vapors may be filtered and cooled further using a water pipe or an inline water/ice attachment. Then vapors are inhaled or stored for subsequent inhalations in a "dome" or "balloon". With little to no smoke produced, cooler temperatures, and less material required to achieve the same effect, the irritating/harmful effects of smoking are greatly reduced or eliminated along with [[Passive smoking|second hand smoke]] by using a vaporizer. This makes vaporizers useful in places where there are [[List of smoking bans|public bans on smoking]].

The shortcomings of '''smoked''' cannabis have been widely viewed as a major obstacle for approval of [[Medical cannabis|medical marijuana]]; in response to the concerns several scientific studies have tried to establish whether vaporizers could offer a clinically reliable and safe method of cannabis use. Though vaporizers show great variations in performance, such studies have always found vaporization superior to smoking, and high-end vaporizers used with High Grade Hybrid Cannabis strains containing elevated levels of THC (the medicinal and psychoactive ingredient in cannabis) have been found to entirely eliminate inhalation of undesired compounds in a manner consistent enough for clinical trials.
In comparison to cannabis use methods such as eating, vaporization offers the advantages of inhaling THC: rapid onset, direct delivery into the bloodstream, and the possibility to gradually increase delivery until the desired level is reached, in this manner enabling more effective self-dosage.

==Types of vaporizers==

Vaporizers are available in many varieties.

Simple vaporizers use a lighter as heat source. Simple vaporizers are inexpensive and have expanded awareness of safer smoking alternatives. However they tend to either be ineffective or may result in accidentally burning the Marijuana.

Precise vaporizers use an electric heating element often featuring a temperature control. Some vaporizers even have a dynamic temperature control as seen with systems that use thermocoupled hot air guns. High-end models may cost several hundred dollars.

Broadly, vaporizers can be classified by how they heat the substance:
* by conduction
* by convection

With '''conduction''' heating, the substance is placed on a metal plate that is then heated to release the active constituents. The direct contact between hot metal and the herbs can cause them to burn.

With '''convection''' heating, the substance itself never touches a heating element. Instead, hot air passes through it heating it rapidly and allowing the release of the active constituents. This method of heating releases far more active constituents than conduction heating, especially if the extraction chamber utilizes [[Venturi effect]] design.{{Fact|date=February 2007}}

Many vaporizers use a tube (called a "whip") that is held to the heat source, and through which the user inhales the vapors. Some vaporizers have a bag or balloon attachment: vapor is blown into the bag, and the user detaches the bag and inhales the contents. Others are more direct extraction and delivery, such as the modular Vaporization "Tools" or "System" approach put forth by VripTech Int. with their VripMaster line which uses a direct venturi or sequential venturi extraction and delivery for maximum potency with delivery via a water pipe or, specialized "Vaporization Water Tool" which is basically a vapor specific water pipe that also holds ice for cooling and condensing the vapor, whilst minimizing oxidation, prior to delivery.

Perhaps the most important classifications for vaporizers include the type of materials used in the heating element, the extraction chambers, and delivery means. Most common "wood box and whip" type vaporizers use a ceramic soldering iron element with a glass extraction chamber and a plastic hose for delivery. This is a low cost and effective approach; however, there are concerns about off-gassing of mercury gas from the solder that is present in wiring of the box and many enthusiasts cringe at the idea of inhaling aromatic vapors through a petroleum based hose for delivery. Some companies, such as VaporBrothers, are now using a higher-grade plastic hose while the makers of the higher end Vapezilla have opted for a silicone hose. The high end Volcano vaporizer uses an aluminum element that works quite well and a metallic extraction chamber with a food grade plastic bag for storage and delivery. Although the FDA considers aluminum heating elements that have not been anodized with a pigment to be compliant, there are concerns about using aluminum in any thermally sensitive application for long durations. The use of metal, a highly conductive material, in the extraction chamber means that to get consistent subsequent vapor extractions one must incrementally dial down the heat to compensate for the heat that is collected in the metal; the upside is that it is very durable. High end thermocoupled heat guns used for vaporization, such as those made by the German company Steinel and sold with the VripTech systems use a medical grade nichrome element encapsulated in ceramic and enclosed in stainless steel.

==Health and Medical Use==
Regardless of the benefits of [[medical cannabis]], the widely perceived health risks of smoking as a route of administration have been viewed as a major obstacle for the legal approval of cannabis for medical uses, though some studies indicate that the expectorant activity of THC may help the lungs remove much of the inhaled tar through coughing. {{Fact|date=July 2007}} In response to the concerns, several studies have aimed to establish whether or not vaporizers could offer a clinically reliable and safe route of administration for cannabis. Though vaporizers show great variations in performance, such studies have consistently found vaporization superior to smoking and with best case (high-end vaporizers used with potent cannabis) results showing an elimination of undesired compounds suitable for clinical trials. {{Fact|date=July 2007}}
In comparison to other routes of administering cannabis such as eating, vaporization offers the advantages of inhalation - immediate delivery into the bloodstream, rapid onset of effect, and more precise [[titration]], the ability to more accurately control the dosage to produce a desired effect.

==Scientific studies==
At least five scientific studies have examined vaporizers. Studies have found the release of harmful constituents dramatically reduced ''Cannabis Vaporizer Combines Efficient Delivery of THC with Effective Suppression of Pyrolytic Compounds'' By D. Gieringer et.al. Journal of Cannabis Therapeutics, Vol. 4(1) 2004, [http://www.maps.org/mmj/Gieringer-vaporizer.pdf] or completely eliminated ''Evaluation of a Vaporizing Device (Volcano) for the Pulmonary Administration of Tetrahydrocannabinol''. By A. HAZEKAMP, R. RUHAAK, et.al. JOURNAL OF PHARMACEUTICAL SCIENCES, VOL. 95, NO. 6, JUNE 2006 [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16637053&query_hl=1&itool=pubmed_docsum abstract]. Substantial reductions were also found for the M1-volatizer ''Cannabis Vaporization: A Promising Strategy for Smoke Harm Reduction''. By D. Gieringer, published in Journal of Cannabis Therapeutics Vol. 1#3-4: 153-70 (2001) [[http://www.maps.org/news-letters/v06n3/06359mj1.html Summary]]. . However, a 1996 study ''Marijuana Water Pipe and Vaporizer Study''. By D. Gieringer. Newsletter of the Multidisciplinary Association for Psychedelic Studies
MAPS - Volume 6 Number 3 Summer 1996 [http://www.maps.org/news-letters/v06n3/06359mj1.html] including two simple vaporizers still found ten times more tar in the vapor than THC, although this was nevertheless up to a 30% improvement compared to the best alternative smoking method.

In 2007, a study by [[University of California, San Francisco]] published in the Official Journal of the American Academy of Neurology{{cite news|url=http://www.sciencedaily.com/releases/2007/05/070515151145.htm|title=Marijuana Vaporizer Provides Same Level Of THC, Fewer Toxins, Study Shows|publisher=Official Journal of the American Academy of Neurology (summarized by [[Science Daily]])|date=05-16-2007|accessdate=2007-06-06}} examined the effectiveness of a vaporizer that heats cannabis to a temperature between 180 and 200 degrees and found:

{{Cquote|Using CO as an indicator, there was virtually no exposure to harmful combustion products using the vaporizing device. Since it replicates smoking's efficiency at producing the desired THC effect using smaller amounts of the active ingredient as opposed to pill forms, this device has great potential for improving the therapeutic utility of THC}}

In 2006, a study performed by researchers at [[Leiden University]], tested a [[Volcano Vaporizer]] with preparations of pure THC and found that:

{{Cquote|Our results show that a safe and effective [[cannabinoid]] delivery system seems to be available to patients. The final pulmonal uptake of THC is comparable to the smoking of cannabis, while avoiding the respiratory disadvantages of smoking.}}

When using plant material (crude flower tops), besides THC, several other cannabinoids as well as a range of other plant components including [[Terpene|terpenoids]] were detected in the plant material. However, using pure THC in the Volcano, no degradation products ([[delta-8-THC]] (D8-THC), [[cannabinol]] (CBN), or unknown compounds) were detected by [[High performance liquid chromatography|HPLC]] analysis. Also, a substantially larger fraction of the THC was delivered to the vapor by using pure THC.

Analysis of the vapor from the Volcano found that using multiple passes it delivered 36% - 61% of the THC in the sample - a more recent study using pure cannabinoid preparations achieved a maximum of 54%.
For comparison, studies of cannabis cigarettes smoked via a smoking machine under varying conditions of puff duration and air speed found very similar efficiencies of 34% to
61%. Consequently, users can achieve the desired effect with a similar amount of material as when smoking.

In a 2001 study testing a device called the M1 Volatizer® , the researchers found that "it is possible to vaporize medically active THC by heating marijuana to a temperature short of the point of combustion, thereby eliminating or substantially reducing harmful smoke toxins that are normally present in marijuana smoke." The M1 Volatizer, produced THC at a temperature of 365 degrees Fahrenheit (185 degrees Celsius), while completely eliminating three measured combustion products, [[benzene]], [[toluene]] and [[naphthalene]]. [[Carbon monoxide]] and smoke [[tar]]s were also reduced, but not quantified.

These positive results are in contrast to [[MAPS]]/[[NORML]]'s previous studies into vaporizers which found less encouraging results, leading one to the conclusion that the effectiveness of vaporization varies greatly from vaporizer to vaporizer. See [[Vaporizer#Factors affecting vaporizer output|Factors affecting vaporizer output]] for possible causes of variation.

A 1996 MAPS study tested two simple vaporizer models against water pipes and filtered and unfiltered cannabis cigarettes ([[joint (cannabis)|joint]]s). The smoke produced by each was analyzed for solid particulates (tars) and 3 major cannabinoids. The various smoking methods were then rated based on their cannabinoid-to-tar ratio. The two tested vaporizers performed up to 25% better than unfiltered cannabis cigarettes (second best) in terms of tar delivery. However, both vaporizers produced more than ten times more tars than cannabinoids, which may partly be attributable to the low potency (2.3%) of the [[NIDA]]-supplied cannabis used in the study. Surprisingly, the same study found that water pipes ([[bongs]]) and filtered cigarettes performed 30% ''worse'' than regular, unfiltered joints. The reason was that waterpipes and filters filter out psychoactive THC with the tars, thereby requiring users to smoke more to reach their desired effect. The study did not, however, rule out the possibility that waterpipes could have other benefits, such as filtering out harmful gases such as carbon monoxide.

These studies have not measured the presence of toxic gases, such as [[ammonia]], [[hydrogen cyanide]] and carbon monoxide, though previous studies have indicated unquantified decreases in carbon monoxide with vaporization.

Although vaporizers produce cleaner vapors than smoking, they do not completely eliminate respiratory irritation. A puff of strong vaporized cannabis will occasionally cause coughing. This however, could be due to THC itself, which is known to have a strong expectorant effect.

===Factors affecting vaporizer extraction and delivery capabilities and the breadth of spectrum of actives deliverable===

The wide range of results from tests of different vaporizers suggest that the choice of vaporizer is a major factor in determining extraction and delivery efficiency as well as the amount of harmful byproducts produced, or not produced, as in the case of a superior system. In Cannabis, and many other medicinal plants, the components responsible for the aromatic nature of the plant will often vaporize at a low-end temperature in the range of extraction temperature values for all the bioactive components. In Cannabis, the temperature range across which the actives will vaporize is at least 132 degrees F starting at around 260F where only aromatic compounds of minimal bioactivity will release and going all the way up to 392F with the higher end of this range representing where the cannabinoids of higher bioactivity appear to be released. It is believed that both the total amount of actives delivered as well as the breadth of spectrum delivered per inhalation is critical in determining the value of the delivered dose and, in turn, systems that deliver the highest amount of actives and broadest spectrum of actives per inhalation are believed to be the most effective for medicinal applications: i.e. venturi enhanced extraction / convection based systems.

Proposed factors affecting output include , :

*temperature;
*specimen density,
*weight, content of water and essential oils,
*consistency of material in the filling chamber
*variety and potency of cannabis used;
*different preparations such as crude flowertops, [[hashish]], [[hash oil]], etc.
*storage time of the vapor
*proportion of THC exhaled (breathing technique)

Not all those have been scientifically tested. Research using the vaporizer found the delivery efficiency highest at around 226 degrees Celsius, falling to about half efficiency at 150 to 180 degrees depending on material .
The purest preparations produced the highest efficiencies, about 54% for pure THC versus 29% for plant material (female flowertops) with 12% [[THCA]] content. Besides THC, several other cannabinoids as well as a range of other plant components including terpenoids were detected in the plant material. Using pure THC in the Volcano, no degradation products (delta-8-THC (D8-THC), cannabinol (CBN), or unknown compounds were detected by HPLC analysis .

The longer vapor is stored, the more of the THC is lost as it condenses on the surface of the vaporizer or the balloon. This loss may be negligible over a few minutes but may exceed 50% after 90 minutes .

Interestingly, the Leiden Univsersity study found that as much as 30%–40% of inhaled THC was not absorbed by the lungs and simply exhaled. However, they did not find large individual differences in the amounts exhaled.

==Byproducts==

'''Browns or Duff''' are the used up herb after vaporization. Instead of being black like ashes they are brown. Though they are in low concentrations, cannaboids may be recovered from an accumulation of Browns using an extraction (such as [[ethanol]]) or may be re-vaped.

'''Scrapings''' are the buildup of resin in a vaporizer. This buildup may be ''scraped'' and vaped for a potent effect, similar to kief.

==Vaporizing For Enhanced Lung Capacity Technique==
http://www.gotvape.com/vaporizer-blog/2005/07/lung-expansion-through-vaporization.html
Although there are a multitude of ways in which to draw vapor from a vaporizer (and much will depend on the type/model of the vaporizer used) the technique used to absorb the maximum amount of THC is also the same way one would enhance lung capacity through exercise. The technique:
*1.) Expel all air from lungs.
*2.) Take very deep breath of air, filling from the abdomen up.
*3.) Expel all air from lungs.
*4.) Fill lungs to 2/3 their capacity from vaporizer, filling from the abdomen up, drawing from fast to slow
*5.) Fill rest of lung with air and if applicable remove vaporizer from heat source, continuing to draw off of the vaporizer (in order to cool vaporizer, stopping vaporization when not in use).
*6.) Hold breath a moment.
*7.) Inhale one last bit of air.
*8.) Hold breath a while (as long as comfortable/possible).
*9.) Exhale slowly and controlled through the nose.

Why is the Media supporting the Government's Crusade Against Marijuana?

By Mike Males

As America’s officially ignored death toll from overdoses of heroin, cocaine, prescription drugs and alcohol mixed with dope took another huge jump in 1995 (taking 10,000 lives, up 65 percent since 1992), America’s media raged with the threat to the republic posed by . . . sick people smoking marijuana to relieve pain. And ABC News teamed up in March with the private Partnership for a Drug-Free America to push a month-long "March Against Drugs," including hourly ads, numerous specials, and "Straight Talk About Drugs" appended to its evening news with a heavy focus on teenage marijuana use.

Newsweek (11/25/96) obediently branded medical-marijuana laws "a newdrug problem" after a two-day law enforcement summit in Washington so decreed. Time and Newsweek followed with lengthy cover stories on weed. But with many respectable, articulate and clearly suffering older folks speaking for the medical-marijuana movement, it was hard for the media to maintain their usual melodrama pitting noble anti-drug knights against evil young stoners.

While intimating that the California and Arizona pot campaigns were deceptive, Newsweek (2/3/97) flatly endorsed their "bottom line": "Marijuana may prove an effective alternative to more commonly prescribed drugs for some diseases." Time’s cover story, "Kids and Pot" (12/9/96),indulged a few pieties but presented unusual complexity: The harshest swipes were at the "time-warping" dishonesty of drug-user-turned-moralist baby boomers, including President Clinton.

Yet these and other mainstream outlets failed to ask the obvious questions:Why the government and press furor over cannabis as medicine? Why raise ahullabaloo that (in the law’s words) "seriously ill Californians have the right to obtain and use marijuana for medical purposes" when "recommended by a physician"? And do the 8 percent of the nation’s teens who smoke marijuana represent such a national calamity that it should lead ABC (3/1/97) to launch "an unprecedented public service campaign"?

The most recent statistics continue to show that marijuana and hallucinogenic drugs like LSD, peyote, mescaline and mushrooms put together account for fewer than five deaths per year. Hospital emergency room reports show a total of 6,500 teens nationwide were treated for any kind of marijuana or hashish effects in 1995—less than 0.1 percent of the 10 million teenage ER visits, and only one-fourth the number of teens treated for adverse affects from aspirin or Tylenol (Drug Abuse Warning Network, Annual Emergency Department Data, 1994). Further, four-fifths of these 6,500 "marijuana" treatments involved youths who had also ingested more dangerous drugs, such as alcohol. Only 1,300 teen emergency cases involved marijuana alone, the same number attributed to the allergy medication Benadryl.

Teens and pot are tiny contributors to the nation’s drug woes, now or in the future. Long-term studies consistently show that only one in five youthful pot smokers will ever try harder drugs such as cocaine, heroin, or methamphetamine, and fewer than one in 25 will use hard drugs regularly. The upshot is not that marijuana leads the masses to hard stuff, but that the few who use stronger drugs will not say no to weaker ones. (For the latest summary of research demolishing "reefer madness 1997," see RollingStone, 2/20/97.)

Free of Some Drugs

The Partnership for a Drug-Free America’s Bulletin (2/97) announced that its campaign with ABC would promote adult "communication" with and control over teens regarding drugs. But what is really needed is a fundamental exercise of the media’s adversary role, including arm’s-length reporting on the Partnership and how its self-interests tie into the monumental failures of the "war on drugs."

For example: If, by the Partnership’s estimate, today’s teens and adults have been bombarded with $2 billion in anti-drug advertising overthe past decade, why do we now see (by the Partnership’s admission)rapidly rising drug use among teens and (by a consensus of federal reports) drug abuse deaths and injuries among adults soaring to record levels? Could one reason be that the Partnership is not a genuine anti-drug effort, but a corporate/media back-patting consortium designed to scapegoat unpopular groups for illegal drug use while protecting the interests of legal-drug industries (who also purchase billions of dollars in media promotions)?

For a group fighting drug abuse, the Partnership has taken cash from some odd parties—including American Brands (Jim Beam whisky), Philip Morris(Marlboro and Virginia Slims cigarettes, Miller beer), Anheuser Busch (Budweiser, Michelob, Busch beer), R.J. Reynolds (Camel, Salem, Winston cigarettes), as well as pharmaceutical firms Bristol Meyers-Squibb, Merck & Company and Proctor & Gamble (Marin Institute Backgrounder, 2/97).

The Partnership recently announced it will quit its alcohol and tobacco habit but will continue to mainline pharmaceutical checks (Village Voice, 3/12/97). And its silence continues on America’s deadliest drug problems: tobacco (400,000 annual deaths), alcohol (100,000, including 20,000 from drunken driving), and pharmaceuticals (6,000 to 9,000).

The most ominous, but seldom mentioned, finding of the 1995 National Household Survey on Drug Abuse: Abusive "binge drinking" among adults ages 26 and older rose sharply since 1992, adding four million potential alcohol abusers to the age group parenting the young. Recent studies have found that hundreds of children and youths die every year from fires and cancers caused by their parents’ smoking (Pediatrics, 4/96), and thousands from homicides, accidents and neglect related to parents’ alcoholism—many times more than perish from youthful drug abuse.

Silence Is Acceptance

But adult drinking and smoking are often taboo topics. In an interview by University of Massachusetts professor David Buchanan (Backgrounder, 2/97), Partnership president Tom Hedrick denounced those who include legal drugs like alcohol in the drug problem as "prohibitionists." (Those who questioned the dangers of marijuana, on the other hand, were dismissed as "legalizers.")

Problem is, adult drug use vs. youthful drug use, and legal vs. illegal drugs, neatly segregated in drug-war dogma, are thoroughly intermixed in real life. The federal Drug Abuse Warning Network reports that of the 560,000 people brought to hospital emergency rooms for abusing illegal drugs in 1995, the companion drug most often mixed with heroin, cocaine, pot or speed was... alcohol. A quarter-million ER cases involved pharmaceuticals, also oftenwashed down with liquor (Preliminary Estimates from DAWN, 5/96).

Interestingly, the concomitant $300 million anti-drug advertising campaign announced by drug czar McCaffrey will include ads against use of alcohol or tobacco—but only by teenagers (Los Angeles Times, 2/26/97). Aside from ignoring the facts that 90 percent of America’s drunken driving toll involves adult drivers 21 and over, and that youths’ drinking, smoking, and drug habits are firmly linked to those of their parents andnearby grownups, this "for adults only" campaign supports subtle themes industries use to promote their products.

University of California professor and industry document analyst Stanton Glantz points to tobacco moguls’ strategy to promote cigarettes as a mature, sophisticated, "adult" habit. Since "kids want to be like adults," Glantz warned, promoting smoking as "for adults only" simply "reinforces tobacco advertising" (American Journal of Public Health, 2/96).

Hedrick also told Buchanan the Partnership maintains that "reducing poverty, improving schools, strengthening families, and providing programs to enhance students’ social and academic skills" are "infeasible and misguided" ways to fight drugs. Drug abuse, Hedrick said, is "solely the result of individual choice," and the only messages the Partnership advances are "stay in school" and "stay off drugs." Such an image of pure choice would be difficult to sustain if mass media openly confronted such issues as the skyrocketing toll of heroin abuse among today’s middle-aged men related to Vietnam War service, or the tens of thousands of deaths from mis-prescribed medical drugs over the last 40 years.

McCaffrey and the Partnership don’t talk about those drug problems. As drug historian David J. Musto pointed out in Scientific American (7/91), government-fomented anti-drug crusades thrive on "linkage between a drug and a feared or rejected group within society": Latinos and marijuana. Blacks and heroin or crack. Native Americans and hallucinogens. And today,teenagers and all the above.

Thus the drug war’s implicit message: Don’t be a loser "child" who smokes pot. Be a mature grownup and puff Marlboros, chase Jim Beam with a Bud, and mellow with Valium.

Any questions?

----------------------------------------
Mike Males is a social ecology graduate student at the University of California, Irvine, and author of The Scapegoat Generation: America’s War on Adolescents (Common Courage Press).

Marijuana is safer than aspirin

When Bayer introduced aspirin in 1899, cannabis was America’s number one painkiller. Until marijuana prohibition began in 1937, the US Pharmacopoeia listed cannabis as the primary medicine for over 100 diseases. Cannabis was such an effective analgesic that the American Medical Association (AMA) argued against prohibition on behalf of medical progress. Since the herb is extremely potent and essentially non-toxic, the AMA considered it a potential wonder drug.
Instead, the invention of aspirin gave birth to the modern pharmaceutical industry and Americans switched away from cannabis in the name of “progress.” But was it really progress? There can be no doubt that aspirin has a long history as the drug of choice for the self-treatment of migraines, arthritis, and other chronic pain. It is cheap and effective. But is it as safe as cannabis?
History:

• Marijuana has been used for over 5,000 years.
• No one has ever overdosed on marijuana.

• Aspirin has been used for 108 years.
• Approximately 500 people die every year by taking aspirin

The Law:

• Marijuana is a Schedule 1 drug, meaning the US government believes it is extremely dangerous, highly addictive, and of no medical value.
• Aspirin is available for pennies and can be purchased by children at any drug, grocery, or convenience store. Often they are just handed out free by people with no medical education.

Marijuana side effects and dangers:

• The dangers of marijuana include possible respiratory problems caused by the deposition of burnt plant material on the lungs. This danger can be eliminated with alternate forms of consumption such as eating or vaporizing the medicine.
• For two to four hours, marijuana causes short-term memory loss, a slight reduction in reaction time, and a reduction in cognitive ability. (It makes you stupid for a little while.)These conditions DO NOT persist after the herb wears off.
  

• Hunger
• Paranoia
• Depression
• Laughter
• Introspection
• Creative Impulse
• Euphoria
• Tiredness
• Forgetfulness

Aspirin side effects and dangers:

• When taken with alcohol, aspirin can cause stomach bleeding.
• Reye Syndrome in children: fat begins to develop around the liver and other organs of the child, eventually putting severe pressure on the brain. Death is common within a few days.
• People with hemophilia can die.
• People with hyperthyroidism suffer elevated T4 levels.
• Stomach problems include dyspepsia, heartburn, upset stomach, stomach ulcers with gross bleeding, and internal bleeding leading to anemia.
• Dizziness, ringing in the ears, hearing loss, vertigo, vision disturbances, and headaches.
• Heavy sweating
• Irreversible liver damage
• Inflamation and gradual destruction of the kidneys
• Nausea and vomiting
• Abdominal pain
• Lethargy
• Hyperthermia
• Dyspepsia: a gnawing or burning stomach pain accompanied by bloating, heartburn, nausea, vomiting and burping.
• Tachypnea: Abnormally fast breathing
• Respiratory Alkalosis: a condition where the amount of carbon dioxide found in the blood drops to a level below normal range brought on by abnormally fast breathing.
• Cerebral Edema: Water accumulates on the brain. Symptoms include headaches, decreased level of consciousness, loss of eyesight, hallucinations, psychotic behavior, memory loss and coma. If left untreated, it can lead to death.
• Hallucinations, confusion, and seizure.
• Prolonged bleeding after operations or post-trauma for up to 10 days after last aspirin.
• Aspirin can interact with some other drugs, such as diabetes medication. Aspirin changes the way the body handles these drugs and can lead to a drug overdose and death.

If you think that cannabis is actually safer than aspirin, you are not alone. In October 2000, Dr. Leslie Iversen of the Oxford University Department of Pharmacology said the same thing.
In her book, ‘The Science of Marijuana,’ Dr. Iversen presents the scientific evidence that cannabis is, by-and-large, a safe drug. Dr. Iversen found cannabis had “an impressive record” when compared to tobacco, alcohol, or even aspirin.
“Tetrahydrocannabinol is a very safe drug,” she said. “Even such apparently innocuous medicines as aspirin and related steroidal anti-inflammatory compunds are not safe.”
So if safety is your concern, cannabis is clearly a much better choice than aspirin. If you eat it or vaporize it, it just might be the safest painkiller the world has ever known.

 
Dependence: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance and the degree to which the substance will be used in the face of evidence that it causes harm.
Withdrawal: Presence and severity of characteristic withdrawal symptoms.

Tolerance: How much of the substance is needed to satisfy increasing cravings for it, and the level of stable need that is eventually reached.
Reinforcement: A measure of the substance’s ability, in human and animal tests, to get users to take it again and again, and in preference to other substances.
Intoxication: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do.
This chart originally appeared on DrugWarFacts.org.
I tracked it down at SaferChoice.org.

NORML: National Organization for the Reform of Marijuana Laws

National Organization for the Reform of Marijuana Laws

Founder
Keith Stroup

Founded
1970

Headquarters
Washington D.C.

Key people
Allen St. Pierre, Richard Cowan, Jon Gettman

Area served
United States

Focus
Reforming marijuana laws in United States

Website

Norml.org

The National Organization for the Reform of Marijuana Laws or NORML (pronounced "normal") is a U.S.-based non-profit corporation whose aim is, according to their most recent mission statement, to "move public opinion sufficiently to achieve the repeal of cannabis prohibition so that the responsible use of this drug by adults is no longer subject to penalty." According to their website, NORML "supports the removal of all criminal penalties for the private possession and responsible use of marijuana by adults, including the cultivation for personal use, and the casual nonprofit transfers of small amounts," and "supports the development of a legally controlled market for cannabis."

NORML (and the NORML Foundation) are organizations that support both the victims of cannabis prohibition and the stakeholders working to reform current laws.
In the 2006 midterm elections, NORML promoted several successful local initiatives that declared marijuana enforcement to be the lowest priority for local law enforcement and freeing-up police resources to combat violent and serious crime.
NORML will support efforts now underway in other states such as California to legalize and tax marijuana, which is now the largest cash crop in the United States,[1] as a means of coping with growing federal and state deficits, without having to raise other taxes.

Contents

• 1 History
• 2 NORML Foundation
• 3 NORML administration
  • 3.1 Board of Directors
  • 3.2 Advisory Board
  • 3.3 Executive directors
• 4 References
• 5 See also
• 6 External links

//

[edit] History

NORML was founded in 1970, and since, the organization has played a central role in the cannabis decriminalization movement. The organization has a large grassroots network with 135 chapters and over 550 lawyers. NORML holds both annual conferences and CLE-quality legal seminars. Once its board of directors included prominent figures such as Senator Philip Hart and Jacob Javits.[2]

[edit] NORML Foundation

The NORML Foundation, the organization's tax-exempt unit, conducts educational and research activities.
Examples of the NORML Foundation's advocacy work is a detailed 2006 report, Emerging Clinical Applications For Cannabis.[3]
A comprehensive report with county-by-county marijuana arrest data, Crimes of Indiscretion: Marijuana Arrest in America, was published in 2005.[4]
In October 1998, NORML Foundation published the NORML Report on U.S. Domestic Marijuana Production that was widely cited in the mainstream media. The report methodically estimated the value and number of cannabis plants grown in 1997, finding that Drug Enforcement Administration, state and local law enforcement agencies seized 32% of domestic cannabis plants planted that year. According to the report, "Marijuana remains the fourth largest cash crop in America despite law enforcement spending an estimated $10 billion annually to pursue efforts to outlaw the plant."[5] Recent studies show that marijuana is larger than all other cash crops combined.[1]

[edit] NORML administration

[edit] Board of Directors

Barbara Ehrenreich

Willie Nelson performing at the Chumash Casino Resort in Santa Ynez, California.

Woody Harrelson

Tommy Chong

• Steve Dillon, Esq. (Chair)
• Dale Gieringer, Ph.D. (Vice Chair)
• Valerie Corral
• Rick Doblin, Ph.D.
• Ann Druyan
• Barbara Ehrenreich
• Dominic Holden
• Norman Elliott Kent, Esq.
• Paul Kuhn
• Nancy Lord, M.D., Esq.
• Christopher Mulligan
• George Rohrbacher
• Jeffrey Steinborn
• Allen St. Pierre
• R. Keith Stroup, Esq.
• Clifford W. Thornton, Jr.
• Richard M. Wolfe
• Dan Viets, J.D.
• Peter Vilkelis

[edit] Advisory Board

• Willie Nelson, Co-Chair (singer and songwriter)
• Nadine Strossen, Esq., Co-Chair (President, American Civil Liberties Union)
• David Boaz (Executive Vice-President, Cato Institute)
• Tommy Chong (comedian, actor, director, author)
• Mitch Earleywine, Ph.D. (Associate Professor of Psychology)
• Lester Grinspoon, M.D. (Harvard Medical School (emeritus))
• Terence Hallinan, Esq. (San Francisco District Attorney)
• Woody Harrelson (actor)
• Bill Maher (comedian and social satirist)
• Ron Mann (documentary filmmaker)
• Sheriff Bill Masters (of Telluride, CO)
• John P. Morgan, M.D. (Physician and Professor of Pharmacology)
• Kary Mullis, Ph.D. (1993 Nobel Laureate (Chemistry))
• Bill Regardie (publisher)
• Mark Stepnoski (former NFL star)
• Daniel Stern (actor, writer and director)
• Rick Steves (travel writer, television host)

Hunter S. Thompson and Robert Altman were also members of the Board until their deaths.

[edit] Executive directors

• Keith Stroup (1970-1979, 1995-2004)
• George Farnham (1979-1982)
• Kevin Zeese (1982-1986)
• Jon Gettman (1986-1989)
• Donald Fiedler (1989-1991)
• Richard Cowan (1992-1995)[6]
• Allen St. Pierre (2005-present); Founding Director of the NORML Foundation, (1996-present)

[edit] References

1. ^ a b Bailey, Eric. "Pot is called biggest cash crop", Los Angeles Times, 2006-12-18. Retrieved on 2007-04-22. 
2. ^ Carlson, Peter (January 4, 2005), "Exhale, Stage Left", Washington Post: C01, <http://www.washingtonpost.com/ac2/wp-dyn/A46033-2005Jan3?language=printer>.
3. ^ Recent Research on Medical Marijuana (2007-02-03). Retrieved on 2007-04-22.
4. ^ Crimes of Indiscretion (2005-03-07). Retrieved on 2007-04-22.
5. ^ NORML Report on U.S. Domestic Marijuana Production (2005-03-07). Retrieved on 2007-04-22.
6. ^ Biographical Data on Richard Cowan. The Marijuana Times. Retrieved on 2007-04-22.

Evaluation of herbal cannabis characteristics by medical users: a randomized trial

Cannabis, in herbal form, is widely used as self-medication by patients with diseases such as HIV/AIDS and multiple sclerosis suffering from symptoms including pain, muscle spasticity, stress and insomnia. Valid clinical studies of herbal cannabis require a product which is acceptable to patients in order to maximize adherence to study protocols.
Methods

We conducted a randomized controlled crossover trial of 4 different herbal cannabis preparations among 8 experienced and authorized cannabis users with chronic pain. Preparations were varied with respect to grind size, THC content and humidity. Subjects received each preparation on a separate day and prepared the drug in their usual way in a dedicated and licensed clinical facility. They were asked to evaluate the products based on appearance (smell, colour, humidity, grind size, ease of preparation and overall appearance) and smoking characteristics (burn rate, hotness, harshness and taste). Five-point Likert scores were assigned to each characteristic. Scores were compared between preparations using ANOVA.
Results

Seven subjects completed the study, and the product with highest THC content (12%), highest humidity (14%) and largest grind size (10 mm) was rated highest overall. Significant differences were noted between preparations on overall appearance and colour (p = 0.003).
Discussion

While the small size of the study precludes broad conclusions, the study shows that medical cannabis users can appreciate differences in herbal product. A more acceptable cannabis product may increase recruitment and retention in clinical studies of medical cannabis.
Background

It is now well-recognized that Cannabis sativa (marijuana, weed, pot) is being used by patients with chronic debilitating diseases such as HIV/AIDS [1], chronic non-cancer pain [2], epilepsy [3], multiple sclerosis [4] and amyotrophic lateral sclerosis [5] for the management of symptoms such as pain, nausea, poor sleep, anxiety and stress. Since 2002, cannabis for medical use has been produced by Prairie Plant Systems Inc (PPS) under license to Health Canada [6]. Cannabis is cultivated for use in clinical trials, open-label safety studies [7], and for distribution to persons authorized under the Medical Marihuana Access Regulations (MMAR) to use marihuana for medical purposes [8]. A number of authorized persons using this product initially reported concerns about the product, include the dryness, grind size (defined as the size of the particles after grinding raw herbal material), and tetrahydrocannabinol (THC) content of the cannabis material [9].

To improve the acceptability of the cannabis product provided to patients and to facilitate recruitment and retention of research subjects in clinical trials, Health Canada and PPS explored mechanisms to vary herbal cannabis products with varying levels of humidity, THC content, and grind size. This study was conducted to evaluate several herbal cannabis presentations in which dryness, grind size and THC content were varied. The aims of the study were to determine experienced users' preference for cannabis products, and to determine whether there was any consistent pattern towards a preferred product.
Methods

A randomized, double-blind study of cannabis products was undertaken over a six week period in June-July 2004. Subjects were all current holders of valid authorizations to possess cannabis under the Medical Marijuana Access Regulations, and were currently using cannabis for medical purposes. Subjects agreed not to drive to or from their scheduled appointments.

Four (4) different PPS preparations of Cannabis sativa were evaluated; an identical species was used for all preparations. THC content was varied by blending the flowering heads with leaves from lower down the plant. The product was milled using a dry conical mill (Quadro® Comill®, Waterloo, Ontario), with particle size varied using screens with circular holes of 5 or 10 mm diameter. Cannabis preparations were packaged at PPS in 30 gram bags and labeled as Presentation # 1 to Presentation # 4 prior to shipment to the site pharmacy. The site pharmacist weighed 1 g quantities of each preparation (LP 3200D scale, Sartorius, Canada). The drug was repackaged in plastic vials closed with a soft plastic/rubber top, which were then dispensed to the study nurse as needed on the days of use. The product was weighed and transferred from the original package to the dispensing container within 5 minutes, and the ambient temperature and humidity conditions in the pharmacy were recorded at the time of preparation (Digital Hygrometer DHM-010, Davidoff, Canada). The original package was resealed immediately after weighing the required amount of product.

The characteristics of the products were determined using a specially designed questionnaire. Items consisted of 5-point Likert scales and included physical characteristics (smell (0: very unpleasant; 4: very pleasant), humidity (0: unacceptably dry; 4: optimum humidity), appearance (0: looks very bad; 4: looks excellent), particle size (0: very poor, 4: excellent), colour (0: very poor, 4: excellent) and ease of preparation (0: very hard to use; 4: very easy to use) and smoking characteristics (hotness (0: very hot; 4: very cool), harshness (0: very harsh; 4: very smooth), burn rate (0: burns too fast; 4: burns just right), and taste (0: worse possible taste; 4: best possible taste). An overall comparison to usual cannabis was made (0: much worse than usual cannabis; 4: much better that usual cannabis). A global assessment was performed on the final day at which subjects were asked to rank the products assessed in order of preference (0: worse; 4: best). Subjects were not asked about clinical parameters such as efficacy.

Eligible subjects were given a scheduled series of 4 appointments. Informed consent was signed at the first appointment. The subjects were randomly assigned to test one cannabis preparation per day over the four days. They were asked to assess physical characteristics of the drug prior to use. They were asked to prepare and use the cannabis in the manner to which they were accustomed. Within five minutes of use they were asked to comment on the harshness, hotness, burn rate and comparison with usual cannabis. Subjects remained in the cannabis laboratory for one hour after use before being allowed to return home by taxi. On the evening after each clinic visit the subjects were contacted at home by the research nurse to determine if they had additional comments or concerns regarding the product they evaluated that day.

It was estimated that recruiting 8 subjects would allow a basic and preliminary assessment of trends in perceptions of differences between product characteristics. This number of subjects was also feasible to recruit within the time period of the study. The data were double entered and validated in a dedicated and secure database. Data were entered without identifiers to protect confidentiality. Cannabis preparations were ranked according to user preferences on each item. All items were rated equally. A total rank score for each preparation was assigned. Ranks according to individual physical and smoking characteristics were examined. All statistical analyses were done using SAS (SAS Institute, North Carolina). Means, frequencies and a multiple analysis of variance (ANOVA) for cross-over design (proc mixed) were calculated to assess the comparison between products. Period effect was analyzed independently. Due to the small sample-size, no adjustments were made for multiple comparisons.

The study was conducted at a dedicated cannabis research laboratory at the Montreal General Hospital in the McGill University Health Centre (MUHC). The study was approved by the Research Ethics Committee of the McGill University Health Centre.
Results

Eight subjects were recruited for the study. No subject refused to participate, but one subject did not attend for the final visit and was excluded from the final analysis. Therefore the final report is based on seven subjects who completed the study. Inclusion of the eighth subject in a limited analysis did not alter the overall direction of the results. The period effect could not be assessed in the main model because one subject missed one visit; however no overall differences were found on overall comparison of the four time periods.

There were 5 males and 2 females, and the mean age was 47 years (range 40–54 y). Diagnoses were varied and included peripheral neuropathic pain (4 subjects), multiple sclerosis (2 subjects), and HIV/AIDS (1 subject).

The overall results based on the Likert scores for each characteristic and the overall scores are shown in Table 1. Product 1 (10.6% THC, 14.4% humidity, 10 mm grind size) was the most well rated product, and significant differences were noted between products overall (p = 0.03), and for physical characteristics including general appearance (p = 0.03) and colour (p = 0.03).

Table 1. Evaluation of four cannabis preparations by physical and smoking characteristics*

Of the 28 different assessments (7 subjects using 4 products), 18 were performed using joints and 10 using pipes. Most assessments (93%) were done with subjects reporting using the same amount of cannabis as usual, and 16/18 stated no problems in preparing their joints. Product 4 received a poor rating in terms of problems rolling it by 2 subjects.
Physical characteristics

Product 2 was treated as having the best smell with 6 subjects rating it pleasant or very pleasant. Product 2 was also rated as the best humidity with 6 subjects rating it acceptable. In general appearance, product 1 was superior; 4 subjects rated product 3 as 'looks bad'. Products 1, 2 and 3 were rated similar in terms of ease of preparation, although all 7 subjects rated products 1 and 2 as easy or very easy to use. Products 1 and 2 were rated equally in terms of colour. Product 1 was rated best in terms of particle size with 5 subjects rating particle size as good or excellent.
Smoking characteristics

Product 3 was rated most 'cool' overall. Product 2 was rated highest in terms of harshness with 6 subjects rating it as moderate or smooth. Product 1 was rated as having the best burn rate (1 subject stated it 'burned just right'), while each of products 2, 3 and 4 were rated by one subject each as burning too fast. Product 2 was rated as having the best overall taste.
Global assessments

Fourteen out of 28 (50%) subjects rated products 1, 3 and 4 as 'worse than their usual cannabis', 11 assessments were the 'same as usual cannabis' (4 of which were for product 2). Only 3 assessments were 'better than usual cannabis' (products 1, 2 and 4). Globally, product 1 received the highest score in terms of all the product characteristics measured (Table 2). In this overall analysis, product 1 was superior to products 3 and 4, and product 2 was superior to product 3.

Of the products tested, over half (4/7) of those using products 1 and 2 would use it on a regular basis, and over half would not use products 3 (5/7) and 4 (5/6) on a regular basis. In terms of overall satisfaction, 3 subjects rated product 1 as good or excellent and 2 subjects rated the other products as good or excellent. Five subjects rated product 3 as poor, and one rated product 2 as very poor.
Ambient humidity and temperature

The drug samples were prepared the day before the visit for the first 5 patients, resulting in the drug being in the new container for 16 to 20 hours. For the last 3 patients, the drug spent from 6 to 17 days in the new container. Temperature and humidity measurements were taken in the pharmacy on 14 days over the 28 day period. Over this period, the mean room temperature was 22.4°C (SD 0.23), and the mean ambient humidity was 46% (SD 4.4).
Discussion

To our knowledge, this is the first ever evaluation of medical cannabis products for physical and smoking characteristics by authorized patients. We have shown that subjects may appreciate differences between cannabis preparations on the basis of physical characteristics of the herbal material, specifically general appearance and colour. We did not show differences in individual smoking characteristics, but overall impressions confirmed that subjects favoured higher THC content, higher humidity and larger grind size.

The results of this study must be interpreted with considerable caution as there are many limitations to the data obtained. The small sample size reduces the power of the study to reach definitive conclusions about patient preference. The detected differences between products could have arisen by chance, or may have been influenced by other factors such as the use of different modes of administration (pipes and joints). Further study should limit the modes of administration to reduce confounding by these factors.

The effect of room air on the humidity levels of the product is a factor which may affect the validity of the final results. The average ambient humidity at the time of product preparation was well above that of the original product specifications (46% versus 10–15%), and could have raised the humidity of the product during the storage period prior to use. This would have the effect of reducing or eliminating the potential differences between products on humidity-based assessments. This may partially explain why differences in physical characteristics such as colour, particle size and general appearance were detected (Table 2), while the hotness, harshness and burn rate appeared to be rated similarly between products.

Subjects' evaluations of smoking characteristics of the samples immediately after use may have been influenced by the psychoactive effects of cannabis. This study recruited experienced medicinal cannabis users who would likely evaluate any cannabis product under similar conditions ('try it and see') so we feel our approach is pragmatic and relevant.

The subjects and investigators were initially blind to the characteristics of the allocated products, but the ability of the subjects to differentiate the products suggests that the blinded condition was compromised. The investigators (study nurse or physician) did not evaluate their own ability to differentiate the products

In spite of these potential limitations, this randomized double-blind study has found that two of these products (products 1 and 2) could be appreciated differently from the other two, in terms of their physical and smoking characteristics. Product 3, which was a 10% THC blend (expiry date June 2004) which had been originally shipped by Health Canada to authorized patients was rated poorly by the subjects in this study, suggesting that the product could be improved by changing physical characteristics such as blending, particle size and humidity. These changes may result in improved patient satisfaction with the product, which may in turn increase the number of patients willing to use the Health Canada product and improve compliance in long term studies using the product. The study results support a decision by Health Canada, made prior to the study in May 2004, to distribute a product made only of flowering head material, taking into account preliminary reports from authorized users, with larger grind size, higher humidity and higher THC content. A review of Health Canada statistics [10] suggests that use of the Health Canada product increased since the new product was shipped in the summer of 2004 (Figure 1). An initial delay in uptake may have been due to media reports from disgruntled users about the poor quality of the product [11].

thumbnailFigure 1. Percentage of authorized users obtaining herbal cannabis from Health Canada (data to Sept 2006)10.

This study should ideally be repeated with larger numbers to validate differences between products. The reliability of the subjects' reports may also be validated by repeating the test with the same subjects and products to see if there is reliability between their assessments over time. Future studies of the effect of humidity could be done with subjects removing cannabis directly from an unopened original package prior to use rather than going through pharmacy dispensing. Methods of rehumidification of herbal material should be explored. Finally, this study design may also be used to detect differences between cannabis products with different cannabinoid profiles or phenotypic characteristics.
Conclusion

We have shown that medical cannabis users may discriminate between cannabis preparations based on physical characteristics such as humidity, grind size, and smoking characteristics. The supply of a standardized herbal cannabis product within a legal medical access program needs to be guided by user's feedback to ensure compliance. Further work is required on other characteristics such as the profile of cannabinoids and other constituents.
Authors' contributions

The study was designed and supervised by Dr. Mark Ware, who prepared the final report and who is responsible for the work. Study management, including coordination, data collection, data entry and statistical analysis, was provided under subcontract to Boreal Primum Inc.
Competing interests

Dr Ware has received speakers fees, honoraria and grant support from companies developing cannabinoid products (AstraZeneca, Bayer, Cannasat, GW Pharma, Solvay and Valeant).
Acknowledgements

The study authors wish to thank the patients for participating in the study and providing their valuable time and interest in the project, the study nurses and pharmacists for their enthusiastic participation. We acknowledge the support of the Office of Controlled Substances and the Office of Cannabis Medical Access, Health Canada. The study was funded through a research contract agreement between the MUHC Research Institute and Health Canada. We are grateful to Suzanne Desjardins for her critical review of the manuscript.
References

1.

Ware MA, Rueda S, Singer J, Kilby D: Cannabis use by persons living with HIV/AIDS: patterns and prevalence of use.

J Can Therapeut 2003, 3(2):3-15. Publisher Full Text | OpenURL

Return to text
2.

Ware MA, Doyle CR, Woods R, Lynch ME, Clark AJ: Cannabis use for chronic non-cancer pain: results of a prospective survey.

Pain 2003, 102(1–2):211-6. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
3.

Gross DW, Hamm J, Ashworth NL, Quigley D: Marijuana use and epilepsy: prevalence in patients of a tertiary care epilepsy center.

Neurology 2004, 62(11):2095-7. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
4.

Clark AJ, Ware MA, Yazer E, Murray TJ, Lynch ME: Patterns of cannabis use among patients with multiple sclerosi.

Neurology 2004, 62(11):2098-100. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
5.

Amtmann D, Weydt P, Johnson KL, Jensen MP, Carter GT: Survey of cannabis use in patients with amyotrophic lateral sclerosis.

Am J Hosp Palliat Care 2004, 21(2):95-104. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
6.

Health Canada. Prairie Plant Systems Inc, 2002 [http://www.hc-sc.gc.ca/dhp-mps/marihuana/supply-approvis/index_e.html] webcite

OpenURL

Accessed 16th Nov 2006

Return to text
7.

Health Canada. Marjuana Open Label Safety Initiative, 2003 [http://www.cihr-irsc.gc.ca/e/4628.html] webcite

OpenURL

Accessed 16th Nov 2006

Return to text
8.

Health Canada. Marihuana Medical Access Regulations, 2002 [http://laws.justice.gc.ca/en/C-38.8/SOR-2001-227/text.html] webcite

OpenURL

Accessed 15 July 2004

Return to text
9.

CBC. Government pot's the pits, 2003 [http://www.cbc.ca/stories/2003/09/16/canada/bad_dope030916] webcite

OpenURL

Accessed July 15th 2004

Return to text
10.

Health Canada: Stakeholder statistics [http://www.hc-sc.gc.ca/dhp-mps/marihuana/stat/index_e.html] webcite

OpenURL

Accessed Nov 10th 2006

Return to text
11.

Federal pot pooh-poohedDean Beeby (Canadian Press) in Globe and Mail; OpenURL

12 July 2004

Mark A Ware1 email, Thierry Ducruet2 email and Ann R Robinson2 email
1Departments of Anesthesia and Family Medicine, McGill University, Montreal, Quebec, Canada
2Boreal Primum Inc., 913 Cherrier, Montreal, Quebec, Canada

author email corresponding author email

Harm Reduction Journal 2006, 3:32doi:10.1186/1477-7517-3-32

The electronic version of this article is the complete one and can be found online at: http://www.harmreductionjournal.com/content/3/1/32
Received: 15 August 2006
Accepted: 13 November 2006
Published: 13 November 2006

© 2006 Ware et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background

Prohibition, crime and the environment

Drug prohibition is one of those "good ideas" which have turned on the world to give us widespread criminality and - now it seems - also environmental destruction. Prohibition is born of the desire to enforce moral standards, "thou shalt not use certain substances" in this case, through criminal laws.

The big drug runners - CIA and other secret services - are easily escaping prohibition and are using the fact that drugs are illegal to eliminate any local competition. The Columbian coca production is one such "local initiative" to be eliminated in the failing war on drugs. Spraying with toxic herbicides has led to the destruction of legitimate food crops, to cattle getting sick and dying, and to the criminalization of a traditional medicinal remedy.

Coca leaves have been used for centuries in the Andes region as a tonic and energy-giving herb. Both chewed and drunk as a tea, the leaves have helped the farmers of the altiplano to overcome fatigue and to fight illness, much like other peoples use coffee or tea. If you happen to take a trip to Peru or Bolivia, and arrive at a hotel in one of the towns on the altiplano, the first thing you are offered is ... coca tea. It does help to overcome high altitude problems and has been used this way by popular tradition.

Prohibition manufactures crime. Not only do users of a certain targetted substance find themselves all of a sudden labelled criminals, the very prohibition of use induces a black market of immense proportions with big time crime gravitating to that great business. Information about drug effects is scarse, pushers are hooking people on the "latest and greatest", users find themselves unable to afford supporting their habit and turn to real criminal behaviour - theft, robbery and break-ins.

The United Nations failed, in its recent conference to re-examine both the basic philosophy behind legally enforced prohibition and the abysmal performance of its great "war on drugs". With law-induced criminality on the rise, our governments close their eyes and ears to the issue. This petition explains the issues in a very concise way - you might want to sign it after reading.

Here is the latest on the fight in Columbia, sent in by Maria Mercedes Moreno of mamacoca.org.

The only options proposed by the blind and subservient Uribe Administration: Chemical war or bloodshed under the Drug War dictum.  

Activists against fumigation are being accused of aiding and supporting narcotics traffickers and/or the insurgency by the Colombian government in its search to put a Constitutional end to all social protest and receive increased military funding towards expanding the scope of the Drug War to include those who prone for legal and non-violent alternatives.   

Colombia could ban U.S. spraying

Farmers, activists say anti-drug effort harmful to citizens, legal crops

09:17 PM CDT on Wednesday, August 13, 2003

By TOD ROBBERSON / The Dallas Morning News

BUESACO, Colombia - With the fate of Washington's flagship anti-drug program hanging in the balance, a Colombian court is days away from deciding whether to ban the spraying of a U.S.-manufactured herbicide used to eradicate illicit drug crops.

The ruling by a judicial tribunal awaits only the submission of an environmental study due this month. Officials acknowledge the decision could force the United States and Colombia to halt the use of glyphosate, the only chemical herbicide approved for aerial eradication of drug crops here.

Colombia is by far the largest supplier of the heroin and cocaine consumed in the United States. A ban on glyphosate, known by its U.S. brand name Roundup, would bring a large part of Washington's $2 billion anti-drug effort to a screeching halt and reverse progress in a 5-year-old effort to end the cultivation of plants that provide the base ingredients for cocaine and heroin.

But in Buesaco and hundreds of other towns across Colombia, peasant farmers have grown increasingly vocal in protesting the herbicide's use, charging that American-piloted crop dusters have mistakenly wiped out their legal crops and that glyphosate poses serious health risks to humans and farm animals.

Their complaints coincide with efforts by constitutional and environmental activists to halt what they call the wanton destruction of the Colombian countryside with glyphosate.

The ban on glyphosate is pending before the Superior Administrative Court tribunal in Cundinamarca state, north of Bogota. In addition, the federal Constitutional Court in Bogota last April ordered the government to restrict herbicide spraying over Indian reservations, which compose about 28 percent of Colombian territory.

Farmers' lawsuit

Buesaco farmers, like others across the country, have filed their own lawsuit against the government that demands payment for losses they say they have suffered from glyphosate.

"The government claims that glyphosate doesn't harm human health or the environment. We know this is not true," said Jose Maria Moncayo, the mayor of Buesaco, in southwestern Colombia. "Our children started vomiting and developed skin rashes as soon as the spraying began. Our cattle developed respiratory infections, then started dying."

Such claims have been made in Buesaco and other towns for years, and studies commissioned by the State Department have dismissed the health problems, in almost all cases, as unrelated to the spraying. Both governments insist the herbicide is safe.

President Alvaro Uribe's administration has pledged to fight any court decision restricting glyphosate. But top officials acknowledge they are worried about the spate of cases.

They say the Cundinamarca tribunal's ruling is only the first of many expected challenges coinciding with new results showing that the eradication campaign has killed up to 25 percent of the country's known illicit drug crops.

"The traffickers are feeling this is for real and that things are going to change for the worse very, very quickly. They're going to resort to any type of means to defeat this policy and to challenge it," said Colombian Vice President Francisco Santos.

"They're going to use the legal system, they're going to use violence and they're going to use corruption," he added. "We're confronting an industry, a huge criminal industry. They don't play games. We have to take these challenges seriously."

Claudia Sampedro, a constitutional law professor who filed the Cundinamarca lawsuit, said she was motivated solely by a desire to see Colombian law applied appropriately.

Ms. Sampedro said the government has failed on two counts: Although it insists that glyphosate is safe, the required environmental-impact studies on file are from U.S. State Department and Environmental Protection Agency studies, which are not necessarily valid under Colombian law. She added that U.S. credibility should be questioned, given the high political stakes and the recent controversy over U.S. claims about Iraqi weapons of mass destruction.

Environmental concerns

Ms. Sampedro and other opponents also argue that the government is using a significantly more powerful mix of glyphosate and other chemicals whose environmental record is not demonstrably safe.

"The law requires the completion of a Colombian environmental impact study. It is the requirement whenever you undertake any kind of activity that could affect the environment, whether it is herbicide spraying or building a house or a gas station or an airport," she said. "This entire case exists because they initiated spraying with glyphosate without carrying out the required environmental studies."

Ms. Sampedro also argued that the technology for spraying glyphosate, using U.S.-piloted crop-dusting planes, is nowhere near as accurate as the U.S. and Colombian governments say..

"They would have us believe that each molecule of glyphosate is individually intelligent, so that, after it is released from the plane, it thinks, 'I am only going to fall on a coca plant,' " ignoring all plots of legally cultivated farmland nearby, she said. "Oh, please. Are they trying to suggest that this chemical only kills illicit plants, and that not a single yucca or corn or plantain plant is harmed? They treat us as if we were stupid."

Although the Cundinamarca court ordered the suspension of spraying, the ruling must await an appeals process and review of an environmental study now being completed.

Determined to spray

Mr. Santos said the government would abide by the final decision, although it would search for any possible legal means to continue spraying ö including introducing a constitutional amendment allowing the government to eradicate with herbicides anywhere illicit drug crops are growing.

He said anyone who thinks he can avoid eradication by intermingling illicit crops with legal crops is sorely mistaken.

"Tough luck. He is using his land to poison Colombia, to destroy the land and to poison American, Colombian, Brazilian and European kids," the vice president said.

He said Ms. Sampedro and others may well force the suspension of spraying. The result, he warned, will be a sudden surge in bloodshed as Colombian troops fight back the insurgents protecting the drug trade.

"Oh, fine. We'll have a great environment but with dead bodies all over," Mr. Santos said. "We'll have a great environment but nobody left to live in it."

Claims of inaccuracy

Many peasant farmers in Buesaco, a mountain community surrounded by peaks where opium poppy flourishes, said they support ending the drug trade but complained that the spraying has at times been wildly inaccurate.

"I live in a low, dry area where opium cannot grow. The closest illicit crops are eight kilometers [4.8 miles] away," said Segundo Ballardo Benavides, from the nearby village of Las Minas. When crop_dusting planes swooped down over his farm last November, he said, the herbicide killed everything: corn stalks, beans, coffee trees.

Other farmers showed a videotape of spraying near Buesaco in April in which a plane swoops low over a hillside and releases herbicide. A strong gust of wind hits the herbicide upon release, dispersing it widely and carrying it far from its intended drop point.

Teodoro Campo, the chief of the National Police, said glyphosate has been in use for 20 years in Colombia.

The computer and satellite technology provided by the United States to guide the crop-dusting planes is said to ensure a very high rate of accuracy. "Yes, it's very possible that, with wind, the [accuracy] of the spraying could be affected," he said. "But if the drug traffickers think they can thwart us by putting, say, a coffee plantation here and here, and put a coca plantation in between so that we won't spray it, they are wrong. We will spray, and yes, that coffee will suffer."

E-mail: trobberson@dallasnews.com

Online at: Dallas News

Harm reduction-the cannabis paradox

Harm reduction-the cannabis paradox

This article examines harm reduction from a novel perspective. Its central thesis is that harm reduction is not only a social concept, but also a biological one. More specifically, evolution does not make moral distinctions in the selection process, but utilizes a cannabis-based approach to harm reduction in order to promote survival of the fittest. Evidence will be provided from peer-reviewed scientific literature that supports the hypothesis that humans, and all animals, make and use internally produced cannabis-like products (endocannabinoids) as part of the evolutionary harm reduction program. More specifically, endocannabinoids homeostatically regulate all body systems (cardiovascular, digestive, endocrine, excretory, immune, nervous, musculo-skeletal, reproductive). Therefore, the health of each individual is dependant on this system working appropriately.
Introduction

The concept of harm reduction is at the heart of conflicting international drug policies. The Dutch pioneered this approach. Today most European countries and Canada have embraced the idea that society benefits most when drug policy is designed to help people with drug problems to live better lives rather than to punish them. In contrast, the United States federal policy demands rigid zero tolerance with overwhelming emphasis on incarceration of offenders (the Drug War). Although, seemingly reasonable arguments can be made to support both sides of the dispute, the recent global trend towards harm reduction has resulted from the acknowledgement that drug use has been a part of all societies throughout history and the realization that repressive policies are expensive, ineffective, and often harmful.

A dramatic example of the benefits that can result from a harm reduction approach to drugs is seen with needle exchange programs. While prohibitionists argue that providing clean injection equipment promotes drug use, the facts do not support this contention. For example, the Australian needle exchange program is credited with keeping the HIV/AIDS infection rate very much lower than what is typically found globally http://www.chr.asn.au/about/harmreduction webcite. Commonly cited examples of the failed repressive policies championed by the United States are the now repealed alcohol prohibition and the current drug war. Crime, financial support for terrorism, disrespect for the law, and destruction of families, communities, and ecosystems can all be attributed to drug prohibition. Yet, the staggering cost of the drug war, driven by United States policy and taxpayers' money, amounts to many billions of dollars a year.

Cannabis is the third most commonly used drug in the world, following tobacco and alcohol. In the United States, much of the drug war is focused on marijuana (over 700,000 people arrested last year alone). Is there justification for this policy? The gateway theory states marijuana use leads to the use of other drugs, and drives the U.S. policy despite evidence that suggests alcohol and tobacco use may foster the gateway effect [1,2]. In contrast, countries that support harm reduction focus their enforcement and social support efforts on "hard drugs." Consequently, many countries have effectively decriminalized marijuana. Holland, having the most liberalized drug laws, does not have more cannabis users (over age twelve) than do more repressive countries, and the per capita number of heroin users is also lower http://www.drugpolicy.org/global/drugpolicyby/westerneurop/thenetherlan/ webcite. The Dutch Ministry of Justice estimates that 0.16% of cannabis users are heroin users. This figure does not support cannabis being a gateway drug. Data from the 2000 National Household Survey on Drug Abuse (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration) also shows that the vast majority of people who try cannabis do not go on to use hard drugs.

A little explored question is what does harm reduction specifically mean with respect to cannabis consumption? This article will address cannabis harm reduction from a biological perspective. Two directions will be examined: what are the biological effects of cannabis use and what are the social effects that emerge from the biological foundation.

Like many substances that are put into the human body, there can be positive or negative consequences that result from cannabis consumption, depending on amount, frequency, quality, and probably most importantly, the idiosyncratic biochemistry of the user. Prohibitionists concentrate their efforts on the negative effects of cannabis use, while anti-prohibitionists tend to focus on the positive effects. If we assume that both sides have valid arguments, the issue to be resolved is one of balance between the negative and positive effects. Would a policy of tolerance, or prohibition, be more likely to reduce harm overall? Which policy would better serve society as a whole, as well as problematic drug users?

Biological science can be more objectively evaluated than social science. The central theme that will be presented in this article is that appropriate cannabis use reduces biological harm caused by biochemical imbalances, particularly those that increase in frequency with age. Proper cannabis use, as distinguished from misuse, may have significant positive health effects associated with the way cannabis mimics natural cannabinoids. In essence, it is proposed that the endocannabinoid system, selected by 600 million years of evolution, is a central mediator of biological harm reduction through its homeostatic activities. The social implications of cannabis use will be viewed as emerging from the biological platform. Herein lies the paradox of cannabis and harm reduction. Is appropriate use of cannabis better than no use?
The Controversy

Cannabis use can be divided into three categories, recreational, medical, and religious. The latter will not be examined in this article. Some, including those who favor or oppose cannabis use, presume recreational and medical use are the same. On the one side, it is often claimed that any cannabis use is justified by some underlying medical need. On the other side, cannabis use is presumed to have no medical value, with the implication that those who use it are simply "getting stoned." While the former claim may be too extreme, the latter defies current scientific understanding of the biological functions of the endocannabinoids. While many people are reluctant to approve recreational cannabis use, it appears that most people support medical use. The United States Federal Government denies that there is any valid medical use for cannabis, while the National Institute of Drug Abuse (NIDA) provides marijuana on a monthly basis to a few medical users through the compassionate Investigatory New Drug (IND) program of the Food and Drug Administration (FDA). Nevertheless, a number of states, through either legislative action or voter initiative, have approved the use of medical marijuana[3].
Current Federally Approved Medical Marijuana Uses

In order to better assess arguments for and against the medical use of marijuana, the scientific evidence for the health benefits of cannabis will be reviewed below. It should be noted that the federally supplied cannabis users have been receiving and using cannabis for 11 to 27 years with clinically demonstrated effectiveness in the treatment of glaucoma, chronic musculoskeletal pain, spasm and nausea, and spasticity of multiple sclerosis [4]. Furthermore, there is no evidence that these patients have suffered any negative side effects from their cannabis use.
The Endocannabinoid System

Cannabis preparations have been used medically for thousands of years for illnesses such as epilepsy, migraine headaches, childbirth, and menstrual symptoms. However, it is only relatively recently that the active components have been identified and their mechanisms of action have begun to be understood. While delta-9-tetrahydrocannabinol (THC) was first synthesized by Mechoulam in 1967 [5], it was not until 1990 that the cannabinoid receptor was localized in the brain [6] and cloned [7]. Since then, discoveries in the field have proceeded at an ever-increasing pace. The discovery of cannabinoid receptors on cells naturally prompted the search for internal compounds (endogenous ligands) that would activate the receptors since it seemed unlikely that cannabis receptors had evolved so people could partake of cannabis. In 1992, anandamide was discovered [8]. This lipid metabolite was the first ligand of an ever-expanding class of molecules known as endocannabinoids (internal marijuana-like compounds) to be discovered. Endocannabinoid synthesis, degradation, transport, and receptors together form the endocannabinoid system.

The broad therapeutic potential that can result from correctly manipulating the endocannabinoid system is just beginning to be realized[9,10]. In fact, major pharmaceutical companies, and university researchers all around the world are now engaged in the cannabinoid-related research [11]. Their efforts focus on learning how the endocannabinoid system functions, and on how to manipulate it in order to increase or decrease its activity, depending on the illness or condition under consideration. GW Pharmaceuticals in Britain has been developing and testing a plant extract-based product line that is in clinical trials in Britain and Canada [12]. The results thus far have been positive to the extent that Bayer AG has entered into a 25-million-dollar distribution agreement for GW's product, Sativex which has recently been approved in Canada. In contrast, Sanofi Research has developed an antagonist that will inhibit the ability of endocannabinoids to stimulate hunger and thus potentially be useful for weight control.
Evolution of Endocannabinoids

The cannabinoid system appears to be quite ancient [13,14], with some of its components dating back about 600 million years to when the first multicellular organisms appeared. The beginnings of the modern cannabinoid system are found in mollusks [15] and hydra [16]. As evolution proceeded, the role that the cannabinoid system played in animal life continuously increased. It is now known that this system maintains homeostasis within and across the organizational scales of all animals. Within a cell, cannabinoids control basic metabolic processes such as glucose metabolism [17]. Cannabinoids regulate intercellular communication, especially in the immune [18] and nervous systems [19]. In general, cannabinoids modulate and coordinate tissues, organ and body systems (including the cardiovascular [20], digestive [16], endocrine [21], excretory [22,23], immune [18], musculo-skeletal [24], nervous [19], reproductive [25], and respiratory [26] systems). The effects of cannabinoids on consciousness are not well understood, but are well known, and underlie recreational cannabis use. These effects also have therapeutic possibilities [27].
Cannabinoids: Homeostatic Regulators

The homeostatic action of cannabinoids on so many physiological structures and processes is the basis for the hypothesis that the endocannabinoid system is nothing less than a naturally evolved harm reduction system. Endocannabinoids protect by fine-tuning and regulating dynamic biochemical steady states within the ranges required for healthy biological function. The endocannabinoid system itself appears to be up- or down-regulated as a function of need. As will be detailed later in this article, endocannabinoid levels naturally increase in the case of head injury and stroke [28], and the number of cannabinoid receptors increases in response to nerve injury and the associated pain [29]. In contrast, the number of cannabinoid receptors is reduced when tolerance to cannabinoids is induced [30].
Physical Characteristics of Living Systems

To illustrate the multidimensional biochemical balancing act performed by cannabinoids, a variety of endo- and exocannabinoid activities will be reviewed below. In order to appreciate these activities a brief introduction to cell biology may provide the context for this review. All life is dependant upon the maintenance of its dynamic organization through sufficient input of nutrients and removal of wastes. The more complicated an organism is, the more complex the coordination required to accomplish the essential tasks necessary to maintain this vital flow of inputs and outputs. Coordination requires communication. Cells communicate by thousands of different, but specific, receptors on cell surfaces that respond to thousands of different, but also specific, molecules (ligands) that bind to the receptors. A receptor that is bound to its activating ligand causes biochemical changes to occur in the cell. In response to such regulatory signals on the membrane, biochemical regulation within the cell occurs at the level of gene expression as well as at the level of enzyme action and other processes outside the nucleus. Ultimately these changes, through complex biochemical pathways, allow cells to divide, carry out specialized tasks, lie dormant, or die. Any of these cellular activities, when not properly coordinated, can result in illness. Two major categories of disease states are those that result from acute illness commonly caused by infections and those that are age-related. Historically, in the United States, the cause of death has transitioned from being pathogen-induced to age-related. Current scientific literature regarding cannabis indicates that its use is often bad for the former but good for the latter (see Immunology section below).
Cannabinoids and Brain Disorders

Since cannabis' action on the brain is most widely known due to its recreational use, the nervous system will serve as the starting point for examining cannabinoid activity as an example of a natural biological harm reduction system. Numerous disease states associated with the nervous system will be seen as potential targets for cannabinoid-based therapy [31]. The nervous system is composed of nerve and supporting cells. In addition to the role cannabinoids play in a healthy nervous system [32], the regulatory effects of cannabinoids in cases of stroke [28], Parkinson's disease [33], Huntington's disease [34], amyotrophic lateral sclerosis (ALS) [35], Alzheimer's disease [36], glioma (a type of brain tumor), [37] multiple sclerosis [38], seizures[39], and pain [40,41] will be examined.
Cannabinoids and the Healthy Brain

In a healthy individual, cannabinoids play a direct role in neurotransmission of many nerve cell types. They exhibit the unusual property of retrograde transmission, in which the cannabinoid neurotransmitter diffuses backwards across the neural cleft to inhibit the presynaptic action potential [42]. This function essentially regulates the sensitivity of a nerve cell by acting as a feedback mechanism that prevents excessive activity. Some nerve cells die when they are excessively stimulated by excitatory neurotransmitters (excitotoxins) such as glutamate. Cannabinoids can reduce the level of stimulation and protect against this form of cell death [43,44]. In addition to their down-regulatory effect on neurotransmission, cannabinoids play other roles in reducing this type of cell death (biological harm reduction) by regulating the role of interleukin-1 (IL-1, an inflammatory cytokine) and the IL-1 receptor antagonist (IL-1ra) [45]. For example, cannabinoids were shown to modulate the release of IL-1ra thereby protecting against IL-1 assisted cell death [46].

The role of cannabinoids in neurological health and disease goes beyond the prevention of cell death and regulates neuronal differentiation. Cannabinoid receptors are functionally coupled to the fibroblast growth factor receptor (FGF). The FGF receptor, when stimulated, activates lipid catabolism via diacylglerol (DAG) lipase which causes the hydrolysis of DAG to produce 2-arachidonyl glycerol (2AG) [47]. 2AG is an endocannabinoid shown to be important for axon growth and guidance[48]. This function is critical for nerves to innervate their target effectors. The ability to control these fundamental neurological activities, in conjunction with the anti-inflammatory properties of cannabinoids, is likely to have important regenerative health benefits for people suffering from neurological damage as occurs with stroke or injury [28].
Multiple Sclerosis

Both animal and human studies provide strong evidence of the therapeutic potential of cannabinoids to provide relief from a number of neurological disease states [49]. The use of cannabinoids to treat people suffering from multiple sclerosis (MS) is an excellent example of the importance of "medical marijuana" as an agent of harm reduction[50] MS is a neurodegenerative disease in which the immune system attacks components of the nervous system. The axons of many central nervous system (CNS) neurons are surrounded by a myelin sheath that acts much like an insulator around a wire. MS is associated with the degradation of the myelin sheath that leads to loss of axon function and cell death, thus producing the disease symptoms.

Cannabis-based therapies for the treatment of MS can provide symptomatic and true therapeutic relief. On the one hand, cannabinoids help to reduce spasticity in an animal model of MS (chronic relapsing experimental autoimmune encephalomyelitis (CREAE) [51]. However, the involvement of the cannabinoid system in the etiology of MS goes much deeper. MS is in reality an autoimmune disease. In order to appreciate why cannabinoids can have in important role, beyond what has already been mentioned, in treating MS on a mechanistic level [52], a brief introduction to immunology is required.
Cannabinoids and the Immune System

The role of the immune system is simplistically thought of as protecting us from foreign attack. More inclusively, however, the immune system has the biological function of modulating the life, death, and differentiation of cells in order to protect us. The immune system accomplishes these tasks, in part, by balancing two mutually opposed pathways known, respectively, as the "Th1" and "Th2" response. The Th1 immune response is critical for fighting infections caused by specific infectious agents [53]. This function is inhibited by cannabinoids. Thus cannabinoids are important homeostatic modulators of the immune system. While often classified as immune inhibitors, cannabinoids actually promote the Th2 response while they inhibit the Th1 response. Therefore cannabinoids are immune system modulators. A specific cannabinoid receptor (Cb2) [54] is found on most cells of the immune system.
Th1 Immune Response

The Th1 pathway is proinflammatory and functions by inducing the defensive production of free radicals that are vital for fending off pathogens, especially intracellular pathogens, such as those that cause Legionnaire's disease, Leishmania, and tuberculosis. Accordingly, the use of cannabis should be avoided when the Th1 arm of the immune system is needed to fight a particular disease. Although contagion as well as immune suppression may have been involved, a recent study supports this perspective, in that a cluster of new tuberculosis cases was traced to a shared water pipe [55]. Free radical production, inflammation and cell-mediated immunity are characteristic of the Th1 response. The targeting of infectious organisms, or infected cells, by a Th1 immune response results in healthy surrounding cells being exposed to free radicals. Much as if radiation had been applied, there is collateral damage that occurs with a targeted Th1 immune response.
Cannabinoids and Th1 Mediated Auto-Immune Diseases

In contrast to the Th1 immune response, the Th2 immune response promotes the humoral arm of the immune system. It turns down the Th1 response, is characterized by antibody production, and is typically anti-inflammatory. Ideally, the Th1 and Th2 pathways are functionally balanced to optimally meet the survival needs of an organism in its environment. In reality however, many autoimmune diseases, and other age related diseases, are characterized by an excessive Th1-driven immune response at the site of the of the tissue damage involved. Multiple sclerosis, arthritis, Crohn's disease, and diabetes are all diseases that fall into this category.

The therapeutic impact of cannabinoids on these diseases can be dramatic. For example, when rodents were given experimental autoimmune encephalomyelitis (EAE) as an MS animal model and were treated with cannabinoids, the results were profound [56]. In a study that involved both guinea pigs and rats, 98% of the EAE animals that were not treated with THC died. In contrast, greater than 95% of THC-treated animals survived. They had only mild symptoms with a delayed onset or no symptoms at all. The capacity of cannabinoids to down-regulate a spectrum of auto-immune diseases should serve as a warning against the long term use of CB1 inhibitors for weight control. Such drugs are currently in the regulatory pipeline [57] and one of the participants in the clinical trial unexpectedly developed multiple sclerosis [58].
Cannabinoid Actions-Biphasic Responses

The brief interludes into cell biology, neurology, and immunology provide a biological platform for considering how cannabinoids might impact a variety of other disease states. It is important to keep in mind that in its role as a general homeostatic modulator, too much or too little cannabinoid activity can be harmful. Cannabinoid levels or concentration ranges vary as a function of an organism's genetics, the cell types under consideration, and their health and environment. Care must be taken when evaluating the scientific literature on cannabinoids and their effects. Cannabinoids often exhibit biphasic responses [59]. Low doses of cannabinoids may stimulate the Th2 immunological response, whereas high doses may inhibit the Th2 response and shift the balance in favor of a Th1 response. From a harm reduction perspective, these observations demonstrate the critical importance of dose-dependent, disease-dependent, state-dependent, and individually tailored approaches to cannabis therapeutics [60].

The use of cannabinoids in the treatment of Parkinson's disease is an example of a condition where excessive or deficient cannabinoid activity may prove problematic. Parkinson's disease results from the loss of levo-dopamine (L-dopa) producing neurons. In an animal model of Parkinson's disease, L-dopa producing cells are killed with 6-hydroxydopamine. Rats so treated exhibit spontaneous glutamatergic activity that can be suppressed by exo- as well as endocannabinoids [61]. The standard treatment for Parkinson's disease involves L-dopa replacement therapy. Unfortunately, this treatment often results in dyskinesia (abnormal voluntary movements). Recent clinical trials have shown that cannabinoid treatment reduces the reuptake of gamma-aminobutyric acid (GABA) and relieves the L-dopa-induced dyskinesia [33], as well as L-dopa induced rotations in 6-hydroxydopamine-lesioned rats [62]. In contrast to the potential benefits of cannabinoid agonists just cited, using a different animal model, the cannabis antagonist SR141716A reduced reserpine-induced suppression of locomotion [63]. Thus, in this model locomotion was restored by inhibiting the endocannabinoid pathway.
Cannabinoids and Cancer

Possibly the greatest harm-reducing potential afforded by cannabinoids comes from their use by cancer patients. Cannabinoids possess numerous pharmacological properties that are often beneficial to cancer patients. Many people are aware of the anti-emetic and appetite stimulating effects of cannabinoids [64]. A systemic study designed to quantify the efficacy of cannabinoids as an anti-emetic agent examined data from 30 randomized controlled studies that were published between 1975 and 1997 and included 1366 patients who were administered non-smoked cannabis [65]. For patients requiring a medium level of control, cannabinoids were the preferred treatment (between 38% and 90%). This preference was lost for patients requiring a low or a high level of control. Sedation and euphoria were noted as beneficial side effects, whereas dizziness, dysphoria, hallucinations, and arterial hypotension were identified as harmful side effects.

The cancer cell killing [66] and pain relieving properties of cannabinoids are less well known to the general public. Cannabinoids may prove to be useful chemotherapeutic agents [67]. Numerous cancer types are killed in cell cultures and in animals by cannabinoids. For example, cannabinoids kill the cancer cells of various lymphoblastic malignancies such as leukemia and lymphoma [68], skin cancer [69], glioma [70], breast and prostate cancer [71], pheochromocytoma [72], thyroid cancer [73], and colorectal cancer[74]. Since 2002 THC has been used in a clinical trial in Spain for the treatment of glioma [75]. However, not all cancers are the same, and cannabinoid-induced biochemical modifications, while effective in killing the cells of some cancers, as indicated above, can have the opposite effect on the cells of other types of cancer. For example, recent work has shown that the synthetic cannabinoid, methanandamide, can promote the growth of lung cancer cells by a receptor independent pathway that involves the up-regulation of COX2 [76]. Although much has been learned about the therapeutic value of cannabinoid agonists and antagonists in different situations, scientific understanding of how to appropriately modulate the endocannabinoid pathways remains preliminary, with much remaining to be learned.
Cannabinoids and Pain

One area of current research that has begun attracting public interest is the pain relieving potential of cannabinoids, for both cancer [77] and non-cancer patients [78]. Medicine based on cannabis extract has demonstrated positive effects for pain relief [79]. Recently, an intrinsic role for cannabinoids in pain circuitry was discovered: the endocannabinoid AEA was identified as the natural ligand for the vanilloid receptors [80]. Vanilloid receptors, which are ligand-gated cation channels, are primary targets for the treatment of pain [81]. The cannabinoids seem to function in a pathway parallel to the opioid pathway [82] and are thought to exert anti-nociceptic activity at the level of the spinal cord and the brain [83], although they can also act peripherally by inhibiting mast cell degranulation [84]. In recognition of the pain relieving properties of cannabinoids, England [11] and Canada [41] are using cannabis preparations to provide relief to citizens suffering from a variety of disorders. Human trials have established that co-administration of cannabinoids can dramatically lower opioid use and can provide pain relief for neurogenic symptoms where other treatments have failed [85]. Recently, the topical application of the synthetic cannabinoid WIN 55,212-2 significantly enhanced the antinociceptive activity of morphine, opening the door for possible cannabis-induced pain relief with reduced cognitive side effects [86]. The intrinsic role of endocannabinoids in modulating pain is further supported by the up-regulation of the CB1 receptor in rats following nerve damage [29]. Once again, nature has selected cannabinoids to reduce harm.
Smoking and Lung Cancer

Fundamental to any consideration of cannabis-based harm reduction, as a biological phenomenon or as a policy, is how to best administer the drug. Smoking cannabis preparations, in contrast to oral administration [87], has the benefit of rapid action that allows self-titration of the drug's activity [88,89]. Unfortunately, cannabis smoke contains numerous carcinogenic compounds [90]. In fact, cannabis smoke may contain more tars than tobacco smoke [91]. However, despite the fact that cannabis smoke does produce cellular changes that are viewed as precancerous, a major epidemiological study does not find that cannabis smoking is associated with tobacco related cancers [92]. A number of recent studies provide a scientific foundation for the clear relationship between tobacco smoking and lung cancer, a relationship that does not hold true for cannabis smoke (manuscript submitted to HRJ). For example nicotine, acting via nicotine receptors, is critical in the development of tobacco related cancer by inhibiting the death of genetically damaged cells [93]. Tobacco also promotes the development of blood vessels needed to support tumor growth [94] whereas cannabis inhibits tumor vascularization in nonmelanoma skin cancer [69] and glioma [95]. Although conclusions derived from an oft-cited study examining the carcinogenic effects of cannabis, tobacco, and cannabis combined with tobacco claims to show a link between cannabis smoking and head and neck cancer [96]. But these results do not hold up under scrutiny. The study does support a link between tobacco use that is exacerbated by concurrent cannabis use and the development of head and neck cancer. However, the "cannabis use only" group was composed only of two subjects, undermining the statistical relevance of conclusions regarding this group.
Smoking Alternatives

Regardless of whether or not smoking cannabis can cause lung cancer, smoking anything containing partially oxidized hydrocarbons, carcinogens, and irritants a priori, is not healthy and will have negative health consequences. Fortunately, harm-reducing alternatives exist. While often touted as a problem, the availability of high THC cannabis with high levels of THC permits less cannabis to be smoked for therapeutic effects. Additionally, methods of vaporizing the active ingredients of cannabis have been shown to successfully remove most compounds of concern while efficiently delivering the desired ones [97]. These results contrast with a recent Australian study that found that the use of a water pipe, or bong, failed to reduce tars or carbon monoxide delivered to the smoker [98]. GW Pharmaceuticals is developing an oral spray that should prove to be an additional safe and effective alternative delivery system [12] and valuable to medical cannabis users. The company has also identified strains with defined ratios of various cannabinoids for which specific medicinal value will be determined.
Cannabinoids Affect Drug Metabolism

Another important cannabis and harm reduction topic that must be considered is that of how the use of cannabis impacts on the pharmacokinetics of other drugs [99]. A number of drugs are metabolized by the P450 family of isoenzymes, including numerous cannabinoids [100]. Even though cannabinoids stimulate the transcription of P450 (2A and 3C), they also directly inhibit the activity of this enzyme [101]. There are likely to be pros and cons associated with P450 inhibition. P450 activity activates procarcinogens in tobacco smoke to create active cancer-causing mutations [102]. Thus, the inhibition of these enzymes by cannabinoids may minimize some of the negative consequences of smoke inhalation. On the other hand, many pharmaceutical drugs are metabolized by these enzymes. The reduction of the rate of drug metabolism by cannabinoids with pharmokinetic consequences has been shown for cocaine [103], barbiturates [104], opiates [105], alcohol, the antipsychotic haloperidol [106], and others [107].

Thus far, both endo- and exocannabinoids are seen to reduce harm in numerous circumstances. Cannabinoid-based therapies have been especially helpful for the treatment of a variety of neurological and immunological disorders. Yet, we have only scratched the surface of the scientific literature on cannabinoids and their biological effects. Nevertheless, it should be apparent that cannabinoids have enormous medical potential as we learn to manipulate the natural cannabinoid harm reduction system that has evolved in the animal kingdom.

A fundamental question that remains unanswered is how basic, complex biochemical phenomena, as touched on briefly in this article, collectively emerge as substantial contributors to health and behavior. In far-from-equilibrium thermodynamic systems, such as living organisms, there are discontinuities between underlying molecular dynamics and associated emergent macroscopic phenomena [108]. In such systems, small changes (called "perturbations") can amplify with consequences for the organization of the whole system. The cannabinoids help to regulate an amazingly broad range of biochemical events. All of these effects have genetic foundations. As such, natural genetic/biochemical variation in a population can be expected to have significant effects on health and behavior. It should be expected that in a population distribution of cannabinoid levels and sensitivities, as a function of an individual's health/disease status, some individuals would naturally need to increase their cannabinoid activity while others would need theirs lowered. Although the focus of this paper has been to suggest the many circumstances in which higher cannabinoid activity would be beneficial, these circumstances will necessarily differ among individuals with different congenital cannabinoid levels and sensitivities. Therefore, reduced cannabinoid activity would be beneficial under some conditions. A prime example of potential harmful effects of excess cannabinoids is their effects on pregnancy where low levels are needed but high levels are harmful [109].
Behavioral Effects: Self-administration and Reward

The broad homeostatic activities of cannabinoids that have been developed in this article have been rooted in hard science. The extension of these ideas to the psychological and behavioral levels is intrinsically more speculative, but remains consistent with the literature. For years, researchers have looked into the possible addictive qualities of cannabis. The lack of significant reward behavior was indicated by the lack of self-administration in primates. Experiments examining preference in rats demonstrated that low doses of THC could induce place preference but that higher doses produced drug aversion [110], again demonstrating the homeostatic nature of cannabinoids. Self-administration is typical of most psychoactive drugs of abuse. Hence, one could conclude that marijuana has a low potential for abuse.

Some may question the conclusion that cannabis has a low abuse potential since an animal model using squirrel monkeys was recently developed in which self-administration behavior was maintained using THC [111]. Interestingly, and consistent with the notion that the cannabinoid system is a biological homeostatic harm reduction mechanism, the self-administration of THC ranges from 2 to 8 ug/kg and peaks at 4 ug/kg [112]. Thus, in this animal model a controlled dose is chosen. To further put these experiments in perspective, the dose used must be examined more closely. A 1-gram joint of 10% THC content would contain 100 mg of THC. The self-administered dose schedule chosen by the animal of 4 ug/kg would correspond to 360 ug of THC (if absorption was complete, approximately 1/278 of the joint) for a 200-pound human. Similarly, in rats, the intravenous self-administration of the synthetic cannabinoid Win 55,212-2 also occurred in a biphasic manner, with a maximum response occurring at 12 ug/kg[113] The self-regulated, controlled use of low drug doses is not characteristic of addictive drugs of abuse.

Additional cannabinoid involvement in reward behavior is suggested by the increased activity of dopaminergic neurons stimulated with psychoactive cannabinoids [114]. This pathway is shared by other major drugs of abuse including, morphine, ethanol, and nicotine [115]. However, the production of glucocorticoid hormones that are normally produced in response to stress [116], are suppressed by cannabinoids [117]. Are cannabinoids addictive, is pleasure addictive, or is a low stress state addictive?
Cannabinoids and Stress

Stress and reward are complicated components of addictive behavior. How does repeated use of THC influence these states? A recent study examines this question by measuring glucose utilization in different areas of the rat brain following repeated treatment with THC [118]. After 7 and 21 days of THC treatment, THC no longer resulted in reduced glucose utilization in many areas of the brain typically affected by a single THC dose (most cortical, thalamic, and basal ganglia regions). In contrast, glucose utilization in other areas of the brain remained unaltered (nucleus accumbens, mediodorsal thalamus, basolateral amygdala, portions of the hippocampus and median raphe). Thus while the effects of THC on body temperature and locomotor activity become resistant to repeated THC administration, those areas involved in many higher brain functions remain responsive to THC. This differential adaptation to THC administration is consistent with a low addictive potential. The best evidence that demonstrates the absence of an addictive response to cannabis use is the fact that most people who use it do not continue to use it, and stop using it without any effort.

The stress-relieving properties of cannabinoids are an important aspect of their pharmacological activity. An interesting mechanism by which cannabinoids may promote stress relief is through their effects on memory. Cannabinoids control the extinction of painful memories [119]. What a blessing for those suffering from debilitating or life threatening illnesses: cannabinoids may help them to forget their misfortune.

Independent of the direct addictive or non-addictive properties of cannabis, the cannabis-opioid connection will be examined in more detail. Both drug families function (not necessarily exclusively) through biochemical pathways that are regulated by specific receptor-ligand interactions. However, there appears to be, as yet not fully defined, crosstalk between these pathways [120]. For example, CB1 receptor knockout mice are non-responsive to CB1 cannabinoid activities and show reduced addictive effects of opiates [121]. Similarly, Lewis rats showed enhanced sensitivity to morphine self-administration after treatment with the synthetic cannabinoid CP55040 [122]. Examining the cannabis-opioid connection from the other direction, chronic morphine administration results in some down-regulation of cannabinoid receptors along with a significant reduction in 2AG [123]. These results show both positive and negative feedback relationships between the endocannabinoid and opiate systems. They also suggest that cannabinoids might serve to reduce the symptoms of opiate withdrawal [124].

The possibility that cannabinoids could serve as an addiction interrupter was demonstrated in rats where the synthetic cannabinoid agonist Win 55-212,2 reduced intravenous self-administration of cocaine [125]. Similarly, recent studies indicate that THC may facilitate nicotine withdrawal in mice [126] and inhibit alcohol preference in a model of alcoholism [127]. The opposite indications, that blocking cannabinoids receptors could serve as an addition interrupter has also been made [128].
Behavioral Complexity

Behavioral processes and their complexities set humans apart from other animals. Can we simply extrapolate from animal to human behavior? It is one thing to comparatively examine the molecular and cell biology of animals and extrapolate to humans. However, the behavioral repertoire of humans appears to be dramatically enhanced over other animals and is therefore more difficult to connect between the species. Evolutionary relationships show that the cannabinoid receptors are located in the more advanced areas of our brains. Again, any population is always a spread around the average value of any parameter. A subset of the human population will inevitably retain a more primitive behavioral repertoire. Is this subset more susceptible to addictive behavior or psychological problems that could result from cannabis consumption? Has the cannabinoid system been optimized for the regulation of more primitive behavior or, alternatively, is it better optimized for the behavioral flexibility required of modern humans? Indeed, is there any evidence that the cannabinoid system, like our cortical capacity, may enable even greater behavioral flexibility in the more complex societies and altered environments of the future?

Answers to these questions are suggested by the data of human cannabis consumption. Most people who use cannabis in their youth stop using it as their lives progress. Most do so as a natural part of their development. They do so without outside intervention or help. They do so without ever having become heroin users, schizophrenic, or motivationally compromised. These facts indicate that for the majority of people who try marijuana, it is not addictive, does not lead to heroin use, nor is it a trigger for the onset of psychological problems. However, due to the complexity of cannabinoid activities, it is likely that in a small percentage of the population, cannabis use may foster problems. The biology presented in this paper suggests that such individual differences should be expected. We must learn to identify individuals who would be negatively affected by cannabis use; they are the people that an intelligent drug policy would help to identify and assist. In contrast, our policy criminalizes the majority of users and further harms them, perhaps psychologically as well as medically, through its repercussions.

The use of cannabis – and any mind-altering drug – by young developing minds rightfully remains an area of focus and concern. For example, is there a relationship between cannabis use and schizophrenia? Schizophrenia is characterized by distortions of reality, disturbances of language and thought processes, and social withdrawal. Certainly, aspects of cannabis intoxication parallel these symptoms. It is feared that cannabis can precipitate this state [129], especially in susceptible individuals [130]. It has been suggested that schizophrenics (or potential schizophrenics) fall into two categories with respect to cannabis use [131]. One group may find symptomatic relief in the use of cannabis, while the other may actually take the risk of inducing the onset of the disease. The complexities of this issue are illuminated by the unpredictable behavior of interacting complex systems such as the nervous and immune systems, as will be considered below.

In an important recent study, De Marchi et al [132], examined the endocannabinoid levels in healthy volunteers and compared them to that of schizophrenic patients, both before and after successful antipsychotic treatment. Patients suffering with acute disease had significantly higher anandamide levels in their blood than did the normal individuals or patients in clinical remission. Might these elevated cannabinoid levels be contributing to the disease symptoms, and what might be causing them? Cannabinoids act homeostatically across biological subsystems. A possible immune involvement in schizophrenia has long been suspected, and immunological parameters have been implicated in the disease. For example, there is an inverse correlation between schizophrenia and rheumatoid arthritis; an individual generally does not get both illnesses [133]. Interestingly, schizophrenia has been correlated with HLA type, Toxoplasma gonodii infection, and exposure to cats [133]. Toxoplasma gonodii infects brain neurons, and is best controlled with a strong pro-inflammatory immune response. Endocannabinoids modulate the pro-inflammatory TH1 response by up-regulating the anti-inflammatory Th2 response. Hence, it is likely that some individuals idiosyncratically respond to Toxoplasma gonodii infections by producing excess endocannabinoids and suffering the associated abnormal mental state. Antipsychotic drugs have actually improved the outcome of infection with this parasite[134].
Conclusion

Evolution has selected the endocannabinoids to homeostatically regulate numerous biological phenomena that can be found in every organized system in the body, and to counteract biochemical imbalances that are characteristic of numerous damaged or diseased states, in particular those associated with aging. Starting from birth, cannabinoids are present in mother's milk [135], where they initiate the eating process. If the activity of endocannabinoids in the mouse milk is inhibited with a cannabinoid antagonist, the newborn mice die of starvation. As life proceeds, endocannabinoids continuously regulate appetite, body temperature, reproductive activity, and learning capacity. When a body is physically damaged, the endocannabinoids are called on to reduce inflammation, protect neurons [136], regulate cardiac rhythms [137] and protect the heart form oxygen deprivation [20]. In humans suffering from colorectal cancer, endocannabinoid levels are elevated in an effort to control the cancer [74]. They help relieve emotional suffering by reducing pain and facilitating movement beyond the fears of unpleasant memories [119].

While this review is far from complete, it attempts to provide a conceptual overview that supports the endocannabinoid system as being nature's method of harm reduction. There is a pattern to all the cannabinoid-mediated activities described. Many of the biochemical imbalances that cannabinoids protect against are associated with aging. Aging itself is a system-wide movement towards chemical equilibrium (away from the highly regulated far-from-equilibrium state) and as such is an imbalance from which all living organisms suffer. In contrast, the harmful consequences of cannabis use, however exaggerated they often appear to be, are likely to represent significant potential risk for a minority of the population for whom reduced cannabinoid levels might promote mental stability, fertility or more regulated food consumption.
Acknowledgements

I thank Suzanne Stradley, Jenell Forschler, and Carolyn Rogers, graduate students in Laura Fillmore's electronic publishing course: Writing and Publishing Program (Emerson College), for creating the text links used in this article (see 1).

Additional File 1. It contains hyperlinks to the text document.

Format: DOC Size: 48KB Download file

This file can be viewed with: Microsoft Word Viewer
References

1.

Lindsay GB, Rainey J: Psychosocial and pharmacologic explanations of nicotine's "gateway drug" function.

J Sch Health 1997, 67:123-126. PubMed Abstract | OpenURL

Return to text
2.

Ginzler JA, Cochran BN, Domenech-Rodriguez M, Cauce AM, Whitbeck LB: Sequential progression of substance use among homeless youth: an empirical investigation of the gateway theory.

Subst Use Misuse 2003, 38:725-758. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
3.

Herstek J, Watson A, Kammer C: Pharmaceuticals issue brief: medical marijuana: year end report-2002.

Issue Brief Health Policy Track Serv 2002, 1-12. PubMed Abstract | OpenURL

Return to text
4.

Russo E, Mathre ML, Byrne A, Velin R, Bach PJ, Sanchez-Ramos J, Kirlin KA: Chronic Cannabis Use in the Compassionate Investigational New Drug Program:An Examination of Benefits and Adverse Effects of Legal Clinical Cannabis.

Journal of Cannabis Therapeutics 2002, 3-56. Publisher Full Text | OpenURL

Return to text
5.

Mechoulam R, Gaoni Y: The absolute configuration of delta-1-tetrahydrocannabinol, the major active constituent of hashish.

Tetrahedron Lett 1967, 12:1109-1111. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
6.

Herkenham M, Lynn AB, Little MD, Johnson MR, Melvin LS, de Costa BR, Rice KC: Cannabinoid receptor localization in brain.

Proc Natl Acad Sci U S A 1990, 87:1932-1936. PubMed Abstract | PubMed Central Full Text | OpenURL

Return to text
7.

Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI: Structure of a cannabinoid receptor and functional expression of the cloned cDNA.

Nature 1990, 346:561-564. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
8.

Devane WA, Hanus L, Breuer A, Pertwee RG, Stevenson LA, Griffin G, Gibson D, Mandelbaum A, Etinger A, Mechoulam R: Isolation and structure of a brain constituent that binds to the cannabinoid receptor.

Science 1992, 258:1946-1949. PubMed Abstract | OpenURL

Return to text
9.

Di M, Bisogno T, De Petrocellis L: Endocannabinoids: new targets for drug development.

Curr Pharm Des 2000, 6:1361-1380. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
10.

Cravatt BF, Lichtman AH: Fatty acid amide hydrolase: an emerging therapeutic target in the endocannabinoid system.

Curr Opin Chem Biol 2003, 7:469-475. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
11.

Baker D, Pryce G, Giovannoni G, Thompson AJ: The therapeutic potential of cannabis.

Lancet Neurol 2003, 2:291-298. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
12.

Cannabis-Based Medicines – GW Pharmaceuticals: High CBD, High THC, Medicinal Cannabis – GW Pharmaceuticals, THC:CBD

Drugs R D 2003, 4:306-309. PubMed Abstract | OpenURL

Return to text
13.

Elphick MR, Satou Y, Satoh N: The invertebrate ancestry of endocannabinoid signalling: an orthologue of vertebrate cannabinoid receptors in the urochordate Ciona intestinalis.

Gene 2003, 302:95-101. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
14.

Elphick MR, Egertova M: The neurobiology and evolution of cannabinoid signalling.

Philos Trans R Soc Lond B Biol Sci 2001, 356:381-408. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
15.

Sepe N, De Petrocellis L, Montanaro F, Cimino G, Di Marzo V: Bioactive long chain N-acylethanolamines in five species of edible bivalve molluscs. Possible implications for mollusc physiology and sea food industry.

Biochim Biophys Acta 1998, 1389:101-111. PubMed Abstract | OpenURL

Return to text
16.

De Petrocellis L, Melck D, Bisogno T, Milone A, Di Marzo V: Finding of the endocannabinoid signalling system in Hydra, a very primitive organism: possible role in the feeding response.

Neuroscience 1999, 92:377-387. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
17.

Guzman M, Sanchez C: Effects of cannabinoids on energy metabolism.

Life Sci 1999, 65:657-664. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
18.

Yuan M, Kiertscher SM, Cheng Q, Zoumalan R, Tashkin DP, Roth MD: Delta 9-Tetrahydrocannabinol regulates Th1/Th2 cytokine balance in activated human T cells.

J Neuroimmunol 2002, 133:124-131. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
19.

Ralevic V: Cannabinoid modulation of peripheral autonomic and sensory neurotransmission.

Eur J Pharmacol 2003, 472:1-21. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
20.

Hiley CR, Ford WR: Endocannabinoids as mediators in the heart: a potential target for therapy of remodelling after myocardial infarction?

Br J Pharmacol 2003, 138:1183-1184. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
21.

Brown TT, Dobs AS: Endocrine effects of marijuana.

J Clin Pharmacol 2002, 42:90S-96S. PubMed Abstract | OpenURL

Return to text
22.

Pinto L, Izzo AA, Cascio MG, Bisogno T, Hospodar-Scott K, Brown DR, Mascolo N, Di Marzo V, Capasso F: Endocannabinoids as physiological regulators of colonic propulsion in mice.

Gastroenterology 2002, 123:227-234. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
23.

Dmitrieva N, Berkley KJ: Contrasting effects of WIN 55212-2 on motility of the rat bladder and uterus.

J Neurosci 2002, 22:7147-7153. PubMed Abstract | OpenURL

Return to text
24.

Grotenhermen F, Muller-Vahl K: IACM 2nd Conference on Cannabinoids in Medicine.

Expert Opin Pharmacother 2003, 4:2367-2371. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
25.

Habayeb OM, Bell SC, Konje JC: Endogenous cannabinoids: metabolism and their role in reproduction.

Life Sci 2002, 70:1963-1977. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
26.

Calignano A, Katona I, Desarnaud F, Giuffrida A, La Rana G, Mackie K, Freund TF, Piomelli D: Bidirectional control of airway responsiveness by endogenous cannabinoids.

Nature 2000, 408:96-101. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
27.

Rottanburg D, Robins AH, Ben-Arie O, Teggin A, Elk R: Cannabis-associated psychosis with hypomanic features.

Lancet 1982, 2:1364-1366. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
28.

Nagayama T, Sinor AD, Simon RP, Chen J, Graham SH, Jin K, Greenberg DA: Cannabinoids and neuroprotection in global and focal cerebral ischemia and in neuronal cultures.

J Neurosci 1999, 19:2987-2995. PubMed Abstract | OpenURL

Return to text
29.

Lim G, Sung B, Ji RR, Mao J: Upregulation of spinal cannabinoid-1-receptors following nerve injury enhances the effects of Win 55,212-2 on neuropathic pain behaviors in rats.

Pain 2003, 105:275-283. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
30.

Caberlotto L, Rimondini R, Hansson A, Eriksson S, Heilig M: Corticotropin-Releasing Hormone (CRH) mRNA Expression in Rat Central Amygdala in Cannabinoid Tolerance and Withdrawal: Evidence for an Allostatic Shift?

Neuropsychopharmacology 2003. OpenURL

Return to text
31.

Croxford JL: Therapeutic potential of cannabinoids in CNS disease.

CNS Drugs 2003, 17:179-202. PubMed Abstract | OpenURL

Return to text
32.

Wilson RI, Nicoll RA: Endocannabinoid signaling in the brain.

Science 2002, 296:678-682. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
33.

Sieradzan KA, Fox SH, Hill M, Dick JP, Crossman AR, Brotchie JM: Cannabinoids reduce levodopa-induced dyskinesia in Parkinson's disease: a pilot study.

Neurology 2001, 57:2108-2111. PubMed Abstract | OpenURL

Return to text
34.

Lastres-Becker I, de Miguel R, De Petrocellis L, Makriyannis A, Di Marzo V, Fernandez-Ruiz J: Compounds acting at the endocannabinoid and/or endovanilloid systems reduce hyperkinesia in a rat model of Huntington's disease.

J Neurochem 2003, 84:1097-1109. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
35.

Raman C, McAllister SD, Rizvi G, Patel SG, Moore DH, Abood ME: Amyotrophic lateral sclerosis: delayed disease progression in mice by treatment with a cannabinoid.

Amyotroph Lateral Scler Other Motor Neuron Disord 2004, 5:33-39. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
36.

Milton NG: Anandamide and noladin ether prevent neurotoxicity of the human amyloid-beta peptide.

Neurosci Lett 2002, 332:127-130. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
37.

Guzman M, Sanchez C, Galve-Roperh I: Control of the cell survival/death decision by cannabinoids.

J Mol Med 2001, 78:613-625. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
38.

Pryce G, Ahmed Z, Hankey DJ, Jackson SJ, Croxford JL, Pocock JM, Ledent C, Petzold A, Thompson AJ, Giovannoni G, Cuzner ML, Baker D: Cannabinoids inhibit neurodegeneration in models of multiple sclerosis.

Brain 2003.PubMed Abstract | OpenURL

Return to text
39.

Wallace MJ, Blair RE, Falenski KW, Martin BR, DeLorenzo RJ: The endogenous cannabinoid system regulates seizure frequency and duration in a model of temporal lobe epilepsy.

J Pharmacol Exp Ther 2003. OpenURL

Return to text
40.

Iversen L: Cannabis and the brain.

Brain 2003, 126:1252-1270. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
41.

Ware MA, Gamsa A, Persson J, Fitzcharles MA: Cannabis for chronic pain: case series and implications for clinicians.

Pain Res Manag 2002, 7:95-99. PubMed Abstract | OpenURL

Return to text
42.

Wilson RI, Nicoll RA: Endogenous cannabinoids mediate retrograde signalling at hippocampal synapses.

Nature 2001, 410:588-592. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
43.

Nadler V, Mechoulam R, Sokolovsky M: The non-psychotropic cannabinoid (+)-(3S,4S)-7-hydroxy-delta 6- tetrahydrocannabinol 1,1-dimethylheptyl (HU-211) attenuates N-methyl-D-aspartate receptor-mediated neurotoxicity in primary cultures of rat forebrain.

Neurosci Lett 1993, 162:43-45. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
44.

Hampson AJ, Grimaldi M, Axelrod J, Wink D: Cannabidiol and (-)Delta9-tetrahydrocannabinol are neuroprotective antioxidants.

Proc Natl Acad Sci U S A 1998, 95:8268-8273. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
45.

Patel HC, Boutin H, Allan SM: Interleukin-1 in the brain: mechanisms of action in acute neurodegeneration.

Ann N Y Acad Sci 2003, 992:39-47. PubMed Abstract | OpenURL

Return to text
46.

Molina-Holgado F, Pinteaux E, Moore JD, Molina-Holgado E, Guaza C, Gibson RM, Rothwell NJ: Endogenous interleukin-1 receptor antagonist mediates anti-inflammatory and neuroprotective actions of cannabinoids in neurons and glia.

J Neurosci 2003, 23:6470-6474. PubMed Abstract | OpenURL

Return to text
47.

Sugiura T, Kondo S, Sukagawa A, Nakane S, Shinoda A, Itoh K, Yamashita A, Waku K: 2-Arachidonoylglycerol: a possible endogenous cannabinoid receptor ligand in brain.

Biochem Biophys Res Commun 1995, 215:89-97. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
48.

Williams EJ, Walsh FS, Doherty P: The FGF receptor uses the endocannabinoid signaling system to couple to an axonal growth response.

J Cell Biol 2003, 160:481-486. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
49.

Glass M: The role of cannabinoids in neurodegenerative diseases.

Prog Neuropsychopharmacol Biol Psychiatry 2001, 25:743-765. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
50.

Page SA, Verhoef MJ, Stebbins RA, Metz LM, Levy JC: Cannabis use as described by people with multiple sclerosis.

Can J Neurol Sci 2003, 30:201-205. PubMed Abstract | OpenURL

Return to text
51.

Baker D, Pryce G, Croxford JL, Brown P, Pertwee RG, Huffman JW, Layward L: Cannabinoids control spasticity and tremor in a multiple sclerosis model.

Nature 2000, 404:84-87. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
52.

Baker D, Pryce G: The therapeutic potential of cannabis in multiple sclerosis.

Expert Opin Investig Drugs 2003, 12:561-567. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
53.

Klein TW, Newton CA, Nakachi N, Friedman H: Delta 9-tetrahydrocannabinol treatment suppresses immunity and early IFN-gamma, IL-12, and IL-12 receptor beta 2 responses to Legionella pneumophila infection.

J Immunol 2000, 164:6461-6466. PubMed Abstract | OpenURL

Return to text
54.

Munro S, Thomas KL, Abu-Shaar M: Molecular characterization of a peripheral receptor for cannabinoids.

Nature 1993, 365:61-65. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
55.

Munckhof WJ, Konstantinos A, Wamsley M, Mortlock M, Gilpin C: A cluster of tuberculosis associated with use of a marijuana water pipe.

Int J Tuberc Lung Dis 2003, 7:860-865. PubMed Abstract | OpenURL

Return to text
56.

Lyman WD, Sonett JR, Brosnan CF, Elkin R, Bornstein MB: Delta 9-tetrahydrocannabinol: a novel treatment for experimental autoimmune encephalomyelitis.

J Neuroimmunol 1989, 23:73-81. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
57.

Fernandez JR, Allison DB: Rimonabant Sanofi-Synthelabo.

Curr Opin Investig Drugs 2004, 5:430-435. PubMed Abstract | OpenURL

Return to text
58.

van Oosten BW, Killestein J, Mathus-Vliegen EM, Polman CH: Multiple sclerosis following treatment with a cannabinoid receptor-1 antagonist.

Mult Scler 2004, 10:330-331. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
59.

Berdyshev EV, Boichot E, Germain N, Allain N, Anger JP, Lagente V: Influence of fatty acid ethanolamides and delta9-tetrahydrocannabinol on cytokine and arachidonate release by mononuclear cells.

Eur J Pharmacol 1997, 330:231-240. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
60.

Melamede RJ: Indications for Cannabinoids: Autoimmune Diseases.

Cannabis and Cannabinoids, Pharmacology, Toxicology and Therapeutic Potential 2000. OpenURL

Return to text
61.

Gubellini P, Picconi B, Bari M, Battista N, Calabresi P, Centonze D, Bernardi G, Finazzi-Agro A, Maccarrone M: Experimental parkinsonism alters endocannabinoid degradation: implications for striatal glutamatergic transmission.

J Neurosci 2002, 22:6900-6907. PubMed Abstract | OpenURL

Return to text
62.

Gilgun-Sherki Y, Melamed E, Mechoulam R, Offen D: The CB1 Cannabinoid Receptor Agonist, HU-210, Reduces Levodopa-Induced Rotations in 6-Hydroxydopamine-Lesioned Rats.

Pharmacol Toxicol 2003, 93:66-70. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
63.

Di Marzo V, Hill MP, Bisogno T, Crossman AR, Brotchie JM: Enhanced levels of endogenous cannabinoids in the globus pallidus are associated with a reduction in movement in an animal model of Parkinson's disease.

FASEB J 2000, 14:1432-1438. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
64.

Mechoulam R, Hanu L: The cannabinoids: an overview. Therapeutic implications in vomiting and nausea after cancer chemotherapy, in appetite promotion, in multiple sclerosis and in neuroprotection.

Pain Res Manag 2001, 6:67-73. PubMed Abstract | OpenURL

Return to text
65.

Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ: Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review.

BMJ 2001, 323:16-21. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
66.

Guzman M, Sanchez C, Galve-Roperh I: Cannabinoids and cell fate.

Pharmacol Ther 2002, 95:175-184. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
67.

Parolaro D, Massi P, Rubino T, Monti E: Endocannabinoids in the immune system and cancer.

Prostaglandins Leukot Essent Fatty Acids 2002, 66:319-332. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
68.

McKallip RJ, Lombard C, Fisher M, Martin BR, Ryu S, Grant S, Nagarkatti PS, Nagarkatti M: Targeting CB2 cannabinoid receptors as a novel therapy to treat malignant lymphoblastic disease.

Blood 2002, 100:627-634. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
69.

Casanova ML, Blazquez C, Martinez-Palacio J, Villanueva C, Fernandez-Acenero MJ, Huffman JW, Jorcano JL, Guzman M: Inhibition of skin tumor growth and angiogenesis in vivo by activation of cannabinoid receptors.

J Clin Invest 2003, 111:43-50. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
70.

Sanchez C, Galve-Roperh I, Canova C, Brachet P, Guzman M: Delta9-tetrahydrocannabinol induces apoptosis in C6 glioma cells.

FEBS Lett 1998, 436:6-10. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
71.

Melck D, De Petrocellis L, Orlando P, Bisogno T, Laezza C, Bifulco M, Di Marzo V: Suppression of nerve growth factor Trk receptors and prolactin receptors by endocannabinoids leads to inhibition of human breast and prostate cancer cell proliferation.

Endocrinology 2000, 141:118-126. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
72.

Wilson RGJ, Tahir SK, Mechoulam R, Zimmerman S, Zimmerman AM: Cannabinoid enantiomer action on the cytoarchitecture.

Cell Biol Int 1996, 20:147-157. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
73.

Portella G, Laezza C, Laccetti P, De Petrocellis L, Di Marzo V, Bifulco M: Inhibitory effects of cannabinoid CB1 receptor stimulation on tumor growth and metastatic spreading: actions on signals involved in angiogenesis and metastasis.

FASEB J 2003, 17:1771-1773. PubMed Abstract | OpenURL

Return to text
74.

Ligresti A, Bisogno T, Matias I, De Petrocellis L, Cascio MG, Cosenza V, D'argenio G, Scaglione G, Bifulco M, Sorrentini I, Di Marzo V: Possible endocannabinoid control of colorectal cancer growth.

Gastroenterology 2003, 125:677-687. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
75.

Blazquez C, Gonzalez-Feria L, Alvarez L, Haro A, Casanova ML, Guzman M: Cannabinoids inhibit the vascular endothelial growth factor pathway in gliomas.

Cancer Res 2004, 64:5617-5623. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
76.

Gardner B, Zhu LX, Sharma S, Tashkin DP, Dubinett SM: Methanandamide increases COX-2 expression and tumor growth in murine lung cancer.

FASEB J 2003. OpenURL

Return to text
77.

Kehl LJ, Hamamoto DT, Wacnik PW, Croft DL, Norsted BD, Wilcox GL, Simone DA: A cannabinoid agonist differentially attenuates deep tissue hyperalgesia in animal models of cancer and inflammatory muscle pain.

Pain 2003, 103:175-186. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
78.

Ware MA, Doyle CR, Woods R, Lynch ME, Clark AJ: Cannabis use for chronic non-cancer pain: results of a prospective survey.

Pain 2003, 102:211-216. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
79.

Berman J, Lee J, Cooper M, Cannon A, Sach J, McKerral S, Taggart M, Symonds C, Fishe K, Birch R: Efficacy of two cannabis-based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.

Anaesthesia 2003, 58:938. Publisher Full Text | OpenURL

Return to text
80.

Smart D, Gunthorpe MJ, Jerman JC, Nasir S, Gray J, Muir AI, Chambers JK, Randall AD, Davis JB: The endogenous lipid anandamide is a full agonist at the human vanilloid receptor (hVR1).

Br J Pharmacol 2000, 129:227-230. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
81.

Caterina MJ, Schumacher MA, Tominaga M, Rosen TA, Levine JD, Julius D: The capsaicin receptor: a heat-activated ion channel in the pain pathway.

Nature 1997, 389:816-824. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
82.

Walker JM, Huang SM: Endocannabinoids in pain modulation.

Prostaglandins Leukot Essent Fatty Acids 2002, 66:235-242. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
83.

Walker JM, Hohmann AG, Martin WJ, Strangman NM, Huang SM, Tsou K: The neurobiology of cannabinoid analgesia.

Life Sci 1999, 65:665-673. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
84.

Rice AS, Farquhar-Smith WP, Nagy I: Endocannabinoids and pain: spinal and peripheral analgesia in inflammation and neuropathy.

Prostaglandins Leukot Essent Fatty Acids 2002, 66:243-256. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
85.

Wade DT, Robson P, House H, Makela P, Aram J: A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms.

Clin Rehabil 2003, 17:21-29. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
86.

Yesilyurt O, Dogrul A, Gul H, Seyrek M, Kusmez O, Ozkan Y, Yildiz O: Topical cannabinoid enhances topical morphine antinociception.

Pain 2003, 105:303-308. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
87.

Hall W, Degenhardt L: Medical marijuana initiatives: are they justified? How successful are they likely to be?

CNS Drugs 2003, 17:689-697. PubMed Abstract | OpenURL

Return to text
88.

Abrams DI: Medical marijuana: tribulations and trials.

J Psychoactive Drugs 1998, 30:163-169. PubMed Abstract | OpenURL

Return to text
89.

Grotenhermen F: Pharmacokinetics and pharmacodynamics of cannabinoids.

Clin Pharmacokinet 2003, 42:327-360. PubMed Abstract | OpenURL

Return to text
90.

Novotny M, Lee ML, Bartle KD: A possible chemical basis for the higher mutagenicity of marijuana smoke as compared to tobacco smoke.

Experientia 1976, 32:280-282. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
91.

Wu TC, Tashkin DP, Djahed B, Rose JE: Pulmonary hazards of smoking marijuana as compared with tobacco.

N Engl J Med 1988, 318:347-351. PubMed Abstract | OpenURL

Return to text
92.

Sidney S, Quesenberry CPJ, Friedman GD, Tekawa IS: Marijuana use and cancer incidence (California, United States).

Cancer Causes Control 1997, 8:722-728. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
93.

Minna JD: Nicotine exposure and bronchial epithelial cell nicotinic acetylcholine receptor expression in the pathogenesis of lung cancer.

J Clin Invest 2003, 111:31-33. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
94.

Heeschen C, Jang JJ, Weis M, Pathak A, Kaji S, Hu RS, Tsao PS, Johnson FL, Cooke JP: Nicotine stimulates angiogenesis and promotes tumor growth and atherosclerosis.

Nat Med 2001, 7:833-839. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
95.

Blazquez C, Casanova ML, Planas A, Del Pulgar TG, Villanueva C, Fernandez-Acenero MJ, Aragones J, Huffman JW, Jorcano JL, Guzman M: Inhibition of tumor angiogenesis by cannabinoids.

FASEB J 2003, 17:529-531. PubMed Abstract | OpenURL

Return to text
96.

Zhang ZF, Morgenstern H, Spitz MR, Tashkin DP, Yu GP, Marshall JR, Hsu TC, Schantz SP: Marijuana use and increased risk of squamous cell carcinoma of the head and neck.

Cancer Epidemiol Biomarkers Prev 1999, 8:1071-1078. PubMed Abstract | OpenURL

Return to text
97.

Gieringer D, Laurent SJ, Goodrich S: Cannabis Vaporizer Combines Efficient Delivery of THC with Effective Suppression of Pyrolytic Compounds.

Journal of Cannabis Therapeutics 4:7-27. Publisher Full Text | OpenURL

Return to text
98.

Gowling L, Ali R, White J: Respiratory Harms of Smoked Cannabis.Adelaide Australia: Drug and Alcohol Services Council; 2000.PubMed Abstract | OpenURL

Return to text
99.

Agurell S, Halldin M, Lindgren JE, Ohlsson A, Widman M, Gillespie H, Hollister L: Pharmacokinetics and metabolism of delta 1-tetrahydrocannabinol and other cannabinoids with emphasis on man.

Pharmacol Rev 1986, 38:21-43. PubMed Abstract | OpenURL

Return to text
100.

Yamamoto I, Watanabe K, Narimatsu S, Yoshimura H: Recent advances in the metabolism of cannabinoids.

Int J Biochem Cell Biol 1995, 27:741-746. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
101.

Bornheim LM, Everhart ET, Li J, Correia MA: Induction and genetic regulation of mouse hepatic cytochrome P450 by cannabidiol.

Biochem Pharmacol 1994, 48:161-171. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
102.

Tretyakova N, Matter B, Jones R, Shallop A: Formation of benzo[a]pyrene diol epoxide-DNA adducts at specific guanines within K-ras and p53 gene sequences: stable isotope-labeling mass spectrometry approach.

Biochemistry 2002, 41:9535-9544. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
103.

Pellinen P, Honkakoski P, Stenback F, Niemitz M, Alhava E, Pelkonen O, Lang MA, Pasanen M: Cocaine N-demethylation and the metabolism-related hepatotoxicity can be prevented by cytochrome P450 3A inhibitors.

Eur J Pharmacol 1994, 270:35-43. PubMed Abstract | OpenURL

Return to text
104.

Deutsch DG, Tombler ER, March JE, Lo SH, Adesnik M: Potentiation of the inductive effect of phenobarbital on cytochrome P450 mRNAs by cannabidiol.

Biochem Pharmacol 1991, 42:2048-2053. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
105.

Cichewicz DL, McCarthy EA: Antinociceptive synergy between delta(9)-tetrahydrocannabinol and opioids after oral administration.

J Pharmacol Exp Ther 2003, 304:1010-1015. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
106.

Marchese G, Casti P, Ruiu S, Saba P, Sanna A, Casu G, Pani L: Haloperidol, but not clozapine, produces dramatic catalepsy in {Delta}9-THC-treated rats: possible clinical implications.

Br J Pharmacol 2003. OpenURL

Return to text
107.

Khanna P, Gupta MB, Gupta GP, Sanwal GG, Ali B: Influence of chronic oral intake of cannabis extract on oxidative and hydrolytic metabolism of xenobiotics in rat.

Biochem Pharmacol 1991, 41:109-113. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
108.

Prigogine I: From Being to Becoming.San Fransisco: W.H. Freeman; 1980. OpenURL

Return to text
109.

Park B, McPartland JM, Glass M: Cannabis, cannabinoids and reproduction.

Prostaglandins Leukot Essent Fatty Acids 2004, 70:189-197. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
110.

Lepore M, Vorel SR, Lowinson J, Gardner EL: Conditioned place preference induced by delta 9-tetrahydrocannabinol: comparison with cocaine, morphine, and food reward.

Life Sci 1995, 56:2073-2080. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
111.

Tanda G, Munzar P, Goldberg SR: Self-administration behavior is maintained by the psychoactive ingredient of marijuana in squirrel monkeys.

Nat Neurosci 2000, 3:1073-1074. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
112.

Justinova Z, Tanda G, Redhi GH, Goldberg SR: Self-administration of Delta(9)-tetrahydrocannabinol (THC) by drug naive squirrel monkeys.

Psychopharmacology (Berl) 2003, 169:135-140. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
113.

Fattore L, Cossu G, Martellotta CM, Fratta W: Intravenous self-administration of the cannabinoid CB1 receptor agonist WIN 55,212-2 in rats.

Psychopharmacology (Berl) 2001, 156:410-416. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
114.

Ameri A: The effects of cannabinoids on the brain.

Prog Neurobiol 1999, 58:315-348. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
115.

Gardner EL: Addictive potential of cannabinoids: the underlying neurobiology.

Chem Phys Lipids 2002, 121:267-290. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
116.

Marinelli M, Piazza PV: Interaction between glucocorticoid hormones, stress and psychostimulant drugs.

Eur J Neurosci 2002, 16:387-394. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
117.

Di S, Malcher-Lopes R, Halmos KC, Tasker JG: Nongenomic glucocorticoid inhibition via endocannabinoid release in the hypothalamus: a fast feedback mechanism.

J Neurosci 2003, 23:4850-4857. PubMed Abstract | OpenURL

Return to text
118.

Whitlow CT, Freedland CS, Porrino LJ: Functional consequences of the repeated administration of Delta(9)-tetrahydrocannabinol in the rat.

Drug Alcohol Depend 2003, 71:169-177. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
119.

Marsicano G, Wotjak CT, Azad SC, Bisogno T, Rammes G, Cascio MG, Hermann H, Tang J, Hofmann C, Zieglgansberger W, Di Marzo V, Lutz B: The endogenous cannabinoid system controls extinction of aversive memories.

Nature 2002, 418:530-534. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
120.

De Vries TJ, Homberg JR, Binnekade R, Raaso H, Schoffelmeer AN: Cannabinoid modulation of the reinforcing and motivational properties of heroin and heroin-associated cues in rats.

Psychopharmacology (Berl) 2003, 168:164-169. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
121.

Ledent C, Valverde O, Cossu G, Petitet F, Aubert JF, Beslot F, Bohme GA, Imperato A, Pedrazzini T, Roques BP, Vassart G, Fratta W, Parmentier M: Unresponsiveness to cannabinoids and reduced addictive effects of opiates in CB1 receptor knockout mice.

Science 1999, 283:401-404. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
122.

Norwood CS, Cornish JL, Mallet PE, McGregor IS: Pre-exposure to the cannabinoid receptor agonist CP 55940 enhances morphine behavioral sensitization and alters morphine self-administration in Lewis rats.

Eur J Pharmacol 2003, 465:105-114. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
123.

Vigano D, Grazia Cascio M, Rubino T, Fezza F, Vaccani A, Di Marzo V, Parolaro D: Chronic morphine modulates the contents of the endocannabinoid, 2-arachidonoyl glycerol, in rat brain.

Neuropsychopharmacology 2003, 28:1160-1167. PubMed Abstract | OpenURL

Return to text
124.

Yamaguchi T, Hagiwara Y, Tanaka H, Sugiura T, Waku K, Shoyama Y, Watanabe S, Yamamoto T: Endogenous cannabinoid, 2-arachidonoylglycerol, attenuates naloxone-precipitated withdrawal signs in morphine-dependent mice.

Brain Res 2001, 909:121-126. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
125.

Fattore L, Martellotta MC, Cossu G, Mascia MS, Fratta W: CB1 cannabinoid receptor agonist WIN 55,212-2 decreases intravenous cocaine self-administration in rats.

Behav Brain Res 1999, 104:141-146. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
126.

Balerio GN, Aso E, Berrendero F, Murtra P, Maldonado R: Delta9-tetrahydrocannabinol decreases somatic and motivational manifestations of nicotine withdrawal in mice.

Eur J Neurosci 2004, 20:2737-2748. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
127.

Basavarajappa BS, Hungund BL: Role of the endocannabinoid system in the development of tolerance to alcohol.

Alcohol Alcohol 2004.PubMed Abstract | OpenURL

Return to text
128.

Le Foll B, Goldberg SR: Cannabinoid CB1 antagonists as promising new medications for drug dependence.

J Pharmacol Exp Ther 2004.PubMed Abstract | OpenURL

Return to text
129.

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. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
130.

Patton GC, Coffey C, Carlin JB, Degenhardt L, Lynskey M, Hall W: Cannabis use and mental health in young people: cohort study.

BMJ 2002, 325:1195-1198. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
131.

Bersani G, Orlandi V, Kotzalidis GD, Pancheri P: Cannabis and schizophrenia: impact on onset, course, psychopathology and outcomes.

Eur Arch Psychiatry Clin Neurosci 2002, 252:86-92. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
132.

De Marchi N, De Petrocellis L, Orlando P, Daniele F, Fezza F, Di Marzo V: Endocannabinoid signalling in the blood of patients with schizophrenia.

Lipids Health Dis 2003, 2:5. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text | OpenURL

Return to text
133.

Torrey EF, Yolken RH: The schizophrenia-rheumatoid arthritis connection: infectious, immune, or both?

Brain Behav Immun 2001, 15:401-410. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
134.

Jones-Brando L, Torrey EF, Yolken R: Drugs used in the treatment of schizophrenia and bipolar disorder inhibit the replication of Toxoplasma gondii.

Schizophr Res 2003, 62:237-244. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
135.

Fride E, Ginzburg Y, Breuer A, Bisogno T, Di Marzo V, Mechoulam R: Critical role of the endogenous cannabinoid system in mouse pup suckling and growth.

Eur J Pharmacol 2001, 419:207-214. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
136.

Mechoulam R, Spatz M, Shohami E: Endocannabinoids and neuroprotection.

Sci STKE 2002, 2002:RE5. PubMed Abstract | OpenURL

Return to text
137.

Krylatov AV, Uzhachenko RV, Maslov LN, Bernatskaya NA, Makriyannis A, Mechoulam R, Pertwee RG, Sal'nikova OM, Stefano JB, Lishmanov Y: Endogenous cannabinoids improve myocardial resistance to arrhythmogenic effects of coronary occlusion and reperfusion: a possible mechanism.

Bull Exp Biol Med 2002, 133:122-124. PubMed Abstract | Publisher Full Text | OpenURL

Return to text

Robert Melamede1,2 email
1Biology Department, 1420 Austin Bluffs Parkway, University of Colorado, Colorado Springs, 80918, USA
2Bioenergetics Institute, 1420 Austin Bluffs Parkway, University of Colorado, Colorado Springs, 80918, USA

author email corresponding author email

Harm Reduction Journal 2005, 2:17doi:10.1186/1477-7517-2-17

The electronic version of this article is the complete one and can be found online at: http://www.harmreductionjournal.com/content/2/1/17
Received: 19 November 2004
Accepted: 22 September 2005
Published: 22 September 2005

© 2005 Melamede; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

You can't trust the drug 'experts'

You can't trust the drug 'experts'
Dan Gardner
The Ottawa Citizen

'One night's ecstasy use can cause brain damage," shouted a newspaper headline in September 2002, after the journal Science published a study that found a single dose of the drug ecstasy injected into monkeys and baboons caused terrible brain damage. Two of the 10 primates in the study had even died. The media trumpeted the news around the world and drug enforcement officials held it up as definitive proof of the vileness of ecstasy.

But a year later, an odd thing happened. The author of the study, George Ricaurte, admitted his team had mistakenly injected the baboons and monkeys with massive doses of methamphetamine, not ecstasy, and Science formally retracted the article.

The retraction was scarcely reported and drug enforcement officials said nothing about it.

Obscure as this incident may sound, it actually demonstrates something vitally important about research on illicit drugs, something few laymen understand but is well known among researchers and academics. It's a deeply politicized field, says Peter Cohen, a professor at the Centre for Drug Research at the University of Amsterdam. "There is no neutral science."

For critics such as Mr. Cohen, George Ricaurte illustrates the problems in illicit drug research. Long before the Science study made him notorious, Dr. Ricaurte was accused by some academics of producing biased science designed to make drugs look as dangerous as possible. The motive was funding. Scientific research and scientific careers are built on funding and drug research is particularly expensive -- the flawed Science study cost $1.3 million U.S. alone.

"Researchers need to get their money from somewhere," says Mr. Cohen, but funding options are extremely limited. Pharmaceutical companies aren't interested. And most governments aren't prepared to pay a great deal of money for research on drugs they have already banned. The one exception is the United States, which lavishes money on drug research. As a result, the U.S. National Institute on Drug Abuse boasts that it "supports over 85 per cent of the world's research on the health aspects of drug abuse and addiction."

But that money comes with ideological strings attached. The American government is dominated by a drug-war ideology in which drugs are not simply another health risk that can be rationally studied and regulated. Drugs are criminal, immoral, even evil. When most people think of alcohol, we draw a line between "use" and "abuse" -- consumption that does no harm versus consumption that does. But because the drug-war ideology sees drugs as inherently wicked, it erases the line between use and abuse of illicit drugs. Any use is abuse. Any use is destructive. And the job of science is to prove it.

In his now-retracted study, Dr. Ricaurte was trying to prove something -- that even one dose of ecstasy causes brain damage -- which neatly fits drug-war ideology. Not surprisingly, NIDA covered the $1.3 million U.S. cost of the research. In fact, Dr. Ricaurte has been given $10 million U.S. by NIDA over his career. In exchange, NIDA consistently got what it wanted: Research that hyped the dangers of ecstasy.

But funding research is just one way American drug-war ideologues control the scientific research on illicit drugs. Not funding research can be just as effective when almost all the funding in the world comes from the U.S. "If I would approach NIDA and say I want to show that marijuana use is far less problematic than the use of alcohol, I wouldn't be funded," says Mr. Cohen.

This control can skew research in subtle but powerful ways. Mr. Cohen mentions his own research into ordinary people whose moderate use of cocaine causes little or no physical or social harm. He had been able to fund this work with money from the Dutch government. "But in many other countries, my colleagues could not find such money. They could find money to do research on cocaine use, but only in people who are in (rehab) clinics or living on the streets." In any other field this "selection bias" would be unacceptable because it distorts the results. In illicit drug research, it's standard.

A final method of control is crude suppression. "It goes on all the time," insists Mr. Cohen. "I was involved in the cocaine research of the World Health Organization and I saw this happen."

In the early 1990s, the WHO asked a group of international scientists, including Mr. Cohen, to produce what it billed as "the largest global study on cocaine use ever undertaken." In 1995, the study was done. It concluded that most users consume cocaine occasionally, that occasional use usually does not lead to compulsive use, and that occasional use does little or no harm to users. It was a flat contradiction of the drug-war ideology, so the U.S. threatened to pull its funding if the report was released. The WHO buckled. The report was buried.

Journalists are starting to catch on to the fact that they cannot always trust what officials say about drugs, Mr. Cohen feels, but few know how "poisoned the production of knowledge about drugs is." As a result, misinformation abounds and "drug policy is not yet a topic that society can deal with in a rational manner."
================================
p>Newshawk: CMAP

Pubdate: Tuesday, April 13, 2004
Source: Ottawa Citizen (CN ON)
Contact: letters@thecitizen.canwest.com

You can't trust the drug 'experts'

Decreased respiratory symptoms in cannabis users who vaporize

Cannabis smoking can create respiratory problems. Vaporizers heat cannabis to release active cannabinoids, but remain cool enough to avoid the smoke and toxins associated with combustion. Vaporized cannabis should create fewer respiratory symptoms than smoked cannabis. We examined self-reported respiratory symptoms in participants who ranged in cigarette and cannabis use. Data from a large Internet sample revealed that the use of a vaporizer predicted fewer respiratory symptoms even when age, sex, cigarette smoking, and amount of cannabis used were taken into account. Age, sex, cigarettes, and amount of cannabis also had significant effects. The number of cigarettes smoked and amount of cannabis used interacted to create worse respiratory problems. A significant interaction revealed that the impact of a vaporizer was larger as the amount of cannabis used increased. These data suggest that the safety of cannabis can increase with the use of a vaporizer. Regular users of joints, blunts, pipes, and water pipes might decrease respiratory symptoms by switching to a vaporizer
Background

Cannabis smoke contains gaseous and particulate matter with the potential to create symptoms of respiratory problems [1]. Although cannabis creates fewer problems than cigarette smoking [2], increasing its safety has the potential to improve quality of life. One step toward increasing the safety of cannabis involves the use of vaporizers. Vaporizers heat cannabis to temperatures that release cannabinoids in a fine mist without creating the toxins associated with combustion [3,4]. Although vaporizers are not common knowledge in popular culture, a recent photograph of one appeared in the New England Journal of Medicine [5], and information about the machine is becoming more available. A vaporizer has the potential to increase the safety of cannabis use, but data from human users appear only rarely [4].

The potential for cannabis-induced lung problems is particularly important in light of frequent concurrent tobacco smoking. Cannabis use may prove especially detrimental in the production of respiratory symptoms in cigarette smokers. For example, one study revealed increased respiratory symptoms in cannabis dependent 21-year-olds, but particularly in those who also smoked cigarettes. Cannabis dependence in the absence of cigarette use led to symptoms comparable to smoking 1–10 cigarettes per day, but quickly escalated when cannabis and tobacco were combined [6].
Method

We sought to identify the impact of vaporizers on respiratory symptoms. In an effort to target frequent cannabis users, three organizations committed to reforming drug laws were asked to send a query to their mailing lists for participation in a survey. Participants responded to an email request and had a chance to win a cash prize. Approximately 9,000 people replied, but we focused on those who had used cannabis at least once in the previous month. (More details of the data collection appear in a paper addressing other aspects of this sample [7].) In an effort to minimize the impact of other sources of respiratory symptoms, only those respondents who did not have cystic fibrosis or asthma and had never inhaled other drugs (inhalants, heroin, methamphetamine, or crack cocaine) were included. Those who reported that their primary method of administration of cannabis was oral ingestion were also omitted, because eating the plant should have no smoke-inhalation-induced respiratory effects.
Participants

The 6,883 people who qualified included 4,493 men (65.3%) and 2,390 women. Ages ranged from 18 to 88 (Mean = 31.3, SD = 12.4). Education ranged from some high school to advanced degrees, with a median of some college but not a degree. Median income was $20,000 to $40,000 per year. Respondents were primarily Caucasian (87%) but included African Americans (1%), Native Americans (3%), Asians (3%) Latinos (4%), and people of mixed race (2%). Participants reported that their first cannabis use was at a mean age of 16.7 (SD = 4.2).
Measures
Respiratory symptoms

Participants reported respiratory symptoms by answering six questions: Do you usually have a cough? Does your chest sound wheezy or whistling other than from colds? Are you troubled by shortness of breath when hurrying on the level ground or walking up a slight hill? Do you have to walk slower than most people your own age on the level ground because of breathlessness? Do you cough up phlegm in the morning? and Do you wake up at night with tightness in your chest? These questions revealed respiratory problems in cannabis-dependent individuals in previous work [6]. Symptoms were not particularly common (mean of the total symptom count = 0.80, SD = 1.1), but ranged from 0 to 6.

The sum of these items had significant skew that would preclude the use of parametric statistics, so we created two groups of participants: those who did (N = 3,016) and did not (N = 3,867) report respiratory problems. This dichotomized outcome served as the dependent variable.
Vaporizer use

Participants reported the technique they used most frequently when ingesting marijuana, and chose from blunts, joints, water pipes, pipes, edibles, vaporizers, and other. Only 152 participants (2.2%) reported vaporizing as their primary method for cannabis use.
Marijuana use

Although assessing the frequency of marijuana use has proven comparable to assessing the frequency of use for other drugs, assessing the quantity of consumption remains quite difficult. Standard units comparable to those found with alcohol or cigarettes are unavailable. Because respiratory effects of marijuana should covary with the amount used rather than the simple frequency of use, we asked participants to estimate the amount of marijuana they consumed per week in 1-gram joint equivalents. This rough estimate is necessarily imperfect, but has proven useful in previous work [8]. Participants reported amount of cannabis use in one-gram joint equivalents, which averaged 9.4 grams per week (SD = 11.9).
Cigarettes

Those who smoked cigarettes (4,829) began at a mean age of 16.0 (SD = 3.4). Cigarette smoking was generally light. Mean cigarettes per day was 8.6 (SD = 10.7) but ranged as high as 4 packs per day.
Results

A simple chi-square test revealed that vaporizer users were less likely to report respiratory problems than participants who did not vaporize, with 100 of 152 vaporizer users (65.8%) reporting no respiratory problems, compared to 3767 of 6731 (56.0%), chi-square (1) = 5.8, p < .05. This analysis provided a rough look at the potential for vaporizers, and suggested that the machines could improve respiratory symptoms. Nevertheless, this analytic approach did not account for important covariates or address potential interactions, so we used logistic regression. We computed interactions by centering the variables to correct for non-essential multicollinearity and then multiplying [9]. We report the full model with all two-way interactions and the three-way interaction present, but deleting any of these effects did not change the pattern of results. A logistic regression analysis with age and sex as covariates revealed main effects for cigarettes, cannabis use, and vaporizer use. The interaction of cigarettes and marijuana was significant, as revealed in previous work [6]. In addition the interaction of marijuana use and vaporizer use was significant, all p-values < .05. (See Table 1.)

Table 1. Predicting Respiratory Symptoms (N = 6,883)
Discussion

These results suggest that the respiratory effects of cannabis can decrease with the use of a vaporizer. The data reveal that respiratory symptoms like cough, phlegm, and tightness in the chest increase with cigarette use and cannabis use, but are less severe among users of a vaporizer. Because a sample this large can produce statistically significant effects that might not be clinically meaningful, a focus on odds ratios could prove fruitful. The odds ratio suggests that vaporizer users are only 40% as likely to report respiratory symptoms as users who do not vaporize, even when age, sex, cigarette use, and amount of cannabis consumed are controlled. The use of cigarettes in conjunction with cannabis exacerbated symptoms, as found in previous work [6]. The interaction between vaporizer use and cannabis consumption also appeared, suggesting that a vaporizer should have more impact on respiratory symptoms in people who use more marijuana. Odds ratios suggest that these effects are relatively small, but interactions often prove difficult to detect at all [9].

Several important limitations of these data deserve mention, particularly those related to sampling, Internet reporting, limitations of our measures, and the lack of random assignment to vaporizer use. In an effort to find regular users of cannabis, we targeted people with a potential interest in changing cannabis policy. These individuals might have consciously or unconsciously minimized their reports of symptoms that might cast cannabis in a negative light. Nevertheless, literally thousands of participants admitted to experiencing respiratory symptoms. The symptoms covaried with cannabis use, cigarette use, and the interaction of the two, as work with samples gathered in other ways has revealed [6]. These results suggest that reports among these participants are comparable to those found in other work. Any bias in reporting remains a problem, and only further work can help address this issue.

Vaporizer users might be more inclined to minimize respiratory symptoms than people who smoke cannabis in other ways. The price of a vaporizer can range as high as hundreds of dollars. Vaporizers also lack some of the convenience of other methods of marijuana use. Users who have spent this much money and effort might minimize reports of their respiratory symptoms, consciously or inadvertently, in an effort to justify their actions. Only a more objective measure of respiratory function that does not rely on self-report can sidestep this potential problem. Laboratory measures of lung function would make a nice addition to further work on this topic. Nevertheless, roughly 1/3 of the participants who used a vaporizer (52/152) did report symptoms, suggesting that self-report biases on symptom reports likely does not account for the entire phenomenon.

The use of the Internet for this type of work has advantages and disadvantages as well. This approach might lead individuals who are unwilling to travel to the laboratory to participate, potentially increasing generalizability. Heavy users with severe symptoms might be particularly disinclined to participate without the convenience of the Internet.

Recent work also suggests that people report more drug use while using the Internet than they do on standard paper-and-pencil measures [10]. Nevertheless, because Internet access was required for participation, these data might not generalize to meaningful subsets of the population without such access.

Our measures of vaporizer use and respiratory symptoms could also have been more detailed. A single question about the primary technique used for administering cannabis neglects potentially meaningful variation in vaporizer use. Some participants might use a vaporizer primarily but also smoke cannabis. In contrast, other participants might use a vaporizer exclusively. Both of these groups of participants would end up in the group who uses a vaporizer primarily. Vaporizers come in several forms, including conduction-style machines that employ a hot plate as well as convection-style devices that use warmed air. The efficacy of these different machines could vary substantially, but we could not address the question with the current data. These limitations, however, should decrease power rather than create a spurious result. By lumping participants who occasionally smoke cannabis into the same group with those who vaporize exclusively, we actually weaken the ability to detect effects. Including any type of vaporizer, no matter how effective, also has the potential to weaken effects. In a sense, the current study's estimate of the effect of a vaporizer on respiratory symptoms might be an underestimate of the improvement that could arise from a good vaporizer used as the exclusive method for ingesting cannabis. We also did not assess the length of time each participant had used a vaporizer. A vaporizer's impact might grow more dramatic with longer use. The assessment of respiratory symptoms was also not particularly elaborate, but the same measures revealed a significant impact of cannabis and cigarettes in this sample and in other work [6].

Finally, the use of a vaporizer was not randomly assigned. The possibility exists that cannabis users who choose a vaporizer might engage in a host of other behaviors designed to minimize respiratory symptoms, or simply be more health conscious in general. Like any correlational study, this one cannot address the role of causality. The current data are consistent, however, with the idea that cannabis vaporizers can decrease respiratory symptoms in regular users of the plant. A better test of a vaporizer's potential for minimizing problems would require recruiting cannabis smokers who report respiratory troubles, randomly assigning a group to use a vaporizer, and assessing any decrease in symptoms. The current data suggest that such an intervention could prove helpful.

Although the use of a vaporizer has the potential to increase the safety of cannabis as far as respiratory symptoms are concerned, pulmonary problems are not the only potential negative consequences of the plant. Reviews suggest that 9–12% of cannabis users develop symptoms of dependence [11]. Cannabis can lead to impaired driving skills [12], and heavy use in adolescence might create deviant brain structure [13] as well as decreases in intelligence [14]. A vaporizer offers no protection against these negative consequences. Nevertheless, a vaporizer has considerable potential for increasing cannabis drug safety by minimizing pulmonary troubles.
Competing interests

ME is affiliated with organizations devoted to changing cannabis laws.
Authors' contributions

ME contributed to study design, coordination and supervision, data analysis and interpretation, and drafted the manuscript. SSB participated in study design and coordination and helped draft the manuscript.
Acknowledgements

This work was funded by a grant from the Marijuana Policy Project. Special thanks to Elana B. Gordis for continued support. We thank two anonymous reviewers for courteous and helpful comments.
References

1.

Tashkin DP, Baldwin GC, Sarafian T, Dubinett S, Roth MD: Respiratory and immunologic consequences of marijuana smoking.

J Clin Pharmacol 2002, 42(Suppl 11):71S-81S. OpenURL

Return to text
2.

Melamede R: Cannabis and tobacco smoke are not equally carcinogenic.

Harm Reduction Journal 2005, 2:21. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text | OpenURL

Return to text
3.

Gieringer D, St Laurent J, Goodrich S: Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds.

Journal of Cannabis Therapeutics 2004, 4:7-27. Publisher Full Text | OpenURL

Return to text
4.

Hazekamp A, Ruhaak R, Zuurman L, van Gerven J, Verpoorte R: Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol.

J Pharm Sci 2006, 95:1308-1317. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
5.

Okie S: Medical marijuana and the Supreme Court.

NEJM 2005, 353(7):648-651. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
6.

Taylor DR, Poulton R, Moffitt TE, Ramankutty P, Sears MR: The respiratory effects of cannabis dependence in young adults.

Addiction 2000, 95:1669-1677. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
7.

Barnwell SS, Earleywine M, Wilcox R: Cannabis, motivation, and life satisfaction in an internet sample.

Subst Abuse Treat Prev Policy 2006, 1:2. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text | OpenURL

Return to text
8.

Reinarman C, Cohen PDA, Kaal HL: The limited relevance of drug policy: Cannabis in Amsterdam and in San Francisco.

Am J Public Health 2004, 94:836-842. PubMed Abstract | Publisher Full Text | PubMed Central Full Text | OpenURL

Return to text
9.

Aiken L, West S: Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage Press; 1991. OpenURL

Return to text
10.

Wang YC, Lee CM, Lew-Ting CY, Hsiao CK, Chen DR, Chen WJ: Survey of substance use among high school students in Taipei: web-based questionnaire versus paper-and-pencil questionnaire.

J Adolesc Health 2005, 37:289-295. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
11.

Earleywine M: Understanding Marijuana. New York: Oxford University Press; 2005. OpenURL

Return to text
12.

Liguori A: Marijuana and driving: trends, design issues, and future recommendations.In Pot Politics. Edited by: Earleywine M. New York: Oxford University Press; 2007. OpenURL

Return to text
13.

Wilson W, Mathew R, Turkington T, Hawk T, Coleman RE, Provenzale J: Brain morphological changes and early marijuana use: a magnetic resonance and positron emission tomography study.

J Addict Dis 2000, 19:1-22. PubMed Abstract | Publisher Full Text | OpenURL

Return to text
14.

Fried P, Watkinson B, James D, Gray R: Current and former marijuana use: preliminary findings of a longitudinal study of effects on IQ in young adults.

CMAJ 2002, 166:887-891.

Mitch Earleywine1 email and Sara Smucker Barnwell2 email
1Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave., SS369, Albany, New York, 12222, USA
2Department of Psychology, University of Southern California, SGM 501, Los Angeles, California, 90089-1061, USA

author email corresponding author email

Harm Reduction Journal 2007, 4:11doi:10.1186/1477-7517-4-11

The electronic version of this article is the complete one and can be found online at: http://www.harmreductionjournal.com/content/4/1/11
Received: 6 December 2006
Accepted: 16 April 2007
Published: 16 April 2007

© 2007 Earleywine and Barnwell; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract