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An Analysis of Marijuana Policy Comminee on Substance Abuse and Habitual Behavior Commission on Behavioral and Social Sciences and Education National Research Council National Academy Press Washington, D.C. 1982

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Re- search Council, whose members are drawn from the coun- cils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and of advis- ing the federal government. The Council operates in accordance with general policies determined by the Acad- emy under the authority of its congressional charter of 1863, which establishes the Academy as a private, non- profit, self-governing membership corporation. The Coun- cil has become the principal operating agency of both the National Academy of Sciences and the National Acad- emy of Engineering in the conduct of their services to the government, the public, and the scientific and engi- neering communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. Available from: Commission on Behavioral and Social Sciences and Education National Research Council 2101 Constitution Avenue, N.W. Washington, D.C. 20418 Printed in the United States of America

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NATIONAL RESEARCH COUNCI L 2101 C~SrrrUnOt' AVIEt4UE - ~UNC~J, D. C. 2~;116 OFFICE OF THE CHAIRMAN Dr. William Pollin, Director National Institute on Drug Abuse Parklawn Building Room 10-05 5600 Fishers Lane Rockville, Maryland 20857 Dear Dr. Pollin: June 21, 1982 I transmit, herewith, a report of the National Research Council's Committee on Substance Abuse and Habitual Behavior: "An Analysis of Marijuana Policy prepared at the request of the National Institute on Drug Abuse. The Committee on Substance Abuse and Habitual Behavior, composed of 18 experts in the several relevant disciplines, has weighed carefully the available data regarding the costs, risks, and benefits of the major policy alternatives regard- ing the control of marijuana use and supply. The Committee is clear in pointing to the deficiencies of this body of evidence and cautions about the hazards of formulating policy recommendations based solely or in part thereon. In this regard, I call your attention to the following statement by Louis Lasagna and Gardner Lindzey contained in the Preface to the report: The Committee wishes to make clear what it regards as the limits of this report for the selection of policy alternatives. Scientific judgment can estimate the prevalence of different kinds of use, risks to health, economic costs, and the like under current policies and try to project such estimates for new policies. It can come to some conclusions based on those estimates. But selection of an alternative is always a value-governed choice, which can ultimately be made only by the political process. This caveat notwithstanding, the Committee has derived from its examination of the scientific data a conclusion about the major policy choices facing the nation with respect to ME NATIONAL RESEWN COUNCIL IS WE ~ INCIP~ OPE"=C MEND ~ ME NA~" AC - Ed ~ FENCES ~ ME NYLONS FEW ~ EMCEED TO SERVE DEWED ~ HER OPENS.

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Dr. William Pollin June 21, 1982 Page Two marijuana: complete prohibition, prohibition of supply only, and regulatory approaches. Specifically, the Committee concurs with the judgment of the National Commission on Marijuana and Drug Abuse, rendered in 1971, that a policy of prohibition of supply only is preferable to a policy of complete prohibition of supply and use. What must be understood by the public, the media, and all who read the Committee's report is that its decision to endorse a policy change was not fashioned from scientific information--old or new--alone. Rather it was the analysis of a combination of factors which affect policy decisions, including the cost and efficacy of enforcement practices. \talues were neces- sarily involved in balancing these factors and there are those within the membership and governing bodies of the Academies and the National Research Council who might not have come to the same policy conclusions, after reviewing the same data. My own view is that the data available to the Committee were insufficient to justify on scientific-or analytical grounds changes in current policies dealing with the use of marijuana. In this respect I am concerned that the Committee may have gone beyond its charge in stating a judgment so value-laden, that it should have been left to the political process. I have one further concern that cannot go unaddressed. I fear that this report, coming as it does from a well- known and well-respected scientific organization, will be misunderstood by the media and the public to imply that new scientific data are suddenly available that justify changes in public attitudes on the use of marijuana. This would be unfortunate at a time when daily use trends by high school students are down significantly. AS the Committee's discussion of marijuana's behavioral and health-related effects clearly demonstrates, there is no new scientific information exonerating marijuana. In fact, the review by our Institute of Medicine, published a few months ago, reevaluated existing scientific evidence and concluded, as have others, that marijuana is a harmful drug whose use justifies serious national concern. .

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Dr. William Pollin June 21, 1982 Page Three I wish to remind you that this is a committee report; the only position that can be inferred with respect to the National Research Council on the issue of marijuana policy is that the National Research Council is satisfied that the Committee was competent to examine the issue and diligent in carrying out its task. Despite my personal disagreement, I believe that the Committee has performed a useful service by illuminating many of the complex issue surrounding this highly controversial subject. Yours sincerely, Act. Frank Press Chairman s

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COMMITTEE ON SUBSTANCE ABUSE AND HABITUAL BEHAVIOR LOUIS LASAGNA (Chair), Department of Pharmacology and Toxicology, University of Rochester School of Medicine and Dentistry HOWARD S. BECKER, Department of Sociology, Northwestern University PETER DEWS, Department of Psychiatry and Psychobiology, Harvard University JOHN L. FALK, Department of Psychology, Rutgers University DANIEL X. FREEDMAN, Department of Psychiatry, University of Chicago JEROME H. JAFFE, Veterans Administration Hospital, Newington, Connecticut , and University of Connecticut School of Medicine, Farmington, Connecticut DENISE KANDEL, Department of Psychiatry and School of Public Health, Columbia University, and New York State Psychiatric Institute JOHN KAPLAN, Stanford University School of Law GARDNER LINDZEY (past chair), Center for Advanced Study in the Behavioral Sciences, Stanford, California GERALD McCLEARN, College of Human Development, Pennsylvania State University CHARLES P. O'BRIEN, Veterans Administration Hospital, Philadelphia, and Department of Psychiatry, University of Pennsylvania JUDITH RODIN, Department of Psychology, Yale University STANLEY SCHACHTER, Department of Psychology, Columbia University THOMAS C. SCHELLING, John F. Kennedy School of Government, Harvard University RICHARD L. SOLOMON, Department of Psychology, University of Pennsylvania

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FRANK STANTON, New York (formerly, president, Columbia Broadcasting System) ALBERT STUNKARD, Department of Psychiatry, University of Pennsylvania RICHARD F. THOMPSON, Department of Psychology, Stanford University PETER K. LEVISON, Study Director DEAN R. GERSTEIN, Senior Research Associate DEBORAH R. MALOFF, Research Associate MARIE A. CLARK, Administrative Secretary

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CONTENTS PREFACE INTRODUCTION THE DANGERS OF MARIJUANA OVERVIEW OF CURRENT MARIJUANA POLICIES A REVIEW OF The REPORT OF TEE NATIONAL COMMISSION ON MARIJUANA AND DRUG ABUSE THE USE OF MARIJUANA: COMPARING COMPLETE AND PARTIAL PROHIBITION Effects of Partial Prohibition Costs of Prohibition of Use Public Attitudes Toward Partial Prohibition THE SUPPLY OF MARIJUANA: COMPARING PROHIBITED AND REGULATED MARRETS Costs of Prohibition of Supply Costs of Regulating Supply Regulatory Systems: Same Concrete Aspects CONCLUSIONS RECOMMENDATIONS FOR RESEARCH Health and Behavior Drug Markets Effects on Use REFERENCES APPENDIX: SUMMARY OF MARIJUANA AND HEALTH ED 1 3 6 9 11 ~2 14 16 17 18 20 24 29 30 30 31 31 33 36

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PREFACE In 1978 the Committee on Substance Abuse and Habitual Behavior began a study of marijuana policy at the re- que~t and with the support of the Nationn1 Institute on Drug Abuse. Sharp increases in marijuana use along with suggestions for reform of existing marijuana lawn from scientists and policy makers prompted a renewed look at those laws. In addition, the National Commission on Marijuana and Drug Abuse, in its 1973 final report, Drug Use in America: Problem in Perspective, had recommended , that a follow-up commission be appointed to review pos- sible changes in the situation four years later. That recommendation was not implemented, so the Committee took as a framework for its tank the assessment that the Commission recommended, especially the assessment of new evidence regarding the effects of recent changes in state marijuana policies. The Committee conducted its study with awareness of the intensity of past controversies about marijuana use in U.S. society. In the four years since the Committee began its work, there has been an increase in visible concern among many parents about marijuana use among youth, its potential risks to the health of children, and the possibility that heavy use by some young people may seriously threaten their education. Parents who have experienced problems with their own children, or observed those of others, have organized to make mari- juana policies a major item on current political agendas. In comparison with the situation at the inception of this study, there is today greater rancor in public discussion, press reports, legislative hearings, and policy-oriented technical meetings related to marijuana use. xi

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xii This is the context in which the Committee completed its review of the evidence and arguments of earlier studies and weighed the significance of subsequent evi- dence for the major policy alternatives. Every policy has potentially good and potentially bad effects, and policy choices involve difficult comparisons of such effects. It is important to recognize that to allow the inertia developed by existing policies to prevent change is itself a choice. The Committee is aware that analyzing a topic that is the subject of heated social debate has its hazards. Many of those participating in the marijuana debate have already selected what they take to be the admissible terms of the discussion and look with disfavor on any- one's insistence on a wider set of considerations. For example, some would settle the issue on physiological grounds alone: whether cannabis products, in the dose ranges customarily used by most people, cause tissue damages Defenders of marijuana use may seize on the ambiguity or absence of evidence for such damage and ignore any other effects on education or safety; those opposed to marijuana use may emphasize the possibility of chronic disease that is suggested by some laboratory findings and ignore the social, political, and economic costs of fighting a well-established custom. This report does not review and analyze every con- ceivable policy nuance or option. It addressee the major choices--both because these families of alterna- tive policies subsume many variants and because the choice among these major options must be discussed before specific, perhaps new, policy instruments can be designed. The Committee wishes to make clear what it regards as the limits of this report for the selection of policy alteratives. Scientific Judgment can estimate the prev- alence of different kinds of use, risks to health, eco- nomic costs, and the like under current policies and can try to project such estimates for new policies. It can come to some conclusions based on those estimates. But selection of an alternative is always a value-governed choice, which can ultimately be made only by the politi- cal process. The role of scientific evidence in this process is not inconsiderable, even though, at times, the strongest evidence may be pushed aside and the wild- eat speculation prevail. But the weight of the evidence is only one factor in the process of policy formation; ultimately, that process involves value choices.

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xiii In completing its report, the Committee has benefited from many people in formulating, revising, and updating the analyses and data. A very early version of this report was discussed at the Com~ittee's annual confer- ence in 1979, and subsequent versions benefited from comments by staff of the National Institute on Drug Abuse and of the National Research Council. The final draft received close and constructive attention by memo bers of the National Research Council's Commission on Behavioral and Social Sciences and Education, the In~ti- tute of Medicine, and the Report Review Committee of the National Academy of Sciences. We have also maintained a close liaison with the Staff and members of the Institute of Medicine's Committee to Study the Health-Related Effects of Cannabis and Its Derivatives, on which three members of our Committee also served, and whose recently published report, MariJuana and Health, significantly contributed to our work. Two former Committee members, Troy Duster and Michael Agar, assisted in the early preparation of the report. At later stages we were very ably assisted by the staff of the Commission on Behavioral and Social Sciences and Education, in particular David Goalin, executive direc- tor, and Eugenic Grohman, associate director for reports. Without their help, it in doubtful that we could have completed this task. Finally, we are indebted to the staff sod members of the Committee, for their diligence, patience, and commitment to a difficult assignment. Louis Lasagna, Chair Gardner Lindsey, Chair, 1977-1980 Committee on Substance Abuse and Habitual Behavior

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