question. However, reasonable inferences can be drawn about the outcome of such a change based on three examples: patterns of abuse for opiate drugs, including painkillers such as morphine and codeine; patterns of drug abuse in the Netherlands and also in some parts of the United States, where marijuana was decriminalized in the 1970s; and the short-term consequences of the campaign to legalize medical marijuana in California in 1996.

Opiates can be considered a “stand-in” for marijuana-based medicines since both classes of drugs have the potential to be abused to great harm as well as to be used for medical benefit. Earlier in this century some physicians raised concerns that liberal use of opiates would cause many patients to become addicted to the drugs. Such worries have proven unfounded, and it is now widely recognized that physicians often needlessly limit doses of opiate medications to patients in pain out of fear of producing addicts. Today, opiates are carefully regulated by medical caregivers and rarely diverted from legitimate use to the black market.

There is no evidence to suggest that the use of opiates or cocaine for medical purposes has increased the perception that the illicit use of these drugs is safe or acceptable. Clearly, some patients may abuse these substances for their psychoactive effects, and others may divert them to recreational users. The same problems have occurred with several other medications, most of which are included in Schedule II of the Controlled Substances Act. Both the dispensation and manufacturing of Schedule II drugs are strictly controlled, and physicians are cautioned to monitor their use by patients who may be at risk for drug abuse.

Two studies designed to probe the effects of marijuana decriminalization have reported somewhat conflicting conclusions. Monitoring the Future, an annual survey of high school seniors, revealed that students in states that had decriminalized marijuana did not report using the drug more than their counterparts in states where marijuana remained illegal between 1975 and 1980.34 Another study, based on drug-related emergency room (ER) cases, concluded that decriminalization had increased marijuana use.35 It indicated that among states that had decriminalized marijuana in 1975-1976, there was a greater increase between 1975 and 1978

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