ACKNOWLEDGMENTS

The preparation of a report of this type would be impossible without the willing cooperation of the many members of the scientific community who have generously made available reports of their current marihuana research. Their comments and assistance are gratefully acknowledged.

Scientists of the National Institute of Mental Health who have had the primary responsibility for preparing each of the sections of this report are

Dr. Monique Braude-Sections on the materials, analytical methodology, preclinical research in animals, pharmacological aspects of tolerance.

Miss Eleanor Carroll-Section on marihuana use in other countries and the historical portion of the section of therapeutic uses of cannabis.

Dr. Alan Ramsey-Section on the Effects in Man, viz: acute physical toxicity, chronic physical effects, genetic and birth defects, and psychiatric illness and contemporary aspects of therapeutic use.

Dr. Louise Richards-Section on Extent, Patterns and Social Context of Use in the United States.

Dr. Jean Paul Smith-Discussion of impurities and adulterants in the section on the material and analytic methodology.

Dr. Stephen Szara-Section on the effects in man, viz: the active ingredient, route of administration, metabolism, subjective, physiological and biochemical aspects, intelletual and psychomotor effets.

Dr. Robert C. Petersen edited and coordinated the preparation of the report in addition to preparing the introduction, summary and section on future research directions.

MARIHUANA AND HEALTH

SECOND ANNUAL REPORT TO CONGRESS

FROM

THE SECRETARY OF HEALTH, EDUCATION, AND WELFARE

INTRODUCTION

This marks the second in a series of reports prepared in accordance with the "Marihuana and Health Reporting Act" (Title V of P.L. 91-296). Under this act the Secretary of Health, Education and Welfare has the responsibility to submit annual reports to the Congress on the health consequences of marihuana use. "Health consequences' for the purposes of this report include not only the effects of the drug on the individual's physical and psychological health, but also the effects of cannabis use on the society.

Our knowledge of marihuana has significantly increased during the past year. A serious problem in evaluating research in a socially controversial area such as this is the ever present temptation for many to overgeneralize far beyond what the research warrants. Each new finding is eagerly sought after and the limitations of any single study are too often overlooked.

There are two important difficulties in the interpretation of much drug research. One is that drugs as investigated in the laboratory are not used under the same conditions as are to be found in illicit social use. Under more typical use conditions marihuana may be used along with other drugs and the social context of use may profoundly alter the individual's response. When cannabis use is studied in cultures that are different in many ways from our own, the implications of use may be quite different from that in American society. For example, the performance demands made by an agrarian society like that of rural Jamaica are quite different from those made by a modern, industrial society.

Each of the various research approaches has both advantages and disadvantages. The limitations of each is to some extent compensated for by the strengths of the others. When the observations derived from clinical observations, systematic laboratory research and cross-cultural observation all converge toward a common conclusion, we can have far greater confidence than that possible based on a single study.

The dilemma posed by present and future marihuana use in our society can only partially be resolved by scientific evidence. The issues profoundly involve questions of values, social custom, legal controls and our often inconsistent view of recreational drug use including that of alcohol and tobacco. These larger issues are appropriately the concern of all segments of society and are currently being considered by many other groups including a Presidential Commission. We have attempted throughout the report to limit ourselves to those issues on which a scientific judgment is possible leaving examination of other, equally important, social, political and economic aspects of use to others.

A major purpose of this report is to serve as an up-to-date compendium of scientific information bearing on the issue of marihuana and health. In order to make the report maximally useful to the technically