SPEAKERS CONTENTS INSERTS Tables
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58–955
1999
MEDICAL MARIJUANA REFERENDA MOVEMENT IN AMERICA
HEARING
BEFORE THE
SUBCOMMITTEE ON CRIME
OF THE
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTH CONGRESS
FIRST SESSION
OCTOBER 1, 1997
Serial No. 110
Printed for the use of the Committee on the Judiciary
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For sale by the U.S. Government Printing Office
Superintendent of Documents, Congressional Sales Office, Washington, DC 20402
COMMITTEE ON THE JUDICIARY
HENRY J. HYDE, Illinois, Chairman
F. JAMES SENSENBRENNER, Jr., Wisconsin
BILL McCOLLUM, Florida
GEORGE W. GEKAS, Pennsylvania
HOWARD COBLE, North Carolina
LAMAR SMITH, Texas
STEVEN SCHIFF, New Mexico
ELTON GALLEGLY, California
CHARLES T. CANADY, Florida
BOB INGLIS, South Carolina
BOB GOODLATTE, Virginia
STEPHEN E. BUYER, Indiana
SONNY BONO, California
ED BRYANT, Tennessee
STEVE CHABOT, Ohio
BOB BARR, Georgia
WILLIAM L. JENKINS, Tennessee
ASA HUTCHINSON, Arkansas
EDWARD A. PEASE, Indiana
CHRISTOPHER B. CANNON, Utah
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JOHN CONYERS, Jr., Michigan
BARNEY FRANK, Massachusetts
CHARLES E. SCHUMER, New York
HOWARD L. BERMAN, California
RICK BOUCHER, Virginia
JERROLD NADLER, New York
ROBERT C. SCOTT, Virginia
MELVIN L. WATT, North Carolina
ZOE LOFGREN, California
SHEILA JACKSON LEE, Texas
MAXINE WATERS, California
MARTIN T. MEEHAN, Massachusetts
WILLIAM D. DELAHUNT, Massachusetts
ROBERT WEXLER, Florida
STEVEN R. ROTHMAN, New Jersey
THOMAS E. MOONEY, Chief of Staff-General Counsel
JULIAN EPSTEIN, Minority Staff Director
Subcommittee on Crime
BILL McCOLLUM, Florida, Chairman
STEVEN SCHIFF, New Mexico
STEPHEN E. BUYER, Indiana
STEVE CHABOT, Ohio
BOB BARR, Georgia
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ASA HUTCHINSON, Arkansas
GEORGE W. GEKAS, Pennsylvania
HOWARD COBLE, North Carolina
CHARLES E. SCHUMER, New York
SHEILA JACKSON LEE, Texas
MARTIN T. MEEHAN, Massachusetts
ROBERT WEXLER, Florida
STEVEN R. ROTHMAN, New Jersey
PAUL J. MCNULTY, Chief Counsel
GLENN R. SCHMITT, Counsel
DANIEL J. BRYANT, Counsel
NICOLE R. NASON, Counsel
DAVID YASSKY, Minority Counsel
C O N T E N T S
HEARING DATE
October 1, 1997
OPENING STATEMENT
McCollum, Hon. Bill, a Representative in Congress from the State of Florida, and chairman, Subcommittee on Crime
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WITNESSES
Brooks, Ronald E., Chair, Drug Policy Committee, California Narcotic Officers' Association
Copple, James E., President & CEO, Community Anti-Drug Coalitions of America
Grinspoon, Lester, M.D., Associate Professor of Psychiatry, Harvard Medical School
Lapey, Janet D., M.D., Executive Director, Concerned Citizens For Drug Prevention, Inc.
McCaffrey, General Barry R., Director, Office of National Drug Control Policy, The White House
McCollum, Hon. Bill, a Representative in Congress from the State of Florida, and chairman, Subcommittee on Crime
Copy of Florida Constitutional Amendment Petition Form
Peron, Dennis, Director, Californians for Compassionate Use
Pilon, Roger, Ph.D., J.D., Senior Fellow and Director, Center for Constitutional Studies, Cato Institute
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Romley, Richard M., Maricopa County Attorney, Maricopa County, AZ
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
Barr, Hon. Bob, a Representative in Congress from the State of Georgia
Washington Post article dated February 7, 1997
Washington Post article dated September 30, 1997
Excerpt from ''Marihuana, the Forbidden Medicine'' by Lester Grinspoon
Brooks, Ronald E., Chair, Drug Policy Committee, California Narcotic Officers' Association: Prepared statement
Copple, James E., President & CEO, Community Anti-Drug Coalitions of America: Prepared statement
Grinspoon, Lester, M.D., Associate Professor of Psychiatry, Harvard Medical School: Prepared statement
Hutchinson, Hon. Asa, a Representative in Congress from the State of Arkansas: Prepared statement
Jackson Lee, Hon. Sheila, a Representative in Congress from the State of Texas: Prepared statement
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Lapey, Janet D., M.D., Executive Director, Concerned Citizens For Drug Prevention, Inc.: Prepared statement
McCaffrey, General Barry R., Director, Office of National Drug Control Policy, The White House: Prepared statement
PET scan from Brookhaven Laboratories
Peron, Dennis, Director, Californians for Compassionate Use: Prepared statement
Pilon, Roger, Ph.D., J.D., Senior Fellow and Director, Center for Constitutional Studies, Cato Institute
Romley, Richard M., Maricopa County Attorney, Maricopa County, AZ: Prepared statement
APPENDIX
Material submitted for the record
MEDICAL MARIJUANA REFERENDA MOVEMENT IN AMERICA
WEDNESDAY, OCTOBER 1, 1997
House of Representatives,
Subcommittee on Crime,
Committee on the Judiciary,
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Washington, DC.
The subcommittee met, pursuant to notice, at 9:40 a.m., in room 2141, Rayburn House Office Building, Hon. Bill McCollum [chairman of the subcommittee] presiding.
Present: Representatives Bill McCollum, Steve Chabot, Bob Barr, Asa Hutchinson, George W. Gekas, Howard Coble, Sheila Jackson Lee, Martin T. Meehan, and John Conyers, Jr.
Also Present: Representative Barney Frank.
Staff present: Paul McNulty, Chief Counsel; Dan Bryant, Majority Counsel; Kara Norris, Staff Assistant, and David Yasskey, Minority Counsel.
OPENING STATEMENT OF CHAIRMAN McCOLLUM
Mr. MCCOLLUM [presiding]. This hearing of the Crime Subcommittee will come to order.
We're here this morning for some very serious business, and I know that many of my colleagues will be joining me as we go through this process. I want to make an opening statement and welcome the first panel. We have two panels of witnesses today for this hearing on medicinal marijuana and the initiatives that are going on in the States.
The backdrop of this morning's hearing is a sobering one. Over the last 5 years, we've been losing ground in our national effort to combat illegal drugs, including marijuana. The drug supply in the United States is up; drug purity is up; drug prices are down, and more kids are becoming users. We have a methamphetamine crisis in our western States, and it's spreading east. We have more than 500 metric tons of cocaine pouring into the United States through Mexico and the Caribbean each year. And when we look to our south—Mexico, the Caribbean, and all of this region—we see criminal drug cartels that are more powerful and sophisticated than ever before with their criminal networks reaching into the streets of every major city in America.
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The crack cocaine crisis which ravaged our large cities in the 1980s is now wreaking havoc in midsize cities throughout the country, and we're now facing a heroin epidemic, with Colombian heroin which is cheaper and stronger than any heroin we ever saw in the 1960's, now commonplace on our streets. Tragically, this has led to unprecedented numbers of teenagers dying from heroin overdoses in the last couple of years.
When it comes to marijuana, we're not doing much better. Marijuana users today are younger than ever before. The most recent survey conducted by the Partnership for a Drug-Free America found that, among children ages 9 to 12 who were surveyed, nearly one-fourth of them were offered drugs during 1996, with marijuana being the predominant drug that was offered. That's up from 19 percent for the same age group in 1993. The University of Michigan survey for 1996 reported that 23 percent of seventh grade students said that they had tried marijuana, and 33 percent of the eighth graders said they'd done so. It's no surprise, then, that surveys show that youths have become more approving of marijuana use over the last 4 years. Today, in the District of Columbia, 96 percent of all youth arrested for crime test positive for marijuana; that's 96 percent of all juveniles arrests.
The typical marijuana dose today is significantly larger and more potent than in past years with doses now often laced with other drugs. As a result, in recent years, there's been a dramatic increase in the number of marijuana-related emergency room episodes of 12-to 17-year olds. The harmful effects of marijuana use are clear, having been extensively studied since the 1960's. For example, the so-called ''gateway effect'' of marijuana is better understood. According to the 1994 study by Columbia University's Center of Addiction and Substance Abuse, 12-to 17-year olds who use marijuana are 85 times more likely to use cocaine than those who abstain from marijuana use. The study further reveals that 60 percent of adolescents who use marijuana before the age of 14 will later use cocaine, and 43 percent of teenagers who use marijuana by age 18, go on to use cocaine.
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In June, 1997 the National Institute of Health announced findings that the long-term use of marijuana produces changes in the brain that are similar to those often seen after long-term use of other major drugs of abuse such as cocaine, heroin, and alcohol. It's with this disturbing backdrop that we convene this morning's hearing to turn our attention to the so-called medical marijuana referenda movement.
Let me say, at the outset, that I find the medical marijuana movement very troubling, and I believe that more and more Americans are troubled by it the more they learn, and that's why we're here this morning: to learn and understand the facts about medical marijuana, and to consider the potential consequences of a shift in public policy toward marijuana legalization.
Now alleviating the suffering of those with terminal illnesses is a concern for which everyone has sympathy, but as I think we'll hear from numerous witnesses today, the recent marijuana initiatives in California and Arizona were not limited to the alleviation of the suffering of the dying. The plain language of these initiatives reveals their much broader scope. Take the California initiative, for example: It doesn't limit the dispensing of marijuana to the terminally ill or to cancer or AIDS victims. It allows marijuana to be dispensed to anyone, and for what purpose? I quote, ''for any illness for which marijuana provides relief.'' The sky's the limit with language this broad, and all you need to get marijuana is a doctor's recommendation; you don't even need a prescription. Marijuana is a Schedule I drug under the Controlled Substances Act because of its dangerous properties, and, yet, under the language of the California initiative, you don't even need a prescription to get it. And the Arizona initiative didn't stop with marijuana; it made crack cocaine, heroin, PCP, LSD, and methamphetamine available. I think there's little doubt, as witnesses will testify today, that the California and Arizona campaigns were more about legalizing drugs than about providing relief for the dying.
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And let me say to those who would cynically exploit the suffering of the terminally ill to advance a drug legalization agenda. I can think of no political strategy more unseemly than drug legalization masquerading as compassion for the dying. You're aiding and abetting the emergence of a drug culture which offers despair and violence.
In closing, I believe the explanation for marijuana's increased popularity is straightforward. America's younger generation, today, sees fewer risks and more personal rewards associated with marijuana use. Too often, condemning messages about drugs are being replaced with encouraging messages about drugs, and State initiatives that seek to label marijuana as medicine, send an unmistakable and dangerous message to our youth. Those who occupy bully pulpits have a moral imperative to use them well. I trust that today's hearing will be one step among many that this Congress and all of those in political leadership, at the local, State and the Federal levels take during the months ahead to use our bully pulpits to declare with a unified voice on the drug use question including marijuana use, that it's harmful, unacceptable, and must remain illegal.
I look forward to the testimony of today's witnesses, and I yield to the ranking member of our Full Committee, Mr. Conyers.
Mr. CONYERS. Thank you, Mr. Chairman, and good morning. Good morning, General McCaffrey, Mr. Leshner. This is about the—I can remember—the second hearing we've had on the medical use of marijuana, and I welcome the fact that Bill McCollum has called this hearing as the Subcommittee Chairman of Crime, because it does several things. First, it gives us a chance to get off our chest our position on marijuana, drugs, and other related items. Number two, it addresses a very important debate that's going on in America: whether or not marijuana can be medically used. And number three, in this instance, it gives us a chance to examine a measure put forward by Barney Frank, H.R. 1782, that would amend the Federal law in relationship to the medical use of marijuana.
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So, let me take my introductory remarks to enunciate a couple of landposts in this discussion, and I do hope in the spirit which the chairman made his opening statement, that we can have a lowered voices discussion of a subject that it's easy to raise your voice. Normally, not always, we get more accomplished by talking with each other in rational tones rather than anything else.
Landpost No. 1: Marijuana is a drug that has harmful consequences. That's—I didn't dream that up, but that's what all the medical science tells me.
No. 2, that marijuana is a gateway drug to a lot of other things even far worse. Now we get into more controversial landposts.
No. 3, there are a lot of drugs that have harmful consequences that are used under medical prescription for health reasons, and so singling out marijuana is—would require us to ignore all the other kinds of medicines, other pharmaceuticals, other drugs that can be used in an exception for medical purposes. Number four: There are those who would take the license that would be required to use marijuana for medicinal purposes to use if for recreational purposes. Now, let's not go ballistic over that. People that want to use drugs will use any cover including medicinal and so forth. So, the fact that we want to make marijuana like other drugs available for medicinal purposes does not mean that we have to stamp it out because there are a few people that would abuse this medical prerogative.
And then, finally, I always have to talk about legalization while I'm in the bully pulpit. Because I shed a tear for all of my conscientious friends in America who because we haven't handled the battle against drugs which is really understanding drugs in an intelligent way, they throw up their hands and say, ''Well, let's legalize it.'' In other words, ''Let's surrender.'' I take the gravest exception to that kind of futile, pessimistic, nihilistic strategy. You can't legalize things that would destroy the national citizenry. I don't care if we're not dealing with it properly or effectively or as well as we should. We cannot, therefore, make drugs permissible. I mean, the consequences are unthinkable.
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So, the framework of this discussion, this morning, is around the medical use of marijuana. Is there someone in the land that objects to saving somebody's life or easing the pain because it's a—because marijuana is prescribed? Well, the answer is yes; there are some people in the land, and so I welcome the witnesses and I thank the chairman for the use of this time.
Mr. MCCOLLUM. You're quite welcome, Mr. Conyers.
I would comment as I go to other Members of the panel, we do need to be as brief as possible, because we're going to have a lot of votes today, unfortunately, and we definitely want to give this hearing, General McCaffrey, and the other witnesses their full due.
Mr. Barr, do you have any opening comments?
Mr. BARR. Just to let you know, Mr. Chairman, that I appreciate the opportunity to revisit this topic. I think we need to revisit it over and over and over again. I still remain concerned that despite previous testimony by General McCaffrey and previous assurances from the administration that they are unalterably opposed to the legalization of drugs including so-called medicinal use of marijuana, that we continue to see requests, as we have, before us in the Congress to spend American taxpayer dollars to study it. The fact of how that can be consistent with saying, ''we're unalterably opposed to it,'' continues to escape me. Perhaps, there's some more light that can be shed on that today.
We in this country and the world, all civilized countries in the world, Mr. Chairman, are under assault by drug proponents seeking to enslave citizens. We see it most recently in the vote 2 days ago, I think. It was in Switzerland, which, unfortunately, the government which believes that it is an appropriate function of government to provide heroin to its citizens at taxpayer expense. We saw a referendum that would roll back that ill-conceived policy defeated. To some extent, we are also seeing some of the so-called international do-gooders—rather a strange name for people like George Soros—that want to pump billions of dollars into the drug legalization movement, euthanasia, and so forth.
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This is a very, very timely topic, Mr. Chairman; one that enough cannot be said about, and I appreciate the chairman, once again, bringing light to bear on this topic and look forward not only to the hearing today, but to continuing hearings on this very pressing topic. Thank you, Mr. Chairman.
Mr. MCCOLLUM. Thank you, Mr. Barr. Mr. Frank, you're recognized.
Mr. FRANK. I appreciate the courtesy, Mr. Chairman. I guess I'm looking forward to the joint hearing you'll be having with the Foreign Affairs Committee when the gentleman from Georgia and the Prime Minister of Malaysia can join together in denouncing Mr. Soros.
The issue is a very important one, and I understand we have a problem, and there are people who do believe that prohibition is the answer; that when you have substances that are debilitating; that cause physical harm; when you have substances that impair people's judgment and cause them to become burdens on others, the answer is prohibition. But I think outlawing either tobacco or alcohol would be a mistake at this point in our Nation's history. I am skeptical that prohibition is the appropriate response to the widespread use of substances, tobacco and alcohol, that cause serious personal and social damage.
Now, that leads us to marijuana, and I must say, Mr. Chairman, I have to take very strong exception to your suggestion that there's somehow some cynical manipulation here. I had a call before I left for work this morning from someone who works for me who had a lost a very close family member to cancer, and her message was, ''Gee, I saw that on the schedule.''—she's up in Massachusetts—''Good for you.'' I think of the suffering of the person close to her, and I don't understand how people could want to deny to anyone something that the doctor and the individual felt might alleviate the suffering.
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I'm also becoming something of a collector of inconsistencies, major glaring inconsistencies. I haven't got enough room in any place I my own for small inconsistencies, and my—high on my list now is the inconsistent attitude toward referenda. When the people of California vote to restrict affirmative action or to restrict benefits that would go to people who are here illegally, vox populi, vox dei—I apologize for my Latin pronunciation, but I apologize for my English pronunciation. Where the people vote in a way that my colleagues, particularly on the other side approve, then a referendum is a sacred act. Where the stupid people go and do something they don't like, then, the hell with them, and that apparently is the attitude.
We have had referenda in Arizona and California in which the people voted to allow medical marijuana. Now, my colleagues say, ''Well, they were worded badly.'' Well, you sound like the people who didn't like the referenda on affirmative action and immigration. I mean, either the public's wishes, expressed through referenda, should have some weight or they shouldn't.
Now, people say, ''Well, they weren't drafted tightly.'' That's true; referenda are not good ways to draft things, but we have the power in Congress to amend those referenda in effect and to tighten them up, because there is a double legal prohibition on marijuana right now. They are prohibited by State laws and by Federal laws to the extent that the State has broadly relaxed the prohibition. It is still not a legal substance even for doctors to prescribe in some cases because of the Federal law, and we could write a Federal law which gave effect to the State referendum only to the extent that you thought it was medically justified. So, no one can argue that the reason for saying no to any use of medical marijuana is that these referenda were too broad. We have the power to tighten them up.
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And then we have the final argument which is, ''Shame on the Federal Government for trying not to be ignorant about this.'' We're told that for the Federal Government to study something—now, we have leading medical people saying it's a good idea, and some medical people, many medical people, saying it isn't a good idea. You have the New England Journal of Medicine saying we should do it, and the notion that it is wrong for an administration to study an issue—two States in this country have passed referenda to say that they want to be able to do it. There is significant medical opinion on one side, a lot of medical opinion on the other side, and the notion that it is somehow wrong for the administration to study it, really means that invincible ignorance is enshrined, and people must simply fear that studying it would yield information that would undermine their position.
So, I appreciate the fact that we are at least talking about this in public. I would hope that we could begin to move on the bill, and I would hope that we would also just affirm the basic principle that people who are terribly ill and in pain and, perhaps, dying, can be given, by their doctors, substances that we don't think people ought to use under other circumstances. It is certainly the case that prescribing things only to people who are very ill and in certain circumstances by doctors is the norm in the practice of medicine. I mean, if we are to set a new rule that doctors can't prescribe anything that we're not prepared to have out in the general public, then I think we have severely restricted the practice of medicine.
And the final thing I would say is to repeat the point about the referendum, Mr. Chairman. If the majority persists in totally ignoring, indeed mocking, the people of California, Arizona, and now 71 percent of the people in Switzerland who voted wrong on the other side—although we're not dealing here with heroin—but if we're going to continue to simply denounce people because they voted wrong in a referendum, I would hope that the notion that every referendum is sacred would not be put forward, and people ought to acknowledge that when they are praising a referendum, they're really praising the subset of results, and the fact that a large majority of people voted for it—more people voted, as I understand it, for the marijuana referendum in California than the affirmative action one. So, I would hope we would get at least minimal consistency.
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Mr. MCCOLLUM. Thank you, Mr. Frank. Mr. Hutchinson, do you have any opening comments?
Mr. HUTCHINSON. Thank you, Mr. Chairman. I would like permission to insert my opening statement into the record.
Mr. MCCOLLUM. Without objection, so ordered.
Mr. HUTCHINSON. I would like to make a couple of comments in summary. I want to congratulate you for holding this hearing. I think it is critically important after the California and Arizona initiatives legalizing marijuana for medical use, and, obviously, other States are considering it as well.
I was in California, and I talked to law enforcement officials, and most in the law enforcement community, agree that the ballot initiative was so poorly drafted that it has become impossible to regulate or enforce.
I'm particularly concerned about the impact, and the signals that we send to our young people concerning marijuana. This year, the administration put out the National Drug Control Strategy, and I was delighted when it sounded the alarm on marijuana. There's a number of statements in there talking about the danger of marijuana; the danger of teenagers using marijuana, but despite theses acknowledgements, as Mr. Barr indicated, the strategy proceeds to call for a study of marijuana's medical effectiveness, and I'm concerned about this, again, because of the signals that we are sending to our young people. I believe that's the wrong way to go on this issue. If marijuana could be legalized for one purpose, I think the question is, why not some others? And, so I'm concerned about it from that standpoint.
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In 1987, only after 6 years of experimenting with legalized medical marijuana, my own State of Arkansas repealed a law allowing doctors to prescribe THC for cancer patients, and so I think that we have to be very, very careful in this area, and I look forward to hearing the testimony of General McCaffrey. Thank you, Mr. Chairman.
[The prepared statement of Mr. Hutchinson follows:]
PREPARED STATEMENT OF HON. ASA HUTCHINSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ARKANSAS
Mr. Chairman, thank you for holding this important hearing. It has been several months now since California and Arizona passed state ballot initiatives legalizing marijuana for medical use. I believe it is appropriate to hold this hearing to learn more about how these initiatives are being implemented—especially in light of the fact that other states are considering similar proposals.
I have to say, though, Mr. Chairman, from what I have heard, things are not going well. I was in California a few months ago and met with agents from the DEA on this particular issue. Most in the law enforcement community agree that the ballot initiative was so poorly drafted that it has become impossible to regulate or enforce.
While there, I also heard a number of disturbing reports about the way the marijuana dens are conducting business. Individuals claiming to be ill can show up at their local marijuana den and smoke a joint without ever having to produce a prescription or note from their doctor. There are absolutely no safeguards in place to prohibit young people from taking advantage of this new drug source.
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The Clinton Administration's own National Drug Control Strategy for 1997 acknowledges the prevalence of marijuana in our society, as well as the frequency of use by young people. Let me just quote a few of these statements:
''Marijuana is the most readily available illicit drug in the United States.''
''Marijuana remains the most commonly-used illegal drug in the United States.''
''Over the past decade, marijuana prices have dropped even as the drug's potency has increased.''
Teenagers who smoke marijuana are ''eighty-five times more likely to use cocaine than a non-marijuana smoking peer.''
Despite these acknowledgments, the strategy proceeds to call for a study of marijuana's medicinal effectiveness. This is absolutely the wrong way to go on this issue. It sends the wrong signal to our young people. If marijuana can be legalized for one purpose, why not others?
Marijuana is a clearly a gateway drug. Studies released this summer indicate for the first time that marijuana activates the same pleasure centers in the brain that are targeted by heroin, cocaine and other so-called ''hard'' drugs. Marijuana, in effect, primes the brain for the use of other drugs.
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Another issue worth mentioning is that we are not dealing with the old maryjane from the 60s. Today's marijuana is significantly more potent.
In 1987, only after six years of experimenting with legalized medical marijuana, my own State of Arkansas repealed a law allowing doctors to prescribe THC for cancer patients.
In light of these comments, Mr. Chairman, I am eager to hear from our witnesses and enter into a dialogue on this important issue.
Mr. MCCOLLUM. Thank you very much, Mr. Hutchinson.
I want to welcome General McCaffrey and Dr. Leshner who are here with us today.
Our first witness is General McCaffrey. On February 29, 1996, he was confirmed by unanimous vote of the United States Senate as Director of the White House Office of National Drug Control Policy. He serves as a full member of the President's Cabinet and as the Senior Drug Policy Official in the executive branch. He is also a member of the National Security Council. Prior to his confirmation as the Nation's drug czar, he was the Commander-in-Chief for the U.S. Armed Forces southern command where he was responsible for coordinating all national security operations in Latin America. Director McCaffrey is a graduate of Andover Academy and the United States Military Academy. He received his M.A. degree in Civil Government from American University and is a graduate of Harvard University's National Security program.
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At General McCaffrey's request, he is being joined today by Dr. Alan Leshner. The Director wanted to have Dr. Leshner's medical and scientific expertise available for this subcommittee in case there should be questions posed of a technical nature. Dr. Leshner is the Director of the National Institute on Drug Abuse for the National Institute of Health. NIH supports over 85 percent of the world's research on health aspects of drug abuse and addiction. Prior to coming to NIDA, he had been the Deputy Director of the National Institute of Mental Health since 1988. Dr. Leshner received his undergraduate degree in Psychology from Franklin and Marshall College and M.S. and Ph.D. degrees in Physiological Psychology from Rutgers University.
I want to welcome both of you today. It's my understanding that General McCaffrey is giving the testimony, and Dr. Leshner's here for questions. Please proceed General McCaffrey. We have your full statement and, without objection, will insert it into the record. Hearing none, it is so ordered. You may give us whatever summary of that you choose.
STATEMENT OF GENERAL BARRY R. MCCAFFREY, DIRECTOR, OFFICE OF NATIONAL DRUG CONTROL POLICY, THE WHITE HOUSE
Mr. MCCAFFREY. Well, thank you, Mr. Chairman, for the opportunity to come over here and make an opening statement and respond to your own questions, and listen to your own views. I do appreciate Dr. Alan Leshner joining me at Secretary Shalala's approval. As you have noted, he is a very distinguished scientist who has a been a tremendous source of support and information. All of us were involved in the drug issue along with Dr. Harold Varmus, the NIH director; Dave Satcher, down at CDC, and others, Dr. Nelba Chavez, and more importantly I would add that I have Dr. Hoover Adger here, my own deputy, a distinguished pediatrician from Johns Hopkins University by background and one who has spent a good bit of his life dealing with the problems of adolescent addiction.
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Mr. Chairman, with your permission, let me also note present in this hearing—and I very much appreciate their influence on our administration policy over the last 18 months—are several other people that I would like to call to your attention: Dr. James Callahan, the executive director of the American Society of Addictive Medicine, which has been a tremendous source of information and experience. He and David Smith out at the Haight Ashbury Free Clinic have been instrumental in helping us understand the enormous problems of drug abuse. Bill Alden is here, the deputy director of DARE, the largest drug prevention program in America. As many of you are aware, it reaches more than 25 million children across the country. Mr. Daryl Grecich, deputy director of the Institute for a Drug-Free Workplace is here. They represent more than a hundred of our principal, national corporations and companies.
I'm very proud that Stacy Reynolds is here representing Dr. Mitch Rosenthall from Phoenix House, which is perhaps, the preeminent therapeutic community organization, non-profit, in the country. Among—I would assert—the most influential people in the Nation on the drug abuse problem is Jim Copple, the president and CEO of Community and Anti-Drug Coalitions of America. As many of you know, the Portman bill recently passed, and over the next 5 years we hope to take the more than 4,000 anti-drug coalitions and more than double them to 10,000.
We have Linda Wolf Jones here from Therapeutic Communities of America. I thank her for her support. Dean Kueter of the National Sheriff's Association; Judge Jeff Tauber, the president of the National Association of Drug Court Professionals, a tremendous movement; more than 3,000 members across the country today. Johnny Hughes is here, delegate at large of the National Troopers Coalition, representing some 45,000 of our most effective domestic law enforcement officers; Dr. Nolan Jones, the deputy director of the National Governor's Association and Laura Waxman, the Assistant Executive Director, U.S. Conference of Mayors, and as you know, the Mayor's Conference has been a big factor in our thinking over the last year. Rich Daly and his associates put together a subconference on the drug issue, which culminated with a meeting with the President and most of his Cabinet here in the last few months.
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Let me, if I may, make some very brief opening remarks, and, perhaps, start by telling Mr. Conyers that I thought your summary is about as eloquent a capturing of the problem as I've heard lately. Perhaps, your final conclusion deserves more discussion, but I think the way you've laid out the logic train, I fully support.
Let me make some quick points.
Mr. CONYERS. Sounds like you're a diplomat as well as a general.
Mr. MCCAFFREY. Well, I mean what I said, though, that your—the logic train is what ought to guide the discussion in the debate.
The first point I would make is that the legalization of pot is a legitimate issue for public debate in a democracy. Men and women are more than welcome to lay out the reasons why they feel that smoked marijuana ought to be available for general use. Having studied the issue, I join the overwhelming majority of the American public in concluding that marijuana legalization is not the answer.
Now, let me turn to the subject of the hearing. Whether smoked marijuana qualifies as a medicine—and I would assert that that is one of the few no-brainer assertions that I face in the drug world in that it should be decided by scientific medical reasoning and not by either public referendum or political debate. This is a subject that should be in front of the National Institute of Health, the Food and Drug Administration, and should be informed in its consideration by institutions like the American Medical Association, the American Cancer Society, the American Society of Ophthalmology, the National Multiple Sclerosis Society, the American Glaucoma Society. They are all in agreement that marijuana has no scientifically-established medical use, and that sound medical research is needed to determine whether or not such use may exist. So, we stand solidly with the NIH and with the great professional associations of this country in saying that smoked pot—so far, the 12,000 studies don't demonstrate validity—is a scientific medical question.
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Now, having said that, I would be disingenuous to not note publicly that we got the point that smoked pot has some 400 plus chemicals; it's an impure, unstable mixture; it has 2,000 chemicals when in smoked form. We understand that regular use impairs learning, memory, and attention span, and we understand that the brain effects caused by marijuana are similar to those produced by cocaine, heroin, alcohol, and nicotine. And I will share with you a handout that we just got out of Brookhaven Laboratories that's essentially a PET scan of normal brain function and brain function of a regular marijuana user.
[The information referred to follows:]
58955a.eps
Mr. MCCAFFREY. So, we do understand that it is a dangerous drug, and under that general definition it ought to be studied carefully for whether it has medical use.
In addition, I would also remain skeptical that at the end of the day, marijuana as a smoked form would end up as a medical therapeutic tool. I would argue that down the line if there are other compounds in smoked marijuana that find medical use, it's more likely you'd see the delivery vehicle being an inhaler or a suppository or a skin patch or some other way of controlling dose rates.
Now, a final thought—if you'll allow me—it seems to me there's no reason to be afraid of science. You know, at the end of the day, we have some distinguished people: the American Academy of Sciences, Institute of Medicine; we've asked them to go review the scientific literature, and tell us what we know and don't know about smoked marijuana and its alleged therapeutic benefits. We have a Dr. Harold Varmus, a reasonably astute lad with a Noble prize in science who ought to be able to marshall the scientific groups in this country to look at the question as to whether it pays off or not, and Dr. Alan Leshner will be, obviously, the point man in that whole effort.
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Finally, I would remind all of us that, you know, we've got to understand history and turn to the scholars. Lloyd Johnson's theory of generational forgetting and generational replacement is the heart and soul of what we're really concerned about. We understand that drug use among children has skyrocketed in the last few years. We're concerned about it. We understand that if you don't use pot, cigarettes, alcohol, or other drugs between the age of 10 and about 19, you'll never have an addictive problem in your entire life. So, again, our message, our intent, is to work with parents, community coalitions, educators, and the medical community to protect our children.
Finally, we ought to turn to history. Dr. David Musto's study of the 30-year cycles of drug abuse in America ought to inform us of past dangers and ensure that we don't fall into the same traps. We've gone through cycles of cocaine use, of heroin use, and it seems to many of us that we've got to talk clearly with one voice and stand against the compulsive use of the Schedule I substances.
Now, very quickly, Steve—let me remind you, this is University of Michigan work. We've got some good data starting in the late 1960's on youth attitudes. And with youth attitudes we say the disapproval rate predetermines whether or not we see enhanced drug use among children. That curve changes, as you may note, in 1990. Then we look at the attitude as to whether there is a perceived risk of using drugs, and that curve, again, changes around 1991. And then, finally, predictably, we see drug use rates among youngsters start uphill in 1992 and continue uphill every year so that it is now about half as bad as it was in 1979, and it will get worse unless we get organized, we as a society, and talk to our children—speaking forcefully against the use of drugs.
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Finally, where are medical marijuana initiatives around the country? And they are all over. In some States in referendum form, and in others, in the form of court challenges, and in other States, in the form of the legislative initiatives. We're going to track it, and provide, as we have, a 15 August, 1997 statement of the administration's position on medical marijuana. And our position is to support it being decided by the NIH and the FDA. We think these initiatives in many parts of the country, plain and simple, are actually being manipulated in a very aggressive way by those who support the legalization of drugs.
I, again, support Mr. Conyers' notion that that shouldn't divert us from deciding it on a scientific basis, but we shouldn't be naive either, and not understand that this is what's going on.
Final chart is just, again, to lay out sort of the background of drug abuse by youngsters. It's been a lot worse. Fifteen years of hard work by community coalitions and parents paid off. We dropped drug abuse among children from disgracefully high rates in the 1970's down to where it is today, and we've got to stay at it.
So, Mr. Chairman, I thank you for the opportunity to talk to this subject, and I look forward to responding to your own questions.
[The prepared statement of Mr. McCaffrey follows:]
PREPARED STATEMENT OF GENERAL BARRY R. MCCAFFREY, DIRECTOR, OFFICE OF NATIONAL DRUG CONTROL POLICY, THE WHITE HOUSE
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OUTLINE OF TESTIMONY
I. A Federal Response Based on Science, Not Ideology
A. What Constitutes Good Medicine Should Not be Determined at the Ballot Box
B. Protecting the American Public from Unproven Substances is Our Shared Responsibility
C. Marijuana Remains a Controlled Substance
D. No Rational Basis Exists for Exempting Marijuana From the Standard
Approval Process—Anecdotes Should Not Drive Public Health Policy
1. Smoked Marijuana Poses Risks for the Individual User
2. Smoked Marijuana is a Significant Risk To America's 68 Million
Children
a. Drug Use is Up Among Young People
b. Attitudes Determine Behaviors
c. Marijuana is a ''Gateway'' Drug
3. Drug Availability Leads to More Abuse and Addiction
4. Science Documents the Risks of Marijuana Use to Individuals and Society
II. Safeguarding the Public Health
A. ONDCP's Efforts to Inform Decision-makers and the Public
B. ONDCP's Efforts Demonstrate the Federal Commitment to Science Over
Ideology
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1. Scientific Studies
2. Recent Advances Have Increased the Availability of Effective Medications
C. ONDCP is Working to Change Perceptions of Drug Use Among Our Nation's Youth
III. A Shared Commitment
STATEMENT
Chairman McCollum, members of the subcommittee, thank you for the opportunity to address the issue of medical marijuana referenda in the United States. The Of lice of National Drug Control Policy is pleased to work with the 105th Congress to dramatically reduce drug use and its consequences. In particular, Chairman McCollum, the Of lice of National Drug Control Policy appreciates your longstanding support, as well as that of this committee's members. Indeed, the Of lice of National Drug Control Policy Reauthorization Act of 1997, which is now before the Congress reflects a continuing and constructive dialogue between committed Senators and Representatives, their expert staff, and ONDCP. Over the past 17 years, bipartisan partnership has contributed to a 50 percent overall reduction in drug use and a 75 percent reduction in casual cocaine use. Nevertheless, America's drug abuse problem will kill another 140,000 Americans and cost our society $700 billion over the coming decade if unchecked. My commitment to the Congress when you considered my appointment in February of last year remains constant—to forge a coherent counter drug strategy that will reduce illegal drug use and protect our youth and society in general from the terrible damage caused by drug abuse and drug trafficking.
Today, it is my purpose to update you on developments since early December 1996, when we addressed the issue of medical marijuana referenda before the Senate Committee on the Judiciary. The ballot initiatives passed in November of 1996 in Arizona and California bypassed the rigorous scientific approval process required of all medicines and allowed for the use of marijuana as a ''medicine.'' The President directed ONDCP to lead an interagency task force responsible for developing a sound federal response. Members of this task force included: ONDCP and the departments of Justice, Treasury, Defense, Health and Human Services, Transportation, Labor, Education, and the Postal Service, and the Nuclear Regulatory Commission. ONDCP also sought input from prominent medical experts, elected state and local officials, Congressional delegations, drug prevention and treatment groups, law enforcement officials, community leaders, and concerned citizens. On December 30, 1996, the federal response was announced at a press conference with Attorney General Reno, Health and Human Services Secretary Shalala, Director of the National Institute on Drug Abuse, Dr. Alan Leshner, and myself
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I. A Federal Response Based on Science, Not Ideology
The logic of the federal response is simple: federal law remains in effect, and science must prevail over ideology. At the heart of the federal response is the preservation of the longstanding, established medical-scientific process for ensuring that any substance purporting to be a medicine must undergo the rigorous evaluation of the scientific process. This process has protected American citizens from snake oils, dangerous drugs, unproven substances and ineffective treatments for over fifty years. Because of this process, American citizens have faith that the drugs they take are both safe and effective. The government's position is that any substance provided or sold to the American public as a medicine must withstand the scrutiny of the same medical-scientific process to which all other potential medicines are subject. To exempt any substance from this time-honored procedure will undermine the established process that has long protected the American public so well.
The federal response on medical marijuana has four goals: 1) preserving the established scientific medical process for determining safe and effective medicines; 2) protecting our youth; 3) upholding existing federal law; and, 4) preserving drug-free workplaces. Attached is a copy of the federal response. (Tab A) All of the agencies listed in the response are undertaking the outlined activities to achieve these four goals.
A. What Constitutes Good Medicine Should Not be Determined at the Ballot Box
Referenda cannot protect American citizens from fraudulent claims and dangerous drugs. Nor can they ensure that potential medicines are subjected to a process of evaluation by both the Food and Drug Administration (FDA) and the National Institute of Health (NIH) based on sound science. A fundamental role of the FDA is to protect the public's health and safety by testing every potential medicine to ensure both their safety and efficacy.. For a purely medical and scientific issue to be decided by popular referendum undercuts the safeguards established over the years by the Congress through the federal Pure Food and Drug Laws. Subverting the public health process and declaring smoked marijuana a ''medicine'' threatens the integrity of our established medical safeguards.
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This issue has nothing to do with marijuana specifically; rather, it has everything to do with protecting the public health and safety of our citizens. Avram Goldstein, M.D., Professor Emeritus of Pharmacology at Stanford University, offers the following analogy: Imagine a ballot initiative to change the rules by which the Federal Aeronautics and Aviation (FAA)'s Air Traffic Control System manages commercial aircraft in California. It is disturbing to think that a well-funded activists in one state could establish different procedures from the rest of the country on a matter that clearly affects the well-being of all of us. If sound medical research demonstrates that there are medical uses for smoked marijuana, there are appropriate and responsive procedures for rescheduling this mind-influencing drug through the time-tested process. The FDA has already demonstrated flexibility in accelerating procedures for allowing the use of emerging AIDS-related drugs without jeopardizing science or the public health.
B. Protecting the American Public from Unproven Substances is Our Shared Responsibility
The medical process for establishing substances as medications is well established and clear: the FDA evaluates clinical and laboratory data developed and submitted by outside scientists and clinicians to determine if the scientific evidence demonstrates that the benefits of the intended use of a particular drug outweigh the associated risks for that use. This process protects the public by ensuring that adequate scientific studies have been performed to provide a rational basis from which to conclude that the benefits of a drug outweighs its risks and by assuring that the product is accompanied by sufficient information to the physician and patient to permit its accurate prescription and use. Allowing any drug to bypass the federal approval process does a grave disservice to the public. Further, allowing any potential medication to bypass this process establishes a loophole that threatens to undermine the imperative for rigorous science as the basis for determining what constitutes good medicine.
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C. Marijuana Remains a Controlled Substance
Marijuana has not been approved by the FDA to treat any disease or condition. Because marijuana has a high potential for abuse and no currently accepted medical use in the United States, it remains a Schedule I drug under the provisions of the Controlled Substance Act, Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. Moreover, the FDA, as reported by Associate Commissioner for Health Affairs Dr. Stuart Nightingale, has not been provided sufficient studies on smoked marijuana to permit the agency to determine if the potential benefits of smoking marijuana for specific indications outweigh the known risks associated with the drug. Absent sufficient scientific evidence, there is no rational basis for a change in the classification of marijuana. It is in the interest of every American to ensure the continued application of the medical-scientific process to determine the safety and efficacy of drugs for therapeutic uses.
D. No Rational Basis Exists for Exempting Marijuana From the Standard Approval Process—Anecdotes Should Not Drive Public Health Policy
We must ensure that all patients receive compassionate treatment using medicines proven to be safe and effective. However, the tragic lessons of history serve to remind us that hope and hearsay are not enough. Drug legalization proponents play on the sympathies all Americans share for those suffering from serious illnesses. We must do all that we can to minimize human suffering and to treat these tragic diseases. However, anectdotal claims about the medical benefits of smoked marijuana are insufficient grounds to subvert the protections Americans rely upon and deserve. In short, science provides no reason to exempt smoked marijuana from meeting the same rigorous standards required by all substances purporting to yield medical benefit.
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1. Smoked Marijuana Poses Risks for the Individual User
The preponderance of scientific evidence to date demonstrates that marijuana is a dangerous drug. Marijuana is a contributing cause in the injury and death to users and non-users alike. Research shows that smoked marijuana, in addition to impairing normal brain function, also damages the heart, lungs, reproductive and immune systems. Recent studies show that regular, heavy marijuana use compromises the ability to learn and remember information primarily by impairing an individual's ability to focus, sustain, and shift attention. The PET scan, attached at Tab B. demonstrates the effects of marijuana on the normal neurochemical activity of the human brain. The four images at the top of the slide show normal brain activity. The four at the bottom show the brain activity of a marijuana abuser. The color red indicates the highest level of activity. Yellow, green, and lastly blue, show respectively diminishing levels of brain activity. Compared to the normal slides, the brain slides of the marijuana abuser clearly show diminished activity in all cross sections, particularly in the cerebellum. Lower cerebellar metabolism explains not only defects in motor coordination, but also seems to account for some of the reported learning disturbances found in chronic marijuana users. These effects are alarming among adults; they are extremely dangerous for adolescents.
2. Smoked Marijuana is a Significant Risk To America's 68 Million Children
Medical marijuana initiatives present even greater risks to our young people. Drug use, in particular marijuana use, among our young people is already too high. The rate of drug use among our children is linked to their perceptions of risks related to drugs. Referenda that tell our children that marijuana is a ''medicine'' send them the wrong signal about the dangers of illegal drugs—increasing the likelihood that more children will turn to drugs. Moreover, marijuana is a ''gateway'' drug, leading children into more harmful drug use and eventually addictions.
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a. Drug Use is Up Among Young People
The results from the National Household Survey on Drug Abuse (NHSDA) over the past few years suggest that the general decline in drug use from the peak of the late 1970s may have ended. No significant changes—either up or down—in illicit drug use or in the total numbers of casual and hardcore users were reported in 1996, compared with 1992, 1993, 1994, or 1995. Current drug use appears to have stabilized at about 6 percent of the general population. However, illicit drug use by adolescents has been increasing steadily since 1992.
The rate of current drug use of any illicit drug among youth ages 12 to 17 was 10.9 percent in 1995. Although that figure dropped to 9 percent in 1996, the rate remains markedly higher over 1992's low of 5.3 percent. Marijuana represents the bulk of this increase in drug abuse among children. According to the 1996 NHSDA, the rate of past-month marijuana use among children ages 12 to 17 was 7.1 percent, more than double the 3.4 percent long-term law for 1992. The consequences of youth marijuana use are devastating; over half (55 percent) of all youths ages 15–17 admitted to drug treatment, were seeking treatment for marijuana. (SAMHSA Office of Applied Studies.)
The 1997 Back to School Survey conducted by the Center on Addiction and Substance Abuse (CASA) at Columbia University also found that drug use is becoming more commonplace for our young people. The study found that an increasing number of children had been exposed to: deaths from substance abuse-related incidents, kids coming to school drunk or high, smoking, drinking and drug sales on school grounds, students expelled or suspended for possessing, using or selling drugs, and parties where marijuana is available. The study further found that teens are more likely to see drugs sold at school than in the neighborhood—41 percent of high school students have seen drugs sold at their schools, while only 25 percent have seen them sold in their neighborhoods. The 1997 CASA study also found that 74 percent of high school students and 52 percent of middle school students say a student has been expelled or suspended for possessing, using, or selling drugs in the past year. 56 percent of high school students and 24 percent of middle school students have attended a party in the past six months where marijuana was available.
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b. Attitudes Determine Behaviors
The University of Michigan's annual Monitoring The Future (MTF) survey of drug use among youth, the preeminent report on juvenile attitudes and drug use rates, shows that as our children become more accepting of drug use and less fearful of its consequences, they increasingly use marijuana and other drugs of abuse.
According to the MTF Survey, youth attitudes about drugs began to soften in 1989. These changes were reflected by lowered rates of disapproval and diminished perceptions of drug use as risky. Two years later, marijuana use by our children began to increase. The MTF reports that marijuana use among 8th graders was 3.2 percent in 1991, and increased each year thereafter to a rate of 11.3 percent in 1996.
The MTF also reports that the rate of marijuana use among 10th and 12th graders began to increase in 1992. Twelfth graders' use increased from 11.9 percent in 1992 to 21.9 percent by 1996; 10th grade use increased from 8.1 percent in 1992 to 20.4 percent by 1996. (See charts at Tab C.)
Dr. Lloyd Johnston, who has directed the MTF survey since the 1970s, suggests ''generational forgetting'' as a major factor contributing to the five-year trend (1991–1996) of increased drug use among our children. His theory holds that as new generations have less direct experience with the negative consequences of drug use, the likelihood that they will begin using drugs increases. Dr. David Musto of Yale University has also documented this phenomenon of learned experience informing decisions to use drugs since the turn of the century. Clearly, when people see firsthand the pernicious effects of illegal drugs, they tend to reject them. This may be one of the reasons past-month marijuana usage rates declined from 10.9 percent to 9 percent in 1996 among those ages 12 to 17 (NHSDA).
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Changing youth attitudes toward marijuana and other drugs is the key to reducing drug use among our children. We cannot afford any further erosion of youth attitudes towards drugs by allowing marijuana to be falsely depicted as a safe and effective medicine. When Americans think of smoking marijuana, erroneously the image they remember is ''Cheech and Chong.'' Whether intended or not, permitting the ''medical'' use of smoked marijuana will send the a false and powerful message to our adolescents that marijuana use is beneficial. If pot is medicine, teenagers rightfully will reason, how can it hurt you? At a time when we need to be reaching out to our young people and explaining the dangers of drug use, we can ill afford to send our children a mixed—or more accurately a mixed up—message on marijuana. No one should make the mistake of believing that increased societal acceptance of marijuana will not cause drug abuse to increase among our children.
c. Marijuana is a ''Gateway'' Drug
The danger of sending the wrong message to our children about marijuana is compounded by the fact that smoking marijuana can often be the first step down a slippery path that leads to the use of drugs like cocaine, heroin, LSD, and methamphetamine. Most young people who smoke marijuana do not end up addicted to drugs. However, NHSDA reports and research by the Center on Addiction and Substance Abuse at Columbia University (CASA) both establish a strong correlation between marijuana use and cocaine use. Among those young people who have tried cocaine, virtually all used marijuana first.
CASA's October 1994 report on Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use, concluded that a 12 to 17-year old who uses marijuana is 85 times more likely to use cocaine than one who does not. This statistical correlation is 8 times stronger than the link between smoking and lung cancer, 17 times stronger than the link between exposure to asbestos and lung cancer and, 20 times stronger than that between high cholesterol and heart disease. The report also found that the earlier children begin to smoke marijuana, the more likely they are to subsequently use cocaine. Sixty percent of children who used marijuana before the age of 15 progressed to cocaine use, while only 20 percent of those who began smoking marijuana after the age of 17 did so.
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These strong statistical correlations should inform both individual behavior and public policy. Parents, mentors, and children should conclude that smoking marijuana is not innocuous. All of us should understand that anything that directly or indirectly causes increased marijuana use by our children also paves the way for increased ''hard'' drug use and addiction.
3. Drug Availability Leads to More Abuse and Addiction
Allowing the medical use of smoked marijuana would also likely increase the availability of marijuana, thereby increasing the risks of widespread drug use. As drugs become more available, abuse and addiction rise. By allowing marijuana to be legally grown, and used, medical marijuana initiatives are likely to increase the amount of marijuana that is available on our streets and in our schools for illegal use. The burgeoning number of cannabis clubs creates a huge potential for diversion to the streets, where teenagers comprise a lucrative target market. The potential for black market spillover is heightened because the referenda that are at issue provide little or no effective medical or law enforcement supervision of the use of marijuana. For example:
California Proposition 215 fails to define both what constitutes a ''caregiver'' and the ''conditions'' for which marijuana could be used. Given that some advocates claim marijuana can be used to help everything from writer's cramp to diarrhea, virtually anyone possessing marijuana could claim some ''caregivers'' relationship to someone with some form of''condition .'' Because 215 contains no age limitation, a child could legally use marijuana on a verbal—or even Internet—recommendation of any physician, even without an examination.
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District of Columbia initiative, ''Measure 57,'' provides that up to 20 people would be allowed to cultivate and sell unlimited quantities of marijuana for an individual with a condition drawn from a similarly amorphous range of conditions. If this initiative were to become law, drug traffickers would be basically shielded from successful prosecution.
The law of supply and demand suggests that increasing the supply of marijuana available in the United States will cause the price of marijuana to drop even more and the psychoactive properties of the drug to further increase.
4. Science Documents the Risks of Marijuana Use to Individuals and Society
For decades, U.S. policy-makers have opposed the legalization of marijuana based on the weight of the available scientific evidence. Marijuana advocates have mounted a well-financed and sophisticated public relations campaign to persuade Americans of their point of view. These deceptive public relations efforts have relied almost exclusively on personal anecdotes to support their position. Anecdotes aside, the scientific data currently available paint a strikingly different picture from the image those who support legalization would have the American public see.
For example, two recent research studies, published this past June in Science, have demonstrated disturbing similarities between marijuana's effects on the brain and those produced by highly addictive drugs like cocaine, heroin, alcohol, and nicotine. According to David Friedman, M.D., a neurobiologist at Bowman Gray School of Medicine, these studies ''send a powerful message that should raise everyone's awareness about the dangers of marijuana use.''
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Meanwhile, misconceptions about marijuana continue to abound. Confused by conflicting messages, it is no wonder that many Americans, especially our youth, do not understand what current scientific research is teaching us about the damaging effects of smoked marijuana. Current research points to serious risks for society. Marijuana smoke contains cancer-causing compounds, reduces workplace productivity, and is increasingly prevalent in automobile accidents and youth fatalities. Examples of recent findings include:
A roadside study, conducted in Memphis, Tennessee, of reckless drivers not believed to be impaired by alcohol, found that 45 percent tested positive for marijuana. (Brookoff D et al., Testing Reckless Drivers for Cocaine and Marijuana, New Eng J Med 320:762–768, 1994.)
Marijuana impairs coordination, perception, and judgment, causing many accidents. A study of 1023 trauma victims revealed that marijuana had been used by 34.7 percent. (Soderstrom CA et al., Marijuana and Alcohol Use Among 1,023 Trauma Patients, Archives of Surg 123:733–737, 1988.)
One study conducted at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, found that 34 (32.1 percent) of the 106 motorcyclists treated for injuries tested positive for marijuana. (Soderstrom CA et. al., Psychoactive Substance Use Disorders Among Seriously Injured Trauma Center Patients, JAMA. 277 (22): 1769–74, 1997 Jun 11.)
A study of 182 fatal truck accidents revealed that 12.5 percent of the drivers had used marijuana, in comparison to 12.5 percent for alcohol, 8.5 percent for cocaine, 7.9 percent for stimulants. (Department of Transportation. National Transportation Safety Board Report, Washington, D.C., February 5, 1990.)
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The most consistent finding from the literature on employee marijuana use is its association with increased absenteeism. It is also associated with increased accidents, higher turnover, low job satisfaction, counterproductive behavior, withdrawal and antagonistic behavior, and higher use of employee assistance programs and medical benefits. (NIDA National Conference on Marijuana Use: Prevention, Treatment and Research, 1995.)
Treatment figures show that 141,000 Americans were admitted in 1995 to drug treatment programs for marijuana addiction. Over half (55 percent) of all youths ages 15–17 admitted to drug treatment, were seeking treatment for marijuana. (SAMHSA Office of Applied Studies.)
II. Safeguarding the Public Health
A. ONDCP's Efforts to Inform Decision-makers and the Public
In order to preserve the protections enjoyed by our citizens, ONDCP will continue to provide assistance to state legislatures and urge them to support the federal response based on science. Our efforts to date include the widespread dissemination of the ONDCP Policy Statements on Marijuana for Medical Purposes and on Industrial Hemp. These policy statements have been sent to the governors of all the states, law enforcement agencies, and numerous nongovernmental organizations. (Copies of these statements can be found under Tab D (Medical Marijuana), and Tab E (Industrial Hemp).) In addition, ONDCP has also focused further efforts to inform the public and decision-makers as to the dangers of medical marijuana referenda in those states where such initiatives are under strong consideration. (States that are currently considering initiatives to allow the medical use of marijuana are outlined in map format under Tab F.)
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B. ONDCP's Efforts Demonstrate the Federal Commitment to Science Over Ideology
1. Scientific Studies
The efforts of the Department of Health and Human Services and ONDCP demonstrate the federal government's commitment to and reliance upon the scientific process as the appropriate means to determine the potential medical use, if any, for smoked marijuana. To that end, we have supported the following actions:
Institute of Medicine (IOM) Study: In January 1997, ONDCP commissioned the IOM of the National Academy of Science (NAS) to conduct a comprehensive review of the known health effects and potential medical use of smoked marijuana. This evaluation is now assessing the current state of scientific knowledge; identify gaps in the knowledge base about marijuana; and will include clinical, medical, and scientific evidence on the following topics:
— the neurological mechanism of action of marijuana;
— the effects of marijuana on health and behavior;
— marijuana's possible ''gateway'' characteristics;
— the efficacy of therapeutic use of marijuana for specific medical conditions; and,
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— the effects of marijuana use compared with approved alternative psychotherapies.
The IOM has selected two ''Principal Investigators'' to conduct the study. These Investigators will now solicit additional expertise from universities, health professional schools, medical centers, hospices, state and local health departments, and other resources as appropriate. There will be three public meetings, at least one will be held on each coast, to foster maximum input. The final report will be released to the public upon completion in December 1998. We look forward to sharing these results with the subcommittee and the other members of Congress as they become available.
THE NATIONAL INSTITUTES OF HEALTH (NIH) WORKSHOP ON MEDICAL UTILITY OF MARIJUANA: In February, 1997, the NIH convened a 2-day meeting to review the scientific data concerning the potential therapeutic uses for marijuana and the need for and feasibility of additional research. The Ad Hoc Group of Experts received testimony from recognized experts in the field as well as public testimony. In August 1997, this group of experts released their report to the NIH, which is currently reviewing its substance and conclusions. (See Tab G.)
The panel concluded that the risks associated with marijuana, especially smoked marijuana, must be considered not only in terms of immediate adverse effects on the lungs, but also the long-term effects in patients with chronic diseases. The experts also were concerned about the possibility that frequent and prolonged marijuana use might lead to clinically significant impairments of immune system function is great enough that studies on immune function should be part of any research project on the medical uses of marijuana. This is especially true in studies involving patients with compromised immune systems. Members of the group also were concerned about the effects of the dangerous combustion byproducts of smoked marijuana on patients with chronic diseases. Based on these risks, they favored the development of a smoke-free inhaled delivery system that could provide to the patient purer forms of marijuana's most active ingredient, delta-9-tetrayhydrocannabinol (THC), or its related compounds known as cannabinoids.
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According to Dr. Harold Varmus, the NIH is open to receiving research grant applications for studies of the medical efficacy of marijuana. Applications will undergo the normal scientific review process. NIH is prepared to fund applications that meet the accepted standards of scientific design and that, on the basis of peer review, are competitive with other applications that qualify for funding.
DEVELOPMENT OF ALTERNATIVE DELIVERY SYSTEMS FOR THC: THC, the major psychoactive ingredient in the marijuana plant, is already available as a synthetic FDA-approved medication known as ''Marinol,'' which is taken by mouth. Like all drugs authorized by the FDA, Marinol has proved itself safe and effective in valid clinical trials for the control of nausea and for wasting due to AIDS. THC has not been shown to be safe and effective for any other condition. Like almost all drugs used in modern medicine—for reasons of quality control and safety—THC is a pure substance, not a crude and variable mixture in a plant.
ONDCP has met with pharmaceutical representatives to determine their time-table for the development of alternative delivery systems such as inhalers, skin patches, and/or suppositories. Development of these alternative delivery systems over the next 2–5 years will provide a safer means of delivering THC. Efforts are now underway to educate physicians regarding the efficacy and availability of Marinol as well as proper dosing strategies to achieve maximum therapeutic effect.
2. Recent Advances Have Increased the Availability of Effective Medications
In addition to the scientific efforts being undertaken by the government, medical research in general is increasing the availability of other effective treatments that stand to render any potential need for medical marijuana as obsolete. Philip Kanof, M.D., Ph.D., a distinguished psychiatrist and pharmacologist at the VA Medical Center in Tucson, raises an important question: How many individuals truly are unable to obtain relief with appropriate use of existing FDA-approved medications? According to Dr. Kanof, newer 5HT3 receptor antagonists such as odansetron and granisetron have been very successful in managing nausea and vomiting in most chemotherapy patients. Drugs such as baclofen, benzodiazepines, and the newly approved tizanidine often produce significant relief from spasticity due to multiple sclerosis. And, as previously mentioned, Marinol is often effective in stimulating appetite in those AIDS patients suffering from a wasting syndrome.
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To the extent that patients are suffering, it is important to question the degree to which their suffering is caused by their inability to obtain relief from existing medications, or because their physicians may not be as well informed as they might be about existing therapeutic options. Dr. Kanof urges that the first step towards alleviating the suffering of these patients should be the dissemination of algorithms for appropriate pharmacological management of these conditions—not encouraging the use of a carcinogenic drug with no accepted medical uses and significant abuse potential.
C. ONDCP is Working to Change Perceptions of Drug Use Among Our Nation's Youth
Regardless of whether smoked marijuana eventually demonstrates scientific merit for medical use, the number one goal of the National Drug Control Strategy remains that of educating and enabling youth to reject illegal drugs. ONDCP has developed a clear and powerful objective to meet that goal: the proposed Anti-drug Abuse Youth-Oriented Media Campaign. We recognize the tremendous power of the media in driving public opinion. Young people are particularly susceptible to the influences of television, the Internetand radio. Unfortunately, in recent years the number of drug-related public service announcements (PSAs) carried by television, radio, and print media have decreased markedly.
At the same time, there has been an increase in music, TV, movies, Internet web sites, fashion, humor, and other forms of communication that normalize or glamorize illegal drugs. Advertising experts believe targeted, high-impact paid media ads are the most cost-effective, quickest means of changing patterns of drug-use behavior by altering adolescent perceptions of danger and social disapproval of drugs. It is also the most effective means of reaching babyboomer parents who may be ambivalent about sending strong anti-drug messages to their kids.
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America needs to reverse the trends of youth drug use and diminishing PSAs by developing a public education campaign that supplements anti-drug announcements already offered by dedicated organizations like the Partnership for a Drug-Free America and the National Center for Advancement and Prevention. Youth will be warned about the hazards of illegal drugs and shown the advantages of a drug-free lifestyle. Information-based material will be repeated with sufficient frequency to reinforce learning and motivate youth to reject illegal drugs.
III. A Shared Commitment
Addressing the problem of drug use in America will only be possible through a shared commitment to progress. The bipartisan support of Congress has been instrumental to the work of the Office of National Drug Control Policy. We welcome and look forward to your continued help on a range of initiatives, including, but not limited to:
Passage of ONDCP's reauthorization;
Protection of the time-proven system that shields Americans from bad medicine;
Approval of the Anti-drug Youth-Oriented Media Campaign; and,
Assistance with restoring the Administration's budget request in drug-related areas, particularly with respect to the Safe and Drug Free Schools Program.
Your support for these and other initiatives is vital to continued progress in decreasing the use of illegal drugs in America.
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Thank you for this opportunity to testify on the issue of medical marijuana referenda in America. ONDCP remains committed to addressing this issue on the basis of sound science. The American public has the right to expect that our medicines are both safe and effective. It is our job—Congress and the Administration working together—to protect our citizens, in particular America's children. We look forward to a continued bipartisan effort to uphold the highest standards of American medicine while ensuring that our youth are equally protected.
58955b.eps
58955c.eps
58955d.eps
58955g.eps
Mr. MCCOLLUM. I thank you very much, again, General McCaffrey, for coming today and being our witness. I'll yield myself 5 minutes, and then we'll go to other members of the subcommittee for questions they may have this morning.
I am struck by what you've said about the increased likelihood of use of other drugs by youngsters who have used marijuana and by some of the statistics we've seen about the perceived acceptability of drugs. I have read the National Center on Addiction and Substance Abuse at Columbia University's study that says that 17-year olds who smoke marijuana are 85 times more likely to use cocaine than those who do not. Do you find that as shocking and disturbing as I do as we talk about medical marijuana initiatives and the possibility of or acceptance of marijuana?
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Mr. MCCAFFREY. Well, I certainly do, and, you know—I know Dr. Leshner has his own viewpoints on it. I frequently quote Dr. Herb Kleber up at Columbia University. What seems unarguable is the younger you are, and the more you use these intoxicating substances, the more likely you'll be to end up with a terrible addiction problem in life. We've got 3.6 million Americans addicted to illegal drugs, and you get there by adolescent use of pot, booze, cigarettes, and other drugs. And the statistical correlations are so overwhelming that if the question was: ''seatbelts; yes or no?'' ''fatty foods; yes or no?'' on heart disease, there'd be no argument about the question. So, the message is clearly to our parents and our educators: tell our children, don't use marijuana, particularly during your adolescent years.
Mr. MCCOLLUM. I'm going to direct this question to Dr. Leshner, but, General, you may certainly respond to it. I've got some more data here, Dr. Leshner. It says that marijuana is now 25 times more potent than it was in the 1960's. I think that may have come out in some studies that were done in your shop. I also have a study that says that the immune systems of people who use marijuana are suppressed, and one study says that those who are HIV positive are more likely to progress to full blown AIDS twice as fast as people who don't use marijuana. Those are both rather shocking numbers and figures.
Do you have any knowledge of those numbers, and can you tell us, number one, is marijuana more potent today than it was in the 1960's? Have we developed a new strain, a stronger more powerful marijuana than past generations were used to? And number two, does marijuana use, to your knowledge, tend to suppress immune systems and make HIV positive people, who are regular smokers, develop full-blown AIDS more quickly?
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Mr. LESHNER. There's no question that marijuana, today, is more potent than the marijuana in the 1960's, however, if you were to look at the average marijuana potency which is about 3.5 percent, it's been relatively stable for the last 20 years. Having said that, it's very important that what we have now is a wider range of potencies available than we had in the 1970's, in particular. That is to say, that people on the street could be getting marijuana very low potency, 1 to 3 percent, or they could be getting marijuana products with very high potency. So, taking an average is not necessarily a clear statement of it, however, we do know that there is a great range including some very high potency marijuana available on the street.
To answer your second question, there's no question that marijuana can compromise immune function; that's been demonstrated particularly in animal studies. The question of whether and what its direct clinical relevance might be to the progression of HIV in humans has not yet been studied extensively, however, if I could refer you to the report that NIH—of the workshop NIH held last February on the potential medical uses of marijuana, the expert group did highlight the question of the immunosuppression, or comprising of the immune system, as an issue for looking and for further study.
Mr. MCCOLLUM. I know that that is a very serious matter, and I know that same report, I believe, tells us that marijuana contains cancer-causing substances—many in higher concentrations in marijuana than in tobacco. Now, I suppose that still merits more study, but that's an interesting observation and a concern that I think is why we're all here today.
Medical marijuana use may have some narrow scope. However, I'm concerned when I read on the ballot initiative, General McCaffrey, that's just been introduced for the State of Florida that each natural person has the right to obtain and use marijuana for medical purposes when a licensed physician has certified: one, that the use of marijuana is medically appropriate for that person in the professional judgment of the physician, and that the person's health may benefit from the use of marijuana in the treatment of HIV, AIDS, anorexia, or other specified medical condition or illness. It's so broad. The door in these kinds of initiatives is open much more widely than the narrow scope that most people attribute to such initiatives for those with a terminal illness, or who are in great pain. That's what's disturbing about these initiatives. I assume, General McCaffrey, you too are disturbed by the broad sweeping scope that some of the initiatives have with regard to what physicians can recommend, not just prescribe. Am I correct?
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Mr. MCCAFFREY. Well, one of the reasons I welcome this hearing is it seems to me we've done a terrible job getting the point out that the medical associations support scientific research, NIH-based, and don't support this kind of approach to determine whether this or any other compound has therapeutic benefits. We don't want to have referenda deciding laetrile, thalidomide, or other substances as to whether or not they're appropriate and have medical value. We haven't made the case very well.
Mr. MCCOLLUM. Thank you very much. Mr. Conyers, you're recognized for 5 minutes.
Mr. CONYERS. Thank you, Chairman McCollum. First of all, let me return General McCaffrey's compliments; it was a good statement, a great statement. I can see the Bergman-Weiner influence in your remarks coming forward. Those are good people you've got on your staff.
Let me start with what we have to separate out. First of all, we have to separate out those neanderthals who don't want us to even study the subject. You know, this is something like reparations. We say, ''Let's have a study—let's talk about race, but we will not talk about reparations.'' That's impossible. ''Let's study the medical use of marijuana—let's talk about the medical use of marijuana, but let's pass a law that there shall be no money appropriated for the study.'' In other words, we don't want to know. ''I don't care what science does, let's not know. Let's just stay in the stone age.'' And so I have special remedial courses for Members of Congress that find themselves in that position.
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Okay, now, next—moving up the chain of intelligence. The ballot initiative. Can we have a discussion about this subject without referring to ballot initiatives. What's that got to do with it? As Barney Frank has humorously told us, I mean, let people make statements about that, but you don't have to go ballistic if it doesn't come out your way. After all, people make up their own minds. So, we should be talking about this subject, and I think you have, General McCaffrey and Dr. Leshner, without reference to what ballot initiatives say in Florida, California, Cucamonga, or anywhere else. I mean, please separate that out for those of you who are able.
And third, and now I'm getting—I may be impinging upon the witness and may require a response—could we not separate out the abuse by high school kids of marijuana when we're talking about the use of medical marijuana. These are two completely different subjects. One is illegal; the other is—it's about—it's like asking the chairman of an oncology department that he can't prescribe something to a cancer patient undergoing chemotherapy because Congress hasn't decided yet, and with all due respect to that huge institution out there in Maryland called NIH, they haven't come to a conclusion yet. Hey, a lot of doctors didn't agree a little more than a century ago that washing your hands didn't make any difference before you go into an operation. I mean, some people get the message before other people. Now, I guess we have to wait till enough doctors catch on that you can use marijuana for medical prescription just like you use cocaine, heroin, and a dozen other addictive drugs. So, you see where I'm going, Dr. Leshner and General McCaffrey? Okay, help me out. What do you prescribe?
Mr. MCCAFFREY. Well, I think, again, the straightforward answer is, let's let Dr. Harold Varmus, the NIH, the American Academy of Sciences, the great professional organizations, in a clinical objective way, determine whether smoked dope is needed for pain management of prostate cancer, and we shouldn't be afraid of the scientific process. It gave us the best medicine on the face of the earth.
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Mr. CONYERS. Could you change that medical term ''dope'' to something else, please?
Mr. MCCAFFREY. Well, I don't want to be naive, Mr. Congressman. When you look at the people who are pushing the issue and what they're alleging the therapeutic benefits are, you know, insomnia, writer's cramp, et cetera, there is a note of humor to all of this, Even though I'm willing to stay on the high ground in the scientific debate, I don't want to lose sight of what's also going on on a parallel intellectual process.
Mr. CONYERS. I know, like me, you are a stark realist, and I appreciate that quality in you.
Mr. MCCAFFREY. Yes, sir.
Mr. CONYERS. Dr. Leshner?
Mr. LESHNER. I would make two comments: one is the place where the issues do appear to intersect is on the question of whether or not marijuana is a benign substance; that is to say, if marijuana is harmless, who cares what you use it for? The truth is marijuana is far from a benign substance, and, therefore, the issue of whether or not it's a medicine just like any other substance that's not a benign substance, needs to be tested by science.
I would make one more point, if I could, and that is that anecdote and clinical experience are not substitutes for science. They do, in fact, because they're skewed samples; you don't hear anecdotes from everybody, and they can help shape scientific questions, and we welcome them to help shape scientific questions, but I think it's important that they not substitute for scientific answers.
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Mr. CONYERS. Well, gentleman, I thank you very, very much for your contribution this morning. Thank you, Mr. Chairman.
Mr. MCCOLLUM. Thank you, Mr. Conyers. Mr. Barr, you're recognized for 5 minutes.
Mr. BARR. Thank you, Mr. Chairman. I think, General McCaffrey, you're right. I mean, you look at what, I think, one of our other witnesses is positing that marijuana can be effective against aging; that it can be effective against phantom limb pain; it can be effective against violence. There is a—you have to take some of this stuff with a large grain of salt or some other substance. It is goofy what these folks are proposing, and one would think that they would have, at least, enough intelligence to not put out silly stuff like this, because it would help their credibility marginally, perhaps, if they didn't, but maybe it's good that they do, because it illustrates very graphically how goofy their ideas are.
I do appreciate—despite efforts by my colleague from Michigan to draw us down to a low road—that you maintain the high road, and I appreciate that, and I believe it's a characteristic of your work in this area.
One of the very few disagreements that we do have relates to the continued Government funding of studies of so-called medicinal use of marijuana, and the concern that I have, General McCaffrey, in pursuing that course of action is illustrated, I think, very graphically by your chart here. As the risk perception drops, use increases, and my concern is that despite that there may be some evidence that somebody can conjure up out there that marijuana doesn't do the things that scientifically we know that it does, and which have provided the basis for years for its inclusion in Schedule I, despite that there may be some institute or person out there that can come up with something that shows that marijuana really does stop people from aging, the fact of the matter is, if the Government is the entity putting forward, spending money, saying, ''We ought to study this,'' I think that sends a very, very wrong and bad and counterproductive message to the people. It is one thing, I think, to say that if there is evidence that can be brought forward that shows that the basis on which marijuana has been classified as a Schedule I substance for many years—very strong scientific evidence that shows that it is in the right place on the list of controlled substances—if there is somebody out there that can bring forward legitimate information to show that we're wrong in this, then that's one thing.
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The concern that I have is the Government, which, on the one hand, is saying it is a controlled substance; it is a Schedule I controlled substance for various and good reasons that are scientifically well-founded and also saying that we are going to continue to enforce, as strongly as we can, laws against the use of mind altering drugs including marijuana which is a mind altering drug. Then, on the other hand we have the Government coming forward and saying, ''Well, but, we're going to spend a million dollars or whatever it is to study to see if it really ought to be there.''
That gets us, I think, squarely to the point of feeding the risk perception drop and, as you've testified, when that happens, drug use goes up. Can't we get away from the Government funding these studies; that, I think, sends a very counterproductive message and, I think, hurts some of the very, very good work that you are trying to do and are doing in a lot of areas.
Mr. MCCAFFREY. Well, Mr. Congressman, your point's a good one. Let me, if I may though, go back to the referendum which right now is in front of the State of Florida. As I read the polls, we've lost the debate already. We have reasonable people throughout that State that have not gotten the point. They're concerned about pain management. They're fearful that a medicine that's alleged in public dialogue to be useful to them is being withheld by a reactionary government. So, again, I would suggest that having these distinguished people in the NIH and the Institute of Medicine—which is not a government body, these are independent scientists—doing an open objective review is good. It's good for the democracy to hear the facts.
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Now, the second thing I would assert is that I've spent a lot of time in hospitals all over the world. I've spent the better part of 2 years in Walter Reed, and I have enormous faith in American medicine. It's my own view that if you let the scientific medical community look at clinical evidence, they come to good judgments just about all the time. And, again, I would argue things like pain management—you know, in Walter Reed, we would be allowed two cans of beer, but not out of the pharmacy. No one alleged it was a medicine, and I think that's what our concern is on this issue. We don't want to confuse the debate about the harmful effects of pot with what ought to be an intellectual argument about whether it's a medicine, and that's where I come down on it, sir.
Mr. MCCOLLUM. Thank you, Mr. Barr. Mr. Meehan, you're recognized for 5 minutes.
Mr. MEEHAN. Thank you, Mr. Chairman, and I'd just point out in terms of response to Mr. Barr's comments that we don't have the study—the scientific evidence that we need to decide that patients ought to be able to use this drug, and every time this amendment offered by Mr. Barr, any legislative proposals, he's always looking to barr any money going for this type of study, basically, willfully, blinding us to any potential study that's going to be done. So, I don't think you can have it both ways. You can't, on the one hand, say that there isn't scientific evidence, and, on the other hand, say, ''But we don't want any scientific evidence.'' If it's out there, the Federal Government shouldn't play any role in getting that information.
But in any event, it seems to me, General McCaffrey, in no small part the argument against permitting individuals to smoke marijuana for medical purposes, specifically to reduce nausea associated with cancer, chemotherapy, and stimulate appetites of AIDS patients who are wasting away, rests on the claim that alternative therapies effectively treat these problems. In other words, there are other medications that can be taken.
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For example, it is said that the THC pill, marinol, works to combat nausea and vomiting that accompany chemotherapy and also that there are many other conventional, traditional medications prescribed by cancer specialists. Now, medical marijuana advocates, on the other hand, typically respond by arguing that nausea treatment is an effective substitute for inhaled marijuana. In particular, what they claim is that patients suffering from nausea cannot take pills like marinol because pills must be swallowed. Inhaling marijuana allows for more accurate dosing as individuals can regulate the amount of THC that they receive, and many also argue that both drugs are too expensive. How do you respond to these arguments disputing the relative effectiveness of alternative therapies?
Mr. LESHNER. If I may, sir, these particular kinds of points are raised in this—which we've offered for the record—the report of the NIH workshop, and it's precisely those sets of questions that we're interested in getting scientific answers to; that is the relative effectiveness of various compounds. And I can mention to you that we do have a safety study literally comparing dronabinol marinol, an oral form of THC, with smoked marijuana on the progression of HIV, so that it is an answerable question from a scientific point of view, and, again, we're hoping that anecdote will not drive a public health issue that deserves and merits a scientific answer to——
Mr. MEEHAN. Well, you would agree that there needs to be more research, scientific research, than is done, wouldn't you?
Mr. LESHNER. I do, sir.
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Mr. MEEHAN. My point, earlier, was that a lot of people within the Congress, they don't want to see any Federal money used for additional research in terms of alternative medicines.
In any event, let me go to another issue. General McCaffrey, I know that you and Attorney General Reno, Secretary Shalala, face many challenges in terms of enforcing Federal law which prohibits the medical use of marijuana. In the face of the California's adoption of proposition 215 in November 1996, specifically, proposition 215 as written, sidesteps Federal law by permitting the use of marijuana if a doctor recommends it orally, thus, doctors would avoid losing their DEA licenses, because they didn't prescribe marijuana. Now, Federal efforts to revoke the DEA license of doctors who merely recommend marijuana for medical purpose, have run into a series of First Amendment challenges, and the prospects for Federal agents arresting specific numbers of terminally ill individuals who are smoking marijuana to combat nausea or AIDS-related wasting away, is undeniably unattractive from at least a public relations standpoint for law enforcement officials. How is the law enforcement community proceeding to overcome these obstacles and enforce the Federal law?
Mr. MCCAFFREY. Well, Mr. Congressman, first of all, let me begin by saying, as far as I know, never in the history of the Republic has a seriously ill patient been arrested for taking any medicine. So, it's almost become a manufactured issue. We start off, certainly Secretary Shalala and I——
Mr. MEEHAN. Excuse me, does that mean, General, that there isn't enforcement of this proposition?
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Mr. MCCAFFREY. Let me just say that it hasn't been an issue, and that Secretary Shalala and I and other members of the administration have absolute confidence—and our position is supported in general by the AMA and every other serious medical organization in this country—that this isn't a legal problem so much as it is a medical problem, and so it's back where it ought to be in front of the NIH and the FDA. So, that's really the center of mass. We think doctors want to have national standards that medicines are safe and effective and that they're not subject to legal liability before they prescribe them. So, we don't think that today, California physicians in general, want to use this or any other non-sanctioned medicine.
Now, what we'll do about proposition 215: beats me. It's a terrible situation in which we have Federal law unaffected by these two State referenda. It is still a violation of Federal law. These are Schedule I substances. They are not available for the medical community, and it's caused tremendous distress, I think, because the Federal Government doesn't, and shouldn't, be in charge of a local criminal law; that's a State function or a local function.
Mr. MCCOLLUM. Thank you, Mr. Meehan. Mr. Hutchinson, you're recognized for 5 minutes.
Mr. HUTCHINSON. Thank you, Mr. Chairman. I want to applaud General McCaffrey for sounding the alarm about the different ballot initiatives. As you pointed out, if you look at the different States in which there are these ballot initiatives, Arkansas is in the yellow, which means there's been a petition to the Secretary of State in reference to this, and they're gathering signatures on it.
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I want to talk about the administration's role in opposition to these ballot initiatives. In reference to California, we see enormous difficulties in the drafting of that legislation; just the language of it is poor, and leads to extraordinary law enforcement problems, and I think the administration came in toward the end, and spoke out in opposition to that. And then you mentioned Florida in which you indicated that we are losing the battle of public perception on the ballot initiative. And, so, General McCaffrey, have you been into Florida to speak out in opposition to this ballot initiative?
Mr. MCCAFFREY. Well, we, the Administration, clearly, have put out a public statement, approved by the President of the United States. All of us were involved in it, from the Food and Drug Administration to the Departments of Transportation, Energy, Attorney General, Health and Human Services, and so our position is public. We followed that with a subsequent statement after one of the two Federal law cases that are proceeding through the courts now, on first amendment rights in California, and also in Washington. And, really, I'd set that aside. I'd rather have the Attorney General address the legal aspects of that. But we think we have a sensible position supported by medical professionals. This should not be a referendum, and we urge the people of Washington, D.C. and Florida to vote against this approach.
Mr. HUTCHINSON. All right. And I think that that is the right position. This administration, and your taking the leadership in it, indicates that the people of Florida should vote against that initiative just like you did in California. The Attorney General, she's from Florida, has she been into Florida to campaign against this initiative? To your knowledge, has she?
Mr. MCCAFFREY. Well, no, and, you know, there will be some judgment we'll have to apply here. It seems to me that at the end of the day what we can do is provide a viewpoint on the truth, on the scientific facts of the matter, and the American people will have to make up their own minds what they want to do.
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Mr. HUTCHINSON. And, of course, I'm leading to a point, here, General McCaffrey. This is such a critical issue to our Nation. As a former law enforcement person, but also as a parent of teenagers, I believe this is a critical issue that faces our Nation, and I think that it deserves investment of political capital, and I believe that you ought to personally be in Florida campaigning against that initiative. I believe that the Attorney General of the United States as the chief law enforcement officer ought to be campaigning against it, and the President of the United States as well.
I recall in Arkansas, when Mr. Clinton was then Governor of our State, there was a ballot initiative on casino gambling, and we didn't wait to see whether, you know, the people were going to pass it. I recall being on the front steps of the capitol in an effort to stop this ballot initiative with the first lady of Arkansas. She did a terrific job. She was saying this is bad for Arkansas. As a United States attorney, I said it was bad for Arkansas, and it was defeated. We need that kind of leadership today, and I just urge the administration to be more engaged in the battle.
You're armed to the teeth with scientific information that this is bad. We don't need more studies, and so I guess I'm asking, what is the possibility of that type of leadership coming out of this administration in opposition to these ballot initiatives?
Mr. MCCAFFREY. Well, there's no question; your points a good one, Mr. Congressman. We are opposed to them; we will state that forcefully. I've got two members—I was just reminded—two members of the California Narcotics Officers Association here. I'll be out talking to their national convention. I've been in Florida already, and spoken out against this issue, including editorial boards. This is the wrong way to go. We don't want cities to vote on FAA flight regulations. We don't want local referenda to decide medical therapeutic compounds. We want science and medicine to decide those issues.
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Mr. HUTCHINSON. One final point: if this gets on the ballot in Arkansas, I want to invite you and I want to invite the President and First Lady to come back in opposition to it. I think the people of Arkansas will exercise good judgment on it, but we need your help.
Mr. MCCOLLUM. Thank you, Mr. Hutchinson. I just want to assure General McCaffrey—and you can carry it back to the White House—that you're welcome to come down to Florida on this initiative anytime, and so's the Attorney General and the First Lady and the President. I hope, as Mr. Hutchinson does, that this gets clarified. If this initiative does get on the Florida ballot, we could certainly use and would expect to receive, that national leadership.
Mr. Chabot, you're recognized for 5 minutes.
Mr. CHABOT. Thank you, Mr. Chairman, and I want to, first, thank the General for being here this morning, and I think many of us have a great deal of respect for you, and the job that you're doing, or attempting to do, within the administration, but I think the President—let's be frank about it—he made some pretty glib remarks about drugs early on, and I think many people believe—and I happen to be one of them—that it was kind of a wink and a nod attitude early on about drug usage in this administration; everything from the ''didn't inhale'' remarks to other things that we all know about. But do you think it can be argued with a straight face that there was no connection between this kind of nonchalant attitude that the administration had early on and the increases in drug usage among American youth?
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Mr. MCCAFFREY. Well, let me, if I may, remind you that by law, 1998 statute, I am a non-political officer of government. I'm not registered to either party; I've been a public servant since I was 17 years old. I would not have accepted this position were I not convinced that the President and the Vice President and the key members of the team I work with: Janet Reno, Donna Shalala, Dick Riley, our DEA administrator, Tom Constantine; Louie Freeh, the FBI Director, and others are adamantly opposed to the compulsive use of these drugs in America. And so are their parents and their grandparents; and the President's been absolutely supportive of what we've been trying to do. So, there's no question in my mind that Janet Reno and I and Donna Shalala know what we're up to, and we're doing so with the full authority of the President.
Mr. CHABOT. Okay. But, I mean, you obviously weren't brought on early on, and so we certainly can't hold you accountable for what went on early on, but I think many of us—there's was a lot of outrage about what did go on early on, particularly with the President cutting his own drug office by 75 percent or whatever it was. I think——
Mr. MCCAFFREY. It was a mistake. Now, having said that, Mr. Congressman, we do have a challenge in America. Seventy million Americans, including a lot of public representatives, school teachers, and police chiefs have smoked marijuana; have tried cocaine. We also drank too much and smoked too many cigarettes. In the sixties or seventies, we had a disaster because of it, and I think a lot of Americans, now, are now hoping to run the country and trying to decide the issue in their own mind. They're opposed to these drugs; adamantly opposed. They don't want their children using them, and they're trying to sort out the message, and that's another reason why I welcome this hearing and other hearings like it so that we can publicly say we've learned from that experience. It killed 100,000 people in the nineties alone. It cost us $300 billion in losses, and we reject the use of illegal drugs. That's, it seems to me, the argument that our public leadership needs to make.
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Mr. CHABOT. General, how do you believe that the medical marijuana movement is related to the broader goals of the drug legalization and do you believe the medical marijuana initiatives are the camel's nose under the tent of legalization?
Mr. MCCAFFREY. Well, there's no question if you listen to their public record and what they're putting on the internet that there—that those very cunning national efforts to legalize drugs includes medical pot. It includes the legalization of industrial hemp which will save American agriculture. It includes a lot of other indirect attempts to lower the gate, because they understand that the overwhelming majority of the American people, more than 85 percent, reject the legalization of drugs. It's not going to happen, and so this is an approach. Now, having said that, let me set that aside and say the medical marijuana issue should be decided by doctors and scientists. And we should not take into account those who would be termed the unsavory cohort that come with them. We ought to look at it on an objective basis, and if it pays off for American medicine, we would consider a variant of smoked marijuana just as we have synthetic THC which is available in a pharmacy with a doctor's prescription. A lot of people don't like using it, because it makes you stoned, and there are better drugs available, but I think we ought to say, ''Let's look at this on a scientific basis.''
Mr. CHABOT. Finally, General, I know that you're well acquainted with the Arizona and California marijuana initiatives, and I think, in fact, back in 1996, you referred to the State initiatives as the Cheech and Chong show, but many of the critics are of the view that those campaigns were more about legalizing marijuana than providing relief from—for suffering for the dying. And do you share that view?
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Mr. MCCAFFREY. Well, again, I will be objective in my own viewpoint of it. I think it's a scientific medical question. We've approached this in the administration with the support of Congress in the right manner. I'm aware of the drug legalization forces in the background. There is an element of humor to growing your own pot in the backyard as an aroma therapist to provide it for amnesia or writer's cramp. That kind of thing doesn't sound like the kind of medicine that sustained me when I was injured, so I'm opposed to it, and we've made the case in public and will continue to make the case: let doctors run medicine.
Mr. MCCOLLUM. Thank you, Mr. Chabot. Mr. Gekas, you're recognized for 5 minutes.
Mr. GEKAS. Yes, I thank you, the Chair. I have been convinced for a long time, and you reaffirm in your oral statements and in your written statements, that, indeed, marijuana is a gateway substance; that it would lead to building the appetite for other harder drugs. I cannot be convinced otherwise. One of the statistics that you mentioned, though, is unfathomable to me, and that is somewhere you state that about 55 percent of the youngsters who submit themselves or are forced into drug treatment, 55 percent of them are being treated for marijuana use. That astounds me, because I don't know of too many cases—I haven't been around the hospitals lately, and that I have been—to note that people go to the emergency room or go even to a private clinician for the purpose of being cured for marijuana use. I always thought that the marijuana user has gone for treatment because he had stepped up to cocaine and that that's—it was an added step to show that he was a marijuana user as well. What is the implication of people going for treatment for marijuana? That's news to me.
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Mr. MCCAFFREY. I, hopefully, have made available to you a newspaper article about Dr. David Smith, past president of the American Society of Addictive Medicine; a very distinguished physician who runs the Haight-Ashbury free clinic. When they talked to him about the legalization of pot, his answer was, ''Look, I treat 200-300 children a month for marijuana dependency. If you are an adolescent and you're stoned a lot and using alcohol, you end up with horrendous problems, and your parents don't like it, and your schoolteachers don't like it.''
Mr. GEKAS. But you mentioned, ''and using alcohol;'' that I understand.
Mr. MCCAFFREY. Well, marijuana dependency has a visible impact on adolescents. You smoke a lot of dope, you're in trouble.
Mr. GEKAS. Do you think it's comparable to those few in our society who are addicted to cigarettes, to nicotine, who go for treatment—some people go for treatment or to try to get off the cigarette, off nicotine. Is that the kind of statistic that you're quoting here?
Mr. MCCAFFREY. Mr. Congressman, the comparative argument is one I try and sidestep. Alcohol has done terrible damage to our society. It may be the worst drug in America; 150,000 dead a year; billions of dollars of damages; cigarettes kill 440,000 plus people a year. These are clearly terrible substances in the way they impact on our society. Many of these psychoactive drugs keep you from working; keep you from functioning as a social member of your family; of your community; develop dependency, psychosis, bizarre behavior. That's the bigger problem in some ways of poly-drug abuse including marijuana.
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Mr. GEKAS. Well, actually, I'm looking on the good side of this. If, indeed, youngsters are being treated for dependency for marijuana, there's a good chance they'll never graduate to the harder drug.
Mr. MCCAFFREY. Oh, sure.
Mr. GEKAS. And so, I would favor that. It simply astounds me that there's the numbers that you're talking about who are undergoing treatment just for marijuana usage.
Mr. MCCAFFREY. if you talk to Dr. Mitch Rosenthall, Phoenix House——
Mr. GEKAS. I understand.
Mr. MCCAFFREY [continuing]. A lot of the youngsters in his program are in there for primary diagnosis of marijuana abuse.
Mr. GEKAS. One other question: I had read some articles—some others have—on the involvement of the renowned George Soros in all of this. Can you tell us what impact his presence has in this field?
Mr. MCCAFFREY. Mr. Congressman, with your permission, could Dr. Leshner add to the answer to the last question?
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Mr. GEKAS. Oh, by all means.
Mr. LESHNER. Thank you. I'll be brief. The latest survey of drug treatment programs around the country revealed 133,000 individuals who were in treatment for primary marijuana abuse. Not all of those are only addicted to marijuana. The second thing that I think is important is as we understand the definition of addiction by every major medical organization in this country to be compulsive, often uncontrollable, drug craving seeking in use, there is no question that marijuana is an addicting substance.
Mr. GEKAS. That's very helpful. George Soros.
Mr. MCCAFFREY. Mr. Congressman, I have not talked to him. I can't impute motives. I really don't know the full range of his thinking on the matter. He has funded several organizations which are supportive of drastic changes in the approach to drug use in America. He had an article in the public newspaper which I read, and a lot of the article I actually agreed with. I think the whole notion of understanding that prevention is the heart and soul of the drug strategy is one embodied in the document the President's put in front of the American people. I think the whole idea of taking 3.6 million addicted Americans and providing treatment programs, particularly for the hundreds of thousands who are in prison primarily because of compulsive drug taking is good. So, those aspects of what may well be his argument are helpful. Where we might well part company is the notion—and I think the Chairman alluded to it in his opening remarks—that we ought to walk away from this. Drug use will stay lower if it's socially disapproved; if it's against the law; if law enforcement supports the law, and then on top of that, our parents, schoolteachers, ministers, coaches, local enforcement, and community coalitions make the case that drugs will wreck you. So, I don't want to really attack Mr. Soros, because I don't know his arguments, but his influence has been unhelpful in many ways to comprehensive support of national drug strategy.
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Mr. GEKAS. I yield back the balance of my non-time.
Mr. MCCOLLUM. Thank you, Mr. Gekas.
I think the record should reflect—and let's make sure that you and I understand this correctly, General McCaffrey—that Mr. Soros is known to support publicly the legalization of marijuana and it is my understanding from reading the newspapers that he has funded a good deal of this initiative effort. Is that not the same information that you've read in the newspaper?
Mr. MCCAFFREY. I'm not sure what his argument is. I read one newspaper article, and, again, a lot of it was very balanced, useful thinking. I think to the extent to which he believes that the problem is that these drugs are illegal, he's probably misguided in his thinking. The problem with marijuana and alcohol abuse; the problem with addiction to methamphetamines, crack cocaine, and heroin—the least of the problems is they're illegal. The biggest problem is they destroy you physically, mentally, and morally. That's the problem with compulsive drug-taking behavior.
Mr. MCCOLLUM. Thank you. Ms. Jackson Lee, you're recognized for 5 minutes.
Ms. JACKSON LEE. Mr. Chairman, I thank very much. Obviously, this is a crucial hearing. I would ask the chairman's permission to submit my full opening statement for the record; I'd ask unanimous consent to have my record submitted—my statement submitted in the record?
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Mr. MCCOLLUM. Without objection.
[The prepared statement of Ms. Jackson Lee follows:]
PREPARED STATEMENT OF HON. SHEILA JACKSON LEE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS
Mr. Chairman, I want to thank you for bringing us together this morning in this forum to examine the issue of the legalization of marijuana for medical purposes. The pressing nature of this issue has been highlighted by the recent referenda in two states—California and Arizona passed initiatives in November 1996, which legalized the possession of marijuana for medical us and the fact that similar referenda or bills are currently pending in 12 other states and are being planned in numerous others around the country. For example, in the District of Columbia, Initiative #57, the ''Legalization of Marijuana for medical treatment Initiative of 1997,'' is on the ballot in November, 1997.
Mr. Chairman, this is a difficult issue for all of us. On one side we have the pain and suffering of persons afflicted with terrible illnesses such as cancer and AIDS. These individuals believe that marijuana eases some of their suffering. If this is the case, then it is difficult to deny them. On the other hand, however, we must consider the interests of our nation's children and the problem of the rising drug use among them.
The evidence with respect to the benefits and dangers of the use of marijuana for medicinal purposes appears to be mixed. Some physicians believe that marijuana is a useful therapy for various ailments. The medical uses for marijuana are to counter nausea and vomiting caused by chemotherapy, and to stimulate the appetite of AIDS sufferers afflicted with ''wasting syndrome.'' Some researchers also believe that marijuana is an effective treatment for glaucoma, migraine headaches, and certain neurological disorders.
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Other physicians, however, argue that there is no legitimate medical use for marijuana and that there are safer, alternative medications for each of the symptoms marijuana is supposed to combat. Their position appears to be supported by a review of more than 6000 articles from medical literature, published in the May 15, 1997 Annals of Internal Medicine evaluating the potential medicinal applications of crude marijuana concluded the following: marijuana is not a medicine; its use causes significant toxicity; and numerous safe and effective medicines are available making the use of crude marijuana unnecessary for medicinal purposes. Further, in June, 1997, the National Institute of Health highlighted a study demonstrating that the long-term use of marijuana produces changes in the brain that are similar to those seen after long-term use of other drugs such as cocaine, heroin, and alcohol.
Even as the medicinal value of marijuana lies in question, we must consider the impact of legalization of that drug on our nation's young people. Many of the opponents of the medical marijuana initiatives argue that efforts to label marijuana ''medicine'' will send precisely the wrong message to adolescents and teenagers and will bring about a corresponding increase in the use of that drug.
These concerns are particularly strong given the fact that after years of decline, marijuana use has dramatically increased in recent years. The National Household Survey on Drug Abuse, published in 1995 by the Department of Health and Human Services, found that the number of 12- to 17-year-olds who smoked marijuana rose from 1.6 million in 1992 to 2.9 million in 1994. Additionally, marijuana users are younger today then in the past. The annual survey conducted by the partnership for a Drug-Free America released on March 4, 1997, found that among children 9 through 12 years of age who were interviewed, nearly one
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fourth of them were offered drugs last year, with marijuana being the predominant drug offered. Only 19 percent of the same age group gave this response on the survey in 1993. Further, the typical marijuana dose today is significantly larger then in years past, with doses too often laced with other drugs. As a result, in recent years there has been a dramatic increase in the number of marijuana-related emergency room episodes for 12- to 17-year-olds. Finally, the ''gateway effect'' of marijuana has been well documented. According to a 1994 study by Columbia University's Center on Addiction and Substance Abuse, 12- to 17-year-olds who use marijuana are 85 more likely to use cocaine than those who abstain from marijuana.
Mr. Chairman, the question of the legalization of marijuana for medical purposes is a difficult and divisive one. I look forward to hearing from our distinguished witnesses this morning and hope that they will address these issues and concerns. Thank you.
Ms. JACKSON LEE. Thank you very much. Mr.—General McCaffrey, I think we have been together on several occasions and certainly acknowledge that we are wrestling with this dilemma as to how we'll respond to some of the numbers that you have presented over the last year with the increasing utilization of marijuana by our teenagers. That is something that we all can stand firmly, with great strength, in opposition. I can also stand with great enthusiasm for dealing with the question of treatment of those who are incarcerated. We had the tension between interdiction, increased border patrols, and know that you've been in my part of the world down in Texas as it borders with Mexico, both in meetings, know that you have had unfortunate threats against your life. Let me say to you that it certainly greatly concerned and, therefore, recognized the depth of the seriousness of this whole question of drugs.
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But as my remarks will reflect, there is a dilemma. I'm not sure as to how many people ran toward Dr. Salk with the polio vaccination albeit we recognize how devastating polio was. I'm not sure whether people immediately thought that he had found something that was going to be the savior that it is, and we're in the same dilemma when we talk about the medical utilization, and I think this hearing is important, but I hope that we are listening and attempting to decipher the facts from the emotions.
Most people don't like to hear politicians make confessions for what may be alleged self-serving purposes, but let me say that I have neither inhaled or exhaled, and so I think I can speak with certain lack of fear of any accusations as to my propensity or friendship or utilization of any drugs for pleasure, but this question that we have should not be taken lightly, and we should not discard forms of medical science and use as compared to others who say that the use of this—of marijuana has no use in the medical arena.
My question to you, General, recognizing the work that you've done, is to share with me how the effort of which I would support you 150 plus 200 percent on bringing down the use of drugs in teenagers particularly marijuana that seems to be a favorite drug, how does that intertwine with any position we may be asked to take on the question of medical use of marijuana as designated by duly certified physicians in this country? What is the interrelation? Would you also answer the question of how we are progressing with the outreach program that we've discussed in my office dealing with a media program as I understand or your outreach effort to reach out to teenagers and children about the detrimental effects of using marijuana? Where does that stand? But the first question is the interrelation, if you will, between these two issues.
Mr. MCCAFFREY. Well, Madam Congresswoman, let me, if I may, start by thanking you for your own leadership in this area. I found it, to be blunt, inspirational; going to your district and seeing the kind of work that you and ministers and community activists have been pulling together to talk drug prevention to children and to work with those who are addicted, and, it seems to me, the kinds of arguments you put on the table are where we ought to go.
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Now, the notion of medical marijuana as a medicine—again, if you would allow me to defer to the scientific judgments of Dr. Harold Varmus; of Dr. Alan Leshner; of the Institute of Medicine, overseen by the great medical professional associations—they ought to take an objective look at this whole question. And I think that just as the seventies produced synthetic THC in measured dose form, in a pill, it may well be that we can find that there are 400 some odd compounds in marijuana, and some or many of them in combination or modified, might have therapeutic benefit. In which case it would seem to me that Secretary Shalala would determine they ought to be made available to the American medical community. Intellectually this is an easy question to address. Let's stand behind rationality and science while not being naive to understanding where the argument's going.
The final one—let me give you some good news—this Congress in bipartisan support gave us $178 million out of the Conference Committee to begin a national youth media strategy. We have now hired an advertising public relations firm, Porter Novelli, and we are working with Jim Burke and the Partnership for a Drug-Free America; with the Advertising Council of America; with the Quad A (the American Association of Advertising Agencies), and we're going to come to Congress with a strategy and get the message on the internet, T.V., radio, and print media this fall to our children 9 to 17. And I must just thank you for the sense of trust you have expressed in what Jim Burke and I have asked you for in support.
Mr. MCCOLLUM. Thank you, General McCaffrey.
Ms. JACKSON LEE. Mr. Chairperson, can I have an additional 30 seconds just to pose a comment?
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Mr. MCCOLLUM. You may.
Ms. JACKSON LEE. Thank you very much. General, let me applaud you as well, and as you well know in discussing this issue, and I'd like to pursue further this dialogue on the question of interrelation, I will leave that to some letters and questions in writing, but I would greatly like to have one of your staff persons brief me in my office as you strategize for the structure of this program particularly I raise the point of emphasizing or trying to reach out to our inner city and rural youngsters, particularly minority youngsters, Hispanic and African-American, and I would greatly appreciate the briefing and the understanding—maybe meeting with the advertising agency as well just, generally, to hear how they're proceeding, and it's a very important issue for me. Can I have someone be in touch with me, General?
Mr. MCCAFFREY. Absolutely, we will do that. Thank you, Ms. Jackson Lee.
Ms. JACKSON LEE. Thank you, General. Thank you, Chairman.
Mr. MCCOLLUM. Thank you, Ms. Jackson Lee. Although we would enjoy it, we don't have time for an entire second round of questions, because we've got a huge second panel. However, as the chairman's prerogative, I've got a couple of things I'd like to wrap up. Also if there's a burning hole question by another member, perhaps we'll allow one other question.
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I notice in the back of the room that there are a couple of t-shirts, Dr. Leshner, that say, ''Medical marijuana saves lives.'' To your knowledge, is there any study which shows that marijuana saves lives?
Mr. LESHNER. I don't know of any such studies. There have been studies that show marijuana can have an influence of a variety of parameters, but I don't that particular—I don't even—to be honest, I don't really know what that means.
Mr. MCCOLLUM. I understand, and I think that's a dramatic example of overstatement of a case. I just wanted to point that out, for medical purposes as well as political.
Also, Dr. Leshner, doesn't the Food and Drug Administration normally approve drugs that may have potential dangers, requiring them to be dispensed by a doctor's prescription? Isn't that the way this Nation normally operates? Wouldn't you expect that if there are medicinal uses for marijuana, that the American public would expect the Food and Drug Administration to approve the medicinal use of marijuana through the normal process?
Mr. LESHNER. Yes, sir. I would just, for a moment, reiterate General McCaffrey's opening point which is the separation of the two issues. We do have substances like morphine that are approved for medicinal use, but they have gone through scientific review, clinical trial, and they have gone through FDA approval. That's the process that I believe we're all advocating.
Mr. MCCOLLUM. When you have a State initiative like the one in my State of Florida or the ones in California and Arizona that allows doctors to certify the use of marijuana for any medicinal purpose without FDA approval, wouldn't you say that circumvents the normal, accepted process to the extreme?
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Mr. LESHNER. Again, I'm in favor of always following the science.
[The information referred to follows:]
58955h.eps
Mr. MCCOLLUM. Thank you. Let me ask you one question, General McCaffrey, that really is not on the subject today, however, I don't think we should have a hearing go by without asking it. The newspapers recently reported that the FBI put Ramone Ariano Felix on the FBI's 10 Most Wanted list, and I believe we've offered a reward for his capture. What's disturbing to me—and I wanted to ask your comment on it—is that the Mexican attorney general, Jorge Madrazo, has been reported in the press as having called the $2 million that Attorney General Reno put on this gentleman's head as something that was not agreed to by the government of Mexico. According to these newspaper articles, he cautions U.S. authorities not to pursue the Ariano Felix brothers across the border. He is quoted as having said, ''What they are not going to do is to come to Mexico to make any apprehensions.'' I might respect his national sovereignty concerns, but I am appalled, General, by the fact that the attorney general of Mexico would make a statement like this one without any accompanying statement that says, ''Boy, I sure hope you folks up there go after these guys if they're north of the border, and we'll cooperate with you any way we can, if they're down here.'' Can you explain this to us? Do you have a comment on that?
Mr. MCCAFFREY. I haven't seen the statement. I'd be glad to follow up on it. I would just suggest to you that there is enormous sensitivity in the border communities, both in the United States and Mexico, to ensuring that only our own law enforcement, our own prosecutors and judges, have authority on our own national terrain. And Mexico, as you know, has heightened sensitivity, historical sensitivity to this problem. And it put everybody's teeth on edge; the brutal murder of our DEA agent in 1985 and the subsequent murder of a Mexican citizen. So, I think it's appropriate that we reassure both Nations, that our cops will protect our own people. Having said that, there's a question that the attorney general; that the president; that their defense minister understand the ferocious threat the Mexican democracy and the Mexican people face from drug criminal organizations. We believe that they are determined to protect their own future, and I think we sent a report over here; two volumes, one classified, volume 2 confidential——
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Mr. MCCOLLUM. I'm just wanting you to take the message back from me, if you didn't concur, and you obviously haven't looked at this article in the newspaper, that the message being sent from the other side of the border to our public is deeply troubling. When the attorney general of Mexico is making statements that are so defensive like this one and not commenting favorably in any fashion on the U.S. putting a reward on the heads of these folks who have committed these atrocities, if those folks are here in the United States, something is wrong.
Mr. MCCAFFREY. No, let me follow up on that, Mr. Congressman.
Mr. MCCOLLUM. Please do. Mr. Barr, you have one burning question? I can't go to a full second round, but you may ask your question.
RESPONSE TO QUESTION BY REP. MCCOLLUM
Question: General McCaffrey, this question is slightly afield from today's hearing but it pertains to an issue you and I have talked about in the past—Mexico—and I wonder if you might respond. I was encouraged by the recent action by the FBI to put Ramon Arellano Felix on the FBI's Ten Most Wanted List. I was then discouraged, however, by the reaction of the Mexican Attorney General Jorge Madrazo, who called the $2 million reward a unilateral decision by Attorney General Janet Reno, which ''was not agreed to by the government of Mexico.'' He then cautioned U.S. authorities not to pursue the Arellano Felix Brothers across the border. I quote: ''What they are not going to do is to come into Mexico to make any apprehensions,'' he said.
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—You were a vocal defender of certifying Mexico this past year, and I wonder if you might comment on the Mexican Attorney General's statement?
Answer: Attorney General Madrazo was reported in the press to have made those comments during an international drug conference in Puerto Vallarta, Mexico. According to the Mexican Embassy in Washington, he recalls having said that Mexico was not consulted prior to the U.S. decision to offer a $2 million reward for Ramon Arellano Felix, but he did not comment on whether Mexico agreed that the decision was appropriate. It seems clear that the Attorney General was telling the press that the decision to offer a reward for Ramon Arellano Felix was a sovereign U.S. action, rather than one that was coordinated with or agreed to by Mexico in advance. Indeed, it would seem odd if the U.S. had sought Mexican agreement in advance of announcing a law enforcement measure that is legal and common under U.S. law but not authorized by Mexican law.
The second part of the Attorney General's remarks also seem appropriate to me. Mexico has cooperated with the United States in arresting fugitives wanted in the United States, and we would expect that cooperation to continue in the context of Mexican domestic law if we learned the whereabouts of Ramon Arellano Felix. We would not send our law enforcement personnel into Mexico to make an arrest any more than we would countenance Mexican law enforcement personnel coming into the United States to make an arrest if the situation were reversed.
FBI spotlights Tijuana drug boss Arellano Felix on Ten Most Wanted list
Marcus Stern and S. Lynne Walker
COPLEY NEWS SERVICE
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Mexico City; 25-Sep-1997
WASHINGTON—In a move that could heighten tensions along the border, the U.S. government yesterday launched a highly public and remarkably personal attack on an increasingly violent Tijuana drug cartel. Calling the Arellano Felix organization one of the most powerful and brutal organized crime syndicates in the world, U.S. officials placed cartel leader Ramon Eduardo Arellano Felix on the FBI's Ten Most Wanted list. The State Department offered up to $2 million in reward money. The FBI kicked in another $50,000. The government began distributing wanted posters in Spanish and English. It set up a toll-free hotline for informants. And U.S. drug warriors began taunting leaders of the deadly cartel. ''They're just a bunch of ignorant thugs who because of dope became rich,'' said one official. ''Otherwise, these guys would be selling lizards alongside the road.'' Ramon Arellano Felix, 33, is the youngest and most audacious of three brothers who run the Tijuana cartel, law enforcement officials say. The brothers, who come from a well-to-do family, control the cocaine, marijuana and methamphetamine trade along 1,000 miles of border. They are responsible for escalating violence that threatens to spill across the border into San Diego, including death threats against U.S. law enforcement officials, authorities say. Ramon Arellano Felix's placement on the FBI's Ten Most Wanted list was triggered by his recent secret indictment in San Diego on charges of conspiring to smuggle cocaine and marijuana into the United States, FBI Director Louis J. Freeh said. Because the indictment remained sealed in U.S. District Court in San Diego, additional details surrounding the charges were unavailable yesterday. The U.S. law enforcement offensive, launched with formidable name-calling directed at the Tijuana cartel, may heighten tensions on the streets of perhaps the world's largest international metropolis—San Diego and Tijuana. The move also may have heated things up in the nations' respective capitals. Mexican Attorney General Jorge Madrazo, offering a testy response yesterday to the new U.S. campaign against the Arellano Felix brothers, called the $2 million reward a unilateral decision by Attorney General Janet Reno, which ''was not agreed to by the government of Mexico.'' He cautioned U.S. authorities not to pursue the Arellano Felix brothers across the border. ''What they are not going to do is to come into Mexico to make any apprehensions,'' he said at an international drug conference in Puerto Vallarta on Mexico's Pacific coast. Freeh, speaking at a packed press conference at FBI headquarters, described the Tijuana cartel as ''the most vicious, ruthless criminal organization involved in smuggling drugs into the United States.'' Standing between enlarged wanted posters of Ramon Arellano Felix, the FBI director and senior officials from other U.S. agencies all but declared war on Ramon, his brothers—Benjamin and Javier—and their Tijuana cartel. ''The Arellano Felix organization preys on U.S. society and Mexican society,'' said Raymond W. Kelly, undersecretary for enforcement matters at the Treasury Department. ''In both of our countries they deal in death.'' ''What we're dealing with here is one of the most powerful organized crime syndicates in the world today,'' said Thomas A. Constantine, head of the Drug Enforcement Administration. Ramon Arellano Felix and his brothers are said to have led high-profile lives in Tijuana and to even cross the border into San Diego, but their current whereabouts are unknown, officials said yesterday. Authorities are hoping that the reward money will persuade someone to come forward with a critical tip that could lead to Ramon Arellano Felix's arrest either in the United States or Mexico. ''If he is arrested by the Mexican authorities, we will immediately begin negotiations to bring him back to the United States,'' said Freeh.Those extradition talks are likely to prove contentious as the issue remains one of the thorniest counter-drug controversies confronting the United States and Mexico. But law enforcement officials savored the prospect of Ramon Arellano Felix and his brothers being hauled across the border and thrown behind bars in the United States. ''It's what drug traffickers fear the most—being extradited to the United States,'' said one official. ''They know they're not going to be living the life of luxury and they're going to be in prison for a long time.'' Ramon Arellano Felix is not the only Mexican to appear on the most-wanted list. Agustin Vazquez Mendoza is being sought for his alleged involvement in the killing of a DEA special agent in 1994 in Glendale, Ariz. Gulf cartel leader Juan Garcia Abrego was put on the list in March 1995 and was captured in January 1996 and immediately whisked to the United States. Officials claimed Garcia Abrego was born in the United States and therefore an easily extraditable U.S. citizen; Garcia Abrego claimed he was Mexican. It is unclear what role, if any, the Mexican government has agreed to play in the capture of Ramon Arellano Felix and his brothers. They've been wanted on murder charges in Mexico in connection with the May 1993 slaying of Roman Catholic Cardinal Juan Jesus Posadas Ocampo. But Mexican law enforcement agencies so far have failed to capture the three brothers. A fourth Arellano Felix brother, Francisco, is in jail. He was captured in a Tijuana safe house in December 1993. The Arellano Felix organization spends a million dollars a week to pay Mexican federal, state and local officials for protection, authorities here contend. U.S. law enforcement agents working in the trenches of the drug war reacted emotionally to the tough talk in Washington, underscoring their frustration with what many say is a losing battle. ''I get a little bit personal about it,'' said one official. ''I get sick of seeing them strut around all over the place without ever being afraid of being caught. Their behavior has been outrageous. They're wholesale drug traffickers. And they're all going to jail.'' In San Diego, the Arellano Felix organization poses a special challenge for local law enforcement officials, who say the cartel recruits street gangs as paid assassins. Authorities believe members of a Logan Heights gang, known as the Calle 30s or Logan 30s, were recruited by the Arellano Felix brothers for a failed ambush of a rival drug baron that resulted instead in the slaying by mistake of Cardinal Posadas Ocampo. ''All of a sudden you have a gang with a war chest,'' said an official. ''They can buy more arms. They can take payment in drugs. And you can end up with a strong spinoff organization.'' The capture of Ramon Arellano Felix or one of his brothers ''would be a moral victory,'' a U.S. official said. But new arrests are not expected to stop the tons of drugs that flow across the border into the United States each year. ''As long as there's a demand, they're going to find a way to get it up here,'' said the official. ''The organizations will grow new heads and the drugs will continue to come.''
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Mr. BARR. I think the gentleman from North Carolina is——
Mr. MCCOLLUM. Oh, Mr. Coble, you have arrived. You can have your 5 minutes, if you would like.
Mr. COBLE. Well, I apologize, Mr. Chairman, I had two other meetings to attend——
Mr. MCCOLLUM. I understand.
Mr. COBLE [continuing]. You've been there, done that. I'm very interested in this. My belated arrival should not indicate lack of interest, but as such, I have no——
Mr. BARR. Would the gentleman yield?
Mr. COBLE. I'll yield to the gentleman from Georgia.
Mr. BARR. Thank you. Part of the problem that I have, General McCaffrey, is pointed out by what's happened over the last hour or so here. While you're up here saying that it's the role of the administration to provide a viewpoint on the truth, these characters, these, basically, walking testimonials to drug use out here, with their billboards, they're out there; they're the ones getting the attention. They're the ones out there pulling the wool over voters eyes. I'd like the T.V. cameras—I can't direct them there—but for all the parents that are having problems; the people in prisons to look at these characters. What I'm asking for you is why don't we see rather than simply sitting up here—I know you're here today at our request—but rather than simply providing a nice sounding viewpoint on the truth, what we'd really like to see is for the administration to provide some leadership; to be out there; to be in Florida letting parents know; letting the voters know that drugs kill if you believe that; not just compulsive use, but any usage of these mind altering substances. I notice that in Washington State, the Department of Justice doesn't have any trouble at all having its personnel from the U.S. Attorneys' office publicly advocate in an anti-gun, a gun-control initiative in Washington.
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So, apparently the administration is willing to step forward and publicly use the, sort of, bully pulpit of the Department of Justice to put its political point of view forward when it's an anti-gun initiative. Why won't the administration? why won't you? Why won't the Attorney General? Why won't the U.S. attorneys in these States where these drug initiatives are on the ballot, be out there so that people can see some passion; so that people can see some leadership and not leave the playing field to these other folks?
Mr. MCCAFFREY. Well, Mr. Congressman, I can't imagine any people who have been more adamant, forceful, or public in our opposition to these measures than I have been, the Attorney General, the Secretary of Health and Human Services, and others. We are committed. We do have the full support of the President and the Vice President. We intend to try and lay the facts in front of the American people. I personally have enormous confidence that if the truth is put out in a debate, that will be the idea that wins out in the end.
Mr. BARR. But it's getting the truth out. You all aren't getting it out there, and just providing a viewpoint on the truth is fine; that's an important part of your work, but I think also an important part of your work is to let the public know, very, very visibly and eloquently, as you're capable of doing, how important these initiatives are and that voters ought to be encouraged to get out there and vote against them.
You talk about that the medical use of marijuana ought to be decided by doctors and scientists, it already has been; that's why it's in Schedule I. Why are we wasting our time redebating and redebating an issue that is very well established by doctors, by scientists; that's why it is a controlled substance in Schedule I. Why aren't you out there instead of worrying about redebating these issues, arguing publicly and visibly, as I say, as you can do, will you commit to us today to go down to Florida and to urge other members of this administration in high profile positions to go down there to Florida and publicly and visibly let the truth out there and encourage the voters to pay attention and vote against these proposals? Will you do that?
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Mr. MCCAFFREY. The measure specifically came out in August, but the answer is we've been to Florida; we've been in the national debate; we'll work even harder to satisfy your concerns, Mr. Congressman.
Mr. BARR. Thank you. I yield back.
Mr. MCCOLLUM. Mr. Barr, I want to assure you that General McCaffrey has been working cooperatively. As I said earlier, I hope that when we really get into the heat of this battle next year, that Attorney General Reno, the President, and you will come down to rally against the initiative; we'd love to have you.
I don't have time for a second round. Ms. Jackson Lee's promised to be very brief. So, please, if you have one burning, ask it, but I do need to move on.
Ms. JACKSON LEE. It is burning in my soul, Mr. Chairman. I'm going to do the very best if Mr. Coble, would have yielded me a second or two, but tobacco and alcohol kills as well, and I think we need to recognize—and that's not in Schedule I—so I think that we need to recognize when we make accusations and don't have all of the facts that there needs to be a balance on this issue.
General McCaffrey, let me congratulate you, because it is well known that the mandatory sentence that locks up 95 percent African-Americans and Hispanics in Federal prisons on drug actions has done nothing to bring anything down in anyone's community. So, we can look at Schedule I and various other directions, and we find that they totally do not work in total. We obviously need to have law enforcement, but they don't work in total.
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My question becomes—as I come from Texas, and obviously Houston, we are facing this problem as we relate to our neighbors in Mexico—your visit there; did you detect a sense of commitment that we have this problem together and that on the law enforcement side, even with the threat against your life, is there some hope? Is there some commonality on this question? And what can we do in Congress to make ourselves very serious or let them know that we're very serious on this issue? I would appreciate that comment or your answer to that question, please.
Mr. MCCAFFREY. Well, let me begin by saying thank God for the border patrol, the Customs Service, the DEA, the FBI, and the others who are involved in defending the American people on the southwest border; 700 violent incidents against U.S. law enforcement last year. This is a dangerous environment, and violence and corruption operate on both sides of that border. Now, having said that, the Mexicans face the impact of possibly $6 billion of U.S. money spent on illegal drugs which are having a corrosive impact on their own democratic institutions. We believe that President Zedillo and his senior offices of government are committed to protecting their own democracy and the future of their own people, but they have a giant threat, and we intend to work in partnership with them in the years to come.
Ms. JACKSON LEE. I'd appreciate, when you come to my office, we can have a briefing on that aspect as well.
Mr. MCCOLLUM. Thank you, Ms. Jackson Lee——
Ms. JACKSON LEE. Thank you very much.
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Mr. MCCOLLUM [continuing]. And thank you, General McCaffrey and Dr. Leshner. Your testimony was very enlightening this morning, and we greatly appreciate your being with us today.
Mr. MCCAFFREY. Yes, sir.
Mr. MCCOLLUM. I am going to introduce the second panel at this point. Hopefully, we can begin it in light of the fact that we have a 15-minute vote just beginning at this moment. However, I'm not going to recess right now. I want to introduce the second panel, and as your names are called and the witness plates are placed for you, please come forward and take your seats.
Our first witness on the second panel is James Copple. Mr. Copple is the president and CEO of Community Anti-Drug Coalitions of America, a non-profit bipartisan initiative formed in 1992 by the President's Drug Advisory Council and designed to promote and facilitate local responses to the Nation's drug and drug-related violence problems. He is the former founding Executive Director of Project Freedom, a nationally recognized substance abuse coalition in Wichita, Kansas. Mr. Copple has been published extensively and is known around the country as an expert on the Nation's drug crisis and on the coalition movement within our country.
Our second witness is Richard Romley, the County Attorney for Maricopa County, Arizona. Sworn in, in 1989, Mr. Romley was named Arizona's County Attorney of the Year in 1992 and was recognized by the United States Department of Justice for his leadership in law enforcement. His anti-drug program properly known as ''Do Drugs, Do Time'' was adopted as a national model by the President's Drug Advisory Committee. Mr. Romley received a degree in Business Management and his juris doctorate degree from Arizona State University.
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The subcommittee's next witness is Dennis Peron. Mr. Peron currently serves as Director of the San Francisco Cannabis Cultivators Club and Californians for Compassionate Use in San Francisco. In 1992, he founded the San Francisco Cannabis Buyers' Club, the first medical marijuana facility in the United States. Mr. Peron has also written and campaigned for several propositions at the State level which would allow for the medicinal use of marijuana including California's Proposition 215.
Our next witness is Ronald Brooks. He is past president of the California Narcotic Officers' Association and currently serves as the Chair of that organization's Drug Policy Committee. He also serves as a Special Agent Supervisor with the California Attorney General's Bureau of Narcotic Enforcement and as the Task Force Commander to the Santa Clara County's Specialized Enforcement Team, a multi-agency narcotic enforcement unit. Mr. Brooks is a member of the International Narcotic Officers' Association and the National Narcotic Officers' Association Coalition.
The subcommittee will then hear testimony from Dr. Lester Grinspoon. Dr. Grinspoon is a Clinical Associate Professor of Psychiatry at the Massachusetts Mental Health Center at Harvard Medical School. He's a former chairman of the Board of Directors of the National Organization for the Reform of Marijuana Laws, and is a member of the Drug Policy Foundation's Advisory Board. He is also editor of Harvard Mental Health Letter. Dr. Grinspoon received his undergraduate degree from Tufts College and his degree in medicine from Harvard Medical School.
Our next witness is Dr. Janet Lapey. A retired pathologist, Dr. Lapey currently serves as the Executive Director of Concerned Citizens for Drug Prevention, Incorporated, a volunteer anti-drug group, which has been instrumental in opposing drug legalization efforts. She has also served on the faculty of Georgetown University School of Medicine and Harvard Medical School and is a member of the International Drug Strategy Institute. Dr. Lapey received her B.A. in Biology from Radcliffe College and her M.D. from the University of Rochester School of Medicine.
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And last, also appearing on the subcommittee's second panel is Roger Pilon.
Mr. MCCOLLUM. Dr. Pilon is the founder and Director of Cato's Center for Constitutional Studies. Prior to joining the Institute in October 1988, he held various posts in the Reagan administration including directorships of the State Department's Bureau of Human Rights and Humanitarian Affairs and the Department of Justice's Asylum Policy and Review Unit. Dr. Pilon received a B.A. in Philosophy from Columbia University; an M.A. and Ph.D. in Philosophy from the University of Chicago, and his J.D. from George Washington University School of Law.
I want to welcome the entire panel today. We're delighted that you're here. Now, I'd like to lay the ground rules for this panel. As you can see, we have a very large panel and, unfortunately, a lot of potential votes today. Without objection, all of your statements will be admitted into the record in their entirety. I hear no objection, so they are. I would request that you abide strictly by the 5 minute time rule for presenting a summary of your written statements. That will allow us to hear from everyone and then have the opportunity to question you further. Even if we stick strictly to the five minute rule, it will take 35–45 minutes just to get through the actual testimony. So, we'd be very grateful for your assistance in this way.
I'm going to try to get Mr. Copple's testimony in before I have to go to vote. We have about 5 minutes. Mr. Copple, you're recognized. Please, give us your summary.
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STATEMENT OF JAMES E. COPPLE, PRESIDENT AND CEO, COMMUNITY ANTI-DRUG COALITIONS OF AMERICA
Mr. COPPLE. Mr. Chairman——
Mr. MCCOLLUM. You need to turn the mike on down below, there's a little switch there. Thank you.
Mr. COPPLE. Thank you, Mr. Chairman, for this opportunity to appear before your committee on this very important topic.
Today is the fifth anniversary of Community Anti-Drug Coalitions of America. Five years ago, we were founded to respond to a growing need that was taking place in this country related to drug abuse. The growth of our organization from 300 coalition members to nearly 5,000, parallels, also, the concern that has taken place in this country over increased use of drugs, alcohol, and tobacco on the part of America's youth, and our coalition efforts have been responding to that.
In the past year and a half, one of the more disappointing features of this effort to deal with youth substance abuse has been the major distraction that the medical marijuana issue has caused and the major disruption, in our judgment, of the process to deal with youth substance abuse. This disruption, from an organizational perspective, included the pro-legalization movement and those supporting medical marijuana on the internet encouraging people to saturate our 800 number in order to financially derail us from our mission; as well as the time and effort that we've had to spend, seriously outfunded in States such as California and Arizona, to deal with this issue.
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Five years ago, on October 1st, in 1992 when we arrived in Washington to start this, that just a week before, I was leading a local coalition in Wichita Kansas. I had attended the 50th funeral in 18 months of a young person in our community who had overdosed on drugs. This has become an epidemic issue within our community. Every one of the 50 children whose funerals I attended, some of which I conducted, had started with marijuana.
This issue is critical, and I must tell you, that on the inner city streets of the community that I lived in that was beginning to deal with a growing gang and gang—drug related violence issue, I never met a parent that supported decriminalization, legalization, or softening of attitudes about drugs in their communities. They wanted it out, and they wanted their children protected from it.
The medical marijuana issue, from our perspective, has been an issue that the intellectually and culturally elite have advanced upon the American people, hiding behind a series of smoke screens to deceive the American people. I have said it before, and I will say it here today, these have been wolves dressed in sheep's clothing using the compassionate issue to advance a broader issue. You have members of this panel, who themselves have very publicly admitted to things like, ''Well, I use marijuana to treat my alcoholism.'' The medical marijuana issue is a gateway issue to open up the whole legalization of drugs which I believe is a pernicious effort on the part of this group to undermine the integrity of our youth and the stability of a culture that wants to be drug-free.
We are very concerned about these kind of intellectual and cultural arguments that want to take place in coffee clutches at universities, but on the streets of America, they don't play. The reality is, is that when California and Arizona passed their initiatives and the propaganda and the material that was advanced—financed by people such as George Soros who would like to advance an open society—and I've read Soros extensively, and I understand his thinking, and there are elements, as General McCaffrey pointed out, that have some merit or some consideration, but on this issue the very open society that he would propose encourages an open behavior that undermines the health and safety of America's children. We cannot afford to do medical policy by ballot, no more than we could have tolerated in 1962 individualized States supporting civil rights actions that undermined Federal law. We overcame those State initiatives, and we need help at the Federal level to overcome those same kind of State initiatives that would advance medical practice by referendum.
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To us, it is unconscionable that these efforts have gone forward. The good news, is that in Arizona—and Mr. Romley, no doubt, will talk specifically about Arizona—but Community Anti-Drug Coalitions of America following the passage of their proposition went in and conducted a poll in Arizona to find out what the citizens of Arizona really voted on. Under the guise of ''We're going to get tough on crime,'' they rescheduled all drugs allowing doctors to prescribe all Schedule I drugs. We went back in and found a number of interesting things which gave the legislature in Arizona the strength to overturn many elements of their proposition. Seventy-three percent of the voters did not believe that doctors should to be able to prescribe drugs like crack cocaine, heroin, PCP, LSD, and methamphetamines to their patients. The American public correctly believes that these Schedule I drugs do not have any medical utility.
Secondly, that we found out in terms of the poll that we conducted in Arizona, was that 70 percent of the Arizona voters believed that legalizing Schedule I drugs for prescription will give children the impression that these drugs are okay and can be used for recreational purposes. Another 87 percent of the voters said that any drug that is to be prescribed should be required to go through an FDA approval process.
In 1916, we established the FDA to prevent and to protect the American people from snake oil salesman, and that's precisely what this is. It's an effort on the part of a pro-legalization movement to push an agenda that, again, will undermine the health and safety, bypassing serious scientific review, serious scientific study, and, essentially, opening up a process that would undermine our efforts.
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We encourage Congress to stand strong on this issue. Any Federal attempts to undermine the health and safety of our children under the guise of medical marijuana, should be scrutinized very carefully.
[The prepared statement of Mr. Copple follows:]
PREPARED STATEMENT OF JAMES E. COPPLE, PRESIDENT & CEO, COMMUNITY ANTI-DRUG COALITIONS OF AMERICA
Chairman McCollum, distinguished members of the committee, thank you for the opportunity to testify on this important issue. The medical marijuana ballot initiatives in Arizona and California were classic examples of the pernicious influence money can have in the political process. Proposition 200 was voted into law by 65 percent of Arizona voters following a 1.5 million dollar advertising campaign which framed the initiative as a ''tough on crime'' bill. California supporters spent nearly $2 million to position Proposition 215 as a compassionate use law to help the terminally ill. A few wealthy donors, including billionaire financier George Soros, were able to effectively advance their drug legalization agenda with one of the finest political campaigns money could buy.
Over the last year since the passage of these ballot initiatives, CADCA has emerged as the leading national anti-drug organization opposing these measures. We have worked tirelessly to educate our 4,300 grassroots groups on the dangers associated with marijuana as medicine laws, and we have led the public debate in the national media against the drug legalizers (see attached Say It Straight manual).
CADCA's low budget efforts to challenge the medical marijuana hoax have been met with fierce opposition from pro-drug organizations. Groups with seemingly harmless names like the Media Awareness Project (MAP) have resorted to dirty tactics to intimidate and silence critics to the marijuana agenda. In a front page article of the New York Times dated June 20, 1997, MAP was exposed for putting CADCA's 1-800 number on pro-drug internet sites to encourage medical marijuana supporters to call the legislative hotline to run up the bill, in effect attempting to bankrupt our organization. Californians for Medical Rights threatened CADCA with legal action for showing communities the distorted and misleading television advertisements supporting Proposition 215.
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Despite these hurdles, CADCA remains unwavering in our resolve to fight medical marijuana legislation. We believe that when the public receives reliable data regarding medical marijuana research and accurate information on the dangerous consequences of medical marijuana legislation, they will be less likely to support future ballot initiatives.
A closer examination of CADCA's activities in Arizona reveals the strategic opportunities for turning around public opinion on this issue. After the initial shock over Proposition 200's wide margin of victory had passed, local anti-drug groups and the Maricopa County District Attorney's office under the leadership of Rick Romley began planning a strategy to nullify the frightening impact of the initiative. The DA's office enlisted the help of CADCA, and we responded by commissioning a post-election survey to determine the views of Arizona voters on the critical issues surrounding Proposition 200. The survey found that once the real-world consequences of Proposition 200 were known, the voters opposed many of the key components of the legislation. Consider the following survey highlights:
73 percent of the voters did not believe doctors should be able to prescribe drugs like crack cocaine, heroin, PCP, LSD, and methamphetamines to their patients, even though Proposition 200 allowed doctors to prescribe these drugs. The American public correctly believes that these Schedule I drugs do not have any medical utility. Emboldened by the success of this brazen strategy, pro-drug organizers have included legalization of all illicit drugs in the upcoming Washington State ballot initiative.
87 percent of voters thought that marijuana, crack cocaine, heroin, PCP LSD, and methamphetamines should be required to undergo rigorous testing before doctors could prescribe them to their patients. This common sense approach to research and testing before drugs are approved for use has ensured the safety and effectiveness of drugs consumed by the American public for nearly a century. Our drug testing guidelines protected this country from approving the dangerous drug Laetrile, which led to many European woman giving birth to deformed children. Marijuana and other Schedule I drugs that have the potential for abuse should be removed from the political process and placed under tough scientific standards to ensure their medical safety. It is clear that this ''medicalization'' effort has never been about sound medicine or reliable research. The medical community has not been pushing these initiatives. In fact, every major medical association, including the AMA and the American Cancer Society to name a few, have opposed marijuana as medicine legislation. The reality is that there has not been one scientific study that has proven that smoke marijuana is both a safe and effective treatment for any medical condition. THC, the key chemical in marijuana that treats nausea and wasting among cancer and AIDS victims has been available in the pill form Marinol. Smokeable marijuana not only provides a dose of the potent chemical THC, but it adds 400 additional chemicals that contain various toxins and carcinogens to patients bodies.
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70 percent of Arizona voters believe that legalizing Schedule I drugs for prescription will give children the impression that these drugs are okay to be used for recreational purposes. CADCA and our 4,300 community coalition members remain concerned that these ballot initiatives will send a mixed message to kids concerning the dangers of illegal drug use. In the last five years alone, marijuana use has tripled among eighth graders, and doubled among 10th and 12th grade students. This country is facing a major drug epidemic among our young people, and we cannot afford to have legislation that undermines the prevention efforts of families, schools and communities.
92 percent of Arizona voters believe persons who commit violent crimes while on drugs should serve 100 percent of their terms before they are released. The pro-drug groups in Arizona seized upon this genuine concern of the citizens, and perpetrated a fraud of massive proportions when they positioned Proposition 200 as a ''get tough on crime approach'' to the drug problem. Supposed low level drug users would be released to provide needed prison space for violent criminals. Any novice to the criminal justice system knows that violent criminals are never housed in the same facilities as nonviolent offenders. The pro-drug mantra that today's jails are filled with innocent marijuana users does not hold up when the facts are scrutinized. Many drug dealing convicts have plea bargained their sentences down to simple possession or use charges, masking the real reason that they were sent to prison. The tough sounding law enforcement rhetoric in the political ads for Proposition 200 disguised the fact that the initiative would have encouraged the immediate eligibility for release of more than 1,000 inmates presently incarcerated for drug offenses, and would have prohibited prison sentences for drug offenders until their third conviction. The release of potentially dangerous criminals, many who had serious criminal records, would have posed a real threat to the safety of Arizonans. Two of the inmates who would have been eligible for release under Proposition 200 will soon stand trial for the recent killing of a prison guard in Arizona. The second part of the ballot measure would have undermined the successful drug court approach which utilizes the coercive threat of prison to mandate treatment participation from drug offenders.
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73 percent of the voters personally opposed the legalization of marijuana. Despite this overwhelming public opposition to drug legalization, the pro-drug groups in California and Arizona were able to legitimize their real agenda by seizing on the medical marijuana issue. Mr. Peron, who testified earlier, stated in a debate that I had with him that he wants to legalize marijuana across the country, and that he regularly smokes marijuana to help him with his alcohol addiction. A senior official from the National Organization to Reform Marijuana laws (NORML) declared that ''the key to it (legalized marijuana) is medical access. Because, once you have hundreds of thousands of people using marijuana medically under medical supervision, the whole scam is going to be bought . . . So that once there's medical access, if we continue to do what we have to do, and we will, then we'll get medical, then we'll get full legalization.''
The impact of this survey in moving the state legislature to act against Proposition 200 in Arizona is instructive for future political battles on this issue. The genius of the three bills that passed the Arizona House and Senate was that they did not disdain the will of the people by openly rejecting Proposition 200, but instead systematically corrected the harmful effects of the ballot initiative. Utilizing the compelling survey findings, a bill was introduced that required all Schedule I drugs to pass the rigorous FDA approval process before they could be prescribed by doctors.
The bill was passed by a one vote margin, and signature gathering efforts to overturn this decision are well underway. More money continues to pour into Arizona and other states to support drug legalization efforts. The initial passage of these ballot initiatives last November was not surprising, when you consider that the opponents of the measure were outspent 75 to 1. The deep pockets of Mr. Soros produced sound bite ads and professional, high-tech political campaigns that obscured the real issues concerning our nation's drug problem.
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Despite public cynicism concerning money and politics, the actions of the Arizona State Legislature have emerged as a hopeful sign for democratic government. What happened in Arizona is a significant political and cultural event. Since 1992, almost all of the news on the drug front has been bad: huge increases in drug use among the youth, lack of parental involvement on the issue, diffident national leadership, and de facto legalization in California and Arizona. The efforts in Arizona demonstrate that a well-informed citizenry can fight back. The passage of this bill shows that effective grassroots organizing by volunteer citizens can defeat a well-funded, professional campaign—and in the process encourage political leaders to stand up against moneyed special interests. What is less clear is whether this effort can be sustained over the long haul, especially when the proponents of medical marijuana have significant financial resources.
The temporary victory achieved in Arizona will be harder to replicate as the battle moves to many new fronts. Ballot Initiative 685 in Washington State and Initiative 57 here in our nation's capital are two of the latest challenges in the medical marijuana combat. Initiative 685 mirrors the worst of Arizona's ballot measure by legalizing all Schedule I drugs, while the district initiative requires the D.C. government to distribute marijuana. Today, I challenge this Congress to amend the federal Controlled Substances Act to ensure that no state law will exempt from state prosecution any activities constituting a violation of federal law. This kind of amendment to the existing Act will have the effect of showing a ''positive conflict'' with federal law, and give the federal government legal standing to challenge these initiatives in the courts.
The medical marijuana issue has been a diversion for CADCA, and for the 4,300 community groups that are working to prevent youth drug use at the local level. Spending limited resources to fight this growing problem will only weaken the ability of community coalitions to focus on their core mission. We know that this country can reduce illegal drug use if we will work to develop comprehensive local strategies that engage the entire community in promoting a clear no use message. CADCA calls on the Congress to assist us in this battle so that we can devote our energies to the task of keeping our children drug-free.
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Mr. MCCOLLUM. Mr. Copple, you have been an excellent example to the rest of the panel of sticking within the 5 minutes. They won't all agree with you on the substance, I'm sure, but your delivery was excellent, and we do need such attention to the time limits.
The subcommittee will be in recess until after this vote, then we'll resume immediately.
[Recess.]
Mr. MCCOLLUM. If the panel will take their seats, we'd like to resume this hearing. We only have about 45 minutes or so before we have a series of votes that will last for upwards of two hours. So, it's very important that we allow everybody fair time.
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Our next witness, Mr. Romley, has a taped presentation of the ads used in the medical marijuana referendum in Arizona. I've assured him that the time that is taken to show those ads will not count toward his 5 minutes, but I'm going to adhere very strictly to the 5-minute rule, and caution you all to really work on summarizing. Hopefully, we'll have time for questions, so you can make extra points then.
Mr. Romley, you're recognized for 5 minutes. As I said at the end of that time, we'll show the tape, but we're going to be strict on the 5 minutes so——
Mr. ROMLEY. Well, the tape's in the middle of the testimony.
Mr. MCCOLLUM. If you want it to be shown in the middle, we'll give you 7 minutes which I think should be adequate time for both your statement and video presentation.
STATEMENT OF RICHARD M. ROMLEY, MARICOPA COUNTY ATTORNEY, MARICOPA COUNTY, AZ
Mr. ROMLEY. Mr. Chairman, members of the committee, first of all, let me thank you very much for providing me this opportunity to present my views regarding the consequences that we, in Arizona, anticipate as a result of the voter initiative called the Drug Medicalization Act. The passage of this initiative means that we can expect more attempts by drug legalization forces to replicate their efforts throughout the United States. As the district attorney for Maricopa County, encompassing Phoenix and 22 other cities, I am gravely concerned that this movement will undermine our ability to combat an ever-increasing drug epidemic.
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On December 2nd of 1996, I had the honor of appearing before the United States Senate Judiciary Committee on this very same subject, following the passage of propositions 200 and 215 in both Arizona and California. I told that committee that we in law enforcement were caught sleeping at the switch. We were overwhelmed by a massively funded, highly deceptive media campaign. Citizens in Arizona and California were bombarded by T.V. commercials that were factually devoid and emotionally driven, but, yet, they were highly successful. I have brought with me—as you mentioned a moment ago—certain examples of these commercials that demonstrate the emotionally-laden content that the citizens of Arizona and California saw, and with your permission, I'll play those very quickly right now.
Mr. MCCOLLUM. Please do. Thank you.
Can we turn the sound up?
Mr. ROMLEY. Mr. Chairman, as you——
Mr. MCCOLLUM. I think that's as much time as we have; I hope that's all of them. Mr. Romley, please.
Mr. ROMLEY. That is. Thank you very much. As you can see in California, the commercials emphasize compassion. They tugged at your heart, and they were very effective. I mean, who could resist the emotional appeal of a widow or a cancer victim speaking on behalf of marijuana to relieve unbearable pain. But omitted, was one important fact: that not one nationally recognized medical organization had endorsed marijuana as medicine, nor was it revealed that there are other medicines, presently available, which treat those conditions for which marijuana is being touted.
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In Arizona, though, a different strategy was employed. Emphasis was placed on getting tough on drugs. Images were invoked that inferred Arizona prisons are overflowing with first-time drug offenders. This is totally false. A recent study by my office revealed that every incarcerated inmate convicted of a drug possession charge had an extensive criminal background or the original charges included more serious offenses. The deceptive nature of the commercials is further highlighted by the absence of any reference to the fact that proposition 200 not only, in a sense, quasi-legalized marijuana, but permitted the use of heroin, LSD, and PCP for medical purposes.
But lest there be any doubt as to the true motives behind these campaigns, let me refer you to the words of Mr. Richard Cowan, a member of the Board of Advisors of the Drug Policy Foundation, a sponsor of propositions 200 and 215, and a former director of NORML. Both of the organizations are at the forefront of the drug legalization movement. In April 1993, when discussing tactics for legalizing drugs at a conference in San Francisco, celebrating the 50th anniversary of the discovery of LSD, he stated, ''The key to it is medical access, because once you have hundreds of thousands of people using marijuana medically, under medical supervision, the whole scam is going to be blown. Once there's medical access, if we continue to do what we have to do, and we will, then we'll get full legalization.'' Now, Mr. Chairman, I have provided your staff with a copy of that entire conference. It is available to this particular committee to show the true motive behind the medical marijuana movement.
These words reveal the duplicity that underlies the drug medicalization issue. We have been presented with the Trojan horse of the 20th century. We must not allow ourselves to be taken in. The drive to legalize drugs is accelerating, and it's taking on new dimensions. The drug legalization advocates are moving from State to State in a strategically orchestrated manner, gradually changing the initiatives from medicalization to outright legalization.
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And by way of example—this was not reflected on General McCaffrey's chart—but I was recently in Oregon, and they are faced with a two-pronged effort to legalize drugs, and it has been launched. The first prong is a proposed amendment to the Oregon constitution which provides for the decriminalization of all narcotic and dangerous drugs. The second prong is a proposed initiative that would allow the sale of marijuana to adults through State liquor stores.
In Washington State, initiatives are on the ballot which would permit doctors to recommend to patients the use of all Schedule I controlled substances, including heroin, LSD, and PCP. The Washington initiative does not even require a prescription.
Even if the proponents are being honest in their claim that all they want is for marijuana to be used as medicine, we in this country have a process which requires drugs to be tested before they can be prescribed. The FDA process has served us well. The horrors of thalidomide, largely restricted to Europe, were, thankfully, not repeated in the United States due to the vigilance of an FDA scientist. I would note that it's currently being undertaken to re-study thalidomide, but it's properly before the FDA.
We all have a right to expect that before medicines are made available to the public, they will have undergone vigorous testing to ensure that their benefits outweigh their negative effects. I have publicly stated, that if after appropriate testing, the FDA declares that marijuana or for that fact, any other drug has medical value, I have no objection to its use, however, until the process is completed, I do not believe that the American public will be properly served by a return to the days of the snake oil salesman who prescribed untested remedies to cure every malady from boils to cancer. I realize that the faith in our system of regulation may be shaken from time to time, but we, you and I, should never shirk our responsibility; not to the people who elected us; not to our families, and, especially, not to our children.
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As a Nation, we must not allow this facade of medicalization to go unchallenged, for that falsehood is simply the first step in a stealth campaign toward the legalization of drugs. I thank you very much for permitting me to express my views. I'll answer any questions at the appropriate time.
[The prepared statement of Mr. Romley follows:]
PREPARED STATEMENT OF RICHARD M. ROMLEY, MARICOPA COUNTY ATTORNEY, MARICOPA COUNTY, AZ
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Mr. MCCOLLUM. Thank you very much, Mr. Romley. Mr. Peron, you are recognized for 5 minutes.
STATEMENT OF DENNIS PERON, DIRECTOR, CALIFORNIANS FOR COMPASSIONATE USE
Mr. PERON. Thank you. My name is Dennis Peron. I'm from Long Island, New York. I was drafted in 1966; served my country in Vietnam in 1967-1968; Thailand, 1968-1969. I'm a gay man who lost his lover from AIDS. I have extensive background in the sales of medical marijuana. I'm also the author of proposition 215.
It was in 1988 when I realized more clearly the medical benefits of marijuana when my lover, Jonathan West, was diagnosed with AIDS. He, like all AIDS patients, was prescribed a myriad of drugs, some 20-odd drugs. All of these drugs had severe side effects, from nausea to appetite suppression. Marijuana was the one drug that eased his nausea. It was the one drug that stimulated his appetite. It was also the one drug that gave him a little dignity to his day in making him feel a little better.
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When Jonathan died in 1990, I dedicated my life to all the suffering Jonathans of America who were being denied a medicine for purely political reasons and set upon a path to legalization. Along that path, I started a club for all the Jonathans of San Francisco and the Bay area who had AIDS and cancer. When I started that club, I primarily thought of AIDS and cancer in the antiemetic value and the munchy value of marijuana.
Along that road, I also met a woman named Dixie Romango who had multiple sclerosis, whose hand shook so much she could hardly hold a glass of water; when she smoked two or three puffs of pot, her muscles would relax, enabling her to hold a glass of water.
I also met a woman named Hazel Rodgers, a 78-year old woman who was going to go into her second operation for glaucoma. Her intra-ocular pressure was getting very high. She tried marijuana. Her intra-ocular pressure stabilized. She did not have to go to that operation.
I also met a senator, Senator Mello, from Watsonville whose sister died of cancer. He and I sponsored a resolution in the California State legislature imploring this Congress and the President to reschedule marijuana to Schedule II to allow physicians to prescribe it.
When I was growing up, I went to civics class. I was told in America, ''All things are possible;'' that if you don't like a law, that you could change that law. They pointed out that women were allowed to vote now, and that we didn't have children working in factories, and that we have the end of desegregation, and that you could change America if you are determined.
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Well, we tried to do that, Mr. McCollum. We sponsored two bills, 2 years in a row in the California State legislature. Both of these bills passed with bipartisan support. The first bill would have allowed California doctors to prescribe marijuana for AIDS, cancer, multiple sclerosis, and glaucoma patients. The second bill sought to keep these people out of jail if they should get caught using it. We passed these bills with Republican and Democratic support only to have it vetoed by Governor Wilson. And then, we took the language from those two bills; put them into an initiative; collected 750,000 signatures to put our initiative on the ballot in California.
Who was against us? The same old cultural warriors of the sixties. We had three former Presidents campaigning against us. We had Barry McCaffrey in the State for a month and a half telling people, ''Don't vote for this. It's a hoax. It's a Cheech and Chong show.'' We had Senator Diane Feinstein telling people, ''If you vote for this, you're going to legalize marijuana.'' We had our own Attorney General saying, ''If you vote for this, you can get a hangnail and get marijuana.'' The people heard them and rejected their arguments, and passed proposition 215. And, now, what do we hear? We hear that people are stupid; that they didn't know what they were voting for; that this is a hoax; that this is not real.
I ask you here, today; I stand here in front of the most powerful Congress in the world asking you to reject those cynics to bring in a new era of hope and optimism to America; to reschedule marijuana. This is about marijuana, but it's also about something else. It's about who we are as Americans and where we are going as a country. Will we be remembered as a people that denied sick and dying people a medicine for purely political reasons, and then as a Nation, are we prepared to build prisons to put these people in? Who are we, and where are we going? I implore you, reschedule, research, and set standards. Thank you very much.
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[The prepared statement of Mr. Peron follows:]
PREPARED STATEMENT OF DENNIS PERON, DIRECTOR, CALIFORNIANS FOR COMPASSIONATE USE
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WHY I WROTE PROPOSITION 215
BY DENNIS PERON
I co-wrote the Compassionate Use Act as a eulogy for my lover, Jonathan, who died of AIDS. Marijuana was the one medicine amongst over 20 others he was legally prescribed, that eased his nausea and stimulated his appetite. It also cheered him up. I wanted to leave for Jonathan, and all the young people who have died of AIDS, a legacy of love and compassion.
What started out as a eulogy for Jonathan has become a much larger and deeper mission of mercy, embracing the sick and dying from all walks of life. If you live in San Francisco, Prop 215 is about AIDS. If you live in the Central Valley, it's about cancer. If you live in Leisure World, it's about glaucoma and arthritis.
Prop 215 is for Scott Hager, a 34-year-old Para-Olympic athlete whose house was raided by Santa Cruz police for growing four marijuana plants that he used to control violent muscle spasms caused by his quadriplegia.
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Prop 215 is for Byron Stamate, a 74-year-old retiree who was arrested in El Dorado County for growing marijuana to treat his girlfriend's chronic back pain. His girlfriend committed suicide so she wouldn't have to testify against him in court. His home and his life savings were seized by the county's sheriff's department, and he spent more than three months in jail.
Prop 215 is for Barbara Sweeny of Fairfax, an AIDS patient, who was arrested in Marin County for growing marijuana. She suffers from a chronic infection and the drugs she has to take have terrible side effects that marijuana helps alleviate. After her arrest she was instructed to try Marinol, a synthetic marijuana substitute which costs $300 a bottle. The Marinol didn't work very well and cost nearly $600 per week, paid by Medi-Cal, to replace the medicine she had been growing at home for free.
Prop 215 is for Samuel Skipper, another AIDS patient, who was arrested in San Diego for growing his own marijuana for himself and his partner who also suffered from AIDS. Sam was sent to prison where he was stabbed and beaten up by violent inmates.
Prop 215 is for Karen Thompson's 15-year-old son with Crohn's disease who sometimes throws up 40-50 times a day after chemotherapy for his illness. Karen, who would watch her son on his knees with his head over the open toilet, said ''when he takes two puffs from a marijuana cigarette, relief is almost immediate.''
Prop 215 is for Hazel Rodgers, a 78-year-old glaucoma sufferer who credits marijuana with helping to save her eyesight.
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Prop 215 is for John Boyce, the late husband of 215 co-proponent Anna Boyce, RN. After he was diagnosed with cancer, Mr. Boyce, a man who prided himself on his law-abiding nature, was pained at the end of his life that he had to do something illegal to get relief from his chemotherapy nausea.
Prop 215 is for Brownie Mary, 76, and the people she calls her ''kids.'' Her kids are the young people with AIDS on Ward 86 at San Francisco General Hospital. Mary has volunteered for 16 years, helping the overburdened doctors and nurses. She has testified to the relief her kids get from her marijuana brownies.
Prop 215 is for all the overworked district attorneys caught up in a moral dilemma forced to prosecute sick and dying people for victimless marijuana offenses. It is for the brave police of California sworn to protect us, not to arrest sick people. I wrote it to ease their load, and ease their consciences. That will allow them to concentrate on stopping violent crime. It will save the taxpayers of California millions of dollars. Marijuana sales will still be illegal, but Prop 215 encourages the state and federal government to make medical marijuana accessible to the ill.
Prop 215 is for the oncologists and AIDS specialists who have to watch helplessly as their cancer patients retch throughout chemotherapy or as their AIDS patients waste away. I wrote it for the senior citizens who sit depressed in nursing homes losing their eyesight and suffering from the pain of arthritis.
Prop 215 is not about encouraging teens to use marijuana. I support all efforts against the glorification of teenage drug use, including alcohol and cigarettes, but denying that marijuana is a legitimate medicine, when so much evidence points to the contrary, will only alienate youth and cause them not to trust what we say. Do we really want to imply to our youth that sick and dying people can't have a medicine because of you? When they are adults won't they resent us for using their generation in such a blatantly mean-spirited political way?
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It is ironic that our opponents, the California Narcotics Association and the California Prison Guards Association, point to Marinol as a solution. On one hand they say marijuana has no medicinal value, yet they take the most psychoactive ingredients of the plant and put it in pill form and tell retching cancer patients to swallow and wait. Marinol has proved the efficacy of marijuana so we are really talking about delivery system. If they are against smoking (again a contradiction, because the government grows marijuana at a farm in Mississippi and supplies it LEGALLY for eight ill people), what about brownies or tincture? Are they against that?
Our proposition is supported by 125 health and service organizations, including 38,000 nurses and doctors. What brings together the American Legion, the National Multiple Sclerosis Society Northern California Chapter, the Congress of California Seniors, the California Federation of Labor, the San Francisco Medical Society (representing 9,000 doctors), the United Methodist Church, and the other organizations supporting this proposition? Compassion and love. Something that has been missing from our political equation.
Will we be remembered as a people who denied patients a medicine that helps them for purely political reasons? Then, as a nation, are we prepared to build prisons to house them? Who are we; where are we going?
The Compassionate Use Act of 1996 reaches into the centuries-old wisdom of the past, where cannabis was not controversial but rather recognized as a valuable medicine, and gives it back as a gift to the people of the future. Prop 215 is concrete help for the sick and dying, but it is not just about marijuana. It represents a turn towards a more loving and compassionate society.
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Mr. MCCOLLUM. Thank you, Mr. Peron. Mr. Brooks, we're going to try to get your 5 minutes in before I have to run to vote.
STATEMENT OF RONALD E. BROOKS, CHAIR, DRUG POLICY COMMITTEE, CALIFORNIA NARCOTIC OFFICERS' ASSOCIATION
Mr. BROOKS. Thank you, Mr. Chairman. I appreciate being here before this subcommittee to discuss this important topic.
As you know, I'm representing the California Narcotic Officers' Association and its 7,000 members and the National Narcotic Officers' Association Coalition with its 33 State associations and 50,000 members.
Since the 1960's, there's been an active political movement in California and across the Nation to promote the legalization of marijuana and other drugs. In 1972, an initiative was qualified for the California ballot to decriminalize marijuana. That initiative was defeated by a margin of 2 to 1, statewide. That defeat taught the pro-legalization lobby that the public would not accept outright legalization.
Based on frustration over issues of crime and drugs and fueled by an underlying feeling that taxes are too high, many citizens are now seeking simple solutions to this Nation's very complex drug problem. This feeling of public frustration is being exploited by a small but growing group of drug legalizers who, over the years, have adopted a strategy of working toward complete drug legalization by first approaching the medical marijuana issue.
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To understand what passage of medical marijuana initiatives and other decriminalization legislation would cause, it's helpful to step back in time. At the turn of the century, unregulated syrups and other remedies were heavily laced with morphine, cocaine, and heroin. These drugs were cheap, legal, and readily available, much like marijuana will become under the medical marijuana initiatives. Drugs were sold without medical examination or prescription.
By 1910, there was an estimated 250,000 drug addicts in this Nation, many of whom became addicted using unregulated patent medicines. Rampant drug use resulted in record levels of crime and social disorder. The leaders of our great Nation strongly rejected the scourge of drugs in our communities. By popular demand, the Food and Drug Act of 1906 required that all ingredients in food and drugs be made known to consumers. This began the development of consumer protection laws which continue to safeguard us to this day. Through vigorous drug enforcement and a strong anti-drug message, America's addict population declined from 250,000 to 50,000 by 1940.
The strategy of using medical marijuana as the first step to drug legalization is well documented. In 1979, NORML director, Keith Stroup, told an Emery University audience that NORML would be using medical marijuana as a red herring to give marijuana a good name. Kevin Zeese of the Drug Policy Foundation was quoted on several occasions as saying, ''that medical marijuana is the first step to decriminalization.'' And Eric Sterling of the Criminal Justice Foundation has said, ''Medical use of marijuana is an integral part of the strategy to legalize.''
During California's general election last November, a fraud was perpetrated on the voters, and a cruel hoax was played on the sick. This hoax and fraud was the passage by voters of the so-called Medical Marijuana Compassionate Use Act, proposition 215. This ballot initiative exploited public compassion for the seriously ill in order to legalize the widespread use and cultivation of marijuana in California.
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I believe that we should talk about compassion for a moment. True compassion would mean that the pro-drug lobby would stop using sick and dying people as pawns in their strategy to achieve drug legalization. Under proposition 215, anyone who claims to have a doctor's verbal approval can grow and smoke marijuana, even children. The pro-proposition 215 lobby led voters to believe that marijuana would be used by persons suffering chronic or terminal illness; in fact, it allows marijuana to be used for minor ailments including headaches and strained muscles. The public was also led to believe that marijuana would be available based on a doctors prescription. In fact, all that is required is a recommendation of a physician without the requirement of an examination, written prescription, or other records.
Marijuana is not a medicine, and the backers of the medical marijuana movement are not doctors. Proposition 215 was written in the fashion that it was without medical examination or prescriptive controls, because it never intended to be medical marijuana initiative. Proposition 215 was written to provide de facto legalization of marijuana in California. This was the pilot project by the pro-drug lobby; the first step toward the legalization of marijuana and drugs across this Nation.
The passage of proposition 215 and other similar initiatives will bring us back to the days of patent medicine. By regulating medicine at the ballot box rather than by scientific study, we have reversed 91 years of progress. Proposition 215 has effectively eliminated all patient and consumer protection established by our pure food and drug laws. In 1992, the National Institute of Health concluded that crude marijuana was not an effective medicine for use in treating nausea, AIDS, glaucoma, MS, or pain. In fact, there are more than 1,000 studies that show the harmful effects of marijuana and no scientific studies that show that smoking crude marijuana has an important benefit.
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It is important to remember that marijuana is a dangerous and addictive drug. In 1994, the Office of National Drug Control Policy reported that more persons are being admitted to treatment for marijuana than for heroin addiction. Dr. Daryl Inaba, of the Haight Ashbury Free Clinic in San Francisco states that marijuana is highly addicting and contains more than 360 chemicals that affect the brain.
Mr. MCCOLLUM. Mr. Brooks, I'm going to have to hold you to the 5 minutes and ask you to conclude. I appreciate it very much. Your entire statement, of course, is in the record.
[The prepared statement of Mr. Brooks follows:]
PREPARED STATEMENT OF RONALD E. BROOKS, CHAIR, DRUG POLICY COMMITTEE, CALIFORNIA NARCOTIC OFFICERS' ASSOCIATION
Mr. Chairman, members of the subcommittee, I appreciate the opportunity to appear before you today to discuss the issues surrounding medical marijuana and the overall movement in this country to legalize marijuana and other drugs. I am here as a past president of the California Narcotic Officer's Association (CNOA) representing President Ed Ladd, the executive board and our 7,000 members. I am also appearing as the chair of the Drug Policy Committee of the National Narcotic Officer's Association Coalition (NNOAC) which represents 33 state narcotic officer's associations and more than 50,000 police officers from across the country. More importantly I am here as the father of two children and a concerned member of my community.
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Although I am not an expert on medicine or drug policy, I am a veteran narcotic agent with more than 22 years of service in California. I have seen firsthand the results of drug use and the affects that it has had on the quality of life of California's citizens. I have been involved in fighting the move to legalize drugs and with drug prevention education for many years.
With the end of the cold war, the greatest threat to the security of our nation is drug use. Use that carries with it the misery of addiction, broken homes, horrific violence, carnage on our highways and ruined health.
Americans, when polled continue to describe drug use, violent crime and gangs as their major concerns, and they should be. As Americans we, have a right to live in safe, drug free communities.
The answer to our nations drug problem is a comprehensive policy which embraces drug prevention education, treatment and strong drug law enforcement.
Since the 1960's, there has been an active political movement in California and across the nation to promote the legalization of marijuana and other drugs. In 1972, an initiative was qualified for the California ballot to decriminalize marijuana. That initiative, proposition 19, was defeated by a margin of 2–1 statewide. It lost in every county except San Francisco. This defeat, taught the pro-legalization lobby that the public would not accept outright legalization. A recent poll by the National Center On Addiction and Substance abuse at Columbia University found that California's attitude towards outright legalization of marijuana has not changed substantially during the past 25 years.
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Our nations drug problems date back to before the turn of the century. They are complex and cannot be solved overnight. Based on frustration over issues of crime and drugs, and fueled by an underlying feeling that taxes are to high and government is not entirely trustworthy, many citizens are now seeking simple solutions to this very complex problem.
This feeling of public frustration is being exploited by a small but growing group of drug legalizers, who over the years have adopted a strategy of working toward complete drug legalization by first approaching the medical marijuana issue.
The tendency to underestimate the hazards of drug abuse has been made by successive generations. We, as voters tend to have short memories, and often times forget what has been painfully demonstrated in years past. Many researchers and physicians have grossly underestimated the danger posed by various drugs. Heroin was first developed as a non-addicting analgesic to replace morphine. And Sigmund Freud thought that cocaine was non-addictive and relatively harmless. A mistake that was repeated in the 1980's by Dr. Lester Grinspoon of Harvard when he declared cocaine to be as safe as aspirin. This statement was made on the eve of the crack cocaine epidemic in this country. Dr. Grinspoon in his book, ''Marihuana, the Forbidden Medicine'' now calls for the use of marijuana for a variety of medical applications. The many claims for the benefits of smoked marijuana made in this book are based on anecdotal information and are not based on scientific study. One of the claims made by Dr. Grinspoon is that marijuana use promotes safe driving.
To understand the problems that passage of medical marijuana initiatives and other decriminalization legislation would cause it is helpful to step back in time. At the turn of the century, unregulated syrups and other remedies were heavily laced with morphine, cocaine and heroin. These drugs were cheap, legal and readily available. Much like marijuana will become under many of the medical marijuana initiatives. Drugs were sold without medical examination or prescription. Opium dens were common in America's cities. By 1910 there was an estimated 250,000 drug addicts. Many of whom became addicted using unregulated patent medicines. Rampant drug use resulted in record levels of crime and social disorder. Our nations murder rate jumped 300% in the ten year period between 1907 and 1917.
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The leaders of our great nation strongly rejected the scourge of drugs in our communities. By popular demand the Food and Drug Act of 1906 required that all ingredients in foods and drugs be made known to consumers. This began the development of consumer protection laws which continue to safeguard us to this day. With the passage of this act along with the Harrison Act in 1914 we began our fight to rid this country of the evils of drug abuse. Through vigorous drug enforcement, a strong anti-drug message and the regulation of patent medicines and other drugs, America's addict population declined from 250,000 in 1900 to 50,000 in 1940. With the decline in drug addicts came a significant reduction in crime and public disorder.
This strategy of using medical marijuana as the first step to drug legalization is well documented. In 1979, NORML director Keith Stroup told an Emory University audience that NORML would be using medical marijuana as a red herring to give marijuana a good name. Kevin Zeese of the Drug Policy Foundation was quoted on several occasions as having said that ''medical marijuana is the first step to decriminalization'', and Eric Sterling, of the Criminal Justice Foundation has said ''medical use of marijuana is an integral part of the strategy to legalize''.
During California's general election last November, a fraud was perpetrated on the voters and a cruel hoax was played on the sick. This hoax and fraud was the passage by voters of the so called medical marijuana compassionate use act-proposition 215. This ballot initiative exploited public compassion for the seriously ill in order to legalize the widespread use and cultivation of marijuana in California.
I believe that we should talk about compassion for a moment. True compassion would mean that the pro-drug lobby would stop using sick and dying persons as pawns in their strategy to achieve drug legalization.
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Under proposition 215, anyone who claims to have a doctor's verbal approval can grow and smoke marijuana even children. Although the age limit for smoking tobacco is 18 and for the consumption of alcohol it's 21, there is no age restriction for the consumption of marijuana under proposition 215.
The pro proposition 215 lobby led voters to believe that marijuana would be used by persons suffering chronic or terminal illnesses. In fact it allows marijuana to be used for minor ailments including headaches and strained muscles.
The public was also led to believe that Marijuana would be available based on a doctors prescription. In fact all that is required is a recommendation of a physician without the requirement of an examination, written prescription or other records. A recommendation that is difficult, at best, for law enforcement officers investigating marijuana related crimes to prove.
Marijuana is not medicine and the backers of the medical marijuana movement are not doctors. Proposition 215 was written in the fashion that it was, without medical examination or prescriptive controls, because it was never intended to be a medical marijuana initiative. Proposition 215 was written to provide de-facto legalization of marijuana in California. This was to be the pilot project, by the pro drug lobby, as the first step toward the legalization of marijuana and other drugs in America.
The passage of proposition 215 and other similar initiatives will bring us back to the days of patent medicine. By regulating medicine at the ballot box rather than by scientific study and approval we have reversed 90 years of progress. Proposition 215 has effectively eliminated all patient and consumer protection established by our pure food and drug laws.
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In 1980, NORML, petitioned to have marijuana moved to schedule II. In 1988 Francis Young, an administrative law judge, ruled that marijuana should be re-scheduled for limited medical purposes. On 12–21–89 Drug Enforcement Administration Administrator John Lawn refused to re-schedule marijuana based on his review of the evidence. NORML petitioned for a review. DEA Administrator Robert Bonner again refused to move marijuana to schedule II based on an extensive review of the evidence and existing studies. In 1994 the U.S. Court of Appeals, in Washington DC, upheld Administrator Bonner's decision. In doing so the court stated that DEA had relied on scientific study and recognized experts while NORML had relied on anecdotal information.
In 1992 the National Institute of Health concluded that crude marijuana was not an effective medicine for use in treating nausea, Aids wasting, glaucoma MS or pain.
In fact there are more than 1,000 studies showing the harmful affects of marijuana, including a recently published study which indicates that marijuana use chemically alters the brain, leading to an increased propensity to use other drugs. This tends to show what many of us in treatment education and law enforcement already knew. Marijuana is a gateway drug. There are in fact no scientific studies that show smoked crude marijuana to have a medical benefit.
It is important to remember that marijuana is a dangerous and addictive drug with a high potential for abuse. In 1994 the Office of National Drug Control Policy (ONDCP) reported that more persons are being admitted to treatment for marijuana use than for heroin addiction. ONDCP and others involved in drug treatment and enforcement believe that marijuana use is on the rise in part due to the mixed message that is sent when marijuana is touted as a safe and effective medicine.
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Dr. Daryl Inaba, of the Haight Ashbuty Free Clinic in San Francisco states that marijuana is a highly addictive drug which contains more than 360 chemicals that affect the brain. With THC contents ranging from 14–24% Dr. Inaba states that smoking one marijuana cigarette today is the equivalent of smoking fourteen marijuana joints in the 1960's. During the 1960's the Haight Ashbury clinic didn't treat anyone for marijuana addiction due to the low THC content of that era. Today they treat 100 addicts each month.
Dr. Eric Voth MD, has stated that ''marijuana is clearly addictive and is responsible for behavioral, intellectual and cognitive deficits and is responsible for severe side-effects to the pulmonary, reproductive and immune systems.
Marijuana could never pass the FDA pure drug standards. It contains 2,000 crude chemicals, some of which are carcinogens stronger than those found in cigarettes. Smoking crude marijuana is known to trigger attacks of manic depression, schizophrenia and memory loss. An increase in teen suicides has been linked to marijuana use. Researchers at the University of California at Davis have identified a strong link between smoking marijuana and throat cancer. Persons under the influence of marijuana are 10 times more likely to be involved in fatal traffic collisions than persons driving under the influence of alcohol.
Despite what we know about marijuana, proposition 215 passed in California. It passed despite in spite of our efforts to stop it. It's passage was opposed by former Surgeon General C. Everett Koop, the California and American Medical Associations and every other credible medical association in California. In fact, the use of medical marijuana is opposed by all credible medical groups, nationwide. It passed despite opposition from politicians and public officials from both sides of the aisle, including, President Clinton; former Presidents Ford, Bush and Carter; Senators Bob Dole and Dianne Feistein, Congressman Vic Fazio, Governor Pete Wilson and Attorney General Dan Lungren and many others.
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Proposition 215 and Arizona's proposition 200 passed, as will other similar initiatives because they received the financial backing of George Soros from New York and a handful of other wealthy pro-legalizers. In fact it has been estimated that Mr. Soros has spent over 15 million dollars to organizations which promote liberalized drug laws. The campaign was aided by the Drug Policy Foundation and other official sounding groups. The two million dollars donated by Mr. Soros and his friends paid for a television advertising campaign to sell proposition 215 to the voters. The adds although deceptive were well crafted and played upon the emotions of the viewers. The adds never told the viewers that proposition 215 would legalize marijuana for any medical condition without a written prescription.
Polls taken in California and Arizona since the election indicate that voters would have rejected proposition 215 if they had simply known the facts.
In the end, the well informed and credible opponents of proposition 215 were simply out shouted by a slick and effective advertising campaign financed primarily by persons living outside of California.
California has been left with a law that allows marijuana to be used with virtually no regulation based on the undocumented recommendation of a physician for any ailment.
The pro drug lobby has bombarded the American public with the theory of harm reduction and the responsible use of marijuana and other drugs. We have, only to look to our nations history of drug use in the nineteenth century, or the pain, suffering and social ills caused by our two legal drugs, alcohol and tobacco to ask ourselves how realistic it is to teach people to use drugs responsibly. With the many documented public safety and healthcare problems associated with alcohol use, why would we want to make other, more powerful and addicting drugs cheap, legal and readily available.
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Serious conflict and confusion will result from the passage of 215 and other similar measures. These initiatives are in direct violation of federal law. The FDA has not approved the use of crude marijuana for any ailment or illness. The so called marijuana initiatives are encouraging doctors and citizens to violate federal law.
There will be significant problems encountered in the enforcement of laws relating to driving under the influence. Unlike alcohol, police officers have no test available to determine if a person is driving under the influence of marijuana. And how will we regulate companies doing business that are controlled under the ''drug free work place act''. We must also ask ourselves if we want commercial truck drivers, airline pilots, doctors and public safety workers to be under the influence of marijuana during the course of their employment.
And who will suffer from this change in drug policy. We all will. Although it is to early to determine the exact fallout from proposition 215 we already know that illegal marijuana cultivation seizures have increased by more than 50% in California since the passage of the initiative.
In the recently published ''California Student Substance Survey'' dramatic increases in teen marijuana use were seen. Within the past six months, marijuana use among 11th graders was 43%, up from 28% in 1989. An increase, I believe due in part to the confusing message sent by the medical marijuana movement.
I believe that we will also see increases in traffic injuries and fatalities associated with marijuana use as well as a dramatic climb in workplace accidents, lost productivity, high school drop out and a whole host of other social problems.
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From 1979 to 1992 through education, treatment and law enforcement, we reduced drug use in America by 50%. If we reduced aids, teen pregnancy or cancer by that amount it would be considered a tremendous success. But for some reason we seem to labor under the belief that we have never achieved success in reducing drug abuse. This has led to frustration and a belief that our nations drug policies need overhauling.
In 1992 we took our eye of the ball. Funding was cut and our drug prevention message was diluted. The passage of medical marijuana legislation further weakens that message and confuses the public, especially our nations youth. Increased drug use will be the direct result of that confusing message.
Americans do not have a history of running away from problems and we shouldn't be running away from the drug problem. It is time that we strengthen our resolve to reduce the scourge of drug use in this great nation. If we don't take a stand now we will lose a generation, or more of our countries most valuable commodity, it's young people. Many will slip through the cracks. The window for learning will be gone. Opportunities will be lost that are impossible to regain. It will be too late to become an engineer, astronaut or physicist. These will be dreams that will always remain unfulfilled.
In closing I would urge you, in the Congress to work towards the development of federal legislation that would prevent individual states from superseding the Federal Controlled Substances Act. This may be the only way to prevent the tragedy of proposition 215 from sweeping our nation.
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Thank you.
Mr. MCCOLLUM. The subcommittee will be in recess until this vote is completed. It should be about 10 minutes, I hope.
[Recess.]
Mr. MCCOLLUM. The Subcommittee on Crime will come to order. I'm led to believe we'll have 20 or 30 minutes until the next series of votes. I certainly want to take advantage of that 30-minute window to complete this hearing, if we possibly can, and still be fair to everybody who's here.
When we recessed, Mr. Brooks had just finished his testimony. We're prepared now to proceed with Dr. Grinspoon's—did I pronounce that right? Grinspoon?
Mr. GRINSPOON. Grinspoon, that's correct.
Mr. MCCOLLUM. I've got it right now. I'm so used to Greenspan coming down here from the Federal Reserve. Dr. Grinspoon, I apologize.
Mr. GRINSPOON. A distant cousin.
Mr. MCCOLLUM. Well, please proceed. You're welcome to give us a summary of your testimony.
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STATEMENT OF LESTER GRINSPOON, M.D., ASSOCIATE PROFESSOR OF PSYCHIATRY, HARVARD MEDICAL SCHOOL
Mr. GRINSPOON. Mr. Chairman and members of the subcommittee, I appreciate the opportunity to appear before you this morning and share my views on the use of marijuana as a medicine.
Now, let me remind you that in 1928, Alexander Fleming discovered penicillin. This discovery was left on the shelf until 1941 when the pressures of World War II and the need for another antibiotic besides sulfonamide compelled two investigators to look at it, and in just six patients they demonstrated how useful it was as an antibiotic. In fact, penicillin went on to earn a reputation as the wonder drug of the forties.
Why was it called a wonder drug? One, because it was remarkably non-toxic; two, because once it was produced in large quantities, it was very inexpensive, and three, because it was remarkably versatile; it would treat everything from pneumonia to syphilis. Cannabis bears some remarkable parallels with penicillin. First of all, cannabis is remarkably safe. Although it is not harmless, it is surely less toxic than most of the conventional medicines it could replace if it were legally available. Despite its use by millions of people over thousands of years, it has never caused an overdose death.
Secondly, cannabis, once it is free of the prohibition tariff, will be quite inexpensive. It will cost, perhaps, $20 to $30 an ounce; this translates to 30 to 40 cents a marijuana cigarette, and if you think that a person who has the severe nausea and vomiting of cancer chemotherapy can get relief from, say, half a marijuana cigarette or 1 to 4 ondansetron pills, the best of the presently available anti-nauseants, each of those pills costing the patient $30 to $40, the 30 cent marijuana cigarette represents a savings of at least 100 fold. And then like penicillin, it is remarkably versatile. It is useful in a number of symptoms and syndrome.
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Let me briefly mention the most commonly used medical uses of cannabis. First of all, cancer chemotherapy; we've already touched on that. It's already been mentioned that it's useful in the treatment of glaucoma; glaucoma, a disorder of the eyes which is the second leading cause of blindness in this country. There are 1 million people who suffer from glaucoma, and many of them do not get relief from conventional medicines, and in situations where surgery is too dangerous, cannabis is very useful. About 20 to 30 percent of people who suffer from various types of epilepsy do not get relief from conventional medicines; many of them get relief from cannabis. It's useful in the treatment of the muscle spasm of multiple sclerosis; much more useful than either baclofen or the dantrolene or the large doses of valium which are commonly used and which have significant toxic side effect liability. It's also used in the muscle spasm of paraplegia and quadriplegia. You have heard how useful it is in AIDS, not just for the nausea of the AIDS itself, but because so many of the medicines, including AZT and the protease inhibitors cause severe nausea. These people get what is known as the wasting syndrome and cannabis, for many of these people, not only retards their loss of weight, but actually allows many of them to put on weight. It's useful in the treatment of migraine. William Osler described it in his last textbook as the single most useful medicine in the treatment of migraine, and many migraine sufferers who do not get relief from calcium channel blockers or the ergotamine derivatives today would agree with that assessment.
Its' useful in the treatment of chronic pain. Let me just illustrate that with arthritis which is one of the major causes of chronic pain, and there are 18 million people in this country who suffer from it. It's usually treated with analgesics and the most widely used of these are aspirin, acetaminophen, (Tylenol), nonsteroidal anti-inflammatory drugs (the NSAIDs), like Ibuprofen and naproxen. They are not addictive, but they are often insufficiently powerful, furthermore, they have serious side effects.
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Mr. MCCOLLUM. Dr. Grinspoon, could you summarize, briefly, you're 5 minutes is really up here.
Mr. GRINSPOON. That went fast.
Well, let me just summarize that point by saying there are about 7,000 people who die from the effects of aspirin and NSAIDs in this country every year. There has never, as I say, been a death from cannabis.
Let me, then, just conclude by saying that during the past few years the medical uses of cannabis have become increasingly clear to many physicians and patients and the number of people with direct experiences of these uses has been growing. Therefore, the discussion is now turning from whether cannabis is an effective medicine to how it should be made available. It is essential to relax legal restrictions that prevent physicians and patients from achieving a workable accommodation that takes into account the needs of suffering people.
I have to conclude by saying to you that there are many thousands of patients who are using cannabis to treat these and other disorders, and given the legal risk, they would not be doing this if they did not believe if was helpful to them. These patients are in urgent need of a legal accommodation that will allow them to use a medicine which they know is important to their well being. Thank you.
[The prepared statement of Mr. Grinspoon follows:]
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PREPARED STATEMENT OF LESTER GRINSPOON, M.D., ASSOCIATE PROFESSOR OF PSYCHIATRY, HARVARD MEDICAL SCHOOL
Mr. Chairman and members of the subcommittee, I appreciate the opportunity to appear before you this morning to share my views on the use of marihuana as a medicine.
In September 1928 Alexander Fleming returned from vacation to his laboratory and discovered that one of the petri dishes he had inadvertently left out over the summer was overgrown with staphylococci except for the area surrounding a mold colony. That mold contained a substance he later named penicillin. He published his finding in 1929, but the discovery was ignored by the medical establishment, and bacterial infections continued to be a leading cause of death. Had it aroused the interest of a pharmaceutical firm, its development might not have been delayed. More than 10 years later, under wartime pressure to develop antibiotic substances to supplement sulfonamide, Howard Florey and Ernst Chain initiated the first clinical trial of penicillin (with six patients) and began the systematic investigations that might have been conducted a decade earlier.1\
After its debut in 1941, penicillin rapidly earned a reputation as ''the wonder drug of the '40s.'' There were three major reasons for that reputation: it was remarkably non-toxic, even at high doses; it was inexpensive to produce on a large scale; and it was extremely versatile, acting against the microorganisms that caused a great variety of diseases, from pneumonia to syphilis. In all three respects cannabis suggests parallels:
(1) Cannabis is remarkably safe. Although not harmless, it is surely less toxic than most of the conventional medicines it could replace if it were legally available. Despite its use by millions of people over thousands of years, cannabis has never caused an overdose death. The most serious concern is respiratory system damage from smoking, but that can easily be addressed by increasing the potency of cannabis and by developing the technology to separate the particulate matter in marihuana smoke from its active ingredients, the cannabinoids (prohibition, incidentally, has prevented this technology from flourishing). Once cannabis regains the place in the U.S. Pharmacopoeia that it lost in 1941 after the passage of the Marihuana Tax Act (1937), it will be among the least toxic substances in that compendium. Right now the greatest danger in using marihuana medically is the illegality that imposes a great deal of anxiety and expense on people who are already suffering.
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(2) Medical cannabis would be extremely inexpensive. Street marihuana today costs $200 to $400 an ounce, but the prohibition tariff accounts for most of that. A reasonable estimate of the cost of cannabis as a medicine is $20 to $30 an ounce, or about 30 to 40 cents per marihuana cigarette. As an example of what this means in practice, consider the following. Both the marihuana cigarette and an 8 mg ondansetron pill—cost to the patient, $30 to $40—are effective in most cases for the nausea and vomiting of cancer chemotherapy (although many patients find less than one marihuana cigarette to be more useful, and they often require several ondansetron pills). Thus cannabis would be at least 100 times less expensive than the best present treatment for this symptom.
(3) Cannabis is remarkably versatile. Let me review briefly some of the symptoms and syndromes for which it is useful.
CANCER TREATMENT
Cannabis has several uses in the treatment of cancer. As an appetite stimulant, it can help to slow weight loss in cancer patients.2\ It may also act as a mood elevator. But the most common use is the prevention of nausea and vomiting of cancer chemotherapy. About half of patients treated with anticancer drugs suffer from severe nausea and vomiting, which are not only unpleasant but a threat to the effectiveness of the therapy. Retching can cause tears of the esophagus and rib fractures, prevent adequate nutrition, and lead to fluid loss. Some patients find the nausea so intolerable they say they would rather die than go on. The antiemetics most commonly used in chemotherapy are metoclopramide (Reglan), the relatively new ondansetron (Zofran), and the newer granisetron (Kytril). Unfortunately, for many cancer patients these conventional antiemetics do not work at all or provide little relief.
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The suggestion that cannabis might be useful arose in the early 1970s when some young patients receiving cancer chemotherapy found that marihuana smoking reduced their nausea and vomiting. In one study of 56 patients who got no relief from standard antiemetic agents, 78% became symptom-free when they smoked marihuana.3\ Oral tetrahydrocannabinol (THC) has proved effective where the standard drugs were not.4,5 but smoking generates faster and more predictable results because it raises THC concentration in the blood more easily to the needed level. Also, it may be hard for a nauseated patient to take oral medicine. In fact, there is strong evidence that most patients suffering from nausea and vomiting prefer smoked marihuana to oral THC.2\
Oncologists may be ahead of other physicians in recognizing the therapeutic potential of cannabis. In the spring of 1990, two investigators randomly selected more than 2,000 members of the American Society of Clinical Oncology (one-third of the membership) and mailed them an anonymous questionnaire to learn their views on the use of cannabis in cancer chemotherapy. Almost half of the recipients responded. Although the investigators acknowledge that this group was self-selected and that there might be a response bias, their results provide a rough estimate of the views of specialists on the use of Marinol (dronabinol, oral synthetic THC) and smoked marihuana.
Only 43% said the available legal antiemetic drugs (including Marinol) provided adequate relief to all or most of their patients, and only 46% said the side effects of these drugs were rarely a serious problem. Forty-four percent had recommended the illegal use of marihuana to at least one patient, and half would prescribe it to some patients if it were legal. On average, they considered smoked marihuana more effective than Marinol and roughly as safe.6\
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GLAUCOMA
Cannabis may also be useful in the treatment of glaucoma, the second leading cause of blindness in the United States. In this disease, fluid pressure within the eyeball increases until it damages the optic nerve. About a million Americans suffer from the form of glaucoma (open angle) treatable with cannabis. Marihuana causes a dose-related, clinically significant drop in intraocular pressure that lasts several hours in both normal subjects and those with the abnormally high ocular tension produced by glaucoma. Oral or intravenous THC has the same effect, which seems to be specific to cannabis derivatives rather than simply a result of sedation. Cannabis does not cure the disease, but it can retard the progressive loss of sight when conventional medication fails and surgery is too dangerous.7\
SEIZURES
About 20% of epileptic patients do not get much relief from conventional anticonvulsant medications. Cannabis has been explored as an alternative at least since 1975 when a case was reported in which marihuana smoking, together with the standard anticonvulsants phenobarbital and diphenylhydantoin, was apparently necessary to control seizures in a young epileptic man.8\ The cannabis derivative that is most promising as an anticonvulsant is cannabidiol. In one controlled study, cannabidiol in addition to prescribed anticonvulsants produced improvement in seven patients with grand mal convulsions; three showed great improvement. Of eight patients who received a placebo instead, only one improved.9\ There are patients suffering from both grand mal and partial seizure disorders who find that smoked marihuana allows them to lower the doses of conventional anticonvulsant medications or dispense with them altogether.2\
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PAIN
There are many case reports of marihuana smokers using the drug to reduce pain: post-surgery pain, headache, migraine, menstrual cramps, and so on. Ironically, the best alternative analgesics are the potentially addictive and lethal opioids. In particular, marihuana is becoming increasingly recognized as a drug of choice for the pain that accompanies muscle spasm, which is often chronic and debilitating, especially in paraplegics, quadriplegics, other victims of traumatic nerve injury, and people suffering from multiple sclerosis or cerebral palsy. Many of them have discovered that cannabis not only allows them to avoid the risks of other drugs, but also reduces muscle spasms and tremors; sometimes they are even able to leave their wheelchairs.10
One of the most common causes of chronic pain is osteoarthritis, which is usually treated with synthetic analgesics. The most widely used of these drugs—aspirin, acetaminophen (Tylenol), and nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen and naproxen—are not addictive, but they are often insufficiently powerful. Furthermore, they have serious side effects. Stomach bleeding and ulcer induced by aspirin and NSAIDs are the most common serious adverse drug reactions reported in the United States, causing an estimated 7,000 deaths each year. Acetaminophen can cause liver damage or kidney failure when used regularly for long periods of time; a recent study suggests it may account for 10% of all cases of end-stage renal disease, a condition that requires dialysis or a kidney transplant.11,12 Marihuana, as I pointed out earlier, has never been shown to cause death or serious illness.
AIDS
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More than 300,000 Americans have died of AIDS. Nearly a million are infected with HIV, and at least a quarter of a million have AIDS. Although the spread of AIDS has slowed among homosexual men, the reservoir is so huge that the number of cases is sure to grow. Women and children as well as both heterosexual and homosexual men are now being affected; the disease is spreading most rapidly among intravenous drug abusers and their sexual partners. The disease can be attacked with anti-viral drugs, of which the best known are zidovudine (AZT) and protease inhibitors. Unfortunately, these drugs sometimes cause severe nausea that heightens the danger of semi-starvation for patients who are already suffering from nausea and losing weight because of the illness—a condition sometimes called the AIDS wasting syndrome.
Marihuana is particularly useful for patients who suffer from AIDS because it not only relieves the nausea but retards weight loss by enhancing appetite. When it helps patients regain lost weight, it can prolong life. Marinol has been shown to relieve nausea and retard or reverse weight loss in patients with HIV infection, but most patients prefer smoked cannabis for the same reasons that cancer chemotherapy patients prefer it: it is more effective and has fewer unpleasant side effects, and the dosage is easier to adjust.
These are the symptoms and syndromes for which cannabis is most commonly used today, but there are others for which clinical experience provides compelling evidence. It is distressing to consider how many lives might have been saved if penicillin had been developed as a medicine immediately after Fleming's discovery. It is equally frustrating to consider how much suffering might have been avoided if cannabis had been available as a medicine for the last 60 years. Initial enthusiasm for drugs is often disappointed after further investigation, but this is hardly likely in the case of cannabis, since it is not a new medicine at all. Its long medical history began 5,000 years ago in China and extended well into the twentieth century. Between 1840 and 1900, more than one hundred papers on its therapeutic uses were published in American and European medical journals. It was recommended as an appetite stimulant, muscle relaxant, analgesic, sedative, anticonvulsant, and treatment for opium addiction. As late as 1913, the great Sir William Osler cited it as the best remedy for migraine in a standard medical textbook.
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In the United States, what remained of marihuana's medical use was effectively eliminated by the Marihuana Tax Act of 1937, which was ostensibly designed to prevent nonmedical use but made cannabis so difficult to obtain that it was removed from standard pharmaceutical references. When the present comprehensive federal drug law was passed in 1970, marihuana was officially classified as a Schedule I drug: a high potential for abuse, no accepted medical use, and lack of safety for use under medical supervision.
But in the 1970s the public began to rediscover its medical value, as letters appeared in lay publications from people who had learned that it could relieve their asthma, nausea, muscle spasms, or pain and wanted to shared that knowledge with readers who were familiar with the drug. The most effective spur to the movement for medical marihuana came from the discovery that it could prevent the AIDS wasting syndrome. It is not surprising that the Physicians Association for AIDS Care was one of the medical organizations that endorsed the California initiative prohibiting criminal prosecution of medical marihuana users. The mid-1980s had already seen the establishment, often by people with AIDS, of cannabis buyers' clubs, organizations that distribute medical marihuana in open defiance of the law. These clubs buy marihuana wholesale and provide it to patients at or near cost, usually on the written recommendation of a physician. Although a few of the clubs have been raided and closed, most are still flourishing, and new ones are being organized. Some of them may gain legal status as a result of the initiative.
Until the recent vote in California, efforts to change the laws had been futile. In 1972 the National Organization for the Reform of Marijuana Laws (NORML) entered a petition to move marihuana out of Schedule I under federal law so that it could become a prescription drug. It was not until 1986 that the Drug Enforcement Administration (DEA) finally agreed to the public hearings required by law. During two years of hearings, many patients and physicians testified and thousands of pages of documentation were introduced. In 1988 the DEA's Administrative Law Judge, Francis L. Young, declared that marihuana fulfilled the requirement for transfer to Schedule II. In his opinion he described it as ''one of the safest therapeutically active substances known to man.'' His order was overruled by the DEA.
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Nevertheless, a few patients have been able to obtain medical marihuana legally in the last twenty years. Beginning in the 1970s, thirty-five states passed legislation that would have permitted medical use of cannabis but for the federal law. Several of those states actually established special research programs, with the permission of the federal government, under which patients who were receiving cancer chemotherapy would be allowed to use cannabis. These projects demonstrated the value of both smoked marihuana and oral THC. The FDA then approved oral THC as a prescription medicine, but ignored the data that suggested that smoked marihuana was more useful than oral THC for some patients. With the approval of Marinol, this research came to an end. In 1976, the federal government introduced the Individual Treatment Investigational New Drug program (commonly referred to as the Compassionate IND), which provided marihuana to a few patients whose doctors were willing to undergo the paperwork-burdened and time-consuming application process. About three dozen patients eventually received marihuana before the program was discontinued in 1992, and eight survivors are still receiving it—the only persons in the country for whom it is not a forbidden medicine. It is safe to say that a significant number of the more than ten million American citizens arrested on marihuana charges in the last thirty years were using the drug therapeutically. The Schedule I classification persists, although in my view and the view of millions of other Americans, it is medically absurd, legally questionable, and morally wrong.
Opponents of medical marihuana often object that the evidence of its usefulness, although strong, comes only from case reports and clinical experience. It is true that there are no double-blind controlled studies meeting the standards of the Food and Drug Administration, chiefly because legal, bureaucratic, and financial obstacles have been constantly put in the way. The situation is ironical, since so much research has been done on marihuana, often in unsuccessful efforts to show health hazards and addictive potential, that we know more about it than about most prescription drugs. In any case, individual therapeutic responses are often obscured in group experiments, and case reports and clinical experience are the source of much of our knowledge of drugs. As Dr. Louis Lasagna has pointed out, controlled experiments were not needed to recognize the therapeutic potential of chloral hydrate, barbiturates, aspirin, insulin, or penicillin.13 Nor was that the way we learned about the use of propranolol for hypertension, diazepam for status epilepticus, and imipramine for enuresis. All these drugs had originally been approved for other purposes.
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In the experimental method known as the single patient randomized trial, active and placebo treatments are administered randomly in alternation or succession. The method is often used when large-scale controlled studies are inappropriate because the disorder is rare, the patient is atypical, or the response to treatment is idiosyncratic.14 Several patients have told me that they assured themselves of marihuana's effectiveness by carrying out such experiments on themselves, alternating periods of cannabis use with periods of abstention. I am convinced that the medical reputation of cannabis is derived partly from similar experiments conducted by many other patients.
Some physicians may regard it as irresponsible to advocate use of a medicine on the basis of case reports, which are sometimes disparaged as merely ''anecdotal'' evidence which counts apparent successes and ignore apparent failures. That would be a serious problem only if cannabis were a dangerous drug. The years of effort devoted to showing that marihuana is exceedingly dangerous have proved the opposite. It is safer, with fewer serious side effects, than most prescription medicines, and far less addictive or subject to abuse than many drugs now used as muscle relaxants, hypnotics, and analgesics.
Thus cannabis should be made available even if only a few patients could get relief from it, because the risks would be so small. For example, as I mentioned, many patients with multiple sclerosis find that cannabis reduces their muscle spasms and pain. A physician may not be sure that such a patient will get more relief from marihuana than from the standard drugs baclofen, dantrolene, and diazepam—all of which are potentially dangerous or addictive—but it is almost certain that a serious toxic reaction to marihuana will not occur. Therefore the potential benefit is much greater than any potential risk.
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During the past few years, the medical uses of marihuana have become increasingly clear to many physicians and patients, and the number of people with direct experience of these uses has been growing. Therefore the discussion is now turning from whether cannabis is an effective medicine to how it should be made available. It is essential to relax legal restrictions that prevent physicians and patients from achieving a workable accommodation that takes into account the needs of suffering people. H.R. 1782 (the Medical Use of Marihuana Act) is a worthwhile move in that direction because it gets the federal government out of the way and allows the states to experiment with their own solutions to the problem. I strongly urge that you pass this law.
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SUMMARY
Mr. Chairman and members of the subcommittee, I appreciate the opportunity to appear before you this morning to share my views on the use of marihuana as a medicine.
It has been well known for thousand of years that cannabis has medical uses. It is far safer than most medicines prescribed by doctors daily and often works for patients who cannot tolerate the side effects of other drugs. In many cases no other drug will do the job as safely or as well. Cannabis has never been demonstrated to have caused an overdose death. It does not disturb any physiological functions or damage any body organ when used in therapeutic doses. It produces little or no physical dependence or tolerance, and there is no evidence that medical use of cannabis has ever led to habitual use as an intoxicant. There are many ways in which marihuana can be used to reduce human suffering at small cost. Clinical experience suggests that it is helpful for patients with severe nausea and vomiting, arthritis, glaucoma, muscle spasms, premenstrual syndrome, seizure disorders, the AIDS weight loss syndrome, asthma, fibromyalgia, Tourette's syndrome, and depression, to name a few.
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Many thousands of patients are using cannabis to treat these and other disorders. Given the legal risks, they would not be doing this if they did not believe it was helpful to them. These patients are in urgent need of a legal accommodation that allow them to use a medicine which they know is important to their well-being.
Mr. MCCOLLUM. Thank you, Dr. Grinspoon. Dr. Lapey, you're recognized for 5 minutes.
STATEMENT OF JANET D. LAPEY, M.D., EXECUTIVE DIRECTOR, CONCERNED CITIZENS FOR DRUG PREVENTION, INC.
Ms. LAPEY. Thank you, Mr. Chairman and members of the committee. I'm Dr. Janet Lapey, president-elect of Drug Watch International. It is important to remember that in the past, many unscrupulous doctors peddled unlabeled medicines which did more harm than good. These Dr. Feelgood's potions often contained addictive substances such as marijuana, cocaine, or morphine, and many people unwittingly became addicts. In order to protect the public, laws were enacted which ensure that no substance is marketed as medicinal until proven to be both safe and effective.
Currently, there is a well-funded marijuana lobby which consists of groups such as the National Organization for the Reform of Marijuana Laws, (NORML), on whose board Dr. Grinspoon serves, which aim to legalize marijuana. In 1972, NORML litigated against the DEA in an attempt to reschedule marijuana as medicine, but in 1994, the U.S. Court of Appeals ruled in favor of the DEA. The Court noted that the pro-marijuana parties, which included physicians connected to NORML, such as Dr. Grinspoon, had relied on non-scientific anecdotes such as he presented here today.
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On the other hand, numerous highly qualified experts testified that marijuana's medicinal value has never been proven in sound scientific studies as required by law. Nevertheless, pro-legalization groups such as NORML have funded State referenda which aim to bypass our Federal consumer protection laws and anti-drug laws. These referenda have deceived the voters with advertisements fraudulently portraying marijuana as a safe, effective medicine. These referenda were also helped by blatantly biased media coverage.
At the same time, NORML funds free rock concerts which target the youth. A recent example occurred on September 20th this year when 40,000 young people were lured to Boston Common to hear rock music glorifying drug use and to smoke marijuana openly. The tobacco industry would never get by with this. The youth were sold hats and cartoon t-shirt promoting marijuana and drug paraphernalia designed as toys. There was a thick cloud of marijuana smoke over the Common, and children as young as 12 explained to reporters they were smoking marijuana because it is a healthy medicine.
The truth is that due to a placebo effect, a patient—and, I might add, his doctor—may erroneously believe a drug is helpful when it is not. This is especially true of addictive, mind-altering drugs like marijuana. A marijuana withdrawal syndrome occurs, consisting of anxiety, depression, sleep and appetite disturbances, irritability, tremor, nausea, restlessness. Often persons using marijuana, erroneously believe the drug is helping them combat these symptoms, when actually marijuana is the cause of these symptoms. Therefore, when a patient anecdotally reports a drug to have medicinal value, this must be followed by objective scientific studies. Nevertheless, some physicians who are not knowledgeable about the harmful effects of marijuana have advocated its use by the ill despite the lack of scientific evidence of safety and efficacy. More informed physicians have pointed out the fallacies and dangers in that type of reasoning, as reported in the April 17th New England Journal, because it is wrong to recommend an unsafe drug of unproved efficacy. Marijuana can make sick people sicker.
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The process by which drugs are approved begins with studies of their chemistry, and interchemical reactions must be known and reproducible, and dosages must be measurable with exactitude. Marijuana is not a pure substance. It's an unstable, varying, complex mixture of over 400 chemicals, many of which are harmful substances which have not been well studied, either alone or in combination with each other. When smoked, marijuana produces over 2,000 chemicals including hydrogen cyanide, ammonia, carbon monoxide, acetaldehyde, napthalene; well-known carcinogens such as benz(a)pyrene, benz(a)anthracene, benzene, and nitrosamines.
Marijuana is not the safe drug portrayed by the marijuana lobby. It is addictive; it adversely affects the immune system; leads to the use of other drugs such as cocaine; is linked to cases of cancer; causes respiratory diseases, mental disorders, including psychosis, depression, panic attacks, hallucinations, paranoia, decreased cognitive performance, disconnected thought, delusions, and impaired memory. Marijuana use is a risk factor for the progression to full-blown AIDS in HIV-positive persons, and HIV-positive marijuana smokers have an increased incidence of bacterial pneumonia. My submitted testimony contains scientific reference for all these effects.
In summary, those who aim to legalize marijuana are preying upon our most vulnerable citizens: the children, the sick, and the dying.
[The prepared statement of Ms. Lapey follows:]
PREPARED STATEMENT OF JANET D. LAPEY, M.D., EXECUTIVE DIRECTOR, CONCERNED CITIZENS FOR DRUG PREVENTION, INC.
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WHY ISN'T MARIJUANA A MEDICINE?
By federal law, a substance may not be marketed as a medicine until it has scientifically been shown to be safe and effective. Marijuana has never been shown scientifically to be a safe effective medicine for the treatment of any condition.1\
WHY MUST A SUBSTANCE BE SHOWN TO BE SAFE AND EFFECTIVE?
Before 1906, the prevailing philosophy was ''caveat emptor'' (let the buyer beware), as many unscrupulous doctors peddled unlabeled medicines which did more harm than good. These ''snake oil'' salesmen's potions often contained addictive substances, such as marijuana, cocaine, or morphine, and many people unwittingly became addicts. In order to protect the public from such scams and quackery, laws were enacted which ensure that no substance is marketed as medicinal until proven to be both safe and effective: the 1906 Pure Food and Drug Act required that ingredients be listed on the label; then the Food, Drug and Cosmetic Act of 1938 gave the Food and Drug Administration (FDA) the authority to require that manufacturers prove their products' safety. In 1962 this requirement was expanded to include both safety and efficacy.
IF THE INGREDIENTS OF MARIJUANA WERE LISTED ON THE LABEL, WHAT WOULD THIS LIST INCLUDE?
Marijuana is not a pure substance but is an unstable, varying, complex mixture of over 400 chemicals, many of which are harmful substances which have not been well-studied either alone or in combination with each other. New harmful chemical components of marijuana are still being discovered.2\ When smoked, marijuana produces over 2000 chemicals, including hydrogen cyanide, ammonia, carbon monoxide, acetaldehyde, acetone, phenol, cresol, naphthalene, and well-known carcinogens such as benz(a)pyrene, benz(a)anthracene, benzene, and nitrosamines. Many of these cancer-causing substances are present in higher concentrations in marijuana smoke than in tobacco smoke.3\
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WHAT ARE THE HARMFUL EFFECTS OF MARIJUANA?
Marijuana is addictive;4\ it adversely affects the immune system,5\ leads to the use of other drugs, such as cocaine,6\ and is linked to cases of cancer, especially in the young, including cancer of the lungs, mouth, throat, lip, and tongue.7\ Marijuana also causes respiratory diseases8\ and mental disorders, including psychosis, depression, panic attacks, hallucinations, paranoia, hostility, depersonalization, flashbacks, decreased cognitive performance, disconnected thought, delusions, and impaired memory.9\ Since marijuana impairs coordination and judgment, it is a major cause of accidents.10 Babies born to women who smoke marijuana during pregnancy have an increased incidence of leukemia,11 low birth weight,12 and other abnormalities.
HOW IS A DRUG APPROVED AS A MEDICINE?
The process by which drugs are approved begins with studies of their chemistry, pharmacology, and toxicology. Interchemical reactions must be known and reproducible, and dosages must be measurable with exactitude. After a potential medicine is tested in animals, there are several required phases of testing for safety and efficacy in healthy human volunteers and later in patients. These clinical trials must be carefully controlled and conducted by qualified scientists.
HAVE THERE BEEN ANY STUDIES ON MARIJUANA AS A MEDICINE?
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Although marijuana continues to be available for research, over 12,000 scientific studies of marijuana have been published, and the drug has never been shown to be a safe effective medicine. In June 1991, the U.S. Public Health Service ordered a study of this issue by scientists at the National Institutes of Health (NIH). The report, issued in March 1992, concluded that scientific studies have never shown marijuana to be a safe effective medicine and that there are better, safer drugs available for all conditions considered.13 Another recent review by another NIH panel came to the same conclusion, namely that marijuana has never been shown scientifically to be a safe effective medicine.14
WHY IS MARIJUANA A SCHEDULE I DRUG?
A Schedule I drug, such as LSD, is a drug which is highly abusable with no medicinal value. A Schedule II drug, such as cocaine, is also highly abusable, but has limited medicinal use. In 1972, the National Organization for the Reform of Marijuana Laws (NORML), a pro-marijuana legalization group, and related organizations commenced litigation against the Drug Enforcement Administration (DEA) in an attempt to reschedule marijuana from Schedule I to Schedule II. On February 18, 1994, the U.S. Court of Appeals (D.C. Circuit) ruled in favor of the DEA. The Court noted that the pro-marijuana parties, which included physicians connected to NORML, relied on non-scientific anecdotal testimonials, as did the late DEA administrative judge Francis Young, who had been overruled by the DEA Administrator. On the other hand, supporting the DEA Administrator were numerous highly qualified experts who testified that marijuana's medicinal value has never been proven in sound scientific studies. In addition to the NIH, the FDA, the American Medical Association, the American Cancer Society, the American Academy of Ophthalmology, the National Multiple Sclerosis Society, and the American Glaucoma Society all stated that marijuana has never been shown scientifically to be a safe effective medicine. Thus, marijuana remains a Schedule I drug: highly abusable, with no medicinal use.15
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WHAT IS THE THC PILL AND WHY IS IT SCHEDULE II?
A synthetic form of delta-9-tetrahydrocannabinol, THC, the main psychoactive ingredient of marijuana, was approved by the FDA in 1985 as an anti-nausea agent for cancer chemotherapy patients who had failed to respond to other drugs. In 1992 it was approved as an appetite stimulant for patients with AIDS Wasting Syndrome. Synthetic THC (''Marinol '') is available by prescription in pill form and is a Schedule II drug: highly abusable, with limited medical use. Unlike marijuana, Marinol fits the definition of a modern pharmaceutical in that it is a stable, well-defined, pure substance in quantified dosage form. The medical use of THC (Marinol) is very restricted because of harmful side effects, such as addiction and mental disorders, which are dose-related, as noted in the Physicians' Desk Reference.16 Fortunately, newer, better anti-emetic medications have been developed recently. Only a very low dose of Marinol is recommended for appetite stimulation, since larger doses increase adverse effects without increasing efficacy. Smoking marijuana produces higher plasma THC levels than are obtained when THC is taken in pill form, and therefore harmful side effects are greater. The recent NIH panel report, noting the harm that smoking, including secondhand smoke, causes to society, has called for the rapid development of an FDA-approved THC inhaler as an alternative to oral FDA-approved THC.17
WHY DO SOME PEOPLE CLAIM THAT MARIJUANA HAS MEDICAL BENEFITS?
Due to a placebo effect, a patient may erroneously believe a drug is helpful when it is not. This is especially true of addictive, mind-altering drugs like marijuana. A marijuana withdrawal syndrome occurs, consisting of anxiety, depression, sleep and appetite disturbances, irritability, tremors, diaphoresis, nausea, muscle convulsions, and restlessness.18 Often, persons using marijuana erroneously believe that the drug is helping them combat these symptoms without realizing that actually marijuana is the cause of these effects. Therefore, when a patient anecdotally reports a drug to have medicinal value, this must be followed by objective scientific studies. For instance, in 1990, Dr. J. P. Frankel conducted a study of the effect of smoked marijuana on his patients with Parkinson's Disease because one of the patients had claimed the drug to be beneficial. Dr. Frankel's study showed that the drug did not improve the symptoms of Parkinson's Disease in any patient, including the patient who had originally believed it useful.19 Similarly, anecdotal reports had claimed that marijuana caused improvement in multiple sclerosis. However, a scientifically-controlled 1994 study by Dr. H. S. Greenberg showed that smoking marijuana makes symptoms of multiple sclerosis worse.20
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WHAT GROUPS ARE TRYING TO CLAIM THAT MARIJUANA IS A MEDICINE?
Just as there is a powerful tobacco lobby, there is a well-funded marijuana lobby which consists of groups, such as NORML, which aim to legalize marijuana. In 1979, Keith Stroup, NORML's founder, told an Emory University audience that they would be using the issue of medicinal marijuana as a red herring to give marijuana a good name.21 The tobacco industry also promoted cigarettes as medicine until the Federal Trade Commission halted the practice in 1955. ''Camels'' were said to prevent fatigue and aid digestion, and ''Kools'' were said to prevent the common cold.22 Currently, these pro-legalization groups have funded state referenda which bypass our consumer protection and anti-drug laws. These groups also fund free rock concerts which target the youth and feature the sale of drug paraphernalia, hats and cartoon T-shirts promoting illegal drugs, marijuana jewelry, etc. A recent example occurred on September 20, 1997, when 40,000 young people were lured to Boston Common to hear rock music glorifying drug use and to smoke marijuana openly.23
Dr. Lester Grinspoon, a psychiatrist the board of NORML, is a long-time advocate of drug legalization. His 1993 book, Marijuana, the Forbidden Medicine, promotes marijuana for myriad conditions, including pain, itching, menstrual cramps, asthma, insomnia, depression and other psychiatric conditions which marijuana is actually known to cause.24 This book downplays marijuana's harmfulness, referring to its addictive and gateway properties as a ''hoary myth.'' It was similar misinformation from Grinspoon downplaying the harmful effects of cocaine25 which was pinpointed by many experts26 as a cause of the nation's cocaine epidemic. Dr. John Morgan is another physician on the board of NORML who advocates drug legalization.
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WHAT WAS THE FEDERAL COMPASSIONATE USE PROGRAM?
In the late seventies, pro-marijuana activists pressured the federal government into providing marijuana cigarettes as ''medicine'' for conditions they claimed it benefited. Following the NIH report, the Bush Administration stopped accepting new customers for the governmental marijuana hand-out program in 1992. The Clinton Administration reviewed the policy and came to the same conclusion in July 1994. Indeed, there is evidence that marijuana makes sick people sicker. For instance, studies show that HIV-positive smokers progress to full-blown AIDS twice as fast as non-smokers,27 and HIV-positive marijuana smokers have an increased incidence of bacterial pneumonia compared to non-marijuana smokers.28 Regardless, some physicians, who are not knowledgeable about the harmful effects of marijuana, have advocated its use by the ill despite the lack of scientific evidence of safety and efficacy. More informed physicians have pointed out the fallacies and dangers in that type of reasoning.29
SUMMARY:
Our government has a very crucial role to play in protecting the public from the modern day snake oil salesmen. Those who aim to legalize marijuana are preying upon our most vulnerable citizens: the children, the sick, and the dying. Marijuana should be subjected to the same rigorous scientific evaluations for safety and efficacy as are all other drugs submitted for FDA approval.
NOTES:
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1\ Voth EA, Schwartz RS, Ann Int Med 126:791–798, 1997.
2\ Yamamoto I et al. Pharm Biochem Behav 40:465–469, 1991.
3\ Huber G. Pharm Biochem Behav 40:630, 1991.
4\ Gold MS. Marijuana, NY:Plenum Medical Book Co., p. 227, 1989.
Tanda G et al, Science 276:2048–2050, 1997.
De Fonseca FR et al, Science 276:2050–2054, 1997.
5\ Sherman MP et al, Am Rev Resp Dis 144:1351–1356, 1991.
Spector S et al. Adv Exp Med Bio 288:47–56, 1991.
Djeu J et al. Adv Exp Med Bio 288: 57–62, 1991.
Watzl B et al. Adv Exp Med Bio 288: 63–70, 1991.
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Cabral GA et al. Adv Exp Med Bio 288: 93–105, 1991.
6\ Kleber HD. J Clin Psych 49:2(Suppl), p. 3–6, 1988.
7\ Donald PJ Otolaryn Head & Neck Surg 94:517–521, 1986.
Ferguson RP et al. JAMA 261:41–42, 1989.
Taylor FM. South Med J 81:1213–1216, 1988.
Donald PJ. Adv Exp Med Bio 288:33–46, 1991.
8\ Tashkin DP. West J Med 158:635–637, 1993.
Polen MR et al West J Med 158:596–601, 1993.
9\ American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM IV), May 1994.
Schwartz RH. Pediatric Clinics of North America 34:305–317, 1987.
Cherek DR et al. Psychopharmacology 111:163–168, 1993.
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Andreasson S et al. Lancet 2:1483–1485, 1987.
Schwartz RH et al. Am J Dis Child 143:1214–1219, 1989.
10 Soderstrom CA et al. Archives of Surg 123:733–737, 1988.
Williams AF et al. Public Health Report 100:19–25, 1985.
Department of Transportation. National Transportation Safety Board Report, Washington DC, February 5, 1990.
Brookoff D et al. New Eng J Med 331:518–522, 1994.
Leirer VO et al. Aviat Space Environ Med 62:221–227, 1991
11 Robison LL et al. Cancer 63:1904–1910, 1989.
12 Zuckerman B et al. New Eng J Med 320:762–768, 1989.
13 Journal of the National Cancer Institute 84:475, April 1, 1992.
14 National Institutes of Health Panel Report, Medical Utility of Marijuana, August 8, 1997.
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15 Federal Register 54:53783, December 29, 1989.
Federal Register 57:10499, March 26, 1992.
16 Physicians' Desk Reference, Medical Economics Company, Oradell, NJ, 1996.
17 National Institutes of Health Panel Report, Medical Utility of Marijuana, August 8, 1997.
18 Gold MS. Marijuana, NY:Plenum Medical Book Co., p. 103, 1989.
19 Frankel JP, Hughes A. J Neurol Neurosurg Psych 53: 436, 1990.
20 Greenberg HS et al. Clin Pharm & Ther 55: 324–328, 1994.
21 Emory Wheel, February 1979.
22 Ecenbarger W. The Philadelphia Inquirer, November 17, 1991.
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23 The Boston Globe, September 21, 1997.
Feder, Don, Boston Herald, September 24, 1997.
24 Grinspoon L, Bakalar JB. Marijuana, the Forbidden Medicine, Yale University Press, New Haven, 1993.
25 Grinspoon L, Bakalar JB. Drug Dependence. In: Kaplan HI et al, eds. Comprehensive Textbook of Psychiatry, 3rd Ed., Baltimore: Williams & Wilkins, 1980.
26 Gawin FH, Ellinwood EH. New Eng J Med 318:1173–1182, 1988.
Kleber HD, op. cit.
27 Nieman RB et al. AIDS 7:705–710, 1993.
Caiaffa WT et al, Am J Respir Crit Care Med 150:1493–1498, 1994.
28 AIDS Weekly, p. 19, June 28, 1993.
Tindall B et al, Aust N Z J Med 18:8–15, 1988.
29 Tashkin DP et al, New Eng J Med 336:1186, 1997.
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Tilelli JA, New Eng J Med 336:1185–1186, 1997.
Kanof PD, New Eng J Med 336:1184, 1997.
Domino L, New Eng J Med 336:1185, 1997.
Taub A, New Eng J Med 336:1185, 1997.
58955bm.eps
SUMMARY
WHY IS MARIJUANA NOT A MEDICINE? In the past, unscrupulous doctors peddled unlabeled quack medicines which did more harm than good and often contained addictive substances, such as marijuana or cocaine. The Pure Food and Drug Act then required that ingredients of medicines be listed on the label, and the Food, Drug and Cosmetic Act gave the Food and Drug Administration (FDA) the authority to require that manufacturers prove their products' safety and efficacy. Marijuana is not FDA-approved because it has never been shown scientifically to be a safe effective medicine for the treatment of any condition.
WHAT ARE THE RESULTS OF STUDIES ON MARIJUANA? A 1992 report by scientists at the National Institutes of Health (NIH) concluded that scientific studies have never shown marijuana to be a safe effective medicine and that there are better, safer drugs available for all conditions considered. The federal government then halted its ''compassionate use'' program; it was determined that it is not compassionate to pass out harmful drugs of unproven efficacy. For instance, studies show that HIV-positive smokers progress to full-blown AIDS twice as fast as non-smokers, and HIV-positive marijuana smokers have an increased incidence of bacterial pneumonia compared to non-marijuana smokers. Marijuana is an unstable, varying, complex mixture of over 400 chemicals, many of which are toxic. When smoked, marijuana produces over 2000 chemicals, including hydrogen cyanide, ammonia, carbon monoxide, and well-known carcinogens, such as benz(a)pyrene, benz(a)anthracene, benzene, and nitrosamines. Marijuana is addictive; it depresses the immune system, leads to the use of other drugs, such as cocaine; it causes respiratory diseases, is linked to cases of cancer of the lungs, mouth, throat, lip, and tongue; it causes mental disorders, such psychosis, depression, panic attacks, hallucinations, paranoia, decreased cognitive performance, disconnected thought, delusions, and impaired memory; it impairs coordination and judgment and is a major cause of accidents. Prenatal exposure causes low birth weight and an increased incidence of leukemia.
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WHAT IS THE THC PILL? A synthetic form of delta-9-tetrahydrocannabinol (THC), the main psychoactive ingredient of marijuana, has been approved by the FDA as an anti-nausea agent for cancer chemotherapy patients and as an appetite stimulant for patients with AIDS Wasting Syndrome. Unlike marijuana, synthetic THC (''Marinol'') is a stable, well-defined, pure substance in quantified dosage form.
WHO IS BEHIND THE MARIJUANA AS MEDICINE MOVEMENT? There is a well-funded marijuana lobby which consists of groups, such as the National Organization for the Reform of Marijuana Laws (NORML), which aim to legalize marijuana. In 1979, Keith Stroup, NORML's founder, announced that they would be using the issue of medicinal marijuana as a ''red herring'' to give marijuana a good name. Psychiatrist Lester Grinspoon, on the board of NORML, is a long-time advocate of drug legalization and promotes marijuana for myriad conditions, such as pain, itching, menstrual cramps, asthma, childbirth, insomnia, depression and other psychiatric disorders which marijuana actually known to cause. NORML and other pro-marijuana groups petitioned the Drug Enforcement Administration (DEA) in an attempt to reschedule marijuana as medicine, but the U.S. Court of Appeals (1994) ruled in favor of the DEA. The Court noted that whereas the physicians connected to NORML relied on non-scientific anecdotal testimonials, numerous highly qualified experts, as well as the FDA, the American Medical Association, the American Cancer Society, the American Academy of Ophthalmology, the National Multiple Sclerosis Society, and the American Glaucoma Society, all testified that marijuana's medicinal value has never been scientifically proven.
WHY-DO SOME PATIENTS BELIEVE TEAT MARIJUANA IS BENEFICIAL? Due to a placebo effect, a patient may erroneously believe a drug is helpful when it is not and may fail to observe its harmful effects. This is especially true of an addictive, mind-altering drug like marijuana. Therefore, when a patient anecdotally reports a drug to have medicinal value, this must be followed by objective scientific studies. For instance, anecdotal reports had claimed that marijuana caused improvement in multiple sclerosis, yet a scientifically-controlled 1994 study by Dr. H. S. Greenberg showed that smoking marijuana makes symptoms of multiple sclerosis worse. Thus, marijuana should be subjected to the same rigorous scientific evaluations for safety and efficacy as are all other drugs submitted for FDA approval.
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| Concerned Citizens for |
| Drug Prevention, Inc., |
| Hanover, MA, October 2, 1997. |
Hon. BILL MCCOLLUM, Chairman,
Subcommittee on Crime,
Committee on the Judiciary,
House of Representatives, Washington, DC.
DEAR CHAIRMAN MCCOLLUM: As an addendum to my testimony at the October 1, 1997 Subcommittee on Crime hearing on medicinal uses of marijuana, I would like to comment on the interchange which occurred when you quoted Dr. Lester Grinspoon's entry in the 1985 Comprehensive Textbook on Psychiatry which stated, ''If used moderately and occasionally, cocaine creates no serious problems.'' You asked, ''Is that an accurate statement?'' Dr. Grinspoon replied, ''That is an accurate statement.''
However, that is not an accurate statement. Indeed, in the Journal of Clinical Psychiatry 49:2 (Suppl) February 1988, Herbert D. Kleber, MD quoted this exact statement by Dr. Grinspoon as an example of his many statements which downplayed the dangers of cocaine and fueled the cocaine epidemic. Cocaine used ''moderately and occasionally'' may result in serious problems. For example, an article in The New England Journal of Medicine 321:1557–1562, 1989 entitled ''Cocaine-Induced Coronary Artery Vasoconstriction'' pointed out that even small amounts of cocaine may cause spasm in the arteries bringing blood to the heart. It is also well known that cocaine is very addictive, that compulsive use generally begins with casual use, and that this process may have a very rapid onset.
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The importance of this is that we are concerned with reducing the demand for drugs. By falsely promoting marijuana as a safe medicine and downplaying the dangers of marijuana, cocaine, etc., the public is encouraged to use drugs, and there is a consequent rise in addiction and rise in the demand for drugs. This was pointed out in two articles: First, in Dr. Kleber's article quoted above, he writes that there are six causes for increased use of cocaine, ''They are myths concerning its safety, the relationship to marijuana use, the media, celebrity endorsements, changes in the routes of administration, and the reinforcing effects of the drug itself.
''Despite earlier cocaine problems, some influential, contemporary scientific writings reflected the noncritical opinions about cocaine that existed before 1910. For example, in the 1980 Comprehensive Textbook on Psychiatry (ref: Grinspoon L, Wilkins & Wilkins, Baltimore, pp 1614–1628) the following passage is found:
'Used no more than two or three times a week, cocaine creates no serious problems. In daily and fairly large amounts, it can produce minor psychological disturbances. Chronic cocaine abuse usually does not appear as a medical problem.'
It should be noted that in the 5 years preceding this quotation, 1974–1979, cocaine use had doubled.
''The 1985 edition of the same textbook (ref: Grinspoon, L, pp 1003–1015) reflected little change in this remarkably benevolent attitude about cocaine's dangers:
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'High price still restricts consumption for all but the very rich and those involved in trafficking. . . . If used moderately and occasionally, cocaine creates no serious problems.'
Authoritative statements such as these fostered the myth that cocaine was safe and contributed to the increase in its use.''
A second article in The New England Journal of Medicine 318: 1173–1182, 1988 entitled ''Cocaine and Other Stimulants'' by Frank H. Gawin, MD and Everett H. Ellinwood, Jr., MD stated, ''Seven years ago, cocaine was claimed to be a relatively safe nonaddicting euphoriant agent. (ref: Grinspoon, L., 1980 Comprehensive Textbook on Psychiatry, Wilkins & Wilkins, Baltimore) . . . Believing the drug was safe, millions of people tried cocaine, and cocaine abuse exploded.''
Since the medicinal marijuana referenda passed because of similar misinformation, I believe that this is a very crucial issue in the debate. Thank you very much for inviting me to testify.
Sincerely,
Mr. MCCOLLUM. Thank you very much, Dr. Lapey. I realize you are going to have to go to the Senate in a few minutes. If you have to excuse yourself early, please do. However, we're going to have questions in just a couple moments and if you can stay, we'd love to have you.
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Dr. Pilon.
STATEMENT OF ROGER PILON, PH.D., J.D., SENIOR FELLOW AND DIRECTOR, CENTER FOR CONSTITUTIONAL STUDIES, CATO INSTITUTE
Mr. PILON. Yes, thank you very much, Mr. Chairman, and thank you for inviting me to testify on the medical marijuana referendum movement in America and the federalism implications. I take both these movements, the federalism movement and the medical marijuana referendum movement, to be part and parcel of the same thing, namely, a cry from the people to ''get Washington off our backs.'' It is, indeed, the accumulation of power in Washington and the kind of bully-boy mindset that we have seen exhibited even in these proceedings this morning that I think is what's driving this issue today.
Federalism is, of course, a principle that stands for returning power to the States, and, more importantly, to the people. It is not something one invokes selectively, although, regrettably, you do see it invoked selectively in this context. It is a neutral principle. It is part and parcel of our founding documents. The idea of the Federal Government being a Government of general power is simply nonsense; it is refuted in constitutional law classes on the very first day of class. The Constitution establishes a Government of enumerated and, thus, limited powers. The government's of general power are the State governments under our system of dual sovereignty.
Now, before I apply these principles to the medical marijuana referendum issue, let me make very clear my own views on the war on drugs. I think that war is an unmitigated disaster. It is what Professor Steven Duke at Yale Law School has called criminogenic; it actually produces crime. All we need to do is look at our neighborhoods throughout the country to see that; to see from the schools to the prisons to the morgues that the crime that is associated with drugs is crime that results from the war on drugs, not from the use of drugs itself.
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Maybe a real-life example will bring this to the fore, and I cite Will Foster, a 30-year old father of three who lives in Tulsa who suffers from rheumatoid arthritis in his back and feet. He's a 5-year army veteran. He turned to marijuana as a last resort to find relief from his pain, and, indeed, he grew it in an old bomb shelter in his basement, and kept his children from knowing what he was doing so that they wouldn't be confused about drugs. Nevertheless, acting on a confidential informants tip, in 1995, the Tulsa Police Department's Special Investigative Division knocked on his door. As his wife was unlocking the door, it exploded inward from the force of a police battering ram, knocking Mrs. Foster to the floor, nearly on top of their 5-year old daughter who was screaming, ''Don't hurt my mommy.'' Guns drawn and in plain-clothes, the police searched the home for 4 hours, saying, for example, that if Mrs. Foster didn't tell them where the ''meth'' was, they would ''kick her ass to the north side of town.'' They held Mr. Foster's cuffed hands straight up behind his back threatening to break his arms if he didn't tell them. They found the marijuana. The Foster's were arrested; they were jailed overnight. In order to ensure that one of them would be there to raise the children, Mrs. Foster agreed to accept a plea and testify against her husband. The prosecutor also listed the children as testifying against their father. What have we come to in this country, where this is the kind of thing we put a man through—Mr. Foster was sentenced, by the way, to 93 years for this—when all he was seeking was relief from chronic pain? The war on drugs, as I said, is an unmitigated disaster producing the crime that we have.
Now, with respect to these medical marijuana referenda, here, we've got the federalism issues coming straightforwardly to the fore. There is no authority under the Constitution for the Federal Government to intrude on this kind of issue. First of all, with respect to the Mr. Foster's of this world, this is activity that takes place entirely within his home. Not even the notorious case of Wickard v. Filburn will justify Federal intervention on this kind of a case.
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With respect to medical advice and counseling, and monitoring the relationship between a local doctor and his patient here, the activity is entirely intra-state; there is no authority, whatsoever, under the Constitution for the Federal Government to have any jurisdiction in this kind of a case either.
In short, what we've got is a breakdown not only of the rule of law in this insane war on drugs, but have a breakdown of constitutional doctrine. Indeed, at the end of the day, it is a matter of constitutional integrity. If we want to wage this war legally, there's a way to do it; you amend the Constitution. The way we are doing it today is through a Constitution that the Founders would not remotely recognize. Thank you, Mr. Chairman.
[The prepared statement of Mr. Pilon follows:]
PREPARED STATEMENT OF ROGER PILON, PH.D., J.D., SENIOR FELLOW AND DIRECTOR, CENTER FOR CONSTITUTIONAL STUDIES, CATO INSTITUTE
THE MEDICAL MARIHUANA REFERENDA MOVEMENT IN AMERICA: FEDERALISM IMPLICATIONS
Mr. Chairman, distinguished members of the subcommittee:
My name is Roger Pilon. I am a senior fellow at the Cato Institute and the director of Cato's Center for Constitutional Studies.
I want to thank you Mr. Chairman for inviting me to testify on the medical marihuana movement in America and on the implications of that movement for the equally robust federalism movement. Both movements, I submit, reflect the growing frustration of Americans with the accumulation of power in Washington. For more than two decades now the federalism movement has been calling for returning power to the states and, even more, to the people—which is nothing less than a call for restoring constitutional government in this nation. The medical marihuana referenda movement is a small part of that larger effort, but it brings to the fore the hypocrisy of those who invoke federalism selectively for their own political purposes.
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Federalism is a neutral principle. It stands for the idea that all power rests originally with the people, who yield up to their governments only such powers as they in fact yield up, as reflected in the constitutions of those governments. The Declaration of Independence invokes the principle when it says that the purpose of government is to secure our rights and, toward that end, that government derives its just powers from the consent of the governed. The Constitution invokes the principle, first, in the Preamble, which says that we the people ''ordain and establish'' the Constitution; second, in the very first sentence of Article I, which states that ''all legislative powers herein granted [are] vested in a Congress,'' implying that not all powers are granted; third, in the enumeration of those powers, primarily in Article I, section 8; and fourth, in the final members of the Bill of Rights, the Ninth and Tenth Amendments, which state, respectively, that only certain rights are enumerated in the Constitution, the rest having been retained by the people; and, by contrast, that the powers delegated to the federal government are its only powers, the rest having been reserved to the states or the people.
In sum, through our Constitution, we established a national government of delegated, enumerated, and thus limited powers. The ongoing federalism movement is an effort to return the federal government to its legitimate foundations, an effort to return power to the states and the people in light of the usurpation of power that has taken place largely over the 20th century, but especially since the New Deal. One manifestation of that movement is the effort by citizens, either through their state legislatures or through state referenda, to restore their rights to use marihuana for medical purposes, including their rights to seek medical advice and direction concerning such use, free from federal government interference. Because federal officials have lately claimed a power to prohibit the exercise of such rights, we have a looming constitutional crisis on this issue.
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Before I examine those conflicting claims in greater detail, however, I want to make clear from the outset my own thoughts on the so-called war on drugs, which has been waged in this nation for nearly two decades and yet shows no signs of either letting up or being won, whatever that might mean. I join—in fact, have long been a member of—that growing body of people who believe that the war on drugs is a monumental failure—indeed, a monumental disaster, wrecking havoc on lives, communities, and institutions across this nation. As Yale Law Professor Steven Duke and California attorney Albert Gross powerfully argued in their 1993 volume entitled America's Longest War, the war on drugs, far from addressing the problem it purports to address, is actually criminogenic—it produces crime.
But how could it be otherwise? As has long been noted by everyone from Nobel laureate Milton Friedman to former secretary of state George Shultz, conservative columnist William F. Buckley, Jr., Baltimore Mayor Kurt Schmoke, numerous judges, and many others, the incentives we create when we make drugs illegal—the economic forces that then come into play—simply guarantee the disaster we have today. After all, we do not have drive-by shootings over tobacco or alcohol, which are legal, even though individual lives may be destroyed by those drugs. We do not because disputes over transactions involving those drugs can be handled through our ordinary legal institutions, whereas disputes over illegal drug transactions, involving the vast sums of money that necessarily accompany that trade, must be settled outside such institutions—on the street. And the victims, made far more numerous by the monetary incentives for pushing drugs, are everywhere—in the streets, the schools, the neighborhoods, the prisons, the morgues. Did we learn nothing from Prohibition? If we cannot keep drugs out of our prisons, and we cannot, what makes us believe we can keep them out of the larger society?
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But apart from the sheer numbers that accompany the war on drugs—the crime, the prison population, the tax dollars spent, the corruption of law enforcement officials and foreign governments-there is nothing like a real-life example of lives destroyed to put the war in perspective. In the May issue of Reason magazine we find such an example, Will Foster, a 38-year-old father of three who lives in Tulsa, Oklahoma, and suffers from rheumatoid arthritis in his back and feet. A five-year Army veteran who served as an M.P., Mr. Foster was unable to get relief from other drugs in a way that left him able to work, so he turned to marihuana, which he grew in an old bomb shelter in his basement, concealed from his children to avoid confusing them about the use of drugs.
On December 28, 1995, the Tulsa Police Department's Special Investigative Division, acting on a tip from a ''confidential informant,'' knocked on Mr. Foster's door. As his wife was unlocking the door it ''exploded inward'' from the force of a police battering ram, knocking Mrs. Foster to the floor, nearly on top of their five-year-old daughter, who was screaming ''Don't hurt my mommy!'' Guns drawn and in plain-clothes, the police held the Fosters for four hours as they tore the house apart. During the search, one officer told Mrs. Foster he would ''kick my ass to the north side of town if I did not tell him what he wanted to hear.'' The same officer later yanked Mr. Foster's cuffed hands straight up behind his back, threatening to break his arms if he didn't say where the ''mesh'' was. After tearing apart even the 5-year-old's teddy bear, the police found no ''meth,'' but they did find Mr. Foster's medicine: about 70 plants, many of them seedlings. The Fosters were arrested and jailed for the night.
That was only the beginning of their nightmare, as the Reason article goes on to detail, with subsequent arrests, subsequent searches, and subsequent harassment. Hoping to ensure that one of them would remain free to raise the children, Mrs. Foster decided to accept the prosecutors' offer of misdemeanor charges in return for her testimony against her sick husband. And in a shocking example of prosecutorial overreach, the three children too were included on the prosecution's witness list. What have we come to in this country when people like Mr. Foster are incarcerated for 93 years—the sentence he later received—and their families are coerced to testify against them? All he was seeking, after all, was relief from chronic pain? For that, like countless other ordinary Americans, he was subjected to the worst abuses of the government's drug-enforcement gestapo.
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Compared to such ''official'' abuse, the abuse of drugs by ordinary people simply pales. Of course people abuse drugs, legal and illegal alike. They always have, they always will, no matter how draconian we make the punishment for doing so. The only question is what, if anything, we should do about it.
In my view, the abuse of drugs now declared illegal, like the abuse of legal drugs, should be treated as a medical matter, not as a crime. Fortunately, a growing number of Americans are coming to that view too, as is evidenced by the referenda last fall in California and Arizona, where the voters of those states authorized physicians licensed in the state to recommend the use of medical marihuana to seriously ill and terminally ill patients residing in the state without being subject to civil and criminal penalties. California and Arizona thus join Virginia and Connecticut, whose legislatures in 1979 and 1981, respectively, enacted similar legislation.
In response to those referenda, however, the administration announced, without any intervening authorization from Congress, that any physician recommending or prescribing medicinal marihuana under state law would be prosecuted. In the February 11, 1997, Federal Register the Office of National Drug Control Policy announced that federal policy would be as follows: (1) physicians who recommend and prescribe medicinal marihuana to patients in conformity with state law and patients who use such marihuana will be prosecuted; (2) physicians who recommend and prescribe medicinal marihuana to patients in conformity with state law will be excluded from Medicare and Medicaid; and (3) physicians who recommend and prescribe medicinal marihuana to patients in conformity with state law will have their scheduled drug DEA registrations revoked.
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The announced federal policy also encourages state and local enforcement officials to arrest and prosecute physicians suspected of prescribing or recommending medicinal marihuana and to arrest and prosecute patients who use such marihuana. And in what can only be described as an act of zealous overkill, especially in light of last week's IRS hearings in the Senate, the policy also encourages the IRS to issue a revenue ruling disallowing any medical deduction for medical marihuana lawfully obtained under state law.
Clearly, this is a blatant effort by the federal government to impose a national policy on the people in the states in question, people who have already elected a contrary policy. Federal officials do not agree with the policy the people have elected; they mean to override it, local rule notwithstanding. That effort cannot be justified under the 14th Amendment, for the states have not enacted a policy that runs roughshod over the privileges or immunities of their citizens or denies them due process or equal protection of the laws. No one in the states is complaining that the state government is violating his rights, which might require federal intervention. On the contrary, state policy in the states in question has been changed to recover rights, the rights of those who might want to prescribe or use medicinal marihuana.
We come then to the question of what warrant, if any, there might be for federal intervention. And we start with an elementary point of constitutional law, namely, that the Constitution does not establish a national government of general power; rather, as I noted at the outset, it establishes a government of enumerated powers only. Search as you will through Article I, section 8 of the Constitution, you will find no power to wage a ''war on drugs,'' or anything close to it. There is no federal police power. The police power—the ''Executive Power,'' as John Locke called it, that each of us has in the state of nature to secure his own rights-resides with the individual states—the general governments under our system of dual sovereignty. Thus, regulations to secure rights in the areas of health, safety, and medical practice are the doctrinal and historic province of the states, not the federal government. Indeed, so clear is that point in our constitutional firmament that when we undertook out misguided effort earlier in the century to prohibit the manufacture, sale, and use of another drug, alcohol, we did it through constitutional amendment. So far have we strayed from that firmament today, however, that we do not even think it necessary to ask, ''Where does the federal government get its authority to prosecute the war on drugs?'' We simply assume it has the power.
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Two years ago, in a not unrelated way, that assumption was challenged in the Supreme Court of the United States when a young public defender from Texas had the temerity to ask where Congress got its authority to enact the Gun-Free School Zones Act of 1990. In response, the government claimed that it was found in the Commerce Clause, the power of Congress to regulate ''commerce among the states.'' But that power, the majority on the Court said, is not a power to regulate anything and everything, which would make a mockery of the doctrine of enumerated powers. Thus in that case, United States v. Lopez, did Chief Justice Rehnquist return to what he called the ''first principles'' of our constitutional order. For the first time since the New Deal the Court said that Congress's regulatory power under the Commerce Clause is not unlimited.
The commerce power was meant primarily to enable Congress to ensure the free flow of commerce among the states, which under the Articles of Confederation had enacted protectionist measures on behalf of local merchants and manufacturers facing competition from out-of-state firms. Faced with a breakdown of free trade, and a classic prisoners' dilemma, the Framers gave Congress the power to regulate—or ''make regular''—commerce among the states. That was the basic purpose of the power. And, indeed, in the first great Commerce Clause case, Gibbons v. Ogden, that was the use made of it by Chief Justice Marshall.
Since the New Deal, however, and the infamous threat by President Roosevelt, when the Court would not give him his way, to pack that body with six additional members, the Commerce Clause has been read by the Court as authorizing Congress to regulate anything that even ''affects'' interstate commerce—which in principle is everything. That reading cannot be right, of course, for it amounts to authorizing a government of general powers under the guise of regulating commerce and hence to eviscerating the centerpiece of the Constitution, the doctrine of enumerated powers. Yet it is, save for the recent and as yet undeveloped Lopez case, the current law.
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We come, then, to the absurdity of it all. When Congress wants to keep guns out of schools—notwithstanding that most states already have laws that address that problem—it does so under its authority to regulate ''commerce'' ''among'' the states. Likewise, when it wants to keep people like Will Foster from growing marijuana for their own medical use, it does so under the guise of regulating ''commerce'' ''among'' the states—a power that was granted, remember, to ensure the free flow of goods and services among the states. The rationale will not even pass the straight-face test. Indeed, in perhaps the most infamous Commerce Clause case ever, Wickard v. Filburn (1942), in which an Ohio farmer was fined for growing wheat in excess of his allotment under a statute enacted pursuant to the Commerce Clause, even though the wheat he grew never left the farm, the Court reasoned that his act ''affected'' interstate commerce because that portion of the wheat that exceeded the allotment was wheat he might have bought on the market. Yet here, the marihuana Mr. Foster grows and uses could not possibly affect interstate commerce since any such commerce in marihuana is illegal! There simply is no power under the Commerce Clause, or under any other clause of the Constitution, for the federal government to regulate the Will Fosters of this world.
Nor is there a federal power to regulate any local doctor who might prescribe or monitor Mr. Foster's use of marijuana, for the ''commerce'' between doctor and patient is entirely intrastate. To be sure, the doctor may have received his education in another state, and his bills may be written on paper manufactured out of state; but the use of such irrelevant facts to bootstrap the federal government into a regulatory role is not only a sign of intellectual bankruptcy—exhibited, unfortunately, by too many courts—but a sign of moral bankruptcy as well. It is a matter of simple intellectual integrity to recognize the Constitution for what it is—a plan for limited government. If we want the federal government to exercise more power than it is authorized to exercise under our Constitution, there is a legitimate way to bring that about. We turn to Article V, where the Framers provided a method for amending the Constitution. Otherwise, we live within its limits, and leave the American people free to plan and live their own lives.
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Mr. MCCOLLUM. Thank you, Dr. Pilon. I appreciate all of the witnesses for staying within the timeframe. I realize I was very strict today. It was not to abuse you, but to be fair to the entire panel with as many votes as we are likely to have.
We will ask questions under the 5-minute rule. Depending upon the number of questioners here, we may be able to give each of you an opportunity to address some other issues as you respond to our questions.
I'll, first, yield myself 5 minutes. Dr. Pilon, I believe I'm correct in saying that you would favor legalization of drugs in general, including marijuana, cocaine, et cetera. Am I not correct in that?
Mr. PILON. You're absolutely correct on that. I don't believe that the Government, Federal, State, or local, has any business telling anyone what he should put in his body in a free society. A free Government would not be engaged in that kind of activity.
Mr. MCCOLLUM. Are you not concerned by the many experts and studies which have shown that if we legalize drugs, generally, that we will see a dramatic increase in drug use among teenagers and underage juveniles—doubling or tripling what the use is today? If that is the case, how do you rationalize that increase with your philosophy on this point?
Mr. PILON. Mr. Chairman, I, too, am the father of two teenagers. I have no fear, whatsoever, that they are going to be involved in drugs, and it has nothing, whatsoever, to do with the war on drugs. Indeed, my fear is that the war on drugs will only encourage them to look at this matter in a way that to my mind distorts fundamental principles about the relationship between the individual and the Government.
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Mr. MCCOLLUM. Dr. Pilon, I respect your views, but I would point out that everything we hear from the majority of the experts would lead this Committee to believe that if you do legalize drugs, you're going to see a dramatic increase in usage. It will be more openly accepted, and more young people will voluntarily use them at a premature age. We can blame that on the family or something else, but that's what the studies show.
Mr. PILON. Mr. Chairman, here, as elsewhere, the conventional wisdom is dead wrong. We have heard the witnesses on the first panel this morning simply echoing each other. I submit that Dr. Grinspoon has the better of it when it comes to the science of the matter.
Mr. MCCOLLUM. Dr. Grinspoon, I want to ask you a question. As a doctor, don't you think that medical marijuana, just like any other medical drug, should be approved by the Federal Food and Drug Administration before it is administered, and then administered by some form of prescription rather than by the general certification that most of these initiatives seem to endorse?
Mr. GRINSPOON. Well, I believe that the Federal Drug Administration should go through its process to approve most drugs, but that approval is really a determination of risk and efficacy. First, a drug, let's say drug x, is patented by the drug company. If the drug company believes that it will have a saleable produce, they will apply for a patent which then lasts 20 years. They then take the drug through the first studies which are done primarily in animals to prove that it's not so risky that it can't be used; it's a risk benefit analysis. Then, they start the human studies, and they determine the efficacy of the drug. You can't find a drug which is completely non-toxic, but you balance its toxicity against its efficacy, and that's what the FDA does, and that's a very important process. But if you consider marijuana, marijuana has been used for thousands of years—the written notations go back 5,000 years. It has been used by millions of people. There has never been a death—that's the most toxic effect of all—from an overdose of marijuana.
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The fact of the matter is that when marijuana regains its rightful place in the pharmacopeia—a place it lost in 1941 after the passage of the first of the draconian anti-marijuana legislative acts, the Marihuana Tax Act of 1937—when it regains that place, it will be seen as one of the least toxic medicines in the pharmacopeia.
Mr. MCCOLLUM. It's just a hard——
Mr. GRINSPOON. As for the efficacy, if any clinician who has had experience with patients; with AIDS; with multiple sclerosis; with migraines, who has seen that these people get better relief than they do from the conventional medicines, in some of them, the only relief they get for this, there's no question about its efficacy.
Mr. MCCOLLUM. Dr. Grinspoon, I must say there is some degree of controversy about this. Doctors have differing views on it. We've had other witnesses in previous hearings who don't agree with you on that point, but even if we accept your word and your assumptions that there is a medically useful purpose for marijuana, particularly smoked marijuana, it seems to me that we ought to have some process of approving the applications of smoked marijuana. How much marijuana?
What is the appropriate dosage? Is it for arthritis or nausea in cancer patients? To allow certification by any doctor for any medical illness, I don't see any scientific basis for that.
I'd like Dr. Lapey to comment on that. You did some in your testimony, before I go to Mr. Barr. Do you have a comment on Dr. Grinspoon's analysis of this?
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Ms. LAPEY. Well, I think that the legalization lobby—and Dr. Grinspoon, as I said, is on the board of NORML and is an advocate of drug legalization—and I think that traditionally the legalization lobby has downplayed the harmful effects of illegal drugs, and his 1993 book, Marijuana, the Forbidden Medicine—which promotes marijuana for conditions including asthma, itching, menstrual cramps, insomnia, depression and other psychiatric conditions which marijuana is actually known to cause—in my view, downplays marijuana's harmfulness, because it refers to the addictive and gateway properties of marijuana as a ''myth'' on page 158, and, indeed, reports in both the New England Journal of Medicine, and the Journal of Clinical Psychiatry stated that a cause of the Nation's cocaine epidemic was misinformation, and they specifically pinpointed an entry by Dr. Grinspoon—which I'd like to have him speak about—in the 1980 Comprehensive Textbook of Psychiatry which downplayed the harmful effects of cocaine, and these authors in the New England Journal and Dr. Kleber, in the Journal of Clinical Psychiatry, stated—and this is in my written testimony—that this misinformation, downplaying the harmful effects of cocaine, was a cause of the cocaine epidemic, and they said that believing it was harmless, millions of people used cocaine, and cocaine use exploded. And, so I think we have to be very careful not to downplay the harmful effects of drugs such as marijuana and cocaine.
Mr. MCCOLLUM. Thank you, Dr. Lapey. Would you like to comment on the cocaine, Dr. Grinspoon?
Mr. GRINSPOON. Yes, well, I'd like to comment on that. First of all, I don't believe that Dr. Lapey has read my book, Cocaine, a Drug and a Social Revolution, because I'd like her to point out the pages where I say that it's a harmless drug. But, secondly, it's true that we have a disagreement here, and how are you to decide who is correct. We're both physicians; we're both, presumably, people who know about this. I would urge you to take a look at our curricula vitae to see what we have written and published on this. I've published—I've been asked to write chapters on marijuana in about three or four major textbooks. I've written a chapter on marijuana for two encyclopedias. I've published two books on it: Marijuana, the Forbidden Medicine, the book she mentioned that's been translated into eight languages. I've published papers in refereed journals, including the Journal of the AMA and the New England Journal of Medicine on marijuana, and I have, with few exceptions, more experience with patients who use marijuana as a medicine than anyone else in the country.
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Now, I think you have to take that into account in looking at our two views of this.
Mr. MCCOLLUM. Let me ask you about this excerpt, Dr. Grinspoon—my staff has handed it to me in light of this exchange that I didn't anticipate here today. They say—and maybe this quotation came out of Dr. Lapey's testimony, I'm not sure—that in the 1985 edition of Comprehensive Textbook of Psychiatry, you're quoted as writing, ''Used moderately and occasionally, cocaine creates no serious problems. Chronic cocaine abuse usually does not appear as a medical problem.'' Is that an accurate statement?
Mr. GRINSPOON. That is an accurate statement, and that is the statement on which Dr. Kleber, who was then deputy assistant to the drug czar, based his view that I believed cocaine to be harmless. His chapter is in the same textbook that I wrote the chapter on marijuana.
Now, if you look at that statement, that does not say that cocaine is harmless. I could make the same statement about alcohol; most people who use alcohol do not get into difficulty with it. That doesn't mean that I don't think that alcohol has a potential to be a dangerous drug.
Mr. MCCOLLUM. But isn't cocaine far more addictive than alcohol?
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Mr. GRINSPOON. No, it's probably about the same. For example, there was someone from NIDA and someone from the University of California were asked to rate six drugs with regard to addictiveness: tobacco, heroin, cocaine and alcohol were right there together, but at the bottom of the list were marijuana and caffeine. It's the only one they couldn't agree on; was caffeine more addicting than marihuana?
Mr. MCCOLLUM. Do you favor legalizing cocaine?
Mr. GRINSPOON. Do I favor legalizing cocaine?
Mr. MCCOLLUM. Yes, sir.
Mr. GRINSPOON. Well, I favor a policy which gets away from the criminal justice approach to cocaine or any other drug and treats it as a public health problem.
Mr. MCCOLLUM. But that would be general legalization, if you decriminalized all drugs.
Mr. GRINSPOON. Well, decriminalizing would be better.
Mr. MCCOLLUM. Mr. Barr, you're recognized for 5 minutes.
Mr. BARR. Thank you, Mr. Chairman. Dr. Grinspoon, earlier, I think you were here for the previous panel. Is that correct?
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Mr. GRINSPOON. Yes, I was.
Mr. BARR. Okay. And I made some references, there, to your suggestion that marijuana can be effective against various things. Do you recall that?
Mr. GRINSPOON. Yes, I do.
Mr. BARR. That list appears in your publication, Marihuana, the Forbidden Medicine. Is that correct?
Mr. GRINSPOON. Yes.
Mr. BARR. Okay. Well, you've discovered something Ponce de Leon didn't discover.
Mr. GRINSPOON. Pardon?
Mr. BARR. Do you remember Ponce de Leon?
Mr. GRINSPOON. Yes.
Mr. BARR. Searching for the fountain of youth; never found it.
Mr. GRINSPOON. Yes.
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Mr. BARR. You've apparently found it.
Mr. GRINSPOON. No, that's not true.
Mr. BARR. Well, you don't——
Mr. GRINSPOON. Mr. Barr, I suggest that you before you say that——
Mr. BARR. Hold on, hold on, hold on.
Mr. GRINSPOON [continuing]. You read the book. Read the book. Have you read the book?
Mr. BARR. Okay, then——
Mr. GRINSPOON. Have you read the book?
Mr. BARR. Then, you're saying that what you say in that book that aging is a condition against——
Mr. GRINSPOON. Well, how do you know what I say in that book if you haven't read it?
Mr. BARR [continuing]. For which marijuana can be effective. That's not true? You're disputing that now?
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Mr. GRINSPOON. Pardon?
Mr. BARR. I'm just asking. You might like to take the opportunity now, then, to correct the record. Your book—your publication, Marihuana, the Forbidden Medicine, does not state that you believe that marijuana can be effective against aging?
Mr. GRINSPOON. No, that's not what it states.
Mr. BARR. Okay, so this—these quotes, apparently, you're changing those.
Mr. GRINSPOON. No, you have them wrong. You obviously have not read that chapter in my book——
Mr. BARR. Oh, I have them wrong? Okay.
Mr. GRINSPOON [continuing]. But, perhaps, that's the only one you haven't read.
Mr. BARR. Well, I know that you're a great self-promoter. You describe yourself in your literature here as the complete medical scholar, and I suppose there may be some of your colleagues——
Mr. GRINSPOON. Mr. Barr, I did not—I did not describe myself—I don't know what you're reading from.
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Mr. BARR. Well, I'm reading from your material here, page 23.
Mr. GRINSPOON. Well, wait a minute. I can assure you, I did not write those words.
Mr. BARR. Well, you could have fooled me, because you're just sitting here—apparently, there are—maybe there are some of your colleagues that are impressed, but simply because——
Mr. GRINSPOON. Well, you are clearly, clearly very easily fooled.
Mr. BARR [continuing]. You're published in different languages that that makes it true, and somehow lends validity to your position. I don't believe that.
I'd like to ask Mr. Brooks, you know, your resume isn't quite as self-promotional, but you're putting your reputation and your life—oh, Mr. Pilon objects to that—the libertarian objects to it. Poor libertarians.
Mr. PILON. No, I think it's just a matter of poor taste, Mr. Barr. It's the kind of cheap, political grandstanding that is out of place in a hearing in this room.
Mr. BARR. You can leave. You can leave. You can leave anytime.
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Mr. MCCOLLUM. Let's have order. I realize that there are emotions involved in this, but Mr. Barr has the time. Please, Mr. Barr.
Mr. BARR. Mr. Brooks, one of the things that we've seen recently, and we had some testimony before another committee, recently; it was International Security Subcommittee before Government Reform Committee, and we had some experts over here from Switzerland, a medical doctor and an attorney, both of whom were active in the anti-drug legalization movement in Switzerland, and they came over here with some other—there were some other witnesses, as well, at this hearing—and they came over here and very clearly, not to lecture us, but just to provide some firsthand experience through their testimony of the experience in Switzerland in which the use of marijuana, the so-called needle giveaway programs, were described similarly to what some of the, you know, that your colleagues on both sides are describing as very benign programs and policies as the gateway to which, as we see in several European countries, in recent years, including Switzerland, that now goes from needle giveaway programs and marijuana legalization policies to heroin programs in which heroin is brought to government-run clinics by the local police—there's an irony for you—on a weekly or a bi-weekly basis, the heroin is brought to these clinics, and people come in up to three times per day—this is all paid for by the government, except for a very nominal fee that these folks might or might not pay—and they're given heroin by the government. And their point was that when you start out—and we see the same thing having happened in the Netherlands; we also saw this happen in Sweden which has come to its senses and reversed those destructive policies.
In your experience—and Mr. Copple, you may want to comment on this also—do you see the same thing happening here in this country? Are there danger signs out there that, coming in with this very benign approach, that marijuana is so nice, and our Government ought not to be keeping it from these folks at these clubs and so forth? And the needle giveaway programs, in your experience, do those lead to more prevalent usage of drugs; a change in society's attitudes to some extent and increased drug usage?
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Mr. BROOKS. Yes, I think that that's been clearly demonstrated that when we reduce our drug enforcement efforts and our anti-drug message, drug use skyrockets. From 1979 to 1991 or 1992, in this country, we reduced drug abuse by about 50 percent with a strong anti-drug message, treatment, and drug law enforcement.
You know what? If we were to reduce cancer or AIDS in this country by 50 percent, we would have rallies in the streets, but for some reason, we did not play off of the successes we had in narcotic enforcement. We've seen now, since the passage of proposition 215 in California, illegal marijuana cultivation arrests up by 50 percent. We've seen in a recent drug use study of 9th and 11th graders in California that in 1989, marijuana use among 11th graders was 28 percent; now, it's 43 percent, up from 40 percent 2 years ago.
You know, I clearly think that when we send mixed messages to our young people, I mean, to Americans in general, but, especially, to our young people, that they become confused by that message. They believe that marijuana is a safe drug. We know, from Dr. Inaba, that because of the high potency, THC potency, of marijuana in sensamillion marijuana today, that smoking one joint of marijuana today is like smoking 14 joints of marijuana in the sixties.
This is a dangerous addictive drug with the height potential for abuse, and we're making light of it, and I think that it's time that we stop, but I would really urge the Congress to take action to stop prevent States from superseding the National Controlled Substances Act. I think that's the only way that we're going to stop this wave of drug legalization. Make no mistake about it, the medical marijuana movement is not a medical movement; it's a drug legalization movement, and I think that's pretty clearly demonstrated.
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Mr. BARR. Thank you. And with the chairman's permission, if Mr. Copple, and, maybe, Mr. Romley, could comment very briefly.
Mr. COPPLE. I would just briefly add that the imagery of the war on drugs, whether you like it or you don't like it, the fact is that from 1979 to 1989 we were making significant progress in this country on eliminating drug abuse in youth. Our messages were persistent and consistent, and they came from multiple voices—national leadership, State and local leadership was being provided on this issue.
Anytime you have an erosion of risk, as General McCaffrey and Alan Leshner pointed out this morning—anytime you have an erosion of risk, you're going to see increased use, and the discussion around the medical uses of marijuana or decriminalization contributes to the erosion.
The CATO Institute and others would like to solve the constitutional problems by creating a public health nightmare, and that's precisely what we would be facing in this climate. If we opened up Pandora's box to let people access drugs easily, we would be creating a criminal justice and public health nightmare with people doing crime while under the influence, and all you have to do is look at our current prison population to see evidence——
Mr. BARR. But, of course, if we legalize drugs, we would no longer have any illegal usage, would we?
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Mr. COPPLE. No illegal drug users, but you'd have a lot of other kind of crime while under the influence.
Might Mr. Romley just comment very briefly, Mr. Chairman?
Mr. MCCOLLUM. Certainly, Mr. Romley may.
Mr. ROMLEY. Just very quickly, I will not echo what has been said already. I, too, concur with the fact that this mixed message does send out a bad precedent to the children and that we will see an increase in use by our youth as well as other individuals in our society.
I would just expand upon one thing that Mr. Copple has said, being the D.A. of a very large county within America, I see the real-life situations that occur from individuals that are using drugs. To imply that you will stop the crime problem, the black market, and that crime will, somehow, disappear by decriminalizing this is a myth in America. I cannot tell you the untold homicides that have occurred by child abuse, and battered children. We're currently prosecuting someone right now in Phoenix, Arizona where the child had 17 broken bones. The internal organs were ripped apart by—allegedly, because she was on crack cocaine.
The number of deaths on the highway; the amount of domestic violence, from the criminal justice perspective, would expand exponentially as well as all of the other societal issues from the business community standpoint; the amount of absenteeism; the amount of danger to just our citizenry in general from being transported by an airline pilot that may have used drugs, because it's no longer improper. I can't phantom America going in that particular direction.
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It is a terrible hoax what has happened here. It is not a medicalization issue. If it truly is good medicine, study it. If the doctors, after scientific testing, say it is appropriate, I'll support it, but until then, don't be hoodwinked by what is really going on here, because this is truly a legalization issue. It is a movement toward the full legalization of all drugs.
Mr. BARR. Thank you.
Mr. MCCOLLUM. With that in mind, Mr. Peron, why in the California initiative did you not provide for a board of some medical group—at least at the State level—to certify the specific medicinal uses for marijuana? Also, why did you not provide in the initiative for prescriptions as the proper method for doctors to prescribe the particular uses of marijuana?
Mr. PERON. Well, of course, Senator, if I had put ''prescription'' there, the initiative would have been dead in the water in the beginning.
Mr. MCCOLLUM. Why is that?
Mr. PERON. Because doctors are not allowed to prescribe Schedule I drugs, but, routinely, cancer chemotherapy doctors have been recommending marijuana for 10-20 years, kind of wink and nod, yes, if you use marijuana, it will help you——
Mr. MCCOLLUM. Well, let me interrupt you—I'm going to let you finish—but let me interrupt here for a moment to say that they're not allowed under Federal laws, General McCaffrey said, to certify Schedule I drugs either. Even though you passed your State initiative in California, it's still in conflict with Federal law, and doctors could be prosecuted for it. Now, the Administration, for whatever reason, has chosen, for the moment, not to do so. However, I'd just remind you it wouldn't make any difference either way; it's still in violation of Schedule I.
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Mr. PERON. Well, perhaps, it would be a violation of Schedule I, and the Federal Government has standards that if there's over 500 plants, the Federal Government will prosecute. Otherwise, it is a State—and every State in our Union has their own drug laws. We have the 10th Amendment, and this is all to be worked out——
Mr. MCCOLLUM. No, sir.
Mr. PERON [continuing]. But I find it very ironic, here, that we're hearing from all these people from the criminal justice system—we're talking about medical marijuana, but they're all talking about crack. They are the people responsible for the price drop in cocaine; the price drop in heroin, and now we have this new smokable form of heroin. We have the inner cities houses blowing up with methamphetamine factories, yet, all they can talk about is medical marijuana. These are the people that are responsible for the price dropping and more people using it.
I am not a drug legalizer. I am against that, but these are the people that we're asking to help us stop this scourge, and what happens? The price drops; it's all over the place. They're running around chasing potheads while Rome is burning. Young people are getting hooked on this new smokable form of heroin that's coming in from Colombia; coming in from Mexico when they're just worried about marijuana, and they're ignoring the real problems of America. This young boy that just died of alcohol; 18 years old in Virginia. It's nothing to everybody. All these people that die of alcohol; all these people that die of cigarettes, they're just written off; no one cares about them. All you're caring about is this medical marijuana. I don't even hear about this; I'm hearing about crack cocaine.
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Mr. MCCOLLUM. I've asked you a medical marijuana question, Mr. Peron, and you have only answered it slightly. Why not a testing approval for it? Why not having at least a certification approval by a board in California? Let's assume the——
Mr. PERON. Politics.
Mr. MCCOLLUM [continuing]. States' rights issue here. Politics? You don't think it could happen?
Mr. PERON. Well, politics, obviously. Can we—we have studies. How do you think marinol became—how did marinol come around? I'll tell you how it came around. In 1974, they had a study that said marijuana decreases nausea in cancer chemotherapy patients. You know the first thing the Nixon administration did? They said, ''Oh, geez, we've got to get a pill. Otherwise, we're going to have to give cancer patient in America marijuana.'' They invented this pill called marinol. They took the most psychoactive ingredient of the marijuana plant; put it into a pill; told the retching patient, ''Here, this is marijuana. This is the stuff that will ease your nausea.'' If it worked, we wouldn't be standing here.
Mr. MCCOLLUM. I hear what you're saying. What bothers me about all these initiatives, including the one that apparently is going onto my State's ballot, is the absence of any scientific procedure that says, ''This is the use that marijuana should be approved for.'' I'm willing to assume, as everybody here is today, that there may be some valid use for smoked marijuana in cases of patients who are nauseous with cancer or some other serious illness, but the broad sweep of these initiatives—including the one you passed in California—is what's disturbing to me, as well as and the absence of normal controls over a drug that you would have used for any purpose.
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I'm going to go on to another question; I may come back to you, Mr. Peron. Mr. Romley, is there reason to believe that the same financial backers and promoters of the Arizona and California initiatives are backing the Washington State and the Oregon initiatives, and, perhaps, the Florida initiative? Is there reason to believe that?
Mr. ROMLEY. Mr. Chairman, I do have some information on the Washington initiative, and there is, at least from Arizona, Mr. John Sperling who contributed a significant amount of money in Arizona, and I'm not sure in California, is contributing to the Washington initiative. So, there is some connections at this point in time. I believe there is the Drug Policy Foundation is involved as well.
Mr. MCCOLLUM. Mr. Copple, can you comment on that. I know there's also an initiative in the District of Columbia, if I'm not mistaken?
Mr. COPPLE. Right. Many of the same sources are contributing to the initiatives in Washington State: Sperling, Soros have yet, at least as of last week, put any money into Washington State. There is discussion is that that's more than likely going to be a possibility as the opposition to their proposition is mounting and is raising money. The Drug Policy Foundation and others are expected to put money into it. I think we're going to see some of the same sponsorships emerge in these various States in these initiatives. There's no doubt in my mind as it becomes threatened, that that will become a reality.
Mr. MCCOLLUM. Mr. Brooks, you are obviously very knowledgeable about the California initiative. Could you give us some idea as to the source of the monies and the support for that State initiative that came out-of-state? I know there may be plenty of folks in the State, but was there not out-of-state support for that initiative as well?
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Mr. BROOKS. Yes, that's correct. Seventy-five percent of all the money, more than $2 million that was raised and used in the prop 215 campaign, came from out-of-state. The vast majority from George Soros and from Mr. Sterling and a handful of other pro-drug legalizers of pro-drug lobby that pumped money from out-of-state into California's problem. What they did was they used that $2 million to buy effective advertising much like you saw here on Mr. Romley's tape, and they really outshouted the credible and informed opinions of public service groups; politicians from both sides of the aisle; the President of the United States; three past Presidents; C. Everett Koop, and every other credible medical association.
I just want to point out that if doctors wanted marijuana as a medicine, it would be backed by the AMA, the California Medical Association, the MS Society or Cancer Society, and it is not. There is not one credible medical association in California or across this Nation that is asking for the use of marijuana, and I echo Mr. Romley's thoughts: if the doctors came to us, and said they needed it, and they needed it rescheduled and there was scientific proof to support that, I would certainly reconsider my position and my association would, but the doctors, the medical community, the scientific community has not asked for that.
Mr. MCCOLLUM. Mr. Barr, you have a follow up question? Obviously, we're going to have to conclude this hearing, now that we have this series of votes.
Mr. BARR. Just a couple of unanimous consent requests, Mr. Chairman, and if I might inquire of the chairman, one thing we haven't gone into, but what I think was included in some materials is the PET studies showing diminished brain activity in chronic marijuana users from Brookhaven National Laboratories, September, 1997. Might I inquire if that is a part of the record?
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Mr. MCCOLLUM. That is a part of the record. It's part of General McCaffrey's presentation.
Mr. BARR. Also, Mr. Chairman, I know in some of the materials provided to us, there are references to the use of marijuana for glaucoma which reduces intra-ocular pressure which can—and it can also restrict blood supply to the optic nerves exasperating visions problems. I'd like to ask unanimous consent to insert into the record an article that discusses that very briefly, and it is supported by other written testimony; by Charles Krauthammer, Washington Post, February 7, 1997.
Mr. MCCOLLUM. Without objection.
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Mr. BARR. In addition, Mr. Chairman, there was an article that appeared just yesterday, September 30, 1997 in the Washington Post by Former Secretary of Health, Education, and Welfare, Joseph Califano, talking about the pied pipers of medical marijuana; some of which we've heard here today. I'd ask for that article also to be inserted into the record.
Mr. MCCOLLUM. Without objection.
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Mr. BARR. And, finally, pursuant to the discussion I had with Dr. Grinspoon, I'd like inserted into the record excerpts from his publication, Marijuana, the Forbidden Medicine, Yale University Press, 1997 edition.
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Mr. MCCOLLUM. Thank you very much, Mr. Barr. I just have one concluding question to ask of Mr. Romley, if I could. What can—and maybe I ought to ask Mr. Copple, too—what can other States learn from the Arizona experience? You've relayed a lot of information to us today; can you summarize what other States can learn?
Mr. ROMLEY. Well, I think that the other States have already perceived that this is a movement that has a tremendous amount of momentum and is going to be very difficult to fight. It deals with compassion; it deals with the very best that Americans are about, and there is a lot of money. I think that the best thing that they can learn from this is that they must organize. They must come together, and they are going to have to fight from the very beginning with a concerted effort to get out the true message of what this is about. We were overwhelmed. Law enforcement—when our initiative was going through, we had the International Chiefs of Police Association in Phoenix, over 15,000 members, and it was unanimously supported to oppose that initiative, and it carried no weight. So it's a tough initiative to fight. The media, to a great degree, does not play an equal share to both sides. There is no real debate and you're overwhelmed with the money, and it's a huge media campaign that's very difficult to overcome unless you have money as well.
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Mr. MCCOLLUM. Mr. Copple, you weren't directly involved with that Arizona experience, but you're certainly experienced with this issue. What advice do you have to give somebody else?
Mr. COPPLE. Well, most of our coalitions, Mr. Chairman, work in alcohol, tobacco, and other drugs very aggressively that when these initiatives come into their States—this is a blunting tactic—they will be diverted from their missions to reduce substance abuse among youth; to fight the distortions and the very real fact that the pro-medical legalization groups are using as props innocent victims to advance an agenda that will jeopardize the health and safety of our citizens. You've got to be prepared to organize this; mobilize parents, grassroots organizations to get truth in advertising in the way these campaigns are run and to expose it for what it is.
Mr. MCCOLLUM. I realize that with this panel, as balanced as it is—and I think this is a balanced panel—that we never are going to be seeking the same end. I've tried very hard today to let everybody have their voice heard on both sides of this issue, and I thank all of you for coming in and being witnesses today. It's been a very enlightening hearing, and I think it's been good for us to have this discussion on the record. As this initiative process proceeds, and it is obviously proceeding, I'm sure we'll have other occasions to discuss this issue. Again, some of you traveled a long distance, and I really appreciate your coming today.
We are going to have to adjourn because of the votes. Thank you very much. This hearing is adjourned.
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[Whereupon, at 1:10 p.m., the subcommittee adjourned.]
A P P E N D I X
MAY 21, 1998
Additional Material Submitted for the Hearing Record
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