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
 

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.

    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 rs, 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.

    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.


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\

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?

    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

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

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.


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:

    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.

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.

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

 
    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.

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


 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.

    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.


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.

    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:

'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,
Janet D. Lapey, M.D.


    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.