THE WASHINGTON POST  Tuesday, September 9, 1997, Page A19

Barry R. McCaffrey
Medical Marijuana?  Don't Do It, D.C.

    As the recipient of Harvard University's Zinberg Award this past spring, I reviewed what the late Dr. Norman Zinberg, a pioneer in drug-related research, had to say about illegal drugs some three decades ago.  Zinberg argued that "set and setting" -- which is to say "text and context" -- are pretty much the whole show.  To assess the cultural meaning of alcohol or tobacco, for example, you have to consider how it is used by whom.  Wine, for instance, is different when framed by a religious ritual in church than when drunk in the street by a "wino" holding a bottle in a bag.
    What has changed in drug use over the past 30 years is both set and setting -- a younger set has adopted the habit, and children are using a wide range of drugs in settings where they spend most of their time: schools, playgrounds and cars.   The new survey conducted by the National Center on Addiction and Substance Abuse (CASA) indicates that a half-million eighth-graders say they began using marijuana in the sixth and seventh grades.  If we picture the 22-year-old co-ed of the 1960s smoking pot at a rock concert, her counterpart in the '90s is 12 years old and stoned during third-period English.
    The joke has been told: "If you remember the '60s, you probably weren't there."  Today's teens are missing their education or the turn on Highway 95, not a political rally or jam session.  The stakes have changed along with the drugs.  With marijuana being the second leading cause of car crashes among young people (after alcohol) and with a hundred thousand teenagers moving on to heroin, life itself is at risk for American kids.
    The context for today's drug abuse is homelessness and hopelessness.   With broken families becoming the rule rather than the exception, and with communities racked by violent crime, too many youngsters no longer have the proverbial kitchen table where parents can tell them not to use drugs.  Teen pregnancy, venereal disease, delinquency, domestic abuse and rising school dropout rates are other features of the setting in which illicit drugs are located.  Many proponents of legalizing drugs fail to notice the new terrain where poly-drug use is likely to include crack cocaine, dangerous hallucinogens, so-called "designer" drugs, and potent chemicals with purity levels that promote addiction.  The short-lived flower children have been replaced by gangs with guns.  What may have begun with pleasure-seeking ends up with pain-control.
    Signatures are now being gathered in the District of Columbia for 1997 Initiative 57, the legalization of "medical marijuana."  If approximately 17,000 names can be collected (a figure determined by a percentage of each ward) and submitted to the D.C. Board of Elections, the petition will be put on the ballot, possibly this November.  Were this measure approved by a majority of voters, Washingtonians would be able to grow, use, and distribute marijuana with a physician's recommendation.   (No written prescription is required.)
    The loosely structured initiative, which allows up to four "friends" to grow or otherwise provide marijuana for any "patient," would permit residents of D.C. to organize and operate marijuana corporations -- ostensibly for the sick.  In Arizona, a similar marijuana ballot was passed -- it also legalized LSD for medical purposes despite the absence of any proven medical benefit -- only to be repealed by the state legislature after careful consideration.
    If pot is such a wonderful medicine, why haven't more doctors prescribed Marinol, the real "medical marijuana"?  The active ingredient in the cannabis leaf, THC, is synthesized in measured dosages as Marinol, a prescription drug that has been available for 15 years.  The argument that this chemical needs to be smoked, exposing patients to carcinogenic agents that damage the lungs, doesn't make sense.  No one argues that in place of penicillin capsules, people should revert to moldy bread.
    Crude marijuana, unlike Marinol, would evade the testing process of the Federal Drug Administration that has made American medicine among the safest in the world.    The current scientific process for approving medications, which entails peer review by researchers and physicians, should not be supplanted by a nonmedical, political process.  Advocates of drug legalization admit that they have couched the question in medical terms to camouflage the issue.
    The latest research suggests that marijuana relies upon the same mechanism of chemical reinforcement in the dopamine pathways that is utilized by addictive drugs such as heroin and cocaine.  By hijacking the body's pleasure system, drugs produce counterfeit highs that substitute for life's genuine rewards.
    In the Netherlands, where marijuana technically has been legalized for personal use, "medical marijuana" was prohibited by the Dutch minister of health.  Holland has no reason to distort the scientific process in order to represent therapeutic applications for pot.  In the United States, a medical blanket has been thrown over marijuana, obscuring debate.  We should not accept a substance with minimal medical efficacy and maximal psychotropic effects.
    The setting for marijuana typically has been in classrooms, where it interferes with learning; automobiles, where it interferes with driving, and the workplace, where it interferes with productivity -- not in hospitals contributing to healing.  Our nation's capital has been inundated by waves of drugs, as have other U.S. cities. D.C. voters should say "yes" to themselves and to our country by voting "no" on drugs.

The writer is director of the White House Office of National Drug Control Policy.