Grassley, Charles, U.S. Senator

October 30, 1996

Mr. Carl E. Olsen Post Office Box 4091 Des Moines, Iowa 50333 Dear Mr. Olsen:

Thank you for your further correspondence on the status of illegal drugs in America. I appreciate your opinions, but I have not been pursuaded to change my stance on the legalization of illicit drugs. Drugs are illegal because they are dangerous. Drugs are not dangerous because they are illegal.

In your most recent letter, you present the following arguments: There is no hope for winning the battle against illegal drug use, drug use is a medical problem and should be treated as such, illegal drugs are less harmful than alcohol and tobacco and therefore should be legalized, and if drugs were legalized, then the price of illegal drugs would drop as well as the crime associated with illegal drugs.

Enclosed you will find a copy of a floor statement that I made on the 23 of January to address these, as well as other arguments made by those who favor legalization. I believe you will find all of your concerns addressed there.

I would like to update certain points with additional information that has been released since this statement was made. On April 25, 1996, the Center on Addiction and Substance Abuse released a study that confirmed what many had all ready suspected. Marijuana users are 79 times as likely as those who do not use marijuana to go on to harder drugs. This is an alarming statistic, and the first time that anyone has proven the statistical link between marijuana and other drugs. To compare, the first studies that raised alarms about the dangers of smoking indicated that those who smoked were nine to ten times more likely to develop lung cancer than those who did not. And those who drank alcohol were three to four times as likely to develop cirrhosis of the liver as those who did not.

You have also contacted me in support of the use of marijuana for medicinal purposes. I would like to mention some additional information for you to consider.

Let me say at the outset that I am opposed to the use of marijuana for medical purposes. There have been over 12,000 published scientific studies of marijuana, none of which have shown smoking marijuana to be a safe or effective medicine for the treatment of any condition. The most recent comprehensive study was ordered by the U.S. Public Health Service and completed by the National Institutes of Health (NIH) in March of 1992. The report concluded that marijuana has never been shown to be safe or effective as a medicine, and that there are better and safer drugs for all of the conditions that were considered. Let me share with you some further history of this issue.

Before 1906, when the Pure Food and Drug Act was passed, placing regulations on the sale and manufacture of medicine, the prevailing attitude was one of "let the buyer beware." Before this, many medicines were touted as the cure-all for a wide variety of ailments. These unlabeled and uncontrolled medicines, sometimes pushed by unscrupulous doctors, often did more harm than good. Often, these snake oil medicines contained addictive substances, such as cocaine, marijuana, or morphine, turning their unwitting customer into an addict who would then clamor for more because it made him "feel better."

In an effort to protect the public from the potentially harmful effects of such "medicines," the Pure Food and Drug Act of 1906 was passed. These laws were written to ensure that no substance is marketed as medicinal until it has been proven to be both safe and effective. In addition, all ingredients must be listed on the label. In 1938, the Food, Drug, and Cosmetic Act established the Food and Drug Administration and gave the FDA the authority and responsibility to require that manufacturers prove their products' safety. The role of the FDA was expanded in 1962 to include both the safety and efficacy of products under their jurisdiction. It is important to note that marijuana has never been shown scientifically to be a safe or effective medicine for the treatment of any condition.

In order for a drug to be approved as a medicine, it must meet several strict requirements to ensure safety standards. The process for approval begins with a study of a drug's chemistry, pharmacology, and toxicology. Because marijuana is not a stable substance, especially when it is smoked, the varying, complex mixture of chemicals is extremely difficult to study. Many of the chemical combinations are known to be harmful, while other components have yet to be studied. New chemical components are still being discovered. Some of the known chemical combinations include hydrogen cyanide, ammonia, carbon monoxide, acetaldehyde, acetone, phenol, cresol, naphthalene, and other well-known carcinogens such as benzpyrene, benzanthracene, benzene, and nitrosamine. These carcinogens have been found to be the cancer causing agents in tobacco smoke, and are present in higher concentrations in marijuana smoke than tobacco smoke.

Next, the chemical reactions that occur when a drug is taken must be known and reproducible for the FDA to consider approving a drug. Dosages must be measurable to a high degree of accuracy. This is necessary to determine what, if any, interactions may occur if the drug being tested is taken in combination with other medicines, as well as the effects of higher or lower dosage rates. I know that there is a lot of anecdotal information around indicating that marijuana helps some people, but this is not generally true. And we need to be careful when we make decisions about drugs and the claims some people make for them.

So where do the claims that marijuana is beneficial for persons suffering from glaucoma, AIDS, Multiple Sclerosis, and other ailments come from? Just as there is a powerful tobacco lobby, there is a well-financed and well-organized marijuana legalization lobby. Many of the same claims and tactics that were used in tobacco advertizing campaigns are now being used for marijuana legalization. Groups such as the National Organization for the Reform of Marijuana Laws (NORML) have stated that the issue of medicinal uses for marijuana will be used in an attempt to give marijuana a good name. Similar tactics were used by the tobacco industry before the Federal Trade Commission halted the practice in 1955. 'Camel' cigarettes were advertized as an aid for digestion and said to prevent fatigue. 'Kool' brand cigarettes claimed to prevent the common cold. Similar to the way that the tobacco industry works to undermine the efforts of the FDA, NORML supports initiatives at both state and federal levels to circumvent current consumer protection laws, such as the guidelines for establishing marijuana as a legal drug. Just as the tobacco industry has denied that tobacco is addictive and causes cancer, the marijuana legalization movement denies the harmful effects of marijuana.

Still, many ill people claim that using marijuana has made their illnesses easier. But science does not support these claims. The National Eye Institute has reported that the intraocular pressure-lowering action of marijuana is not effective enough to prevent optic nerve damage caused by glaucoma. As of June, 1994, there are 24 agents, all approved by the Food and Drug Administration, that are incorporated into a variety of medicines to be used for glaucoma treatment. There are also surgical options available. Studies performed in the early l970s showed that marijuana, when smoked, did lower the intraocular pressure in people with normal pressure and in those with glaucoma. However, follow-up studies, conducted over a ten year period, (1978 - 1988) by the National Eye Institute showed that although marijuana -- or more specifically, delta-9-tetrahydrocannabinol (THC) -- did lower intraocular pressure when administered, none of the studies showed that marijuana, or any of its components, could safely and effectively lower intraocular pressure enough to prevent optic nerve damage. In addition, these studies showed that marijuana had a number of undesirable and potentially harmful side effects, such as elevated blood pressure, dry eye, euphoria, as well as a greater risk for respiratory system damage. These are in addition to the psychological side effects. According to a fact sheet released by the Department of Health and Human Services, entitled National Eye Institute Fact Sheet on the Therapeutic Use of Marijuana for Glaucoma, "The availability of a wide variety of alternative treatments that do not have marijuana's psychoactive and other specific side effects argues against the use of marijuana for treating glaucoma. Marijuana offers no advantage over currently available glaucoma drugs and indeed may be less effective than these agents."

Marijuana supporters have also endorsed its use for AIDS patients with wasting syndrome. This syndrome is characterized by severely debilitating anorexia and weight loss, and is of particular concern because it can exacerbate the primary illness and is associated with a poor prognosis. Marijuana is said to be beneficial because it increases the patient's appetite and decreases nausea that sometimes occurs as a result of other medications. However, according to researchers, marijuana smoking also causes a number of problems, causing more harm than good. Marijuana has also been shown to suppress the body's natural immune system, which is especially dangerous to persons with the HIV virus or AIDS. Smokers have about half the life expectancy of non-smokers, and have an increased incidence of pneumonia when compared to non-marijuana smokers. Drug absorption from marijuana smoking is dependent upon deep inhalation of marijuana smoke, an impractical suggestion for non-smoking patients or those with limited lung capacity because of illness (such as pneumonia). Also, there currently is a synthetic form of THC, called "Marinol" available as an anti-nausea agent for patients who have failed to respond to other drugs. Unlike marijuana, Marinol has met and passed all of the testing and regulations that the FDA requires. The medical use of Marinol is highly restricted because of the potential side effects. Fortunately, newer, better anti-emetic medications have been developed and are now available.

Because of a placebo effect, a patient may believe a drug is helpful when it is not. Anecdotal evidence may point to a drug having medicinal value, but this needs to be followed up with scientific studies. Because of marijuana's addictive and mind-altering effects, a placebo effect can be magnified. Users are likely to exaggerate the benefits. For example, there have been numerous reports from patients that have claimed that marijuana has cause improvement in multiple sclerosis. However, a controlled, scientific study by Dr. H. S. Greenberg, reported in Clinical Pharmacology & Therapy (Vol. 55:324-328, 1994) showed that smoking marijuana actually made the symptoms of multiple sclerosis worse.

In addition, many reports of marijuana's beneficial effects are based not on science but on anecdotes from individuals who claim results for themselves. While these individuals may feel they have benefited, we cannot base public policy decisions on important issues on anecdotal information. Unfortunately, many in the press and elsewhere do not look beyond such information. The best available science, however, clearly and overwhelmingly demonstrates the contrary.

I hear from many thoughtful persons, such as yourself, who urge me to consider supporting marijuana for medical use. I have looked at the copious research that has been done on this issue and urge you to do so as well. For a further discussion on the therapeutic uses of marijuana, there are a number of reports that examine the available scientific information. "Health Aspects of Cannabis," written by Leo E. Hollister and published in Pharmacological Reviews (Vol. 38, No. 1:1986) is an excellent starting point. Numerous other studies have also been published in The New England Journal of Medicine, The Lancet, and other reputable medical journals as well as those available from NIH and the FDA.

In closing, I want to relay to you my strong feelings about representative government. For democracy to function, there has to be two-way communication between Americans and their elected representatives. By sharing your views with me, Iowans play a vital role in this process. Hearing from you enables me to be a better U.S. Senator, and I very much appreciate the time you took to inform me of your concerns. Thanks again for keeping in touch.

Sincerely, Charles E. Grassley United States Senator 721 Federal Building 210 Walnut Street Des Moines, Iowa 50309-2140 (515) 284-4890 chuck_grassley@grassley.senate.gov CEG/eja enclosure