"Our results indicate a moderate relation between early teen marijuana use and young adult abuse of other illicit substances; however, this association fades from statistical significance with adjustments for stress and life-course variables. Likewise, our findings show that any causal influence of teen marijuana use on other illicit substance use is contingent upon employment status and is short-term, subsiding entirely by the age of 21. In light of these findings, we urge U.S. drug control policymakers to consider stress and life-course approaches in their pursuit of solutions to the 'drug problem.'"

Is Marijuana Addictive? The best scientific data available indicate that marijuana is less potentially addictive than many other substances in common use. This should not be construed as meaning that marijuana has no potential for dependence or that it is entirely safe.

"People who develop problems with marijuana may indeed be different from those who do not, but this phenomenon has been observed with other substances of abuse. A comparison with alcohol use and dependence provides a case in point. The great majority of Americans have tried alcohol and continue to drink alcoholic beverages regularly. However, only an estimated 10 to 15 percent of alcohol drinkers develop problems, and only some of these problem drinkers seek treatment. This is also true of those who have tried cocaine or heroin (Anthony, Warner, and Kessler, 1994).

"That said, the experience of dependence on marijuana tends to be less severe than that observed with cocaine, opiates, and alcohol (Budney, 2006; Budney et al., 1998). On average, individuals with marijuana dependence meet fewer DSM dependence criteria; the withdrawal experience is not as dramatic; and the severity of the associated consequences is not as extreme. However, the apparently less severe nature of marijuana dependence does not necessarily mean that marijuana addiction is easier to overcome. Many factors besides a drug’s physiological effects -- including availability, frequency and pattern of use, perception of harm, and cost -- can contribute to cessation outcomes and the strength of addiction. The low cost of marijuana, the typical pattern of multiple daily use by those addicted, the less dramatic consequences, and ambivalence may increase the difficulty of quitting. Although determining the relative difficulty of quitting various substances of abuse is complex, the treatment literature reviewed here suggests that the experience of marijuana abusers rivals that of those addicted to other substances."

"The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs. A recent Australian study⁹⁶ estimated that cannabis use caused 0·2% of total disease burden in Australia—a country with one of the highest reported rates of cannabis use. Cannabis accounted for 10% of the burden attributable to all illicit drugs (including heroin, cocaine, and amphetamines). It also accounted for around 10% of the proportion of disease burden attributed to alcohol (2·3%), but only 2·5% of that attributable to tobacco (7·8%)."

"The global market for hemp consists of more than 25,000 products in nine submarkets: agriculture, textiles, recycling, automotive, furniture, food and beverages, paper, construction materials, and personal care (Table 1). Hemp can be grown as a fiber, seed, or dual-purpose crop.⁶ The stalk and seed are the harvested products. The interior of the stalk has short woody fibers called hurds; the outer portion has long bast fibers. Hemp seed/grains are smooth and about one-eighth to one-fourth of an inch long.⁷

"Hemp fibers are used in fabrics and textiles, yarns and spun fibers, paper, carpeting, home furnishings, construction and insulation materials, auto parts, and composites. Hurds are used in animal bedding, material inputs, papermaking, and oil absorbents. Hemp seed and oilcake are used in a range of foods and beverages (e.g., salad and cooking oil and hemp dairy alternatives) and can be an alternative food and feed protein source.8 Oil from the crushed hemp seed is used in soap, shampoo, lotions, bath gels, and cosmetics.⁹ Hemp is also being used in nutritional supplements and in medicinal and therapeutic products, including pharmaceuticals. It is also used in a range of composite products. Hempcrete (a mixture of hemp hurds and lime products) is being used as a building material. Hemp is also used as a lightweight insulating material and in hemp plastics and related composites for use as a fiberglass alternative by the automotive and aviation sectors.¹⁰ Hemp is also promoted as a potential biodiesel feedstock¹¹ and cover crop.

"These types of commercial uses are widely documented in a range of feasibility and marketing studies conducted by researchers at USDA and various land grant universities and state agencies. (A listing of these studies is in the Appendix A.) Currently, finished hemp products and raw material inputs are mostly imported into the United States and sold for use in further processing and manufacturing for a wide range of products."

"This study of crash risk found a statistically significant increase in unadjusted crash risk for drivers who tested positive for use of illegal drugs (1.21 times), and THC specifically (1.25 times). However, analyses incorporating adjustments for age, gender, ethnicity, and alcohol concentration level did not show a significant increase in levels of crash risk associated with the presence of drugs. This finding indicates that these other variables (age, gender, ethnicity and alcohol use) were highly correlated with drug use and account for much of the increased risk associated with the use of illegal drugs and with THC.

"This study found a statistically significant association between driver alcohol level and crash risk both before and after adjustment for demographic factors. These findings were generally consistent with similar analyses conducted in prior crash risk studies. Findings from this study indicate that crash risk grows exponentially with increasing BrAC. The study shows that at low levels of alcohol (e.g., 0.03 BrAC) the risk of crashing is increased by 20 percent, at moderate alcohol levels (0.05 BrAC) risk increases to double that of sober drivers, and at a higher level (0.10 BrAC) the risk increases to five and a half times. At a BrAC of 0.15, the risk is 12 times, and by BrACs of 0.20+ the risk is over 23 times higher."

"The costs of this national obsession, in both money and time, are astonishing. Each year, enforcing laws on possession costs more than $3.6 billion, according to the American Civil Liberties Union. It can take a police officer many hours to arrest and book a suspect. That person will often spend a night or more in the local jail, and be in court multiple times to resolve the case. The public-safety payoff for all this effort is meager at best: According to a 2012 Human Rights Watch report that tracked 30,000 New Yorkers with no prior convictions when they were arrested for marijuana possession, 90 percent had no subsequent felony convictions. Only 3.1 percent committed a violent offense."
* Important here to note that New York is a decriminalized state, that is, personal possession of less than 25 grams of marijuana by an adult is supposedly decriminalized.

"It was not until 1951, when Congress again took up the issue, that a reputable researcher was called to testify. Dr. Harris Isbell, director of research at the Public Health Service Hospital in Lexington, Ky., disputed the insanity, crime and addiction theories, telling Congress that 'smoking marijuana has no unpleasant aftereffects, no dependence is developed on the drug, and the practice can easily be stopped at any time.'
"Despite Dr. Isbell’s testimony, Congress ratcheted up penalties on users. The states followed the federal example; Louisiana, for instance, created sentences ranging from five to 99 years, without parole or probation, for sale, possession or administration of narcotic drugs. The rationale was not that marijuana itself was addictive — that argument was suddenly relinquished — but that it was a 'steppingstone' to heroin addiction. This passed largely without comment at the time.
"The country accepted a senselessly punitive approach to sentencing as long as minorities and the poor paid the price. But, by the late 1960s, weed had been taken up by white college students from the middle and upper classes. Seeing white lives ruined by marijuana laws altered public attitudes about harsh sentencing, and, in 1972, the National Commission on Marihuana and Drug Abuse released a report challenging the approach."

The Times misses part of the story when they write:
"Marijuana was found -- alone or in combination with other drugs -- in more than 455,000 patients visiting emergency rooms in 2011."
http://www.nytimes.com...

A drug mention does not mean that the drug is what caused the visit. Rather, it simply means that the substance was in their system. Arguably, drug mentions in an emergency room may have some meaning yet unless the drug is at fault, those mentions are merely an indicator of prevalence of use:
"DAWN captures drugs that are explicitly named in the medical record as being involved in the ED visit. The relationship between the ED visit and the drug use need not be causal. That is, an implicated drug may or may not have directly caused the condition generating the ED visit; the ED staff simply named it as being involved." (p. 15)

According to the DAWN report, "Of the approximately 2.5 million drug misuse or abuse ED visits that occurred during 2011, a total of 1,252,500, or just over half (50.9%), involved illicit drugs (Table 4). A majority (56.3%) of illicit drug ED visits involved multiple drugs. Overall, 27.9 percent of visits involving illicit drugs also involved alcohol.
"Cocaine and marijuana were the most commonly involved drugs, with 505,224 ED visits (40.3%) and 455,668 ED visits (36.4%), respectively. Cocaine and marijuana were followed by heroin, at 258,482 ED visits, or 20.6 percent, and then by amphetamines/methamphetamine, at 159,840 visits, or 12.8 percent." (DAWN ED Report 2011, p. 25)

"Compelling evidence in other states suggest racial disparities persist or have become worse after legalization and the opening of a licensed marijuana market, even while total marijuana-related criminal justice incidents have decreased.

"In Colorado, marijuana court filings decreased by 85% from 2010 to 2014 after legalizing marijuana in 2012. During the same time frame the rate of arrests for marijuana possession among African Americans/Blacks remained 2.4 times higher compared to the arrest rate for whites. The disparities for African American/Blacks were even larger for arrests for marijuana cultivation (2.5 times the arrest rate for whites) and distribution of marijuana (5.4 times the arrest rate for whites).¹³

"Results from Oregon are consistent with findings in Colorado. The Oregon Public Health Division examined changes in the age-adjusted rates of marijuana arrests by racial groups.14 The age adjusted rate of marijuana arrests for African Americans/Blacks was 2 to 3 times the rate of whites during 2010–2014. Oregon legalized marijuana in 2014 and in the following year the disparity between African Americans/Blacks and whites persisted. Specifically, the rate of arrest was 77% higher among African Americans/Blacks in 2015 when compared to whites.

"Preliminary results suggest that legalization of marijuana for adults has greatly reduced the number of people arrested and convicted for marijuana-related crimes, yet racial disparities persist in Washington and in other states. Other factors may contribute to sustaining the racial disparities, such as over-policing in low-income neighborhoods, racial profiling, and other racially biased police practices. 15 These inequitable practices may minimize the potential positive impacts of I-502 and marijuana legalization on all communities."

"As noted in the illicit drug use section, an estimated 24.0 million Americans aged 12 or older in 2016 were current users of marijuana (Figure 15). This number of past month marijuana users corresponds to 8.9 percent of the population aged 12 or older (Figure 17). The percentage of people aged 12 or older who were current marijuana users in 2016 was higher than the percentages from 2002 to 2015. This increase in marijuana use among people aged 12 or older reflects the increase in marijuana use by adults aged 26 or older and, to a lesser extent, the increase in marijuana use among young adults aged 18 to 25."

"Marijuana positivity continued its upward climb in both the federally-mandated, safety-sensitive and general U.S. workforces. In oral fluid testing, which detects recent drug use, marijuana positivity increased nearly 75 percent, from 5.1 percent in 2013 to 8.9 percent in 2016 in the general U.S. workforce. Marijuana positivity also increased in both urine testing (2.4% in 2015 versus 2.5% in 2016) and hair testing (7.0% in 2015 versus 7.3% in 2016) in the same population.
"Among the federally-mandated, safety-sensitive workforce, which only utilizes urine testing, marijuana positivity increased nearly ten percent (0.71% in 2015 versus 0.78% in 2016), the largest year-over-year increase in five years.
"In Colorado and Washington, the first states in which recreational marijuana use was legalized, the overall urine positivity rate for marijuana outpaced the national average in 2016 for the first time since the statutes took effect. The increase was more pronounced in Colorado, which increased 11 percent (2.61% in 2015 versus 2.90% in 2016), than in Washington, which increased nine percent (2.82% in 2015 versus 3.08% in 2016). The national positivity rate for marijuana in the general U.S. workforce in urine testing increased four percent (2.4% in 2015 compared to 2.5% in 2016).
"'We have been tracking the trends in marijuana positivity in states that have passed medical and recreational marijuana use statutes for several years now. 2016 is the first year since Colorado and Washington approved recreational use that the rates of year-over-year change were sharply higher than the national average,' said Dr. Sample."

"Hemp fields, in fact, could be a deterrent to marijuana growers. A strong case can be made that the best way to reduce the THC level of marijuana grown outdoors would be to grow industrial hemp near it. An experiment in Russia found that hemp pollen could travel 12 kilometers. This would mean that a hemp field would create a zone with a 12-kilometer radius within which no marijuana grower would want to establish a crop.

"The reciprocal also applies. Growers of hemp seed would not want Cannabis of an 'off type' (i.e., not the intended genetic type) mixing its pollen with their flowers. The isolation of genotypes is a common procedure used by the seed industry to preserve the genetic integrity of varieties. Valued strains are created by plant breeding, at substantial expense. Marijuana pollen would destroy this value."

"Alcohol and marijuana are the two most commonly used substances by teenagers to get high, and a question that is often asked is to what extent does change in one lead to a change in the other. If the substances co-vary negatively (an increase in one is accompanied by a decrease in the other) they are said to be substitutes; if they co-vary positively, they are said to be complements.

"Interestingly, the answer may differ by historical era. Before 2007 patterns of use for the two substances suggested they acted as complements. When marijuana use increased in the late 1970s, so too did alcohol use. Between 1979 and 1992 marijuana use declined and a parallel decline took place in annual, monthly, and daily alcohol use, as well as in binge drinking among 12th graders. As marijuana use increased again in the 1990s, alcohol use again increased with it, although not as sharply. In sum, before 2007 there was little evidence from MTF to support what we have termed “the displacement hypothesis,” which asserts that an increase in marijuana use will lead to a decline in alcohol use, or vice versa.8

"However, since 2007 a new trend has emerged that would be consistent with the “displacement” hypothesis. From 2007 through 2019 alcohol use declined markedly, reaching historic lows in the life of the study. Meanwhile, for most of this time period marijuana use has stayed steady or increased for all age groups. For the first time trends in alcohol and marijuana use are substantially diverging, suggesting that the historical relationship between these two drugs may have changed."

"In 2009-2010, past month marijuana use was reported by 6.8 percent of the U.S. population aged 12 years or older, an increase from 6.4 percent in 2008-2009 (Table C.3). Nine States that were in the top fifth for past month illicit drug use among persons aged 12 or older also were ranked in the top fifth for past month marijuana use: Alaska, Colorado, District of Columbia, Maine, Massachusetts, New Hampshire, Oregon, Rhode Island, and Vermont (Figures 2.1 and 2.9).
"Seven States were ranked in the top fifth for past month marijuana use in age groups 12 to 17, 18 to 25, 26 or older, and 12 or older: Colorado, Maine, Massachusetts, New Hampshire, Oregon, Rhode Island, and Vermont (Figures 2.9 to 2.12). The rate of past month marijuana use in the 12 or older population ranged from 3.1 percent in Utah to 11.8 percent in Alaska (Table B.3). Utah had the lowest rate in all age groups. Between 2008-2009 and 2009-2010, past month marijuana use among persons 12 or older increased in 10 States: Colorado, District of Columbia, Idaho, Illinois, Massachusetts, Michigan, New Mexico, Oklahoma, Texas, and Washington (Table C.3). During the same time period, past month marijuana use increased in one State among 12 to 17 year olds (District of Columbia), eight States among 18 to 25 year olds (Florida, Illinois, Iowa, New Mexico, North Carolina, Oklahoma, Pennsylvania, and Washington), and four States among persons aged 26 or older (District of Columbia, Idaho, Michigan, and Texas). Decreases only occurred in two States: Tennessee, among persons aged 12 or older, and Utah, among youths aged 12 to 17. All four census regions had higher rates of past month marijuana use among persons aged 12 or older in 2009-2010 compared with 2008-2009."

"Breeders and producers of sweet corn go to great lengths to isolate their crops from the pollen of field corn. The same applies to hemp and marijuana. People who grow strains of Cannabis for smoking try to avoid pollination of the flowers. The superior quality material is obtained from seedless plants, the so-called “sinsemilla.”

"Hemp fields, in fact, could be a deterrent to marijuana growers. A strong case can be made that the best way to reduce the THC level of marijuana grown outdoors would be to grow industrial hemp near it. An experiment in Russia found that hemp pollen could travel 12 kilometers. This would mean that a hemp field would create a zone with a 12-kilometer radius within which no marijuana grower would want to establish a crop.

"The reciprocal also applies. Growers of hemp seed would not want Cannabis of an “off type” (i.e., not the intended genetic type) mixing its pollen with their flowers. The isolation of genotypes is a common procedure used by the seed industry to preserve the genetic integrity of varieties. Valued strains are created by plant breeding, at substantial expense. Marijuana pollen would destroy this value."

"The THC levels in industrial hemp are so low that no one can get high from smoking it. Moreover, industrial hemp, while low in THC, is high in another kind of cannabinoid, CBD, which counteracts THC’s psychoactivity.

"As William M. Pierce Jr., Ph.D., Associate Professor of Pharmacology and Toxicology at the University of Louisville School of Medicine notes, “Industrial hemp does in fact contain a psychoactive substance, tetrahydrocannabinol (THC) and thus the question appears at first reading to be a reasonable one. Upon closer consideration, however, using the most fundamental principles of pharmacology, it can be shown that it is absurd, in practical terms, to consider industrial hemp useful as a drug.”²⁷

"According to Professor Pierce, to obtain a psychoactive effect with even 1 percent THC hemp (industrial hemp and feral hemp, the wild hemp the DEA aggressively harvests and burns²⁸, contain less than 0.5% percent THC29 ), would require the user to smoke 10-12 cigarettes containing hemp in a “very short period of time. . . . This large volume (and) high temperature inhalation of vapor, gas, and smoke would be difficult for a person to withstand, much less enjoy.” Professor Pierce goes on to note that anyone who ate hemp hoping to get “high” would be consuming the fiber equivalent of several doses of a high-fiber laxative. In other words, the very unpleasant side effects would dissuade anyone from trying to use industrial hemp as a drug.

"Dr. Pierce points out that beer sold as “nonalcohol” contains measurable alcohol. So does mouthwash. Even nutmeg contains a psychoactive substance. But the authorities are not aggressively concerned about the abuse of these products because the side effects are so severe as to discourage such abuse.

"Critics have alleged that the marijuana of the sixties had THC levels comparable to those of industrial hemp. But when Lynn Zimmer, Ph.D., and John Morgan, M.D., examined this assertion they found it lacked substance."

"Daily marijuana use held steady at 6.8% in 2015 among young adults, but that is triple the rate in 1992 (2.3%), the low point since estimates for this age group first became available in 1986. The 2014 and 2015 rates are the highest levels of daily use ever observed in this young adult population since tracking of their use began 29 years ago."

Click here for complete datatable of Thirty-Day Prevalence of Daily Marijuana, Alcohol, and Tobacco Use Among 19-30 Year Olds in the US

"• Marijuana was the illicit drug with the largest number of persons with past year dependence or abuse in 2013, followed by pain relievers, then by cocaine. Of the 6.9 million persons aged 12 or older who were classified with illicit drug dependence or abuse in 2013, 4.2 million persons had marijuana dependence or abuse (representing 1.6 percent of the total population aged 12 or older, and 61.4 percent of all those classified with illicit drug dependence or abuse), 1.9 million persons had pain reliever dependence or abuse, and 855,000 persons had cocaine dependence or abuse (Figure 7.2)."
"• The number of persons who had marijuana dependence or abuse in 2013 (4.2 million) was similar to the number in 2012 (4.3 million) and in each year from 2002 through 2011 (ranging from 3.9 million to 4.5 million) (Figure 7.3). The rate of marijuana dependence or abuse in 2013 (1.6 percent) was lower than the rates in 2002 (1.8 percent) and 2004 (1.9 percent). Otherwise, the rate in 2013 was similar to the rates in prior years (ranging from 1.6 to 1.8 percent).
"• The number of persons who had pain reliever dependence or abuse in 2013 (1.9 million) was similar to the number in 2012 (2.1 million) and in each year from 2006 through 2011 (ranging from 1.6 million to 1.9 million) (Figure 7.3). However, the number in 2013 was higher than the numbers in 2002 to 2005 (ranging from 1.4 million to 1.5 million)."

According to the Substance Abuse and Mental Health Service's Treatment Episode Data Set, in 2015 in the US there were 213,001 admissions to treatment with marijuana reported as the primary substance of abuse out of the total 1,537,025 admissions to treatment in the US for those aged 12 and older for all substances that year. This is the lowest number of marijuana admissions and total treatment admissions in at least a decade: marijuana admissions peaked in 2009 at 373,338, and total admissions peaked in 2008 at 2,074,974.

"• In 2011, an estimated 16.7 percent of past year marijuana users aged 12 or older used marijuana on 300 or more days within the past 12 months. This translates into nearly 5.0 million persons using marijuana on a daily or almost daily basis over a 12-month period.

"• In 2011, an estimated 39.1 percent (7.1 million) of current marijuana users aged 12 or older used marijuana on 20 or more days in the past month. This was similar to the 2010 estimate of 39.8 percent or 6.9 million users."

"In 1990, half of California’s marijuana possession arrestees were African-American, Latino, Asian, or other nonwhite and 35% were under age 20. In 2010, 64% were nonwhite and 52% were under age 20. Marijuana possession arrests of teenagers of color rose from 3,100 in 1990 to 16,400 in 2010 – an arrest surge 300% greater than population growth in that group."

"To provide a sense of the intensity of enforcement, we calculated the risk a marijuana user faces of being arrested for possession. If calculated per joint consumed, the figure nationally is trivial—perhaps one arrest for every 11,000–12,000 joints.⁴ However, the relevant risk may be the probability of being arrested during a year of normal consumption. Since marijuana is mostly consumed by individuals who use it at least once a month,⁵ we estimated the risk that such individuals face. We know from prior studies (e.g., Reuter, Hirschfield, and Davies, 2001) that these risks are higher for youth. Table 2.2 presents separate estimates for those aged 12–17 and for the entire population 12 and over. We observe that the annual risk of misdemeanor arrest for those 12–17 (6.6 percent) is more than twice the rate for the full population (3.0 percent)."

"In sum, these findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes. To be sure, medical marijuana laws were not found to have a crime exacerbating effect on any of the seven crime types. On the contrary, our findings indicated that MML precedes a reduction in homicide and assault. While it is important to remain cautious when interpreting these findings as evidence that MML reduces crime, these results do fall in line with recent evidence [29] and they conform to the longstanding notion that marijuana legalization may lead to a reduction in alcohol use due to individuals substituting marijuana for alcohol [see generally 29, 30]. Given the relationship between alcohol and violent crime [31], it may turn out that substituting marijuana for alcohol leads to minor reductions in violent crimes that can be detected at the state level. That said, it also remains possible that these associations are statistical artifacts (recall that only the homicide effect holds up when a Bonferroni correction is made)."

" A recent issue of The DASIS Report² examined marijuana treatment admissions between 1992 and 2002 and found that between these years [1992 and 2002] the rate of substance abuse treatment admissions reporting marijuana as their primary substance of abuse³ per 100,000 population increased 162 percent. Similarly, the proportion of marijuana admissions increased from 6 percent of all admissions in 1992 to 15 percent of all admissions reported to the Treatment Episode Data Set (TEDS) in 2002.
"During this time period, the percentage of marijuana treatment admissions that were referred from the criminal justice system increased from 48 percent of all marijuana admissions in 1992 to 58 percent of all marijuana admissions in 2002."

"California, Hawaii, Kentucky, Oregon, Tennessee, Washington, and West Virginia are the primary marijuana cultivation states (M7 states). Domestic Cannabis Eradication/Suppression Program (DCE/SP) data show that more than 8 million plants were eradicated in 2008, 89 percent (7,136,133 plants of 8,013,308 plants) of which were eradicated in the M7 States."

"Although marijuana grown in the United States was once considered inferior because of a low concentration of THC, advancements in plant selection and cultivation have resulted in higher THC-containing domestic marijuana. In 1974, the average THC content of illicit marijuana was less than one percent. Today most commercial grade marijuana from Mexico/Columbia and domestic outdoor cultivated marijuana has an average THC content of about 4 to 6 percent. Between 1998 and 2002, NIDA-sponsored Marijuana Potency Monitoring System (MPMP) analyzed 4,603 domestic samples. Of those samples, 379 tested over 15 percent THC, 69 samples tested between 20 and 25 percent THC and four samples tested over 25 percent THC."

Click here for complete datatable of THC Potency of Tested Cannabis from Federal Seizure and State and Local Eradication Samples, by Type, 1985-2014.

"Data on the THC content of cannabis products in the USA have been collected by ElSohly et al. (1984, 2000) for many years as part of the University of Mississippi Potency Monitoring Project. Samples were submitted by law enforcement agencies and it has to be assumed that they were representative of the market. Mean THC values are shown in Figure 16 for normal herbal cannabis, sinsemilla and resin. The anomalously high value for resin in 1997 (19.24 %) has been excluded; it was based on only five values and is over nine standard deviations above the mean potency for the period 1980–1996. Although there has been an increase in the potency of herbal cannabis over the twenty-five-year period, cannabis resin (and hash oil) showed no long-term trends since 1980 when data were first collected. Although the potency of sinsemilla showed a clear upward trend in the final three years of the study, no such trend was obvious when the longer period of 1980–1995 is examined, particularly in view of the wide variations in potency that occurred from year to year (ElSohly et al., 2000). The THC content of herbal cannabis increased from around 1% before 1980 to around 4% in 1997. This increase, when seen in the European context, is deceptive. Before 1980, all mean herbal cannabis THC levels in the ElSohly study were less than 2.4%. By contrast, and as shown in Figure 10, comparable levels at that time in the United Kingdom were twice as great. In other words, it must be assumed that the quality of herbal cannabis consumed in the USA more than twenty years ago was unusually poor, but that in recent years it has risen to levels typical of Europe. So even the modest increase found by ElSohly et al. (2000) may be less significant than it seems. A recent analysis of cannabis seized in Florida in 2002 (Newell, 2003) showed amounts of THC found in samples ranging from 1.41% to 12.62%; the average THC content was 6.20%, which is almost identical to the 2002 value reported by the University of Mississippi Potency Monitoring Project."

"Despite continuing increases in the amount of cannabis produced domestically, much of the marijuana available within the United States is foreign-produced. The two primary foreign source areas for marijuana distributed within the United States are Canada and Mexico. Mexican drug trafficking organizations (DTOs) have relocated many of their outdoor cannabis cultivation operations in Mexico from traditional growing areas to more remote locations in central and northern Mexico, primarily to reduce the risk of eradication and gain easier access to U.S. drug markets. Asian criminal groups are the primary producers of high-potency marijuana in Canada."

"The identification of cannabis as a potentially dangerous psychoactive substance did not, however, prevent a substantial number of these enquiries to explore the issue of whether current legislation reflected the real dangers posed by cannabis. Already in 1944, the La Guardia Committee Report on Marihuana concluded that ‘the practice of smoking marihuana does not lead to addiction in the medical sense of the word’ and that ‘the use of marihuana does not lead to morphine or heroin or cocaine addiction’ (Zimmer and Morgan, 1997). In 1968 the Wootton Report stated that ‘the dangers of cannabis use as commonly accepted in the past and the risk of progression to opiates have been overstated’ and ‘cannabis is less harmful than other substances (amphetamines, barbiturates, codeine-like compounds)’. A similar conclusion was arrived at 34 years later in 2002 when the Advisory Committee on Drug Dependence proposed the reclassification of cannabis from Class B to Class C (enforced by law in 2004 and confirmed in 2005). These views were reiterated by other enquiries, such as the Baan Committee in the Netherlands, which affirmed in 1971 that ‘cannabis use does not lead directly to other drug use’ (¹⁶) or by the US National Commission on Marihuana and Drug Abuse, which in 1973 stated that ‘the existing social and legal policy is out of proportion to the individual and social harm engendered by the use of the drug [cannabis]’ (¹⁷). The Canadian Le Dain Commission saw ‘the UN Single Convention of 1961 as responsible’ for such a situation which ‘might have reinforced the erroneous impression that cannabis is to be assimilated to the opiate narcotics’. The same commission, however, suggested that the UN Convention did ‘not prevent domestic legislation from correcting this impression’ (¹⁸)."

"There are health risks of cannabis use, most particularly when it is used daily over a period of years or decades. Considerable uncertainty remains about whether these effects are attributable to cannabis use alone, and about what the quantitative relationship is between frequency, quantity and duration of cannabis use and the risk of experiencing these effects.
"On existing patterns of use, cannabis poses a much less serious public health problem than is currently posed by alcohol and tobacco in Western societies."

In 1988, the DEA's Administrative Law Judge, Francis Young, concluded: "In strict medical terms marijuana is far safer than many foods we commonly consume. For example, eating 10 raw potatoes can result in a toxic response. By comparison, it is physically impossible to eat enough marijuana to induce death. Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care."

"Of the approximately 2.5 million drug misuse or abuse ED visits that occurred during 2011, a total of 1,252,500, or just over half (50.9%), involved illicit drugs (Table 4). A majority (56.3%) of illicit drug ED visits involved multiple drugs. Overall, 27.9 percent of visits involving illicit drugs also involved alcohol.
"Cocaine and marijuana were the most commonly involved drugs, with 505,224 ED visits (40.3%) and 455,668 ED visits (36.4%), respectively. Cocaine and marijuana were followed by heroin, at 258,482 ED visits, or 20.6 percent, and then by amphetamines/methamphetamine, at 159,840 visits, or 12.8 percent."

Note: According to the DAWN report, "DAWN captures drugs that are explicitly named in the medical record as being involved in the ED visit. The relationship between the ED visit and the drug use need not be causal. That is, an implicated drug may or may not have directly caused the condition generating the ED visit; the ED staff simply named it as being involved." (p. 15)

"In this 20-year study of marijuana and pulmonary function, we confirmed the expected reductions in FEV1 [Forced expiratory volume in the first second of expiration] and FVC [forced vital capacity] from tobacco use. In contrast, marijuana use was associated with higher FEV1 and FVC at the low levels of exposure typical for most marijuana users. With up to 7 joint-years of lifetime exposure (eg, 1 joint/d for 7 years or 1 joint/wk for 49 years), we found no evidence that increasing exposure to marijuana adversely affects pulmonary function. This association, however, was nonlinear: at higher exposure levels, we found a leveling off or even a reversal in this association, especially for FEV1. Although our sample contained insufficient numbers of heavy users to confirm a detrimental effect of very heavy marijuana use on pulmonary function, our findings suggest this possibility."

"We found that moderate marijuana use was significantly associated with reduced risk of HNSCC [head and neck squamous cell carcinoma]. This association was consistent across different measures of marijuana use (marijuana use status, duration, and frequency of use). Diminished risk of HNSCC did not differ across tumor sites, or by HPV [human papillomavirus] 16 antibody status. Further, we observed that marijuana use modified the interaction between alcohol and cigarette smoking, resulting in a decreased HNSCC risk among moderate smokers and light drinkers, and attenuated risk among the heaviest smokers and drinkers."

"Despite several lines of evidence suggesting the biological plausibility of marijuana use being carcinogenic (1), it is possible that marijuana use does not increase cancer risk, as suggested in the recent commentary by Melamede (26). Although the adjusted ORs <1 may be chance findings, they were observed for all non-reference exposure categories with all outcomes except oral cancer. Although purely speculative, it is possible that such inverse associations may reflect a protective effect of marijuana. There is recent evidence from cell culture systems and animal models that 9-tetrahydrocannabinol, the principal psychoactive ingredient in marijuana, and other cannabinoids may inhibit the growth of some tumors by modulating key signaling pathways leading to growth arrest and cell death, as well as by inhibiting tumor angiogenesis (27-29). These antitumoral associations have been observed for several types of malignancies including brain, prostate, thyroid, lung, and breast."

"Our analyses of adults aged 20-59 years in the NHANES [National Health and Nutrition Examination Survey] III database showed that participants who used marijuana had lower prevalence of DM [Diabetes Mellitus] and had lower odds of DM relative to non-marijuana users. We did not find an association between the use of marijuana and other chronic diseases, such as hypertension, stroke, myocardial infarction and heart failure. This could be due to the smaller prevalence of stroke, myocardial infarction and heart failure in the examined age group.
"We noted the lowest prevalence of DM in current light marijuana users, with current heavy marijuana users and past users also having a lower prevalence of DM than non-marijuana users. The finding that past marijuana users had lower odds of prevalent DM than non-users suggests that early exposure to marijuana may affect the development of DM and a window of time of marijuana exposure earlier in life could be a factor to study. Similarly, our findings of a significant association between marijuana use and DM was only found in those aged $40 years suggest that the possibility of some protection from marijuana use may require many years before they become manifested. By contrast, it could reflect the increased prevalence of DM with age and the ability to detect an association with a lesser sample size when there is a greater cohort at risk for DM. The possible association of light marijuana use with decreased DM is similar to that of alcohol on DM and the metabolic syndrome, in which mild alcohol use was associated with lower prevalence of DM and the metabolic syndrome,^{14 15} and higher alcohol use associated with higher prevalence of DM and the metabolic syndrome.^{14 16}"

"People who develop problems with marijuana may indeed be different from those who do not, but this phenomenon has been observed with other substances of abuse. A comparison with alcohol use and dependence provides a case in point. The great majority of Americans have tried alcohol and continue to drink alcoholic beverages regularly. However, only an estimated 10 to 15 percent of alcohol drinkers develop problems, and only some of these problem drinkers seek treatment. This is also true of those who have tried cocaine or heroin (Anthony, Warner, and Kessler, 1994).

"That said, the experience of dependence on marijuana tends to be less severe than that observed with cocaine, opiates, and alcohol (Budney, 2006; Budney et al., 1998). On average, individuals with marijuana dependence meet fewer DSM dependence criteria; the withdrawal experience is not as dramatic; and the severity of the associated consequences is not as extreme. However, the apparently less severe nature of marijuana dependence does not necessarily mean that marijuana addiction is easier to overcome. Many factors besides a drug’s physiological effects—including availability, frequency and pattern of use, perception of harm, and cost—can contribute to cessation outcomes and the strength of addiction. The low cost of marijuana, the typical pattern of multiple daily use by those addicted, the less dramatic consequences, and ambivalence may increase the difficulty of quitting. Although determining the relative difficulty of quitting various substances of abuse is complex, the treatment literature reviewed here suggests that the experience of marijuana abusers rivals that of those addicted to other substances."

"CUD is defined in the DSM-5 as a problematic pattern of cannabis use leading to clinically significant impairment or distress occurring within a 12-month period as manifested by cannabinoid tolerance and withdrawal; increasing amounts of cannabis use over time; inability to control consumption; craving; and recurrent cannabis use having negative implications on social, professional and educational life [3]. Withdrawal symptoms usually appear approximately 24 hours after abstinence initiation, peak within two to six days and remit within two weeks [4]. Symptoms may include irritability, anger or aggression; nervousness or anxiety; sleep difficulty (insomnia, disturbing dreams); decreased appetite or weight loss; restlessness; depressed mood; or physical discomforts (abdominal pain, shakiness/tremors, fever, chills or headache) [5, 6, 7•]. Withdrawal is diagnosed if at least three of these symptoms develop. A week after cessation of use, additional symptoms may appear such as fatigue, yawning, difficulty in concentration, and rebound periods of increased appetite or hypersomnia [3]."

"Differences in cannabis smoking behaviour may also represent different risks for cannabis dependence independently of total THC exposure. Similar to cigarette smokers [16,21–24], cannabis smokers typically gradually decrease the puff volume and puff duration during the course of one joint, whereas puff velocity and interpuff interval gradually increase [20]. Interestingly, in a 2-year prospective study, nicotine dependence has been shown to develop more rapidly in tobacco smokers who smoke with stable or increasing puff volume and increasing puff duration ('atypical' smoking) [16]. One interpretation of this finding is that the risk of becoming nicotine-dependent is lower in smokers who reach nicotine saturation before the cigarette is finished and decrease their pace of smoking. If this mechanism also applies to cannabis smoking, one may expect that the risk for and the severity of cannabis dependence is associated with 'atypical' cannabis smoking."

"Although experienced young adult cannabis users with a preference for stronger joints titrated their THC exposure to some extent by inhaling less smoke, in general more potent cannabis was used in higher dosages leading to a higher THC exposure compared to users preferring lower potency cannabis. None the less, in our population of frequent cannabis users, total THC exposure was only a weak predictor of dependence severity, and did not remain significant after adjustment for baseline dependence severity. However, cannabis smoking behaviours predicted cannabis dependence severity independently of baseline THC exposure and baseline cannabis dependence severity. As the amount of explained variance was low, due possibly to the multifactorial aetiology of dependence, future studies should include other predictors, such as genetic variations, early traumatic experiences and — most importantly — time-dependent variables representing the dynamic nature of personal and dependence development. Meanwhile, smoking variables, such as smoking topography and completely finishing high-dose/high-potent joints in one smoking session, may be helpful to identify people at risk of escalating cannabis dependence severity."

"The withdrawal syndrome associated with dronabinol, the API [Active Pharmaceutical Ingredient] in Marinol®, produces symptoms in humans such as restlessness, irritability, mild agitation, anxiety, anger, insomnia, sleep EEG disturbances, nausea, decreased appetite, and decreased weight. Since a withdrawal syndrome is indicative of physical dependence, it is reasonable to conclude that generic dronabinol products (both naturally-derived [from the cannabis plant] or synthetically produced, and in hard or soft gelatin capsules) in sesame oil, will also produce physical dependence similar to those produced by Marinol®."

"There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs."

"In summary, the notion that cannabis use itself is causally related to lower IQ and poorer educational performance was not supported in this large teenage sample. However, this study indeed has limitations, in particular the young age of outcome assessment. While we have demonstrated that confounding may be an explanation for links between cannabis use and poorer outcomes, large prospective cohorts tracking young people prior to, during and after stopping cannabis use, using more objective measures of drug use (e.g. the new NIH-funded ‘ABCD study’ in the United States; National Institute on Drug Abuse, 2015) are required before we can make strong conclusions. Cigarette smoking in particular has once again (Hooper et al., 2014; McCaffrey et al., 2010; Silins et al., 2014; Stiby et al., 2014) been highlighted as an important factor in adolescent outcomes, as well as a robust independent predictor of educational performance, and the reasons for this need to be elucidated."

"In the present study, the most persistent adolescent-onset cannabis users evidenced an average 8-point IQ decline from childhood to adulthood. Quitting, however, may have beneficial effects, preventing additional impairment for adolescent-onset users. Prevention and policy efforts should focus on delivering to the public the message that cannabis use during adolescence can have harmful effects on neuropsychological functioning, delaying the onset of cannabis use at least until adulthood, and encouraging cessation of cannabis use particularly for those who began using cannabis in adolescence."

"Our findings suggest that regular cannabis use before age 18 y predicts impairment, but others have found effects only for younger ages ^{(10, 15)}. Given that the brain undergoes dynamic changes from the onset of puberty through early adulthood ^{(37, 38)}, this developmental period should be the focus of future research on the age(s) at which harm occurs."

"Nevertheless, when considering all 15 studies (i.e., those that met both strict and more relaxed criteria) we only noted that regular cannabis users performed worse on memory tests, but that the magnitude of the effect was very small. The small magnitude of effect sizes from observations of chronic users of cannabis suggests that cannabis compounds, if found to have therapeutic value, should have a good margin of safety from a neurocognitive standpoint under the more limited conditions of exposure that would likely obtain in a medical setting."

"Current marijuana use had a negative effect on global IQ score only in subjects who smoked 5 or more joints per week. A negative effect was not observed among subjects who had previously been heavy users but were no longer using the substance. We conclude that marijuana does not have a long-term negative impact on global intelligence. Whether the absence of a residual marijuana effect would also be evident in more specific cognitive domains such as memory and attention remains to be ascertained."

"These results can be interpreted in several ways. A statistically reliable negative effect was observed in the domain of learning and forgetting, suggesting that chronic long-term cannabis use results in a selective memory defect. While the results are compatible with this conclusion, the effect size for both domains was of a very small magnitude. The "real life" impact of such a small and selective effect is questionable. In addition, it is important to note that most users across studies had histories of heavy longterm cannabis consumption. Therefore, these findings are not likely to generalize to more limited administration of cannabis compounds, as would be seen in a medical setting."

"One of the major concerns about the psychological effects of chronic heavy cannabis use has been that it impairs adult motivation. The evidence for an 'amotivational syndrome' among adults consists largely of case histories and observational reports (e.g. Kolansky and Moore, 1971; Millman and Sbriglio, 1986). The small number of controlled field and laboratory studies have not found compelling evidence for such a syndrome (Dornbush, 1974; Negrete, 1983; Hollister, 1986). The evidential value of the field studies is limited by their small sample sizes, and the limited sociodemographic characteristics of their samples, while the evidential value of the laboratory studies is limited by the short periods of drug use, the youthful good health of the volunteers, and minimal demands made on volunteers in the laboratory (Cohen, 1982). Some regular cannabis users report a loss of ambition and impaired school and occupational performance as adverse effects of their use (e.g. Hendin et al, 1987) and that some ex-cannabis users give impaired occupational performance as a reason for stopping (Jones, 1984). Nonetheless, it is doubtful that cannabis use produces a well defined amotivational syndrome. It may be more parsimonious to regard the symptoms of impaired motivation as symptoms of chronic cannabis intoxication rather than inventing a new psychiatric syndrome."

"A review of the literature suggests that the majority of cannabis users, who use the drug occasionally rather than on a daily basis, will not suffer any lasting physical or mental harm. Conversely, as with other 'recreational' drugs, there will be some who suffer adverse consequences from their use of cannabis. Some individuals who have psychotic thought tendencies might risk precipitating psychotic illness. Those who consume large doses of the drug on a regular basis are likely to have lower educational achievement and lower income, and may suffer physical damage to the airways. They also run a significant risk of becoming dependent upon continuing use of the drug. There is little evidence, however, that these adverse effects persist after drug use stops or that any direct cause and effect relationships are involved."

"Although individual lifetime risk of chronic psychotic disorders such as schizophrenia, even in people who use cannabis regularly, is likely to be low (less than 3%), cannabis use can be expected to have a substantial effect on psychotic disorders at a population level because exposure to this drug is so common."

"The lead researcher in the Christchurch study, Professor David Fergusson, said the role of cannabis in psychosis was not sufficient on its own to guide legislation. 'The result suggests heavy use can result in adverse side-effects,' he said. 'That can occur with ( heavy use of ) any substance. It can occur with milk.' Fergusson's research, released this month, concluded that heavy cannabis smokers were 1.5 times more likely to suffer symptoms of psychosis that non-users. The study was the latest in several reports based on a cohort of about 1000 people born in Christchurch over a four-month period in 1977. An effective way to deal with cannabis use would be to incrementally reduce penalties and carefully evaluate its impact, Fergusson said. 'Reduce the penalty, like a parking fine. You could then monitor ( the impact ) after five or six years. If it did not change, you might want to take another step.'

"The younger and more often teens use marijuana, the more likely they are to engage in other substance use and the higher their risk of developing a substance use disorder. Among high school students, 7.5 percent used marijuana for the first time before the age of 13. CASA’s analysis of national data finds that the average age of initiation of marijuana use among high school students is 14.3 years old. Compared to those who began using marijuana after age 21, those who first used it before age 15 are:
• More likely to have ever smoked a cigarette (93.3 percent vs. 86.4 percent);
• More than twice as likely to have ever misused controlled prescription drugs (56.5 percent vs. 22.9 percent); and
• Two and a half times as likely to have ever used other illicit drugs (70.2 percent vs. 27.8 percent)."

"High school students are more likely to use marijuana than to smoke cigarettes. High school students are:
"• More likely to have tried marijuana than tobacco (24 percent vs. 15 percent); and
"• More likely to say their close friends use marijuana than smoke cigarettes (51 percent vs. 39 percent)."

"• Table 8-8 lists the proportions of 12th graders in 2015 who favor various legal consequences for marijuana use: making it entirely legal (42%), a minor violation like a parking ticket but not a crime (27%), or a crime (15%). The remaining 15% said they 'don’t know.' It is noteworthy just how variable attitudes about this contentious issue are.
"• Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about three in five (64%) said “yes.” However, about 86% of those answering 'yes' (55% of all respondents) would permit sale only to adults. A small minority (9%) favored the sale to anyone, regardless of age, while 23% said that sale should not be legal even if use were made legal, and 13% said they 'don’t know.' Thus, while the majority subscribe to the idea of legal sale, if use is allowed, the great majority agree with the notion that sale to underage people should not be legal.
"• Most 12th graders felt that they would be little affected personally by the legalization of either the sale or the use of marijuana. Over half (53%) of the respondents said that they would not use the drug even if it were legal to buy and use, while others indicated that they would use it about as often as they do now (14%) or less often (1%). Only 9% said they would use it more often than they do at present, while 13% thought they would try it. Another 11% said they did not know how their behavior would be affected if marijuana were legalized. Still, this amounts to 22% of all 12th graders, or about one in five, who thought that they would try marijuana, or that their use would increase, if marijuana were legalized."

"Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about three in five (62%) said 'yes.' However, about 80% of those answering 'yes' (51% of all respondents) would permit sale only to adults. A small minority (11%) favored the sale to anyone, regardless of age, while 28% said that sale should not be legal even if use were made legal, and 10% said they 'don’t know.'"

"Risk thresholds could be formulated only for THC which was the most prevalent illicit drug in the general driving population and in injured/killed drivers. The prevalence of THC across all countries that participated in DRUID is 1.37%. This is about one third of the alcohol prevalence. The epidemiological, the experimental and the meta-analytical approaches result in rather low risk estimations. Epidemiological case-control studies assess at maximum a 2.4-fold risk for injury, experimental studies and meta-analysis rank the risk between 0.5 and 2 times than that of sober driving. So THC seems to be much less impairing and risky than most of the other examined substances. Although a relationship between THC concentration and accident risk was found in the epidemiological studies, it was only possible to set an exact THC cut-off by a meta-analysis of experimental studies. Thereby it was found that the serum concentration of 3.8ng/mL THC (?2ng/mL in whole blood) causes the same amount of impairment as 0.5g/L alcohol. This value could be an empirical basis for a threshold discussion. The meta-analysis could also be used to define limits comparable to lower BAC levels."

"Our primary analysis looked at the risk of a motor vehicle collision while under the influence of cannabis and included all nine studies (relating to 49 411 participants). The pooled risk of a motor vehicle collision while driving under the influence of cannabis was almost twice the risk while driving unimpaired (odds ratio 1.92 (95% confidence interval 1.35 to 2.73); P=0.0003); we noted heterogeneity among the individual study effects (I2=81%).
"We also assessed culpability and non-culpability studies separately and explored differences between motor vehicle collisions resulting in deaths and non-fatal injuries. Meta-analyses on subgroups of studies explored the potential effect of specific features related to study design and potential biases: case-control studies versus culpability studies, fatal collisions versus non-fatal collisions, and high quality studies versus medium quality studies (fig 3?).
"High quality studies had a pooled odds ratio that was higher than that for medium quality studies, although both results showed a significant association at the 0.05 level. Furthermore, case-control studies (2.79 (1.23 to 6.33); P=0.01) estimated the effect of cannabis use on crash risk to be higher than that estimated by culpability studies (1.65 (1.11 to 2.46); P=0.07). Studies of fatal collisions (2.10 (1.31 to 3.36); P=0.002) had a pooled odds ratio that was statistically significant, but studies of non-fatal collisions (1.74 (0.88 to 3.46); P=0.11) did not show significant results.
"In all studies assessing cannabis use in conjunction with alcohol, the estimated odds ratio for cannabis and alcohol combined was higher than for cannabis use alone, suggesting the presence of a synergistic effect."

"Although for the mobile phone conversation and cannabis studies the reaction times were slightly different, they were still comparable. The same visual stimulus was used and was presented in the same visual scene. When reaction times under each condition were compared with the baseline reaction times measured, alcohol gave a 12.5% increase in reaction times, cannabis a 21% increase, a hands-free mobile phone conversation increased reaction times by 26.5%, texting by 37.4%, using a smartphone for social networking by 37.6% and using a mobile phone for a hand-held mobile phone conversation increased reaction times by 45.9% compared to the baseline condition. Thus, using a smartphone for social networking resulted in a greater impairment to reaction times than alcohol, cannabis, hand held mobile phone conversations and texting, but less than a hand held mobile conversation."

"We found only limited evidence to support the claim that cannabis use increases accident risk. Participants who had driven under the influence of cannabis in the previous year appeared to be no more likely than drug-free drivers to report that they had had an accident in the previous 12 months. Prima facie, this would seem to suggest that cannabis-intoxicated driving is not a risk factor for non-fatal accidents. In this sense, the results would support those of Longo et al. (2000b) who found no relationship between recent cannabis use and driver culpability for non-fatal accidents."

"THC is the major psychoactive constituent of cannabis. Potency is dependent on THC concentration and is usually expressed as %THC per dry weight of material. Average THC concentration in marijuana is 1-5%, hashish 5-15%, and hashish oil ³ 20%. The form of marijuana known as sinsemilla is derived from the unpollinated female cannabis plant and is preferred for its high THC content (up to 17% THC). Recreational doses are highly variable and users often titer their own dose. A single intake of smoke from a pipe or joint is called a hit (approximately 1/20th of a gram). The lower the potency or THC content the more hits are needed to achieve the desired effects; 1-3 hits of high potency sinsemilla is typically enough to produce the desired effects. In terms of its psychoactive effect, a drop or two of hash oil on a cigarette is equal to a single “joint” of marijuana. Medicinally, the initial starting dose of Marinol® is 2.5 mg, twice daily."

"Cannabis use impairs cognitive, memory and psycho-motor performance in ways that may impair driving.¹⁰ Recent data suggest that approximately 5% of Canadian drivers/adults report driving after cannabis use in the past year.³⁹ Large-scale epidemiological studies using different methodologies (e.g., retrospective epidemiological and case control studies) have found that cannabis use acutely increases the risk of motor vehicle accident (MVA) involvement and fatal crashes among drivers.^40,41 Recent reviews have found the increase in risk to be approximately 1.5-3.0, an increase which is substantially lower, however, than that in alcohol-impaired drivers. The impairment from concurrent alcohol and cannabis use may be multiplicative, so individuals who drive under the influence of both drugs may be at higher risk for MVAs.⁴² An expert consensus view was that a THC concentration of 7-10 nanograms per millilitre in serum would produce impairment equivalent to that of 0.05% blood alcohol content (BAC). It was suggested that this level could serve as a 'per se' limit to define cannabis-impaired driving.⁴³ Current research suggests that acute impairment from cannabis typically clears 3-4 hours after use.⁴⁴
"This time span could be recommended to users as a minimum wait period before driving. The required wait before driving would need to be longer for higher doses, and would also vary on the basis of individual variation."

"Cannabis is only considered a risk factor for traffic accidents if drivers operate vehicles after consuming the drug. Robbe (1994) found that 30% to 90% of his participants were willing to drive after consuming a typical dose of cannabis. This is consistent with a recent Australian survey in which more than 50% of users drove after consuming cannabis (Lenne, Fry, Dietze, & Rumbold, 2000). A self administered questionnaire given to 508 students in grades 10 to 13 in Ontario, Canada, found that 19.7% reported driving within an hour after using cannabis (Adlaf, Mann, & Paglia, 2003)."

"The present study's subtle finding of decreased speed under the influence of acute marijuana is generally consistent with the literature, which has found that marijuana's effects on driving can be subtle. In Berghaus's review of the literature prior to 1995, 45% of driving simulator studies showed no impairment from marijuana within the first hour after use (Berghaus, Scheer & Schmidt 1995), More cautious driving behaviors were found in several studies (Lamers & Ramaekers 2001; Stein et al, 1983; Ellingstad, McFarling & Struckman 1973; Rafaelsen, Bech & Rafaelsen 1973; Dott 1972), while an increased reaction time for stopping was the most common finding (Liguori, Gatto & Robinson 1998; Rafaelsen, Bech & Rafaelsen 1973), Moskowitz, Ziedman and Sharma (1976) also found slowed reaction times for a visual choice-reaction time task administered while driving and Smiley, Moskowitz and Zeidman (1981) found increased variability in velocity and lateral position while following curves and while controlling the car in gusts of wind with a high dose of marijuana (200 mcg/kg THC) but not with a lower dose (100 mcg/kg THC), They also found an increase in variability of headway and lateral position while following other cars."

"Epidemiological studies have been inconclusive regarding whether cannabis use causes an increased risk of motor vehicle accidents; in contrast, unanimity exists that alcohol use increases crash risk.³⁰ In tests using driving simulation, neurocognitive impairment varies in a dose-related fashion, and symptoms are more pronounced with highly automatic driving functions than with more complex tasks that require conscious control.³¹ Cannabis smokers tend to over-estimate their impairment and compensate effectively while driving by utilizing a variety of behavioral strategies."

"Several studies have examined cannabis use in driving simulator and on-road situations. The most comprehensive review was done by Smiley in 1986 and then again in 1999. Several trends are evident and can be described by three general performance characteristics:

"1. Cannabis increased variability of speed and headway as well as lane position (Attwood, Williams, McBurney, & Frecker, 1981; Ramaekers, Robbe, & O'Hanlon, 2000; Robbe, 1998; Sexton et al., 2000; Smiley, Moskowitz, & Zeidman, 1981; Smiley, Noy, & Tostowaryk, 1987). This was more pronounced under high workload and unexpected conditions, such as curves and wind gusts.

"2. Cannabis increased the time needed to overtake another vehicle (Dott, 1972 [as cited in Smiley, 1986]) and delayed responses to both secondary and tracking tasks (Casswell, 1977; Moskowitz, Hulbert, & McGlothlin,
1976; Sexton et al., 2000; Smiley et al., 1981).

"3. Cannabis resulted in fewer attempts to overtake another vehicle(Dott, 1972) and larger distances required to pass (Ellingstad et al., 1973 [as cited in Smiley, 1986]). Evidence of increased caution also included slower speeds (Casswell, 1977; Hansteen, Miller, Lonero, Reid, & Jones, 1976; Krueger & Vollrath, 2000; Peck, Biasotti, Boland, Mallory, & Reeve, 1986; Sexton et al., 2000; Smiley et al., 1981; Stein, Allen, Cook, & Karl, 1983) and larger headways (Robbe, 1998; Smiley et al., 1987)."

"Both Australian studies suggest cannabis may actually reduce the responsibility rate and lower crash risk. Put another way, cannabis consumption either increases driving ability or, more likely, drivers who use cannabis make adjustments in driving style to compensate for any loss of skill (Drummer, 1995). This is consistent with simulator and road studies that show drivers who consumed cannabis slowed down and drove more cautiously (see Ward & Dye, 1999; Smiley, 1999. This compensation could help reduce the probability of being at fault in a motor vehicle accident since drivers have more time to respond and avoid a collision. However, it must be noted that any behavioral compensation may not be sufficient to cope with the reduced safety margin resulting from the impairment of driver functioning and capacity."

"Another paradigm used to assess crash risk is to use cross-sectional surveys of reported nonfatal accidents that can be related to the presence of risk factors, such as alcohol and cannabis consumption. Such a methodology was employed in a provocative dissertation by Laixuthai (1994). This study used data from two large surveys that were nationally representative of high school students in the United States during 1982 and 1989. Results showed that cannabis use was negatively correlated with nonfatal accidents, but these results can be attributed to changes in the amount of alcohol consumed. More specifically, the decriminalization of cannabis and the subsequent reduction in penalty cost, as well as a reduced purchase price of cannabis, made cannabis more appealing and affordable for young consumers. This resulted in more cannabis use, which substituted for alcohol consumption, leading to less frequent and less heavy drinking. The reduction in the amount of alcohol consumed resulted in fewer nonfatal accidents."

"In 1937, Congress passed the first federal law to discourage cannabis production for marijuana while still permitting industrial uses of the crop (the Marihuana Tax Act; 50 Stat. 551). Under this statute, the government actively encouraged farmers to grow hemp for fiber and oil during World War II. After the war, competition from synthetic fibers, the Marihuana Tax Act, and increasing public anti-drug sentiment resulted in fewer and fewer acres of hemp being planted and none at all after 1958. The Controlled Substances Act of 1970 (CSA, 21 U.S.C. §801 et. seq.) placed the control of select plants, drugs, and chemical substances under federal jurisdiction and was enacted, in part, to replace previous federal drug laws with a single comprehensive statute.⁴³

"The CSA adopted the same definition of Cannabis sativa that appeared in the 1937 Marihuana Tax Act. The definition of “marihuana” (21 U.S.C. §802(16)) reads:

"The term marihuana means all parts of the plant Cannabis sativa L., whether growing or not; the seeds thereof; the resin extracted from any part of such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant, its seeds or resin. Such term does not include the mature stalks of such plant, fiber produced from such stalks, oil or cake made from the seeds of such plant, any other compound ... or preparation of such mature stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of such plant which is incapable of germination."

"The statute thus retains control over all varieties of the cannabis plant by virtue of including them under the term marihuana and does not distinguish between low- and high-THC varieties. The language exempts from control the parts of mature plants—stalks, fiber, oil, cake, etc.—intended for industrial uses. Some have argued that the CSA definition exempts industrial hemp under its term exclusions for stalks, fiber, oil, cake, and seeds.⁴⁴ DEA refutes this interpretation.⁴⁵

"Strictly speaking, CSA does not make growing cannabis illegal; rather, it places strict controls on its production, making it illegal to grow the crop without a DEA permit. Regarding industrial hemp, however, growers that comply with the 2014 farm bill provision (discussed in the next section) do not need DEA approval."

"RECOMMENDATIONS
"1. The severity of punishment for a cannabis possession charge should be reduced. Specifically, cannabis possession should be converted to a civil violation under the Contraventions Act.
"The current law involves considerable enforcement and other criminal justice costs, as well as adverse consequences to individual drug offenders, with little evidence of a substantial deterrent impact on cannabis use, and at best marginal benefits to the public health and safety of Canadians. As a minimal measure, jail should be removed as a sentencing option for cannabis possession. The available evidence indicates that removal of jail as a sentencing option would lead to considerable cost savings without leading to increases in rates of cannabis use. Punishing cannabis possession with a fine only would be consistent with current practices and prevailing public opinion."

"There is no evidence that the depenalization component of the 1976 policy, per se, increased levels of cannabis use. On the other hand, the later growth in commercial access to cannabis, after de facto legalization, was accompanied by steep increases in use, even among youth. In interpreting that association, three points deserve emphasis. First, the association may not be causal; we have already seen that recent increases occurred in the United States and Oslo despite very different policies. Second, throughout most of the first two decades of the 1976 policy, Dutch use levels have remained at or below those in the United States. And third, it remains to be seen whether prevalence levels will drop again in response to the reduction to a 5-g limit, and to recent government efforts to close down coffee shops and more aggressively enforce the regulations."

"In 1968, the National Institute of Mental Health began funding a Drug Supply Program to provide researchers with compounds necessary to conduct biomedical research. Initially, the program focused on THC and other naturally occurring cannabinoids, and then gradually expanded to a wide range of compounds. (Since its beginning, the program has synthesized or obtained over 1,500 different compounds that have been supplied to over 2,500 researchers.) Cannabis was among the first substances to be made available through the Drug Supply Program for use by scientists conducting both nonhuman research and human research under a variety of investigational new drug protocols. It was grown through a contract with the University of Mississippi. With its establishment in 1974, NIDA became the successor to NIMH as the administrator of the cannabis contract and the sole U.S. source for legal cannabis."

"Our conclusion is that the present law on cannabis produces more harm than it prevents. It is very expensive of the time and resources of the criminal justice system and especially of the police. It inevitably bears more heavily on young people in the streets of inner cities, who are also more likely to be from minority ethnic communities, and as such is inimical to police-community relations. It criminalizes large numbers of otherwise law-abiding, mainly young, people to the detriment of their futures. It has become a proxy for the control of public order; and it inhibits accurate education about the relative risks of different drugs including the risks of cannabis itself."

"Marihuana's relative potential for harm to the vast majority of individual users and its actual impact on society does not justify a social policy designed to seek out and firmly punish those who use it. This judgment is based on prevalent use patterns, on behavior exhibited by the vast majority of users and on our interpretations of existing medical and scientific data. This position also is consistent with the estimate by law enforcement personnel that the elimination of use is unattainable."

"Only orally given THC and, to a lesser extent, nefazodone have shown promise [in treating marijuana dependence]. THC reduced craving and ratings of anxiety, feelings of misery, difficulty sleeping, and chills (Haney et al., 2004). In addition, participants could not distinguish active THC from placebo. These findings were replicated in an outpatient study, which found that a moderate oral dosage of THC (10 mg, three times daily) suppressed many marijuana withdrawal symptoms and that a higher dosage (30 mg, three times daily) almost completely abolished withdrawal symptoms (Budney et al., 2007)."

"Under the current contract with the University of Mississippi for any given year NIDA [National Institute on Drug Abuse] has the option to grow either 1.5 or 6.5 acres of cannabis, or to not grow any at all, depending on research demand. Generally, 1.5 acres are grown in alternate years. The number of cannabis cigarettes produced from 1.5 acres is about 50,000-60,000, although it can be higher. Cigarettes are produced in three potencies: strength 1 - 3-4 %; strength 2 - 1.8-2.2 %; and strength 3 - placebo, as close to 0% as possible. During the past three years, the following quantities have been shipped: 1994 - 24,000 cigarettes; 1995 - 23, 100 - cigarettes; and 1996 17,700 cigarettes. Virtually all of the cigarettes shipped in the last three years have been for single patient INDs. As of March 1997 there were 278, 100 cigarettes in stock. The cigarettes are maintained in frozen storage and have a useful life of approximately five years."

"Synthetic cannabinoids are functionally similar to delta9-tetrahydrocannabinol (THC), the psychoactive principle of cannabis, and bind to the same cannabinoid receptors in the brain and peripheral organs."

"There are indications that cannabis was used as early as 4000 B.C. in Central Asia and north-western China, with written evidence going back to 2700 B.C. in the pharmacopeia of emperor Chen-Nong. It then gradually spread across the globe, to India (some 1500 B.C., also mentioned in Altharva Veda, one of four holy books about 1400 B.C.¹), the Near and Middle East (some 900 B.C.), Europe (some 800 B.C.), various parts of South-East Asia (2nd century A.D.), Africa (as of the 11th century A.D.) to the Americas (19th century) and the rest of the world.²"