I have read some criticisms of the Institute of Medicine report on
the state of scientific knowledge regarding medical marijuana that have
enough validity to be worth considering. Overall, however, the report
(available to read or download here)
competently summarizes and synthesizes a good deal of what is known and
should prove valuable for those who hope that eventually science and
reason will triumph over obfuscatory prohibitionism.

Richard Cowan, former executive director of the National Organization
for Reform of Marijuana Laws (NORML), notes an excessive emphasis on the
dangers of smoking that is curious in the absence of any confirmed cases
of lung cancer caused by marijuana smoking (a fact the report had to
acknowledge). He also criticizes the report’s writers’ fixation on what
he calls the “single molecule paradigm,” the unproven assertion that
isolation of single active molecules in the plant would be obviously
superior to “licensing” the whole plant. Many advocates of herbal
medicine claim the unique combination of ingredients found in natural
plants (not just marijuana) accounts for their therapeutic value. Maybe
they’re wrong, but shouldn’t the viewpoint be mentioned, if only to be

Steve Kubby, the former Libertarian Party candidate for governor in
California who is a medical marijuana patient (adrenal cancer and high
blood pressure) facing criminal trafficking charges for growing his own
in his own home, notes that the IOM committee didn’t discuss
vaporization as an alternative to smoking though it had information
about it, and that the study makes no mention of the eight patients who
have received 7.1 pounds of marijuana a year from the federal government
since the early 1980s, courtesy of the taxpayers. Surely they would have
made good subjects for studies on long-term effects.

All in all, says Mr. Kubby, “the IOM report is badly flawed science
with politically poisoned conclusions.” It may be true that the
conclusions have been politically colored, but that may not be such a
bad thing. Perhaps including a few politically correct demurrers like
undue fear about the effects of smoking per se in an era in which
smoking anything has been so demonized is a small price to pay for
enhancing the credibility of the nuggets of valuable truth the report

I suspect the report’s authors knew what most legalizers believe —
that, as they conclude after extensive documentation, “the adverse
effects of marijuana use are within the range tolerated for other
medications,” that “a distinctive marijuana withdrawal syndrome has
been identified but it is mild and short-lived,” and that strict
prohibition is a stupid policy.

I infer some of this from a single sentence matter-of-factly included
in a lengthy discussion of the perception that marijuana is a “gateway”
to the use of other more dangerous illicit drugs. The authors don’t
bother to tease out the implications but it isn’t that difficult.

The report notes that one of the main reasons many are so adamantly
opposed to allowing marijuana to be used medicinally is “the fear that
marijuana use might cause, as opposed to merely precede, the use of
drugs that are more harmful.” The authors divide the issue rather

“The gateway analogy evokes two ideas that are often confused. The
first, more often referred to as the ‘stepping stone’ hypothesis, is the
idea that progression from marijuana to other drugs arises from
pharmacological properties of marijuana itself. The second
interpretation is that marijuana serves as a gateway to the world of
illegal drugs in which youths have greater opportunity and are under
greater social pressure to try other illegal drugs. This is the
interpretation most often used in the scientific literature, and it is
supported by — although not proven by — the available data.”

They then discuss various studies and conclude that “there is no
evidence that marijuana serves as a stepping stone on the basis of its
particular drug effect,” a fact even many prohibitionists will
reluctantly concede.

Then comes the sly kicker:

“Whereas the stepping stone hypothesis presumes a predominantly
physiological component to drug progression, the gateway theory is a
social theory. The latter does not suggest that the pharmacological
qualities of marijuana make it a risk factor for progression to other
drug use. Instead it is the legal status of marijuana that makes it a
gateway drug.”

Savor that apparently innocent sentence for a moment: “Instead it is
the legal status of marijuana that makes it a gateway drug.”

What implications can be teased from that sentence?

The main rationale for keeping marijuana illegal is not that it is so
dangerous in and of itself, but that it can serve as a gateway to other,
more genuinely dangerous drugs. But insofar as there is evidence that
marijuana use sometimes leads to the use of harder drugs — and there is
some though it’s not conclusive — the reason is that marijuana
possession and use is illegal. A nice piece of logic, eh?

Take it another step. Those who insist on keeping the plant illegal
bear a serious degree of moral responsibility for young marijuana users
who do go on to use cocaine, heroin, PCP or other genuinely dangerous or
addictive drugs.

If Barry McCaffery and other drug warriors were really, seriously
troubled by the possibility that use of marijuana might lead innocent or
psychologically troubled people to harder drugs with much more severe
physiological dangers, they would move as quickly as possible to
legalize marijuana. The fact that they don’t do so makes their plaintive
pleas of compassionate concern for those victimized by addiction and
drug-induced disorders ring hollow.

In a word, they refuse to take the action that would be most likely
to eliminate (or at least ameliorate) the only “gateway” properties of
marijuana that have a shred of scientific support because their drug war
— with all the money it shovels their way, with the opportunities it
presents to seize property, kick in doors and shred the U.S.
Constitution — is far more precious to them than the ruined lives of

Give them the benefit of the doubt that they didn’t understand about
the circularity of the “gateway” contention before. But with this
report — commissioned by “drug czar” McCaffery (your tax dollars at
work), remember — they have no excuse left. If they don’t take the
logical step of legalizing marijuana to reduce harm, how far beneath
contempt are they?

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