THE GRASS ROOTS OF TEEN DRUG ABUSE

"FEDS GO TO POT" screamed the New York Post headline last week, after the
Institute of Medicine released its report "Marijuana and Medicine: Assessing
the Science Base." The Associated Press reported that the IOM had found
"there was no conclusive evidence that marijuana use leads to harder drugs."

A look at the actual report shows that these press accounts are misleading.
Consider these words from the report: "Not surprisingly, most users of other
illicit drugs have used marijuana first. In fact, most drug users begin with
alcohol and nicotine before marijuana-usually before they are of legal age.
In the sense that marijuana use typically precedes rather than follows
initiation of other illicit drug use, it is indeed a 'gateway' drug. But
because underage smoking and alcohol use typically precede marijuana use,
marijuana is not the most common and is rarely the first, 'gateway' to
illicit drug use."

Those are the words that precede the tentatively worded statement the AP
paraphrased: "There is no conclusive evidence that the drug effects of
marijuana are causally linked to the subsequent abuse of other illicit
drugs." The report notes, however, that "people who enjoy the effects of
marijuana are, logically, more likely to be willing to try other
mind-altering drugs than are people who are not willing to try marijuana or
who dislike its effects. In other words, many of the factors associated with
a willingness to use marijuana are, presumably, the same as those associated
with a willingness to use other illicit drugs. " And the report recognizes
"intensity" of marijuana use as increasing the risk of progression to other
drugs.

The medical benefits and risks of marijuana-the subjects to which the report
devotes most of its attention -are matters for doctors, scientists and the
Food and Drug Administration. The potential of marijuana as a gateway drug
is a matter of concern for teenagers, parents and policy makers.

The IOM's brief, three-page discussion of the gateway issue fails to discuss
mounting statistical and scientific evidence that children who smoke pot are
much likelier than those who don't to use drugs like cocaine, heroin and
LSD. And the press coverage has been dangerously deceptive.

The Institute of Medicine study fails to discuss mounting scientific
evidence that children who smoke pot are much likelier to use drugs like
cocaine, heroin and LSD.

I have not read or heard in any news report the important finding that "the
... interpretation . . . 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 ... is the interpretation most
often used in the scientific literature, and is supported by-although not
proven by the available data."

The National Center on Addiction and Substance Abuse, which I head, analyzed
the data from the Centers for Disease Control and Prevention's 1995 Youth
Risk Behavior Survey of 1l, 000 ninth-through 12th graders, adjusting for
other risk factors such as repeated acts of violence and sexual promiscuity.

The correlations are potent:

* Teens who drank and smoked cigarettes at least once in the past month are
30 times more likely to smoke marijuana than those who didn't.

* Teens who drank, smoked cigarettes, and used marijuana at least once in
the past month are more than 16 times as likely to use another drug like
cocaine, heroin or LSD.

To appreciate the significance of these relationships, consider this: The
first Surgeon General's report on smoking and health found a nine to 10
times greater risk of lung cancer among smokers. The early returns from the
monumental Framingham heart study found that individuals with high
cholesterol were two to four tirnes as likely to suffer heart disease.

Most people who smoke pot do not move on to other drugs, but then only 5% to
7% of cigarette smokers get lung cancer. The point for parents and teens is
that those youngsters who smoke pot are at vastly greater risk of moving on
to harder drugs. CASA'S studies reveal that the younger and more often a
teen smokes pot, the more likely that teen is to use cocaine. A child who
uses marijuana before age 12 is 42 times more likely to use cocaine, heroin
or other drugs than one who first smokes pot after age 16.

The IOM report also fails to discuss findings of recent scientific studies
that suggest some of the reasons for this high correlation. Studies in Italy
reveal that marijuana affects levels of dopamine (the substance that gives
pleasure) in the brain in a manner similar to heroin. Gaetana DiChiara, the
physician who led this work at the University of Cagliari, indicates that
marijuana may prime the brain to seek substances that act in a similar way.
Studies in the U.S. have found that nicotine, cocaine and alcohol also
affect dopamine levels.

Nor does the IOM report mention studies at the distinguished Scripps
Research Institute in California and Cumplutense University in Madrid which
found that rats subjected to immediate cannabis withdrawl exhibited changes
in behavior similar to those seen after withdrawal of alcohol, cocaine and
opiates, Science magazine called this "the first neurological basis for a
marijuana withdrawal syndrome, and one with a strong emotional component
shared by other drugs." Alan Leshner, director of the National Institute on
Drug Abuse, has estimated that at least 100,000 individuals are in treatment
because of marijuana use. Most are believed to be teenagers.

Our concern should be to prevent teen drug use. We know that someone who
gets to age 21 without smoking, using drugs or abusing alcohol is virtually
certain never to do so. We have known for some time, as the IOM report
confirms that marijuana harms short-term memory, motor skills and the
ability to concentrate, attributes teenagers need when they are learning in
school.

Parents, teachers and clergy need to send teens a clear message: Stay away
from pot. The incompleteness of the IOM report and the press's sloppy
summaries of it must not be permitted to dilute that message.

Mr. Califano is President of the National Center on Addiction and Substance
Abuse at Columbia University. He was secretary of. health, education and
welfare from 1977 to 1979.