THE CASE AGAINST MARIJUANA A Pathologist's Perspective As a medical doctor and board-certified pathologist, I am often asked about cannabis ("marijuana", "hashish"). It is my judgement as a physician that Lambda Chi Alphas should not use cannabis, and should let our brothers know that we will not accept its use. Taking cannabis produces a mild euphoria, often enhances the appetite and libido, and causes the user to focus on simple things, long and attentively, one at a time. Specific receptors for the active component are widespread in the brain, and are named "cannabinoid receptors". The national debate over drugs is highly politicized, with much rhetoric and few facts. I am not writing this to argue for or against legalization of marijuana or any other psychoactive drugs. I am not interested in defending the old draconian laws against cannabis, or the false claims of past decades. I will not review the case for cannabis in treating glaucoma, AIDS wasting syndrome, or the side-effects of cancer chemotherapy. I am not going to make comparisons with alcohol. What I will do is present what I think is a convincing case against its use by members of our fraternity. SMOKING MARIJUANA IS UNHEALTHY The current medical literature lacks credible, non-partisan reviews of marijuana's effects on physical and mental health (Aust. Fam. Phys. 24: 1237, 1995). However, there is reason to be concerned about the long-term effects on the brain. Users frequently report problems with short-term memory, both while using and between uses. Short-term memory is the most fragile brain function, and this spontaneous observation tells me that something real is happening. The mental aftereffects of a pot high are measurable, and are commensurate with the aftereffects of a drunken debauch (Psychopharmacology 115: 340, 1994). The active component of cannabis (tetrahydrocannabinol), when administered for five days or more, is now known to greatly increase the numbers of cannabinoid receptors, and to alter their chemical binding characteristics (Pharm. Bioch. Behav. 51: 731, 1995). We don't know what this means yet, except that it's clear that using cannabis does alter the molecular structure of the brain. Although we don't know what the cannabinoid receptors do for us in health, they must be there for a reason. And smoking cannabis alters them. A marijuana smoker's performance on tests of thinking and coordination is impaired while on the drug (J. Exp. Anal. Behav. 62: 73, 1994; Psych. Res. 51: 115, 1994). Contrary to what you may have heard, it's clear that marijuana smoking does impair a user's ability to drive a car safely (NEJM 332: 892, 1995). The effects of marijuana smoking on the unborn child are unknown. A group of scientists in Madrid has found long-term behavioral damage in rats exposed in the womb to cannabis (Pharm. Bioch. Behav. 47: 47, 1994). This is in keeping with the idea of real damage, albeit milder, in adult users. In the 1960's, it was generally considered, by my college friends, that heavy marijuana smokers exhibited changes that were different from, but as obvious as, the changes seen in deteriorating alcoholics. The primary changes were loss of motivation and interest in what most of us like best (i.e., other people, sports, learning, exchanging ideas). "It makes you lazy and kind of stupid" was a common description. Of course, it's impossible to do a prospective study demonstrating cause-and- effect. But reflect that it's only been in the past few years that anyone has demonstrated anatomic damage to individual brain cells in old alcoholics whose cognition is obviously deranged. And the receptor studies cited above are as impressive as anything I've found in a recent review of alcohol's medium-term effects on brain tissue. In summary, there is serious reason to be concerned that long- term use of marijuana causes brain damage. We do not know whether this is reversible on cessation of use. SMOKING MARIJUANA IS UN-BROTHERLY You know the lawful penalties for using marijuana while you are a fraternity member. For me, though, it's about ZAX. Right or wrong, wise or foolish, cannabis is illegal. In a democracy, most people disapprove of most lawbreaking, and those who associate with lawbreakers. Smoking cannabis can damage the reputation of your fraternity and your brothers. Some people who are depressed use marijuana as a short-term medicine to feel better. But it's a poor long-term strategy, and makes the problems worse tomorrow. Depression is often a physiological, programmed illness, and is almost always treatable by conventional medicine. If a brother is suffering in this way, we have a duty to recognize it and get the appropriate help. Cannabis promotes single-minded focusing of attention, and this is seldom on other people. A user may become pleasantly engrossed in a candle flame, but will not make a real friend or practice a skill. The drug makes its users markedly less sociable when they are high. Now, there's a time for introversion and introspection, but a marijuana high is not meditation or serious reflection. The people whom you select as friends tend to be those who share common activities, and a marijuana smoker is likely to end up with a circle of friends who are less interested in interacting with one another. This is antithetical to the Greek spirit, at least as we treasure it. Now, if I were in a fraternity based on hazing, I'd probably prefer being around my "brothers" when they're stoned, passive, and self-absorbed. But if you actually like your brothers, it's stupid to choose a drug that will make you withdraw from each other into fantasy. On a campus, different fraternities define themselves and thus fill different niches. The fraternity I know attracts the men who want to receive and give real friendship. "We don't haze" says it up front. "There's a lot of love over there" says, and perpetuates, who we are, and it's this reputation that attracts the new members. If people said that "They do drugs" instead, the character of the brotherhood will change dramatically. And in a few years, we would no longer have a home on that campus. Brothers. Vir quisque vir. Anybody can smoke cannabis. Not everybody can be a Lambda Chi. Anybody can know what it feels like to have a pot high. Most men go through life without ever knowing what ZAX is all about. And many men have even sought death, and found it, just for lack of brotherly love. Please do not use marijuana or hashish, and please do not encourage its use among us. In ZAX, Ed Friedlander, M.D. Sigma Rho 229