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sumption among youth in California; the consequences of "message" that marijuana might have medical use are examined below.

Medical Use and Abuse of Opiates

Two highly influential papers published in the 1920s and 1950s led to widespread concern among physicians and medical licensing boards that liberal use of opiates would result in many addicts (reviewed by Moulin and co-workers106 in 1996). Such fears have proven unfounded; it is now recognized that fear of producing addicts through medical treatment resulted in needless suffering among patients with pain as physicians needlessly limited appropriate doses of medications.27,44 Few people begin their drug addiction problems with misuse of drugs that have been prescribed for medical use.114 Opiates are carefully regulated in the medical setting, and diversion of medically prescribed opiates to the black market is not generally considered to be a major problem.

No evidence suggests that the use of opiates or cocaine for medical purposes has increased the perception that their illicit use is safe or acceptable. Clearly, there are risks that patients will abuse marijuana for its psychoactive effects and some likelihood of diversion of marijuana from legitimate medical channels into the illicit market. But those risks do not differentiate marijuana from many accepted medications that are abused by some patients or diverted from medical channels for nonmedical use. Medications with abuse potential are placed in Schedule II of the Controlled Substances Act, which brings them under stricter control, including quotas on the amount that can be legally manufactured (see chapter 5 for discussion of the Controlled Substances Act). That scheduling also signals to physicians that a drug has abuse potential and that they should monitor its use by patients who could be at risk for drug abuse.

Marijuana Decriminalization

Monitoring the Future, the annual survey of values and lifestyles of high school seniors, revealed that high school seniors in decriminalized states reported using no more marijuana than did their counterparts in states where marijuana was not decriminalized.72 Another study reported somewhat conflicting evidence indicating that decriminalization had increased marijuana use.105 That study used data from the Drug Awareness Warning Network (DAWN), which has collected data on drugrelated emergency room (ER) cases since 1975. There was a greater increase from 1975 to 1978 in the proportion of ER patients who had used marijuana in states that had decriminalized marijuana in 1975-1976 than in states that had not decriminalized it (Table 3.6). Despite the greater



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