SAN FRANCISCO — For parents and others concerned about teen drug use, this is a time for extra vigilance, say analysts.
The intensifying debate over the medical value of marijuana is, in many respects, a loud clanging over a relatively minor issue. In the world of medicine and drugs, marijuana as a treatment is a peripheral topic, way down the list of pressing national health concerns.
But the decibel level of the debate and its content, rich with mixed messages, make it especially dangerous, analysts add. The argument, they point out, is well within earshot of the nation's teens, who could find it confusing at best or, at worst, justification for experimentation.
A report last week by the Institute of Medicine found marijuana "potentially effective" in treating certain symptoms of illnesses, including AIDS, a message that ran counter to the Clinton administration policy of staunchly opposing any medical use of the drug. While the administration's own Office of National Drug Control Policy requested the study, it's unclear what, if any changes in policy will result.
Yet the message to teens could well be "first, marijuana is sort of healthy, and second, the government is stupid and doesn't get it," says Mark Kleiman, a specialist in drug policy at the University of California at Los Angeles.
What Mr. Kleiman and other experts worry is that the medical-marijuana debate is, for teens, morphing into questions about marijuana itself, and even drugs in general. And because the issue of marijuana's medicinal value is not clear-cut, it could muddy unequivocal warnings against marijuana, and drugs, overall.
Indeed, Joseph Califano, chairman of the National Center on Addiction and Substance Abuse (NCASA) at Columbia University in New York, warned in a statement following the release of the government report: "It is imperative to distinguish between the issue of medical marijuana and marijuana as a threat to America's kids."
Propelling the debate has been a rebellion of sorts from seven Western states where voters in recent years have passed ballot measures legalizing the use of marijuana for medical purposes. Since California did that in 1996, marijuana club owners and state and federal law-enforcement officials have engaged in an cat-and-mouse game of closures and legal appeals.
Vaguely worded ballot initiatives have provoked some of the legal wrangling. They didn't clearly spell out how the process - from cultivation to use - was to work. But the federal government says state laws can't supercede federal law outlawing the drug.
Beyond the state actions and legal maneuvers, though, are deeper reasons explaining the intensity of the medical marijuana wars. In many respects, marijuana sits on a fault line of American culture, an emblem of the 1960s social revolution that continues to ripple across the political landscape today.
"In many respects, this issue eludes analysis on a scientific basis and quickly descends to passionately held positions," says Eric Sterling, president of the Criminal Justice Policy Foundation in Washington.
On one hand, there is the position that allowing marijuana as medicine will encourage recreational marijuana use, which, in turn, will lead to use of other drugs. On the other, many fighting for medicinal marijuana believe the marijuana laws in general are too heavy-handed and inconsistent with the status of other drugs, like alcohol.
Some groups pushing for medicinal marijuana clearly would like to go further. Chuck Thomas of the Marijuana Policy Project says: "It's possible that legalization might bring a net harm. But there is a whole range of policies, including permitting adults to grow their own, that might be a net positive," compared with the blanket-criminalization approach used now.
There are indications the teen-drug picture is improving. While illicit drug use by teenagers has risen during the 1990s, there has been a modest decline in the last two years, according to surveys by the University of Michigan. Still, the problem is seen as large - so large that some dismiss the notion that allowing controlled medical use of marijuana will have any measurable impact on the overall problem. Kleiman says there is no evidence to support the notion of "leakage" from one type of use to another.
On the question of whether marijuana is a "gateway" to other drug use, there is disagreement. For his part, Robert MacCoun, a professor of public policy at UC Berkeley, wrote in a recent report: "In the absence of causal evidence, a strong allegiance to any particular gateway theory would seem to reflect ideology or politics, rather than science."
Whatever the linkages to other drugs, NCASA says parents should talk more to their children about drugs and be watchful when they turn 13, a "critical turning point" when access and exposure to drugs skyrocket.
Exposure to the arguments about medical marijuana has also skyrocketed, and that holds its own risk. As Kleiman puts it, "the argument about medicinal marijuana carries a greater threat to changing juvenile attitudes than any policy that's adopted."