July 19, 1982 Dear Dr. Koop: Dr. Robbins has asked me to respond to your draft Surgeon General's advisory on marijuana, which I think is very good as it stands and much needed. The suggestions that follow are not major but may be useful to strengthen your case. First of all, many people brush aside the acute effects of marijuana demanding evidence of chronic effects before they can be convinced of the drug's harm. The committee felt that the acute effects of the drug were substantial. In addition to affecting perception and motor skills, there is good evidence that marijuana impairs short term memory and slows learning. Since surveys show marijuana is primarily used during school hours (rather than on weekends or at night), a student's ability to perform in school will be lessened. In persons with underlying mental illness, use of marijuana appears to worsen mental symptoms. Even in those without mental illness, a surprising number report reactions such as panic or anxiety that they regard as unpleasant. Under your list of known or suspected chronic effects of marijuana I would add to the last point " . . . the by-products of marijuana remain in body fat for several weeks with unknown consequences. The storage of these by-products increases the possibilities for chronic effects as well as residual effects on performance even after the effects of the drug have worn off." If I can be helpful in any way don't hesitate to call (202)334-2383. Sincerely, Queta Bond, Ph.D. Director, Divisions of Health Sciences Policy and Health Promotion and Disease Prevention