The hallmark of a good health care delivery system is preventing as much illness as possible. This objective is achieved by means of immunizations, regular routine checkups, and educational programs.

Education programs regarding marihuana have been notably ineffective, partly due to an exaggeration of the effects of using the drug and partly because the effects of the opiates and marihuana have been compared inaccurately. As a result, many persons have developed a conscious or unconscious denial of nearly all dangers associated with marihuana use. Some educators believe that drug programs merely sharpen the curiosity of children and tempt them to use drugs which they otherwise would not use. Others believe that the responsibility should not be lodged with the schools but rather with the home or the community.

Because of the uncertainty about the efficacy of these, programs, education programs dealing with drug usage simply do not exist in the school systems of a number of major cities; in others, token programs are offered in response to the demand that something be done. Health educators have the responsibility to help this vulnerable group of Americans become aware of all options so that they are able to make enlightened choices.

The educational role of physicians and other clinical health personnel should not be underestimated. The National Survey shows that the public believes young people should receive information concerning marihuana first from schools and second from family physicians. The health professional has a unique position as both teacher and confidant to an individual struggling with a "drug abuse" problem. Honest, sincere, and confidential guidance from a physician may prevent later difficulties to both the individual and the society. The Commission believes that action must be taken to inform and support the physician in his role as confidant and counsellor to those seeking assistance.

Considering the current patterns of marihuana use in the United States, the need for treatment and/or rehabilitation does not appear necessary for the vast majority of persons who are experimenting with the drug or using it intermittently. Rather, these persons need to be realistically educated regarding the potential hazards they face. To this end, a comparison of the personal and public health risks of marihuana and those of heroin, cocaine, amphetamines, and other drugs would be useful.

A concern for public health also requires thoughtful consideration of the consequences of any change in public policy. We have objectively appraised the present scope of public health concerns concluding that the most serious risk lies with the population of heavy users, which is, at this time, quite small in this country.

Now, we must soberly consider the likely effect of adoption of a social policy of neutrality or approval toward marihuana use. Any legal policy which institutionalizes availability of the drug carries with it a likely increase in the at-risk population. This factor is not necessarily conclusive in itself , but it does weigh heavily for the policymaker. Even though the proportion of heavy users in the total using population might not increase if such a social or legal policy were adopted, the absolute number of heavy users would probably increase. Thus, we would have an increase in the at-risk segment of the populace. A greater stress would thereby be placed on the general health care delivery system in all the areas of health concern described earlier.

Regardless of emerging social policy, greater emphasis must be placed on educating our youth regarding the prospective dangers inherent in expanded marihuana use. This anticipatory guidance can serve to defuse or at least forestall a potentially serious social phenomenon.