With increasing frequency, the editorial pages of local and national newspapers are featuring articles on liberalizing the use of marijuana. In view of the 2013 legislative action in the states of Washington and Colorado — plus a failed push in the state of Oregon — to provide legalization for recreational use as well as for medical care, focus on the ongoing debate is highly appropriate. However, support for medical purposes is a markedly different matter than establishing and trying to control marijuana availability for recreational use. Senior legislators, judges and candidates for higher offices who are approving and promoting recreational legality and less criminal consequence have decidedly forgotten the psyche of their youth with recognized lack of reality about mortality and the tendency — or even need — of teenagers to "explore" new experiences. Well before legalization in Colorado, if one simply strolled campgrounds, ski slopes or Friday evening teenage hangouts, the distinct odor of marijuana would soon become evident.

As has been carefully documented in medical literature since 1942, the toxicities of marijuana are well established. Within minutes, a desired sense of euphoria will develop, which is soon accompanied by slowing of neural impulse transmissions to and within the brain and delayed reflexes, akin to alcohol ingestion. Admittedly marijuana does not possess the severe addictive properties with the degree of withdrawal problems that alcohol and so-called "hard" drugs impose. Nevertheless, both physical and psychiatric symptoms and responses occur that vary not only with the type and purity of hemp sources, but also with the dose and — unfortunately often not appreciated — with the personality and stability of the teenager. A huge range of reactions can evolve from inane giggling and loquaciousness with a sense of wellbeing to overt depression, psychosis and thoughts of suicide or physical injury to others, depending on the level of personality distortion.

As a physician with primary emphasis on the care of infants, children and teenagers for over 50 years, I greatly fear the present "fad" for legalizing recreational marijuana. For the 2014 and 2016 election campaigns, this will be an increasingly prominent but badly misguided issue to gain favor among voters. Moreover, one must ask the questions of who gains the most from marijuana financing, who is the most eager to propel its use as a recreational enjoyment instead of medical care for the pain of disease or the terminal illness of the aged? Does it make sense that marijuana will become less habitual and harmful with less restriction, or that emergency rooms and trauma centers will incur a lower incidence of knife and gun injuries and deaths from gangs and the corruption often reported among greedy bureaucrats and authorities, even smuggling drugs in jails?

Obviously adults devise their own faulty judgments and decisions, but youth is naive in not possessing the important knowledge or experience to generate correct decisions with easy availability of "pot" on the streets. One can predict in the states allowing recreational drug use that teenage accidents in cars, trucks, on bicycles or just walking will result in increasing serious injuries not only to themselves but to others. While commanding vehicles and using power tools and equipment, whether for hobbies, during school labs or for job duties, among students a rising need for medical care or surgery due to avoidable injuries, if not mortality, can be predicted. Parents, teachers, police and judges can anticipate lack of attention to studying, more classroom trouble-making, a rising school dropout rate and heightened gang and gangster activities. Furthermore, social workers and psychiatric services will incur striking upsurges in patient numbers and consequences with their mandatory mounting budgetary costs. Most critical, legal recreational marijuana represents an easy "next step" and provides additional "oil" onto the slippery slope to the use of hard narcotics among our youthful and naive teenagers. Let us not regress to such a monumental physical and mental mistake.

Dr. J. Laurance Hill, Baltimore

The writer is a professor emeritus of pediatric, thoracic and general surgery at the University of Maryland.

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