Many concerns are based on a growing amount of scientific literature about risks of marijuana use that were not recognized when Bob Dylan laughingly advised in song that "everybody must get stoned."

The PIER (Portland Identification and Early Referral) program, with which I am associated, is working to prevent first psychotic episodes and hospitalizations in young people in the greater Portland area.

Marijuana use can create such an occurrence. A first psychotic episode might be the start of a serious lifelong mental illness, which can rob a young person of the ability to hold a job, get married and live an independent life.

When heavy marijuana use starts in early adolescence, the risk of the user developing schizophrenia or another major psychiatric illness may be up to five or six times the risk in the general population of a similar age.

New brain imaging techniques show drug use to be particularly damaging to regions that have not yet fully matured in young people.

The pre-frontal cortex is the part of the developing brain that makes us most fully human. It is responsible for judgment, planning and forethought, regulation of emotional life, and many other functions. It constantly evaluates and integrates input from lower or more primitive brain centers.

Through the PIER program, we have discovered that some of the least favorable outcomes, those interfering with treatment, in the at-risk population, people aged 12 to 25 years old, can be laid squarely at the doorstep of drug use, primarily marijuana.

Some examples include dishonesty about the true extent of one's substance use; quitting prescribed medications without disclosing having done so; and frequent failure to keep individual or group appointments.

Marijuana use can result in a recurrence of paranoid delusions, hallucinations or other frightening psychotic level experiences, even in those individuals whose early "red flag" symptoms have been well-controlled with medication and the psychosocial supports that PIER offers.

Marijuana's role as a "gateway drug" is well-known, and the dangers of its psychological and physical addiction are under-recognized but significant. The drug, however, also may cause memory impairment and erosion of other cognitive functions. Regular use can diminish motivation, derail educational or vocational aspirations, impair relationships and arrest personality growth.

As the consulting psychiatrist at the old Maine Youth Center, I often heard wishful, and hopelessly unrealistic, boasts from chronic marijuana users soon to be discharged. They planned to "get an apartment, a great job, and party every night" even though they had virtually no employable skills or work experience, poor to absent emotional controls, and little capacity for any emotional intimacy. Their legal problems and incarceration associated with marijuana use already had compromised their own future and provoked worry, conflict and turmoil for their families.

A first psychotic episode, however, dwarfs all other shorter-term problems with its ominous potential for kindling a severe and persistent mental illness.

As with all other medical illnesses, prevention and early intervention makes far better sense than treatment after the fact. I call it "putting a guard rail at the top of the cliff instead of parking ambulances underneath it."

Professionals also are concerned that the marijuana people smoke today is "not your mother's marijuana."

The National Institute of Drug Abuse has found a four-fold increase in the strength of marijuana during the many years that street samples have been analyzed.

A recent article in the British Journal of Psychiatry also warns that levels of the active ingredient, tetrahydrocannabinol (THC), are much higher now in Britain than in samples from a decade ago. THC is found in marijuana leaves, seeds and stems, and in the concentrated forms of the plant's resin, such as hashish.

Those charged with implementing Maine's Medical Marijuana Law need to consider the significant risks the drug poses for young people. There are almost no legitimate medical reasons for marijuana use by people younger than 18.

Excluding those minors from accessing medical marijuana could prevent the opening of a truly dangerous Pandora's Box.

James H. Maier, M.D., has been a child and adult psychiatrist practicing in Portland for almost four decades, and the father of a son who died last year from a psychotic recurrence of bipolar disorder. He lives in Scarborough.

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