Medical Marijuana

[Guest guest]

Medical Marijuana

 

" Federal authorities should rescind their prohibition of the medical

use of marijuana for seriously ill patients and allow physicians to

decide which patients to treat. The government should change

marijuana's status from that of a Schedule I drug ... to that of a

Schedule II drug ... and regulate it accordingly. "

- The New England Journal of Medicine, January 30, 1997

 

Introduction

 

 

Marijuana prohibition applies to everyone, including the sick and

dying. Of all the negative consequences of prohibition, none is as

tragic as the denial of medicinal cannabis to the tens of thousands

of patients who could benefit from its therapeutic use.

 

 

Evidence Supporting Marijuana's Medical Value

 

 

Written references to the use marijuana as a medicine date back

nearly 5,000 years.[1] Western medicine embraced marijuana's medical

properties in the mid-1800s, and by the beginning of the 20th

century, physicians had published more than 100 papers in the Western

medical literature recommending its use for a variety of disorders.

[2]

Cannabis remained in the United States pharmacopoeia until 1941,

removed only after Congress passed the Marihuana Tax Act which

severely hampered physicians from prescribing it. The American

Medical Association (AMA) was one of the most vocal organizations to

testify against the ban, arguing that it would deprive patients of a

past, present and future medicine.[3]

 

 

Modern research suggests that cannabis is a valuable aid in the

treatment of a wide range of clinical applications.[4] These include

pain relief -- particularly of neuropathic pain (pain from nerve

damage) -- nausea, spasticity, glaucoma, and movement disorders.[5]

Marijuana is also a powerful appetite stimulant, specifically for

patients suffering from HIV, the AIDS wasting syndrome, or dementia.

[6] Emerging research suggests that marijuana's medicinal properties

may protect the body against some types of malignant tumors[7] and

are neuroprotective.[8]

 

 

Currently, more than 60 U.S. and international health organizations --

 

including the American Public Health Association [9] , Health

Canada[10] and the Federation of American Scientists[11] -- support

granting patients immediate legal access to medicinal marijuana under

a physician's supervision. (Click here for a complete listing of

organizations.) Several others, including the American Cancer

Society[12] and the American Medical Association[13] support the

facilitation of wide-scale, clinical research trials so that

physicians may better assess cannabis' medical potential. In

addition, a 1991 Harvard study found that 44 percent of oncologists

had previously advised marijuana therapy to their patients.[14] Fifty

percent responded they would do so if marijuana was legal. A more

recent national survey performed by researchers at Providence Rhode

Island Hospital found that nearly half of physicians with opinions

supported legalizing medical marijuana.[15]

 

 

Government Commissions Back Legalization

 

 

Virtually every government-appointed commission to investigate

marijuana's medical potential has issued favorable findings. These

include the U.S. Institute of Medicine in 1982[16] the Australian

National Task Force on Cannabis in 1994[17] and the U.S. National

Institutes of Health Workshop on Medical Marijuana in 1997.[18]

 

 

More recently, Britain's House of Lord's Science and Technology

Committee found in 1998 that the available evidence supported the

legal use of medical cannabis.[19] MPs determined: " The government

should allow doctors to prescribe cannabis for medical use. ...

Cannabis can be effective in some patients to relieve symptoms of

multiple sclerosis, and against certain forms of pain. ... This

evidence is enough to justify a change in the law. " [20] The Committee

reaffirmed their support in a March 2001 follow-up report criticizing

Parliament for failing to legalize the drug.[21]

 

 

U.S. investigators reached a similar conclusion in 1999. After

conducting a nearly two-year review of the medical literature,

investigators at the National Academy of Sciences, Institute of

Medicine affirmed: " Scientific data indicate the potential

therapeutic value of cannabinoid drugs ... for pain relief, control

of nausea and vomiting, and appetite stimulation. ...

Except for the harms associated with smoking, the adverse effects of

marijuana use are within the range tolerated for other

medications. " [22] Nevertheless, the authors noted cannabis

inhalation " would be advantageous " in the treatment of some diseases,

and that marijuana's short- term medical

benefits outweigh any smoking-related harms for some patients.

Predictably, federal authorities failed to act upon the IOM's

recommendations, and instead have elected to continue their long-

standing policy of denying marijuana's medical value.

 

 

Administrative Ruling Supports Medical Use

 

 

NORML first raised this issue in 1972 in an administrative petition

filed with the Drug Enforcement Administration. NORML's petition

called on the federal government to reclassify marijuana under the

Controlled Substances Act as a Schedule II drug so that physicians

could legally prescribe it. Federal authorities initially refused to

accept the petition until mandated to do so by the US Court of

Appeals in 1974, and then refused to properly process it until again

ordered by the Court in 1982.

 

 

Fourteen years after NORML's initial petition in 1986, the DEA

finally held public hearings on the issue before an administrative

law judge. Two years later, Judge Francis Young ruled that the

therapeutic use of marijuana was recognized by a respected minority

of the medical community, and that it met the standards of other

legal medications. Young found: " Marijuana has been accepted as

capable of relieving distress of great numbers of very ill people,

and doing so with safety under medical supervision. It would be

unreasonable, arbitrary and capricious for DEA to continue to stand

between those sufferers and the benefits of this substance in light

of the evidence in this record. " [23] Young recommended, " The

Administrator transfer marijuana from Schedule I to Schedule II, to

make it available as a legal medicine. "

 

 

DEA Administrator John Lawn rejected Young's determination, choosing

instead to invoke a differing set of criteria than those used by

Judge Young. The Court of Appeals allowed Lawn's reversal to stand,

effectively continuing the federal ban on the medical use of

marijuana by seriously ill patients. It is urgent that state

legislatures and the federal government act to correct this

injustice.

 

 

Public Support for Medical Marijuana

 

 

Since 1996, voters in nine states -- Alaska, Arizona, California,

Colorado, Maine, Maryland, Nevada, Oregon and Washington -- have

adopted initiatives exempting patients who use marijuana under a

physician's supervision from state criminal penalties. (Click here

for a summary of state medical marijuana laws.) In 1999, the Hawaii

legislature ratified a similar law. These laws do not legalize

marijuana or alter criminal penalties regarding the possession or

cultivation of marijuana for recreational use. They merely provide a

narrow exemption from state prosecution for defined patients who

possess and use marijuana with their doctor's recommendation.

Available evidence indicates that these laws are functioning as

voters intended, and that reported abuses are minimal.

 

 

As the votes in these states suggest, the American public clearly

distinguishes between the medical use and the recreational use of

marijuana, and a majority support legalizing medical use for

seriously ill patients. A March 2001 Pew Research Center poll[24]

reported that 73 percent of Americans support making marijuana

legally available for doctors to prescribe, as did a 1999 Gallup poll.

[25] Similar support has been indicated in every other state and

nationwide poll that has been conducted on the issue since 1995.

Arguably, few other public policy issues share the

unequivocal support of the American public as this one.

 

 

Medical Marijuana and the Supreme Court

 

 

The Supreme Court ruled on May 14, 2001 that federal law makes no

exceptions for growing or distributing marijuana by third party

organizations (so-called " cannabis buyers' cooperatives " ), even if

the goal is to help seriously ill patients using marijuana as a

medicine. Nevertheless, the Court's decision fails to infringe upon

the rights of individual patients to use medical cannabis under state

law, or the ability of legislators to pass laws exempting such

patients from criminal penalties. This fact was affirmed by Justices

Stevens, Ginsburg and Souter, who wrote in a concurring opinion: " By

passing Proposition 215, California voters have decided that

seriously ill patients and their primary caregivers should be exempt

from prosecution under state laws for cultivating and possessing

marijuana. ... This case does not call on the Court to deprive all

such patients of the benefit of the necessity defense to federal

prosecution when the case does not involve any such patients. "

 

 

NORML filed an amicus curiae (friend of the court) brief in this

case, and hoped the Court would protect California's patient-support

efforts from federal prosecution. The sad result of this decision is

that tens of thousands of seriously ill patients who use marijuana to

relieve their pain and suffering no longer have a safe and secure

source for their medical marijuana. NORML calls on our elected

officials to correct this injustice and is currently lobbying

Congress to legalize marijuana as a medicine.

 

 

Endnotes

1. L. Grinspoon and J. Bakalar. 1997. Marihuana the Forbidden

Medicine

(second edition). New Haven, CT: Yale University Press; B. Zimmerman

et al. 1998. Is Marijuana the Right Medicine for You? A Factual Guide

to Medical Uses of Marijuana. New Canaan, CT: Keats Publishing.

 

 

2. T. Mikuriya. (Ed.) 1973. Marijuana: Medical Papers 1839-1972.

Oakland: Medi-Comp Press.

 

 

3. AMA (American Medical Association) Legislative Counsel William C.

Woodword told Congress on July 12, 1937: " The obvious purpose of and

effect of this bill is to impose so many restrictions on the

medicinal

use [of cannabis] as to prevent such use altogether. ... It may serve

to deprive the public of the benefits of a drug that on further

research may prove to be of substantial benefit. "

 

 

4. Several books explore this issue in further detail. These include:

A. Mack and J. Joy. 2001. Marijuana as Medicine: The Science Beyond

the Controversy. Washington, DC: National Academy Press; L. Iverson.

2000. The Science of Marijuana. New York: Oxford University Press; B.

Zimmerman et al. 1998. Is Marijuana the Right Medicine for You?; C.

Conrad. 1997. Hemp for Health: The Medicinal and Nutritional Uses of

Cannabis Sativa. Rochester VT: Healing Arts Press; L. Grinspoon and

J.

Bakalar J. 1997. Marihuana the Forbidden Medicine; E. Rosenthal et

al.

1997. Marijuana Medical Handbook. Oakland: Quick American Archives;

and R. Mechoulam. (Ed.) 1986. Cannabinoids as Therapeutic Agents.

Boca

Raton: CRC Press.

 

 

5. NSW (New South Wales) Working Party on the Use of Cannabis for

Medicinal Purposes. 2000. Report of the Working Party on the Use of

Cannabis for Medical Purposes. Sydney: Parliament House; J. Joy et

al.

1999. Marijuana and Medicine: Assessing the Science Base. Washington,

DC: National Academy Press; House of Lords Select Committee on

Science

and Technology. 1998. Ninth Report. Cannabis: The Scientific and

Medical Evidence. London: The Stationary Office; J. Morgan and L.

Zimmer. 1997. Marijuana Myths, Marijuana Facts: A Review of the

Scientific Evidence. New York: Lindesmith Center; Grinspoon and

Bakalar. 1997. Marihuana the Forbidden Medicine.

 

 

6. Joy et al. 1999. Marijuana and Medicine: Assessing the Science

Base.

 

 

7. I. Galve-Roperph et al. 2000. Antitumoral action of cannabinoids:

involvement of sustained ceramide accumulation of ERK activation.

Nature Medicine 6: 313-319.

 

 

8. M. Van der Stelt et al. 2001. Neuroprotection by delta-9

tetrahydrocannabinol, the main active compound in marijuana, against

ouabain-induced in vivo excitotoxicity. The Journal of Neuroscience

21: 6475-6479; J. Joy et al. 1999. Marijuana and Medicine: Assessing

the Science Base.

 

 

9. APHA (American Public Health Association) Resolution 9513: " Access

to Therapeutic Marijuana/Cannabis, " adopted November 1995 states in

part, " [The APHA] encourages research of the therapeutic properties

of

various cannabinoids and combinations of cannabinoids, and ... urges

the Administration and Congress to move expeditiously to make

cannabis

available as a legal medicine. "

 

 

10. Health Canada legalized the possession and cultivation of medical

marijuana on July 31, 2001.

 

 

11. The FAS' (Federation of American Scientists) position on medical

marijuana, adopted November 1994, states in part: " Based on much

evidence, from patients and doctors alike, on the superior

effectiveness and safety of whole cannabis compared to other

medications, ... the President should instruct the NIH and the Food

and Drug Administration to make efforts to enroll seriously ill

patients whose physicians believe that whole cannabis would be

helpful

to their conditions in clinical trials, both to allow data-gathering

and to provide an alternative to the black market while the

scientific

questions about the possible utility of cannabis are resolved. "

 

 

12. In a July 24, 1997 letter to California Senator John

Vasconcellos,

American Cancer Society Legislative Advocate Theresa Renken wrote:

" [California Senate Bill] 535 focuses on medical marijuana research.

[The] American Cancer Society ... Supports S.B. 535 because it is

consistent with our long-held position of supporting research of any

agent or technique for which there may be evidence of a therapeutic

advantage. "

 

 

13. AMA (American Medical Association) Council on Scientific Affairs

1997 Report #10: Medical Marijuana contains the following statements

supporting a physician's right to freely discuss marijuana therapy

with a patient, and favoring further research into medical

marijuana's

therapeutic potential: " The AMA recommend that adequate and well-

controlled studies of smoked marijuana be conducted in patients who

have serious conditions for which preclinical, anecdotal or

controlled

evidence suggests possible efficacy, including AIDS wasting syndrome,

severe acute or delayed emesis induced by chemotherapy, multiple

sclerosis, spinal cord injury, dystonia and neuropathic pain. "

 

 

14. R. Doblin and M. Kleiman. 1991. Marijuana as anti-emetic

medicine:

a survey of oncologists attitudes and experiences. Journal of

Clinical

Oncology 9: 1275-1280.

 

 

15. Reuters News Wire. April 23, 2001. " Physicians divided on medical

marijuana. "

 

 

16. " Cannabis and its derivatives have shown promise in a varieties

of

disorders. The evidence is most impressive in glaucoma, ...

asthma, ... and in [combating] the nausea and vomiting of cancer

chemotherapy. ... Smaller trials have suggested cannabis might also

be

useful in seizures, spasticity, and other nervous system disorders. "

Conclusion of the National Academy of Sciences Institute of Medicine.

1982. Marijuana and Health. Washington, DC: National Academy Press.

 

 

17. " First, there is good evidence that THC is an effective anti-

emetic agent for patients undergoing cancer chemotherapy. ... Second,

there is reasonable evidence for the potential efficacy of THC and

marijuana in the treatment of glaucoma, especially in cases which

have

proved resistant to existing anti-glaucoma agents. Further research

is ... required, but this should not prevent its use under medical

supervision. ... Third, there is sufficient suggestive evidence of

the

potential usefulness of various cannabinoids as analgesic, anti-

asthmatic, anti-spasmodic, and anti-convulsant agents. " W. Hall et

al.

1994. The health and psychological consequences of cannabis use:

Monograph prepared for the National Task for on Cannabis. Canberra:

Australian Government Publishing Service.

 

 

18. " Marijuana looks promising enough to recommend that there be new

controlled studies done. The indications in which varying levels of

interest was expressed are the following: appetite stimulation/

cachexia, nausea and vomiting following anti-cancer therapy,

neurological and movement disorders, analgesia [and] glaucoma. "

Conclusions of the National Institutes of Health. 1997. Workshop on

the Medical Utility of Marijuana: Report to the Director. Bethesda:

National Institutes of Health.

 

 

19. House of Lords Select Committee on Science and Technology. 1998.

Ninth Report: Cannabis: the Scientific and Medical Evidence. London:

The Stationary Office.

 

 

20. " Lords Say, Legalise Cannabis for Medical Use. " 1998. Press

Release. House of Lords Select Committee on Science and Technology

Press Office.

 

 

21. " We are concerned that the MCA [Medicines Control Agency] approach

to the licensing of cannabis-based medicines ... place the

requirements of safety and the needs of patients in an unacceptable

balance. ... Patients with severe conditions such as multiple

sclerosis are being denied the right to make informed choices about

their medication. There is always some risk in taking any

medication, ... but these concerns should not prevent them from

having

access to what promises to be the only effective medication available

to them. " Conclusion of the British House of Lords Select Committee

on

Science and Technology. 2001. Second Report: Therapeutic Uses of

Cannabis. London: The Stationary Office.

 

 

22. J. Joy et al. 1999. Marijuana and Medicine: Assessing the Science

Base.

 

 

23. In the Matter of Marihuana Rescheduling Petition, Docket 86-22,

Opinion, Recommended Ruling, Findings of Fact, Conclusions of Law,

and

Decision of Administrative Law Judge, September 6, 1988. Washington,

DC: Drug Enforcement Administration.

 

 

24. Seventy-three percent of respondents supported allowing doctors

" to prescribe marijuana. " Sample size: 1,513.

 

 

25. Seventy-three percent of respondents said they " would vote for

making marijuana legally available for doctors to prescribe. " Sample

size: 1,018. Released March 1999.

 

updated: Aug 22, 2003

 

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