Medical Marijuana in the United States

Medical Marijuana

by David Ferry

As 2013 began, federal authorities were continuing their latest crackdown on dispensaries founded under Proposition 215, the 1996 ballot initiative that legalized pot for personal, medical use. (See Cal. Health & Saf. Code § 11362.5.) They said they were targeting for-profit operations that were flouting federal law. (Later in the year, the Department of Justice indicated a softer stance on marijuana – at least in other states.)

May brought defeats for pot providers at the state and local levels. First, the California Supreme Court upheld the use of zoning ordinances to prohibit dispensaries, validating more than 200 bans enacted by cities across the state since 2004. (See City of Riverside v. Inland Empire Patients Health & Wellness Center, Inc., 56 Cal. 4th 729 (2013).) Opponents of medical marijuana – including the California Narcotics Officers’ Association and the California Police Chiefs Association – praised the decision, while advocacy groups worried it would force pot patients to drive hours for a dose. “It’s pushing the patient community into the illicit market,” says Kris Hermes of Americans for Safe Access. Later that month, Los Angeles voters capped the number of pot shops allowed in the state’s largest city at 135, down from more than 700 registered there in 2012.

Advocates and opponents actually agree the state should regulate medical marijuana more heavily. Attorney David Welch, who represents patients and dispensaries in Los Angeles, says that would ensure patient access and add clarity to a legally murky business. “We want statewide control. We want rules that are concrete,” Welch says. Kim Raney, president of the state police chiefs group, says more effective regulation could help control fraud, limit the commercialization of medical pot, protect minors, and set standards for driving under the influence.

Most Californians support allowing the use of medical marijuana, and a Field Poll in February found 54 percent even say pot should be legalized for recreational use, as it was last year in Colorado and Washington state. But federal authorities still classify it as a Schedule 1 drug, meaning it has “no currently accepted medical use and a high potential for abuse.” In June the U.S. Attorney’s office sent a new round of warning letters to more than 100 dispensaries in and around Los Angeles, threatening some of their landlords with asset seizure and jail time for hosting commercial marijuana operations. The DOJ seemed to relax in August, saying it would respect Colorado’s and Washington’s new pot laws if the states set up strong regulatory systems. But in the Northern District of California, the office of U.S. Attorney Melinda Haag said she doesn’t expect “a significant change” on marijuana enforcement.

At the state level, nothing changed in 2013. In June, the Assembly rejected a bill from Assemblyman Tom Ammiano (D-San Francisco) to create a division to regulate medical marijuana within the Department of Alcoholic Beverage Control. In August, Senate President pro Tem Darrell Steinberg (D-Sacramento) put off a proposal to exempt dispensaries from prosecution as long as they abide by the state attorney general’s security guidelines for medical marijuana. And September saw the defeat of another bill Ammiano sponsored after seeing the DOJ’s apparent shift; he says he’ll introduce it again next year. And at least one pot measure is likely to be on the statewide ballot in 2014.

Medical Marijuana Crackdown in California in 2011

The crackdown that shuttered in 2011 hundreds of storefront shops and large-scale medical marijuana growers in certain regions was a homegrown request from local governments, with a boost from California’s U.S. attorneys, not a top-down directive from the White House.

Responding to complaints from city and county officials and residents who opposed medical marijuana, representatives for the state’s four U.S. attorneys in 2011 held a series of joint meetings to develop a response.

After the proposed campaign was drawn up, Eastern District U.S. Attorney Benjamin B. Wagner, whose district spans 15 counties from Bakersfield to the Oregon border and who sits on an advisory committee to U.S. Attorney General Holder, went to Washington, D.C. to personally present the plan to Holder and other top Justice Department officials.

Obama Administration Position

Marijuana and other drugs are addictive and unsafe, especially for use by young people. Unfortunately, efforts to “medicalize” marijuana have widened the public acceptance and availability of the drug.

There is no substitute for the scientific approval process employed by the FDA. For a drug to be made available to the public as medicine, the FDA requires rigorous research followed by tests for safety and efficacy. Only then can a substance be classified as medicine and prescribed by qualified health care professionals to patients.

In the wake of state and local laws that permit distribution of “medical” marijuana, dozens of localities have been left to grapple with poorly written laws that bypass the FDA process and allow marijuana to be used as a so-called medicine. John Knight, director of the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston, recently wrote: “Marijuana has gotten a free ride of sorts among the general public, who view it as non-addictive and less impairing than other drugs. However, medical science tells a different story.”

Similarly, Christian Thurstone, a board-certified Child and Adolescent Psychiatrist, an Addiction Psychiatrist, and also an Assistant Professor of Psychiatry at the University of Colorado, said:

“In the absence of credible data, this debate is being dominated by bad science and misinformation from people interested in using medical marijuana as a step to legalization for recreational use. Bypassing the FDA’s well-established approval process has created a mess that especially affects children and adolescents. Young people, who are clearly being targeted with medical marijuana advertising and diversion, are most vulnerable to developing marijuana addiction and suffering from its lasting effects.” —Dr. Christian Thurstone, MD, Assistant Professor at Denver Health & Hospital Authority

In the United States, the Drug Enforcement Administration (DEA) has approved 109 researchers to perform bona fide research with marijuana, marijuana extracts, and marijuana derivatives such as cannabidiol and cannabinol. Studies include evaluation of abuse potential, physical/psychological effects, adverse effects, therapeutic potential, and detection. Fourteen researchers are approved to conduct research with smoked marijuana on human subjects.

As a result of this extensive research, several marijuana-based medications have been found to be safe and effective by the FDA and are available for doctors to prescribe. Dronabinol, a synthetic form of tetrahydrocannabinol (THC), the most active ingredient in marijuana, is used to treat nausea and vomiting caused by chemotherapy. It is also used to treat loss of appetite and weight loss in people who have AIDS. Nabilone, a synthetic drug that mimics marijuana’s main ingredient, is also prescribed to treat nausea and vomiting caused by cancer chemotherapy. Other medications based on one or more marijuana components are being carefully studied.

Aside from the problems accompanying the commercialization of marijuana, smoking any drug is unhealthy. That is why no major medical association has come out in favor of smoked marijuana for widespread medical use. For example, the American Cancer Society, American Glaucoma Foundation, National Pain Foundation, National Multiple Sclerosis Society, and other medical societies are not in favor of smoked “medical” marijuana. The American Medical Association has called for more research on the subject, with the caveat that this “should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.”

According to the American Academy of Pediatrics:

Evidence suggests that pediatricians should continue their vigilant efforts to prevent the use of this drug by young people. The abuse of marijuana by adolescents is a major health problem with social, academic, developmental, and legal ramifications. Marijuana is an addictive, mind-altering drug capable of inducing dependency. Pediatricians are obligated to develop a reasoned approach to dealing with its use by children and adolescents so they can provide appropriate care and counsel… Additional reasons for concern and counsel include anxieties and uncertainties about the potential harm that marijuana use may cause to adolescents during a period of rapid change in hormonal secretion, possible teratogenicity, and the known consequences of long-term use.

This Administration joins major medical societies in supporting increased research into marijuana’s many components, delivered in a safe (non-smoked) manner, in the hopes that they can be available for physicians to legally prescribe when proven to be safe and effective. Outside the context of Federally approved research, the use and distribution of marijuana is prohibited in the United States.