Whether marijuana should be made legally available for doctors to prescribe as a drug for the treatment of certain medical conditions is hotly debated among politicians, lawyers, scientists, physicians, and members of the general public.
A look at the U.S. legal landscape surrounding medical marijuana shows a complex and rapidly changing scene. Fourteen states—California, Alaska, Oregon, Washington, Maine, Hawaii, Colorado, Nevada, Vermont, Montana, Rhode Island, New Mexico, Michigan, and, most recently, New Jersey—allowed its use in 2010. At least a dozen more were considering eliminating criminal penalties for using marijuana for medical purposes. Its therapeutic use is constantly under fresh review. Recently, the American Medical Association (AMA) adopted a resolution urging review of marijuana as a Schedule I controlled substance.
II. The Debate
III. “Medical Use” Laws
The cannabis plant (marijuana) has been cultivated for psychoactive, therapeutic, and nondrug uses for over 4,000 years. The primary psychoactive drug in the plant is tetrahydrocannabinol (THC)—a molecule that produces a “high” feeling when ingested and, as is most often the case with cannabis, when inhaled in smoke or vapor form. There are hundreds of other chemical components in marijuana, from vitamin A to steroids, making it somewhat unclear how the human body will react physiologically to short- and long-term use of the substance.
Supporters of medical marijuana argue that the drug is acceptable for medical treatment, citing reports and several scientific peer-reviewed studies. There has been considerable interest in the use of marijuana for the treatment of glaucoma, neuropathic pain, AIDS “wasting,” symptoms of multiple sclerosis, and chemotherapy-induced nausea, to name a few. The government opposes the move.
The Food, Drug, and Cosmetic Act—a key law used by the U.S. Food and Drug Administration (FDA) in carrying out its mandate—requires that new drugs be shown to be safe and effective before being marketed in the United States. These two conditions have not been met through the formal processes of the FDA for medical marijuana, and it is therefore not an FDA-approved drug.
Proponents of medical marijuana argue that the drug would easily pass the FDA’s risk– benefit tests if the agency would give the drug a fair and prompt review. One significant hurdle to obtaining FDA approval is the fact that marijuana has been listed as a Schedule I drug in the Controlled Substances Act (CSA) since 1972. As such, it is considered by the U.S. government to have a “lack of accepted safety,” “high potential for abuse,” and “no currently accepted medical use.” Schedule I drugs, however, have occasionally been approved by the FDA for medical use in the past, with significant restrictions on how they must be manufactured, labeled, and prescribed.
At present, the possession and cultivation of marijuana for recreational use is illegal in all 50 states and in most countries around the world. Further, representatives of various agencies in the current U.S. federal government have consistently stated that there is no consensus on the safety or efficacy of marijuana for medical use, and without sufficient evidence and full approval by the FDA, the government cannot allow the medical use of a drug that may be hazardous to health. Some say that the availability of various other FDA-approved drugs, including synthetic versions of the active ingredients in marijuana, make the use of marijuana unnecessary. They claim furthermore that marijuana is an addictive “gateway” drug that leads to abuse of more dangerous drugs and that it injures the lungs, damages the brain, harms the immune system, and may lead to infertility. The use of marijuana for some medical purposes is allowed in Canada, however, though under strict Health Canada regulations.
Proponents maintain that the approved synthetic versions of marijuana are not chemically identical to the actual plant and therefore not as medically beneficial. They further argue that many of the claims of harm either have not been shown to be true or are not at all unique to marijuana but are comparable to the potential side effects of a number of alternative drugs currently on the market. They insist that the government is setting unfair standards for medical marijuana for sociopolitical rather than scientific reasons. They point to a respected scientific report, published in 1999 by the U.S. Institute of Medicine (IOM) and commissioned by the U.S. government through a $1 million grant, which recommends that under certain conditions marijuana should be made medically available to some patients, even though “numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease.”
“Medical Use” Laws
Despite a broad federal stance in opposition to the distribution, possession, and cultivation of marijuana for any drug-related use, many U.S. states have enacted their own “medical use” laws. The level of permissibility for marijuana use in state laws varies. Some states, such as California, allow doctors to prescribe marijuana very liberally, whereas others, such as New Mexico, allow access to medical marijuana only for patients suffering pain as a result of a few specific conditions. The enactment of medical marijuana state statutes that conflict with the federal Controlled Substances Act has given rise to lawsuits brought by both sides in the controversy.
The issue has gone so far as to reach the U.S. Supreme Court in the case of Gonzales v. Raich. In that 2005 case, the Court ruled that Congress has the authority to prohibit the cultivation and use of marijuana in California and across the United States despite laws in California allowing the use of medical marijuana. the court did not require California to change its laws, however. As a result, both the California medical-use statutes and the conflicting federal laws remain in force today. Some doctors in California continue to prescribe medical marijuana through the state’s program, and the federal government’s Drug Enforcement Administration (DEA) continues to enforce the federal statute in California against those who choose to prescribe, possess, or cultivate marijuana for medical use. The issue remains largely undecided in law.
In Gonzales v. Raich, the Supreme Court did state that Congress could change the federal law to allow the medical use of marijuana if it chose to do so. Congress has voted on several bills to legalize such use, but none has been passed. Most recently, a coalition has petitioned the U.S. government to change the legal category of marijuana from “Schedule I” to a category that would permit physicians to prescribe marijuana for patients they believe would benefit from it. Given recent trends, it is unlikely that the federal government will respond entirely favorably to this petition; it is equally unlikely, however, that supporters of medical marijuana will be quick to abandon their cause.
- Chapkis, Wendy, and Richard J. Webb, Dying to Get High: Marijuana as Medicine. New York: New York University Press, 2008.
- Controlled Substances Act, U.S. Code Title 21, chapter 13.
- Federal Food, Drug, and Cosmetic Act, U.S. Code Title 21, chapter 9.
- Fielding, Amanda, ed., Cannabis Policy: Moving Beyond Stalemate. New York: Oxford University Press, 2010.
- Gonzales v. Raich (previously Ashcroft v. Raich), 545 U.S. 1 (2005).
- Hoff man, D., and Webber, E., “Medical Marijuana and the Law.” New England Journal of Medicine 362, no. 16 (2010): 1453–1457.
- Joy, Janet Elizabeth, Stanley J. Watson, and John A. Benson, Marijuana and Medicine: Assessing the Science Base. Institute of Medicine Report. Washington, DC: National Academies Press, 1999.