state-by-state medical marijuana laws
TRANSCRIPT
STATE-BY-STATE
MEDICAL MARIJUANA LAWS:
How To Remove the Threat of Arrest
Marijuana Policy Project
February 2001
Written by Richard Schmitz and Chuck Thomas
Edited by Robert Kampia
“I believe each state can choose that decision as they so choose.”— George W. Bush in “Bush Backs States’ Rights on Marijuana: He Opposes
Medical Use But Favors Local Control,” Dallas Morning News (10/20/99)
Kenny and Barbra Jenks were
arrested for using medical
marijuana to treat AIDS wasting
syndrome in Florida in 1990.
Jim Montgomery, who is paralyzedfrom the chest down, was arrestedand imprisoned in Oklahoma in 1993
for using medical marijuana to treat
pain and spasticity.
Hazel Rodgers legally used marijuana to
treat glaucoma after California voters
passed a medical marijuana ballot
initiative in 1996.
Jim Harden needs medical
marijuana to treat the
pain and muscle spasms
caused by a broken back
and other injuries.
Cheryl Miller was arrested in March
1998 for using marijuana in Washington,
D.C., to treat multiple sclerosis.
Renee Emry was arrested in September 1998
for smoking one marijuana cigarette in
Washington, D.C., to treat multiple sclerosis.
Bill Anderson was
arrested in 1997 for
using marijuana in
Michigan to treat the
pain caused by massive
head injuries.
Richard Brookhiser, senioreditor of National Review, used
medical marijuana during cancer
chemotherapy in the early 1990s.
Calvin Nokes uses
marijuana to treat AIDS
wasting syndrome.
➤
➤
Should these medical marijuana users be treated like criminals?
Marijuana can treat the symptoms of cancer, AIDS, multiple sclerosis, glaucoma, and other
serious illnesses. Doctors often recommend it when other medicines have failed to help.
More than 100,000 Americans are already using medical marijuana.
“We concluded that there are some limitedcircumstances in which we recommendsmoking marijuana for medical uses.”
— National Academy of Sciences’ Institute ofMedicine, March 17, 1999
Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington all have effective medical
marijuana laws. And every nationwide survey of voters shows at least 60% support. Yet most state
governments continue to wage war on marijuana-using patients!
Table of Contents
Executive Summary .......................................................................................................................................iii
Overview.........................................................................................................................................................1
Marijuana’s medical uses ................................................................................................................................1
Criminalizing patients ....................................................................................................................................1
Changing federal law......................................................................................................................................2
Changing state laws: Past efforts ....................................................................................................................2
Changing state laws: Since 1996 ....................................................................................................................3
What the new state laws do............................................................................................................................3
Conflict between new state laws and federal law...........................................................................................4
Court rulings have not overturned state laws ................................................................................................5
Overview of kinds of state laws ......................................................................................................................5
Where things are going from here................................................................................................................ 10
Maps
States with effective medical marijuana laws.................................................................................................6
States with other medical marijuana laws......................................................................................................7
States that considered medical marijuana legislation during the 1999-2000 legislative sessions ............... 10
Tables
Table 1: Effective medical marijuana laws in eight states..............................................................................8
Table 2: Tally of state medical marijuana laws ............................................................................................ 11
Appendices
Appendix A
States with effective medical marijuana laws (removal of criminal penalties) .................................... A-1
States with medical marijuana research laws (therapeutic research programs) ................................... A-3
States with symbolic medical marijuana laws....................................................................................... A-5
States in which medical marijuana laws have expired or have been repealed..................................... A-8
States that have never had medical marijuana laws............................................................................. A-10
States that have passed non-binding resolutions urging the federal government to make marijuana medically available .................................................................................................. a-10
Appendix B: Medical marijuana briefing paper ....................................................................................... B-1
Appendix C: Excerpts from the Institute of Medicine’s 1999 report ....................................................... C-1
Appendix D: Surveys of public support for medical marijuana ................................................................ D-1
Appendix E: The Controlled Substances Act (and drug schedules) ....................................................... E-1
Appendix F: How the effective laws are currently working..................................................................... F-1
Appendix G: Types of legal defenses afforded by effective state medical marijuana laws ....................... G-1
i
Table of Contents (continued)
Appendix H: Types of physician documentation required to cultivate, possess, or usemedical marijuana ............................................................................................................... H-1
Appendix J: Federal litigation and other federal attempts to thwart effective state medicalmarijuana laws ..................................................................................................................... J-1
Appendix K: Therapeutic research programs ........................................................................................... K-1
Appendix L: Medical necessity defense.................................................................................................... L-1
Appendix M: State medical marijuana legislation considered during the 1999-2000 legislativesessions................................................................................................................................. M-1
Appendix N: Resolution to protect seriously ill people from arrest and imprisonment for usingmedical marijuana ............................................................................................................... N-1
Appendix O: Initiative states .................................................................................................................... O-1
Appendix P: Responses to anti-medical marijuana arguments ................................................................ P-1
Appendix Q: Partial list of organizations with favorable positions on medical marijuana ...................... Q-1
Appendix R: Model medical marijuana bill ............................................................................................. R-1
Appendix S: Analysis of bill ..................................................................................................................... S-1
ii
Executive Summary
• Favorable medical marijuana laws have been enacted in 35 states since 1978. However, most of theselaws are ineffectual, due to the federal government’s overarching prohibition. (Five of these lawshave since expired or been repealed.)
• Currently, 30 states and the District of Columbia have laws on the books that recognize marijuana’smedical value:
— Twelve states with “Therapeutic Research Program” laws are nevertheless unable to give patientslegal access to medical marijuana because of federal obstructionism.
— Ten states and the District of Columbia have symbolic laws that recognize marijuana’s medicalvalue but fail to provide patients with protection from arrest.
— And, since 1996, eight states have enacted laws that effectively allow patients to use medicalmarijuana despite federal law.
• The effective medical marijuana laws were enacted through ballot initiatives in Alaska, California,Colorado, Maine, Nevada, Oregon, and Washington. In Hawaii, an effective law was passed by thelegislature and signed by the governor in June 2000.
• To be effective, a state law must remove criminal penalties for patients who use, possess, and growmedical marijuana with their doctors’ approval.
— Even though patients can still be penalized for violating federal marijuana laws, states are notrequired to have laws that are identical to federal law.
— Because 99% of all marijuana arrests in the nation are made by state and local (not federal)officials, properly worded state laws can effectively protect 99 out of every 100 medical marijuanausers who otherwise would have been prosecuted.
• Ultimately, federal law should be changed to treat marijuana like any other legal medication,available through pharmacies upon a doctor’s prescription. However, the federal governmentcurrently refuses to budge. In the meantime, the only way to protect marijuana-using patients fromarrest is through legislation in the states.
• This report describes all favorable medical marijuana laws ever enacted in the United States, detailsthe differences between effective and ineffective state laws, and explains what must be done to givepatients immediate legal access to medical marijuana. Accordingly, a model bill and a compilation ofresources for effective advocacy are provided.
iii
Overview Thousands of patients and their doctors havefound marijuana to be beneficial in treating thesymptoms of AIDS, cancer, multiple sclerosis,glaucoma, and other serious conditions.3 For manypeople, marijuana is the only medicine with asuitable degree of safety and efficacy.
Despite marijuana’s widely recognizedtherapeutic value, the medical use of marijuanaremains a criminal offense under federal law.Nevertheless, favorable medical marijuana lawshave been enacted in 35 states since 1978.1
In March 1999, the National Academy ofSciences’ Institute of Medicine (IOM) released itslandmark study, Marijuana and Medicine: Assessing
Most of the favorable state laws areineffectual, due to the federal government’soverarching prohibition. Fortunately, since 1996,
the Science Base. Thescientists who wrote thereport concluded that “thereare some limitedcircumstances in which werecommend smokingmarijuana for medical uses.”4
eight states have found a wayto help seriously ill peopleuse medical marijuana withvirtual impunity despitefederal law.2
The most cost-effective way to allowpatients to use medical marijuana isfor state legislatures to pass billssimilar to the law enacted by theHawaii legislature in June 2000This report analyzes the
existing federal and statelaws and describes what can
Accordingly, publicopinion polls typically find
be done to give patients legal access to medicalmarijuana. In the near future, the most cost-effective way to allow patients to use medicalmarijuana is for state legislatures to pass billssimilar to the law enacted by the Hawaiilegislature in June 2000.
that more than 60% of the American peoplesupport legal access to medical marijuana.5
Criminalizing patients
The federal marijuana penalties are up to ayear in prison for as little as one marijuanacigarette, and up to five years for growing evenone plant. There is no exception for medical use,and the laws are similar in most states.
Accordingly, MPP has prepared samplelegislation which would effectively removecriminal penalties for the medical use of marijuanain any given state.
State and local police make approximately700,000 marijuana arrests in the United Stateseach year, more than 600,000 of which are forpossession (not sale or manufacture).6 Even if onlyone percent of those arrested were using marijuanafor medical purposes, then there are more than6,000 medical marijuana arrests every year!
Marijuana’s medical uses
Marijuana has a wide range of therapeuticapplications, including:
• relieving nausea and increasing appetite;
• reducing muscle spasms and spasticity;
• relieving chronic pain; and
• reducing intraocular (“within the eye”)pressure.
3See Appendix B for a more detailed briefing paper aboutmarijuana’s medical uses.4See Appendix C for excerpts from the IOM report.
1See Appendix A for a chart of all 50 state laws. 5See Appendix D for the results of major public opinionpolls.2See Table 1, page 8, for details on the eight effective state
laws. 6FBI Uniform Crime Reports, Crime in the United States:1999, published in October 2000.
1
Until a more sympathetic president or Congress isin power, there is little chance of changing federallaw to give patients legal access to medicalmarijuana. Consequently, the greatest chance ofsuccess is in the states.
However, there are several other ways tochange federal law to give patients legal access tomedical marijuana10:
• Since FDA is part of the U.S. Departmentof Health and Human Services (HHS), theU.S. Secretary of Health can declare thatmarijuana meets sufficient standards ofsafety and efficacy to warrant rescheduling.
Changing federal law
The federal Controlled Substances Act of1970 establishes a series of five “schedules”(categories) into which all illicit and prescriptionsubstances are placed. Marijuana is currently inSchedule I, defining the substance as having ahigh potential for abuse and no currently acceptedmedical use in treatment in the United States.7
The federal government does not allow Schedule Isubstances to be prescribed by doctors or sold inpharmacies. Schedule II substances, on the otherhand, are defined as having accepted medical use“with severe restrictions.” Schedules III, IV and Vare progressively less restrictive.
• Since Congress created the ControlledSubstances Act (CSA), Congress can changeit. Some possibilities include: passing a bill tomove marijuana into a less restrictiveschedule; moving marijuana out of the CSAentirely; or even replacing the entire CSAwith something completely different. Inaddition, Congress can remove criminalpenalties for the medical use of marijuanaregardless of what schedule it is in.
• HHS can allow patients to apply for specialpermission to use marijuana on a case-by-case basis. In 1978, the InvestigationalNew Drug (IND) compassionate accessprogram was established, enabling dozens ofpatients to apply for and receive marijuanafrom the federal government. Unfortunately,the program was closed to all new applicantsin 1992, and only eight patients remain inthe program.
The federal Drug EnforcementAdministration (DEA) has the authority to movemarijuana into a less restrictive schedule. Afteryears of litigation, it has essentially beendetermined that DEA will not move a substanceinto a less restrictive schedule without an officialdetermination of “safety and efficacy” by the Foodand Drug Administration (FDA).8
Unfortunately, current federal researchguidelines make it nearly impossible to dosufficient research to meet FDA’s exceedinglyhigh standard of medical efficacy for marijuana.9
Since 1995, MPP has been helping scientistsattempt to navigate the federal research obstacles,and it has become clear that it will take at least adecade—if ever—for FDA to approve the use ofnatural marijuana as a prescription medicine.
All of these routes have been tried—andfailed. Until a more sympathetic president orCongress is in power, there is little chance ofchanging federal law to give patients legal accessto medical marijuana. Consequently, the greatestchance of success is in the states.
Changing state laws: Past efforts
States have been trying to give patients legalaccess to marijuana since 1978. By 1991, favorablelaws had been passed in 34 states and the Districtof Columbia. (The 35th state, Hawaii, did notenact its law until 2000.) Unfortunately, due tothe overarching federal restrictions, most of these
7See Appendix E for more details on the federal ControlledSubstances Act.8Appendix B provides more information about this litigation.9See “Suggested Revisions to the HHS Medical MarijuanaResearch Guidelines,” which may be obtained by contactingMPP or viewing http://www.mpp.org/guidelines. 10Appendix B details some of these other routes.
2
laws have been largely symbolic, with little or nopractical effect.
a state legislature. Hawaii’s governor, whosubmitted the original bill and signed the finalmeasure into law on June 14, said, “The idea ofusing marijuana for medical purposes is one that’sgoing to sweep the country.”
For example, several states passed laws statingthat doctors may “prescribe” marijuana. However,federal law prohibits doctors from writing“prescriptions” for marijuana—so doctors areunwilling to risk federal sanctions for doing so.Furthermore, even if a doctor would give a patientan official “prescription” for marijuana, the statesdid not account for the fact that it is a crime forpharmacies to distribute it, so patients would haveno way to legally fill their marijuana prescriptions.(See “Overview of kinds of state laws” on page 5.)
More than 51 million Americans—19% of theU.S. population—now live in the eight states wheremedical marijuana users are protected by state law.
What the new state laws do
The seven state initiative-created laws andthe Hawaii law are similar in what theyaccomplish.11
Changing state laws: Since 1996 Each of the eight states allows patients to grow,possess, and use medical marijuana if approved by amedical doctor. Patients may also be assisted by acaregiver, who is authorized to help the patientgrow, acquire, or consume medical marijuana.Further, physicians are immune from liability fordiscussing or recommending medical marijuana inaccordance with the law.
The tide began to turn in 1996 with thepassage of a California ballot initiative. Californiabecame the first state to effectively removecriminal penalties for qualifying patients whogrow, possess, and use medical marijuana. Toqualify, the law specified that patients need adoctor to “recommend” marijuana. By avoidingthe word “prescribe,” doctors do not need toviolate federal law in order to help their patients.(Of note, Arizona voters passed a medicalmarijuana initiative at the same time, but itturned out to be only symbolic because it used theword “prescribe” rather than “recommend.”)
To qualify for protection under the law,patients must have documentation verifying theyhave been diagnosed with a specified seriousillness. Most states require a statement of approvalsigned by the patient’s physician, but some permita patient’s pertinent medical records to serve asvalid documentation. To help law enforcementidentify qualifying patients, some states haveimplemented formal state registry programs whichissue identification cards to registered patients andtheir caregivers.
Over the next four years, seven states and theDistrict of Columbia followed in California’sfootsteps. Alaska, Oregon, Washington, and theDistrict of Columbia passed similar initiatives in1998. Maine passed an initiative in 1999, whileColorado and Nevada followed suit in 2000. Eachstate approved its initiative by a wide margin, andno state has rejected an initiative that solelyaddressed medical marijuana.
Patients’ marijuana possession and cultivationlimits are generally restricted to a concrete number:1-3 ounces of usable marijuana and
(Congress was able to prevent the D.C.initiative from taking effect, because it is adistrict, not a state, and is therefore subject tostrict federal oversight.)
11See Table 1 on page 8 for specifics on each state law. Alsosee Appendix F for how these laws are working in the realworld.
To qualify, the law specified that patients need adoctor to “recommend” marijuana. By avoiding theword “prescribe,” doctors do not need to violatefederal law in order to help their patients.
Hawaii broke new ground in 2000, when itbecame the first state to enact a law to removecriminal penalties for medical marijuana users via
3
Some believe that the federal governmentcan nullify those laws, or that the lawshave no real value in the face of conflictingfederal law. That is simply not the case.
individuals who can readily show that they arequalified patients, eliminating the need for a trial.Further, patients in some of the eight states havean exemption from prosecution, although this levelof legal protection is usually reserved for those whoare registered with the state.12
6-7 plants, three of which may be mature. Twostates, Washington and California, have conceptualmarijuana limits, respectively permitting a “sixty daysupply” and enough “marijuana for the personalmedical purposes of the patient.”
Conflict between new state laws andfederal law
Regardless of whether patients grow theirown, get it from a caregiver, or buy it on thecriminal market, a patient in possession of anallowable quantity of marijuana and otherwise incompliance with the law is typically protectedfrom arrest and/or prosecution.
With the recent advent of state laws toprotect patients who grow, possess, and usemedical marijuana, many questions have surfacedregarding the status of those laws in relation tofederal law. Some believe that the federalgovernment can nullify those laws, or that thelaws have no real value in the face of conflictingfederal law. That is simply not the case.
To illustrate how the law works, consider thefollowing prototypical vignette:
Even though patients can be penalized forviolating federal marijuana laws, a state governmentis not required to have identical laws. Therefore, astate may still allow its residents to possess, grow, ordistribute marijuana for medical purposes.
“Joe” has AIDS. His doctor advised him to smokemarijuana in order to boost his appetite, so he hasthree marijuana plants growing in the closet of hisapartment, and he smokes four puffs of marijuanaevery day before dinner. One day, Joe’s neighborsmells the marijuana smoke and calls the police. Theofficer knocks on Joe’s door, and when Joe opens it,the officer sees the marijuana pipe on the table.
The crucial distinction is frequentlymisunderstood: It is true that the federalgovernment can enforce federal laws anywhere inthe United States, even within the boundaries of astate that rejects those laws. Nevertheless, thefederal government cannot force states to havelaws that are identical to federal law, nor can thefederal government force state and local police toenforce federal laws.
Luckily, Joe lives in one of the eight states witheffective medical marijuana laws. Joe admits togrowing and using marijuana, but then shows theofficer a note on his doctor’s letterhead, which says,“I am treating Joe for AIDS, and in my professionalmedical opinion I believe that the benefits of Joe’smedical marijuana use outweigh any possible healthrisks.” The officer documents or verifies Joe’sinformation, gives Joe his best wishes, and goes on hisway. Joe takes another puff and finishes his dinner.
This division of power is extremelyadvantageous to patients who need to usemarijuana: Because 99% of all marijuana arrests inthe nation are made by state and local—notfederal—officials, favorable state laws caneffectively protect 99 out of 100 medicalmarijuana users who otherwise would have beenprosecuted. Federal drug enforcement agentssimply do not have the resources or the mandateto patrol the streets of any state looking for cancerpatients growing a few marijuana plants.
If Joe lived in one of the other 42 states, he wouldbe arrested, prosecuted, and possibly sent to prison.
In the unlikely event that a patient is arrestedin one of the eight states with effective laws, thepatient is still allowed to argue at trial that his orher marijuana use was medically necessary, ifcharged with unlawful marijuana possession orcultivation. As a matter of practice, police often donot arrest and prosecutors often do not prosecute 12See Appendix G for more detailed definitions of these
defenses.
4
Simply put, individual medical marijuanausers generally are not on the federalgovernment’s radar screen.
are in compliance with the state law. State-levelcases have focused on whether individuals qualifyas patients or caregivers, or whether they possessan amount of marijuana in excess of the specifiedlegal limit. Thus, it is the actions of individuals inrelation to the law—not the law itself—that hasbeen litigated.
(One drawback is that distributors are on thefederal radar screen. Pharmacies do not sellmarijuana anywhere in the United States, andnumerous medical marijuana distribution centersthat emerged in various states—commonly knownas “cannabis buyers’ clubs”—have been hamperedby federal law.)
Overview of kinds of state laws14
At various times since 1978, 35 states and theDistrict of Columbia have had favorable medicalmarijuana laws. Laws in five states have eitherexpired or have been repealed, but 30 states andD.C. currently have a law on the books. Althoughwell-intentioned, most of these laws do notprovide effective protection for patients who needto use medical marijuana.
Court rulings have not overturnedstate laws
To date, there have only been two significantlegal cases at the federal level which deal withmedical marijuana policy: Conant v. McCaffreyand U.S. v. Oakland Cannabis Buyers’ Cooperative(OCBC).13 These cases do not challenge thelegitimacy of the state medical marijuana laws,and therefore do not affect the ability of states toprotect medical marijuana patients under statelaw. Instead, they focus solely on federal issues.
(Because some states have enacted more thanone type of law, the totals for the followingsubsections add up to more than 35.)
Effective laws. The only laws that currentlyprovide meaningful protection for patients areones that remove state-level criminal penalties forcultivation, possession, and use of medicalmarijuana. Eight states—Alaska, California,Colorado, Hawaii, Maine, Nevada, Oregon, andWashington—have effective laws of this nature,all of which were enacted since 1996. (Seepreceding three sections of this report.)
Conant considers whether the federalgovernment can punish physicians for discussingor recommending medical marijuana, and afederal district court ruling says the federalgovernment cannot.
The OCBC case examines whether a medicalmarijuana distributor can use a medical necessitydefense against federal marijuana distributioncharges. A federal appeals court said it could, butthat ruling is pending before the U.S. SupremeCourt. Regardless of the outcome of that case—which is expected to be resolved in the summer of2001—medical marijuana patients affordedprotection under state law will continue to havethe right to the medical necessity defense (or otherdefenses allowed) against state marijuana charges.
Therapeutic research programs. 15 Fourteen statescurrently have laws that allow patients to legallyuse medical marijuana through a state-runtherapeutic research program, and during the late1970s and early 1980s at least seven states
14See Appendix A for details on all state medical marijuanalaws.15See Appendix K for details on therapeutic researchprograms.At the state level, there have been no serious
challenges to the legality of medical marijuanalaws. The only cases that have emerged havequestioned whether individuals or organizations
The federal government cannot force states tohave laws that are identical to federal law, norcan the federal government force state andlocal police to enforce federal laws.13See Appendix J for details on these two cases.
5
The only laws that currently provide meaningfulprotection for patients are ones that removestate-level criminal penalties for cultivation,possession, and use of medical marijuana.
Federal law prohibits the distribution of marijuanaand other Schedule I substances for anythingother than research. Doctors cannot “prescribe”marijuana, and pharmacies cannot dispense it.
obtained all of the necessary federal permissions,received marijuana from the federal government,and distributed the substance to approved patientsthrough pharmacies. None of these programs,however, has been operational since 1985.
Laws of this nature demonstrate a state’srecognition of marijuana’s therapeutic use, butthey are not effective as written without a changein federal policy.
Establishing Provisions for the StateGovernment to Distribute Confiscated Marijuana.Before it was repealed in 1987, Oregon lawallowed physicians to prescribe confiscatedmarijuana. Several other states have consideredsimilar legislation, although it does not appearthat confiscated marijuana has ever beendistributed in any state.
The federal approval process for medicalmarijuana research is excessively cumbersome.As a result, state health departments are generallyunwilling to devote their limited resources to along and potentially fruitless application process.Additionally, many patient advocates opposeresearch programs as a primary mode of medicalmarijuana access because enrollment in researchprograms is highly restrictive. It is one thing for states to look the other way
while patients grow medical marijuana forthemselves, but it’s another thing for the stategovernment itself to distribute a Schedule Isubstance for anything other than federallyapproved research. State officials would be highlyvulnerable to federal prosecution for marijuanadistribution, as they are more visible targets thanindividual patients. States would also risk losing
In sum, therapeutic research program laws areno longer effective due to federal obstructionism.
Symbolic measures. Pseudo-Prescriptive Access.Seven states have laws that allows patients topossess marijuana if obtained directly from a validprescription. The problem is that there is no legalsupply of marijuana to fill such a prescription.
federal funding for operating state-run distribution systems. Anotherconcern is that confiscatedmarijuana may contain adulterants
6
The role of state legislatures in the movementto protect medical marijuana patients cannotbe overstated. Only 24 states and the Districtof Columbia have the initiative process, whichmeans that citizens in 26 states cannotdirectly enact their own laws.
and would require screening, which could beprohibitively expensive.
Rescheduling Marijuana. States have theirown controlled substance schedules, whichtypically mirror the federal government’s.However, states are free to place substances inwhatever schedules they see fit.
allow doctors to prescribe marijuana. Non-bindingresolutions are passed by both houses of a state’slegislature and do not require the governor’ssignature. The resolutions send a message,officially proclaiming the legislatures’ positions,but do not change policy on the state level andare unlikely to be of any practical help to patients.
Four states—Alaska, Iowa, Montana, andTennessee—and the District of Columbiacurrently have marijuana placed in a schedule thatrecognizes its therapeutic use.
However, there is little or no practicalsignificance to rescheduling marijuana on thestate level, because the federal schedules supersedestate schedules and the federal government doesnot permit marijuana prescriptions. Similar to“pseudo-prescriptive access,” it is unclear whethercourts would interpret these laws as permitting a“medical necessity” defense.
Laws that have been repealed or expired.In addition to the 30 states with current laws,Arkansas, Florida, and North Carolina haverepealed a medical marijuana law, while Michiganhas had one expire. In Ohio, one law expired anda second law was repealed. Other states have hadlaws that have expired or have been repealed—but subsequently have enacted other medicalmarijuana laws. Further, 15 states have never hada favorable medical marijuana law.
Non-Binding Resolutions. At least six statelegislatures—California, Michigan, Missouri, NewHampshire, New Mexico, and Washington—havepassed non-binding resolutionsurging the federal government to
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ior t
o ar
rest
)as
hav
ing
a de
bilit
atin
g co
ndit
ion
and
“adv
ised
” by
the
phys
icia
n, in
the
cont
ext
of a
bon
a fid
e ph
ysic
ian-
pati
ent
rela
tion
ship
, tha
t the
pat
ient
“m
ight
bene
fit”
from
med
ical
mar
ijuan
a
opti
onal
, wit
hst
ate
Dep
artm
ent
of P
ublic
Hea
lth
and
Envi
ronm
ent
2 us
able
oun
ces a
nd 6
plan
ts; p
atie
nts m
ayus
e af
firm
ativ
ede
fens
e to
arg
ue th
atgr
eate
r am
ount
s are
med
ical
ly n
eces
sary
an in
divi
dual
who
has
sign
ifica
nt re
spon
sibi
lity
for m
anag
ing
the
wel
l-be
ing
of th
e pa
tien
t
yes
Haw
aii
S.B
. 862
HD
1(e
nact
ed b
y le
gisl
atur
e)Ju
ne 1
4, 2
000
stat
utor
yex
empt
ion
from
pros
ecut
ion
if in
law
ful
poss
essi
on o
f a re
gist
ry c
ard;
“cho
ice
of e
vils
” de
fens
eal
so o
n th
e bo
oks,
inde
pend
ent o
f thi
s sta
tute
pati
ent’s
med
ical
reco
rds o
r a st
atem
ent
sign
ed b
y th
e pa
tien
t’s p
hysi
cian
, sta
ting
that
in th
e ph
ysic
ian’
s pro
fess
iona
lop
inio
n, th
e pa
tien
t has
a d
ebili
tati
ngco
ndit
ion
and
the
“pot
enti
al b
enef
its o
fth
e m
edic
al u
se o
f mar
ijuan
a w
ould
like
lyou
twei
gh th
e he
alth
risk
s”
man
dato
ry,
wit
h st
ate
Dep
artm
ent
of P
ublic
Safe
ty
7 pl
ants
, 3 o
f whi
chm
ay b
e m
atur
e, a
nd1
ounc
e pe
r mat
ure
plan
t
one
care
give
r per
pati
ent,
and
a ca
regi
ver
may
serv
e on
ly o
nepa
tien
t at a
ny g
iven
tim
e
yes
Mai
neQ
uest
ion
2(b
allo
t ini
tiat
ive/
61%
)N
ovem
ber 2
, 199
9
stat
utor
ypr
ovid
es a
sim
ple
defe
nse,
whi
ch m
eans
the
burd
en is
on th
e st
ate
to p
rove
that
apa
tien
t’s m
edic
al u
se o
rpo
sses
sion
was
not
auth
oriz
ed b
y st
atut
e
an a
uthe
ntic
ated
cop
y of
per
tine
ntm
edic
al re
cord
s or w
ritt
en d
ocum
enta
tion
from
a p
hysi
cian
show
ing
that
the
pati
ent
has a
qua
lifyi
ng c
ondi
tion
; has
dis
cuss
edth
e ri
sks a
nd b
enef
its o
f med
ical
mar
ijuan
a; a
nd h
as b
een
“adv
ised
” by
the
phys
icia
n th
at h
e or
she
“mig
ht b
enef
it”
from
med
ical
mar
ijuan
a
N/A
1 1/
4 ou
nces
and
6pl
ants
, 3 o
f whi
chm
ay b
e m
atur
e
one
care
give
r, w
ho h
asbe
en c
onsi
sten
tly
resp
onsi
ble
for t
hepa
tien
t’s w
ell-
bein
g an
dis
nam
ed in
a w
ritt
enin
divi
dual
inst
ruct
ion
orpo
wer
of a
ttor
ney
for
heal
th c
are
no
Nev
ada
Que
stio
n 9
(bal
lot i
niti
ativ
e/65
%)
59%
in 1
998
also
Nov
embe
r 7, 2
000
cons
titu
-ti
onal
exem
ptio
n fr
ompr
osec
utio
n“a
dvic
e re
quir
ed;”
spec
ifics
to b
ede
term
ined
by
legi
slat
ure
man
dato
ry,
wit
h an
agen
cy n
otye
tde
term
ined
to b
e de
term
ined
by
legi
slat
ure
to b
e de
term
ined
by
legi
slat
ure
yes
stat
e;m
easu
re/%
of v
ote;
date
ena
cted
stat
utor
yor
cons
titu
-ti
onal
aho
w la
w p
rote
cts p
atie
nts
(def
ense
s pro
vide
d)b
docu
men
tati
on re
quir
ed
regi
stry
syst
emfo
r pat
ient
s and
care
give
rsm
ariju
ana
quan
tity
lim
its
care
give
r pro
visi
ons
can
med
ical
cond
itio
ns
be a
dded
?
Ore
gon
Mea
sure
67
(bal
lot i
niti
ativ
e/55
%)
Nov
embe
r 3, 1
998
(mod
ified
by
H.B
. 305
2, e
ffect
ive
July
21,
199
9)
stat
utor
yex
empt
ion
from
pros
ecut
ion
if in
law
ful
poss
essi
on o
f a re
gist
ry c
ard;
affir
mat
ive
defe
nse
if no
tre
gist
ered
, but
inco
mpl
ianc
e w
ith
the
law
;“c
hoic
e of
evi
ls”
defe
nse
also
aut
hori
zed
by st
atut
e
diag
nose
d w
ithi
n 12
mon
ths p
rior
to a
rres
tw
ith
a qu
alify
ing
cond
itio
n; a
dvis
ed b
yat
tend
ing
phys
icia
n th
at m
ariju
ana
“may
mit
igat
e th
e sy
mpt
oms o
r effe
cts”
of t
hede
bilit
atin
g co
ndit
ion
opti
onal
, wit
hst
ate
Hea
lth
Div
isio
n
if no
t at a
loca
tion
whe
re m
ariju
ana
ispr
oduc
ed, u
p to
1us
able
oun
ce m
ay b
epo
sses
sed;
if at
the
loca
tion
whe
re m
ariju
ana
ispr
oduc
ed, u
p to
7pl
ants
, 3 o
f whi
chm
ay b
e m
atur
e, a
ndon
e us
able
oun
ce o
fm
ariju
ana
per m
atur
epl
ant;
affir
mat
ive
defe
nse
may
be
used
to a
rgue
that
gre
ater
am
ount
is m
edic
ally
nec
essa
ryas
det
erm
ined
by
the
pati
ent’s
att
endi
ngph
ysic
ian
one
care
give
r per
pati
ent,
alth
ough
care
give
rs c
an se
rve
mul
tipl
e pa
tien
tssi
mul
tane
ousl
y
yes
Was
hing
ton
Mea
sure
692
(bal
lot i
niti
ativ
e/59
%)
Nov
embe
r 3, 1
998
stat
utor
yex
empt
ion
from
pros
ecut
ion
if pa
tien
t mee
tsal
l cri
teri
a fo
r sta
tus a
s aqu
alify
ing
pati
ent,
poss
esse
sno
mor
e m
ariju
ana
than
isne
cess
ary
for h
is o
r her
pers
onal
med
ical
use
, and
pres
ents
val
iddo
cum
enta
tion
to la
wen
forc
emen
t who
que
stio
nm
edic
al u
se; a
ffirm
ativ
ede
fens
e av
aila
ble
if in
com
plia
nce
wit
h st
atut
e
stat
emen
t sig
ned
by p
atie
nt’s
phys
icia
n, o
ra
copy
of t
he p
atie
nt’s
pert
inen
t med
ical
reco
rds,
whi
ch st
ates
that
in th
eph
ysic
ian’
s pro
fess
iona
l opi
nion
, the
“pot
enti
al b
enef
its”
of m
edic
al m
ariju
ana
“wou
ld li
kely
out
wei
gh th
e he
alth
risk
s”
N/A
“six
ty d
ay su
pply
”on
e ca
regi
ver p
erpa
tien
t, an
d a
care
give
rm
ay se
rve
only
one
pati
ent a
t any
giv
en ti
me
yes
a The
re is
no
diffe
renc
e in
the
func
tion
alit
y of
med
ical
mar
ijuan
a la
ws t
hat a
re e
nact
ed b
y “s
tatu
te”
vers
us “
cons
titu
tion
al a
men
dmen
t.” T
he o
nly
diffe
renc
e is
that
aco
nsti
tuti
onal
am
endm
ent c
anno
t be
chan
ged
by st
atut
ory
law
; it m
ay o
nly
be c
hang
ed o
r rep
eale
d by
ano
ther
con
stit
utio
nal a
men
dmen
t. T
here
fore
, con
stit
utio
nal
amen
dmen
ts a
re m
ore
entr
ench
ed th
an st
atut
ory
law
, whi
ch c
an b
e m
ore
easi
ly c
hang
ed o
r rep
eale
d by
the
legi
slat
ure.
b See
App
endi
x G
for d
efin
itio
ns o
f “af
firm
ativ
e de
fens
e,”
“exe
mpt
ion
from
pro
secu
tion
,” a
nd “
choi
ce o
f evi
ls.”
c In
prac
tice
, Ala
ska
cons
ider
s an
indi
vidu
al in
pos
sess
ion
of a
val
id re
gist
ry c
ard
and
othe
rwis
e in
com
plia
nce
wit
h th
e la
w to
be
exem
pt fr
om p
rose
cuti
on.
Where things are going from here Vermont, and Wyoming—considered symbolicpieces of legislation.16
The nine medical marijuana initiatives, sevenof which resulted in effective state laws, have beendescribed as the first wave of activity to protectmedical marijuana patients nationwide. Not onlydo they provide legal protection for patients instates that collectively contain more than 18% ofthe U.S. population, but they verified Americans’strong support for favorable medical marijuanalaws.
The role of state legislatures in the movementto protect medical marijuana patients cannot beoverstated. Only 24 states and the District ofColumbia have the initiative process, whichmeans that citizens in 26 states cannot directlyenact their own laws. They must rely on theirstate legislatures to enact favorable medicalmarijuana laws, and the number of futurelegislative victories will depend on how manypeople effectively lobby their state officials.Moreover, legislation is much more cost-effectivethan ballot initiatives, which can be veryexpensive endeavors.
In turn, Hawaii’s success has been called thebeginning of the second wave, whereby statelegislatures will enact effective laws to protectmedical marijuana-using patients. Statelegislatures are increasingly supportive of medicalmarijuana. In the 1999-2000 legislative sessions,17 states considered medical marijuana legislation.Seven states, including Hawaii, consideredlegislation to remove criminal penalties formedical marijuana. Six states consideredlegislation to amend existing medical marijuanalaws, and four states—Colorado, New Hampshire,
State medical marijuana laws have the addedbenefit of putting political pressure on the federalgovernment to change its laws.
The third and final wave will be a change infederal law.
16See Appendix M for a listing of all state medical marijuanabills and resolutions considered during the 1999-2000legislative sessions.
10
Table 2: Tally of State Medical Marijuana Laws
Effective
TherapeuticResearchProgram Symbolic
Non-BindingResolution
State
Alabama ✔
Alaska ✔ ✔
Arizona ✔ ✔
Arkansas ✔
California ✔ ✔ ✔
Colorado ✔ ✔
Connecticut ✔
Delaware
District of Columbia ✔
Florida ✔
Georgia ✔
Hawaii ✔
Idaho
Illinois ✔
Indiana
Iowa ✔ ✔
Kansas
Kentucky
Louisiana ✔ ✔
Maine ✔ ✔
Maryland
Massachusetts ✔
Michigan ✔ ✔
Minnesota ✔
Mississippi
Missouri ✔
Montana ✔
Nebraska
Nevada ✔ ✔
11
Table 2: Tally of State Medical Marijuana Laws (continued)
Effective
TherapeuticResearchProgram Symbolic
Non-BindingResolution
State
New Hampshire ✔ ✔
New Jersey ✔
New Mexico ✔ ✔
New York ✔
North Carolina ✔
North Dakota
Ohio ✔ ✔
Oklahoma
Oregon ✔ ✔
Pennsylvania
Rhode Island ✔
South Carolina ✔
South Dakota
Tennessee ✔ ✔
Texas ✔
Utah
Vermont ✔
Virginia ✔
Washington ✔ ✔ ✔
West Virginia ✔
Wisconsin ✔
Wyoming
Totals 1 8 12 14 2 10plusD.C.
Grand Totals 9 26 12 plus D.C. 6
At some point in time, 35 states have had a favorable medical marijuana law. Twelve of
those 35 states have had more than one type of medical marijuana law. California, for
example, currently has both an effective law and a research law, while Arizona previously
had a research law and currently has a symbolic law.
12
Sta
tes
wit
h Ef
fect
ive
Med
ical
Mar
ijuan
a La
ws
(Rem
oval
of C
rim
inal
Pen
alti
es)
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll/in
itia
tive
#se
ssio
n la
wci
tati
on fo
rm
ed. m
j law
mar
ijuan
asc
hedu
leci
tati
on fo
rsc
hedu
les
AK
Nov
. 3, 1
998
Mar
ch 4
, 199
9B
allo
t Mea
sure
8Se
ctio
n 1,
199
8 B
allo
tM
easu
re 8
§ 17
.37
VIA
§ 11
.71.
160
Cur
rent
Law
:B
allo
t Mea
sure
8 re
mov
es st
ate-
leve
l cri
min
al p
enal
ties
for m
edic
al m
ariju
ana
use,
pos
sess
ion,
and
cul
tiva
tion
. How
ever
, S.B
. 94,
whi
ch to
ok e
ffect
June
2,
1999
, mad
e th
e st
ate’
s med
ical
mar
ijuan
a re
gist
ry p
rogr
am m
anda
tory
and
rem
oved
the
affir
mat
ive
defe
nse
for p
atie
nts (
or th
eir c
areg
iver
s) w
ho p
osse
ssm
ore
mar
ijuan
a th
an is
per
mit
ted
by th
e la
w.
His
tory
:A
ther
apeu
tic
rese
arch
pro
gram
— w
hich
was
nev
er o
pera
tion
al —
for c
ance
r che
mot
hera
py a
nd ra
diol
ogy
and
glau
com
a (s
tatu
te §
17.
35)
was
ena
cted
in19
82 (
sess
ion
law
§ 5
ch.
45)
. The
law
was
repe
aled
by
ch. 1
46 (
1986
). D
etai
ls o
f the
pro
gram
incl
uded
adm
inis
trat
ion
by th
e B
oard
of P
harm
acy;
pat
ient
cert
ifica
tion
by
a Pa
tien
t Qua
lific
atio
n R
evie
w C
omm
itte
e; th
e B
oard
of P
harm
acy
was
als
o pe
rmit
ted
to in
clud
e ot
her d
isea
se g
roup
s if a
phy
sici
anpr
esen
ted
pert
inen
t med
ical
dat
a.A
s a S
ched
ule
VIA
dru
g, m
ariju
ana
has t
he “
low
est d
egre
e of
dan
ger o
r pro
babl
e da
nger
to a
per
son
or th
e pu
blic
.”
CA
Nov
. 5, 1
996
Nov
. 6, 1
996
Bal
lot I
niti
ativ
e, P
ropo
siti
on 2
15N
/AH
& S
§ 1
1362
.5I
H &
S §
110
54C
urre
nt L
aws:
Prop
osit
ion
215
rem
oves
stat
e-le
vel c
rim
inal
pen
alti
es fo
r med
ical
mar
ijuan
a us
e, p
osse
ssio
n, a
nd c
ulti
vati
on.
In a
ddit
ion,
S.B
. 847
, whi
ch to
ok e
ffect
Oct
. 7, 1
999
(ses
sion
law
Ch.
750
), e
stab
lishe
d th
e C
alifo
rnia
Cen
ter f
or M
edic
inal
Can
nabi
s Res
earc
h (H
& S
§11
362.
9). A
one
-tim
e $3
mill
ion
appr
opri
atio
n w
as p
rovi
ded
in th
e 20
00-2
001
stat
e bu
dget
for t
he re
sear
ch, w
hich
is a
thre
e-ye
ar p
roje
ct c
oord
inat
ed b
yth
e Sa
n D
iego
and
San
Fra
ncis
co c
ampu
ses o
f the
Uni
vers
ity
of C
alifo
rnia
. Res
earc
h w
ill fo
cus o
n sa
fety
and
effi
cacy
of m
ariju
ana
for t
reat
ing
a w
ide
rang
eof
deb
ilita
ting
con
diti
ons.
Mar
ijuan
a us
ed in
the
rese
arch
will
be
obta
ined
from
the
fede
ral g
over
nmen
t. If
the
fede
ral g
over
nmen
t fai
ls to
pro
vide
an
adeq
uate
supp
ly, t
he st
ate
“Att
orne
y G
ener
al sh
all p
rovi
de a
n ad
equa
te su
pply
.”H
isto
ry:
From
July
25,
197
9 un
til J
une
30, 1
989,
a th
erap
euti
c re
sear
ch p
rogr
am —
whi
ch w
as o
pera
tion
al —
for c
ance
r and
gla
ucom
a ex
iste
d (H
& S
§ 1
1260
and
H &
S §
114
80);
ena
cted
via
S.B
. 184
, ses
sion
law
Ch.
300
(19
79).
The
Res
earc
h A
dvis
ory
Pane
l coo
rdin
ated
rese
arch
wit
h m
ariju
ana
and
its d
eriv
ativ
es;
$100
,000
was
app
ropr
iate
d fo
r the
firs
t yea
r. M
inor
am
endm
ents
by
ch. 3
74 (
1980
) an
d ch
. 101
(19
83).
H &
S §
112
60 w
ould
hav
e ex
pire
d on
June
30,
1985
, but
the
prog
ram
was
ext
ende
d an
d m
odifi
ed sl
ight
ly b
y ch
. 417
(19
84);
the
prog
ram
fina
lly e
xpir
ed o
n Ju
ne 3
0, 1
989;
§ 1
1480
rem
ains
on
the
book
s.
CO
Nov
. 7, 2
000
June
30,
200
1B
allo
t Ini
tiat
ive,
Am
endm
ent 2
0N
/AC
onst
itut
iona
lA
men
dmen
t 20
N/A
§ 18
-18-
203
Cur
rent
Law
:A
men
dmen
t 20
rem
oves
stat
e-le
vel c
rim
inal
pen
alti
es fo
r med
ical
mar
ijuan
a us
e, p
osse
ssio
n, a
nd c
ulti
vati
on.
His
tory
:A
ther
apeu
tic
rese
arch
pro
gram
— w
hich
was
nev
er o
pera
tion
al —
for c
ance
r and
gla
ucom
a (§
25-
5-90
1 to
-907
) w
as e
nact
ed a
nd to
ok e
ffect
on
June
21,
1979
(H
.B. 1
042,
ch.
265
). D
etai
ls o
f the
pro
gram
incl
uded
adm
inis
trat
ion
by a
Pha
rmac
y an
d T
hera
peut
ics C
omm
itte
e (P
TC
) at
the
Uni
vers
ity
ofC
olor
ado;
the
PTC
cou
ld in
clud
e ot
her d
isea
se g
roup
s aft
er re
view
of p
erti
nent
dat
a pr
esen
ted
by a
phy
sici
an; a
pply
to re
ceiv
e m
ariju
ana
from
the
Nat
iona
lIn
stit
ute
on D
rug
Abu
se (
NID
A);
if u
nabl
e to
obt
ain
mar
ijuan
a fr
om N
IDA
, inv
esti
gate
the
feas
ibili
ty o
f usi
ng se
ized
mar
ijuan
a th
at h
as b
een
test
ed fo
rim
puri
ties
; $15
,000
was
app
ropr
iate
d. A
men
ded
by c
h. 3
22 (
1981
) to
say
that
oth
er d
isea
se g
roup
s can
be
incl
uded
aft
er p
erti
nent
dat
a ar
e pr
esen
ted
by a
phys
icia
n w
ho h
as a
n IN
D (
Inve
stig
atio
nal N
ew D
rug)
num
ber i
ssue
d by
FD
A; a
pply
to re
ceiv
e m
ariju
ana
from
fede
ral g
over
nmen
t. T
he la
w w
as re
peal
edby
H.B
. 95-
1020
in 1
995
(ch.
71)
.
HI
June
14,
200
0Ju
ne 1
4, 2
000
S.B
. 862
Act
228
, SLH
200
0§
329
I§
329-
14C
urre
nt L
aw:
S.B
. 862
rem
oves
stat
e-le
vel c
rim
inal
pen
alti
es fo
r med
ical
mar
ijuan
a us
e, p
osse
ssio
n, a
nd c
ulti
vati
on. T
his i
s the
firs
t law
of t
his n
atur
e to
be
enac
ted
by a
stat
e le
gisl
atur
e, ra
ther
than
by
a ba
llot i
niti
ativ
e. (
Oth
er st
ate
legi
slat
ures
hav
e en
acte
d m
edic
al m
ariju
ana
rese
arch
law
s and
sym
bolic
law
s rel
atin
g to
mar
ijuan
a sc
hedu
ling
or p
resc
ript
ive
acce
ss.)
Thi
s is H
awai
i’s fi
rst m
edic
al m
ariju
ana
law
of a
ny k
ind.
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll/in
itia
tive
#se
ssio
n la
wci
tati
on fo
rm
ed. m
j law
mar
ijuan
asc
hedu
leci
tati
on fo
rsc
hedu
les
ME
Nov
. 2, 1
999
Dec
. 22,
199
9R
efer
endu
m E
lect
ion
Bal
lot
Que
stio
n 2
Law
s of M
aine
199
9,In
itia
ted
Bill
Ch.
122
§ 2
383
N/A
17-A
§ 1
102
Cur
rent
Law
:Q
uest
ion
2 re
mov
es st
ate-
leve
l cri
min
al p
enal
ties
for m
edic
al m
ariju
ana
use,
pos
sess
ion,
and
cul
tiva
tion
.H
isto
ry:
A th
erap
euti
c re
sear
ch p
rogr
am —
whi
ch w
as n
ever
ope
rati
onal
— fo
r gla
ucom
a an
d ca
ncer
che
mot
hera
py (
22 §
240
1-24
10)
was
ena
cted
on
Sept
. 14,
1979
(H
.B. 6
65, c
h. 4
57).
The
pro
gram
exp
ired
in 1
981,
but
an
alm
ost i
dent
ical
law
rein
stat
ed th
e pr
ogra
m o
n Se
pt. 2
3, 1
983
(H.B
. 102
5, c
h. 4
23, 2
2§
2411
-242
0). T
hat l
aw e
xpir
ed o
n D
ec. 3
1, 1
987,
whi
ch a
utho
rize
d a
rese
arch
pro
gram
wit
hin
the
Dep
artm
ent o
f Hum
an S
ervi
ces t
o us
e fe
dera
l mar
ijuan
aor
, if n
eces
sary
, mar
ijuan
a co
nfis
cate
d by
stat
e la
w-e
nfor
cem
ent a
genc
ies;
a Pa
rtic
ipat
ion
Rev
iew
Boa
rd w
ould
app
rove
phy
sici
ans.
Con
trol
led
subs
tanc
es a
re in
Sch
edul
es W
, X, Y
, and
Z, w
hich
det
erm
ine
the
seve
rity
of p
enal
ties
for p
osse
ssio
n, m
anuf
actu
re, a
nd d
istr
ibut
ion
of th
ese
subs
tanc
es. T
he sc
hedu
les m
ake
no st
atem
ent a
s to
the
med
ical
val
ue o
f the
con
trol
led
subs
tanc
es.
NV
Nov
. 7, 2
000
requ
ires
legi
slat
ive
impl
emen
tati
onB
allo
t Que
stio
n 9
N/A
Con
stit
utio
nal
Am
endm
ent
I45
3.51
0 N
AC
Cur
rent
Law
:Q
uest
ion
9 re
mov
es st
ate-
leve
l cri
min
al p
enal
ties
for m
edic
al m
ariju
ana
use,
pos
sess
ion,
and
cul
tiva
tion
.H
isto
ry:
A th
erap
euti
c re
sear
ch p
rogr
am —
whi
ch w
as n
ever
ope
rati
onal
— fo
r gla
ucom
a or
can
cer c
hem
othe
rapy
or o
ther
app
rove
d co
ndit
ions
(45
3.74
0 - 4
53.8
10an
d45
3.74
0 N
AC
) w
as e
nact
ed o
n Ju
ne 2
, 197
9 (S
.B. 4
70, c
h. 6
10).
Adm
inis
tere
d by
Hea
lth
Div
isio
n of
Dep
artm
ent o
f Hum
an S
ervi
ces a
nd a
Boa
rd o
fR
evie
w fo
r Pat
ient
s. T
he la
w w
as re
peal
ed b
y A
.B. 6
95 in
198
7 (c
h. 4
17).
OR
Nov
. 3, 1
998
Dec
. 3, 1
998
Bal
lot M
easu
re 6
7O
rego
n La
ws 1
999,
Ch.
447
5.30
0-34
6I
475.
035
and
OA
R 8
55-8
0C
urre
nt L
aw:
Mea
sure
67
rem
oves
stat
e-le
vel c
rim
inal
pen
alti
es fo
r med
ical
mar
ijuan
a us
e, p
osse
ssio
n, a
nd c
ulti
vati
on. M
inor
am
endm
ents
wer
e m
ade
via
H.B
. 305
2,w
hich
took
effe
ct Ju
ly 2
1, 1
999,
whi
ch m
anda
tes t
hat p
atie
nts m
ay n
ot u
se m
edic
al m
ariju
ana
in a
cor
rect
iona
l fac
ility
; lim
its p
atie
nts a
nd c
areg
iver
s to
grow
ing
mar
ijuan
a at
one
loca
tion
eac
h; re
quir
es th
at a
pat
ient
be
diag
nose
d w
ithi
n 12
mon
ths p
rior
to a
rres
t to
asse
rt a
n af
firm
ativ
e de
fens
e; re
lieve
spo
lice
from
the
resp
onsi
bilit
y to
mai
ntai
n liv
e m
ariju
ana
plan
ts w
hile
a c
ase
is p
endi
ng.
His
tory
:A
law
to a
llow
phy
sici
ans t
o pr
escr
ibe
mar
ijuan
a fo
r can
cer c
hem
othe
rapy
and
gla
ucom
a (§
475
.505
) w
as e
nact
ed o
n Ju
ne 1
8, 1
979
(H.B
. 226
7, c
h. 2
53).
Ore
gon
Stat
e Po
lice
coul
d m
ake
conf
isca
ted
mar
ijuan
a av
aila
ble
to th
e H
ealt
h D
ivis
ion
to te
st it
for c
onta
min
ants
; if m
ariju
ana
was
foun
d to
be
free
of
cont
amin
ants
, Hea
lth
Div
isio
n co
uld
mak
e m
ariju
ana
avai
labl
e to
phy
sici
ans u
pon
wri
tten
requ
est;
pati
ents
who
are
pre
scri
bed
such
mar
ijuan
a co
uld
poss
ess l
ess t
han
an o
unce
. In
1980
, the
Hea
lth
Div
isio
n re
ceiv
ed fe
dera
l per
mis
sion
to d
istr
ibut
e m
ariju
ana,
pur
suan
t to
the
stat
ute,
and
a fe
dera
l sup
ply
ofm
ariju
ana;
how
ever
, it i
s unl
ikel
y th
at d
istr
ibut
ion
ever
occ
urre
d. T
he la
w w
as re
peal
ed b
y S.
B. 1
60 in
198
7 (c
h. 7
5).
WA
Nov
. 3, 1
998
Nov
. 3, 1
998
Init
iati
ve M
easu
re N
o. 6
9219
99 c
2 §
1R
CW
69.
51A
I69
.50.
204
and
WA
C 2
46-8
87-1
00C
urre
nt L
aws:
Mea
sure
692
rem
oves
stat
e-le
vel c
rim
inal
pen
alti
es fo
r med
ical
mar
ijuan
a us
e, p
osse
ssio
n, a
nd c
ulti
vati
on.
In a
ddit
ion,
a th
erap
euti
c re
sear
ch p
rogr
am —
whi
ch w
as o
pera
tion
al —
for c
ance
r che
mot
hera
py a
nd ra
diol
ogy,
gla
ucom
a, a
nd o
ther
dis
ease
gro
ups
(RC
W 6
9.51
) w
as e
nact
ed o
n M
arch
27,
197
9 (H
.B. 2
59, c
h. 1
36)
and
rem
ains
on
the
book
s. Pr
ogra
m a
dmin
iste
red
by B
oard
of P
harm
acy
and
Pati
ent
Qua
lific
atio
n R
evie
w C
omm
itte
e; “
Boa
rd sh
all o
btai
n m
ariju
ana
thro
ugh
wha
teve
r mea
ns it
dee
ms m
ost a
ppro
pria
te a
nd c
onsi
sten
t wit
h re
gula
tion
spr
omul
gate
d by
fede
ral g
over
nmen
t”; “
boar
d m
ay u
se m
ariju
ana
whi
ch h
as b
een
conf
isca
ted
by lo
cal o
r sta
te la
w e
nfor
cem
ent a
genc
ies a
nd h
as b
een
dete
rmin
ed to
be
free
from
con
tam
inat
ion.
”T
here
was
dua
l sch
edul
ing
for m
ariju
ana
and
ever
y co
mpo
und
(inc
ludi
ng T
HC
— te
trah
ydro
cann
abin
ol, t
he p
rim
ary
acti
ve in
gred
ient
) in
the
mar
ijuan
apl
ant;
amen
dmen
t in
1986
(ch
. 124
) re
mov
ed th
e du
al sc
hedu
ling
of m
ariju
ana
and
TH
C; m
inor
am
endm
ents
mad
e in
198
9 (c
h. 9
).O
n M
arch
30,
199
6, W
ashi
ngto
n St
ate
enac
ted
the
1996
supp
lem
enta
l ope
rati
ng b
udge
t whi
ch a
lloca
ted
$130
,000
for t
wo
med
ical
mar
ijuan
a-re
late
dpr
ojec
ts: $
70,0
00 to
rese
arch
a ta
mpe
r-fr
ee m
eans
of c
ulti
vati
ng m
ariju
ana
for m
edic
inal
pur
pose
s, an
d $6
0,00
0 to
rese
arch
the
ther
apeu
tic
pote
ntia
l of
mar
ijuan
a. R
esea
rch,
how
ever
, was
nev
er c
ondu
cted
and
the
$60,
000
appr
opri
atio
n ex
pire
d.
Sta
tes
wit
h M
edic
al M
ariju
ana
Res
earc
h La
ws
(The
rape
utic
Res
earc
h P
rogr
ams)
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll #
sess
ion
law
cita
tion
for m
ed. m
j law
mar
ijuan
asc
hedu
leci
tati
on fo
rsc
hedu
les
AL
July
30,
197
9Ju
ly 3
0, 1
979
S. 5
59A
ct N
o. 7
9-47
2§
20-2
-110
I§
20-2
-23(
3) a
ndA
AC
Cha
p. 4
20-7
-2
Cur
rent
Law
:Fo
r can
cer c
hem
othe
rapy
and
gla
ucom
a.St
ate
Boa
rd o
f Med
ical
Exa
min
ers i
s aut
hori
zed
to c
reat
e re
view
com
mit
tee
to a
dmin
iste
r pro
gram
— w
hich
has
nev
er b
een
oper
atio
nal.
S. 1
63 (
Act
. No.
81-
506)
mad
e m
inor
cha
nges
.
GA
Feb.
22,
198
0Fe
b. 2
2, 1
980
H.B
. 107
7N
o. 7
10 (
1980
)43
-34-
120
and
Rul
es a
ndR
egul
atio
ns C
hapt
er 3
60-
12
N/A
16-1
3-25
Cur
rent
Law
:Fo
r can
cer a
nd g
lauc
oma
(mar
ijuan
a or
TH
C).
Com
posi
te S
tate
Boa
rd o
f Med
ical
Exa
min
ers h
as a
utho
rity
to a
ppoi
nt a
Pat
ient
Qua
lific
atio
n R
evie
w B
oard
whi
ch c
an a
ppro
ve p
atie
nts,
phys
icia
ns, a
ndph
arm
acie
s for
par
tici
pati
on in
the
prog
ram
— w
hich
was
ope
rati
onal
; no
othe
r ailm
ents
allo
wed
.
ILSe
pt. 9
, 197
8Se
pt. 9
, 197
8H
.B. 2
625
80-1
426
720
ILC
S 55
0/11
and
77
IAC
Ch.
X,
Sec.
208
5N
/A72
0 IL
CS
570/
206
and
77 I
AC
Ch.
X,
Sec.
207
0
Rem
arks
:Fo
r gla
ucom
a an
d ca
ncer
che
mot
hera
py a
nd ra
diol
ogy
or o
ther
pro
cedu
res.
The
pro
gram
has
nev
er b
een
oper
atio
nal.
Allo
ws p
erso
ns “
enga
ged
in re
sear
ch”
to u
se m
ariju
ana
whe
n au
thor
ized
by
phys
icia
n; m
ust b
e ap
prov
ed b
y D
epar
tmen
t of M
enta
l Hea
lth
and
Dev
elop
men
tal D
isab
iliti
es.
MA
Dec
. 31,
199
1D
ec. 3
1, 1
991
S. 1
582
ch. 4
80 (
1991
)94
D §
1N
/A94
C §
31
Cur
rent
Law
:Fo
r can
cer c
hem
othe
rapy
and
radi
olog
y, g
lauc
oma,
and
ast
hma
(mar
ijuan
a or
TH
C).
The
pro
gram
has
nev
er b
een
oper
atio
nal.
On
Aug
ust 8
, 199
6, M
assa
chus
etts
pas
sed
a se
cond
med
ical
mar
ijuan
a bi
ll (H
. 217
0) w
hich
man
date
d th
at w
ithi
n 18
0 da
ys, t
he st
ate’
s pub
lic h
ealt
hde
part
men
t mus
t est
ablis
h th
e ru
les a
nd re
gula
tion
s nec
essa
ry to
get
its t
hera
peut
ic re
sear
ch p
rogr
am ru
nnin
g an
d to
allo
w a
def
ense
of m
edic
al n
eces
sity
for
enro
lled
pati
ents
. Rul
es w
ere
esta
blis
hed,
but
fede
ral p
erm
issi
on fo
r res
earc
h w
as n
ever
obt
aine
d.C
ontr
olle
d su
bsta
nces
are
in C
lass
es A
, B, C
, and
D, w
hich
det
erm
ine
the
seve
rity
of p
enal
ties
for p
osse
ssio
n, m
anuf
actu
re, a
nd d
istr
ibut
ion
of th
ese
subs
tanc
es. T
he c
lass
es m
ake
no st
atem
ent a
s to
the
med
ical
val
ue o
f the
con
trol
led
subs
tanc
es.
MN
Apr
il 24
, 198
0A
pril
25, 1
980
H.F
. 247
6ch
. 614
(19
80)
§ 15
2.21
I§
152.
02 a
nd M
R 6
800.
4200
Cur
rent
Law
:Fo
r can
cer o
nly
(TH
C o
nly)
. TH
C is
in S
ched
ule
I but
is c
onsi
dere
d to
be
in S
ched
ule
II w
hen
used
for m
edic
inal
pur
pose
s.T
he 1
980
bill
orig
inal
ly a
ppro
pria
ted
$100
,000
to th
e T
HC
The
rape
utic
Res
earc
h A
ct, b
ut th
is li
ne-i
tem
was
vet
oed
by th
e go
vern
or. T
he p
rogr
am h
asne
ver b
een
oper
atio
nal.
NJ
Mar
ch 2
3, 1
981
Mar
ch 2
3, 1
981
A.B
. 819
ch. 7
2 (1
981)
26:2
LI
24:2
1-5
and
8:65
-10
New
Jer
sey
Adm
inist
rativ
e C
ode
Cur
rent
Law
:Fo
r life
- or s
ense
-thr
eate
ning
dis
ease
s. T
he p
rogr
am h
as n
ever
bee
n op
erat
iona
l.Pe
rtai
ns to
any
Sch
edul
e I s
ubst
ance
(no
t spe
cific
to m
ariju
ana)
; adm
inis
tere
d by
Dep
artm
ent o
f Hea
lth;
onl
y fo
r pat
ient
s par
tici
pati
ng in
rese
arch
prog
ram
s con
duct
ed b
y FD
A; p
atie
nts a
nd p
hysi
cian
s cer
tifie
d by
The
rape
utic
Res
earc
h Q
ualif
icat
ion
Boa
rd; g
et su
bsta
nces
from
NID
A.
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll #
sess
ion
law
cita
tion
for m
ed. m
j law
mar
ijuan
asc
hedu
leci
tati
on fo
rsc
hedu
les
NM
Feb.
21,
197
8Fe
b. 2
1, 1
978
H.B
. 329
ch. 2
2 (1
978)
26-2
AI*
30-3
1-3
Cur
rent
Law
:Fo
r gla
ucom
a an
d ca
ncer
che
mot
hera
py (
mar
ijuan
a or
TH
C);
pat
ient
s wit
h ot
her d
isea
ses m
ust g
et a
ppro
val f
rom
Pat
ient
Qua
lific
atio
n R
evie
w B
oard
.A
dmin
iste
red
by th
e D
epar
tmen
t of H
ealt
h an
d En
viro
nmen
t; th
e pr
ogra
m w
as o
pera
tion
al. W
ould
hav
e ex
pire
d on
July
1, 1
979,
but
ch.
11
(197
9)ex
tend
ed th
e pr
ogra
m in
defin
itel
y.*S
tate
follo
ws t
he fe
dera
l gov
ernm
ent’s
sche
dulin
g of
con
trol
led
subs
tanc
es a
s art
icul
ated
in th
e C
ode
of F
eder
al R
egul
atio
ns [3
0-31
-5; B
oard
of P
harm
acy,
505-
841-
9102
]. M
ariju
ana
and
TH
C a
re in
Sch
edul
e I b
ut a
re c
onsi
dere
d to
be
in S
ched
ule
II w
hen
used
for m
edic
al p
urpo
ses.
NY
June
30,
198
0Se
pt. 1
, 198
0S.
B. 1
123-
6ch
. 810
(19
80)
PHL
§ 33
97 a
nd P
HL
§ 33
28I
PHL
§ 33
06
Cur
rent
Law
:Fo
r can
cer,
glau
com
a, a
nd o
ther
life
- and
sens
e-th
reat
enin
g di
seas
es a
ppro
ved
by th
e co
mm
issi
oner
. Adm
inis
tere
d by
Dep
artm
ent o
f Hea
lth
and
Pati
ent
Qua
lific
atio
n R
evie
w B
oard
; the
pro
gram
was
ope
rati
onal
; con
fisca
ted
mar
ijuan
a m
ay b
e us
ed if
nec
essa
ry.
In 1
981,
the
nam
e of
the
“con
trol
led
subs
tanc
es th
erap
euti
c re
sear
ch p
rogr
am”
was
cha
nged
to th
e “A
nton
io G
. Oliv
ieri
con
trol
led
subs
tanc
es th
erap
euti
cre
sear
ch p
rogr
am”
by c
h. 2
08 (
1981
).
RI
May
19,
198
0M
ay 1
9, 1
980
H.B
. 79.
6072
ch. 3
75 (
1980
)§
21-2
8.4-
1I
§ 21
-28-
2.08
Cur
rent
Law
:Pa
tien
ts m
ust b
e in
volv
ed in
a li
fe- o
r sen
se-t
hrea
teni
ng si
tuat
ion
(ori
gina
l law
spec
ified
can
cer c
hem
othe
rapy
, gla
ucom
a, a
nd o
ther
dis
ease
gro
ups)
; pro
gram
— w
hich
has
nev
er b
een
oper
atio
nal —
adm
inis
tere
d by
dir
ecto
r of t
he D
epar
tmen
t of H
ealt
h; d
irec
tor o
r dir
ecto
r’s d
esig
nee
auth
oriz
ed to
revi
ew p
atie
nts
and
phys
icia
ns fo
r par
tici
pati
on in
pro
gram
(or
igin
al la
w sp
ecifi
ed P
atie
nt Q
ualif
icat
ion
Rev
iew
Boa
rd).
Am
ende
d by
86-
H 7
817
in 1
986
(ch.
236
) to
inst
ead
say
“life
- or s
ense
-thr
eate
ning
con
diti
ons,”
and
del
etes
refe
renc
es to
Pat
ient
Qua
lific
atio
n R
evie
w B
oard
.
SCFe
b. 2
8, 1
980
Feb.
28,
198
0S.
350
Act
No.
323
(198
0)§
44-5
3-61
0I
§ 44
-53-
160
and
§ 44
-53-
190
Cur
rent
Law
:Fo
r gla
ucom
a, c
ance
r che
mot
hera
py a
nd ra
diol
ogy,
and
oth
er d
isea
se g
roup
s (m
ariju
ana
and
TH
C).
The
pro
gram
has
nev
er b
een
oper
atio
nal.
Adm
inis
tere
d by
com
mis
sion
er o
f Dep
artm
ent o
f Hea
lth
and
Envi
ronm
enta
l Con
trol
and
pat
ient
qua
lific
atio
n re
view
adv
isor
y bo
ard;
“C
omm
issi
oner
shal
lob
tain
mar
ijuan
a th
roug
h w
hate
ver m
eans
he
deem
s mos
t app
ropr
iate
con
sist
ent w
ith
fede
ral l
aw.”
Min
or a
men
dmen
ts m
ade
by A
ct N
o. 1
81 (
1993
).
TX
June
14,
197
9Ja
nuar
y 1,
198
0S.
B. 8
77ch
. 826
(19
79)
H &
S §
481
.111
and
§ 48
1.20
1-20
5I
H &
S §
481
.032
and
§ 4
81.0
38 a
nd37
TA
C §
13.
1
Cur
rent
Law
:Fo
r can
cer a
nd g
lauc
oma
(TH
C o
r its
der
ivat
ives
). T
he p
rogr
am h
as n
ever
bee
n op
erat
iona
l.A
dmin
iste
red
by B
oard
of H
ealt
h an
d R
esea
rch
Prog
ram
Rev
iew
Boa
rd; R
PRB
, aft
er a
ppro
val o
f Boa
rd o
f Hea
lth,
may
seek
aut
hori
zati
on to
exp
and
rese
arch
pro
gram
to in
clud
e ot
her d
isea
ses;
get T
HC
from
fede
ral g
over
nmen
t.M
inor
am
endm
ents
mad
e by
S.B
. 688
in 1
983
(ch.
566
). H
.B. 2
136
in 1
989
(ch.
678
) m
oved
the
ther
apeu
tic
rese
arch
pro
gram
law
from
Civ
il St
atut
esH
ealt
h A
rt. 4
476-
15 to
H &
S §
481
.201
-205
.H
.B. 2
213,
sign
ed in
to la
w b
y T
exas
Gov
erno
r Geo
rge
W. B
ush
on Ju
ne 1
8, 1
997,
pro
hibi
ts lo
cal g
over
nmen
ts in
Tex
as fr
om a
dopt
ing
polic
ies o
f not
fully
enfo
rcin
g ex
isti
ng st
ate
drug
law
s. T
he b
ill w
as in
spir
ed b
y th
e vo
ter i
niti
ativ
e in
San
Mar
cos —
reje
cted
by
vote
rs o
n M
ay 3
, 199
7 —
whi
ch w
ould
hav
eal
low
ed p
olic
e to
ove
rloo
k th
e m
edic
al u
se o
f mar
ijuan
a. T
his l
aw d
oes n
ot a
ffect
the
exis
ting
ther
apeu
tic
rese
arch
pro
gram
law
.
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll #
sess
ion
law
cita
tion
for m
ed. m
j law
mar
ijuan
asc
hedu
leci
tati
on fo
rsc
hedu
les
WV
Mar
ch 1
0, 1
979
June
8, 1
979
S.B
. 366
ch. 5
6 (1
979)
§ 16
-5A
-7I
§ 60
A-2
-204
Cur
rent
Law
:Fo
r can
cer c
hem
othe
rapy
and
gla
ucom
a. T
he p
rogr
am h
as n
ever
bee
n op
erat
iona
l.Pr
ogra
m a
dmin
iste
red
by d
irec
tor o
f the
Dep
artm
ent o
f Hea
lth
and
Pati
ent Q
ualif
icat
ion
Rev
iew
Boa
rd; P
QR
B a
utho
rize
d to
cer
tify
the
part
icip
atio
n of
pati
ents
, phy
sici
ans,
and
phar
mac
ies f
or p
arti
cipa
tion
in th
e pr
ogra
m; m
ay in
clud
e ot
her d
isea
se g
roup
s if a
ppro
ved;
dir
ecto
r sha
ll co
ntra
ct w
ith
fede
ral
gove
rnm
ent f
or su
pply
of m
ariju
ana.
Sta
tes
wit
h S
ymbo
lic M
edic
al M
ariju
ana
Law
s
stat
em
ed. m
j law
appr
oved
took
effe
ctm
easu
rese
ssio
n la
wci
tati
on fo
rm
ed. m
j law
desc
ript
ion
of la
wm
ariju
ana
sche
dule
cita
tion
for
sche
dule
s
AZ
Nov
. 5, 1
996
Dec
. 6, 1
996
Prop
osit
ion
200
N/A
§ 13
-341
2.01
phys
icia
ns m
ay p
resc
ribe
I§
36-2
512
Cur
rent
Law
:Si
mila
r to
othe
r sta
te m
edic
al m
ariju
ana
init
iati
ves,
but u
ses t
he w
ord
“pre
scri
be”
rath
er th
an “
reco
mm
end.
” B
ecau
se o
f thi
s nar
row
lang
uage
, pat
ient
s do
not h
ave
lega
l pro
tect
ion.
Pre
scri
ptiv
e au
thor
ity
is c
ontr
olle
d by
the
fede
ral g
over
nmen
t, w
hich
doe
s not
per
mit
mar
ijuan
a pr
escr
ipti
ons.
The
refo
re, a
val
idpr
escr
ipti
on c
anno
t be
obta
ined
.H
.B. 2
518
was
sign
ed b
y th
e go
vern
or o
n A
pril
21, 1
997,
to re
peal
the
med
ical
mar
ijuan
a pr
ovis
ion
of P
rop.
200
. H.B
. 251
8 re
quir
es th
e FD
A to
app
rove
the
med
ical
use
of m
ariju
ana
befo
re A
rizo
na p
hysi
cian
s can
pre
scri
be it
. To
prev
ent H
.B. 2
518
from
taki
ng e
ffect
, the
spon
sors
of P
rop.
200
qua
lifie
dan
othe
r bal
lot p
ropo
sal (
Prop
. 300
) th
at w
ould
allo
w th
e m
edic
al m
ariju
ana
prov
isio
n of
Pro
p. 2
00 to
rem
ain
in e
ffect
. On
Nov
. 3, 1
998,
Ari
zona
vot
ers
vote
d “n
o” to
the
legi
slat
ure’
s law
by
reje
ctin
g Pr
op. 3
00 (
57%
opp
osed
, 43%
in fa
vor)
and
thus
uph
oldi
ng th
e m
edic
al m
ariju
ana
stat
ute.
The
med
ical
mar
ijuan
a pr
ovis
ions
of P
ropo
siti
on 2
00 w
ere
only
a sm
all p
art o
f thi
s mor
e co
mpr
ehen
sive
dru
g po
licy
refo
rm in
itia
tive
, whi
ch is
effe
ctiv
ely
keep
ing
man
y lo
w-l
evel
, non
viol
ent d
rug
offe
nder
s out
of p
riso
n.H
isto
ry:
A m
edic
al m
ariju
ana
(and
TH
C)
rese
arch
law
— w
hich
was
nev
er o
pera
tion
al —
for c
ance
r and
gla
ucom
a re
sear
ch (
§ 36
-260
1), e
nact
ed o
n A
pril
22, 1
980
(H.B
. 202
0; C
h. 1
22),
exp
ired
on
June
30,
198
5. D
irec
tor o
f the
Dep
artm
ent o
f Hea
lth
Serv
ices
aut
hori
zed
to a
ppoi
nt a
Pat
ient
Qua
lific
atio
n R
evie
wB
oard
; PQ
RB
was
aut
hori
zed
to re
view
pat
ient
s and
doc
tors
for p
arti
cipa
tion
in th
e pr
ogra
m; U
nive
rsit
y of
Ari
zona
was
to o
btai
n m
ariju
ana
or T
HC
from
NID
A. S
.B. 1
023
in 1
981
(ch.
264
) m
oved
the
ther
apeu
tic
rese
arch
pro
gram
pro
visi
ons f
rom
§ 3
6-10
31 to
§ 3
6-26
01.
Had
a d
ual s
ched
ulin
g sc
hem
e fo
r mar
ijuan
a, b
ut th
e pr
ovis
iona
l Sch
edul
e II
mar
ijuan
a pr
ovis
ion
was
ult
imat
ely
repl
aced
wit
h a
perm
anen
t Sch
edul
e II
prov
isio
n fo
r TH
C.
CT
not a
vaila
ble
July
1, 1
981
Sub.
H.B
. 521
7Pu
blic
Act
No.
81-
440
§ 21
a-24
6 an
d §
21a-
253
phys
icia
ns m
ay p
resc
ribe
I§
21a-
243
and
§ 21
a-24
3-7
Reg
.of
Con
n. S
tate
Age
ncie
s
Cur
rent
Law
:Fo
r can
cer c
hem
othe
rapy
and
gla
ucom
a.La
w fo
rmer
ly se
t out
as §
19-
453
and
§ 19
-460
a, b
ut se
ctio
ns w
ere
tran
sfer
red
in 1
983;
allo
ws p
hysi
cian
s lic
ense
d by
the
Com
mis
sion
er o
f Con
sum
erPr
otec
tion
to p
rovi
de m
ariju
ana;
allo
ws p
atie
nts t
o po
sses
s mar
ijuan
a ob
tain
ed fr
om a
pre
scri
ptio
n; m
akes
no
prov
isio
n fo
r the
sour
ce o
f the
mar
ijuan
asu
pply
.
stat
em
ed. m
j law
appr
oved
took
effe
ctm
easu
rese
ssio
n la
wci
tati
on fo
rm
ed. m
j law
desc
ript
ion
of la
wm
ariju
ana
sche
dule
cita
tion
for
sche
dule
s
DC
July
27,
200
0pr
ojec
ted
to ta
keef
fect
May
200
1B
ill N
o. 1
3-24
0A
ct 1
3-39
5(2
000)
§ 33
-518
sche
dulin
g re
cogn
izes
mar
ijuan
a’s t
hera
peut
ic u
seII
I§
33-5
16
Cur
rent
Law
:D
.C. m
oved
mar
ijuan
a fr
om S
ched
ule
V to
Sch
edul
e II
I in
2000
, whi
ch m
eans
“T
he su
bsta
nce
has c
urre
ntly
acc
epte
d m
edic
al u
se in
trea
tmen
t in
the
Uni
ted
Stat
es o
r the
Dis
tric
t of C
olum
bia.
” D
.C. i
nsti
tute
d a
sche
dulin
g sy
stem
in 1
981
(Bill
No.
4-1
23, L
aw 4
29 (
1981
), e
nact
ed o
n Ju
ne 9
, 198
1, to
okef
fect
on
Aug
ust 5
, 198
1) th
at li
sted
mar
ijuan
a (“
cann
abis
”) a
mon
g th
e su
bsta
nces
in S
ched
ule
V, t
he le
ast r
estr
icti
ve sc
hedu
le.
His
tory
:D
.C. v
oter
s pas
sed
Bal
lot I
niti
ativ
e 59
on
Nov
. 3, 1
998
(69%
in fa
vor,
31%
opp
osed
), w
hich
is si
mila
r to
othe
r sta
te in
itia
tive
s and
rem
oves
cri
min
alpe
nalt
ies f
or m
edic
al m
ariju
ana
use.
The
U.S
. Con
gres
s, ho
wev
er, n
ullif
ied
the
elec
tion
resu
lts i
n N
ovem
ber 1
999
and
agai
n in
Dec
embe
r 200
0, th
war
ting
the
will
of t
he v
oter
s. D
.C. i
s the
onl
y ju
risd
icti
on w
here
the
fede
ral g
over
nmen
t can
pre
vent
such
law
s fro
m ta
king
effe
ct. I
niti
ativ
e 59
wou
ld h
ave
perm
itte
d pa
tien
ts to
hav
e up
to fo
ur c
areg
iver
s; pe
rmit
ted
non-
prof
it m
ariju
ana
supp
liers
; and
allo
wed
a “
suffi
cien
t qua
ntit
y” o
f mar
ijuan
a to
trea
t illn
ess.
Itis
unc
lear
whe
ther
Con
gres
s mus
t blo
ck th
e in
itia
tive
eve
ry y
ear i
n or
der t
o pr
even
t it f
rom
taki
ng e
ffect
, or w
heth
er it
s Nov
embe
r 199
9 ac
t per
man
entl
yov
ertu
rned
the
ballo
t ini
tiat
ive.
IAJu
ne 1
, 197
9Ju
ly 1
, 197
9S.
F. 4
87C
h. 9
(19
79)
§ 12
4.20
4 an
d §
124.
206
sche
dulin
g re
cogn
izes
mar
ijuan
a’s t
hera
peut
ic u
seI*
§ 12
4.20
4 an
d§
124.
206
Cur
rent
Law
:*T
he b
ill im
plem
ente
d a
dual
sche
dulin
g sc
hem
e fo
r mar
ijuan
a an
d T
HC
, whi
ch a
re in
Sch
edul
e I b
ut a
re c
onsi
dere
d to
be
in S
ched
ule
II w
hen
used
for
med
icin
al p
urpo
ses.
His
tory
:T
he b
ill a
ppro
pria
ted
$247
,000
to th
e B
oard
of P
harm
acy
Exam
iner
s whi
ch w
as c
onti
ngen
t upo
n th
e B
oard
of P
harm
acy
Exam
iner
s’ es
tabl
ishi
ng a
ther
apeu
tic
rese
arch
pro
gram
wit
hin
90 d
ays o
f the
effe
ctiv
e da
te o
f the
act
(Ju
ly 1
, 197
9); t
he b
oard
was
man
date
d to
org
aniz
e a
Phys
icia
ns A
dvis
ory
Gro
up to
adv
ise
the
boar
d on
the
stru
ctur
e of
the
prog
ram
— w
hich
was
nev
er o
pera
tion
al.
Sche
dulin
g in
form
atio
n w
as o
rigi
nally
loca
ted
at §
204
.204
but
was
mov
ed to
§ 1
24.2
04 in
199
3 by
the
Iow
a C
ode
Edit
or. N
o di
seas
e gr
oups
wer
e sp
ecifi
edin
the
bill.
The
dua
l sch
edul
ing
sche
me
still
exi
sts i
n th
e st
atut
es, b
ut th
e la
ngua
ge fo
r the
ther
apeu
tic
rese
arch
pro
gram
— A
dmin
istr
ativ
e C
ode
620-
12 —
was
act
ive
from
Oct
ober
1, 1
979,
to Ju
ne 3
0, 1
981,
and
was
rem
oved
on
Janu
ary
20, 1
987.
LAJu
ly 1
7, 1
978;
July
23,
199
1A
ugus
t 14,
197
8;A
ugus
t 21,
199
1S.
B. 2
45 (
1978
);H
.B. 1
187
(199
1)A
ct N
o. 7
25(1
978)
;A
ct N
o. 8
74(1
991)
40:1
021
phys
icia
ns m
ay p
resc
ribe
I40
:964
Cur
rent
Law
:Fo
r gla
ucom
a, c
ance
r che
mot
hera
py, a
nd “
spas
tic
quad
ripl
egia
.”A
pre
viou
s law
, 40:
1021
- 40
:102
6, h
ad b
een
repe
aled
by
H.B
. 122
4 in
198
9 (A
ct N
o. 6
62).
The
pre
viou
s law
was
a th
erap
euti
c re
sear
ch p
rogr
am th
atad
dres
sed
only
gla
ucom
a an
d ca
ncer
.T
he p
rese
nt la
w a
llow
s phy
sici
ans w
ith
Sche
dule
I lic
ense
s to
pres
crib
e m
ariju
ana
in a
ccor
danc
e w
ith
regu
lati
ons p
rom
ulga
ted
by th
e Se
cret
ary
of H
ealt
han
d H
ospi
tals
.
MT
Mar
ch 2
6, 1
979
Mar
ch 2
6, 1
979
H.B
. 463
ch. 3
20 (
1979
)50
-32-
222(
7)sc
hedu
ling
reco
gniz
esm
ariju
ana’
s the
rape
utic
use
I50
-32-
222
Cur
rent
Law
:W
ould
aut
omat
ical
ly re
sche
dule
TH
C a
nd m
ariju
ana
to S
ched
ule
II if
the
fede
ral g
over
nmen
t aut
hori
zes t
he p
resc
ript
ion
or a
dmin
istr
atio
n of
thes
esu
bsta
nces
.
stat
em
ed. m
j law
appr
oved
took
effe
ctm
easu
rese
ssio
n la
wci
tati
on fo
rm
ed. m
j law
desc
ript
ion
of la
wm
ariju
ana
sche
dule
cita
tion
for
sche
dule
s
NH
Apr
il 23
, 198
1Ju
ne 2
2, 1
981
S.B
. 21
ch. 1
07 (
1981
)31
8-B
:9ph
ysic
ians
may
pre
scri
beI*
318-
B:1
-a
Cur
rent
Law
:Fo
r can
cer c
hem
othe
rapy
and
radi
olog
y.A
men
ded
by H
.B. 1
563
(ena
cted
June
8, 1
998;
took
effe
ct Ja
n. 1
, 199
9), w
hich
says
doc
tors
may
onl
y pr
escr
ibe
mar
ijuan
a if
it is
app
rove
d by
the
FDA
;pr
evio
usly
doc
tors
cou
ld p
resc
ribe
it w
itho
ut F
DA
app
rova
l, bu
t the
abs
ence
of a
lega
l sup
ply
mad
e th
e la
w in
effe
ctiv
e.*S
tate
follo
ws t
he fe
dera
l gov
ernm
ent’s
sche
dulin
g of
con
trol
led
subs
tanc
es a
s art
icul
ated
in th
e C
ode
of F
eder
al R
egul
atio
ns [3
18-B
:1-a
; Jun
e 11
, 199
6,ph
one
conv
ersa
tion
wit
h Jo
hn M
cCor
mic
k at
New
Ham
pshi
re S
tate
Lib
rary
, 603
-271
-223
9].
TN
Apr
il 2,
198
1A
pril
2, 1
981
H.B
. 314
ch. 1
14 (
1981
)§
68-5
2-10
1sc
hedu
ling
reco
gniz
esm
ariju
ana’
s the
rape
utic
use
VI*
§ 39
-17-
408
Cur
rent
Law
:O
nly
the
sche
dulin
g pr
ovis
ion
of th
e th
erap
euti
c re
sear
ch p
rogr
am re
mai
ns o
n th
e bo
oks.
His
tory
:T
he b
ill c
reat
ed a
ther
apeu
tic
rese
arch
pro
gram
— w
hich
was
ope
rati
onal
— fo
r can
cer c
hem
othe
rapy
or r
adio
logy
or g
lauc
oma
(mar
ijuan
a or
TH
C);
adm
inis
tere
d by
Pat
ient
Qua
lific
atio
n R
evie
w B
oard
cre
ated
wit
hin
Boa
rd o
f Pha
rmac
y; P
QR
B w
as a
utho
rize
d to
con
trac
t wit
h fe
dera
l gov
ernm
ent f
orm
ariju
ana.
The
rape
utic
rese
arch
pro
gram
was
repe
aled
by
S.B
. 181
8 in
199
2 (c
h. 5
37),
but
dua
l sch
edul
ing
sche
me
still
rem
ains
.*M
ariju
ana
and
TH
C a
re in
Sch
edul
e V
I but
are
con
side
red
to b
e in
Sch
edul
e II
whe
n us
ed fo
r med
icin
al p
urpo
ses.
(Sch
edul
e V
I inc
lude
s con
trol
led
subs
tanc
es th
at “
shou
ld n
ot b
e in
clud
ed in
Sch
edul
es I
thro
ugh
V.”
Sch
edul
es I
thro
ugh
V h
ave
the
typi
cal d
efin
itio
ns u
sed
in o
ther
stat
es.)
VA
Mar
ch 2
7, 1
979
Spri
ng 1
979
S. 9
13ch
. 435
(19
79)
§ 18
.2-2
50.1
and
§ 1
8.2-
251.
1ph
ysic
ians
may
pre
scri
beN
/A§
54.1
-344
3
Cur
rent
Law
:Fo
r can
cer a
nd g
lauc
oma
(mar
ijuan
a or
TH
C).
Allo
ws p
hysi
cian
s to
pres
crib
e an
d ph
arm
acis
ts to
dis
pens
e m
ariju
ana
and
TH
C fo
r suc
h pu
rpos
es.
VT
Apr
il 27
, 198
1A
pril
27, 1
981
H. 1
30A
ct N
o. 4
9(1
981)
18 V
SA §
447
1ph
ysic
ians
may
pre
scri
beN
/AN
/A
Cur
rent
Law
:Fo
r can
cer a
nd o
ther
med
icin
al u
ses a
s det
erm
ined
by
the
Com
mis
sion
er o
f Hea
lth.
Adm
inis
tere
d by
Dep
artm
ent o
f Hea
lth;
cal
led
a “r
esea
rch
prog
ram
” bu
t rea
lly e
nabl
es p
hysi
cian
s to
pres
crib
e m
ariju
ana;
“co
mm
issi
oner
of h
ealt
h sh
all
have
the
auth
orit
y to
obt
ain
… c
anna
bis a
dmin
iste
red
unde
r thi
s pro
gram
.”
WI
not a
vaila
ble;
Apr
il 20
, 198
8A
pril
20, 1
982;
Apr
il 28
, 198
8A
.B. 6
97;
A.B
. 662
ch. 1
93(1
981)
; Act
339
(198
7)
46.6
0ph
ysic
ians
may
pre
scri
beI
161.
13; 1
61.4
1(3r
)
Cur
rent
Law
:N
o di
seas
e gr
oups
spec
ified
(m
ariju
ana
or T
HC
).A
llow
s med
ical
mar
ijuan
a pr
escr
ipti
ons i
n ac
cord
ance
wit
h fe
dera
l IN
D (
Inve
stig
atio
nal N
ew D
rug)
per
mit
s; gi
ves c
ontr
olle
d su
bsta
nces
boa
rd th
eau
thor
ity
to se
t up
regu
lati
ons.
A.B
. 662
in 1
987
(Act
339
), e
nact
ed in
198
8, a
llow
s for
the
poss
essi
on o
f TH
C if
obt
aine
d di
rect
ly fr
om a
val
id p
resc
ript
ion.
Sta
tes
in w
hich
Med
ical
Mar
ijuan
a La
ws
Hav
e EX
PIR
ED o
r H
ave
Bee
n R
EPEA
LED
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll #
sess
ion
law
cita
tion
for
med
. mj l
awde
scri
ptio
nof
law
law
exp
ired
/rep
eale
dm
ariju
ana
sche
dule
cita
tion
for
sche
dule
s
AR
Jan.
30,
198
1Ja
n. 3
0, 1
981
H.B
. 171
Act
No.
8 (
1981
)§
82-1
007
(num
beri
ngsy
stem
has
chan
ged
sinc
ela
w w
asre
peal
ed)
phys
icia
nsm
aypr
escr
ibe
repe
aled
by
Act
No.
52
(198
7)V
I§
5-64
-215
Cur
rent
Law
:M
ariju
ana
and
TH
C a
re li
sted
in S
ched
ule
VI,
but S
ched
ule
VI s
ubst
ance
s are
def
ined
sim
ilarl
y —
yet
eve
n m
ore
rest
rict
ivel
y —
than
Sch
edul
e I s
ubst
ance
s.H
isto
ry:
For c
ance
r (la
wfu
lly o
btai
ned
TH
C).
FLJu
ne 2
6, 1
978
July
1, 1
978
H.B
. 123
7c.
78-
413
(197
8)§
402.
36th
erap
euti
cre
sear
chpr
ogra
m
repe
aled
by
c. 8
4-11
5(1
984)
I§
893.
03
His
tory
:Fo
r can
cer a
nd g
lauc
oma
(mar
ijuan
a or
TH
C).
The
rape
utic
Res
earc
h Pr
ogra
m —
whi
ch w
as n
ever
ope
rati
onal
— a
dmin
iste
red
by S
ecre
tary
of D
epar
tmen
t of H
ealt
h an
d R
ehab
ilita
tive
Ser
vice
s (H
RS)
who
wou
ld d
eleg
ate
to P
atie
nt Q
ualif
icat
ion
Rev
iew
Boa
rd th
e au
thor
ity
to a
ppro
ve c
ance
r and
gla
ucom
a pa
tien
ts; P
QR
B a
utho
rize
d to
incl
ude
othe
rdi
seas
e gr
oups
aft
er p
erti
nent
dat
a ha
ve b
een
pres
ente
d by
phy
sici
an; S
ecre
tary
of H
RS
was
man
date
d to
app
ly to
fede
ral g
over
nmen
t for
mar
ijuan
a an
dtr
ansf
er m
ariju
ana
to c
erti
fied
stat
e-op
erat
ed p
harm
acie
s for
dis
trib
utio
n to
cer
tifie
d pa
tien
ts u
pon
wri
tten
pre
scri
ptio
n of
cer
tifie
d ph
ysic
ians
.M
inor
mod
ifica
tion
s: c.
79-
209
(197
9), c
. 81-
279
(198
1); i
nter
esti
ng m
odifi
cati
on w
ith
c. 8
2-12
(19
82),
whi
ch c
hang
ed n
ame
from
“co
ntro
lled
subs
tanc
esth
erap
euti
c re
sear
ch”
to “
canc
er th
erap
euti
c re
sear
ch”
to a
llow
for “
unco
nven
tion
al th
erap
ies”
that
are
not
yet
app
rove
d by
the
fede
ral g
over
nmen
t.
MI
Oct
. 22,
197
9;D
ec. 2
1, 1
982
Oct
. 22,
197
9;D
ec. 2
1, 1
982
S.B
. 185
(19
79);
S.B
. 816
(19
82)
Act
No.
125
(19
79);
Act
No.
352
(19
82)
§ 33
3.73
35th
erap
euti
cre
sear
chpr
ogra
m
1979
law
exp
ired
Nov
embe
r 1, 1
982;
1982
law
doe
s not
appl
y af
ter
Nov
embe
r 1, 1
987
I§
333.
7212
; MA
C33
8.31
14 a
nd33
8.31
19a
(198
6 A
nnua
lSu
pple
men
t);
MA
C 3
38.3
113
(198
8 A
nnua
lSu
pple
men
t)
His
tory
:Fo
r gla
ucom
a an
d ca
ncer
che
mot
hera
py (
mar
ijuan
a or
TH
C);
allo
wed
pat
ient
s wit
h ot
her d
isea
ses i
f pat
ient
s hav
e IN
D (
Inve
stig
atio
nal N
ew D
rug)
per
mit
from
FD
A.
Adm
inis
tere
d by
the
Dep
artm
ent o
f Pub
lic H
ealt
h, th
e pr
ogra
m w
as o
pera
tion
al; m
ariju
ana
and
TH
C c
onsi
dere
d to
be
in S
ched
ule
II w
hen
disp
ense
dth
roug
h th
e pr
ogra
m; u
sed
fede
ral m
ariju
ana;
als
o au
thor
ized
to u
se m
ariju
ana
conf
isca
ted
by st
ate
law
-enf
orce
men
t age
ncie
s (w
hich
alm
ost c
erta
inly
nev
erha
ppen
ed).
1979
law
exp
ired
on
Nov
embe
r 1, 1
982,
and
then
a n
earl
y id
enti
cal l
aw w
as e
nact
ed a
mon
th la
ter,
whi
ch e
xpir
ed o
n N
ovem
ber 1
, 198
7.
stat
em
ed. m
j law
appr
oved
took
effe
ctbi
ll #
sess
ion
law
cita
tion
for
med
. mj l
awde
scri
ptio
nof
law
law
exp
ired
/rep
eale
dm
ariju
ana
sche
dule
cita
tion
for
sche
dule
s
NC
June
5, 1
979
June
5, 1
979
H.B
. 106
5ch
. 781
(19
79)
§ 90
-101
phys
icia
nsm
aypr
escr
ibe
de fa
cto
repe
aled
by
H.B
. 878
in 1
987
(ch.
412
), w
hich
allo
ws p
hysi
cian
s to
adm
inis
ter o
nly
dron
abin
ol(s
ynth
etic
TH
C)
for
canc
erch
emot
hera
py
VI
§ 90
-90
His
tory
:“A
phy
sici
an …
may
pos
sess
, dis
pens
e or
adm
inis
ter t
etra
hydr
ocan
nabi
nols
in d
uly
cons
titu
ted
phar
mac
euti
cal f
orm
for h
uman
adm
inis
trat
ion
for
trea
tmen
t pur
pose
s pur
suan
t to
rule
s ado
pted
by
the
[Nor
th C
arol
ina
Dru
g] C
omm
issi
on.”
Sche
dule
VI (
§ 90
-94)
is sp
ecifi
c to
mar
ijuan
a: “
no c
urre
ntly
acc
epte
d m
edic
al u
se in
the
Uni
ted
Stat
es, o
r a re
lati
vely
low
pot
enti
al fo
r abu
se in
term
s of
risk
to p
ublic
hea
lth
and
pote
ntia
l to
prod
uce
psyc
hic
or p
hysi
olog
ical
dep
ende
nce
liabi
lity
base
d up
on p
rese
nt m
edic
al k
now
ledg
e, o
r a n
eed
for f
urth
eran
d co
ntin
uing
stud
y to
dev
elop
scie
ntifi
c ev
iden
ce o
f its
pha
rmac
olog
ical
effe
cts.”
OH
Mar
ch 2
1, 1
980;
1995
June
20,
198
0;Ju
ly 1
, 199
6S.
B. 1
84; S
.B. 2
Act
No.
230
(19
80);
not a
vaila
ble
§ 29
25.1
1(I)
ther
apeu
tic
rese
arch
prog
ram
;m
edic
alne
cess
ity
defe
nse
first
law
exp
ired
in19
84; m
edic
alne
cess
ity
defe
nse
repe
aled
by
S.B
. 2 in
1997
I§
3719
.41
His
tory
:19
80 la
w, w
hich
exp
ired
on
June
20,
198
4, w
as a
ther
apeu
tic
rese
arch
pro
gram
— w
hich
was
nev
er o
pera
tion
al —
to b
e ad
min
iste
red
by th
e D
irec
tor o
fH
ealt
h; m
ariju
ana
and
TH
C; P
atie
nt R
evie
w B
oard
; gla
ucom
a, c
ance
r che
mot
hera
py o
r rad
iolo
gy, o
r oth
er m
edic
al c
ondi
tion
s; la
w a
ppea
red
at §
371
9.85
.19
96 la
w re
ad a
s fol
low
s: “I
t is a
n af
firm
ativ
e de
fens
e …
to a
cha
rge
of p
osse
ssin
g m
ariju
ana
unde
r thi
s sec
tion
that
the
offe
nder
, pur
suan
t to
the
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edic
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— w
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de p
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For thousands of years, marijuana has been used to treat awide variety of ailments. Until 1937, marijuana (C a n n a b i ssativa L.) was legal in the United States for all purposes.P r e s e n t l y, federal law allows only eight (8) Americans to usemarijuana as a medicine.
On March 17, 1999, the National Academy of Sciences’Institute of Medicine (IOM) concluded that “there are somelimited circumstances in which we recommend smokingmarijuana for medical uses.” The IOM report released thatday was the result of two years of research that was funded bythe White House drug policy office, which comprised ameta-analysis of all existing data on marijuana’s therapeuticuses. Please see <http://www. m p p . o r g / s c i e n c e . h t m l > .
Medicinal Va l u eMarijuana is one of the safest therapeutically active sub-stances known. No one has ever died from an overdose, andit has a wide variety of therapeutic applications:
■ Relief from nausea and increase of appetite;■ Reduction of intraocular (“within the eye”) pressure;■ Reduction of muscle spasms;■ Relief from chronic pain.Marijuana is frequently beneficial in the treatment of the
following conditions:■ AIDS. Marijuana can reduce the nausea, vomiting, and
loss of appetite caused by the ailment itself and by vari-ous AIDS medications.
■ Glaucoma. Marijuana can reduce intraocular pressure,thereby alleviating the pain and slowing—and some-times stopping—the progress of the condition.(Glaucoma is the leading cause of blindness in theUnited States. It damages vision by increasing eye pres-sure over time.)
■ C a n c e r. Marijuana can stimulate the appetite and alle-viate nausea and vomiting, which are common sideeffects of chemotherapy treatment.
■ Multiple Sclerosis. Marijuana can limit the musclepain and spasticity caused by the disease, as well asrelieving tremor and unsteadiness of gait. (Multiple scle-rosis is the leading cause of neurological disability amongyoung and middle-aged adults in the United States.)
■ E p i l e p s y. Marijuana can prevent epileptic seizures insome patients.
■ Chronic Pain. Marijuana can alleviate the chronic,often debilitating pain caused by myriad disorders andi n j u r i e s .
Each of these applications has been deemed legitimate byat least one court, legislature, and/or government agency inthe United States.
Many patients also report that marijuana is useful fortreating arthritis, migraine, menstrual cramps, alcohol and
opiate addiction, and depression and other debilitating moodd i s o r d e r s .
Marijuana could be helpful for millions of patients in theUnited States. Nevertheless, other than for the eight p e o p l ewith special permission from the federal government, med-ical marijuana remains illegal!
People currently suffering from any of the conditionsmentioned above, for whom the legal medical options haveproven unsafe or ineffective, have two options:
1 . Continue to suffer from the ailment itself; or2 . Illegally obtain marijuana—and risk suffering conse-
quences such as:■ an insufficient supply due to the prohibition-
inflated price or scarcity;■ impure, contaminated, or chemically adulterated
marijuana; ■ arrests, fines, court costs, property forfeiture, incar-
ceration, probation, and criminal records.
B a c k g r o u n dThe Marijuana Tax Act of 1937 federally prohibitedmarijuana. Dr. William C. Wo odward of the AmericanMedical Association opposed the Act, testifying that prohi-bition would ultimately prevent the medicinal uses ofm a r i j u a n a .
The Controlled Substances Act of 1970 placed all illicitand prescription drugs into five “schedules” (categories).Marijuana was placed in Schedule I, defining the substanceas having a high potential for abuse, no currently acceptedmedicinal use in treatment in the United States, and a lackof accepted safety for use under medical supervision.
This definition simply does not apply to marijuana. Ofcourse, at the time of the Controlled Substances Act,marijuana had been prohibited for more than three decades.Its medicinal uses forgotten, marijuana was considered adangerous and addictive narcotic.
A substantial increase in the number of recreational usersin the 1970s contributed to the rediscovery of marijuana’smedicinal uses:
■ Many scientists felt the obligation to study the healtheffects of marijuana. They inadvertently discoveredm a r i j u a n a ’s astonishing medicinal history in thep r o c e s s .
■ Many people who used marijuana recreationally werealso suffering from diseases for which marijuana isbeneficial. By fluke, they discovered its therapeuticu s e f u l n e s s .
As the word spread, more and more patients started self-medicating with marijuana. However, because of marijuana’sSchedule I status, doctors cannot prescribe it, and researchapproval and funding are severely curtailed.
Medical Marijuana Briefing Paper – 2001– The Need to Change State and Federal La w –
■ ■ ■
■ ■ ■
Appendix B
B-1
The Struggle in CourtIn 1972, a petition was submitted to the Bureau of Narcoticsand Dangerous Drugs—now the Drug EnforcementAdministration (DEA)—to reschedule marijuana to make itavailable by prescription.
After 16 years of court battles, the DEA’s chief adminis-trative law judge, Francis L. Young, ruled:
“Marijuana, in its natural form, is one of the safesttherapeutically active substances known. ...
“... [T]he provisions of the [Controlled Substances]Act permit and require the transfer of marijuana fromSchedule I to Schedule II.
“It would be unreasonable, arbitrary and capricious forDEA to continue to stand between those sufferers andthe benefits of this substance. ...”
(September 6, 1988)
M a r i j u a n a ’s placement in Schedule II would enabledoctors to prescribe it to their patients. But top DEAbureaucrats rejected Judge Y o u n g ’ s ruling and refused toreschedule marijuana. Two appeals later, petitioners experi-enced their first defeat in the 22-year-old lawsuit. OnF e b r u a r y 18, 1994, the U.S. Court of Appeals (D.C. Circuit)ruled that the DEA is allowed to reject its judge’s ruling andset its own criteria—enabling the DEA to keep marijuana inSchedule I.
H o w e v e r , Congress still has the power to reschedulemarijuana via legislation, regardless of the DEA’s wishes.
Te m p o r a ry CompassionIn 1975, Robert Randall, who suffers from glaucoma, wasarrested for cultivating his own marijuana. He won his caseby using the “medical necessity defense,” forcing thegovernment to find a way to provide him with his medicine.As a result, the Investigational New Drug (IND) compas-sionate access program was established, enabling somepatients to receive marijuana from the government.
The program was grossly inadequate at helping the poten-tially millions of people who need medical marijuana:
■ Most patients would never consider the idea that anillegal drug might be their best medicine;
■ Most patients fortunate enough to discover marijuana’smedicinal value did not discover the IND program;
■ Most of those who did learn of the program could notfind doctors willing to take on the arduous task ofenrolling in and working through the IND program.
In 1992, in response to a flood of new applications fromAIDS patients, members of the Bush administration closedthe program to all new applicants. On December 1, 1999,the Clinton administration implemented its medicalmarijuana policy restating that the IND program would notbe reopened. Consequently, the IND program remains inoperation only for the eight surviving previously approvedp a t i e n t s .
Public OpinionThere is tremendous public support for ending the prohibi-tion of medical marijuana:
■ Since 1996, a majority of voters in Alaska, California,Colorado, the District of Columbia, Maine, Nevada,Oregon, and Washington state have voted in favor ofballot initiatives to remove criminal penalties for seri-ously ill people who grow or possess medical marijuana.
■ A 1990 scientific survey of oncologists (cancer special-ists) found that 54% of those with an opinion favoredthe controlled medical availability of marijuana and 44%had already broken the law by suggesting at least oncethat a patient obtain marijuana illegally. [R. D o b l i n &M . Kleiman, “Marijuana as Antiemetic Medicine,”Journal of Clinical Oncology 9 (1991): 1314-1319.]
■ A nationwide Gallup poll taken on March 19-21, 1999,found that 73% of American adults are for “makingmarijuana legally available for doctors to prescribe in orderto reduce pain and suffering.” All other public opinionpolls taken in the 1990s have shown between 60% and80% support for making marijuana medically available.
Changing State La w sThe federal government has no legal authority to preventstate governments from changing their laws to remove state-level criminal penalties for medical marijuana use. Indeed,Hawaii enacted a medical marijuana law via its state legisla-ture in June 2000. State legislatures have the authority andmoral responsibility to change state law to:
■ exempt seriously ill patients from state-level prosecutionfor medical marijuana possession and cultivation; and
■ exempt doctors who recommend medical marijuanafrom prosecution or the denial of any right or privilege.
Even within the confines of federal law, states can enactreforms that have the practical effect of removing the fear ofpatients being arrested and prosecuted under state law—aswell as the symbolic effect of pushing the federal governmentto allow doctors to prescribe marijuana.
U.S. Congress: The Final BattlegroundState governments that want to allow marijuana to be soldin pharmacies have been stymied by the federal govern-m e n t ’s overriding prohibition of marijuana.
Patients have exhausted the option of working throughthe judicial branch of the federal government. The courtsultimately defer to the judgment of the DEA, which createsits own regulations in order to keep medical marijuana illegal.
Efforts to obtain FDA approval of marijuana have similar-ly been thwarted by prohibitionist agencies. Instead of sup-plying marijuana to any FDA-approved researcher whorequests it, the National Institute on Drug Abuse—the onlylegal source of marijuana for clinical research in the UnitedStates—uses unnecessary bureaucratic hurdles to justifydenying researchers the marijuana they need.
In the meantime, patients continue to suffer. C o n g r e s shas the power and the responsibility to change federal lawso that seriously ill people nationwide can use medicalmarijuana without fear of arrest and imprisonment.
Appendix B (continued)
B-2
What conditions can marijuana treat?
“The accumulated data indicate a potential thera-peutic value for cannabinoid drugs, particularly forsymptoms such as pain relief, control of nausea andvomiting, and appetite stimulation.” [p. 3 ]
“[B]asic biology indicates a role for cannabinoids inpain and control of movement, which is consistentwith a possible therapeutic role in these areas. Theevidence is relatively strong for the treatment ofpain and, intriguing although less well established,for movement disorders.” [p . 7 0]
“For patients such as those with AIDS or who are under-going chemotherapy and who suffer simultaneouslyfrom severe pain, nausea, and appetite loss, cannabinoiddrugs might offer broad-spectrum relief not found in anyother single medication. The data are weaker for mus-cle spasticity but moderately promising.” [p. 1 7 7 ]
“The most encouraging clinical data on the effects ofcannabinoids on chronic pain are from three studiesof cancer pain.” [p . 1 4 2]
Why can’t patients use medicines that arealready legal?
“[T]here will likely always be a subpopulation ofpatients who do not respond well to other medica-tions.” [Pp. 3, 4]
“The critical issue is not whether marijuana orcannabinoid drugs might be superior to the newdrugs, but whether some group of patients mightobtain added or better relief from marijuana orcannabinoid drugs.” [p. 1 5 3 ]
“The profile of cannabinoid drug effects suggests thatthey are promising for treating wasting syndrome inAIDS patients. Nausea, appetite loss, pain, andanxiety are all afflictions of wasting, and all can bemitigated by marijuana. Although some medica-tions are more effective than marijuana for theseproblems, they are not equally effective in allpatients.” [p. 1 5 9 ]
What about Marinol®, the major activeingredient in marijuana in pill form?
“It is well recognized that Marinol’s oral route ofadministration hampers its effectiveness because ofslow absorption and patients’ desire for more con-trol over dosing.” [Pp. 205, 206]
Why not wait for more research before makingmarijuana legally available as a medicine?
“[R]esearch funds are limited, and there is a dauntingthicket of regulations to be negotiated at the federallevel (those of the Food and Drug Administration,FDA, and the Drug Enforcement Administration,DEA) and state levels.” [p. 1 3 7 ]
“Some drugs, such as marijuana, are labeledSchedule I in the Controlled Substance Act, andthis adds considerable complexity and expense totheir clinical evaluation.” [p. 1 9 4 ]
“[O]nly about one in five drugs initially tested inhumans successfully secures FDA approval for mar-keting through a new drug application.” [p. 1 9 5 ]
“From a scientific point of view, research is difficultbecause of the rigors of obtaining an adequate supplyof legal, standardized marijuana for study.” [p . 2 1 7 ]
Questions about medical marijuana answered by the
Institute of Medicine’s report
Marijuana and Medicine: Assessing the Science Base*
Excerpts compiled by the Marijuana Policy Pr o j e c t
■ ■ ■
■ ■ ■
“[W]e concluded that there are some limited circumstances in which we recommendsmoking marijuana for medical uses.”
— from Principal Investigator Dr. John Benson’s opening remarks at IOM’s 3/17/99 news conference
*Copyright 1999 by the National Academy of Sciences (ISBN 0-309-07155-0)
Appendix C
C-1
“In short, development of the marijuana plant isbeset by substantial scientific, regulatory, and com-mercial obstacles and uncertainties.” [p. 2 1 8 ]
“[D]espite the legal, social, and health problems asso-ciated with smoking marijuana, it is widely used bycertain patient groups.” [p. 7 ]
Do the existing laws really hurt patients?
“G.S. spoke at the IOM workshop in Louisianaabout his use of marijuana first to combat AIDSwasting syndrome and later for relief from the sideeffects of AIDS medications. … [He said,] ‘Everyday I risk arrest, property forfeiture, fines, andi m p r i s o n m e n t . ’ ” [Pp. 27, 28]
Why shouldn’t we wait for new drugs based onmarijuana’s components to be developed, ratherthan allowing patients to eat or smoke naturalmarijuana right now?
“Although most scientists who study cannabinoidsagree that the pathways to cannabinoid drug devel-opment are clearly marked, there is no guaranteethat the fruits of scientific research will be madeavailable to the public for medical use.” [p. 4 ]
“[I]t will likely be many years before a safe and effec-tive cannabinoid delivery system, such as an inhaler,is available for patients. In the meantime there arepatients with debilitating symptoms for whomsmoked marijuana might provide relief.” [p . 7]
“[W]hat seems to be clear from the dearth of prod u c t sin development and the small size of the companiessponsoring them is that cannabinoid development isseen as especially risky.” [Pp. 211, 212] [IOM later notesthat it could take more than five years and cost $200-300million to get new cannabinoid drugs approved—if ever. ]
“Cannabinoids in the plant are automatically placedin the most restrictive schedule of the ControlledSubstances Act, and this is a substantial deterrentto development.” [p. 2 1 9 ]
I s n’t marijuana too dangerous to be used as am e d i c i n e ?
“[E]xcept for the harms associated with smoking, theadverse effects of marijuana use are within the rangeof effects tolerated for other medications.” [p . 5]
“Until the development of rapid onset antiemeticdrug delivery systems, there will likely remain a sub-population of patients for whom standard antiemetictherapy is ineffective and who suffer from debilitat-ing emesis. It is possible that the harmful effects ofsmoking marijuana for a limited period of time
might be outweighed by the antiemetic benefits ofmarijuana, at least for patients for whom standardantiemetic therapy is ineffective and who suffer fromdebilitating emesis. Such patients should be evaluat-ed on a case-by-case basis and treated under closemedical supervision.” [p . 1 5 4]
“Terminal cancer patients pose different issues. Forthose patients the medical harm associated withsmoking is of little consequence. For terminalpatients suffering debilitating pain or nausea and forwhom all indicated medications have failed to pro-vide relief, the medical benefits of smokedmarijuana might outweigh the harm.” [p. 1 5 9 ]
What should be done to help the patients whoalready benefit from medical marijuana, prior tothe development of new drugs and delivery devices?
“Patients who are currently suffering from debilitatingconditions unrelieved by legally available drugs, andwho might find relief with smoked marijuana, willfind little comfort in a promise of a better drug1 0 years from now. In terms of good medicine,marijuana should rarely be recommended unless allreasonable options have been eliminated. But thenwhat? It is conceivable that the medical and scientif-ic opinion might find itself in conflict with drug reg-ulations. This presents a policy issue that mustweigh—at least temporarily—the needs of individualpatients against broader social issues. Our assessmentof the scientific data on the medical value ofmarijuana and its constituent cannabinoids is butone component of attaining that balance.” [p . 1 7 8]
“Also, although a drug is normally approved formedical use only on proof of its ‘safety and efficacy, ’patients with life-threatening conditions are some-times (under protocols for ‘compassionate use’)allowed access to unapproved drugs whose benefitsand risks are uncertain.” [p. 1 4 ]
“Until a nonsmoked rapid-onset cannabinoid drugdelivery system becomes available, we acknowledgethat there is no clear alternative for people sufferingfrom chronic conditions that might be relieved bysmoking marijuana, such as pain or AIDS wasting.One possible approach is to treat patients as n- o f - 1clinical trials (single-patient trials), in whichpatients are fully informed of their status as experi-mental subjects using a harmful drug delivery systemand in which their condition is closely monitoredand documented under medical supervision. … ”[ p . 8] [The federal government’s “compassionate use”program, which currently provides marijuana to eightpatients nationwide, is an example of an n-of-1 study. ]
Appendix C (continued)
C-2
The IOM report doesn’t explicitly endorse statebills and initiatives to simply remove criminalpenalties for bona fide medical marijuana users.Does that mean that we should keep the lawsexactly as they are and keep arresting patients?
“This report analyzes science, not the law. As in anypolicy debate, the value of scientific analysis is thatit can provide a foundation for further discussion.Distilling scientific evidence does not in itself solvea policy problem.” [p. 1 4 ]
If patients were allowed to use medicalmarijuana, wouldn’t overall use increase?
“F i n a l l y, there is a broad social concern that sanc-tioning the medical use of marijuana might increaseits use among the general population. At this pointthere are no convincing data to support this con-cern. The existing data are consistent with the ideathat this would not be a problem if the medical useof marijuana were as closely regulated as other med-ications with abuse potential. … [T]his question isbeyond the issues normally considered for medicaluses of drugs and should not be a factor in evaluat-ing the therapeutic potential of marijuana orcannabinoids.” [Pp . 6, 7]
“No evidence suggests that the use of opiates or cocainefor medical purposes has increased the perception thattheir illicit use is safe or acceptable.” [p. 1 0 2 ]
“Thus, there is little evidence that decriminalizationof marijuana use necessarily leads to a substantialincrease in marijuana use.” [p. 1 0 4 ][Decriminalization is defined as the removal of criminalpenalties for all uses, even recreational.]
D o e s n’t the medical marijuana debate sendchildren the wrong message about marijuana?
“[T]he perceived risk of marijuana use did not changeamong California youth between 1996 and 1997. In summary, there is no evidence that the medicalmarijuana debate has altered adolescents’ perceptionsof the risks associated with marijuana use.” [p. 1 0 4 ]
“Even if there were evidence that the medical use ofmarijuana would decrease the perception that it canbe a harmful substance, this is beyond the scope oflaws regulating the approval of therapeutic drugs.Those laws concern scientific data related to thesafety and efficacy of drugs for individual use; theydo not address perceptions or beliefs of the generalpopulation.” [p. 1 2 6 ]
I s n’t marijuana too addictive to be used as am e d i c i n e ?
“Some controlled substances that are approved med-ications produce dependence after long-term use;this, however, is a normal part of patient manage-ment and does not generally present undue risk tothe patient.” [p. 9 8 ]
“Animal research has shown that the potential forcannabinoid dependence exists, and cannabinoidwithdrawal symptoms can be observed. However,both appear to be mild compared to dependenceand withdrawal seen with other drugs.” [p. 3 5 ]
“A distinctive marijuana and THC withdrawal syn-drome has been identified, but it is mild and subtlecompared with the profound physical syndrome ofalcohol or heroin withdrawal.” [Pp. 89, 90]
Proportion Of Users That Drug Category Ever Became Dependent (%)
A l c o h o l 1 5
Marijuana (including hashish) 9 [ p . 9 5 ]
“Compared to most other drugs … dependenceamong marijuana users is relatively rare.” [p. 9 4 ]
“In summary, although few marijuana users developdependence, some do. But they appear to be lesslikely to do so than users of other drugs (includingalcohol and nicotine), and marijuana dependenceappears to be less severe than dependence on otherdrugs.” [p. 9 8 ]
D o e s n’t the use of marijuana cause people touse more dangerous drugs?
“[I]t does not appear to be a gateway drug to the extentthat it is the c a u s e or even that it is the most signifi-cant predictor of serious drug abuse; that is, care mustbe taken not to attribute cause to association.” [p. 1 0 1 ]
“There is no evidence that marijuana serves as a step-ping stone on the basis of its particular physiologicaleffect.” [p. 9 9 ]
“Instead, the legal status of marijuana makes it agateway drug.” [p. 9 9 ]
S h o u l d n’t medical marijuana remain illegalbecause it is bad for the immune system?
“The short-term immunosuppressive effects are notwell established; if they exist at all, they are probablynot great enough to preclude a legitimate medicaluse. The acute side effects of marijuana use are with-in the risks tolerated for many medications.” [p . 1 2 6]
Appendix C (continued)
C-3
D o e s n’t marijuana cause brain damage?
“Earlier studies purporting to show structural changes inthe brains of heavy marijuana users have not beenreplicated with more sophisticated techniques.” [p. 1 0 6 ]
Doesn’t marijuana cause amotivational syndrome?
“When heavy marijuana use accompanies thesesymptoms, the drug is often cited as the cause, butno convincing data demonstrate a causal relation-ship between marijuana smoking and these behav-ioral characteristics.” [Pp. 107, 108]
D o e s n’t marijuana cause health problems thatshorten the life span?
“[E]pidemiological data indicate that in the generalpopulation marijuana use is not associated withincreased mortality.” [p. 1 0 9 ]
I s n’t marijuana too dangerous for ther e s p i r a t o ry system?
“Given a cigarette of comparable weight, as much asfour times the amount of tar can be deposited in thelungs of marijuana smokers as in the lungs of tobac-co smokers.” [p. 1 1 1 ]
“H o w e v e r, a marijuana cigarette smoked recreational-ly typically is not packed as tightly as a tobacco ciga-rette, and the smokable substance is about half thatin a tobacco cigarette. In addition, tobacco smokersgenerally smoke considerably more cigarettes per daythan do marijuana smokers.” [Pp. 111, 112]
“There is no conclusive evidence that marijuana caus-es cancer in humans, including cancers usually relat-ed to tobacco use. … More definitive evidence thathabitual marijuana smoking leads or does not lead torespiratory cancer awaits the results of well-designedcase control epidemiological studies.” [p. 1 1 9 ]
D o n’t the euphoric side effects diminishmarijuana’s value as a medicine?
“The high associated with marijuana is not generallyclaimed to be integral to its therapeutic value. Butm o od enhancement, anxiety reduction, and mildsedation can be desirable qualities in medications—particularly for patients suffering pain and anxiety.Thus, although the psychological effects ofmarijuana are merely side effects in the treatment ofsome symptoms, they might contribute directly torelief of other symptoms.” [p. 8 4 ]
What other therapeutic potential does marijuanah a v e ?
“One of the most prominent new applications ofcannabinoids is for ‘neuroprotection,’ the rescue ofneurons from cell death associated with trauma,ischemia, and neurological diseases.” [p . 2 1 1]
“There are numerous anecdotal reports that marijuanacan relieve the spasticity associated with multiplesclerosis or spinal cord injury, and animal studies haveshown that cannabinoids affect motor areas in thebrain—areas that might influence spasticity.” [p . 1 6 0]
“High intraocular pressure (IOP) is a known risk fac-tor for glaucoma and can, indeed, be reduced bycannabinoids and marijuana. However, the effect istoo and [sic] short lived and requires too high doses,and there are too many side effects to recommendlifelong use in the treatment of glaucoma. Thepotential harmful effects of chronic marijuana smok-ing outweigh its modest benefits in the treatment ofglaucoma. Clinical studies on the effects of smokedmarijuana are unlikely to result in improved treat-ment for glaucoma.” [p. 177] [Note that IOM foundthat marijuana does work for glaucoma, but was uncom-fortable with the amount that a person needs to smoke.P r e s u m a b l y, it would be an acceptable treatment forglaucoma patients to eat marijuana. Additionally, MPPbelieves that IOM would not support arresting patientswho choose to smoke marijuana to treat glaucoma.]
Do the American people really support legalaccess to medical marijuana, or were voterssimply tricked into passing medical marijuanaballot initiatives?
“Public support for patient access to marijuana formedical use appears substantial; public opinion pollstaken during 1997 and 1998 generally report 60-7 0 percent of respondents in favor of allowing med-ical uses of marijuana.” [p. 1 8 ]
But shouldn’t we keep medical marijuana illegalbecause some advocates want to “legalize”marijuana for all uses?
“[I]t is not relevant to scientific validity whether anargument is put forth by someone who believes thatall marijuana use should be legal or by someone whobelieves that any marijuana use is highly damagingto individual users and to society as a whole.” [p . 1 4]
The full report by the National Academy of Sciences can be viewed on-line ath t t p : / / b o b . n a p . e d u / b o o k s / 0 3 0 9 0 7 1 5 5 0 / h t m l /
Appendix C (continued)
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Appendix D: Surveys of public support for medical marijuana
Every scientifically conducted public opinion poll has found a majority of support for making marijuanamedically available to seriously ill patients.
In addition to the following tables, which break down nationwide and state-specific public opinionpolling results, there have been two reports that have analyzed nationwide polls on medical marijuana overtime:
Meta-analysis of nationwide polls
1997-1998: The Institute of Medicine (IOM) in its 1999 report, Marijuana and Medicine: Assessing theScience Base, reports that “public support for patient access to marijuana for medical use appears substantial;public opinion polls taken during 1997 and 1998 generally reported 60-70 percent of respondents in favor ofallowing medical uses of marijuana” (p. 18).
1978-1997: A study by the Harvard School of Public Health — published on March 18, 1998, in theJournal of the American Medical Association — analyzed the results of 47 national drug policy surveysconducted between 1978 and 1997. The study reports that more than 60% of the public support the“legalized use of marijuana for medical purposes.”
Nationwide medical marijuana public opinion polling results
date percent in favormargin of error /
respondents wording polling firm/where reported
Mar. 19-21, 1999 73 ±5%1,018 randomlyselected adults
support “making marijuana legallyavailable for doctors to prescribe inorder to reduce pain and suffering”
Gallup
Sept. 7-21, 1997 62 N/AN/A
favor legalizing marijuana “strictly formedical use”
The Luntz Research Companiesfor Merrill Lynch and Wiredmagazine
1997 66 - Independents64 - Democrats57 - Republicans
N/Aresponsesdivided amongparty affiliations
“doctors should be allowed to prescribesmall amounts of marijuana forpatients suffering serious illnesses”
CBS News/The New York Times,June 15, 1997
May 27, 1997 69 ±4.5 %517 adults
support “legalizing medical use ofmarijuana”
ABC News/Discovery News poll,conducted by Chilton Research,released May 29, 1997
Feb. 5-9, 1997 60 N/A1,002 registeredvoters
favor allowing doctors to prescribemarijuana for medical purposes forseriously ill or terminal patients
Lake Research on behalf ofThe Lindesmith Center
Feb. 5-9, 1997 68 N/A1,002 registeredvoters
the federal government should notpenalize physicians who prescribemarijuana, regardless of whether statelaws permit it
Lake Research on behalf ofThe Lindesmith Center
1997 74 ±2.8 %1,000 registeredvoters
“people who find that marijuana iseffective for their medical conditionshould be able to use it legally”
commissioned by theFamily Research Council
1995 79 ±3.1%1,001 registeredvoters
“it would be a good idea … to legalizemarijuana to relieve pain and for othermedical uses if prescribed by a doctor”
Belden & Russonello, ofWashington, D.C., on behalf ofthe American Civil LibertiesUnion
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Appendix D (continued)
State-specific medical marijuana public opinion polling results
state date% infavor
margin of error/respondents wording polling firm/where reported
Florida 1997 63 ±4%
400 registeredvoters
favor approving an amendment to theFlorida Constitution legalizing“medicinal” marijuana
Florida Voter Poll ofFt. Lauderdale/The MiamiHerald, Sept. 23, 1997
Hawaii Feb. 3-12, 2000 77 ±3.7%
703 registeredvoters
favor “the Hawaii State Legislaturepassing a law in Hawaii to allowseriously or terminally ill patients to usemarijuana for medical purposes ifsupported by their medical doctor”
QMark Research & Polling onbehalf of the Drug PolicyForum of Hawaii
Illinois 1998 67 ±3.5%
850 stateresidents
“doctors should be allowed to prescribesmall amounts of marijuana for patients”
Center for GovernmentalStudies at Northern Ill. Univ./Daily Chronicle (Dekalb/Sycamore, Ill.) April 9, 1998
Maryland 1999 73 N/A
1,000 stateresidents
“physicians should be allowed toprescribe marijuana for medical use”
Center for Substance AbuseResearch at the University ofMaryland, College Park, resultsreleased on January 24, 2000
Massachusetts 1999 81 N/A
N/A
would definitely (62%) or probably(19%) support “an initiative that wouldallow the medical use of marijuana bypatients with certain diseases, who havea doctor’s recommendation. … with theproper credentials could not be arrestedor prosecuted for marijuana possession”
Fairbank, Maslin, Maullin &Associates on behalf ofAmericans for Medical Rights
Minnesota March 10-12,1999
68 ±3.5%
N/A
“If a patient has a debilitating illnessand a doctor recommends marijuana asa medicine for that patient,” the patientand doctor should “be protected fromcivil and criminal penalties”
Mason-Dixon political andmedia research firm
Nebraska April 1979 83 N/A
1,040respondents
favor marijuana’s prescriptive medicalavailability
Joe B. Williams, ResearchConsultant, Elmwood,Nebraska
New York April 26-28,1999
80 ±3.8%
700 registeredvoters
allow physicians “to prescribe marijuanafor medical purposes to seriously andterminally ill patients, and to alleviatesymptoms of diseases and the side effectsassociated with treatments”
Zogby International
Pennsylvania Dec. 1978 83 N/A
1,008respondents
favor marijuana’s prescriptive medicalavailability
National Center for TelephoneResearch, Princeton, NJ
South Dakota Dec. 26, 2000 -Jan. 9, 2001
811
952N/A
505 registeredvoters
1 “favor a change in South Dakota lawso that seriously ill people — with adoctor’s approval — can use medicalmarijuana legally without fearing thepossibility of being arrested”2 do not “think that patient should bearrested and sent to prison"
Creative Broadcast Systems,Inc.
Virginia 1999 77 ±4.4 %
514 adults
“doctors should be allowed to prescribemarijuana for medical use when itreduces pain from cancer treatment orfor other illnesses”
Center for Survey Research atVirginia Tech University(Quality of Life in VirginiaSurvey)
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Appendix E: The Controlled Substances Act (and drug schedules)
The federal Controlled Substances Act of1970 created a series of five schedules establishingvarying degrees of control over certain substances.Marijuana and its primary active ingredient—tetrahydrocannabinol (THC)—are presently inSchedule I. As such, doctors may not prescribemarijuana under any circumstances.
Schedule II(includes morphine, used as a pain-killer, andcocaine, used as a topical anesthetic)
A. The drug or other substance has a high potential for
abuse.
B. The drug or other substance has a currently accepted
medical use in treatment in the United States or a
currently accepted medical use with severe restrictions.Although the DEA has not rescheduledmarijuana, it has made the drug “dronabinol”available by prescription. Dronabinol—marketedas “Marinol”—is synthetic THC in sesame oil in agelatin capsule. Unfortunately, evidence indicatesthat it is less effective than marijuana for manypatients. Dronabinol is currently in Schedule III.
C. Abuse of the drug or other substance may lead to severe
psychological or physical dependence.
Schedule III(includes anabolic steroids and Marinol)
A. The drug or other substance has a potential for abuse
less than the drugs or other substances in Schedules I
and II.Most states mirror the scheduling criteriaestablished by the federal government. However,marijuana has been assigned to Schedule II orlower in a few states that have recognized itsmedicinal value and/or relative safety.Rescheduling on the state level is mainly symbolicat this time—doctors may not prescribe marijuanain those states because the federal schedulessupersede state law.
B. The drug or other substance has a currently accepted
medical use in treatment in the United States.
C. Abuse of the drug or other substance may lead to
moderate or low physical dependence or high
psychological dependence.
Schedule IV(includes Valium and other tranquilizers)
The criteria for each of the schedules, listed inTitle 21 of the U.S. Code, Section 812(b)(21 U.S.C. 812(b)), and a few example substancesfrom Title 21 of the Code of Federal Regulations,Section 1308, are:
A. The drug or other substance has a low potential for abuse
relative to the drugs or other substances in Schedule III.
B. The drug or other substance has a currently accepted
medical use in treatment in the United States.
C. Abuse of the drug or other substance may lead to
limited physical dependence or psychological
dependence relative to the drugs or other substances in
Schedule III.
Schedule I(includes heroin, LSD, and marijuana)
A. The drug or other substance has a high potential for
abuse. Schedule V(includes codeine-containing analgesics)
B. The drug or other substance has no currently accepted
medical use in treatment in the United States. A. The drug or other substance has a low potential for
abuse relative to the drugs or other substances in
Schedule IV.C. There is a lack of accepted safety for use of the drug or
other substance under medical supervision.B. The drug or other substance has a currently accepted
medical use in treatment in the United States.
C. Abuse of the drug or other substance may lead to
limited physical dependence or psychological
dependence relative to the drugs or other substances in
Schedule IV.
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Appendix F: How the effective laws are currently working
California highlighted the discrepancies: In a case againstfive individuals connected to a medical marijuanaclinic in Hillcrest, Judge William Mudd said thedefendants “took all steps necessary to complywith the statute,” but the law is so “botched up”that what is legal in some parts of the state isillegal in San Diego. Consequently, Mudddismissed the charges which could have put thedefendants behind bars for six years if they hadbeen convicted.
California’s initiative was the first to beenacted and, as with all initial efforts,Proposition 215 did not address every aspect ofmedical marijuana policy. Most notably,California’s law did not place a specific limit onthe amount of marijuana that may be possessed bya patient, nor did it permit any state agency toestablish guidelines for the law.
Estimates of the number of patients currentlyutilizing Proposition 215 range from 25,000 tomore than 100,000. Patients throughout the state,with the help of their primary caregivers, aregrowing and using medical marijuana upon therecommendations of their physicians.
Attempting to address the questions leftunanswered by Proposition 215, CaliforniaAttorney General Bill Lockyer formed a task forcein 1999 to develop recommendations forimplementing the law. Co-chaired by state SenatorJohn Vasconcellos and Santa Clara DistrictAttorney George Kennedy, the task force produceda number of recommendations that were amendedinto a bill sponsored by Vasconcellos. The bill,Senate Bill 848, contained four major provisions:
The major unresolved issue is supply. Howmuch marijuana is sufficient for the “personalmedical purposes” of a patient, as defined byProposition 215? Without any specified numericalguidelines, law enforcement sometimes err on theside of arresting — or at least hassling — patients ifthe quantity seems too large. One ruling in thestate court of appeals, People v. Trippet (1997), 56Cal.App.4th 1532, addressed the issue, but failed toprovide much clarification. Commenting on thematter, Judge Paul Haerle said “the rule should bethat the quantity possessed should be reasonablyrelated to the patient’s current medical needs.” (Ofnote, that same ruling also said that transportationof marijuana by patients and caregivers wasimplicitly included in Proposition 215.)
• Establish a registry program within theDepartment of Health Services;
• Allow the Department of Health Servicesto determine what constitutes anappropriate medical marijuana supply;
• Permit regulated operation of cooperativecultivation projects; and
• Clarify those instances where medicalmarijuana may be authorized, and requirethat a patient’s personal physician makethe recommendation.
Another state appeals court ruling, People v.Rigo (1999), 69 Cal.App.4th 409, determined thatphysician approval is necessary prior to arrest inorder to assert an affirmative defense in courtagainst a charge of marijuana possession.
Although SB 848 was developed in abipartisan atmosphere, it failed to pass thelegislature in 1999 or 2000. As a result, many ofthe state's medical marijuana rules remain open-ended. As a related matter, the Department ofHealth Services feels little responsibility forcommunicating with patients about the law untila standardized policy is in place.
As one would expect, without statewideregulations, enforcement of Proposition 215 varieswidely. Some jurisdictions allow distribution,while some are hesitant to recognize a patient’sright to use medical marijuana at all. A September2000 ruling in San Diego Superior Court
Despite this problem, patients who possessand use a small amount of marijuana face very
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little threat of prosecution, despite the fact thatmany jurisdictions in California remain hostile tomedical marijuana. Most medical marijuanaarrests involve two dozen plants or more, althoughthere have been arrests for as few as six plants.
Unfortunately, most of the CBCs were shutdown either by state and local law enforcement orby federal legal action. The San Francisco CBC,for example, was targeted by the state attorneygeneral’s office. In the San Francisco case, theCalifornia First District Court of Appeals ruledthat a commercial enterprise that is sellingmarijuana does not qualify as a primary caregiver(People ex rel. Lungren v. Peron (1997),59 Cal.App.4th 1383).
As the pioneering state of effective medicalmarijuana laws, California has been the site of twokey cases of federal litigation. The first case,Conant v. McCaffrey, examines whetherphysicians have a right under federal law todiscuss marijuana and recommend it to theirpatients. (See Appendix J for detailedinformation.)
Distinct from a commercial enterprise, theOakland Cannabis Buyers’ Cooperative (OCBC)fought a January 1998 civil suit brought by theU.S. Department of Justice to stop the operationof OCBC and five other distribution centers innorthern California. (See Appendix J for detailedinformation on this case.)
The second case, U.S. v. Oakland CannabisBuyers’ Cooperative, considers whether “medicalnecessity” is a valid defense against federalmarijuana distribution charges.
Regardless of how these matters areresolved, patients and their primary caregiverswill continue to be allowed to acquire or growmedical marijuana under state law.
Similar to most other medical marijuanainitiatives, California’s law does not explicitlypermit distribution beyond individual caregiversassisting individual patients. Unfortunately, manypatients are not capable of growing their ownmarijuana, nor do they have a capable caregiver.In response to this unmet need, a number ofmedical marijuana distributors — often referred toas cannabis buyers’ cooperatives or clubs (CBCs)— emerged throughout the state. In fact, somehad been in existence before the initiative becamelaw. The CBCs essentially act as “caregivers” forthe patients they serve. In many CBCs, patientsare required to designate the CBC as his or herprimary caregiver.
Oregon
Oregon may have the most functional medicalmarijuana law: There have been few complaintsby either patients or law enforcement; the HealthDivision of the Department of Human Serviceshas taken the most active role of any state healthagency in the country; physicians have beenbroadly supportive; and only one registeredpatient out of the first 1,000 enrolled in theprogram has had a registry card revoked.
The most successful CBCs have been low-keyand politically savvy, carefully orchestrating theiroperation every step of the way. Working aboveground and above scrutiny, they have forgedpositive relationships with local governments,including law enforcement. These CBCs carefullyscrutinize all applicants, take careful inventory,and have strict policies for on-site behavior. Thesesteps allow local authorities to support thedistributors’ operation with the knowledge thatonly qualified patients receive marijuana and thatno marijuana is diverted for illicit purposes.
All of these elements have led law enforcementto ease its opposition to medical marijuana. Whenthe initiative was passed, law enforcement wasrunning to the legislature, fighting to have the lawoverturned. However, two years of enforcementhave shown that there is no widespread abuse, andnearly all Oregonians utilizing the law are legitimatepatients and caregivers.
The system is not perfect, however. Patients,law enforcement, and state health officials agreethat the greatest problem is the law’s failure toprovide for medical marijuana distribution —
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suppliers are not permitted. If a patient and his orher primary caregiver cannot cultivate their ownmarijuana, they must turn to the criminal market.Unfortunately, growing marijuana has been aproblem for many patients. For some, the costs areprohibitive, while others may not have the spaceor may not possess the horticultural skillsnecessary to cultivate a consistent supply.According to estimates by one patient advocate,as few as 25% of qualified patients have access to asteady supply.
To address remaining ambiguities, the stateattorney general’s office convened a workinggroup on medical marijuana to developrecommendations on how state and localauthorities should enforce the law. Issued onDecember 15, 1999, the recommendationselaborate on the range of defenses provided by thelaw and when they are applicable. Also, cautiouspolicies for seizing and destroying marijuana areprovided for jurisdictions to consider.
A major unresolved issue is whether acaregiver who serves multiple patients can havemore than seven plants at a single location. Oneinterpretation of the law says that if a caregiverserves three patients, then the caregiver couldgrow up to 21 plants, as each caregiver-patientpair is permitted to collectively possess sevenplants. A competing interpretation says acaregiver cannot exceed the seven-plant limit,regardless of the number of patients under his orher care. This issue is also addressed in theattorney general’s recommendations, which areavailable on-line:http://www.doj.state.or.us/medmar.htm
Patients are also unable to travel out of statewith their medicine, as the law protects them onlyin Oregon. Consequently, patients have suggestedthat Oregon develop reciprocity agreements withother states that allow medical marijuana. Undersuch an arrangement, patients could carry theirmedical marijuana with them when travelingbetween states that allow the possession and use ofmedical marijuana.
Amendments to and interpretations of the law
In July 1999, less than nine months after theinitiative was passed, the state amended theMedical Marijuana Act when Governor JohnKitzhaber (D) signed H.B. 3052 into law. Thechanges included:
Another looming question is what constitutesa “mature” plant. The law says that only three of apatient’s seven plants can be mature, which hasled to some disagreements between patients andpolice. According to a local patient advocate,however, police are beginning to ignore themature-immature distinction as long as patientshave seven or fewer plants. In cases whereregistered or qualified patients possess more thanseven plants, police are regularly destroying theplants in excess of the specified number, whileleaving the permissible limit intact, which was thepreferred policy by the legislative working groupthat produced the 1999 amendments to the law.
• mandating that patients may not usemarijuana for medical purposes incorrectional facilities;
• limiting a given patient and primarycaregiver to growing marijuana at onelocation each;
• requiring that people arrested for marijuanawho want to raise the medical necessitydefense in court must have been diagnosedwith a debilitating medical conditionwithin 12 months prior to the arrest; and
The Oregon Medical Marijuana Program—Registration System• specifying that a law enforcement agency
that seizes marijuana plants from a personwho claims to be a medical user has noresponsibility to maintain live marijuanaplants while the case is pending.
Though staffed by just one full-timeindividual, the Oregon Medical MarijuanaProgram—the state’s registration program—haslaid firm groundwork for a highly functionalmedical marijuana system. Beginning with its
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inception in May 1999, the program registeredjust over 1,600 patients in its first 20 months ofexistence and consistently receives 5-10 newapplications each day. The steady enrollment canbe attributed to growing comfort levels for bothpatients and physicians with medical marijuana.
laws, and Oregon is the only state to provide—asa courtesy—contact information for independentmedical marijuana organizations.
In addition to its direct work with the patients,the program has a public education component.Though not compelled by statute, the program—more specifically its director—has spoken tocountless groups across the state, includingemployers, attorneys, law enforcement, students,patient groups, other state agencies, and healthcare professionals. Through this outreach, theprogram has heightened awareness about the lawand assured patients, physicians, law enforcement,and citizens alike that the state is committed tohandling this issue in a sound manner.
The program has compiled extensive data onthe 594 patients who enrolled in the programduring its first year of operation (May 1, 1999 -April 30, 2000). Seventy percent of registrants aremale and the average age is 46—with a range ofages from 14 to 87. Sixty percent registered aprimary caregiver. Many patients report multiplesymptoms. Multiple sclerosis patients, forexample, often report both muscle spasms andsevere or chronic pain. The following tableprovides percentages for the diseases andsymptoms reported by card-holders.
Because of the outreach effort, all parties areincreasingly comfortable with the law and itsimplementation. For example, Oregon has asurprisingly high rate of physician participation inthe registry program. Approximately 500physicians have submitted documentation forpatients seeking a registry card. There is aboutone recommending physician for every 3.2patients in the registry system, which shows that itis not just a handful of doctors who recognize themedical benefits of marijuana. Comparatively,patient networks in Washington state andCalifornia report that there is one recommendingdoctor for every 3.5 to 5.5 patients. In addition toindividual physicians supporting the program,Kaiser Permanente, one of the nation’s largestHealth Maintenance Organizations, developed astandardized recommendation letter for its Oregonphysicians to use in conjunction with the registryprocess.
Symptoms reported by patients enrolled inOregon’s medical marijuana program
disease or condition percentage reported*
severe or chronic pain 67
muscle spasms 41
nausea 29
HIV/AIDS 10
cancer 9
cachexia 7
seizures 6
glaucoma 3*percentages total more than 100% because many patients report
multiple symptoms
In tune with the information age, the programprovides up-to-date information via the Internet.Recent changes to the law and relatedadministrative rules, application forms, and afrequently-asked-questions page, featuring contactinformation for patient network organizations thatcan assist those patients who are eligible to growtheir own medical marijuana, are available athttp://www.ohd.hr.state.or.us/hclc/mm/welcome.
htm (the program’s Web site). Oregon’s Web site isunmatched by other states with medical marijuana
The only clear flaw in the registry program isthat the legislature has not provided any funds forits operation. As a result, the program is entirelysupported by patient fees, which are $150 perapplication and must be renewed each year. Thispresents a financial hardship to many patientswho are too ill to work. Further, when this cost iscoupled with the costs of cultivating marijuana, itcould cost a patient $1,000 to get started, andinsurance does not cover any of this.
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In addition to administering the registryprogram, the Health Division considers petitionsto add conditions to the list of qualifyingconditions, diseases, and symptoms covered by thelaw. In the first year of the program, eightconditions were considered: agitation ofAlzheimer’s disease, anxiety, attention deficitdisorder, bipolar disorder, insomnia, posttraumatic stress disorder, schizophrenia, andschizo-affective disorder. After review by anexpert panel, three of the conditions (agitation ofAlzheimer’s disease, anxiety, and bipolar disorder)were recommended to the Health Division forfinal approval. The Division approved agitation ofAlzheimer’s disease, while rejecting the other two.The unapproved conditions may be reconsideredif additional supporting evidence can be offered.
often complain that the plant limit is too low andtoo restrictive.
Related to the low plant limit, local advocatesbelieve some patients are unable to maintain aconsistent supply of medical marijuana. With thenation’s shortest growing season, Alaskans generallyhave no choice but to grow indoors, which oftenpresents a financial hardship. Not only does thestate not permit medical marijuana distribution, butthe Department of Health and Social Servicesrejected an idea to allow the registry program toprovide patients with a list of independent groupsthat could provide them with the assistancenecessary to grow marijuana on their own.
Despite these restrictions, 180 patientsregistered with the program in the first 14 months ofits existence. Seventy-seven physicians submitteddocumentation on behalf of those patients—a ratioof 2.3 patients for every physician, almost identicalto Oregon’s ratio. Although physician participationappears strong, patient advocates argue that manydoctors refuse to sign statements on behalf ofpatients because of fear of federal retribution. Thisproblem may be uniquely compounded in Alaska,where many doctors are federal employees, workingfor either the Indian Health Services or VeteransAdministration. Outside of Washington, D.C.,Alaska has the nation’s largest per capita share offederal employees.
Alaska
Alaska’s medical marijuana history resemblesOregon’s. Both states passed initiatives in 1998.Registry programs were established in both states,and each legislature amended the law within ayear of its enactment. Differences, however, canbe traced to the legislature’s amendments, wherelawmakers imposed far greater restrictions onAlaska’s medical marijuana statute.
Signed into law on June 1, 1999, Senate Bill94 made Alaska’s medical marijuana registrationmandatory. No longer can residents assert amedical necessity defense if they adhere to theintent of the law but do not obtain a registry card.
Alaska has no breakdown of its registrants’conditions and symptoms because the physicianstatement forms do not name the specific ailment,in order to protect patient confidentiality.Despite the state’s efforts to protect patient
privacy, many Alaskans are reluctant to add theirnames to a list of individuals who have seriousmedical conditions and use medical marijuana. Asa result, many patients do not register and have nolegal protection.
Since the program has opened, no registrycards have been revoked, and there have been noreal test cases of the law. However, there arepending cases involving individuals who are onfelony probation and have applied for andreceived a medical marijuana registry card. Underthe terms of their probation, they are strictlyprohibited from using any controlled substanceand the state contends they are not eligible for themedical marijuana exception. The cases were stillpending as of November 2000.
Further, the legislature limited the amount ofmarijuana that a patient may legally possess to oneounce and six plants, with no exception.Previously, patients who exceeded the numericallimit could argue at trial that a greater amount wasmedically necessary. Understandably, patients
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Although the scope of the law has narrowed,police and prosecutors typically exercise discretionand maintain the spirit of the law whenconducting medical marijuana investigations,according to the state attorney general’s office.Unregistered patients are often either not chargedor are charged with a lesser crime, if they canclearly demonstrate their medical need to theinvestigating officer.
designate any state agency to implement oroversee the law. As a result, Washington has noformal system for identifying patients and therehas been no clarification of what a “sixty daysupply” of medical marijuana is.
Patient advocates such as Joanna McKee,director of Seattle’s Green Cross PatientCooperative, estimate that there are at least 3,000medical marijuana patients utilizing the state law.Most patients grow their own medical marijuana,either by themselves or with the help of acaregiver. To assist those patients who cannotgrow marijuana, a number of patient cooperativesexist. These discreet organizations verify patients’credentials, distribute marijuana, and providerelated services. Although they do not meet thestate’s strict definition of a caregiver, many of theorganizations—particularly the ones that provideidentification cards or certificates—bolster thecredibility of patients who are confronted bypolice. Nonetheless, disagreements and conflictsbetween patients and law enforcement remaincommon.
In one case, according to the Alaska attorneygeneral’s office, an unregistered wife and husbandwho possessed plants in excess of the specifiedlimit were initially charged with felonies. Afterobtaining evidence that the woman had aqualified medical need, the charges against herwere dropped and the husband was allowed toplead guilty to a lesser charge. Although notwholly absolved, the couple avoided prosecutionfor serious charges. At the same time, thisexample stresses the value of obtaining a registrycard. As enforcement practices vary fromjurisdiction to jurisdiction, patients are notguaranteed the same treatment across Alaska.
Overall, patients have made few complaints toeither the health department or attorney general’soffice regarding the law. State officials interpretthis to mean that those patients with a truemedical need are having their needs met.
Not only do police lack clear guidanceregarding what constitutes an appropriate supply,but they also complain that it is difficult todetermine what is an appropriate doctor’srecommendation. Although the law defines “validdocumentation” more clearly than supply, lawenforcement claims that it must guess at bothissues. As a result, enforcement practices varythroughout the state, and several patients havebeen arrested or have had their marijuana seizedbecause police and patients have differinginterpretations of the law.
Patient advocates have argued that the letterof the law permits nurse practitioners andphysician assistants to sign the recommendationform. However, the Department of Health andSocial Services obtained an opinion from theattorney general that only medical doctors anddoctors of osteopathy meet the law’s definition of“physician.” Alaskans for Medical Rights isattempting to overturn this opinion.
There have been several attempts to modifythe law. A bill was introduced in both the 1999and 2000 legislative sessions that would authorizethe state Department of Health to adoptadministrative rules to implement the medicalmarijuana law. Although the bill (S.B. 5704)passed the Senate in each session, it failed to movein the House. In Washington, it requires a two-thirds majority vote for the legislature to amend aninitiative in the two years after it takes effect.
Washington
Similar to California’s law, Washington’smedical marijuana statute does not place anumerical limit on the amount of marijuana thatmay be possessed by a patient. Instead, the lawallows patients to possess no more than a “sixtyday supply.” Further, the initiative did not
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Beginning in 2001, it will only take a simplemajority to amend the law via the legislature.
The only state agency with any administrativeauthority over the law is the Medical QualityAssurance Commission. It can expand the list ofterminal or debilitating conditions that may betreated with marijuana under state law. During thelaw’s first two years of effectiveness, the commissionadded Crohn’s disease and Hepatitis C, as well asdiseases that cause specific symptoms, includingnausea, vomiting, wasting, appetite loss, cramping,seizures, muscle spasms and/or spasticity, when thesesymptoms are unrelieved by standard treatments.The commission has rejected the inclusion ofinsomnia and post traumatic stress disorder.According to Rob Killian, M.D., who has frequentlypetitioned the commission, Washington state hascarefully listened to patient needs and has done themost of any state to expand the range of conditionsthat may be treated with medical marijuana.
In the interim, local law enforcement hastaken steps to limit the scope of the law. TheSeattle Police Department, for example,developed directives to streamline how medicalmarijuana investigations are conducted.Attempting to address the supply issue, Seattlepolice consider “suspicious” the possession of morethan two usable ounces of marijuana and morethan nine marijuana plants (3 mature, 3immature, and 3 starter plants). However, this isonly a benchmark and not an absolute standard.Each case is reviewed on an individual basis. TheSeattle police also obtained advice from the U.S.attorney for Western Washington, which said thepolice would not face any federal penalties forfollowing in good faith the state’s medicalmarijuana law. Maine
To assist patients, the Health Departmentprovides a toll-free phone number (800-525-0127)where patients can obtain information about thelaw. Although patient networks in Oregonmaintain toll-free hotlines, Washington is theonly state to provide this service through a stateagency. As an informational courtesy, thedepartment also distributes copies of the statute, afact sheet on the law, and a guide to the lawproduced by Washington Citizens for MedicalRights and the ACLU, which includes aphysician’s recommendation form developed bythe Washington State Medical Association.
According to the state attorney general’soffice, Maine’s medical marijuana law is bestsuited for patients to grow their marijuana supplyindoors. Indeed, for patients who can produce aconsistent supply with six indoor plants, the lawseems to be working well. Arrests have been fewand complaints have been minimal.
According to Mainers for Medical Rights, theadvocacy organization that sponsored the initiative,there are approximately 250 patients in the statewho use medical marijuana. Unfortunately, not allpatients can afford to grow their medical marijuanaindoors. The expensive lighting equipmentnecessary for growing indoors and the related energycosts are too great for some patients, many of whomhave limited incomes and face other financialhardships due to their conditions.
Most patients who contact the HealthDepartment know very little about the law andsometimes confuse it with the law in neighboringOregon. Patients most often ask about how theycan obtain marijuana, if they can be referred to aphysician, and what their status is under federallaw. The department does not refer patients tophysicians who can provide a recommendation,nor does it refer them to patient networks that canprovide medical marijuana. With no formal role inthe administration of the law, the department’smain advice for patients is to read the law carefully.
As an alternative, some patients have chosento grow their medical marijuana outdoors. Whilethis is not a crime, Maine’s short growing seasonalmost necessitates that many plants be grownsimultaneously, if the goal is to produce a reliablesupply for the entire year. Not surprisingly, largegrow operations, in excess of the law’s specified
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six-plant limit, have driven the state’s few arrestsrelated to the law.
a simple defense, the defendant need only producea relatively small amount of evidence at trial insupport of the defense, with the state then havingto disprove the existence of facts establishing thedefense beyond a reasonable doubt. Maine is theonly state where unregistered patients are affordedmore than an “affirmative defense” at trial. An“affirmative defense” places the burden on thedefendant to prove his or her medical necessity bya preponderance of the evidence. The “simpledefense,” on the other hand, makes it easier for alegitimate patient to avoid a conviction. Notsurprisingly, law enforcement and prosecutorswould like to see the simple defense tied to a stateregistry program. (California also does not have aregistry program and the law provides anexemption from prosecution. However, the courtshave interpreted the law as providing anaffirmative defense at trial, for those patients whoare prosecuted.)
For example, two patients in separate cases—a62-year-old man with muscular dystrophy and a53-year-old man with muscle hardening torticollisand a degenerative bone condition—were arrestedfor possessing 83 and 37 plants, respectively, inaddition to at least one pound each of processedmarijuana. These cases were reported in theBangor Daily News on August 23, 2000, and thePortland Press Herald on September 23, 2000,respectively. There is little doubt about thevalidity of their medical need. However, they arein clear violation of the law. Despite this, theyclaim that the excessive amounts are necessary tomaintain a medical marijuana supply throughoutthe year. The law does not, however, allowpatients to assert an affirmative defense and arguethat excessive amounts are medically necessary.
Patients who feel compelled to exceed theplant limit in outdoor grows are not the only oneswho find access to medical marijuana a problem.Some patients live in apartments and do not havethe space to grow marijuana. Others are too sickto grow for themselves and do not have acaregiver capable of growing it for them. Somelack the horticultural skills needed to cultivate areliable supply of marijuana. Time is anotherconsideration, especially for cancer patients whoneed immediate chemotherapy treatment and animmediate supply; it takes several months for amarijuana plant to mature.
Attempting to address law enforcementquestions, the attorney general’s office released a“Patrol Officer’s Guide to the MedicinalMarijuana Law,” which appeared in the MaineLaw Officer’s Bulletin on December 18, 1999, fourdays before the law took effect. The guide tellsofficers to conduct thorough investigations andexercise discretion. Of particular note, officers areencouraged to accompany suspects, whenreasonable, to the location where medicaldocumentation exists, if the suspect does not haveit on hand.
Access and enforcement issues drove the stateto examine additional proposals for implementingthe law. The state attorney general convened abroadly representative task force, which voted onthree legislative recommendations following sixmeetings spread over five months (May toSeptember 2000). Although the task force wasunable to reach a consensus, a majority (15–10)voted in favor of a pilot project to establish asingle non-profit center to sell medical marijuanato registered patients. A community oversightboard would administer the center. There was alsostrong support for a bill to establish a stateresearch program, and another bill to create a
In addition to access and distribution issues,other questions about the law have surfaced. Withno formal registry system, law enforcementmaintains that it cannot readily identifylegitimate patients. The law simply says that apatient’s documentation must be “available.” As aresult, police can be unnecessarily harsh whenindividuals possess marijuana, claim to haveappropriate medical documentation, but are not inpossession of the documentation.
Although the plant limit is low with noexceptions, patients are afforded a “simpledefense” to a charge of marijuana possession. With
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registry program for patients and caregivers, aswell as to allow patients to furnish marijuana toother patients on a one-to-one basis. Manysupporters of the two latter bills favored variousamendments. The results of the votes highlightedthe task force’s final report which was forwardedto the state legislature. The legislature willultimately determine if further implementationtakes place. The report is available on-line at theattorney general’s Web site:http://www.state.me.us/ag/medicalmarijuana.htm
One concern, however, is that the stateHealth Department has declined to take an activerole in the implementation of the law. In otherstates with formal systems, medical marijuana lawsare administered by health officials rather thanpublic safety officials. It remains to be seenwhether physicians and patients will be less likelyto utilize a program developed and maintained bylaw-enforcement officials.
Colorado
Maine’s Bureau of Health has expressed littleinterest in helping implement the law. TheBureau is not interested in conducting research,maintaining a registry, or monitoring medicalmarijuana distribution by patient cooperatives. Infact, the Bureau’s director, Dr. Dora Mills, was theonly medical marijuana task force member whovoted against all three legislative proposals thatwere considered.
Colorado voters passed a medical marijuanainitiative on November 7, 2000, with 53% of thevote. Similar to Nevada’s, the Colorado initiativeamends the state constitution, but it only requiredone vote.
Currently, the Colorado Department of PublicHealth and Environment is developing rules for aregistry identification card program that will providepatients and their primary caregivers an exceptionfrom the state’s marijuana laws. The registryprogram is expected to be effective by June 1, 2001.Until the registry is in place, Colorado patients havean affirmative defense to charges of unlawfulmarijuana possession or cultivation.
Hawaii
Although Hawaii’s medical marijuana statutewas signed into law on June 14, 2000, it did nottake effect until December 28, 2000, when theDepartment of Public Safety issued itsadministrative regulations and finalized designatedforms, allowing patients to register with the state.
Nevada
Voters in Nevada enacted a medicalmarijuana law via initiative with 65% of the voteon November 7, 2000. (Because Nevada’s lawamends the state constitution, it required twovotes. In 1998, Nevadans supported the proposalwith 59% of the vote.) The new law requires thestate legislature to provide for a system that allowsqualified patients to use medical marijuana. Untilthe legislature acts, however, patients in Nevadahave no legal protection for medical marijuana.
In addition to the registry, patients have a“choice of evils” defense to a charge of marijuanapossession if they have qualifying medical records ora signed statement by their physician stating thatthey have a debilitating condition and the medicalbenefits of marijuana likely outweigh the risks.
It is difficult to estimate how many patientswill utilize the law. However, Oregon has a similarlaw and twice as many residents as Hawaii.Therefore, it may be assumed that 500 citizens ofHawaii will register in the first two years of thelaw’s effectiveness.
Hawaii’s law is well written with preciselydefined terms, which may allow the state to avertmuch of the ambiguity and confusion experiencedby other states with medical marijuana laws.
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Medical conditions approved for treatment with marijuana in the eight states withmedical marijuana laws
Californiaa Oregon Alaska Washington Maine Hawaii Colorado Nevada
Specific diseases
cancer ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔
glaucoma ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔
AIDS or HIV ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔
Crohn’s disease ✔b, c ✔
Hepatitis C ✔b, c
Debilitating medical
conditions or symptoms
produced by those
conditions
cachexia, anorexia, or
wasting syndrome
✔ ✔ ✔ ✔b, c ✔ ✔ ✔
severe or chronic pain ✔ ✔ ✔ ✔b ✔ ✔
severe or chronic
nausea
✔ ✔ ✔ ✔ ✔ ✔ ✔
seizure disorders
(e.g., epilepsy)
✔ ✔ ✔ ✔ ✔ ✔ ✔
muscle spasticity
disorders (e.g.,
multiple sclerosis)
✔ ✔ ✔ ✔ ✔ ✔ ✔
arthritis ✔
migraines ✔
agitation of
Alzheimer’s disease
✔c
Allows addition of
diseases or conditions
by state health agency
a ✔ ✔ ✔ ✔ ✔ ✔
aIn addition to the specific diseases and conditions listed, the law covers treatment of “any other illness for which marijuanaprovides relief.”bRequires that medications available by prescription have failed to provide relief.cCondition added by state agency.
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Appendix G: Types of legal defenses affordedby effective state medical marijuana laws
i. Exemption from Prosecution
State governments are not required to enforce federal laws. A state may establish that it is no longer astate-level crime for patients to possess or cultivate marijuana for medicinal purposes. Federal lawswould be broken by individual patients, but an “exemption from prosecution” prevents the state fromprosecuting qualified patients. Most exemptions are tied to a state registry program, which allowspatients’ credentials to be easily verified.
ii. Simple Defense
With a simple defense to a charge of marijuana cultivation or possession, the defendant need onlyproduce a relatively small amount of evidence at trial in support of the defense that the cultivation orpossession was solely for a legitimate medical purpose. In order to win a conviction, the state mustdisprove the existence of facts establishing the defense beyond a reasonable doubt. Maine is the onlystate where unregistered patients are afforded a simple defense at trial.
In contrast to the affirmative defense, which places the burden on defendants to prove that theirmarijuana use or possession is medically necessary, a simple defense places the burden on prosecutorsto prove that marijuana use or possession is not medically necessary for the defendant. As a result, it isdifficult for prosecutors to win a conviction against legitimate patients afforded a simple defense inmedical marijuana cases.
iii. Affirmative Defense
Several state medical marijuana laws allow individuals to assert an affirmative defense to charges ofunlawful marijuana cultivation or possession. To establish the affirmative defense, individuals mustprove at trial—by a preponderance of the evidence—that they are in compliance with the medicalmarijuana statute. The affirmative defense is the only defense afforded individuals by the medicalmarijuana law in Alaska. Although this defense does not prevent patients from being arrested, as amatter of practice, individuals who are clearly in compliance with the law are typically not arrested.Two states, Colorado and Oregon, allow individuals to use an affirmative defense to argue that anamount of marijuana in excess of the specified legal limit is medically necessary.
iv. “Choice of Evils” Defense
In addition to providing one or more of the above specific defenses (exemption from prosecution,simple defense, or affirmative defense), the enactment of a medical marijuana law may allowdefendants to raise a medical necessity defense, often referred to as a “choice of evils” defense. Thisdefense is long recognized in common law and may be applied in states where a law or court decisiondefines or indicates circumstances where medical marijuana cultivation, possession, and use arepermitted. See Appendix L for more information on the medical necessity defense.
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Appendix H: Types of physician documentation required tocultivate, possess, or use medical marijuana
California and Arizona, the first two states to enact medical marijuana initiatives, used slightly differentwording in their enacting statutes:
• California law allows patients to use medical marijuana if they possess a recommendation from aphysician.
• Arizona law allows patients to use medical marijuana if they possess a prescription.
The differences seem slight, but their effects are great. Patients in California are now protected understate law if they possess a valid recommendation for medical marijuana. In Arizona, however, patients donot enjoy state-level legal protection because it is impossible to obtain a prescription for medical marijuana.
Definitions of “prescription” and “recommendation,” as they apply to medical marijuana, explain thedifferences in legal protection for California and Arizona patients.
Prescription
A prescription is a legal document from a licensed physician ordering a pharmacy to release a controlledsubstance to a patient. Prescription licenses are granted by the federal government; therefore, it is aviolation of federal law to “prescribe” marijuana, regardless of state law. Furthermore, it is illegal forpharmacies to dispense marijuana (unless as part of a federally sanctioned research program).
Six older state medical marijuana laws also use the word “prescribe,” and are consequently alsoineffective.
Recommendation
A recommendation is not a legal document, but a professional opinion provided by a qualified physicianin the context of a bona fide physician-patient relationship. The term “recommendation” skillfullycircumvents the federal prohibition on marijuana prescriptions, and federal court rulings have affirmed aphysician’s right to discuss medical marijuana with patients, as well as to recommend it. A“recommendation” is constitutionally protected speech. See Appendix J for details.
Whereas patients do not receive meaningful legal protection via marijuana “prescriptions” because theycannot be lawfully obtained, those who have a physician’s “recommendation” can meet their state’s legalrequirements for medical marijuana use.
States which followed California and Arizona in the initiative and legislative processes generallyavoided both “prescription” and “recommendation.” Instead, they require physicians to discuss, in thecontext of a bona fide physician-patient relationship, the risks and benefits of medical marijuana use andadvise patients that the medical benefits of marijuana would likely outweigh the health risks. Not only doesthis circumvent the federal prohibition on marijuana, but it minimizes physician concerns that they mightface liability related to medical marijuana.
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Appendix J: Federal litigation and other federal attemptsto thwart effective state medical marijuana laws
A New York Times article that covered the signing of Hawaii’s medical marijuana law on June 14, 2000,said, “the Justice Department is challenging those laws” that remove state-level criminal penalties forpatients who cultivate, possess, and use medical marijuana. That is simply false. The federal government hasnot tried to overturn any state medical marijuana law, nor does it plan on trying.
In fact, high-ranking members of the U.S. Department of Justice evaluated the legal prospects of a courtchallenge to the medical marijuana initiatives, and they concluded that such a challenge would fail.
This was stated on the record by David Anderson of the U.S. Department of Justice during a hearing inWayne Turner v. D.C. Board of Elections and Ethics, et al, (Civil Action No. 98-2634 RWR, September 17,1999).*
Anderson’s comments are supported by Footnote 5 in the federal court’s Turner opinion: “In addition,whatever else Initiative 59 purports to do, it proposes making local penalties for drug possession narrowerthan the comparable federal ones. Nothing in the Constitution prohibits such an action.”
Testifying at a June 16, 1999, hearing of the Government Reform Subcommittee on Criminal Justice,Drug Policy and Human Resources of the U.S. House of Representatives, Drug Czar Barry McCaffrey alsoadmitted that “these [medical marijuana] statutes were deemed to not be in conflict with federal law.”
Further, McCaffrey said that the federal government has “a problem” because there are not enoughDEA agents to enforce federal law against personal use, possession, and cultivation in the states that haveremoved criminal penalties for medical marijuana.
Speaking directly to that point, Kristina Pflaumer, U.S. attorney for Western Washington, informed theSeattle Police Department that her office did not intend to prosecute cases relating to the state’s medicalmarijuana law. Specifically, Pflaumer wrote:
Speaking for this office, we do not intend to alter our declination policies on marijuana, which preclude ourcharging any federal offense for the quantities legalized by the new ‘medical marijuana’ initiative. (I am assumingan authorized 60 day supply would be fewer than 250 plants.) Given our limited funding and overwhelmingresponsibilities to enforce an ever larger number of federal offenses, we simply cannot afford to devote prosecutiveresources to cases of this magnitude. In short, we anticipate maintaining our present declination standards.
We therefore have no interest in the Seattle Police Department investigating or forwarding such cases to us. Wecan also assure you in advance we will also decline to prosecute a police officer who merely returns to its ownermarijuana he believes to meet the ‘medical marijuana’ standards.
Further, Pflaumer said the U.S. attorney’s office did not expect that the Seattle Police Department wouldjeopardize any of its federal funding for complying with the state’s medical marijuana law. Pflaumer’sstatements were made to Seattle Police Department Vice and Narcotics Section Commander Tom Grabickiin a letter dated August 11, 1999, in response to Grabicki’s letter of July 22, 1999.
*Turner challenged the constitutionality of U.S. Rep. Bob Barr’s amendment to the fiscal year 1999 D.C. budget, which prohibitedthe District from spending any funds to conduct any initiative that would reduce the penalties for possession, use, or distribution ofmarijuana. The United States District Court for the District of Columbia ruled in Turner’s favor, the votes were counted, and themedical marijuana initiative passed; however, Congress subsequently prevented it from taking effect. This occurred only becauseD.C. is a district, not a state, and therefore is legally subject to greater federal oversight and control.
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Appendix J (continued)
Thus it seems doubtful that the federal government will ever be able to overturn the state medicalmarijuana initiatives. That is, the federal government cannot force states to have laws that are identical tofederal law, nor can the federal government force state and local police to enforce federal laws. In selectcases, however, the U.S. Department of Justice may take legal action against selected individuals andorganizations for federal marijuana offenses.
Since 1996, there have been two key cases of federal litigation relating to medical marijuana.
Dr. Marcus Conant v. Barry R. McCaffrey (Case No. C 97-00139 WHA)
Ruling: A federal district court ruled that the federal government cannot punish physicians for discussingor recommending medical marijuana.
Background:
Shortly after California voters approved Proposition 215 in 1996, the federal government threatened topunish—even criminally prosecute—physicians who recommend medical marijuana. Specifically, thefederal government wanted to take away their authority to write prescriptions for any controlled substances.In response to those threats, a group of California physicians and patients filed suit in federal court onJanuary 14, 1997, claiming that the federal government had violated their constitutional rights.
The lawsuit asserts that physicians and patients have the right—protected by the First Amendment tothe U.S. Constitution—to communicate in the context of a bona fide physician-patient relationship,without government interference or threats of punishment, about the potential benefits and risks of themedical use of marijuana.
On April 30, 1997, federal District Court Judge Fern Smith issued a preliminary injunction prohibitingfederal officials from threatening or punishing physicians for recommending medical marijuana to patientssuffering from HIV/AIDS, cancer, glaucoma, and/or seizures or muscle spasms associated with a chronic,debilitating condition. According to Judge Smith, "[t]he First Amendment allows physicians to discuss andadvocate medical marijuana, even though use of marijuana itself is illegal."
The case was finally heard in U.S. district court in August 2000. Plaintiffs argued that the threats amountto censorship. The federal government countered that there is a national standard for determining whichmedicines are accepted and that using marijuana should not be decided by individual physicians. In responseto that argument, Judge William Alsup stated, “Who better to decide the health of a patient than a doctor.”
Alsup ruled, on September 8, 2000, that the federal government cannot penalize California doctors whorecommend medical marijuana under state law. Specifically, he said the U.S. Department of Justice ispermanently barred from revoking licenses to dispense medication “merely because the doctor recommendsmedical marijuana to a patient based on a sincere medical judgment and from initiating any investigationssolely on that ground.”
Alsup further wrote that the ruling applies even if “the physician anticipates that the recommendationwill, in turn, be used by the patient to obtain marijuana in violation of federal law.”
The U.S. Department of Justice has not yet appealed Judge Alsup’s ruling.
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Appendix J (continued)
United States of America v. Oakland Cannabis Buyers’ Cooperative (Case No. 98-16950)
Ruling: A federal appeals court ruled that a medical marijuana distributor can use a medical necessitydefense against federal marijuana distribution charges.
Background:
Large-scale distribution is the key unresolved issue surrounding state laws that remove criminal penaltiesfor medical marijuana-using patients and the caregivers who assist them. In California, dozens of medicalmarijuana distribution centers received considerable media attention following the passage ofProposition 215. Many of them had been quietly operating for years before the law was enacted. State andlocal responses ranged from prosecution to uneasy tolerance to hearty endorsement.
In January 1998, the U.S. Department of Justice filed a civil suit to stop the operation of six distributioncenters in northern California, including the Oakland Cannabis Buyers’ Cooperative (OCBC).U.S. District Judge Charles Breyer issued a temporary injunction in May 1998 to shut down the distributioncenters, pending the outcome of the case. OCBC, however, remained open, fighting the injunction forseveral months until Breyer ultimately rejected their arguments in October 1998 and ordered them to stopdistributing marijuana. Six days later, OCBC complied—but immediately appealed the ruling.
Almost a year later, in September 1999, the Ninth U.S. Circuit Court of Appeals ruled 3–0 that“medical necessity” is a valid defense against federal marijuana distribution charges, provided that adistributor can prove in a trial court that the patients it serves are seriously ill, face imminent harm withoutmarijuana, and have no effective legal alternatives.
The case then went back to the district level, where Breyer reconsidered arguments in July 2000 beforeruling in favor of OCBC, which led him to modify his 1998 injunction. His new decision said OCBC coulddistribute marijuana to seriously ill people who meet the Ninth Circuit Court’s medical necessity criteria.
The Justice Department immediately filed two appeals: (1) asking the U.S. Supreme Court to overturnthe Ninth Circuit Court’s decision establishing a federal “medical necessity defense” for marijuanadistribution, and (2) asking the Ninth Circuit Court to overturn Judge Breyer’s ruling specifically allowingOCBC to operate. The Justice Department also asked both courts for emergency injunctions to preventmedical marijuana distribution during the appeals process.
The Ninth Circuit Court refused to grant an emergency stay of Breyer’s ruling, but on August 29, 2000,the U.S. Supreme Court granted the Justice Department’s request, preventing OCBC from distributingmedical marijuana in accordance with Breyer’s order until appeals are heard. And, on November 27, theU.S. Supreme Court announced that it will hear the Justice Department’s appeal of the Ninth CircuitCourt’s medical necessity decision.
Of note, the most recent stay applies only to OCBC. At least until the U.S. Supreme Court issues itsfinal ruling in June 2001, medical marijuana distributors in the Ninth Circuit can still raise a medicalnecessity defense at trial against federal marijuana distribution charges during the appeals process of theOCBC case.
Furthermore, even if the U.S. Supreme Court rules against allowing a medical necessity defense, it willnot affect the rights of California patients to grow, possess, and use medical marijuana under the state lawcreated by Proposition 215. The case deals only with federal law, and only with the distribution of medicalmarijuana.
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Appendix K: Therapeutic research programsThe federal government allows one exception to its prohibition of the cultivation, distribution, and use
of Schedule I controlled substances: research. Doctors who wish to conduct research on Schedule Isubstances such as marijuana must receive special permission from the federal government, including aspecial license from the DEA to handle the substance, FDA approval of the research protocol (ifexperimenting with human subjects), and a legal supply of the substance from a federally approved source—currently, the National Institute on Drug Abuse (NIDA).
An individual doctor may conduct research if all of the necessary permissions have been granted. Inaddition, a state may run a large-scale program involving many doctor-patient teams if the state secures thenecessary permission from the federal government for the researchers.
Beginning in the late 1970s, a number of state governments sought to give large numbers of patientslegal access to medical marijuana through federally approved research programs.
While 26 states passed laws creating therapeutic research programs, only seven obtained all of thenecessary federal permissions, received marijuana and/or THC (tetrahydrocannabinol, the primary activeingredient in marijuana) from the federal government, and distributed the substances to approved patientsthrough approved pharmacies. Those seven states were California, Georgia, Michigan, New Mexico,New York, Tennessee, and Washington.
Typically, patients were referred to the program by their personal physicians. These patients, who had notbeen responding well to conventional treatments, underwent medical and psychological screening processes.Then the patients applied to the state’s patient qualification review board, which resided within thedepartment of health. If granted permission, they would receive marijuana from approved pharmacies. Patientswere required to monitor their usage and its effects, which the state used to prepare reports for the FDA.
(Interestingly, Al Gore’s sister received medical marijuana through the Tennessee program whileundergoing chemotherapy for cancer in the early 1980s.)
These programs were designed to enable patients to use marijuana. The research was not intended togenerate data that could lead to FDA approval of marijuana as a prescription medicine. For example, theprotocols did not involve double-blind assignment to research and control groups, nor did they involve theuse of placebos.
Since the programs ceased operating in the mid-1980s, the federal government has made it moredifficult to obtain marijuana for research, preferring to approve only those studies that are well-controlledclinical trials designed to yield essential scientific data.
Outlining its position on medical marijuana research, the U.S. Department of Health and HumanResources—which oversees NIDA—issued new guidelines for research that became effective onDecember 1, 1999. The guidelines were widely criticized as being too cumbersome to enable research tomove forward as expeditiously as possible. (See http://www.mpp.org/guidelines.)
Because of the excessively strict federal guidelines for research and the high cost of performing double-blind, placebo-controlled studies, it is unlikely that the therapeutic research laws will again distributemarijuana to patients on a meaningful scale in the near future. States are generally unwilling to devote theirlimited resources to a long and potentially fruitless application process for research. However, the lawsestablishing these programs currently remain on the books in 14 states.
The one exception may be California—a large and wealthy state—which appropriated $3 million formedical marijuana research in the state’s fiscal year 2000-2001 budget. Research is expected to resume therein 2001, provided that federal approvals can be obtained. California’s new research program is morescientifically modern than previous therapeutic research programs and is administered within the Universityof California system, rather than through a state health agency.
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Appendix L: Medical necessity defense
The necessity defense, long recognized in common law, gives a defendant the chance to prove in courtthat his or her violation of the law was necessary to avert a greater evil. It is often referred to as the “defenseof choice of evils.”
If allowed in a medical marijuana case, the medical necessity defense may lead to an acquittal, even ifthe evidence proves that the patient did indeed possess or cultivate marijuana. This defense generally holdsthat the act committed (marijuana cultivation or possession, in this case) was an emergency measure toavoid an imminent harm. The threatened harm is so great that ordinary standards of intelligence andmorality consider the desirability of avoiding the harm to be greater than the harm that is caused byviolating the marijuana laws. Hence, it is the selection of the lesser harm.
Unlike “exemption from prosecution,” a patient is still arrested and prosecuted for the crime; given thatthe judge and/or jury may decide that the evidence was insufficient to establish medical necessity.
The necessity defense is not allowed as a defense to any and all charges. Typically, courts look to priorcourt decisions or legislative actions that indicate circumstances where a necessity defense may beapplicable. Regarding medical marijuana and the necessity defense, for example, a court’s decision onwhether to permit the defense may depend on whether the legislature has enacted a law that recognizesmarijuana’s medical benefits.
This defense is typically established by decisions in state courts of appeals. Additionally, a statelegislature may codify a medical necessity defense into law. Oregon’s medical marijuana law permits thisdefense (in addition to allowing an affirmative defense for unregistered but documented patients and anexemption for registered patients).
The first successful use of the medical necessity defense in a marijuana cultivation case led to the 1976acquittal of Robert Randall, a glaucoma patient in Washington, D.C.
In the Randall case, the court determined that the defense was available if (1) the defendant did notcause the compelling circumstances leading to the violation of the law, (2) a less offensive alternative wasnot available, and (3) the harm avoided was more serious than the conduct to avoid it, i.e., cultivatingmarijuana.
In addition to Washington, D.C., courts in at least five states have allowed the medical necessitydefense in medical marijuana cases, and in some cases those decisions have been reaffirmed.
States where courts have allowed the medical necessity defense in marijuana cases
California People v. Trippet, 56 Cal. App. 4th 1532, review denied (1997)
Florida Jenks v. Florida, 582 So. 2d 676 (Ct. App. 1st Dist., Fl. 1991)
Florida Sowell v. State, 738 So. 2d 333 (Ct. App. 1st Dist., Fl. 1998)
Hawaii State v. Bachman, 595 P. 2d 287 (Haw. 1979)
Idaho Idaho v. Hastings, 801 P. 2d 563 (Sup. Ct. Idaho 1990)
Washington Washington v. Diana, 604 P.2d 1312 (Ct. App. Wash. 1979)
Washington v. Cole, 874 P. 2d 878 (Ct. App. Wash. 1994)
Washington, D.C. United States v. Randall, 104 Wash. Daily L. Rep. 2249 (D.C. Super. Ct. 1976)
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Appendix L (continued)
It is also possible for a judge to allow an individual to raise a medical necessity defense based on thestate having a symbolic medical marijuana law. For example, an Iowa judge ruled (in Iowa v. Allen DouglasHelmers) that a medical marijuana user’s probation could not be revoked for using marijuana because theIowa legislature has defined marijuana as a Schedule II drug with a “currently accepted medical use.”There is presently no way for patients to obtain a legal prescription for marijuana in Iowa, however, becauseof federal law. Nevertheless, the Iowa judge ruled that the legislature’s recognition of marijuana’s medicalvalue protects Allen Helmers from being sent to prison for a probation violation for using marijuana.
Of note, Iowa moved marijuana into Schedule II in 1979, when it enacted a therapeutic researchprogram. The research program expired in 1981, but the schedule remains in place.
A different judge could have ruled that the legislature intended for marijuana to be used solely inconnection with the research program and, without the program, the medical necessity defense should notbe available. In fact, some state courts—Minnesota and Alabama, for example—have made similarinterpretations and have refused to allow this defense.
States where courts have refused to allow the medical necessity defense in marijuana cases
Alabama Kauffman v. Alabama,620 So. 2d 90 (1993)
The state Court of Appeals refused to allow a patient touse the medical necessity defense because the legislaturehad already expressed its intent by placing marijuana inSchedule I—and by establishing a therapeutic researchprogram, thereby directly establishing the very limitedcircumstances under which marijuana may be used.
Georgia Spillers v. Georgia,245 S.E. 2d 54, 55 (1978)
The state Court of Appeals ruled that the lack of anymedical marijuana recognition by the state legislatureprecluded the court from allowing the medical necessitydefense.
Massachusetts Massachusetts v. Hutchins,575 N.E. 2d 741, 742 (1991)
The state Supreme Judicial Court ruled that the societalharm of allowing the medical necessity defense would begreater than the harm done to a patient denied theopportunity to offer the medical necessity defense.
Minnesota Minnesota v. Hanson,468 N.W. 2d 77, 78 (1991)
The state Court of Appeals refused to allow a patient touse the medical necessity defense because the legislaturehad already expressed its intent by placing marijuana inSchedule I—and by establishing a therapeutic researchprogram, thereby directly establishing the very limitedcircumstances under which marijuana may be used.
New Jersey New Jersey v. Tate,505 A. 2d 941 (1986)
The state Supreme Court ruled that the state legislature—by placing marijuana in Schedule I—had already indicatedits legislative intent to prohibit the medical use ofmarijuana. In addition, the court claimed that the criteriaof “necessity” could not be met because there wereresearch program options that could have been pursuedinstead.
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Appendix L (continued)
These cases demonstrate that—although it is up to the courts to decide whether to allow the medicalnecessity defense—the activities of a state legislature may significantly impact this decision.
Some states have statutes that authorize a “necessity defense” generally and have specified elements ofproof needed to succeed. But this does not guarantee that the courts will recognize a medical necessitydefense for marijuana. It depends on how the courts interpret the legislature’s intent. If the defense is notrecognized, the case proceeds as if the defendant possessed marijuana for recreational purposes ordistribution. If found guilty, the offender is subject to prison time in most states.
The medical necessity defense is a very limited measure. Though a legislature may codify the defenseinto law, this is typically not the best course of action for a state legislature to pursue.
Preferably, a state would have a law that (1) exempts from prosecution qualified patients who cultivateand/or possess medical marijuana, and (2) allows patients to use a simple defense or an affirmative defense ifthey are arrested and prosecuted anyway. An ideal statute would allow the defense for personal-usecultivation, as well as possession.
MPP has identified only three states where legislators have passed bills to establish the medical necessitydefense for medical marijuana offenses—Maine, Massachusetts, and Ohio. Ultimately, the efforts wereshort-lived, if not unsuccessful.
Maine’s legislature passed a bill in 1992, but it was vetoed by the governor. An Ohio bill that included amedical necessity defense provision became law in 1996, only to be repealed a year later. Massachusettsenacted a law in 1996 to allow patients to use the defense, but only if they are “certified to participate” inthe state’s therapeutic research program. Unfortunately, the state has never opened its research program. Asa result, Massachusetts patients are likely to be denied the necessity defense, similar to patients inMinnesota and Alabama, as noted above.
The U.S. Supreme Court has not yet recognized the necessity defense for medical marijuana. A decisionfrom the U.S. Ninth Circuit Court of Appeals, however, has recognized medical necessity as a valid defenseto federal marijuana charges. That case—United States v. Oakland Cannabis Buyers’ Cooperative—is nowpending before the U.S. Supreme Court. (See Appendix J.)
L-3
Appendix M: State medical marijuana legislation consideredduring the 1999-2000 legislative sessions
StateBill
Number IntentGoodor Bad
Alaska S.B. 94* amend the law created by the medical marijuana initiative B
Arkansas H.B. 1043 remove criminal penalties for patients with state-issued ID cards who grow, possess, anduse medical marijuana
G
California S.B. 847* establish a medical marijuana research program within the state university system G
California S.B. 848 implement the law created by the medical marijuana initiative, based onrecommendations of the attorney general’s task force
B
California S.B. 2089 narrow the scope of the law created by the medical marijuana initiative by establishing amandatory registration system and limiting a patient’s use to less than one year, amongother provisions
B
Colorado H.J.R. 00-1033**
non-binding resolution opposing Amendment 20, the medical marijuana initiative B
Hawaii S.B. 862* remove criminal penalties for patients who grow, possess, and use medical marijuana G
Iowa S.F. 2076 remove criminal penalties for patients who grow, possess, and use medical marijuana;establish a medical necessity defense; and establish a therapeutic research program
G
Maine S.P. 1012/L.D. 2580*
implement the law created by the medical marijuana initiative by requiring theDepartment of Public Safety to distribute confiscated marijuana to registered patients;bill was converted into a resolution creating a task force to examine broadimplementation issues
G
Maryland H.B. 308 remove criminal penalties for patients who grow, possess, and use medical marijuana G
Massachusetts H.B. 2128 expand therapeutic research program to include additional disease groups G
Minnesota S.F. 780/H.F. 936
remove criminal penalties for patients who grow, possess, and use medical marijuana(introduced in 1999)
G
Minnesota S.F. 3326/H.F. 3669
establish a medical necessity defense for patients who possess small amounts of marijuana(introduced in 2000)
G
New Hampshire H.B. 202 remove criminal penalties for patients who grow, possess, and use medical marijuana witha prescription (symbolic)
G
New York A.B. 8082 remove criminal penalties for patients who grow, possess, and use medical marijuana, andpermit distribution of medical marijuana
G
Oregon H.B. 3052* amend the law created by the medical marijuana initiative B
Rhode Island S.B. 2390/H.B. 7398
remove criminal penalties for patients who grow, possess, and use medical marijuana G
Vermont J.R.H. 72 implement a symbolic 1981 law that permits physicians to “prescribe” marijuana topatients
G
Washington S.B. 5704 implement the law created by the medical marijuana initiative, giving the Department ofHealth the authority to adopt rules
G
Washington S.B. 5771 narrow the scope of the law created by the medical marijuana initiative, designatingparameters of valid documentation, requiring physicians to determine specific dosage andmaximum quantity limits that may be legally possessed
B
Wyoming S.F. 20 move marijuana from Schedule I to Schedule II under state law should the federalgovernment do the same (symbolic)
G
*passed and signed into law (Maine’s resolution does not create statutory law, but it did appropriate funds for the task force)
**passed, but as a non-binding resolution does not require governor’s signature
M-1
Appendix N
Resolutions demonstrate an organization’s support for a particular policy and can encourage publicofficials to take action. MPP encourages activists to urge local and state organizations—especially
health and medical groups—to pass this resolution, then forward a copy to MPP.
Resolution to Protect Seriously Ill Peoplefrom Arrest and Imprisonment for Using Medical Marijuana
Whereas, the National Academy of Sciences’ Institute of Medicine concluded, after reviewing relevantscientific literature including dozens of works documenting marijuana’s therapeutic value1, that there aresome circumstances in which smoking marijuana is a legitimate medical treatment2; and,
whereas, a scientific survey conducted in 1990 by Harvard University researchers found that 54% ofoncologists with an opinion favored the controlled medical availability of marijuana, and 44% had alreadysuggested at least once that a patient obtain marijuana illegally3; and,
whereas, tens of thousands of patients nationwide—people with AIDS, cancer, glaucoma, chronic pain, andmultiple sclerosis—have found marijuana in its natural form to be therapeutically beneficial4 and arealready using it with their doctors’ approval; and,
whereas, numerous organizations have endorsed medical access to marijuana, including the AIDS ActionCouncil, American Academy of Family Physicians, American Bar Association, American Medical StudentAssociation, American Preventive Medical Association, American Public Health Association, CaliforniaAcademy of Family Physicians, California Legislative Council for Older Americans, California MedicalAssociation, California Nurses Association, California-Pacific Annual Conference of the United MethodistChurch, California Pharmacists Association, California Society of Addiction Medicine, Florida MedicalAssociation, Gray Panthers, Lymphoma Foundation of America, Multiple Sclerosis California ActionNetwork, National Association for Public Health Policy, National Association of Attorneys General,National Association of People with AIDS, National Black Police Association, National Women’s HealthNetwork, New York State Nurses Association, Public Citizen, Virginia Nurses Association, Whitman-Walker Clinic (Washington, D.C.), Women of Reform Judaism; and,
whereas, a scientific survey conducted in 1995 by Belden & Russonello (a Washington, D.C.-based pollingfirm) indicated that 79% of U.S. voters support the idea of “legaliz[ing] marijuana to relieve pain and forother medical uses if prescribed by a doctor”5; and,
whereas, national public opinion polls conducted by ABC News, CBS News, the Family Research Council,and the Gallup Organization between 1997 and 1999 found substantial support for medical marijuana6; and,
whereas, since 1996, medical marijuana initiatives received a majority of votes in every state in which theyappeared on the ballot—Alaska, Arizona, California, Colorado, the District of Columbia, Maine, Nevada,Oregon, and Washington state7; and,
whereas, on June 14, 2000, Governor Ben Cayetano of Hawaii signed into law the first medical marijuana billenacted via a state legislature which permits the cultivation, possession, and use of medical marijuana; and,
whereas, on September 6, 1988, after reviewing all available medical data, the Drug EnforcementAdministration’s chief administrative law judge, Francis L. Young, declared that marijuana is “one of thesafest therapeutically active substances known” and recommended making marijuana available byprescription8; and,
N-1
whereas, the federal penalty for possessing one marijuana cigarette—even for medical use—is up to one yearin prison, and the penalty for growing one plant is up to five years9; and,
whereas, the penalties are similar in most states, where medical marijuana users must live in fear of beingarrested; and,
whereas, the present federal classification of marijuana10 and the resulting bureaucratic controls impedeadditional scientific research into marijuana’s therapeutic potential11, thereby making it nearly impossiblefor the Food and Drug Administration to evaluate and approve marijuana through standard proceduralchannels; and,
whereas, seriously ill people should not be punished for acting in accordance with the opinion of theirphysicians in a bona fide attempt to relieve suffering; therefore,
Be it resolved that licensed medical doctors should not be punished for recommending the medical use ofmarijuana to seriously ill people, and seriously ill people should not be subject to criminal sanctions forusing marijuana if the patient’s physician has told the patient that such use is likely to be beneficial.
1“The Medical Value of Marijuana and Related Substances,” Chapter 4 of the Institute of Medicine’s Marijuana and Medicine: Assessingthe Science Base (Washington: National Academy Press, 1999), lists 198 references in its analysis of marijuana’s medical uses.2From Principal Investigator Dr. John Benson’s opening remarks at the Institute of Medicine’s news conference releasing the reportMarijuana and Medicine: Assessing the Science Base (March 17, 1999).3R. Doblin and M. Kleiman, “Marijuana as Antiemetic Medicine,” Journal of Clinical Oncology 9 (1991): 1314-1319.4The therapeutic value of marijuana is supported by existing research and experience. For example, the following statementappeared in the American Medical Association’s “Council on Scientific Affairs Report 10 — Medicinal Marijuana,” adopted by theAMA House of Delegates on December 9, 1997:
— “Smoked marijuana was comparable to or more effective than oral THC, and considerably more effective thanprochlorperazine or other previous antiemetics in reducing nausea and emesis.” (page 10)
— “Anecdotal, survey, and clinical data support the view that smoked marijuana and oral THC provide symptomatic relief insome patients with spasticity associated with multiple sclerosis (MS) or trauma.” (page 13)
— “Smoked marijuana may benefit individual patients suffering from intermittent or chronic pain.” (page 15)5Belden & Russonello interviewed 1,001 registered voters, selected by a national random digit dial survey, on behalf of theAmerican Civil Liberties Union, which released the results via its Department of Public Education on November 27, 1995.6ABC News/Discovery News (69% support medical marijuana, poll conducted May 27, 1997 by Chilton Research); CBS News(66% of Independent respondents, 64% of Democrat respondents, and 57% of Republican respondents support medical marijuana,poll reported in The New York Times, June 15, 1997); Family Research Council (74% support medical marijuana, poll conductedSpring 1997); Gallup (73% support medical marijuana, poll conducted March 19-21, 1999).7Alaska , Measure 8, Nov. 1998, received 58% of the vote; Arizona , Proposition 200, Nov. 1996, received 65% of the vote;Arizona , Proposition 300, Nov. 1998, rejected by 57% of the vote (by rejecting Proposition 300, voters upheld the medicalmarijuana provision in 1996’s Proposition 200); California , Proposition 215, Nov. 1996, received 56% of the vote; Colorado,Amendment 20, Nov. 2000, received 54% of the vote; District of Columbia , Initiative 59, Nov. 1998, received 69% of the vote;Maine, Question 2, Nov. 1999, received 61% of the vote; Nevada, Question 9, Nov. 2000, received 65% of the vote; Oregon,Measure 67, Nov. 1998, received 55% of the vote; Washington, Initiative 692, Nov. 1998, received 59% of the vote.8U.S. Department of Justice, Drug Enforcement Administration. “In The Matter Of Marijuana Rescheduling Petition, Docket No.86-22, Opinion and Recommended Ruling, Findings of Fact, Conclusions of Law and Decision of Administrative Law Judge,”Francis L. Young, Administrative Law Judge, September 6, 1988.9Section 844(a) and Section 841(b)(1)(D), respectively, of Title 21, United States Code.10Section 812(c) of Title 21, United States Code.11The U.S. Department of Health and Human Services (HHS) issued written guidelines for medical marijuana research, effectiveDecember 1, 1999. The guidelines drew criticism from a coalition of medical groups, scientists, members of Congress, celebrities,and concerned citizens. The coalition called the guidelines “too cumbersome” and urged their modification in a letter to HHSSecretary Donna Shalala, dated November 29, 1999. Signatories of the letter included 33 members of Congress, former SurgeonGeneral Joycelyn Elders, and hundreds of patients, doctors, and medical organizations.
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Appendix O: Initiative states
The initiative process allows citizens to vote on proposed laws, as well as amendments to the stateconstitution. There is no national initiative process, but 24 states plus the District of Columbia have theinitiative process in some form.
Some states allow citizens to propose laws which are placed directly on a ballot for voters to decide. Thelegislature has no role in this process, known as the direct initiative process. Some other states have anindirect initiative process, where laws or amendments proposed by the people must first be submitted to thestate legislature. If the legislature fails to approve the law or amendment, the proposal appears on the ballotfor voters to decide. Maine’s medical marijuana initiative, for example, was an indirect initiative; all otherstate medical marijuana initiatives have been direct.
Colorado’s and Nevada’s initiatives amended the state constitution, while measures in Alaska, Arizona,California, Maine, Oregon, and Washington enacted statutory law. (The initiative that appeared on theballot in the District of Columbia was also a statutory law.)
The initiative process is not a panacea, however. Twenty-six states do not have it, which means votersin more than half of the states cannot enact favorable medical marijuana laws via the ballot; rather, theymust rely on their elected representatives to change the medical marijuana laws. Moreover, legislation ismuch more cost-effective than ballot initiatives, which can be very expensive endeavors.
In contrast to “initiatives,” “referenda” deal with matters not originated by the voters. There are twotypes of referenda. A popular referendum is the power to refer to the ballot, through a petition, specificlegislation that was enacted by the legislature for the voters’ approval or rejection. A legislative referendum iswhen a state legislature places a proposed amendment or statute on the ballot for voter approval or rejection.
States with the Initiative Process
StatutoryLaw
ConstitutionalAmendment
StatutoryLaw
ConstitutionalAmendment
State Direct Indirect Direct Indirect State Direct Indirect Direct Indirect
Alaska Y N N N Missouri Y N Y N
Arizona Y N Y N Montana Y N Y N
Arkansas Y N Y N Nebraska Y N Y N
California Y N Y N Nevada N Y Y N
Colorado Y N Y N North Dakota Y N Y N
District of Columbia Y N N N Ohio N Y Y N
Florida N N Y N Oklahoma Y N Y N
Idaho Y N N N Oregon Y N Y N
Illinois N N Y N South Dakota Y N Y N
Maine N Y N N Utah Y Y N N
Massachusetts N Y N Y Washington Y Y N N
Michigan N Y Y N Wyoming Y N N N
Mississippi N N N Y Y = has the process; N = does not have the process
O-1
P-1
C h a l l e n g e # 1 : “There is no reliable evidence thatmarijuana has medical value.”
C h a l l e n g e # 2 : “Other drugs work better than marijuana.We should not make marijuana medically availableunless it is shown to be the most effective drug for treat-ing a particular condition.”
C h a l l e n g e # 3 : “Why is marijuana needed when it isalready available in pill form?”
C h a l l e n g e # 4 : “Why not isolate the other useful cannabi-noids and make them available in a pure, synthetic form?”
C h a l l e n g e # 5 : “Why not make THC and other cannabi-noids available in inhalers, suppositories, and so forth?”
C h a l l e n g e # 6 : “ We should not subvert the FDA approvalprocess by passing bills and initiatives.”
C h a l l e n g e # 7 : “ D o e s n ’t medical marijuana send thewrong message to children?”
C h a l l e n g e # 8 : “Marijuana is too dangerous to be used as amedicine. Over 10,000 scientific studies have shownthat marijuana is harmful and addictive.”
C h a l l e n g e # 9 : “ I s n ’t marijuana bad for the immunes y s t e m ? ”
C h a l l e n g e # 1 0 : “Marijuana contains hundreds of com-pounds. Doesn’t that make it too dangerous?”
C h a l l e n g e # 1 1 : “ M a r i j u a n a ’s side effects—for instance,increased blood pressure—negate its effectiveness infighting glaucoma.”
C h a l l e n g e # 1 2 : “What exactly do all of the medicalmarijuana ballot initiatives do?”
C h a l l e n g e # 1 3 : “ D o n ’t state-level medical marijuana lawsput the states in violation of federal law?”
C h a l l e n g e # 1 4 : “ A r e n ’t these medical marijuana bills andinitiatives full of loopholes?”
C h a l l e n g e # 1 5 : “ We r e n ’t the initiatives passed because ofwell-funded campaigns that hoodwinked the voters?”
C h a l l e n g e # 1 6 : “This bill/initiative doesn’t even require ad o c t o r ’s prescription!”
C h a l l e n g e # 1 7 : “These bills and initiatives are confusingto law-enforcement officials.”
C h a l l e n g e # 1 8 : “Cannabis buyers’ clubs are totally out ofc o n t r o l ! ”
C h a l l e n g e # 1 9 : “If the U.S. Supreme Court rules againstthe buyers’ clubs, will state-level medical marijuana lawsbe effectively overturned or negated?”
C h a l l e n g e # 2 0 : “ I s n ’t the medical marijuana issue just asneaky step toward legalization?”
C h a l l e n g e # 2 1 : “Are people really arrested for medicalm a r i j u a n a ? ”
C h a l l e n g e # 2 2 : “Do people really go to prison for medicalmarijuana offenses?”
C h a l l e n g e # 2 3 : “Is the federal government allowing med-ical marijuana research?”
C h a l l e n g e # 2 4 : “How would doctors control the dosagesof medical marijuana?”
C h a l l e n g e # 2 5 : “Why make marijuana medically avail-able when no other medicines are smoked? How can youcall something a medicine when you have to smoke it?Smoke is not a medicine, and smoking is not a safedelivery system!”
C h a l l e n g e # 2 6 : “Medical marijuana is opposed by allmajor health and medical organizations.”
C h a l l e n g e # 2 7 : “Medical marijuana is advocated by thesame people who support drug legalization!”
C h a l l e n g e # 2 8 : “ Very few oncologists support medicalmarijuana. Newer surveys negate the Doblin/Kleimans u r v e y. ”
C h a l l e n g e # 2 9 : “In 1994, the U.S. Court of Appeals over-ruled DEA Administrative Law Judge Francis Yo u n g ’sdecision, so his ruling in favor of medical marijuana isi r r e l e v a n t . ”
C h a l l e n g e # 3 0 : “Drug policy should be based on ‘science,not ideology’.”
C h a l l e n g e # 3 1 : “ D o e s n ’t the federal government alreadyallow some people to use medical marijuana?”
Marijuana Policy Project ■ P. O. Box 7 7 4 9 2 ■ Capitol Hill ■ Washington, D.C. 2 0 0 1 3
tel 2 0 2 - 4 6 2 - 5 7 4 7 ■ fax 2 0 2 - 2 3 2 - 0 4 4 2 ■ M P P @ M P P. O R G ■ h t t p : / / w w w. m p p . o r g
The issue at hand is the removal of criminal penalties for patients who use medical marijuana. It is crucial to avoid get-ting lost in side arguments. Federal law and 42 state laws subject seriously ill people to arrest and imprisonment for usingmarijuana. It is important to ask opponents, “Should seriously ill people be arrested and sent to prison for using marijuanawith their doctors’ approval?”
The key issue is not making a “new drug” available. Rather, the goal is to protect from arrest and imprisonment the tensof thousands of patients who are already using marijuana, as well as the doctors who are recommending such use.
R e m e m b e r : Patients for whom the standard, legal drugs are not safe or effective are left with two terrible choices: (1) con-tinue to suffer, or (2) obtain marijuana illegally and risk arrests, fines, court costs, property forfeiture, incarceration, proba-tion, and criminal records.
This paper provides the Marijuana Policy Project’s (MPP’s) answers to the following common challenging questions:
Responses to Anti-Medical Marijuana Arguments
Appendix P
Appendix P (continued)
P-2Page 2
“There is no reliable evidencethat marijuana has medicalv a l u e . ”
R e s p o n s e : In March 1999, the National Academy ofSciences’ Institute of Medicine concluded that “there aresome limited circumstances in which we recommend smokingmarijuana for medical purposes.” The report noted that “nau-sea, appetite loss, pain and anxiety … all can be mitigated bymarijuana.” (See h t t p : / / w w w . m p p . o r g / s c i e n c e . h t m l . )
“Other drugs work betterthan marijuana. We shouldnot make marijuanamedically available unless itis shown to be the mosteffective drug for treating aparticular condition.”
R e s p o n s e A : In March 1999, the National Academy ofSciences’ Institute of Medicine concluded, “Althoughsome medications are more effective than marijuana …they are not equally effective in all patients.”
Everyone knows that different people respond differ-ently to different medicines. The “most” effective drug forone person might not work at all for another person. Thatis why there are different drugs on the market to treat thesame ailment. Treatment decisions should be made in doc-tors’ offices, not by federal bureaucrats.
R e s p o n s e B : A 1997 National Institutes of Health med-ical marijuana report noted, “There was considerable dis-cussion and debate as to whether smoked marijuana …would need to demonstrate clear superiority or some uniquebenefit compared with other medications currently avail-able for these conditions. The Expert Group concludedthat smoked marijuana should be held to standards equiva-lent to other medications for efficacy and safety considera-tions.” [Emphasis added.]1
“Why is marijuana neededwhen it is already availablein pill form?”
R e s p o n s e A : Marijuana contains about 60 active cannabi-noids in addition to THC. Many of these compounds pro-duce therapeutic effects that THC alone does not. Forexample, cannabidiol seems to be primarily responsible forcontrolling spasticity.
R e s p o n s e B : In March 1999, the National Academy ofSciences’ Institute of Medicine noted, “It is well recognizedthat Marinol’s oral route of administration hampers itseffectiveness because of slow absorption and patients’ desirefor more control over dosing.”
“Why not isolate the otheruseful cannabinoids andmake them available in apure, synthetic form?”
R e s p o n s e : It took many years of research before THC wasapproved in pill form, and no other cannabinoids have sincebeen made available. What pharmaceutical company isgoing to spend millions of dollars on research when naturalmarijuana is currently widely available? How many decadeswould it take to synthesize, approve, and market 60 differentcompounds? Why make patients wait that long when thenatural substance already exists? Should patients who usemarijuana be arrested and put in prison in the meantime?
“Why not make THC andother cannabinoids availablein inhalers, suppositories,and so forth?”
R e s p o n s e A : If these delivery systems would help patients,then they should be made available. However, the devel-opment of these systems should not substitute for theresearch of smokable marijuana that is necessary for FDAapproval of the natural, whole marijuana.
R e s p o n s e B : The availability of such delivery systemsshould not be used as an excuse to maintain the prohibitionof the use of smokable marijuana. As long as there arepatients and doctors who prefer the natural substance, theyshould not be criminalized for using or recommending it,no matter what alternatives are available.
“We should not subvert theFDA approval process bypassing bills and initiatives.”
R e s p o n s e : There is already enough scientific evidence toestablish that marijuana is a safe and effective medicine forsome people. More research is needed simply to satisfy rigidFDA requirements for marketing, labeling, and distributingthe substance in pharmacies. But the current federalresearch guidelines make it nearly impossible to do theresearch required by the FDA to approve natural, smokablemarijuana as a prescription medicine. Even if the researchwere allowed to proceed, it could still take several yearsbefore marijuana is approved by the FDA.
Should the thousands of seriously ill people alreadyusing medical marijuana be arrested and sent to prison inthe meantime? Of course not. Therefore, the only immedi-ate solution is to change federal and state laws—throughlegislation and ballot initiatives—to exempt patients fromcriminal prosecution for using and obtaining marijuana, aslong as their doctors agree that it is medically beneficial.
CHALLENGE #6:
CHALLENGE #5:
CHALLENGE #4:
CHALLENGE #3:
CHALLENGE #2:
CHALLENGE #1:
1 . “Report on the Possible Medical Uses of Marijuana,” NIH medical marijuana expert group; Rockville, MD: NationalInstitutes of Health, August 8, 1997; page 5.
Appendix P (continued)
P-3Page 3
“D o e s n’t medical marijuanasend the wrong message toc h i l d r e n ? ”
R e s p o n s e A : The federal government’s annual NationalHousehold Survey on Drug Abuse has found thatmarijuana use has not increased among young people inCalifornia since the passage of Proposition 215 in 1996. Infact, the marijuana usage rates among California teenagersis currently lower than the national average.
R e s p o n s e B : Children can and should be taught the differ-ence between medicine and drug abuse. There are no legalmedications that children should use for fun. In fact, doctorscan prescribe cocaine, morphine, and methamphetamine.Children are not taught that these drugs are good to userecreationally just because they are used as medicines.
R e s p o n s e C : It is absurd to think that children will want tobe as “cool” as a dying cancer patient. If anything, the use ofmarijuana by seriously ill people might de-glamorize it forchildren. The message is, “Marijuana is for sick people.”
R e s p o n s e D : Under federal law, cocaine and morphine arecurrently legal as medicines. This means that federal lawdefines cocaine and morphine as being better for you—inthat they have more therapeutic value and are less danger-ous—than marijuana. What kind of message does currentfederal law send to children?
“Marijuana is too dangerousto be used as a medicine.Over 10,000 scientificstudies have shown thatmarijuana is harmful anda d d i c t i v e . ”
R e s p o n s e A : Doctors are allowed to prescribe cocaine,morphine, and methamphetamine. Can anyone say with astraight face that marijuana is more dangerous than theses u b s t a n c e s ?
R e s p o n s e B : All medicines have some negative side effects.The question is this: Do the benefits outweigh the risks foran individual patient? That decision should be made by ap a t i e n t ’s doctor, not the criminal justice system. Patientsshould not be criminalized if their doctors believe that thebenefits of using medical marijuana outweigh the risks.
R e s p o n s e C : The medical marijuana opponents’ popular“10,000 studies” claim is simply not true. The University ofMississippi Research Institute of Pharmaceutical Sciences
maintains a 12,000-citation bibliography on the entirecanon of marijuana literature. The Institute notes: “Manyof the studies cited in the bibliography are clinical, but thetotal number also includes papers on the chemistry andbotany of the Cannabis plant, cultivation, epidemiologicalsurveys, legal aspects, eradication studies, detection, stor-age, economic aspects and a whole spectrum of others thatdo not mention positive or negative effects. … However,we have never broken down that figure into positive/nega-tive papers, and I would not even venture a guess as to whatthat number would be.”2
“I s n’t marijuana bad for theimmune system?”
R e s p o n s e A : No studies have conclusively establishedthat marijuana’s effects on the immune system exacerbatethe condition of AIDS or cancer patients, according to theJournal of the American Medical Association.3
R e s p o n s e B : According to Marijuana Myths, MarijuanaFacts, there is no evidence that marijuana users are moresusceptible to infections than non-users. Early studies thatshowed decreased immune function in cells taken frommarijuana users have since been disproved.4 Indeed, not asingle case of marijuana-induced immune impairment hasever been observed in humans.
“Marijuana containshundreds of compounds.D o e s n’t that make it tood a n g e r o u s ? ”
R e s p o n s e : Coffee, mother’s milk, broccoli, and most food salso contain hundreds of different chemical compounds.This number doesn’t mean anything. Marijuana is a rela-tively safe medicine, regardless of the number of chemicalcompounds found therein.
“Marijuana’s side effects — for instance, increasedb l o o d pressure — negate itseffectiveness in fightingg l a u c o m a . ”
R e s p o n s e A : NIH medical marijuana panelist PaulPalmberg, M.D., Ph.D., a glaucoma expert, said onF e b r u a r y 20, 1997, “I don’t think there’s any doubt about itseffectiveness, at least in some people with glaucoma.”5
CHALLENGE #11:
CHALLENGE #10:
CHALLENGE #9:
CHALLENGE #8:
CHALLENGE #7:
2 . Letter from Beverly Urbanek, Research Associate of the University of Mississippi Research Institute of PharmaceuticalSciences (601-232-5914), to Dr. G. Alan Robison, Drug Policy Forum of Texas, June 13, 1996.
3 . Journal of the American Medical Association, 267(19), May 20, 1992; page 2573.4 . Marijuana Myths, Marijuana Facts, L. Zimmer, Ph.D., and J. Morgan, M.D.; New York, NY: The Lindesmith Center,
1997; page 106.5 . Ibid note xx formerly “1”, pages 96-97.
Appendix P (continued)
P-4Page 4
R e s p o n s e B : The federal government gives marijuana toat least three patients with glaucoma, and it has preservedtheir vision for years after they were expected to go blind.
R e s p o n s e C : So should someone who uses marijuana totreat glaucoma be arrested? Shouldn’t we trust a patient anda doctor to make the right decision regarding a particularp a t i e n t ’s circumstances?
R e s p o n s e D : Even if the benefits of using marijuana totreat glaucoma did not outweigh the risks, that would notnegate the medical utility of marijuana for treating all ofthe other conditions that marijuana helps treat. Should acancer patient be arrested for using marijuana if it is notparticularly helpful for glaucoma patients?
“What exactly do all of themedical marijuana ballotinitiatives do?”
R e s p o n s e : In short, they remove state-level criminal penal-ties for using, obtaining, or cultivating marijuana strictly formedicinal purposes. To verify a legitimate medical need, ad o c t o r ’s recommendation is required. Doctors may not bepunished by the state for making such recommendations.
U n f o r t u n a t e l y, federal laws still apply to patients.L u c k i l y, the federal government does not have the resourcesto arrest and incarcerate a significant number of small-scalemedical marijuana users and growers. Therefore, seriously illpeople in the eight states that have passed effective medicalmarijuana laws are essentially free to grow and usemarijuana if their doctors deem it appropriate.
“D o n’t state-level medicalmarijuana laws put the statesin violation of federal law?”
R e s p o n s e : No. There is no federal law that mandates thatstates must enforce federal laws against marijuana posses-sion or cultivation. States are free to determine their ownpenalties—or lack thereof—for drug offenses. State govern-ments cannot directly violate federal law by givingmarijuana to patients, but states can refuse to arrest patientswho grow their own.
“Aren’t these medicalmarijuana bills andinitiatives full of loopholes?”
R e s p o n s e A : The voters intended to allow seriously illpeople to use marijuana without being arrested. Whilesome of the wording of the California initiative may havebeen sloppy, the judicial system is clearing up the grayareas. The courts are making sure that the new laws arebeing implemented as the voters intended and making surethat healthy people do not have a green light to usemarijuana for fun. In California, there are still no reports ofpeople getting away with using marijuana recreationally by
using the initiative falsely as a defense. Judges and juries areable to decide who is a patient and who is not.
R e s p o n s e B : More recent bills and initiatives were draftedvery carefully to ensure that there are no loopholes, real orimagined. Read them carefully and you’ll see. Medicalmarijuana advocates have nothing to gain and everythingto lose by writing initiatives that enable recreationalmarijuana use.
R e s p o n s e C : If the bills and initiatives are not perfect,they are the best attempt to protect patients and physiciansfrom punishment for using or recommending medicalmarijuana. The real problem is that the federal govern-m e n t ’s overriding prohibition of medical marijuana leavesstate bills and initiatives as the only option to help patientsat this point. As soon as federal law changes, this processwill no longer be needed.
“We r e n’t the initiativespassed because of well-funded campaigns thathoodwinked the voters?”
R e s p o n s e A : No. Independent polls conducted before anymoney was spent on these campaigns indicated solid sup-port for the initiatives. Furthermore, opponents used taxdollars, government officials (such as Drug Czar BarryMcCaffrey), and statements from three former presidents tooppose the initiatives.
R e s p o n s e B : Proposition 215 was the culmination of morethan three years of legislative activity in Sacramento. TheCalifornia legislature passed one medical marijuana resolu-tion and two bills in 1993, 1994, and 1995. The 1995 bill—which Governor Pete Wilson vetoed—became the basis forProposition 215.
R e s p o n s e C : Ninety-five percent of California voters wereaware that marijuana is sometimes used for medical purpos-es, according to a June 1996 poll conducted for the cam-paign. In fact, 32% of the voters said that they knewsomeone who had used medical marijuana.
R e s p o n s e D : The budget for Proposition 215 (less than $2million) was peanuts compared to California campaignstandards. The campaign budgets for Governor PeteWilson and U.S. Senator Dianne Feinstein, for example,were each about $20 to $30 million in 1994. Interestingly,the entire Proposition 215 budget was less than half of whatthe so-called Partnership for a Drug-Free America spendseach week on its advertising campaign.
“This bill/initiative doesn’ teven require a doctor’ sp r e s c r i p t i o n ! ”
R e s p o n s e A : The federal government prohibits doctorsfrom “prescribing” marijuana for any reason. A prescriptionis a legal document ordering a pharmacy to release a
CHALLENGE #16:
CHALLENGE #15:
CHALLENGE #14:
CHALLENGE #13:
CHALLENGE #12:
Appendix P (continued)
P-5Page 5
controlled substance. Currently, the federal governmentdoes not allow this for marijuana.
H o w e v e r, there needs to be some way for state crimi-nal justice systems to determine which marijuana usershave a legitimate medical need. So the initiatives and billsrequire a physician to document that a patient has a debil-itating medical condition whereby the potential benefits ofthe medical use of marijuana would likely outweigh thehealth risks for the qualifying patient.
The recommendation for marijuana must be written,or a physician must be willing to testify in court that he orshe orally recommended marijuana. Doctors do not risktheir reputations and livelihoods unless they very stronglybelieve that their patients need marijuana.
R e s p o n s e B : If you would trust a doctor to write a prescrip-tion for marijuana, why not trust a doctor to write a profes-sional opinion on his or her letterhead instead? Opponentssimply do not want patients to use medical marijuana, andthey’re just nit-picking for an excuse to attack the bill/initiative. What advantage would there be to a prescriptioninstead of a written, signed recommendation on a physician’sletterhead? What is the big difference, in practical terms?
“These bills and initiativesare confusing to law-enforcement officials.”
R e s p o n s e A : W h a t ’s so confusing? If a person is growing orusing marijuana and has a written recommendation from aphysician, do not arrest the patient or caregiver. If the per-son does not have suitable documentation, either call thep e r s o n ’s doctor or arrest the person and let the courts decide.
It should be no more confusing than determining ifsomeone drinking alcohol is underage or on probation, ifsomeone is the legal owner of a piece of property, or if a per-son is a legal immigrant or not.
R e s p o n s e B : Law enforcement officials are just playingdumb in order to scare the public into opposing medicalmarijuana bills and initiatives. Why? Because they have avested financial interest in being able to arrest as many peo-ple as possible.
“Cannabis buyers’ clubs aretotally out of control!”
R e s p o n s e : Most medical marijuana distribution centers(also known as cannabis buyers’ clubs) in Californiaworked out arrangements with local governments and law-enforcement officials. They were subject to strict guide-lines, and they verified patients’ diagnoses andrecommendations from physicians. Photo IDs were issuedin most cases. The marijuana was checked for quality con-trol. The buyers’ clubs were run above ground and wouldnot risk the consequences of providing marijuana tohealthy people.
U n f o r t u n a t e l y, federal and overzealous state law-enforcement officials shut down almost all of the centers,including those that were the most tightly run—drivingmany patients back to the streets to buy their medicine.Nevertheless, even without buyers’ clubs, the initiatives arestill effective, in that they protect patients from being arrest-ed regardless of how they obtain their medical marijuana.
“If the U.S. Supreme Courtrules against the buyers’clubs, will state-level medicalmarijuana laws be effectivelyoverturned or negated?
R e s p o n s e : Absolutely not. Contrary to common belief, thepending U.S. Supreme Court opinion on medicalmarijuana—which is expected to be issued in June 2001—will rule only on whether distribution (and presumably use)of medical marijuana is legal under federal law. The validityor nature of state medical marijuana laws is not in question.C o n s e q u e n t l y, state legislators should not use the upcomingCourt decision as an excuse for inaction during the 2001 leg-islative session, because the upcoming Court ruling will notimpact one way or the other on a state’s ability to changestate law in order to protect patients and primary caregiversfrom arrest. (If the Court rules that medical marijuana dis-tribution is legal under federal law, state legislatures will stillneed to pass bills to protect patients under state law. If, onthe other hand, the Court rules that medical marijuana dis-tribution is prohibited under federal law, that is the assump-tion that most patients, physicians, and state governmentshave been working under all along, so this would not changethe need to pass state medical marijuana bills.)
“I s n’t the medical marijuanaissue just a sneaky steptoward legalization?”
R e s p o n s e A : How? Exactly how does allowing seriously illpeople to use marijuana lead to the end of the prohibitionof marijuana for recreational use? Doctors are allowed toprescribe cocaine and morphine, and these drugs are noteven close to becoming legal for recreational use.
R e s p o n s e B : Each law should be judged on its own merits.Should seriously ill people be subject to arrest and impris-onment for using marijuana with their doctors’ approval? Ifnot, then people should support the new medical marijuanabills and initiatives. Should healthy people be sent toprison for using marijuana for fun? If so, then we shouldkeep all non-medical uses of marijuana illegal. There’s nomagic tunnel between the two.
“Are people really arrestedfor medical marijuana?”
R e s p o n s e A : There were dozens of known medicalmarijuana users arrested in California in the 1990s, which
CHALLENGE #21:
CHALLENGE #20:
CHALLENGE #19:
CHALLENGE #18:
CHALLENGE #17:
Appendix P (continued)
P-6
is what prompted people to launch the medical marijuanainitiative in 1996. There have been many other publicizedand not-so-publicized cases across the United States.
R e s p o n s e B : More than 12 million marijuana users havebeen arrested since 1970.6 U n f o r t u n a t e l y, the governmentdoes not keep track of how many were medical users.H o w e v e r, even if only 1% of those arrestees used marijuanafor medical purposes, that is 120,000 patients arrested!
R e s p o n s e C : The threat of arrest is itself a terrible punish-ment for seriously ill people. Imagine the stress of knowingthat you can be arrested and taken to jail at any moment.Stress and anxiety are proven detriments to health and theimmune system. Should patients have to jump out of bedevery time they hear a bump in the night, worrying that thepolice are finally coming to take them away?
“Do people really go toprison for medicalmarijuana offenses?”
R e s p o n s e A : Federal law and the laws of most states do notmake any exceptions for medical marijuana. On the federallevel, possession of even one joint carries a maximum penal-ty of one year in prison. And cultivation of even one plantis a felony, with a maximum sentence of five years. Moststate laws are in this same ballpark. With no medical neces-sity defense available, medical marijuana users are treatedthe same as recreational users. Many are sent to prison.
R e s p o n s e B : There are numerous examples. The followingis a small sampling: Gordon Hanson served six months in aMinneapolis jail for growing his own marijuana to treat grandmal epilepsy. Byron Stamate spent three months in aCalifornia jail for growing marijuana for his disabled girlfriend(who killed herself so that she would not have to testifyagainst Byron). Gordon Farrell Ethridge spent 60 days in anOregon jail for growing marijuana to treat the pain from histerminal cancer. Will Foster was sentenced to more than9 0 years in Oklahoma for growing marijuana for chronic pain.
R e s p o n s e C : There are an estimated 60,000 marijuanaoffenders in prisons and jails at any given time.7 Even ifonly 1% of them are medical marijuana users, that is 600patients in prison at this moment!
R e s p o n s e D : Even if a patient is not sent to prison, con-sider the trauma of the arrest: A door kicked in, a houseransacked by police, a patient handcuffed and put into apolice car. Perhaps a night or two in jail. Court costs andattorney fees paid for by the patient and the taxpayers.Probation—which means urine tests for a couple of years,
which means that the patient must go without his or hermedical marijuana. Huge fines and possible loss of employ-ment, all of which hurt the patient’s ability to pay insur-ance, medical bills, rent, food bills, home care expenses,and so on. Then there’s the stigma of being a “druggie.”Doctors might be too afraid to prescribe pain medication tosomeone that the system considers a “drug addict.” Shouldany of this happen to seriously ill people for using what theyand their doctors believe is a beneficial medicine?
“Is the federal governmentallowing medical marijuanar e s e a r c h ? ”
R e s p o n s e : The 1999 federal medical marijuana researchguidelines still make it nearly impossible to do research thatwould generate the necessary data to enable the FDA toapprove natural, smokable marijuana as a prescription med-icine. (See h t t p : / / w w w . m p p . o r g / g u i d e l i n e s . )
Two things that would make it much easier to conductresearch would be (1) moving marijuana from Schedule I toSchedule II of the federal Controlled Substances Act, and(2) ending the National Institute on Drug Abuse’s monop-oly on the supply of marijuana for research.
“How would doctors controlthe dosages of medicalm a r i j u a n a ? ”
R e s p o n s e : According to NIH medical marijuana panelistAvram Goldstein, M.D., “We know that there are noextreme immediate toxicity issues. It’s a very safe drug, andtherefore it would be perfectly safe medically to let thepatient determine their own dose by the smoking route.”9
“Why make marijuanamedically available when noother medicines are smoked?How can you call somethinga medicine when you have tosmoke it? Smoke is not amedicine, and smoking is nota safe delivery system!”
R e s p o n s e A : While there are health hazards associatedwith smoking, medicines do not have to be completely safeto be approved. They must be safe relative to otherapproved medicines. Considering that cocaine, morphine,and methamphetamine are legal medicines, it is absurd toprohibit medical marijuana.
CHALLENGE #25:
CHALLENGE #24:
CHALLENGE #23:
CHALLENGE #22:
Page 6
6 . Crime in the United States, FBI Uniform Crime Reports; Washington, D.C.: U.S. Government Printing Office, annu-al series from 1970 to 1998.x x 7 . “Marijuana Arrests and Incarceration in the United States: Preliminary Report,” C. Thomas; Washington, D.C.:
Marijuana Policy Project, 1998.8 . Ibid note xx, page 82.
Appendix P (continued)
P-7Page 7
R e s p o n s e B : Most medical marijuana users do not need tosmoke so much that they are put at risk. For example, AIDSand cancer patients generally need just a couple of puffs justbefore a meal. And the hazards of smoking can be reducedby (1) using higher potency marijuana, (2) using vaporiza-tion devices, or (3) eating the marijuana.
R e s p o n s e C : Many medical practices that seemed absurdat one time are now generally accepted; for example,acupuncture, massage therapy, hypnotherapy, guided visu-alizations, and herbal medicines.
R e s p o n s e D : Smoked medicine is not unprecedented. Forexample, stramonium cigarettes were used to treat asthmain the 20th century.
“Medical marijuana isopposed by all major healthand medical organizations.”
R e s p o n s e A : No medical organizations state that seriouslyill people should be subject to arrest and imprisonment forusing marijuana with their doctors’ approval, so the currentfederal laws are not in step with these organizations’ positions.
R e s p o n s e B : Numerous health and medical organizationsand other prominent associations do have favorable med-ical marijuana positions, including AIDS Action Council,American Academy of Family Physicians, American BarAssociation, American Medical Student Association,American Preventive Medical Association, AmericanPublic Health Association, California Academy of FamilyPhysicians, California Legislative Council for OlderAmericans, California Medical Association, CaliforniaNurses Association, California-Pacific Annual Conferenceof the United Methodist Church, California PharmacistsAssociation, California Society of Addiction Medicine,Florida Medical Association, Gray Panthers, Ly m p h o m aFoundation of America, Multiple Sclerosis CaliforniaAction Network, National Association for Public HealthP o l i c y, National Association of Attorneys General,National Association of People with AIDS, National BlackPolice Association, National Wo m e n ’s Health Network,New York State Nurses Association, Public Citizen,Virginia Nurses Association, Whitman-Walker Clinic( Washington, D.C.), Women of Reform Judaism, andnumerous other organizations.9
“Medical marijuana isadvocated by the samepeople who support drugl e g a l i z a t i o n ! ”
R e s p o n s e A : Many health and medical associations sup-port medical access to marijuana but do not advocatebroader reform of the drug laws.
R e s p o n s e B : Surely you’re not suggesting that patientsshould be punished just to spite people who believe thathealthy people should not go to prison for using marijuana.
“Ve ry few oncologistssupport medical marijuana.Newer surveys negate theDoblin/Kleiman surv e y. ”
R e s p o n s e A : The Doblin/Kleiman (Harvard University)scientifically valid, random survey of oncologists conductedin 1990 found that 54% of those with an opinion favoredthe controlled medical availability of marijuana, and 44%had already suggested to at least one of their cancer patientsthat they obtain marijuana illegally. This was published inthe peer-reviewed Journal of Clinical Oncology.1 0
R e s p o n s e B : Critics of the Doblin/Kleiman study typical-ly cite surveys by Schwartz/Beveridge and Schwartz/Vo t h ,claiming that a very small number of oncologists supportmedical marijuana. In actuality, a substantial minority ofoncologists (one-third) who responded to the Schwartz sur-veys said they “would prescribe” marijuana if it were legal.
In addition, a majority were not opposed to resched-uling marijuana to allow doctors to prescribe it (thoughmany registered no opinion). Because Schwartz did notguarantee anonymity, it is reasonable to expect that thenon-respondents had even more favorable opinions thanthe respondents.1 1
R e s p o n s e C : Even if only a small percentage of all oncol-ogists recommend medical marijuana, this translates tothousands of patients. Should these patients be subject toarrest and imprisonment?
CHALLENGE #28:
CHALLENGE #27:
CHALLENGE #26:
9 . “Partial List of Organizations With Favorable Positions on Medical Marijuana,” Marijuana Policy Project; 2001.1 0 . “Marijuana as Antiemetic Medicine: A Survey of Oncologists’ Experience and Attitudes,” Journal of Clinical Oncology,
9, R. Doblin & M. Kleiman, 1991; pages 1314-1319.1 1 . “The Medical Use of Marijuana: The Case for Clinical Trials,” Journal of Addictive Diseases 14(1), R. Doblin &
M . Kleiman, 1995; pages 5-14. (Refutes critics’ surveys.)
Appendix P (continued)
P-8
“In 1994, the U.S. Court ofAppeals overruled DEAAdministrative Law JudgeFrancis Young’s decision, sohis ruling in favor of medicalmarijuana is irrelevant.”
R e s p o n s e : The U.S. Court of Appeals simply ruled thatthe DEA has the authority to ignore the administrative lawj u d g e ’s ruling and, therefore, may create the standards fordetermining which schedule a substance belongs in. Thiscatch-22 bolsters the argument that medical marijuanalaws should be changed by legislation or ballot initiatives.The DEA has proven itself to be completely opposed tomaking marijuana medically available, and the courts arewilling to allow this tyrannical behavior.
“Drug policy should be basedon ‘science, not ideology’ . ”
R e s p o n s e A : While science is important, mercy and com-passion are essential. Even if there were no scientific evidencesupporting the medical use of marijuana, it would be immoralto punish patients for doing something with the intent oftreating their pain. Fortunately, there is considerable scientif-ic evidence supporting marijuana’s therapeutic benefits.
R e s p o n s e B : What is the “scientific” basis for arrestingmedical marijuana users? What peer-reviewed research hasfound that prison is healthier than marijuana? The oppo-nents of medical marijuana have it backwards: In a frees o c i e t y, the burden of proof should be on the governmentto prove that marijuana is so worthless and dangerous thatpatients should be criminalized for using it.
R e s p o n s e C : Former Drug Czar Barry McCaffrey’s state-ment about “science, not ideology” is hollow rhetoric.When science did not back his favorite policies, he ignoredthe science. For example: The D.A.R.E. program has beenproven ineffective, but it still receives federal funds; needleexchanges have been shown to reduce HIV transmissionwithout encouraging more drug use, but the federal govern-ment does not fund them; the Institute of Medicine (IOM)once wrote “evidence of effectiveness” of community-baseddrug abuse prevention programs “is relatively weak,” yet thefederal government enacted a law in 1997 to spend morethan $140 million over five years to fund such programs;IOM also wrote, “Prevention intervention research shouldfocus more attention on the transition from use to abuseand dependence,” yet most programs and studies focus onthe unrealistic goal of preventing experimental use; andf i n a l l y, every comprehensive, objective government com-mission that has examined the marijuana phenomenonduring the past 100 years has recommended that adultsshould not be criminalized for using marijuana—yet simplepossession of marijuana remains a criminal offense in 40states and on the federal level.
“D o e s n’t the federalgovernment already allowsome people to use medicalm a r i j u a n a ? ”
R e s p o n s e : Only eight patients in the United States legal-ly receive marijuana from the federal government. Thesepatients are in an experimental program that was closed toall new applicants in 1992. Thousands of Americans usedmarijuana through experimental state programs in the late1970s and early 1980s, but none of these programs arepresently operating.
CHALLENGE #31:
CHALLENGE #30:
CHALLENGE #29:
Page 8
Other Important Points to Make When Advocating Legal Access to Medical Marijuana:
■ Which is worse for seriously ill people: marijuana or prison?
■ Saying that the THC pill is medicine but marijuana is not is like saying that vitamin C pills are good for you but orangesare not.
■ We’re very concerned about the message that’s sent to children when government officials deny marijuana’s medicinalvalue. They’re destroying the credibility of drug education.
■ The central issue is not research. It’s not the FDA. The issue is arresting patients.
■ How many more studies do we need to determine that seriously ill people should not be arrested for using their medi-c i n e ?
■ Tens of thousands of patients are already using medical marijuana. Should they be arrested and sent to prison? If so, thenthe laws should remain exactly as they are.
■ Arrest suffering, not patients.
■ If there must be a war against marijuana users, can’t we at least remove the sick and wounded from the battlefield?
revised2/2001
Appendix Q: Partial list of organizations with favorable positions onmedical marijuana
Definitions
Legal/prescriptive access: This category encompasses the strongest of all favorable medical marijuanapositions. Although the exact wording varies, organizations advocating “legal/prescriptive access” assert thatmarijuana should be legally available upon a doctor’s official approval. Some groups say that marijuanashould be “rescheduled” and/or moved into a specified schedule (e.g., Schedule II) of the federal ControlledSubstances Act; others say that doctors should be allowed to “prescribe” marijuana or that it should beavailable “under medical supervision.” If federal and state laws were changed accordingly, marijuana wouldbe as available through pharmacies as other tightly controlled prescription drugs, e.g., morphine. Thiscategory also includes endorsements of specific efforts to remove state-level criminal penalties for medicalmarijuana use with a doctor’s approval.
Compassionate access: Organizations with positions in this category assert that patients should have theopportunity to apply to the government for special permission to use medical marijuana on a case-by-casebasis. Most groups in this category explicitly urge the federal government to re-open the compassionateaccess program which operated from 1978 until it was closed to all new applicants in 1992. (Only eightpatients remain enrolled and receive free marijuana from the federal government.) “Compassionate access”is a fairly strong position, as it acknowledges that at least some patients should be allowed to smokemarijuana right now. However, access to marijuana would be more restrictive than access to legallyavailable prescription drugs, as patients would have to jump through various bureaucratic hoops to receivespecial permission.
Research: This category includes positions urging the government to make it easier for scientists to conductresearch into the medical efficacy of natural, smokable marijuana. Many of these groups have recognizedthat the federal government’s current medical marijuana research guidelines are unnecessarily burdensome.Modifying the guidelines would increase the likelihood that the FDA will eventually approve natural,smokable marijuana as a prescription medicine. These groups want patients to be allowed to smokemarijuana as research subjects and—if the results are favorable—to eventually qualify marijuana as an FDA-approved prescription drug. Groups listed with a "research" position differ from the White House Office ofNational Drug Control Policy and numerous other drug war hawks that claim to support research. Groupsthat claim to be in favor of research are not listed if they (1) oppose research that has a realistic chance ofleading to FDA approval of natural marijuana, or (2) actively support the laws which criminalize patientscurrently using medical marijuana. (The groups listed as supporting research at worst remain silent on theissue of criminal penalties—and many, in fact, concurrently endorse legal/prescriptive access and/orcompassionate access.)
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l/pr
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ipti
veac
cess
com
pass
iona
teac
cess
rese
arch
othe
rC
omm
ents
Ref
eren
ce
Cal
iforn
ia L
egis
lati
ve C
ounc
ilfo
r Old
er A
mer
ican
s12
/1/1
993;
11/2
9/19
99;
12/2
000
✔✔
✔pr
escr
ipti
ve a
cces
s: ur
ges r
esch
edul
ing
adop
ted
at 2
3rd
Ann
ual A
ctio
nC
onfe
renc
e; si
gnat
ory
of 1
999
and
2000
lett
ers t
o U
.S. D
ept.
of H
ealt
han
d H
uman
Ser
vice
s
Cal
iforn
ia M
edic
alA
ssoc
iati
on19
97;
1/11
/200
0✔
✔✔
othe
r: le
tter
opp
oses
fede
ral t
hrea
tsag
ains
t doc
tors
for d
iscu
ssin
g ri
sks a
ndbe
nefit
s of m
ariju
ana
Mar
ch 1
4, 1
997
lett
er; M
ay 2
1,19
97 e
ndor
sem
ent o
f CA
rese
arch
bill;
am
icus
cur
iae
brie
f sup
port
ing
righ
t to
dist
ribu
te m
edic
alm
ariju
ana
in C
alifo
rnia
(U
.S.
v.O
akla
nd C
anna
bis
Buy
ers’
Coo
pera
tive)
Cal
iforn
ia N
urse
s Ass
ocia
tion
9/21
/199
5;12
/200
0✔
✔pr
escr
ipti
ve a
cces
s: su
ppor
ted
Cal
iforn
iabi
ll A
B 1
529
to re
mov
e pe
nalt
ies f
orm
edic
al u
se
lett
er to
Cal
iforn
ia G
over
nor P
ete
Wils
on; s
igna
tory
of 2
000
lett
er to
U.S
. Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Cal
iforn
ia-P
acifi
c A
nnua
lC
onfe
renc
e of
the
Uni
ted
Met
hodi
st C
hurc
h
6/19
96✔
pres
crip
tive
acc
ess:
via
reso
luti
on (
also
spec
ifica
lly e
ndor
sed
Prop
osit
ion
215)
Res
olut
ion
104
of th
e C
alifo
rnia
-Pa
cific
Ann
ual C
onfe
renc
e of
the
Uni
ted
Met
hodi
st C
hurc
h, Ju
ne 1
2-16
, 199
6
Cal
iforn
ia P
harm
acis
tsA
ssoc
iati
on2/
97;
11/2
9/99
;12
/200
0
✔✔
✔pr
escr
ipti
ve a
cces
s: ac
cord
ing
toA
ssoc
iate
d Pr
ess,
the
CPA
“pa
ssed
are
solu
tion
supp
orti
ng p
harm
acy
part
icip
atio
n in
the
lega
l dis
trib
utio
n of
med
ical
mar
ijuan
a”
AP
Fina
ncia
l New
s, 5/
26/9
7;si
gnat
ory
of 1
999
and
2000
lett
ers
to U
.S. D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Cal
iforn
ia S
ocie
ty o
fA
ddic
tion
Med
icin
e5/
1997
✔pr
escr
ipti
ve a
cces
s: ur
ges r
esch
edul
ing
Cal
iforn
ia S
ocie
ty o
f Add
ictio
nM
edic
ine
New
s, Sp
ring
199
7
Col
orad
o N
urse
s Ass
ocia
tion
1995
✔pr
escr
ipti
ve a
cces
s: ur
ges r
esch
edul
ing
Col
orad
o N
urse
s Ass
ocia
tion
199
5C
onve
ntio
n D
irec
tory
and
Boo
k of
Rep
orts
, p. 2
8
Con
sum
er R
epor
ts m
agaz
ine
5/19
97✔
pres
crip
tive
acc
ess:
“Fed
eral
law
s sho
uld
be re
laxe
d in
favo
r of s
tate
s’ ri
ghts
toal
low
phy
sici
ans t
o ad
min
iste
r mar
ijuan
ato
thei
r pat
ient
s on
a ca
ring
and
com
pass
iona
te b
asis
.”
May
199
7 C
R a
rtic
le -
“Mar
ijuan
aas
med
icin
e: H
ow st
rong
is th
esc
ienc
e?”,
Pp.
62-
63
Epis
copa
l Chu
rch
1982
✔67
th C
onve
ntio
n of
the
Epis
copa
lC
hurc
h (B
-004
)a
Part
ial L
ist o
f Org
aniz
atio
ns W
ith
Favo
rabl
e Po
siti
ons o
n M
edic
al M
ariju
ana
Nam
e of
Gro
upD
ate
lega
l/pr
escr
ipti
veac
cess
com
pass
iona
teac
cess
rese
arch
othe
rC
omm
ents
Ref
eren
ce
Haw
aii N
urse
s Ass
ocia
tion
10/2
1/19
99;
12/2
000
✔✔
“sup
port
legi
slat
ion
to re
mov
e st
ate
leve
lcr
imin
al p
enal
ties
for b
oth
bona
fide
med
ical
mar
ijuan
a pa
tien
ts a
nd th
eir
heal
thca
re p
rovi
ders
”
reso
luti
on; s
igna
tory
of 2
000
lett
erto
U.S
. Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Life
Ext
ensi
on F
ound
atio
n3/
1997
;12
/200
0✔
✔co
mpl
aint
for d
ecla
rato
ry ju
dgm
ent
and
inju
ncti
ve re
lief,
Pear
son
and
Show
v.
McC
affr
ey; s
igna
tory
of
2000
lett
er to
U.S
. Dep
t. of
Hea
lth
and
Hum
an S
ervi
ces
Lym
phom
a Fo
unda
tion
of
Am
eric
a1/
1997
;11
/29/
1999
✔✔
✔pr
escr
ipti
ve a
cces
s: ur
ges r
esch
edul
ing
reso
luti
on; s
igna
tory
of 1
999
lett
erto
U.S
. Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Mul
tipl
e Sc
lero
sis C
alifo
rnia
Act
ion
Net
wor
k19
96✔
pres
crip
tive
acc
ess:
“the
dec
isio
n as
tow
heth
er o
r not
mar
ijuan
a co
nsti
tute
s an
appr
opri
ate
trea
tmen
t is o
ne b
est l
eft t
oph
ysic
ian
and
pati
ent o
n a
case
-by-
case
basi
s”
Gov
ernm
ent I
ssue
s Act
ion
(GIA
)R
epor
t, pa
ge 2
, Jan
uary
/Feb
ruar
y19
96
Nat
iona
l Ass
ocia
tion
of
Att
orne
ys G
ener
al6/
25/1
983
✔pr
escr
ipti
ve a
cces
s (ca
ncer
or g
lauc
oma)
reso
luti
on
Nat
iona
l Ass
ocia
tion
of
Peop
le W
ith
AID
S19
92;
11/2
9/19
99;
12/2
000
✔✔
✔si
gnat
ory
of 1
999
and
2000
lett
ers
to U
.S. D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Nat
iona
l Nur
ses S
ocie
ty o
nA
ddic
tion
s5/
1/19
95✔
✔ha
s sin
ce m
odifi
ed it
s sup
port
of
pres
crip
tive
acc
ess
“Pos
itio
n Pa
per:
Acc
ess t
oT
hera
peut
ic C
anna
bis,”
app
rove
dby
NN
SA B
oard
of D
irec
tors
New
Mex
ico
Nur
ses
Ass
ocia
tion
7/28
/199
7;12
/200
0✔
✔“e
ndor
se th
e co
ncep
t of a
llow
ing
for t
heth
erap
euti
c us
e of
mar
ijuan
a in
a v
arie
tyof
dis
ease
stat
es …
whe
n co
nven
tion
altr
eatm
ents
are
inef
fect
ive”
lett
er to
Bry
an A
. Kru
mm
, RN
,B
SN; s
igna
tory
of 2
000
lett
er to
U.S
. Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
New
Yor
k St
ate
Nur
ses
Ass
ocia
tion
6/29
/199
5;11
/29/
1999
;12
/200
0
✔✔
✔si
gnat
ory
of 1
999
and
2000
lett
ers
to U
.S. D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Nor
th C
arol
ina
Nur
ses
Ass
ocia
tion
10/1
5/19
96✔
✔“P
osit
ion
Stat
emen
t of T
hera
peut
icU
se o
f Can
nabi
s”
Part
ial L
ist o
f Org
aniz
atio
ns W
ith
Favo
rabl
e Po
siti
ons o
n M
edic
al M
ariju
ana
Nam
e of
Gro
upD
ate
lega
l/pr
escr
ipti
veac
cess
com
pass
iona
teac
cess
rese
arch
othe
rC
omm
ents
Ref
eren
ce
San
Fran
cisc
o M
edic
al S
ocie
ty8/
8/19
96;
2/19
97✔
✔✔
“The
SFM
S ta
kes a
supp
ort p
osit
ion
onth
e C
alifo
rnia
Med
ical
Mar
ijuan
aIn
itia
tive
” (P
ropo
siti
on 2
15);
oth
er:
endo
rsem
ent o
f a p
hysi
cian
’s ri
ght t
odi
scus
s mar
ijuan
a th
erap
y w
ith
a pa
tien
t
mot
ion
pass
ed b
y SF
MS
Boa
rd o
fD
irec
tors
; “M
edic
al M
ariju
ana:
APl
ea fo
r Sci
ence
and
Com
pass
ion,
”is
sued
join
tly
by G
LMA
and
San
Fran
cisc
o M
edic
al S
ocie
ty
Vir
gini
a N
urse
s Ass
ocia
tion
10/7
/199
4;12
/200
0✔
✔re
solu
tion
; sig
nato
ry o
f 200
0 le
tter
to U
.S. D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Wom
en o
f Ref
orm
Juda
ism
12/1
999;
12/2
000
✔✔
✔H
ealt
h Is
sues
Res
olut
ion,
ado
pted
at th
e 19
99 O
rlan
do A
ssem
bly;
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
AID
S Fo
unda
tion
of C
hica
go2/
17/1
999
✔on
e of
17
orga
niza
tion
s tha
t sig
ned
lett
er to
ON
DC
P D
irec
tor B
arry
McC
affr
ey
AID
S N
atio
nal I
nter
fait
hN
etw
ork
2/17
/199
9✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
AID
S Pr
ojec
t Ari
zona
2/17
/199
9✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
AID
S Pr
ojec
t Los
Ang
eles
2/17
/199
9✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
AID
S T
reat
men
t Ini
tiat
ives
(Atl
anta
)12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Bay
Are
a Ph
ysic
ians
for
Hum
an R
ight
s1/
1997
;12
/200
0✔
✔ot
her:
endo
rsem
ent o
f a p
hysi
cian
’s ri
ght
to d
iscu
ss m
ariju
ana
ther
apy
wit
h a
pati
ent
plai
ntiff
in C
onan
t v.
McC
affr
ey;
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Bou
lder
Cou
nty
AID
S Pr
ojec
t(C
olor
ado)
2/17
/199
9;12
/200
0✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
; sig
nato
ry o
f 200
0 le
tter
to U
.S. D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Part
ial L
ist o
f Org
aniz
atio
ns W
ith
Favo
rabl
e Po
siti
ons o
n M
edic
al M
ariju
ana
Nam
e of
Gro
upD
ate
lega
l/pr
escr
ipti
veac
cess
com
pass
iona
teac
cess
rese
arch
othe
rC
omm
ents
Ref
eren
ce
The
Cen
ter f
or A
IDS
Serv
ices
(Oak
land
)2/
17/1
999
✔on
e of
17
orga
niza
tion
s tha
t sig
ned
lett
er to
ON
DC
P D
irec
tor B
arry
McC
affr
ey
Col
orad
o A
IDS
Proj
ect
2/17
/199
9✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
Con
tigo
-Con
mig
o12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Embr
ace
Life
(Sa
nta
Cru
z)12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Flor
ida
Med
ical
Ass
ocia
tion
6/1/
1997
✔✔
reso
luti
on #
97-6
1
Gay
and
Les
bian
Med
ical
Ass
ocia
tion
5/19
95;
2/19
97;
11/2
9/19
99;
12/2
000
✔✔
✔ot
her:
endo
rsem
ent o
f a p
hysi
cian
’s ri
ght
to d
iscu
ss m
ariju
ana
ther
apy
wit
h a
pati
ent
GLM
A P
olic
y St
atem
ent #
066-
95-
104;
“M
edic
al M
ariju
ana:
A P
lea
for S
cien
ce a
nd C
ompa
ssio
n,”
issu
ed jo
intl
y by
GLM
A a
nd S
anFr
anci
sco
Med
ical
Soc
iety
;si
gnat
ory
of 1
999
and
2000
lett
ers
to U
.S. D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Gra
y Pa
nthe
rs12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Har
m R
educ
tion
Coa
litio
n12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Lati
no C
omm
issi
on o
n A
IDS
2/17
/199
9✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
Life
Fou
ndat
ion
12/2
000
✔si
gnat
ory
of 2
000
lett
er to
U.S
.D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Mai
ne A
IDS
Alli
ance
12/2
000
✔si
gnat
ory
of 2
000
lett
er to
U.S
.D
ept.
of H
ealt
h an
d H
uman
Serv
ices
Part
ial L
ist o
f Org
aniz
atio
ns W
ith
Favo
rabl
e Po
siti
ons o
n M
edic
al M
ariju
ana
Nam
e of
Gro
upD
ate
lega
l/pr
escr
ipti
veac
cess
com
pass
iona
teac
cess
rese
arch
othe
rC
omm
ents
Ref
eren
ce
Mis
siss
ippi
Nur
ses A
ssoc
iati
on12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Mob
iliza
tion
Aga
inst
AID
S(S
an F
ranc
isco
)2/
17/1
999
✔on
e of
17
orga
niza
tion
s tha
t sig
ned
lett
er to
ON
DC
P D
irec
tor B
arry
McC
affr
ey
Mot
hers
Aga
inst
Mis
use
and
Abu
se12
/200
0✔
sign
ator
y of
200
0 le
tter
to U
.S.
Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
Mot
hers
’ Voi
ces t
o En
d A
IDS
2/17
/199
9✔
one
of 1
7 or
gani
zati
ons t
hat s
igne
dle
tter
to O
ND
CP
Dir
ecto
r Bar
ryM
cCaf
frey
Nat
iona
l Aca
dem
y of
Scie
nces
’ Ins
titu
te o
f Med
icin
e3/
17/1
999
✔✔
Mar
ijuan
a an
d M
edic
ine:
Ass
essin
gth
e Sc
ienc
e B
ase;
see
http
://w
ww
.mpp
.org
/sci
ence
.htm
l
Nat
iona
l Ass
ocia
tion
for
Publ
ic H
ealt
h Po
licy
11/2
9/19
99;
12/2
000
✔✔
sign
ator
y of
199
9 an
d 20
00 le
tter
sto
U.S
. Dep
t. of
Hea
lth
and
Hum
anSe
rvic
es
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apy
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Affa
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edic
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New
s, S
prin
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tish
Med
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Ass
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11/1
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noid
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mac
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cals
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enie
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ical
mar
ijuan
a-us
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crea
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isus
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sses
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Are
port
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ses o
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s on
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otio
n pa
ssed
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CN
P
Fede
rati
on o
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eric
anSc
ient
ists
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994
✔FA
S Pe
titi
on o
n M
edic
al M
ariju
ana
Hum
an R
ight
s Cam
paig
n1/
15/1
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✔re
solu
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eric
an P
sych
iatr
icA
ssoc
iati
on19
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othe
r: “e
ffect
ive
pati
ent c
are
requ
ires
the
free
and
unf
ette
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ange
of
info
rmat
ion
on tr
eatm
ent a
lter
nati
ves;
disc
ussi
on o
f the
se a
lter
nati
ves b
etw
een
phys
icia
ns a
nd p
atie
nts s
houl
d no
tsu
bjec
t eit
her p
arty
to a
ny c
rim
inal
pena
ltie
s”
appr
oved
by
the
APA
Boa
rd o
fT
rust
ees i
n re
spon
se to
fede
ral
thre
ats a
gain
st p
hysi
cian
s fol
low
ing
the
pass
age
of C
alif.
Pro
p. 2
15,
repo
rted
in P
sych
iatr
ic N
ews,
9/4/
1998
Kai
ser P
erm
anen
te19
97✔
othe
r: M
ay/J
une
1997
edi
tion
of t
heir
Hea
lth
Educ
atio
n Se
rvic
es’ “
HIV
New
slet
ter”
incl
udes
mar
ijuan
a as
atr
eatm
ent o
ptio
n fo
r AID
S w
asti
ngsy
ndro
me;
dev
elop
ed fo
rm le
tter
for
Cal
iforn
ia a
nd W
ashi
ngto
n do
ctor
s to
ackn
owle
dge
pati
ents
’ med
ical
mar
ijuan
a us
e
on fi
le
Appendix R
MPP’s model state medical marijuana billbased on Hawaii law enacted on June 14, 2000
Marijuana Policy Project 202-462-5747 (phone)P.O. Box 77492 202-232-0442 (fax)Capitol Hill [email protected], D.C. 20013 http://www.mpp.org
TITLE: An Act to Protect Seriously Ill People from Prosecution and Prison for UsingMedical Marijuana Under a Medical Doctor’s Supervision
SECTION 1: Findings
(a) Modern medical research has discovered a beneficial use for marijuana in treatingor alleviating the pain or other symptoms associated with certain debilitatingmedical conditions, as found by the National Academy of Sciences’ Institute ofMedicine in March 1999.
(b) The legislature admits that it would prefer for the federal government to permitmarijuana to be prescribed by physicians and to be dispensed at pharmacies.However, the legislature finds that the federal government has shown noindication that it will change federal policy with regard to medical marijuana, asevidenced by the federal government’s reluctance to allow even FDA-approvedclinical trials to move forward.
(c) According to the U.S. Sentencing Commission and the Federal Bureau ofInvestigation, more than 99 out of every 100 marijuana arrests are made understate law, rather than under federal law. Consequently, the legislature finds thatchanging state law will have the practical effect of protecting from arrest the vastmajority of seriously ill people who have a medical need to use marijuana.
(d) Although federal law expressly prohibits the use of marijuana, the legislaturerecognizes that the laws of Alaska, California, Colorado, Hawaii, Maine, Nevada,Oregon, and Washington permit the medical use and cultivation of marijuana.The legislature intends to join in this effort for the health and welfare of its citizens.However, the legislature does not intend to make marijuana legally available forother than medical purposes.
(e) The legislature finds that the state is not required to enforce federal law orprosecute people for engaging in activities prohibited by federal law. Therefore,compliance with this act does not put the state in violation of federal law.
(f) The legislature finds that state law should make a distinction between the medicaland non-medical use of marijuana. Hence, the purpose of this act is to ensure thatphysicians are not penalized for discussing marijuana as a treatment option withtheir patients, and seriously ill people who engage in the medical use of marijuanaupon their physicians’ advice are not arrested and incarcerated for usingmarijuana for medical purposes.
R-1
Appendix R (continued) 2
SECTION 2: Definitions
(a) “Adequate supply” means an amount of marijuana collectively possessed betweenthe qualifying patient and the qualifying patient’s primary caregivers that is notmore than is reasonably necessary to ensure the uninterrupted availability ofmarijuana for the purpose of alleviating the symptoms or effects of a qualifyingpatient’s debilitating medical condition; [ADDING THE FOLLOWING ISOPTIONAL … provided that an “adequate supply” shall not exceed three maturemarijuana plants, four immature marijuana plants, and one ounce of usablemarijuana per each mature plant. “Usable marijuana” means the dried leaves andflowers of marijuana, and any mixture or preparation thereof, that are appropriatefor the medical use of marijuana, and does not include the seeds, stalks, and rootsof the plant.]
(b) “Debilitating medical condition” means:
(1) cancer, glaucoma, positive status for human immunodeficiency virus,acquired immune deficiency syndrome, or the treatment of these conditions;
(2) a chronic or debilitating disease or medical condition or its treatment thatproduces one or more of the following: cachexia or wasting syndrome; severepain; severe nausea; seizures, including those characteristic of epilepsy; orsevere and persistent muscle spasms, including those characteristic ofmultiple sclerosis or Crohn’s disease; or
(3) any other medical condition or its treatment approved by the department, asprovided for as follows: Not later than 90 days after the effective date of thisact, the department shall promulgate regulations governing the manner inwhich it will consider petitions from the public to add debilitating medicalconditions to those included in this act. In considering such petitions, thedepartment shall include public notice of, and an opportunity to comment in apublic hearing upon, such petitions. The department shall, after hearing,approve or deny such petitions within 180 days of submission. The approvalor denial of such a petition shall be considered a final agency action, subject tojudicial review.
(c) “Department” means state department of health.
(d) “Marijuana” shall have the same meaning as “marijuana” and “marijuanaconcentrate” as provided in sections _____ and _____.
(e) “Medical use” means the acquisition, possession, cultivation, use, transfer, ortransportation of marijuana or paraphernalia relating to the administration ofmarijuana to alleviate the symptoms or effects of a qualifying patient’s debilitatingmedical condition. For the purposes of “medical use,” the term “transfer” islimited to the transfer of marijuana and paraphernalia between primary caregiversand qualifying patients.
(f) “Physician” means a person who is licensed under section _____, and is licensedwith authority to prescribe drugs under section _____.
R-2
Appendix R (continued) 3
(g) “Primary caregiver” means a person who is at least 18 years old and who hasagreed to undertake responsibility for managing the well-being of a person withrespect to the medical use of marijuana.
(h) “Qualifying patient” means a person who has been diagnosed by a physician ashaving a debilitating medical condition.
(i) “Written certification” means the qualifying patient’s medical records or astatement signed by a physician, stating that in the physician’s professionalopinion, after having completed a full assessment of the qualifying patient’smedical history and current medical condition made in the course of a bona fidephysician-patient relationship, the qualifying patient has a debilitating medicalcondition and the potential benefits of the medical use of marijuana would likelyoutweigh the health risks for the qualifying patient.
SECTION 3: Exemption from criminal and civil penalties for the medical use ofmarijuana
(a) A qualifying patient who has in his or her possession written certification shall notbe subject to arrest, prosecution, or penalty in any manner for the medical use ofmarijuana, provided the quantity of marijuana does not exceed an adequatesupply.
(b) Subsection (a) shall not apply to a qualifying patient under the age of 18 years,unless:
(1) The qualifying patient’s physician has explained the potential risks andbenefits of the medical use of marijuana to the qualifying patient and to aparent, guardian, or person having legal custody of the qualifying patient; and
(2) A parent, guardian, or person having legal custody consents in writing to:
(A) allow the qualifying patient’s medical use of marijuana;
(B) serve as the qualifying patient’s primary caregiver; and
(C) control the acquisition of the marijuana, the dosage, and the frequency ofthe medical use of marijuana by the qualifying patient.
(c) When the acquisition, possession, cultivation, transportation, or administration ofmarijuana by a qualifying patient is not practicable, the legal protectionsestablished by this act for a qualifying patient shall extend to the qualifyingpatient’s primary caregivers, provided that the primary caregivers’ actions arenecessary for the qualifying patient’s medical use of marijuana.
(d) A physician shall not be subject to arrest or prosecution, penalized in any manner,or denied any right or privilege for providing written certification for the medicaluse of marijuana to qualifying patients.
R-3
Appendix R (continued) 4
(e) Any property interest that is possessed, owned, or used in connection with themedical use of marijuana, or acts incidental to such use, shall not be harmed,neglected, injured, or destroyed while in the possession of state or local lawenforcement officials, provided that law enforcement agencies seizing live plantsas evidence shall not be responsible for the care and maintenance of marijuanaplants. Any such property interest shall not be forfeited under any provision ofstate or local law providing for the forfeiture of property other than as a sentenceimposed after conviction of a criminal offense or entry of a plea of guilty to acriminal offense. Marijuana, paraphernalia, or other property seized from aqualifying patient or primary caregivers in connection with the claimed medicaluse of marijuana shall be returned immediately upon the determination by a courtor prosecutor that the qualifying patient or primary caregivers are entitled to theprotections of this act, as may be evidenced by a decision not to prosecute, thedismissal of charges, or an acquittal.
(f) No person shall be subject to arrest or prosecution for “constructive possession,”“conspiracy,” or any other offense for simply being in the presence or vicinity ofthe medical use of marijuana as permitted under this act.
SECTION 4: Prohibitions, restrictions, and limitations regarding the medical use ofmarijuana
(a) The authorization for the medical use of marijuana in this act shall not apply to:
(1) The medical use of marijuana that endangers the health or well-being ofanother person, such as driving or operating heavy machinery while underthe influence of marijuana;
(2) The smoking of marijuana:
(A) in a school bus, public bus, or other public vehicle;
(B) in the workplace of one’s employment;
(C) on any school grounds;
(D) in any correctional facility; or
(E) at any public park, public beach, public recreation center, or youth center;and
(3) The use of marijuana by a qualifying patient, primary caregiver, or any otherperson for purposes other than medical use permitted by this act.
(b) Insurance companies shall not be required to cover the medical use of marijuana.
(c) Notwithstanding any law to the contrary, fraudulent representation to a lawenforcement official of any fact or circumstance relating to the medical use ofmarijuana to avoid arrest or prosecution shall be a petty misdemeanor and subject
R-4
Appendix R (continued) 5
to a fine of $500. This penalty shall be in addition to any other penalties that mayapply for the non-medical use of marijuana.
SECTION 5: Establishing a defense in court for patients and primary caregivers
A person and a person's primary caregivers may assert the medical use ofmarijuana as a defense to any prosecution involving marijuana, and such defense shallbe presumed valid where the evidence shows that:
(a) the person’s medical records indicate, or a physician has stated that, in thephysician’s professional opinion, after having completed a full assessment of theperson’s medical history and current medical condition made in the course of abona fide physician-patient relationship, the potential benefits of the medical useof marijuana would likely outweigh the health risks for the person; and
(b) the person and the person’s primary caregivers were collectively in possession of aquantity of marijuana that was not more than was reasonably necessary to ensurethe uninterrupted availability of marijuana for the purpose of alleviating thesymptoms or effects of the person's medical condition.
SECTION 6: Severability of this act
If any provision of this act or the application thereof to any person or circumstanceis held invalid, the invalidity does not affect other provisions or applications of the actwhich can be given effect without the invalid provision or application, and to this endthe provisions of this act are severable.
SECTION 7: Implementation of this act
This act shall take effect upon its approval.
R-5
Appendix R (continued) 6
SECTION __: Registry identification cards issued by state health department
[OPTIONAL: This section can be removed without affecting any other section of thebill; a registry identification card section appeared in the Hawaii law.]
(a) “Registry identification card” means a document issued by the department thatidentifies a person as a qualifying patient or primary caregiver.
(b) A qualifying patient or primary caregiver shall qualify for the legal protections ofSection 3 only if the qualifying patient or primary caregiver is in possession of aregistry identification card.
(c) Not later than 90 days after the effective date of this act, the department shallpromulgate regulations governing the manner in which it will considerapplications for registry identification cards, and for renewing registryidentification cards, for qualifying patients and primary caregivers.
(d) The department shall issue registry identification cards to qualifying patients, andto qualifying patients’ primary caregivers, if any, who submit the following, inaccordance with the department’s regulations:
(1) written certification that the person is a qualifying patient;
(2) registration fee, not to exceed $25 per qualifying patient;
(3) name, address, and date of birth of the qualifying patient;
(4) name, address, and telephone number of the qualifying patient’s physician;and
(5) name, address, and date of birth of the qualifying patient’s primarycaregivers, if the qualifying patient has designated any primary caregivers atthe time of application.
(e) The department shall verify the information contained in an application submittedpursuant to this section, and shall approve or deny an application within 30 daysof receipt of the application. The department may deny an application only if theapplicant did not provide the information required pursuant to this section, or ifthe department determines that the information provided was falsified. Anyperson whose application has been denied may not reapply for six months fromthe date of the denial, unless so authorized by the department or a court ofcompetent jurisdiction.
(f) The department shall issue registry identification cards within five days ofapproving an application, which shall expire one year after the date of issuance.Registry identification cards shall contain:
(1) the name, address, and date of birth of the qualifying patient and primarycaregivers, if any;
(2) the date of issuance and expiration date of the registry identification card; and
R-6
Appendix R (continued) 7
(3) other information that the department may specify in its regulations.
(g) A person who possesses a registry identification card shall notify the departmentof any change in the person’s name, address, qualifying patient’s physician,qualifying patient’s primary caregiver, or change in status of the qualifyingpatient’s debilitating medical condition within 10 days of such change, or theregistry identification card shall be deemed null and void.
(h) Possession of, or application for, a registry identification card shall not aloneconstitute probable cause to search the person or property of the person possessingor applying for the card, or otherwise subject the person or property of the personpossessing the card to inspection by any governmental agency.
(i) The department shall maintain a confidential list of the persons to whom thedepartment has issued registry identification cards. Individual names on the listshall be confidential and not subject to disclosure, except to:
(1) authorized employees of the department as necessary to perform officialduties of the department; or
(2) authorized employees of state or local law enforcement agencies, only for thepurpose of verifying that a person who is engaged in the suspected or allegedmedical use of marijuana is lawfully in possession of a registry identificationcard.
===============================================================
SECTION __: State-sanctioned non-profit distribution of medical marijuana
[OPTIONAL: This section can be removed without affecting any other section of thebill; this section does not appear in the Hawaii law.]
(a) A “registered organization” is a non-profit corporation registered with the stateunder section _____ and organized for the purpose of lawfully selling,administering, delivering, dispensing, distributing, cultivating, or possessingmarijuana, cultivation equipment, related supplies and educational materials, ormarijuana seeds for medical use.
(b) Prior to selling, administering, delivering, dispensing, distributing, cultivating, orpossessing marijuana for medical use, a registered organization shall file aregistration statement with the department, and thereafter shall file an annualregistration statement with the department, in accordance with departmentregulations which shall provide for the form and content of the registrationstatement.
(c) Not later than 90 days after the effective date of this act, the department shallpromulgate regulations that include procedures for the oversight of registeredorganizations, specifications for the membership of the staff and the boards ofdirectors of registered organizations, appropriate protections for people associatedwith registered organizations, a registration system for qualifying patients and
R-7
Appendix R (continued) 8
primary caregivers who use the services of registered organizations, record-keeping and reporting requirements for registered organizations, the potentialtransference or sale of seized cultivation equipment and related supplies from lawenforcement agencies to registered organizations, and procedures for suspendingor terminating the registration of registered organizations.
(d) It shall be lawful to sell, administer, deliver, dispense, distribute, cultivate, orpossess marijuana where it is:
(1) by a registered organization to a qualifying patient or primary caregiver; or
(2) by any federal, state, or local law enforcement agency to a registeredorganization.
(e) The registered organization is prohibited from:
(1) obtaining marijuana from outside the state in violation of federal law;
(2) employing or utilizing the services of any person who has a criminal recordinvolving a controlled substance offense; and
(3) selling, administering, delivering, dispensing, or distributing marijuana toqualifying patients or primary caregivers without first verifying the validity ofthe qualifying patient’s written certification by:
(A) contacting the office of the qualifying patient’s physician; and
(B) contacting the appropriate state medical board or association to determinethat the physician is licensed to practice medicine under section _____.
R-8