On November 6, the ballots in six states contained initiatives dealing with the medical or recreational use of smoked marijuana. Marijuana advocates already have obtained approval of smoked marijuana for medical use in 17 states and Washington D.C.
In Colorado, Washington, and Oregon, voters were asked to consider legalization for recreational use, and the measures passed in Colorado and Washington. Montana voters decided whether or not to approve a 2011 bill that cut back an earlier measure to legalize marijuana for medical purposes, as of writing this article the results had not been finalized. In Arkansas and Massachusetts, legalization for medical purposes was voted on, with the Massachusetts initiative passing and the Arkansas initiative failing.
Recent Court Action
In addition to ballot initiatives, recent efforts by medical marijuana advocates have also focused on asking the Drug Enforcement Administration (DEA) to reschedule marijuana from Schedule I of the Controlled Substances Act (CSA) to a lower level, such as Schedule III or even lower. The CSA gives the DEA the authority to divide drugs into one of 5 schedules, based on their potential for abuse, medical value, and risk of dependency. Schedule I contains drugs that require the strictest control. Drugs placed in Schedule I are drugs Congress and the DEA have found have a high potential for abuse, no currently accepted medical use in the United States, and a lack of accepted safe use even under medical supervision.
In 2011, the DEA rejected a petition by Americans for Safe Access (ASA), a medical marijuana advocacy association, to change the classification of marijuana. Following rejection of its petition, ASA asked the U.S. Court of Appeals for the D.C. Circuit to force the DEA to (1) hold a hearing and make scientific findings from the growing body of medical evidence that marijuana is effective in reducing pain and nausea and (2) relax its Schedule I classification of the drug. The D.C. Circuit has asked the parties for additional briefing on the issue of standing. The matter is pending.
The DEA’s Position on Marijuana
Since ASA has claimed that the DEA has failed to consider the growing body of evidence for medical use of marijuana, let’s examine the DEA’s position. In finding that smoked marijuana has not withstood the rigors of science, is not a medicine, and is unsafe, the DEA has considered the positions of the Food and Drug Administration (FDA), the Supreme Court of the United States (SCOTUS), the American Medical Association (AMA), the Institute of Medicine (IOM), the American Society of Addiction Medicine (ASAM), the American Cancer Society (ACS), the American Glaucoma Society (AGS), and many other voices in the medical community.
- The FDA has thus far declined to approve smoked marijuana for any condition or disease. In fact, the FDA has stated that “there is currently sound evidence that smoked marijuana is harmful.”
- SCOTUS has refused on two occasions to carve out an exception for smoked marijuana under a theory of medical viability. In U.S. v. Oakland Cannabis Buyers’ Cooperative (2001), the court decline to create a “medical necessity” defense for the defendants in a criminal prosecution because Congress had placed marijuana into Schedule I, which enumerates controlled substances without any medical benefits. And in Gonzales v. Raich (2005), the court again declined to carve out a “medical necessity” defense, finding that the authority of the CSA was not reduced in the face of California’s Compassionate Use Act, which gave severely ill persons who had received physician approval the right to cultivate and use marijuana.
- While the AMA has always endorsed “well-controlled studies of marijuana and related cannabinoids in patients with serious conditions,” in November 2009 the AMA amended its policy, urging marijuana’s Schedule I status be reviewed. However, in calling for this review, the AMA made it clear that this new policy “should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for prescription drug product. “
- A 1999 IOM study concluded that “there is little future in smoked marijuana as a medically approved medication. The study pointed out that the “effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. According to IOM, “smoked marijuana…is a crude THC delivery system that also delivers harmful substances.”
- The ASAM public policy statement on medical marijuana clearly rejects smoking as a means of drug delivery and discourages state interference in the federal medication approval process.
- The ACS does not advocate inhaling smoke or the legalization of marijuana. The organization supports carefully controlled studies for alternative delivery methods, such as through a tetrahydrocannabinol (THC) skin patch.
- The AGS believes that despite the fact that marijuana can lower intraocular pressure, the side effects, the short duration of action, and the lack of evidence that it alters the course of glaucoma precludes recommending it for treatment of glaucoma at this time.
Not Your 1970’s Marijuana
The DEA’s position is also supported by a 2009 study from the University of Mississippi’s Potency Monitoring Project, funded by the National Institute on Drug Abuse (NIDA), which revealed that marijuana potency is the highest ever reported. According to the study, the average amount of THC has reached 10.1 percent, compared to an average of 4 percent in 1983.
Mental Health Problems
In addition to the adverse physical effects of smoking, the DEA cites mounting evidence that serious mental health problems can result from use of marijuana, especially in adolescents. According to the DEA, a January 2008 NIDA-funded study of drug use from the Center for Substance Abuse Research at the University of Maryland found that nearly one in 10 first-year college students at a mid-Atlantic university had a cannabis use disorder (CUD). Students who admitted to using cannabis five or more times a year reported concentration problems (40.1 percent), regularly putting themselves in danger (24.3 percent), and driving after using marijuana (18.6 percent). Finally, the DEA cites a May 2008 report by the Office of National Drug Control Policy on teens, depression, and marijuana use which found that marijuana use can worsen depression and lead to more serious mental illness such as schizophrenia, anxiety, and suicide.
Gateway to Other Drugs
The DEA believes that marijuana use by teens is a precursor to abuse of other drugs and signals a significantly enhanced chance of drug problems as an adult. The DEA offers a study of 300 twins by the Office of National Drug Control Policy, as reported in the AMA Journal in support of this belief. In that study, marijuana-using twins were four times as likely than their siblings to use cocaine and crack cocaine, and five times more likely to use hallucinogens like LSD.