History
Cannabis has been used for medicinal purposes for over 4,800 years. Surviving texts from China, Greece and Persia confirm that its psychoactive properties were recognized, and the ancient doctors used it for a variety of illnesses and ailments. These included a whole host of gastrointestinal disorders, insomnia, headaches and as a pain reliever, frequently used in childbirth. In India, cannabis can be definitely identified in such contexts only from about AD 1000.
Cannabis as a medicine was common throughout most of the world in the 1800s. It was used as the primary painkiller until the invention of aspirin. Modern medical and scientific inquiry began with doctors like O'Shaughnessy and Moreau de Tours, who used it to treat melancholia, migraines, and as a sleeping aid, analgesic and anticonvulsant.
By the time the United States banned the plant (the third country to do so), it was no longer extremely popular. The only opponent to the bill, The Marihuana Tax Act, was the representative of the American Medical Association.
Later in the century, researchers investigating methods of detecting marijuana intoxication discovered that smoking the drug reduced intraocular pressure. High intraocular pressure causes blindness in glaucoma patients, so many believed that using the drug could prevent blindness in patients. Many Vietnam War veterans also believed that the drug prevented muscle spasms caused by battle-induced spinal injuries. Later medical use has focused primarily on its role in preventing the wasting syndromes and chronic loss of appetite associated with chemotherapy and AIDS, along with a variety of rare muscular and skeletal disorders. Less commonly, cannabis has been used in the treatment of alcoholism and addiction to other drugs such as heroin and the prevention of migraines.
In 1972 Tod H. Mikuriya, M.D. reignited the debate concerning marijuana as medicine when he published "Marijuana Medical Papers 1839-1972".
Later in the 1970s, a synthetic version of THC, the primary active ingredient in cannabis, was synthesized to make the drug Marinol. Users reported several problems with Marinol, however, that led many to abandon the pill and resume smoking the plant. Patients complained that the violent nausea associated with chemotherapy made swallowing pills difficult. Smoked marijuana takes effect almost immediately, and is therefore easily dosed; many patients only smoke enough to feel the medical effects -- many complained that Marinol was more potent than they needed, and that the mental effects made normal daily functioning impossible. In addition, Marinol was far more expensive, costing upwards of several thousand dollars a year for the same effect as smoking a plant easily grown throughout most of the world. Many users felt Marinol was less effective, and that the mental effects were far more disastrous; some studies have indicated that other chemicals in the plant may have a synergistic effect with THC.
In addition, during the 1970s and 1980s, six US states' health departments performed studies on the use of medical marijuana. These are widely considered some of the most useful and pioneering studies on the subject.
Early studies on efficacy
New Mexico
Approved by the Food and Drug Administration, the study included 250 patients and compared smoked marijuana to oral THC. All participants were referred by a medical doctor and had failed to control vomiting using at least three alternative antiemetics. Patients chose smoking marijuana or taking the THC pill. Multiple objective and subjective standards were used to determing the effectiveness.
* Conclusion: Marijuana is far superior to the best available drug, Compazine, and smoked marijuana is clearly superior to oral THC. "More than ninety percent of the patients who received marijuana... reported significant or total relief from nausea and vomiting". No major side effects were reported, though three patients reported adverse reactions that did not involve marijuana alone.
New York
New York ran a large scale study using 199 patients who had not found success with other antiemetic therapies. Each patient received 6,044 marijuana cigarettes, which were provided to the patient during 514 treatment episodes
* Conclusions: North Shore Hospital reported marijuana was effective at reducing emesis 92.9 percent of the time; Columbia Memorial Hospital reported efficacy of 89.7 percent; Upstate Medical Center, St. Joseph's Hospital and Jamestown General Hospital reported 100 percent of the patients smoking marijuana gained significant benefit. "Patient evaluations have indicated that approximately ninety-three (93) percent of marijuana inhalation treatment episodes are reported to be effective or highly effective when compared to other antiemetics."; no serious adverse side effects were reported.
Tennessee
27 patients had failed on other antiemetic therapies, including oral THC.
* Conclusion: 90.4% success for smoked marijuana; 66.7% for oral THC. "We found both marijuana smoking and THC capsules to be effective antiemetics. We found an approximate 23 percent higher success rate among those patients administered THC capsules. We found no significant differences in success rates by age group. We found that the major reason for smoking failure was smoking intolerance; while the major reason for THC capsule failure was nausea and vomiting so severe that the patient could not retain the capsule.
California
A series of studies throughout the 1980s involved 90–100 patients a year. The study was designed to make it easier for patients to enter the oral THC part of the study. Patients who wanted smoked marijuana had to be over 15 years old (oral THC patients had to be over 5) and use the drug only in the hospital and not at home. Smoked marijuana patients also had to receive rare and painful forms of chemotherapy.
* Conclusion: Despite the bias towards oral THC, the California study concluded that smoked marijuana was more effective and established a safe dosage regimen that minimized adverse side effects. The full text of the study can be seen here.
Michigan
165 patients were randomly assigned to use either Torecan, an antiemetic, or smoked marijuana. The randomization process failed, however, and the patients were allowed to crossover.
* Conclusion: 71.1% of marijuana users reported no or moderate nausea and 90% chose to continue using it; 8 out of 83 patients who had initially been randomly assigned to marijuana chose to switch to Torecan; 22 out of 23 patients randomized to Torecan chose to switch to smoked marijuana. Side effects included increased appetite (this is a positive effect) reported by 32.3%, insomnia, reported by 21% and sore throat, reported by 13 patients out of 165.
Georgia
119 patients that had failed using other antiemetics were randomly assigned to oral THC pills and either standardized or patient-controlled smoking of marijuana.
* Conclusion: All three categories were successful -- patient controlled smokers at 72.2%; standardized smokers at 65.4%; oral THC at 76%. Failure of oral THC patients was due to adverse reaction (6 out of 18) or failure to improve (9 out of 18); failure of smoking marijuana was due to intolerance for smoking (6 out of 14) or failure to improve (3 out of 14).
Current status of medical marijuana around the world
International law
Marijuana is in Schedule IV of the Single Convention on Narcotic Drugs, making it subject to special restrictions. Article 2 provides for the following, in reference to Schedule IV drugs:
A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the direct supervision and control of the Party.
This provision, while apparently providing for the limitation of marijuana to research purposes only, also seems to allow some latitude for nations to make their own judgments. The official Commentary on the Single Convention indicates that Parties are expected to make that judgment in good faith.
Albania
In spite of laws prohibiting growing and possessing cannabis, enforcement has been virtually nil. There have been fewer than ten arrests in five years.
Australia
After politicians in the Australian Capital Territory voted to allow doctors to determine when cannabis was appropriate for their patients, intense lobbying by the federal government resulted in the legislation being overturned.
Belgium
Though the drug is still illegal, the Belgian government has recently initiated trials to determine the effectiveness of medical marijuana, and may soon decriminalize possession of small amounts.
Cameroon
Growing cannabis for any reason is illegal, though AIDS and cancer patients are allowed to use the drug to treat their symptoms.
Canada
In Hitzig v. Canada (2003), a court again declared Canada's Marijuana Medical Access Regulations unconstitutional "in not allowing seriously ill Canadians to use marijuana because there is no legal source of supply of the drug." In effect, this means that Canadians cannot be prosecuted for using marijuana medically because the Marijuana Medical Access Regulations gives patients the right to do so, but does not set up any legal apparatus for obtaining cannabis.
Back in July 2000, in the "Parker" (epileptic Terry Parker) decision, another judge had made a declaration of invalidity of Canada's drug laws as they relate to the "simple possession" of marijuana due to the lack of a reasonable exemption from the law for medicinal use. The Canadian government was given one year (a suspension of the declaration of invalidity) to remedy the situation, and created the Marijuana Medical Access Regulations. These regulations have been repeatedly deemed unconstitutional in a series of court decisions including "Hitzig."
In a similar case based upon these decisions, lawyer Brian McAllister argued on behalf of a 16 year old that because the Canadian government, after setting up the MMAR, never reenacted the relevant section of the Controlled Drugs and Substances Act, Canada effectively has no prosecutable laws prohibiting the "simple possession" of any amount of cannabis.
Representatives of the United States federal government have claimed that decriminalizing cannabis in Canada may disrupt border trade and relations between the two countries; many Canadians believe that this remains the primary obstacle to decriminalization in Canada. There is some belief that American egotism or desire to be "the world's policeman" is a factor in its attitudes.
Canada produces about 400kg of medical marijuana annually, in an abandoned mine in Flin Flon, Manitoba. On April 19, 2005, the Canadian government additionally licenced the prescription sale of a natural marijuana extract - effectively liquid marijuana - called Sativex. [3]
Germany
Purportedly, use is legal and possession of small amounts not enforced.
Israel
A small number of people have been granted special permission to use cannabis for medical uses by the Health Ministry.
The Israeli military uses marijuana for experimental treatment of post-traumatic stress disorder of soldiers. [4] [5] [6]
Jamaica
Cannabis possession remains illegal for any reason, though enforcement is scarce. A recent panel recommended legalizing possession for adults for recreation or medical use.
Japan
All THC-containing forms of cannabis have been illegal since 1948, when the occupying forces of the United States enacted the Hemp Control Law after World War II.
Luxembourg
Cannabis possession is now legal for adults for recreational or medical uses as long the possessor is not near a campus and no children are involved. A loophole in the law makes it impossible for police to search for or seize cannabis, making enforcement difficult.
Netherlands
Cannabis has been legally available for recreational use in coffee shops for several years. Thus it has also been available without a prescription for medical uses. In addition, since 2003 it is a legal prescription drug known as "Mediwiet", available at the pharmacy. There it costs more than in the coffee shop: ca. €9 per gram. It is important to note that laws remain on the books classifying possesion and sale as illegal, but due to a non-enforcement policy, it has been de facto legalized. See Drug policy of the Netherlands.
New Zealand
Health Minister Annette King has stated that she is not "unsympathetic to using cannabis in a medicinal form. But that's different to saying we should let everybody smoke it." Her official position is that more conclusive studies are needed, and a method of regulating dosage is necessary before she support medical access to cannabis.
Scott David Findlay, a paraplegic, was convicted of cannabis charges. The judge, Robert Spear (Dunedin District Court) offered to allow community service instead of imprisonment, but Findlay does not recognize the validity of New Zealand's cannabis laws and would not perform community service. Judge Spear claimed this was a "hollow protest" that he was nonetheless allowed to make, and sentenced him to three months imprisonment.
Portugal
Since 2001, possession of any drug for personal use has been legal, though sale and trafficking are still criminal offenses. One can still be arrested and fined for using cannabis in public, or for possession of more than 25 grams.
Spain
Research provides an important new lead compound for anticancer drugs, links to the story can be found here. The full text of the study can be seen here.
In October 2005, the autonomous government in the region of Catalonia launched a program of therapeutical use of Cannabinol for six hundred patients of a wide set of illnesses, from multiple sclerosis to cancer, in order to avoid nauseas or to relax tense muscles. The project involves six hospitals, forty researchers and sixty drugstores. The product is presented as an atomizer to be taken orally, and it will be delivered at drugstores inside some hospitals.
South Africa
Prof. Frances Ames completed her research in 1958. The full text of the study can be seen here. Further medical research is currently being performed by the University of the Western Cape by Dr John Thomas.
Switzerland
Though all possession and cultivation remains illegal in most parts of the country, coffee shops can still be found in Bienne and Interlaken. However, power rests in the hands of the UDC (Union Droite Cretienne; Right Catholic Government), which is strongly committed to winning the fight against marijuana and all drugs in Switzerland.
United Kingdom
In 1998, a House of Lords inquiry recommended that cannabis be made available with a doctor's prescription. Though the government of the UK has not accepted the recommendations, new long-term clinical trials have been authorized. Increasingly, juries have returned verdicts of "not guilty" for people charged with marijuana possession for medical use.
In 2003, GW Pharmaceuticals, the UK company granted the exclusive licence to cultivate cannabis for medicinal trials announced the completion of its clinical trials. The company has said that it is on track for obtaining regulatory approval to license the manufacture and sale of a cannabis based medicine starting in 2004. (In April 2005 its Sativex marijuana extract was licenced for prescription sale in Canada.)
United States
There is a split between the US federal and state governments over medical marijuana policy. On June 6, 2005, the Supreme Court, in Gonzales v. Raich, ruled in a 6-3 decision that Congress has the right to outlaw medicinal marijuana, thus subjecting all patients to federal prosecution even in states where the treatment is legalized. Currently, there are ten states with effective medical marijuana laws on the books: Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Vermont, and Washington.
The case brought into tension two themes of the Rehnquist court: the limits it has imposed on the federal government and the latitude it has afforded law enforcement officers. Those issues produced an unusual breakdown among the nine justices.
Joining Justice John Paul Stevens's majority decision were Justices Anthony M. Kennedy, David H. Souter, Ruth Bader Ginsburg and Stephen G. Breyer. Justice Antonin Scalia wrote separately to say he agreed with the result, though not the majority's reasoning. Chief Justice William H. Rehnquist and Justices Sandra Day O'Connor and Clarence Thomas dissented.
According to the federal Controlled Substances Act of 1970, marijuana "has no accepted medical use" and is illegal for any reason, with the notable exception of FDA-approved research programs. The Act allows mis-controlled substances to be reclassified by petition by any member of the public, but federal agencies whose power and budgets depend on the illegal status of marijuana have denied each such petition (another, by Jon Gettman, is pending). See cannabis rescheduling in the United States.
A successful "medical necessity" defense by patient Robert Randall led the FDA to create an "Investigational New Drug Program", which provides medical marijuana grown under a NIDA contract at the Research Institute for Pharmaceutical Science at the University of Mississippi to a small number of patients since 1978. The program was closed to new patients in 1992 when many AIDS patients applied. Six living patients continue to receive federal marijuana, including Irvin Rosenfeld [7] (for bone spurs), Elvy Musikka (for glaucoma), and George McMahon (who authored Prescription Pot, a book detailing the federal program, which contains the only existing medical study performed on the legal patients). These patients are required by the U.S. Government to smoke the marijuana through a "rolled paper tube" (they are not allowed to eat it or use pipes or vaporizers). All the patients and their doctors report significant medical benefits from their use of marijuana.
DEA and NIDA opposition prevented any scientific studies of medical marijuana for more than a decade, but in the 1990s, activists and doctors were energized by seeing marijuana help dying AIDS patients. A study of smoked marijuna at the University of California at San Francisco under Dr. Donald Abrams was approved after five years of bureacracy. Further research followed, particularly due to a ten million dollar research appropriation by the California legislature. Many years of work remain before sufficient research could be approved and conducted to meet the FDA's standards for approving marijuana as a new prescription medicine. Politicians are generally hostile to altering the status of marijuana. However, the popularity of medical marijuana among ordinary citizens, who regularly poll at about 75% in favor, has resulted in the introduction of bills in Congress which would eliminate federal controls in states which approve medical marijuana. No such bill has received enough votes in Congress to become law, possibly because the currently dominant Republican Party is opposed.
At the state level, thirty-three states and the District of Columbia have legislation on the books which allows for medical use of marijuana. Most require that it be "prescribed", which is problematic when federal agencies control doctors' power to prescribe. Ten states have made laws which permit doctors to instead "recommend" marijuana, starting with California Proposition 215 (1996). The most recent such state was Montana in 2004, with voters 62% in favor and 38% opposed. Hawaii, Maine and Maryland have legalized medical marijuana by legislative action, and the California legislature expanded patient protections in 2003. District of Columbia voters also passed several modern medical marijuana initiatives, but Congress first denied the funds to count the vote, then when that was declared unconstitutional, voted to overturn the initiative. Even in the best states, law enforcement agencies and individual officers frequently violate the law and the rights of patients, by stealing or destroying medical marijuana, and/or arresting the patients. For example, the official position of the California Narcotics Officers Association is that medical marijuana activists "misled" the public which voted to change the law [8]. Legal and social support groups such as Americans for Safe Access [9] have sprung up in defense.
Sale of medical marijuana is illegal or barely legal, even in states where patients have the right to grow or use it, due to public confusion between dispensaries and "drug dealers". However, medical marijuana dispensaries have been established in many locations, particularly in California, where they work openly with local government officials to resolve any difficulties. Many offer social services, medical consultations, and support groups as well as medicine. The first such dispensary, known as the Cannabis Buyer's Club (CBC), was opened by Dennis Peron in February, 1994. The club operated openly in San Francisco for years, even before medical marijuana was legalized. Thousands of otherwise healthy and well-behaved local gay men had died, before scientists could be persuaded to begin researching their disease. Local police and politicians did not want to be seen arresting suffering AIDS patients, or denying them any medicine that could help them. This gay community activism led directly to the "Compassionate Use Act" medical marijuana initiative, California Proposition 215 (1996), which voters approved.
Federal Drug Enforcement Administration agents regularly harass, steal from, and/or arrest medical marijuana growers and sellers. Close to 30 federal criminal cases about medical marijuana are pending. Several jurisdictions, including Oakland, California and San Mateo County, California have announced plans to distribute medical marijuana to patients. Ed Rosenthal, author of dozens of books on marijuana cultivation, grew small "starter" plants for patients on behalf of the city government of Oakland. He was convicted in federal court of manufacturing marijuana, by a jury which was never told that his marijuana was for medical patients. Shortly after the trial, eight of the fourteen jurors (and alternates) who convicted him called a press conference and denounced their verdict, arguing that the trial was not fair because the evidence that Rosenthal was growing marijuana for medical use, working on behalf of the city, and was told by DEA agents and city officials that he was immune to prosecution, was all suppressed by the judge as "irrelevant under federal law". The jury discovered the real facts, by reading newspapers, within hours after delivering their verdict. As a result of the intense public scrutiny, Rosenthal was given a sentence of only one day. He is appealing his felony conviction, and the federal government is appealing the short sentence; both appeals are on hold pending the Supreme Court's Raich decision.
Washington state Initiative 692, passed by the voters in 1998, also authorizes the medical use of marijuana. On November 2, 2004, the voters of Ann Arbor, Michigan passed a similar resolution with 74% approval.
The official policy of the federal government in the United States is that medical marijuana is a myth, promulgated by activists who have the eventual goal of legalizing all drugs. The federal government has also applied considerable pressure to other nations so that they would enact and enforce laws against marijuana. It regularly threatens the government of Canada whenever Canada announces that it will relax restrictions on marijuana.
