Effective Arguments for Medical Marijuana Advocates

Introduction

The key to being a successful medical marijuana advocate is effective communication. Specifically, advocates must be able to: 1) convey the most important arguments in support of medical marijuana laws, and 2) respond to arguments made in opposition to medical marijuana laws. Whether you are engaging in personal discussions, participating in public debates, conducting media interviews, or corresponding with government officials, it is critical that you are prepared.

This document will provide you with the most persuasive talking points and strongest rebuttals to employ when communicating about medical marijuana. We recommend you keep it handy when conducting interviews or engaging in public debates. You are also welcome to convey the information verbatim or simply use it as a general guide when carrying out advocacy activities.

NOTE: Statistics can change rapidly and there are constant developments surrounding the issue. If you would like to confirm whether a given piece of information is current, or if you would like to suggest additions or revisions to this document, please contact the Marijuana Policy Project communications department at media@mpp.org.

Last updated: November 16, 2020

Proactive Arguments

These are the key points to convey when given the opportunity to make our case.

Medical marijuana is proven to be effective in the treatment of a variety of debilitating medical conditions. A vast majority of Americans recognize the legitimate medical benefits of marijuana, as well as a large number of medical organizations. It is far less harmful and poses fewer negative side effects than most prescription drugs — especially opiate-based painkillers — and patients often find it to be a more effective treatment.
Seriously ill people should not be subject to arrest and criminal penalties for using medical marijuana. If marijuana can provide relief to those suffering from terrible illnesses like cancer and HIV/AIDS, it is unconscionable to criminalize them for using it. People who would benefit from medical marijuana should not have to wait — and in some cases cannot wait — for the right to use it legally.
Regulating the cultivation and sale of medical marijuana would ensure patients have legal, safe, and reliable access to medical marijuana. Patients should not have to resort to the potentially dangerous underground market to access their medicine. By regulating medical marijuana, we can ensure it is free of pesticides, molds, and other impurities, and patients will know exactly what they are getting.
Ninety-three percent of U.S. voters think marijuana should be legal for medical use, including 85% of Republicans, more than 95% of Democrats and independents, and more than 92% of each age group.¹ Thirty–six states, the District of Columbia, and four U.S. territories have adopted laws that allow people with certain medical conditions to use medical marijuana, and similar laws are being considered in states around the country. An additional 13 states have adopted laws that recognize the medical value of at least some preparations of marijuana, but are either unworkable or exceptionally restrictive. Only one state — Idaho — has not approved any form of medical marijuana law.

Reactive Arguments

These are responses to arguments frequently made by opponents.

Marijuana has no medical value.

There is a mountain of scientific evidence that demonstrates marijuana is a safe and effective medicine for people suffering from a variety of debilitating medical conditions. According to a review of more than 10,000 scientific abstracts released by the National Academies of Sciences, Engineering, and Medicine in January 2017, “There is conclusive or substantial evidence that cannabis or cannabinoids are effective” in the treatment of chronic pain in adults, chemotherapy-induced nausea and vomiting, and multiple sclerosis spasticity.² In 1999, the Institute of Medicine (IOM) reported, “Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.”³Seven University of California studies published since July 2015⁴ have found that marijuana relieves neuropathic pain (pain caused by damage to nerves), a symptom commonly associated with multiple sclerosis, HIV/AIDS, diabetes, and a variety of other conditions for which conventional pain drugs are notoriously inadequate — and it did so with only minor side effects.⁵^{, 6, 7, 8, 9, 10}^{, 11} Further, a 2015 McGill University study — the “‘first and largest study of the long term safety of medical cannabis use by patients suffering from chronic pain’” — found marijuana to have a “‘reasonable safety profile’”¹² with no increased risk of serious adverse effects.¹³A 2008 article in the journal Cancer Research reported that marijuana has profound cancer-fighting abilities, killing malignant cancer cells associated with brain cancer, prostate cancer, breast cancer, lung cancer, pancreatic cancer, skin cancer, and lymphoma.¹⁴An observational study published in the European Journal of Gastroenterology & Hepatology found that hepatitis C patients using marijuana had three times the cure rate of non-users because it appeared to relieve the noxious side effects of anti-hepatitis C drugs, allowing patients to successfully complete treatment.¹⁵A 2011 study published in the Israel Medical Association Journal found marijuana to be effective in treating Crohn’s disease, with 45% of patients going into full remission and most of the remaining patients reporting significant improvement.¹⁶

Some federal agencies have taken actions that demonstrate it recognizes the medical benefits of marijuana. For example, the U.S. Department of Health and Human Services holds a patent on the use of cannabinoids as neuroprotectants and antioxidants. The U.S. Food and Drug Administration (FDA) recognized the medical benefits of THC, a key component of marijuana, when it approved a synthetic form known as Marinol (or dronabinol in its generic form). Unfortunately, this prescription pill version has proven to be less effective than actual marijuana and has much more pronounced side effects, and many patients need the synergistic effects of many or all of cannabis’ compounds. The FDA also recognized the benefits of CBD, another cannabinoid, when it approved Epidiolex (which has CBD as its sole active ingredient) for certain intractable seizures.

On September 6, 1988, after hearing two years of testimony, Drug Enforcement Administration (DEA) chief administrative law judge Francis Young, ruled: “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care ... It would be unreasonable, arbitrary, and capricious for DEA to continue to stand between those sufferers and the benefits of this substance.”¹⁷

Numerous medical organizations have examined the evidence and concluded that marijuana can be a safe, effective medicine for some patients. They include the American Public Health Association, the American College of Physicians, the American Nurses Association, and a number of state medical and public health organizations, among others. For example, the American College of Physicians stated, “Evidence not only supports the use of medical marijuana in certain conditions, but also suggests numerous indications for cannabinoids.”¹⁸ In 2009, the American Medical Association called on the federal government to reconsider marijuana’s classification under federal law, noting clinical trials have shown marijuana’s medical efficacy. (See the following section for a larger list of organizations that support medical marijuana).

Medical marijuana is opposed by the American Medical Association, the American Cancer Society, and other medical organizations.

A large and growing number of medical and health organizations have recognized marijuana’s medical value. In 2009, the American Medical Association made a major shift in its position, calling on the federal government to reconsider marijuana’s status as a Schedule I drug, which bars medical use under federal law.¹⁹ Some medical organizations — such as the American Cancer Society — do not have a position on allowing medical marijuana, but neutrality shouldn’t be confused with supporting the arrest and imprisonment of patients. As former U.S. Surgeon General Dr. Joycelyn Elders put it in a 2004 newspaper column, “I know of no medical group that believes that jailing sick and dying people is good for them.”²⁰
Surveys of physicians show strong support for medical marijuana. For example, a 2013 national survey of physicians conducted by the New England Journal of Medicine found that 76% of doctors supported use of marijuana for medical purposes.²¹
Several prominent organizations have taken favorable positions on medical marijuana, including but not limited to:²²
The American Academy of HIV Medicine; the American Association for Social Psychiatry; the American Bar Association; the American Civil Liberties Union; the American College of Physicians; the American Nurses Association (and at least 12 state nurses associations); the American Public Health Association; Americans for Democratic Action; the Arthritis Research Campaign; the Associated Medical Schools of New York; the British Medical Association; the California Pharmacists Association; the California Society of Addiction Medicine; the Epilepsy Foundation; the Episcopal Church; the Florida Medical Association; the Leukemia & Lymphoma Society; the Life Extension Foundation; the Lymphoma Foundation of America; the Medical Society of the State of New York; the Medical Student Section of the American Medical Association; the National Association of People With AIDS; the National Association of Public Health Policy; the Presbyterian Church (USA); the Progressive National Baptist Convention; the New York State Hospice and Palliative Care Association; Project Inform (national organization for people with HIV/AIDS and hepatitis C); the Rhode Island Medical Society; the Texas Medical Association; the Union of Reform Judaism; the Unitarian Universalist Association; the United Church of Christ; the United Methodist Church; and the Wisconsin Public Health Association.

Medicine should be based on science, not politics or public opinion.

The science is clear — marijuana is a safe and effective treatment for a variety of debilitating medical conditions. Countless researchers and organizations have documented the medical benefits of marijuana, including the Institute of Medicine, the American College of Physicians, the American Public Health Association, the American Nurses Association, and the Epilepsy Foundation. If medicine should be based on science and not politics, our laws should reflect the facts and allow doctors to recommend marijuana to patients if they believe it will be effective. If politicians stand in the way in states with a ballot initiative process, citizens often have no other option than to take the issue to the voters.

Medical marijuana is already available to some people.

Thirty-six states have adopted laws that allow patients with certain conditions to access medical marijuana if their doctors recommend it, but it is still illegal in the other 14 states and under federal law. Three patients in the United States legally receive marijuana from the federal government. These patients are in an experimental program that was closed to all new applicants in 1992. Thousands of Americans used marijuana through experimental state programs in the late 1970s and early 1980s, but none of these programs are presently operating.

Medicine should be prescribed, not recommended.

Doctors who recommend medical marijuana must examine patients and review their records, just as they would before prescribing any other medication. If we can trust doctors to write prescriptions, why not trust them to provide their professional recommendations on their letterhead? The only difference is that a prescription is recognized under federal law. The vast majority of doctors who are willing to write such recommendations do not do so lightly or casually, and state medical boards often investigate and discipline physicians who fail to follow appropriate standards of care.
Despite its proven medical benefits, federal law prohibits doctors from “prescribing” marijuana for any reason. There needs to be a way for state criminal justice systems to determine who has a legitimate medical need for medical marijuana, so they require doctors’ recommendations instead. Doctors recommend many things: exercise, rest, chicken soup, vitamins, cranberry juice for bladder infections, and so on. The right of physicians to recommend marijuana when appropriate for a patient’s condition has been upheld by the federal courts.

There are already drugs available that work better than marijuana.

Marijuana can be the most effective treatment — or the only effective treatment — for some patients. For example, existing prescription drugs often fail to relieve neuropathic pain — pain caused by damage to the nerves — whereas marijuana has been shown to provide effective relief, even in patients for whom the conventional drugs have failed. This type of pain affects millions of Americans with multiple sclerosis, diabetes, HIV/AIDS, and other illnesses.
Different people respond differently to different medicines; the most effective drug for one person might not work at all for another, or it might have more pronounced side effects. There are often a variety of drugs on the market to treat the same ailment, which is why the Physicians’ Desk Reference comprises 3,000 pages of prescription drugs instead of just one drug per symptom or condition. For example, consider all of the prescription drugs available to treat pain: Oxycontin, Vicodin, Percocet, Codeine, etc. There is a reason why we don’t just determine which is “best” and then ban all of the rest. Treatment decisions should be made in doctors’ offices, not by politicians, bureaucrats, and law enforcement officials. Doctors must have the freedom to choose what works best for each of their patients.

In 1999, the Institute of Medicine reported:

“Although some medications are more effective than marijuana for these problems, they are not equally effective in all patients.”²³“[T]here will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for certain conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting.”²⁴“The critical issue is not whether marijuana or cannabinoid drugs might be superior to the new drugs, but whether some group of patients might obtain added or better relief from marijuana or cannabinoid drugs.”²⁵

Marijuana is already available in the form of a prescription pill.

The prescription pill can be problematic for many patients. The prescription pill known as Marinol (with the generic name dronabinol) is not actually marijuana; it is a synthetic version of THC, the psychoactive component responsible for marijuana’s “high.” It can take an hour or longer to take effect, whereas vaporized or smoked marijuana is effective almost instantaneously. Also, the dose of THC absorbed in the pill form is often too high or too low, and its slow and uneven absorption makes dosing difficult. In 2003, The Lancet Neurology reported, “Oral administration is probably the least satisfactory route for cannabis.”²⁶ In its 2008 position paper on medical marijuana, the American College of Physicians noted, “Oral THC is slow in onset of action but produces more pronounced, and often unfavorable, psychoactive effects than those experienced with smoking.”²⁷ If the prescription pill were sufficient, why would hundreds of thousands of seriously ill people break the law by using whole marijuana instead?
Marijuana contains more than 80 active cannabinoids in addition to THC, and many of them contribute to marijuana’s therapeutic effects.²⁸ For example, cannabidiol (CBD) has been shown to have anti-nausea, anti-anxiety, anti-seizure, and anti-inflammatory actions, as well as the ability to protect nerve cells from many kinds of damage.²⁹ CBD also moderates the effects of THC, so patients are less likely to get excessively “high.” Other cannabinoids naturally contained in marijuana have also shown significant therapeutic promise.
Patients suffering from nausea, such as those undergoing chemotherapy, are often unable to keep pills down. During a meeting of an expert panel convened by the National Institutes of Health in 1997 to review the scientific data on medical marijuana, panel member Mark Kris, M.D. said, “[T]he last thing that [patients] want is a pill when they are already nauseated or are in the act of throwing up.”³⁰

We can make synthetic forms of other useful cannabinoids.

Seriously ill people should not have to wait for a potentially less effective drug when marijuana could be helping them now. Spending time and money testing and producing pharmaceutical versions of marijuana’s many cannabinoids might produce useful drugs some day, but it will be years before any new cannabinoid drugs reach pharmacy shelves. In 1999, the Institute of Medicine urged such research into potential new drugs, but it noted, “In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief.”³¹ In its natural form, marijuana is a safe and effective medicine that has already provided relief to millions of people.
We support research into the different cannabinoids, but it should not be used as a stall tactic to keep medical marijuana illegal. Patients should be allowed to use marijuana if their doctors think it is currently the best treatment option. Why should seriously ill patients have to risk arrest and jail waiting for new drugs that simply replicate marijuana’s effects?

If the prescription pill form doesn’t work, we should just develop other forms of delivery.

The availability of such delivery systems should not be used as an excuse to maintain the prohibition of the use of natural marijuana. As long as there are patients and doctors who believe whole marijuana is effective, they should not be punished for using or recommending it, regardless of what alternatives are available.
A safe and effective delivery system for whole marijuana already exists: vaporization. Vaporizers are simple devices that give users the fast action of inhaled cannabinoids without most of those unwanted irritant.³²^{, 33} Essentially, vaporizing entails heating it to the point that it releases the active chemicals in vapor form, so there is no smoke involved. Any delivery system that helps patients should be made available, but their development should not substitute for the research into marijuana that is necessary for FDA approval of this natural medicine.

There is a marijuana spray that makes the crude plant unnecessary.

The liquid extract of whole marijuana proves marijuana is an effective medicine. Sativex (or nabiximols in its generic form) is a mouth spray that has been approved in Canada and a number of European countries for the treatment of symptoms associated with multiple sclerosis. Its producer, GW Pharmaceuticals, in the process of getting it approved in the United States, but it is likely to take several years.
Marijuana in its natural form has significant advantages over Sativex. For one thing, Sativex acts much more slowly than marijuana that is vaporized or smoked. Peak blood levels are reached in one and a half to four hours, as opposed to a matter of minutes with inhalation.³⁴ Also, patients have found that different strains of marijuana are often more effective for different conditions. Sativex is just one specific strain of marijuana, so it is unlikely to help every patient who benefits (or could benefit) from whole marijuana. Patients and doctors should be able to choose which form of marijuana presents the best option.

The FDA says that marijuana is not a medicine and medical marijuana laws subvert its drug approval process.

The FDA issued its April 2006 statement without conducting any studies or even reviewing studies performed by others. It was immediately denounced by health experts and newspaper editorial boards around the country as being political and unscientific. The agency, which was under pressure from rabidly anti-medical marijuana politicians such as former Congressman Mark Souder (R-Indiana), ignored any evidence that contradicts federal policy, such as the 1999 Institute of Medicine report. A co-author of the IOM report, Dr. John A. Benson, told The New York Times that the government “loves to ignore our report ... They would rather it never happened.”³⁵
We know much more about marijuana’s safety and efficacy than most off-label prescriptions. Half of all current prescriptions have not been declared safe and effective by the FDA. Around 20% of all drug prescriptions in this country are “off-label” — i.e., they are prescribed to treat conditions for which they were not approved.³⁶
State medical marijuana laws do not conflict with the FDA drug approval process. They simply protect medical marijuana patients from arrest and jail under state law. Also, the FDA does not bar Americans from growing, using, and possessing a wide variety of medical herbs that it has not approved as prescription drugs, including echinacea, ginseng, and St. John’s Wort.
The federal government has blocked most researchers from doing the specific types of studies that would be required for licensing, labeling, and marketing marijuana as a prescription drug. They’ve created a perfect Catch-22: Federal officials say “Marijuana isn’t a medicine because the FDA hasn’t approved it,” while making sure that the studies needed for FDA approval never happen.
Technically, marijuana should not require FDA approval. Prior to the agency being created by the 1938 Food, Drug, and Cosmetics Act, about two-dozen preparations of marijuana were on the market, many of which were produced by well-known pharmaceutical companies. Under the terms of the Act, marijuana is not a “new” drug, thus it should not be subject to FDA new drug approval requirements. Many older drugs, such as aspirin and morphine, were “grandfathered in” under this provision without ever being submitted for new-drug approval by the FDA.

Marijuana is too dangerous to be used as a medicine; there are 10,000 studies showing marijuana is dangerous.

A large and growing body of scientific evidence demonstrates that the health risks associated with marijuana are actually relatively minor. The 1999 Institute of Medicine report noted, “[E]xcept for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.³⁷ In 2008, the American College of Physicians agreed, citing marijuana’s “relatively low toxicity.”³⁸ (See the following section for more information about smoking.)
Marijuana is non-lethal and does not contribute to or increase the likelihood of death. In January 2017, the National Academies of Sciences released an exhaustive review of marijuana-related research that found no link between marijuana use and increased mortality or fatal overdoses.³⁹ The U.S. Centers for Disease Control and Prevention has never listed marijuana as a cause of death (although it does list alcohol and other drugs). A government-funded study conducted by researchers at the Kaiser Permanente HMO found no association between marijuana use and premature death in otherwise healthy people.⁴⁰ Marijuana is so safe that patients can easily find the proper dose themselves with no danger of overdose. As University of Washington researcher Dr. Gregory Carter and colleagues noted in a recent journal article, “THC (and other cannabinoids) has relatively low toxicity and lethal doses in humans have not been described ... It has been estimated that approximately 628 kilograms of cannabis would have to be smoked in 15 minutes to induce a lethal effect.”⁴¹ Meanwhile, prescription drugs have become one of the leading causes of accidental death in the United States.⁴² Why is it okay for people to use these potentially deadly prescription drugs, but not okay for them to use a drug that has never killed anyone?
All medicines can have some negative side effects, but with marijuana they are relatively minimal. For example, Tylenol (acetaminophen) has been estimated to kill nearly 500 Americans per year by causing acute liver failure,⁴³ while no one has ever died from marijuana poisoning. But no one would seriously suggest banning Tylenol because it’s too dangerous. In contrast, recent medical marijuana studies have found no significant side effects. The question is this: Do the benefits outweigh the risks for an individual patient? Such decisions should be made by doctors and patients, not the criminal justice system.
The “10,000 studies” claim is simply not true. The University of Mississippi Research Institute  of Pharmaceutical Sciences maintains a 12,000-citation bibliography on the entire body of marijuana literature. The institute notes: “Many of the studies cited in the bibliography are clinical, but the total number also includes papers on the chemistry and botany of the Cannabis plant, cultivation, epidemiological surveys, legal aspects, eradication studies, detection, storage, economic aspects and a whole spectrum of others that do not mention positive or negative effects ... However, we have never broken down that figure into positive/negative papers, and I would not even venture a guess as to what that number would be.”⁴⁴

Medicine should not be smoked, and smoking marijuana is more harmful than smoking tobacco.

There are many ways to consume marijuana other than smoking, such as vaporizing, edible products, tinctures, and capsules. Vaporizers are simple devices that give users the fast action of inhaled cannabinoids without most of the unwanted irritants found in smoke. Research on vaporizers has proceeded more slowly than it should have because of federal obstructionism.
Extensive research has failed to find a link between marijuana and cancer. In January 2017, the National Academies of Sciences released a review of more than 10,000 scientific abstracts that concluded there is no link between smoking marijuana and the development of lung, head, or neck cancers.⁴⁵ It also did not find a link between marijuana use and asthma or other respiratory diseases, and the respiratory problems it did link to smoking marijuana, such as bronchitis, appeared to improve after consumers stopped using it. Similarly, in 1999, the National Academies’ Institute of Medicine reported, “There is no conclusive evidence that marijuana causes cancer in humans, including cancers usually related to tobacco use.”⁴⁶

According to research published in the journal Cancer, Causes, and Control, marijuana inhalation — unlike tobacco smoking — has not been positively associated with increased incidences of cancers of the lung, mouth, pharynx, larynx, esophagus, breast, colon, skin, or prostate.⁴⁷ It was also reaffirmed in 2006 by the largest case-controlled study ever conducted to investigate the respiratory effects of marijuana smoking and cigarette smoking. The study, led by Dr. Donald Tashkin at the University of California at Los Angeles, found “no association at all” between marijuana smoking and an increased risk of developing lung cancer, even among subjects who reported smoking more than 22,000 joints over their lifetimes.⁴⁸^{, 49}Surprisingly, the UCLA researchers found that people who smoked marijuana actually had lower incidences of cancer compared to non-users, leading them to the conclusion that marijuana might have a protective effect against lung cancer. Other studies have shown that marijuana can kill cancer cells and inhibit tumor growth.⁵⁰^{, 51}

All medicines have risks and side effects, and part of a physician’s job is to evaluate those risks in relation to the potential benefits for the individual patient. Many prescription drugs have side effects — most of which are far more severe than those of marijuana — but that doesn’t mean it should be illegal for seriously ill people to use them.

Marijuana is bad for the immune system.

Scientific studies have not demonstrated any significant harm to the immune system caused by marijuana. The Institute of Medicine reported, “Despite the many claims that marijuana suppresses the human immune system, the health effects of marijuana-induced immunomodulation are still unclear.”⁵² The IOM also noted, “The short-term immunosuppressive effects [of marijuana] are not well established; if they exist at all, they are probably not great enough to preclude a legitimate medical use.”⁵³
Extensive research in HIV/AIDS patients — whose immune systems are particularly vulnerable — shows no sign of marijuana-related harm. University of California at San Francisco researcher Donald Abrams, M.D. has studied marijuana and Marinol in AIDS patients taking anti-HIV combination therapy. Not only was there no sign of immune system damage, but the patients gained T-lymphocytes, the critical immune system cells lost in AIDS, and also gained more weight than those taking a placebo. Patients using marijuana also showed greater reductions in the amount of HIV in their bloodstream.⁵⁴ Long-term studies of HIV/AIDS patients have shown that marijuana use (including social or recreational use) does not worsen the course of their disease. For example, in a six-year study of HIV patients conducted by Harvard University researchers, marijuana users showed no increased risk of developing AIDS-related illness.⁵⁵ In her book Nutrition and HIV, internationally known AIDS specialist Mary Romeyn, M.D. noted, “The early, well-publicized studies on marijuana in the 1970s, which purported to show a negative effect on immune status, used amounts far in excess of what recreational smokers, or wasting patients with prescribed medication, would actually use ... Looking at marijuana medically rather than sociopolitically, this is a good drug for people with HIV.”⁵⁶

Marijuana contains over 400 chemicals, including most of the harmful compounds found in tobacco smoke.

The number of chemical compounds in a substance is irrelevant. Coffee, mother’s milk, broccoli, and most foods also contain hundreds of different chemical compounds. Marijuana is a relatively safe medicine, regardless of the number of chemical compounds found therein.

Marijuana’s side effects (e.g., increased blood pressure) negate its effectiveness in fighting glaucoma.

Marijuana has been found to be exceptionally beneficial for people with glaucoma, and its side effects are minimal compared to other drugs. In fact, the federal government has given marijuana to at least three patients with glaucoma, and it preserved their vision for years after they were expected to go blind. Paul Palmberg, M.D. one member of an expert panel convened by the National Institutes of Health in 1997 to review the scientific data on medical marijuana, explained during the group’s discussion on February 20, 1997, “I don’t think there’s any doubt about its effectiveness, at least in some people with glaucoma.”⁵⁷

Marijuana use can increase the risk of mental illness, including schizophrenia.

There is no compelling evidence demonstrating marijuana causes psychosis in otherwise healthy individuals. Overall, the evidence suggests that marijuana can precipitate schizophrenia in vulnerable individuals but is unlikely to cause the illness in otherwise normal persons.⁵⁸ A recent study implied the reverse, finding that those predisposed to schizophrenia may be more likely to use cannabis.⁵⁹ Epidemiological data show no correlation between rates of marijuana use and rates of psychosis or schizophrenia. Countries with high rates of marijuana use don’t have higher rates of these illnesses than countries where marijuana use is more rare, and research has consistency failed to find a connection between increases in marijuana use and increased rates of psychosis.⁶⁰^{, 61, 62} As with all medications, the physician needs to consider what is an appropriate medication in light of the individual patient’s situation and may well suggest avoiding marijuana or cannabinoids in patients with a family or personal history of psychosis. This is the sort of risk/benefit assessment that physicians are trained to make.

Medical marijuana laws send the wrong message to teens.

There does not appear to be a link between the passage of medical marijuana laws and increases in teen marijuana use, and in some cases it appears to be associated with decreases in teen use. A national study covering 24 years of data published in The Lancet Psychiatry in 2015 found that medical marijuana laws do not lead to an increase in teen marijuana use. According to the lead researcher, the findings “provide the strongest evidence to date that marijuana use by teenagers does not increase after a state legalizes medical marijuana.”⁶³ A 2012 study conducted by researchers at universities in Colorado, Montana, and Oregon found “no statistical evidence that legalization increases the probability of [teen] use,” and noted that “the data often showed a negative relationship between legalization and [teen] marijuana use.”⁶⁴ State surveys of students in several states with medical marijuana laws have consistently reported declines in teen marijuana use since those laws were passed.⁶⁵In 2014, an annual survey conducted by the U.S. Centers for Disease Control and Prevention found that marijuana use by Colorado high school students has dropped since the state began regulating medical marijuana in 2010.⁶⁶ California has had a similar experience. According to the state-sponsored California Student Survey (CSS), marijuana use by California teens was on the rise until 1996 — the year California adopted its medical marijuana law — at which point it began dropping dramatically (by nearly half in some age groups).⁶⁷ As part of the 1997-1998 CSS, the State of California also commissioned an independent study examining the effects of its medical marijuana law, which concluded, “There is no evidence supporting that the passage of Proposition 215 increased marijuana use during this period.”⁶⁸

Laws that are not based on science send the wrong message to young people — especially those that needlessly criminalize seriously ill people for using a substance with proven medical benefits. Children should be taught the facts about all drugs and the difference between medical use and abuse. We allow doctors to prescribe cocaine, morphine, and methamphetamine, and we teach young people that these drugs are used for medical purposes. We can do the same thing with marijuana.

We can’t allow patients to grow marijuana, especially in homes with children.

Patients should be able to grow their own medical marijuana if it is the best way for them to access it, and sometimes it’s the only way to access it. Some patients are not able to access a medical marijuana dispensary because there isn’t one nearby or they do not have a means of transportation.
We allow people to possess all sorts of prescription drugs, most of which are far more dangerous than a few marijuana plants being grown in a patient’s basement or closet. All medicines need to be handled with appropriate care and kept out of easy reach of children. There are already laws against selling marijuana to non-patients, and child protective services agencies already have the power to protect children whose parents are engaged in criminal activity. A medical marijuana law that allows patients to grow limited amounts of marijuana will not change any of this.
Criminals break into homes every day to steal valuable items — jewelry, high-end electronics, and even prescription drugs. We don’t ban possession of these items because the owners might be victims of a crime. By this logic, parents shouldn’t be allowed to drive Honda Accords (the most-stolen vehicle in 2014, according to the National Insurance Crime Bureau). If medical marijuana is legal, it should be treated like any other legal product.

Medical marijuana laws are full of loopholes.

With 36 states having enacted medical marijuana laws, the laws are as varied as the states themselves. Some early laws did not include regulations, while some newer ones are so restrictive and onerous that they leave behind most patients or force them to make lengthy drives to get their medicine. There are also plenty of examples of states that have taken a more reasonable middle ground, imposing reasonable regulations without steering pain patients away from medical cannabis and toward opiates. Arizona, Illinois, Nevada, and New Mexico are some of the many states that fall into that category. States considering medical marijuana legislation have a variety of examples to learn from, which allows them to craft a well-regulated program that serves both patients and communities.
No law will ever be considered entirely perfect by everyone. The goal is to produce the best possible law that is supported by the most voters. Ultimately, medical marijuana advocates have nothing to gain and everything to lose by wording initiatives poorly.

Medical marijuana laws basically legalize marijuana for everyone.

These laws typically only allow people to use marijuana if they have a qualifying medical condition and receive a recommendation from a licensed physician who believes it will benefit them. The General Accounting Office (the investigative arm of Congress, renamed the Government Accountability Office) interviewed officials from 37 law enforcement agencies in four states with medical marijuana laws. A key issue they examined was whether medical marijuana laws had interfered with enforcement of laws regarding non-medical use. According to the GAO’s November 2002 report, the majority of these officials “indicated that medical marijuana laws had had little impact on their law enforcement activities.”⁶⁹ Whenever medical marijuana laws are being considered by voters or legislators, opponents claim it will result in marijuana basically being legalized for everyone. Yet, voters and lawmakers still approve these laws — oftentimes in states where there isn’t strong support for broader legalization — because they recognize that these medical laws are a safe and responsible means of helping patients.
Government data shows that between 0.14% and 3.1% of medical marijuana states’ populations are enrolled in most medical marijuana programs, with the numbers varying depending on the particulars of the state’s law.⁷⁰ In comparison, about 13% of Americans were prescribed painkilling opioids, and 12% use marijuana each year.⁷¹

Medical marijuana laws only pass because of well-funded and/or misleading campaigns.

National and state public opinion polls have consistently shown overwhelming public support for allowing seriously ill people to use medical marijuana. Also, polling in states that have had medical marijuana laws for years shows support is just as high or — in most cases — higher than when they were on the ballot.⁷² Clearly, voters are not being fooled into voting for these laws. The amount spent in support of passing medical marijuana laws is a drop in the bucket compared to the billions of dollars spent by our federal government to keep marijuana entirely illegal.

Medical marijuana laws confuse law enforcement officials.

What’s so confusing? If a person has documentation showing they are a legal medical marijuana patient or caregiver, they shouldn’t be arrested or prosecuted. If the person does not have suitable documentation, either call the person’s doctor or arrest the person and let the courts decide. It is no more confusing than determining whether someone is the legal owner of a piece of property, whether they are a legal immigrant, or whether they are drinking alcohol underage or in violation of their probation.
It is not uncommon for law enforcement to initially be wary of or opposed to proposed medical marijuana laws; but post-enactment, law enforcement officials often recognize that the laws have not caused problems. For example, Minnesota Police and Peace Officers Association Executive Director Dennis Flaherty had strenuously opposed allowing medical marijuana. However, a year after enactment, he did not oppose adding intractable pain to the program. As a local paper reported, Flaherty “said police are unaware of any problems with the current cannabis program and do not expect any now that pain will be included.”

Medical marijuana dispensaries are out of control or magnets for crime.

State-regulated medical marijuana dispensaries are tightly controlled and have not been linked to any significant problems. Until 2018, dispensaries were less controlled in California, whose medical marijuana law was the first and most loosely worded, but the laws that have passed since then have been much clearer and will be much more effective at keeping things controlled. In most states, medical marijuana dispensaries are among the most tightly regulated businesses, and they are under an exceptional amount of scrutiny. As a result, they do everything they can to follow the rules and keep things under control.
There is no evidence that medical marijuana businesses contribute to an increase in crime, and there is some evidence that they might reduce it. In February 2017, researchers published an analysis of FBI crime data from 1988-2013 that found “no causal effects of medical marijuana laws on violent or property crime” at the national level or in individual states.⁷³ The one exception it highlighted was California, where the medical marijuana law appears to have contributed to a 20% drop in such crimes.

In Colorado, a Denver Police Department analysis conducted at the request of the city council found robbery and burglary rates at dispensaries were lower than area banks and liquor stores and on par with those of pharmacies.⁷⁴ The Colorado Springs Police Department also found no correlation between medical marijuana businesses and increased crime.⁷⁵

Medical marijuana is just a Trojan horse for broader legalization.

Medical marijuana laws are being passed to help people, not to further broader legalization efforts. Criminalizing seriously ill people for using medical marijuana is the most egregious element of marijuana prohibition, so it’s not surprising that voters and lawmakers are addressing it before moving on to the broader legalization debate. Supporters of medical marijuana include some of the most respected medical and public health organizations in the country, including the American College of Physicians, the American Public Health Association, the American Nurses Association, the Academy of HIV Medicine, and the Epilepsy Foundation. Surely these organizations are not part of a conspiracy to legalize marijuana and other drugs.
Every law should be judged on its own merits. If voters or lawmakers believe seriously ill people should be allowed to use medical marijuana, they will support a law that allows it. If a broader reform measure comes up, they can decide then whether they want to support or oppose it. There is no reason why we can’t pass a medical marijuana law now just because some people are worried there will be support for other laws later.

People aren’t actually arrested for medical marijuana.

There were approximately 545,601 Americans arrested for marijuana-related offenses in 2019.⁷⁶ Unfortunately, the government does not keep track of how many were medical patients. But even if only one percent of those arrestees were using marijuana for medical purposes, that is nearly 6,000 arrests! There have been countless publicized and unpublicized arrests for medical marijuana throughout the country. It was the arrest of well-known medical marijuana patients in California in the 1990s that prompted people to launch the medical marijuana initiative there in 1996.
Even the fear of arrest is a terrible punishment for seriously ill patients. The stress and anxiety associated with it can be more detrimental to a person’s health and immune system than marijuana itself. We know medical marijuana can help people; we should not be scaring them away from using it by threatening them with arrest.
If you don’t think patients are really getting arrested for using medical marijuana, why is it a problem to have a law that ensures they do not get arrested?

Nobody is in prison for using/providing medical marijuana.

Federal law and the laws of 14 states do not make any exceptions for medical marijuana, and without a medical necessity defense available, medical marijuana users are treated the same as recreational users. Federally, possession of even one joint carries a penalty of up to one year in prison. Cultivation of even one plant is a felony, with a maximum sentence of five years. Many states’ laws are in this same ballpark. Some patients are even sent  to prison.

Here are just a few examples:

In December 2009, New Jersey multiple sclerosis patient John Wilson was convicted of “operating a drug manufacturing facility” for growing the marijuana he used to treat his multiple sclerosis, and faced a sentence of five to 10 years in state prison. Rancher and Vietnam veteran Larry Rathbun was arrested in December 1999 for cultivating medical marijuana to relieve his degenerative multiple sclerosis. When he was arrested in 1999, he could still walk, which he attributed to the medical use of marijuana. After serving 19 months, Rathbun came out of Montana State Prison confined to a wheelchair. Byron Stamate spent three months in a California jail for growing marijuana for his disabled girlfriend (who killed herself so that she would not have to testify against Byron). Gordon Farrell Ethridge spent 60 days in an Oregon jail for growing marijuana to treat the pain from his terminal cancer. Quadriplegic Jonathan Magbie, who used marijuana to ease the constant pain from the childhood injury that left him paralyzed, died in a Washington, D.C. jail in September 2004 while serving a 10-day sentence for marijuana possession.

Patients are being punished even if they are not sent to prison. They are arrested and sometimes handcuffed and put in the back of a police car. Sometimes their doors get kicked in, and police ransack their houses. Sometimes they spend a day or two in jail. They have to appear in court, and court costs and attorney fees must be paid by the patient and the taxpayers. Probation — which means urine tests for a couple of years and the patient being unable to use his or her medical marijuana. There are huge fines and possible loss of employment, which hurt the patient’s ability to pay insurance, medical bills, rent, food, home-care expenses, and so on. Then there’s the stigma of having a drug conviction on one’s record, which could also result in doctors being unwilling to prescribe some medications. Should any of this happen to seriously ill people for using what they and their doctors believe is a beneficial medicine?

The government is making it easier to do medical marijuana research.

The federal government remains intensely hostile to medical marijuana. As a Schedule I drug, marijuana can be researched as a medicine only with federal approval. Some studies have been completed, and they have all shown medical marijuana to be safe and effective, but they have not been large enough to bring about FDA approval of marijuana as a prescription drug. More research is always desirable, but we know enough right now to know that there is no justification for arresting patients using medical marijuana under their doctors’ care.

Until California voters passed Proposition 215 in 1996, federal authorities blocked all efforts to study marijuana’s medical benefits. Since then, federal restrictions have been loosened somewhat, and a small number of studies have gone forward, but that happened because the passage of ballot initiatives forced the government to acknowledge the need for research. To put it in perspective, the federal government has refused to study the patients to whom it has provided medical marijuana for more than 30 years as part of an investigative new drug program. If the political pressure created by ballot initiatives and legislative proposals subsides, the feds will surely go back to their old, obstructionist ways.

All medical marijuana research must use marijuana supplied by the National Institute on Drug Abuse, which is known for its very poor quality. This low-grade marijuana has less efficacy and more side effects than the marijuana that is now available through medical marijuana dispensaries. Scientists and activists have appealed to the Drug Enforcement Administration to allow other sources of marijuana to be used, and in 2007, DEA Administrative Law Judge Mary Ellen Bittner ruled that a proposed University of Massachusetts project to grow and study marijuana for medical purposes should be allowed to proceed. But the DEA did not follow Bittner’s ruling and has given no indication that it intends to do so. The U.S. government remains the largest single obstacle to medical marijuana research.

State medical marijuana laws violate federal law.

Since late 2014, Congressional appropriations bills have prohibited the Department of Justice (including the DEA) from using funds to interfere in the implementation of laws that allow the cultivation, distribution, and use of marijuana for medical purposes.⁷⁷ A federal court of appeals ruling found that this provision was applicable not only to state government programs, but to individuals and groups that are acting in compliance with state laws.⁷⁸
States are not required to enforce federal laws against marijuana possession or cultivation. The Controlled Substances Act (CSA) specifically allows states to enact their own laws related to controlled substances, and states are free to determine their own penalties — or lack thereof — for drug offenses.
State government employees have never faced punishments for carrying out state medical marijuana laws — even in situations when law enforcement officials have returned seized marijuana to the owners. Following the passage of a medical marijuana law in Arizona, Gov. Jan Brewer filed a lawsuit claiming the state could not implement the law because state employees would face prosecution. In a reply brief, the Department of Justice basically said the fears were unfounded.

The courts have ruled marijuana is not medicine and states cannot legalize medical marijuana.

No court has ruled that marijuana is not medicine, and no court has ruled that states cannot adopt and implement medical marijuana laws.

The majority opinion in the Supreme Court’s June 2005 decision in Gonzales v. Raich stated unequivocally that “marijuana does have valid therapeutic purposes.” The ruling did not overturn state medical marijuana laws or prevent states from enacting new ones. It simply preserved the status quo — states can stop arresting medical marijuana patients and caregivers under state law, but these laws don’t create immunity from federal prosecution. The Supreme Court’s other ruling related to medical marijuana — a 2001 case involving a California medical marijuana dispensary — did not overturn state medical marijuana laws. It simply declared that under federal law, those distributing medical marijuana could not use a “medical necessity” defense in federal court. This extremely narrow ruling did not in any way curb the rights of states to protect patients under state law.

In both cases, the court went out of its way to leave open the possibility that individual patients could successfully present a “medical necessity” claim.

The U.S. Department of Justice has never tried to challenge the rights of states to enact medical marijuana laws.

¹ Quinnipiac University Poll, “Republicans Out Of Step With U.S. Voters On Key Issues, Quinnipiac University National Poll Finds; Most Voters Support Legalized Marijuana,” February 23, 2017: 13.
²National Academies of Sciences, Engineering, and Medicine. “The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research,” (2017).
³ Institute of Medicine, Marijuana and Medicine: Assessing the Science Base (Washington, D.C.: National Academy Press, 1999), 159.
⁴ “Completed Studies,” Center for Medicinal Cannabis Research, University of California, San Diego. http://www.cmcr.ucsd.edu/index.php?option=com_content&view=category&id=41&Itemid=135
⁵ Abrams, D., Jay, C., Shade, S., Vizoso, H., Reda, H., Press S., Kelly M., Rowbotham M., and Petersen, K., “Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial,” Neurology 68: 515-521.
⁶ Wilsey, B. et al., “A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain.” The Journal of Pain 9(6): 506-521.
⁷ Ellis, R.J. et al., “Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial,” Neuropsychopharmacology. Published online ahead of print, August 6, 2008.
⁸ Abrams D., et al., “Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial,” Neurology 68 (2007): 515-521.
⁹ Wallace, M., et al., “Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers,” Anesthesiology 107(5) (2007): 785-796.
¹⁰ Wallace, M., et al., “Effect of smoked cannabis on painful diabetic peripheral neuropathy,” The Journal of Pain 16(7) (2015): 616-627.
¹¹ Wilsey, B., et al., “Low-dose vaporized cannabis significantly improves neuropathic pain,” The Journal of Pain 14(2) (2013): 136-148.
¹² “Medical Cannabis in the Treatment of Chronic Pain,” The Research Institute of the McGill University Health Centre, September 29, 2015.
¹³ Ware, M., et al., “Cannabis for the Management of Pain: Assessment of Safety Study,” The Journal of Pain 16(12) 2015: 1233-1242.
¹⁴ Sarfaraz et al., “Cannabinoids for Cancer Treatment: Progress and Promise,” Cancer Research 68 (2008): 339-342.
¹⁵ Sylvestre D., Clements B., Malibu Y., “Cannabis use improves retention and virological outcomes in patients treated for hepatitis C,” European Journal of  Gastroenterology & Hepatology 18 (2006): 1057-1063.
¹⁶ Naftali, T., et al., “Treatment of Crohn’s Disease with Cannabis: An Observational Study,” Israel Medical Association Journal 13(8) (2011): 455-8.
¹⁷ “In the Matter of Marijuana Rescheduling Petition,” DEA Docket No. 86-22, September 6, 1988.
¹⁸ American College of Physicians, “Supporting Research into the Therapeutic Role of Marijuana,” 2008.
¹⁹Hoeffel, John, “Medical Marijuana Gets a Boost From Major Doctors Group,” Los Angeles Times, November 11, 2009.
²⁰ Elders, Joycelyn, “Myths About Medical Marijuana,” Providence Journal, March 26, 2004.
²¹ Adler, Jonathan N. & James A. Colbert, “Medicinal Use of Marijuana — Polling Results,” New England Journal of Medicine 368 (2013): 30.
²² “Partial List of Organizations with Favorable Medicinal Marijuana Positions,” State-By-State Report, Marijuana Policy Project, 2016.
²³ Institute of Medicine, 159.
²⁴ Institute of Medicine, 3-4.
²⁵ Institute of Medicine, 153.
²⁶Baker, David, et al., “The Therapeutic Potential of Cannabis,” The Lancet Neurology 2 (May 2003): 291-298.
²⁷American College of Physicians, “Supporting Research into the Therapeutic Role of Marijuana,” 2008.
²⁸Izzo A.A., et al. “Non-Psychotropic Plant Cannabinoids: New Therapeutic Opportunities From an Ancient Herb,” Trends in Pharmacological Sciences 30(10), 2009: 515-527.
²⁹ Mechoulam R., et al., “Cannabidiol — Recent Advances, ” Chemistry and Biodiversity 4 (2007): 1678-1692.
³⁰“Report on the Possible Medical Uses of Marijuana,” NIH medicinal marijuana expert group, Rockville, MD, National Institutes of Health, August 8, 1997; notes 8, 89.
³¹Institute of Medicine, 7.
³²Abrams, D.I., et al., “Vaporization as a Smokeless Cannabis Delivery System: A Pilot Study,” Clinical Pharmacology and Therapeutics, April 11, 2007.
³³Earleywine, M., Barnwell, S.S., “Decreased Respiratory Symptoms in Cannabis Users Who Vaporize,” Harm Reduction Journal 4 (2007): 11.
³⁴GW Pharmaceuticals, “Product Monograph: Sativex,” April 13, 2005, 27.
³⁵Harris, Gardiner, “FDA Dismisses Medical Benefit From Marijuana,” The New York Times, April 21, 2006.
³⁶Radley, David C., Finkelstein Stan N., and Stafford, Randall S., “Off-label Prescribing Among Office-Based Physicians," Archives of Internal Medicine 166 (9), 2006: 1021–1026.
³⁷ Institute of Medicine, 5.
³⁸American College of Physicians, “Supporting Research into the Therapeutic Role of Marijuana,” 2008.
³⁹National Academies of Sciences, Engineering, and Medicine. “The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research,” (2017).
⁴⁰Sidney S., et al., “Marijuana Use and Mortality,” American Journal of Public Health 87(4), April 1997: 585-590.
⁴¹Carter, Gregory T., et al., “Medicinal Cannabis: Rational Guidelines for Dosing,” IDrugs 7(5), 2004: 464-470.
⁴²Guarino, Mark, “Prescription drug abuse now more deadly than heroin, cocaine combined,” Christian Science Monitor, October 7, 2013.
⁴³ Fontana, Robert J., “Acute Liver Failure including Acetaminophen Overdose,” Medical Clinics of North America 92(4), 2008: 761-794.
⁴⁴ Letter from Beverly Urbanek, Research Associate of the University of Mississippi Research Institute of Pharmaceutical Sciences (601-232-5914), to Dr. G. Alan Robison, Drug Policy Forum of Texas, June 13, 1996.
⁴⁵National Academies of Sciences, Engineering, and Medicine. “The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research,” (2017).
⁴⁶Institute of Medicine, Marijuana and Medicine: Assessing the Science Base (Washington, D.C.: National Academy Press, 1999).
⁴⁷ Sidney, et al., “Marijuana Use and Cancer Incidence,” Cancer, Causes, and Control 8 (1997): 722–28.
⁴⁸ Hashibe, et al., “Marijuana Use and the Risk of Lung Cancer and Upper Aerodigestive Tract Cancer: Results of a Population-based Case-control Study,” Cancer Epidemiology Biomarkers and Prevention 15 (2006): 1829–34.
⁴⁹Mark Kaufman, “Study Finds No Cancer-Marijuana Connection,” The Washington Post, May 26, 2006.
⁵⁰ Sarfaraz, et al., “Cannabinoids for Cancer Treatment: Progress and Promise,” Cancer Research 68 (2008): 339–42.
⁵¹ Manuel Guzman, “Cannabinoids: Potential Anticancer Agents,” Nature Reviews Cancer 3 (2003): 745–755.
⁵² Institute of Medicine, 109.
⁵³ Institute of Medicine, 126.
⁵⁴ Abrams D., et al., “Short-Term Effects of Cannabinoids in Patients With HIV-1 Infection,” Annals of Internal Medicine 139 (2003): 258-266.
⁵⁵Di Franco, M.J., et al., “The Lack of Association of Marijuana and Other Recreational Drugs With Progression to AIDS in the San Francisco Men’s Health Study,” Annals of Epidemiology 6(4), 1996: 283-289.
⁵⁶ Romeyn, Mary, Nutrition and HIV: A New Model for Treatment, Second Edition (San Francisco: Jossey-Bass, 1998), 117-118.
⁵⁷“Transcripts of Open Discussions Held on February 20, 1997, Book Two, Tab C, Pp. 96-97; Washington, D.C.: ACE-Federal Reporters, Inc.
⁵⁸Hall, W., Degenhardt L., “What are the policy implications of the evidence on cannabis and psychosis?,” Canadian Journal of Psychiatry 51(9), August 2006: 566-574.
⁵⁹ Power, R. A., et al., “Genetic predisposition to schizophrenia associated with increased use of cannabis,” Molecular Psychiatry 19 (2014): 1201-1204.
⁶⁰ Hall, W., “Is Cannabis Use Psychotogenic?,” The Lancet, vol. 367, January 22, 2006.
⁶¹Frisher, M., et al., “Assessing the Impact of Cannabis Use on Trends in Diagnosed Schizophrenia in the United Kingdom from 1996 to 2005,” Schizophrenia Research, Vol. 113, September 2009.
⁶²Proal, Ashley C. et al., “A controlled family study of cannabis users with and without psychosis,” Schizophrenia Research 152 (2014): 283-288.
⁶³Hasin, Deborah S, et al., “Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys,” The Lancet Psychiatry, Vol. 2, Issue 7, 601-608.
⁶⁴ Anderson, D. Mark, Hansen, Benjamin, and Rees, Daniel I., “Medical Marijuana Laws and Teen Marijuana Use,” Institute for the Study of Labor, May 2012.
⁶⁵O’Keefe, Karen, et al., “Marijuana Use by Young People: The Impact of State Medical Marijuana Laws,” Marijuana Policy Project, June 2011.
⁶⁶Centers for Disease Control and Prevention, 1991-2013 High School Youth Risk Behavior Survey Data. Available at http://www.cdc.gov/healthyyouth/data/yrbs/index.htm.
⁶⁷“Report to Attorney General Bill Lockyer, 11th Biennial California Student Survey, Grades 7, 9 and 11,” WestEd, 2006.
⁶⁸ Skager, Rodney, Austin, Greg, and Wong, Mamie, “Marijuana Use and the Response to Proposition 215 Among California Youth, a Special Study From the California Student Substance Use Survey (Grades 7, 9, and 11), 1997-1998.”
⁶⁹ General Accounting Office, “Report to the Chairman, Subcommittee on Criminal Justice, Drug Policy and Human Resources, Committee on  Government Reform, U.S. House of Representatives. Marijuana: Early Experiences With Four States’ Laws that Allow Use for Medical Purposes,” Washington, D.C.: GAO, 2002, p. 32.
⁷⁰ See: “Medical Marijuana Patient Numbers, Marijuana Policy Project, https://www.mpp.org/issues/medical-marijuana/state-by-state-medical-marijuana-laws/medical-marijuana-patient-numbers/.
⁷¹“Study shows 70 percent of Americans take prescription drugs,” CBS News, June 20, 2013; Seth Motel, “6 facts about marijuana” Pew Research Center, April 14, 2015.
⁷²Marijuana Policy Project, “Proposition 215 10 Years Later: Medical Marijuana Goes Mainstream,” November 2006.
⁷³ Chu, Yu-Wei Luke and Townsend, Wilburn. “Joint Culpability: The Effects of Medical Marijuana Laws on Crime,” February 2017: 1.
⁷⁴Ingold, John, “Analysis: Denver pot shops’ robbery rate lower than banks,” Denver Post, January 27, 2010.
⁷⁵Rodgers, Jakob, “Marijuana shops not magnets for crime, police say,” Colorado Springs Gazette, September 13, 2010.
⁷⁶ United States Department of Justice, Federal Bureau of Investigation, Crime in the United States, 2019, September 2020.
⁷⁷Pub. L. 113-235, 128 Stat. 2130 (2014) (“2015 Appropriations Act”).
⁷⁸ U.S. v. McIntosh 833 F.3d 1163 (9th Cir, 2016).

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