For thousands of years, cannabis has been used to treat a wide variety of ailments. Until 1937, cannabis (also known as marijuana) was legal in the United States for all purposes. Presently, even though more than two-thirds of U.S. states have medical cannabis laws, federal law allows only one American to use cannabis as a medicine.
On March 17, 1999, the National Academy of Sciences' Institute of Medicine (IOM) concluded, "[T]here are some limited circumstances in which we recommend smoking marijuana for medical uses." The IOM report, the result of two years of research that was funded by the White House drug policy office, analyzed all existing data on cannabis's therapeutic uses. In its 2017 follow-up review of subsequent research, the National Academy of Sciences, Engineering, and Medicine concluded there is conclusive or substantial clinical evidence of cannabis’ and cannabinoids’ efficacy at alleviating chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis spasticity symptoms.
Cannabis is one of the safest therapeutically active substances known. No one has ever died from an overdose, and it has a wide variety of therapeutic applications, including:
Cannabis has shown to be beneficial in the treatment of the following conditions:
AIDS. Cannabis can reduce the nausea, vomiting, and loss of appetite caused by the ailment itself and by various AIDS medications. Observational research has found that by relieving these side effects, medical cannabis increases the ability of patients to stay on life-extending treatment.
AUTISM. Research has found cannabis treatments can reduce hyperactivity, self-injury, sleep problems, anxiety, restlessness, psychomotor agitation, behavioral problems, and irritability while improving cognition, language, and social interaction.
CANCER. Cannabis can stimulate the appetite and alleviate nausea and vomiting, which are common side effects of chemotherapy treatment. It can also alleviate pain.
CHRONIC PAIN. Cannabis can alleviate chronic, often debilitating pain caused by myriad disorders and injuries. Several published clinical trials have found that cannabis effectively relieves neuropathic pain (pain caused by nerve injury), a particularly hard to treat type of pain that afflicts millions suffering from diabetes, HIV/AIDS, multiple sclerosis, and other illnesses. In addition, a yearlong trial in Canada that was published in 2015 found that cannabis reduced chronic pain and had a reasonable safety profile.
CROHN’S DISEASE. A placebo-controlled clinical trial that was published in 2013 found that complete remission was achieved in five out of 11 subjects who were administered cannabis, compared to one of the 10 who received a placebo.
EPILEPSY. Cannabis can prevent epileptic seizures in some patients.
MULTIPLE SCLEROSIS. Cannabis can limit the muscle pain and spasticity caused by the disease, as well as relieving tremor, unsteadiness of gait, and pain. (Multiple sclerosis is the leading cause of neurological disability among young and middle-aged adults in the United States.)
POST-TRAUMATIC STRESS DISORDER (PTSD). A study of participants in New Mexico’s medical cannabis program with PTSD found a statistically significant decline in the Clinician- Administered PTSD Score (CAPS) for patients using cannabis across all major categories.
Each of these applications has been deemed legitimate by at least one court, legislature, and/or government agency in the United States.
Many patients and loved ones also report that cannabis is useful for treating other conditions, including agitation of Alzheimer's, glaucoma, migraines, opiate addiction, depression, and other debilitating mood disorders.
Cannabis could be helpful for millions of patients in the United States. Nevertheless, other than for a single person with special permission from the federal government, medical cannabis remains illegal under federal law!
People currently suffering from any of the conditions mentioned above, for whom legal medical options have proven unsafe or ineffective, have two options if they live in one of the states without an effective medical cannabis law:
Prior to 1937, at least 27 medicines containing cannabis were legally available in the United States. Many were made by well-known pharmaceutical firms that still exist today, such as Squibb (now Bristol- Myers Squibb) and Eli Lilly. The Marijuana Tax Act of 1937 federally prohibited cannabis. Dr. William C. Woodward of the American Medical Association opposed the Act, testifying that prohibition would ultimately prevent the medical uses of cannabis.
The Controlled Substances Act of 1970 placed all illicit and prescription drugs into five "schedules" (categories). Cannabis was placed in Schedule I, defining it as having a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.
This definition simply does not apply to cannabis. Of course, at the time of the Controlled Substances Act, cannabis had been prohibited for more than three decades. Its medical uses forgotten, cannabis was considered a dangerous and addictive narcotic.
A substantial increase in the number of recreational users in the 1970s contributed to the rediscovery of cannabis's medical uses:
As the word spread, more and more patients started self-medicating with cannabis. However, cannabis's Schedule I status bars doctors from prescribing it and severely curtails research.
THE STRUGGLE IN COURT
In 1972, a petition was submitted to the Bureau of Narcotics and Dangerous Drugs — now the Drug Enforcement Administration (DEA) — to reschedule cannabis to make it available by prescription. After 16 years of court battles, the DEA's chief administrative law judge, Francis L. Young, ruled on September 6, 1988:
"Marijuana, in its natural form, is one of the safest therapeutically active substances known. ..."
"... [T]he provisions of the [Controlled Substances] Act permit and require the transfer of marijuana from Schedule I to Schedule II."
"It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance. ... "
Cannabis's placement in Schedule II or lower could eventually enable doctors to prescribe it to their patients. But top DEA bureaucrats rejected Judge Young's ruling and refused to reschedule cannabis. Two appeals later, petitioners experienced their first defeat in the 22-year-old lawsuit. On February 18, 1994, the U.S. Court of Appeals (D.C. Circuit) ruled that the DEA is allowed to reject its judge's ruling and set its own criteria — enabling the DEA to keep cannabis in Schedule I.
However, Congress has the power to reschedule or de-schedule cannabis via legislation, regardless of the DEA's wishes. It is important that any federal law that reschedules cannabis also preserves state medical cannabis programs and exempting those participating in them from federal criminal laws.
In 1975, Robert Randall, who suffered from glaucoma, was arrested for cultivating his own cannabis. He won his case by using the "medical necessity defense," forcing the government to find a way to provide him with his medicine. As a result, the Investigational New Drug (IND) compassionate access program was established, enabling some patients to receive cannabis from the government.
The program was grossly inadequate at helping the potentially millions of people who need medical cannabis. Many patients would never consider the idea that an illegal drug might be their best medicine, and most who were fortunate enough to discover cannabis's medical value did not discover the IND program. Those who did often could not find doctors willing to take on the program's arduous, bureaucratic requirements.
In 1992, in response to a flood of new applications from AIDS patients, the George H.W. Bush administration closed the program to new applicants, and pleas to reopen it were ignored by subsequent administrations. The IND program remains in operation only for one previously approved patient.
PUBLIC AND PROFESSIONAL OPINION
There is wide support for ending the prohibition of medical cannabis among both the public and the medical community:
CHANGING STATE LAWS
The federal government has no legal authority to prevent state governments from changing their laws to remove state-level penalties for medical cannabis use. Thirty-seven states and the District of Columbia have already done so. State legislatures have the authority and moral responsibility to change state law to:
Even without a change in federal law, states can enact reforms that have the practical effect of removing the fear of patients being arrested and prosecuted under state law and providing safe, regulated access.
U.S. CONGRESS: THE FINAL BATTLEGROUND
Congressional amendments to government funding bills passed since 2014 have prevented the U.S. Department of Justice from using funds to interfere with state medical cannabis laws. However, medical cannabis remains illegal under federal law — even though criminal penalties are not being enforced — creating numerous complications. For example, federal law prohibits cannabis consumers from owning or purchasing guns. Federally subsidized housing can be denied to medical cannabis patients. Medical cannabis businesses cannot deduct business expenses, dramatically driving up prices. And health insurance doesn’t cover federally illegal medications.
Efforts to obtain FDA approval of cannabis remain stalled. Federal policies have prevented researchers from doing the sort of large-scale, extremely costly trials required for FDA approval. Until recently, the National Institute on Drug Abuse (NIDA) was the only legal source of cannabis for clinical research in the U.S. — and NIDA consistently made it difficult (and often nearly impossible) for researchers to obtain cannabis for their studies.
In the meantime, patients continue to suffer. Congress has the power and the responsibility to change federal law so that seriously ill people nationwide can safely access and use medical cannabis without fear of arrest and imprisonment. Dozens of countries — including Australia, Canada, Costa Rica, Germany, and Israel — allow medical cannabis nationwide. It’s past time the United States follow suit.