History of medical marijuana policy in US

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  • International Journal of Drug Policy 10 (1999) 319–328 History of medical marijuana policy in US� Kevin B. Zeese 1 Common Sense for Drug Policy Foundation, 3619 Tallwood Terrace, Falls Church, VA 22041, USA www.elsevier.com:locate:drugpo 1. Introduction The medical use of marijuana has been subject to a long, contentious policy debate since the mid-1970s when Robert Randall became the first person to succeed in defending himself against marijuana charges using a medical necessity defence.2 He later filed suit seeking access to medical marijuana and in a settlement with the federal government was granted access under the Compassionate In- vestigational New Drug (IND) program of the Food and Drug Administration. Randall’s success highlighted an issue that had been simmering since 1972 when the National Organization for the Reform of Mar- ijuana Laws (NORML) filed a petition with the Bureau of Narcotics and Dangerous Drugs (BNDD), the predecessor to the US Drug Enforcement Administration (DEA), to reschedule marijuana under the Controlled Substances Act (CSA). When the Act was created in 1970 marijuana was placed in Sched- ule I of the CSA, a classification reserved for drugs with ‘no accepted medical use in treat- ment in the United States’. Marijuana remains a Schedule I drug today. During the nearly 30-year history of the CSA, legal, regulatory, research and legislative battlegrounds over medical marijuana have emerged. Unfortu- nately, the losers thus far have been the sick and dying patients who have been denied by the federal government legal access to a legit- imate and often highly effective medicine. 2. Litigation The BNDD rejected NORML’s initial peti- tion out of hand claiming that rescheduling � This paper has been peer reviewed. 1 Zeese litigated the placement of marijuana in Schedule I of the US Controlled Substances Act with the DEA for many years. Initially he got involved in this litigation in 1978 when he was at George Washington University Law School in Washington, DC. He went on to become the Chief Counsel and Executive Director of the National Organization for the Reform of Marijuana Laws which had petitioned the DEA to reschedule marijuana. After he left NORML he started the Drug Policy Foundation with Arnold Trebach. Zeese contin- ued to represent NORML in litigation over medical marijuana until the mid-1990s. Throughout his career Zeese has worked with patients and doctors seeking medical marijuana and advised patients who had been arrested for their medical use of marijuana. Zeese is author of a review of marijuana research entitled: ‘Research Findings of Medicinal Marijuana Proper- ties’ (1997) which can be viewed at: www.csdp.org. 2 US. v Randall, 104 Wash. Daily L. Rep. 2249 (D.C. Super. Ct. 1976). Over the years other patients have succeeded in raising the medical necessity defence as well, see, e.g. State versus Diana, 604 P.2d 1312 (Ct. App. Wash. 1979); Jenks versus State, No. 90-2462 (Ct. App. 1st Dist., Fla. Apr. 16, 1991); State versus Mussika, No. 88-4395 CFA (17th Judicial Cir., Broward County, Dec. 1988). 0955-3959:99:$ - see front matter © 1999 Elsevier Science B.V. All rights reserved. PII: S0955 -3959 (99 )00031 -6
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328320 marijuana would violate treaty obligations.3 The BNDD held no hearings on this issue, nor did they evaluate the scientific evidence. NORML appealed the decision to the US Court of Appeals (the CSA requires that reviews of agency decisions on petitions go directly to the federal appeals court4). On January 15, 1975 the court ruled in NORML’s favor, reversing the decision of the Agency and remanding the case for further consideration, finding that international treaties did not bar rescheduling.5 The court used strong language to criticize the agency for failing to hold hearings and ordered the agency to reconsider the petition. Twenty months later, after the Court’s first ruling, the DEA published an order denying the petition ‘in all aspects’,6 acknowledging the possibility of rescheduling marijuana but maintaining the inappropriateness of this measure. Once again NORML appealed. For a second time the Court of Appeals ruled against the agency7 and again the court was critical of the DEA.8 This time the court criticized the DEA for failing to obtain the scientific and medical evaluation of the NORML petition by the Department of Health Education and Welfare (HEW; the predecessor to the Department of Health and Human Services (HHS)). The court noted that the review of the science by HEW was mandated by the Controlled Substances Act9 and remanded the petition to the agency for another review. In response to the remand the DEA sent the NORML petition to HEW for consideration. HEW’s Controlled Substances Advisory Committee recommended that components of marijuana (cannabinol and cannabidiol) be rescheduled. HEW took no further action over the next year despite repeated requests by NORML. On March 28, 1979, NORML filed a complaint in the US District Court alleging that HEW had unreasonably delayed the action on the NORML petition.10 Shortly after this suit was filed HEW sent its scientific evaluation to DEA. NORML and HEW entered a stipulation dismissing the lawsuit. The HEW evaluation concluded that marijuana and all its components could be properly placed in Schedule I or Schedule II of the Controlled Substances Act but recommended it be retained in Schedule I.11 Ten days after receipt of the HEW evaluation, DEA denied the NORML petition in all respects.12 Once again NORML appealed. Prior to argument the DEA sought a remand of part of the NORML petition concerning THC. The federal government wanted to make THC available in an attempt to relieve the mounting political pressure in support of marijuana. For a third time, the Court reversed the decision of the DEA and remanded the entire case for reconsideration. The Court was criti- cal of the process of the DEA and ordered HEW to make ‘scientific and medical find- ings’ on ‘all substances at issue… consistent 3 37 Fed. Reg. 18093 (Sept. 1, 1972). 4 21 U.S.C. Sec. 877. 5 NORML versus Ingersoll, 497 F.2d 654 (D.C. Cir. 1974). 6 40 Fed. Reg. 44164, 44168 (Sept. 25, 1975). 7 It is important to note that the general rule in administra- tive law is to favor the decision of the agency. He court views the agency as the expert and does not like to substitute its judgment for the decision of the expert. Thus, succeeding twice in getting a remand was an unusual occurence. 8 NORML versus DEA, 559 F.2d 735 (D.C. Cir. 1977). 9 21 U.S.C. Sec. 811 (a)–(c), 559 F. 2d 747–48. 10 NORML versus HEW, Civ. Act. No. 79-0898 US District Court for the District of Columbia. 11 44 Fed. Reg. 36127 (June 4, 1979). 12 44 Fed. Reg. 36123 (June 20, 1979).
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328 321 with both this order and the prior orders of the court’.13 The Court went on to reprimand the DEA, stating: We regrettably find it necessary to remind respondents of an agency’s obligation on remand not to ‘do anything which is con- trary to either the letter or spirit of the mandate continued in the light of the opin- ion of (the) court deciding the case.’ (cita- tion omitted).13 3. Legislative developments circa 1978–1982 With the litigation with the DEA ongoing, legislative action concerning medical mari- juana quickly emerged at the state level. The Alliance for Cannabis Therapeutics, led by Robert Randall and his partner Alice O’Leary, worked with patients across the United States on legislation. Between 1978 and 1982, 33 states passed laws to make marijuana available to their seriously ill citi- zens. These laws were setup as research pro- grams, consistent with federal law14. Once a state passed a law, its state department of health or a similar agency had to apply to the federal government to acquire marijuana from the IND program. This was not an easy task but several states succeeded in meeting the requirements of the FDA, DEA and the National Institute on Drug Abuse. By 1984, 17 states had active INDs for medical marijuana15 and up to 10 000 medical mari- juana cigarettes had been supplied annually by NIDA.16 These state programs allowed hundreds of patients each year to get marijuana as well as a wealth of information about its medical uses. The health departments of six states— California, Georgia, New Mexico, New York, Michigan and Tennessee—conducted studies focusing on the anti-emetic properties of marijuana for cancer patients under re- search protocols approved by the US Food and Drug Administration. The studies com- pared marijuana to prescription anti-emetics, including synthetic THC or Marinol. In each study, marijuana was found to be an effective and safe anti-emetic that for many patients is more effective than other available drugs. 3.1. New Mexico This study, which involved 250 patients, compared marijuana to THC capsules. In order to participate in the research, according to the protocol approved by the FDA in 1978, patients had to be referred by a physi- cian and have failed on at least three other anti-emetics. Patients were permitted to choose marijuana or the THC pill. Both ob- jective (e.g. frequency of vomiting, amount of vomiting, muscle biofeedback, blood sam- ples) and subjective measures were used to determine the effectiveness of the drug. The study concluded that marijuana was not only an effective anti-emetic but also far superior to the best available conventional drug, Compazine, and clearly superior to synthetic THC pill. The study found that ‘‘[m]ore than 90% of the patients who re- 13 NORML versus DEA, No. 79-1660 (D.C. Cir. Oct. 15, 1980). 14 Initial drafts of bills would have made marijuana legally available as a prescription drug, but the federal government saw these drafts and mounted an aggressive lobbying cam- paign and convinced the states that the only way for them to legally make marijuana available was as part of a research program. The federal government would provide the mari- juana for these research programs through the Compassionate IND program which had been created as part of the settlement in Robert Randall’s case. 15 Affidavit of Edward Tocus, In the Matter of Marijuana Rescheduling Petition, Dkt. No. 86-22, July 24, 1987. 16 Affidavit of Richard Hawks, In the Matter of Marijuana Rescheduling Petition, Dkt. No. 86-22, July 24, 1987.
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328322 ceived marijuana... reported significant or to- tal relief from nausea and vomiting and had no major adverse side effects. Only three patients reported adverse reactions, none of these reactions involved marijuana alone. The 1984 report concluded… the data accu- mulated over all 5 years of the program’s operation do show that marijuana smoked resulted in a higher percentage of success than does THC ingested’’.17 3.2. Michigan The Michigan research, which involved 165 patients, compared marijuana to Torecan. Upon admission to the program patients were randomly assigned to a control group, a conventional anti-emetic Torecan group or a marijuana group. When failure on the initial randomized drug occurred, patients could elect to crossover to an alternate therapy. This procedure allowed the Michigan De- partment of Health to evaluate how well patients responded to both drugs and allowed patients to register their preference. The Michigan study found that 71.1% of the patients who received marijuana reported no emesis to moderate nausea. Ninety per- cent of the patients receiving marijuana elected to remain on marijuana and only eight of 83 patients randomized to marijuana chose to alter their mode of anti-emetic ther- apy. In contrast, among patients randomized to Torecan, more than 90% or 22 out of 23 patients, elected to discontinue use and switched to marijuana.18 Very few serious side effects were traced to marijuana and the most common side effect, increased appetite reported by 32.3% of patients, was positive. The most common negative effects were sleepiness, reported by 21 patients and sore throat, reported by 13 patients. 3.3. Tennessee This study, which involved 27 patients, all of whom had failed on other forms of anti- emetic therapy including oral THC, found an overall success rate of 90.4% for marijuana inhalation therapy. In comparison it found a 66.7% success rate for THC capsules. In the under 40 age group, the study found a 100% success rate for marijuana inhalation therapy. In sum, the researchers found ‘‘both mari- juana smoking and THC capsules to be effec- tive anti-emetics… We found that the major reason for smoking failure was smoking in- tolerance; while the major reason for THC capsule failure was nausea and vomiting so severe that patient could not retain the capsule.’’19 3.4. New York In describing the purpose of the marijuana research program the New York Department of Health stated: ‘‘[t]he program is a large- scale (Phase III) cooperative clinical trial…’’20 The central question addressed is 19 Annual Report: Evaluation of Marijuana and Tetrahy- drocannabinol in the Treatment of Nausea and:or Vomiting Associated with Cancer Therapy Unresponsive to Conven- tional Anti-Emetic Therapy: Efficacy and Toxicity. Board of Pharmacy, State of Tennessee, July 1983. 20 Phase III is the final stage of the FDA drug approval process. See footnote 25. The New York State Department of Health stated that [t]he program is a large-scale (phase III) cooperative clinical trial...‘ see: Evaluation of the Anti-emetic Properties of Inhalation Marijuana in Cancer Patients Receiv- ing Chemotherapy Treatment,’ New York Department of Health, Office of Public Health, Chapter 810, Laws of 1980 Article 33-A, Public Health Law, September, 1981, at 3 cited in Randall, R.C. (editor), Marijuana, Medicine and the Law Volume II, Galen Press, 1989, page 47. 17 The Lynn Pierson Therapeutic Research Program, the Behavioral Health Sciences Division, Health and Environment Department, March 1983 and 1984. 18 Michigan Department of Public Health Marijuana Thera- peutic Research Project, Trial A 1980–81, Department of Social Oncology, Evaluation Unit, Michigan Cancer Founda- tion (March 18, 1982).
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328 323 ‘‘[h]ow effective is inhalation marijuana in preventing nausea and vomiting due to chemotherapy in patients… who have failed to respond to previous anti-emetic therapy?’’ By 1985, the New York program had ex- tended marijuana therapy to 208 patients through 55 practitioners. They received a total of 6044 NIDA-supplied marijuana cigarettes during 514 treatment episodes. Ultimately, 199 patients were evaluated. In percentage terms the results were stunning: North Shore Hospi- tal reported marijuana was effective at reduc- ing emesis 92.9% of the time; Columbia Memorial Hospital reported efficacy of 89.7%; Upstate Medical Center, St. Joseph’s Hospital and Jamestown General Hospital reported significant benefits among all patients smoking marijuana. The report concludes: ‘‘Patient evaluations have indicated that approximately 93% of marijuana inhalation treatment episodes are reported to be effective or highly effective when compared to other antiemetics.’’ The New York study reports no serious adverse side effects. No patient receiving marijuana required hospitalization or any other form of medical intervention (Vinciguerra et al., 1988). 3.5. Georgia The Georgia program, which evaluated 119 patients, compared THC to standardized smoking of marijuana and with patient-con- trolled smoking. To enter the program a pa- tient had to have failed on other anti-emetics. Patients were randomized to either patient- controlled smoking of marijuana, standard- ized smoking of marijuana or THC pills. The report found that both THC and mar- ijuana were effective in providing anti-emetic relief for patients who were previously unre- sponsive to anti-emetics. Patient controlled smoking of marijuana was successful in 72.2%, standardized smoking was successful in 65.4% and THC was effective in 76% of the cases. In comparing the reasons for failure between marijuana and THC the report found: The primary reasons for failure of THC capsules were due to either adverse reac- tion (six out of 18) or failure to improve nausea and vomiting (nine out of 18). The primary reason for failure of smoking mar- ijuana were due to smoking intolerance (six out of 14) or failure to improve the nausea and vomiting (three out of 14)21. 3.6. California California conducted a series of studies from 1981 through 1989. Annual reports were sub- mitted to the FDA, state legislature and Gov- ernor. Each year approximately 90 to 100 patients received marijuana. The California research was described as a Phase III trial.22 21 See, Evaluation of the Anti-emetic Properties of Inhala- tion Marijuana in Cancer Patients Receiving Chemotherapy Treatment,’ New York Department of Health, Office of Public Health (Annual Reports). Kutner, Michael H., Evaluation of the Use of Both Marijuana and THC in Cancer Patients for the Relief of Nausea and Vomiting Associated with Cancer Chemotherapy After Failure of Conventional Anti-Emetic Therapy: Efficacy and Toxicity‘‘ as prepared for the Com- posite State Board of Medical Examiners, Georgia Depart- ment of Health, by physicians and researchers at Emory University, Atlanta, (January 20, 1983). 22 In describing Phase III research, the final phase before market approval, the California Research Among the safeguards for developing an investigational new drug is a step-wise testing process: the drug is tested in animals before humans, in normal volunteers before pa- tients, and in small groups of people before large groups. Preclinical refers to non-human experiments, e.g., toxicity and pharmacology experiments in animals. Phase I is con- ducted in small numbers of normal human volunteers to determine dosage levels and other pharmacologic parame- ter. Phase II clinical trials typically involve small numbers of patients and comparisons to other treatment. Phase III is confirm effectiveness and to assess adverse effects in a large and diverse patient population. Phase IV is used to describe post-marketing reporting on drug safety and effectiveness. Eleventh Annual Report for 1980 to the Governor and Legislature, CRAP, San Francisco, 1981 at 5. Advisory Panel stated:
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328324 The study protocol stipulated that patients who received marijuana had to be over 15 years of age whereas the THC pill patients had only to be over 5 years of age. They had to be marijuana experienced, receiving rarely used and severe forms of chemotherapy. They were required to use the drug in the hospital. Despite stricter controls on marijuana, the study consistently found it to be an effective anti-emetic. In 1981 the California Research Advisory Panel reported: ‘‘Over 74% of the cancer patients treated in the program have reported that marijuana is more effective in relieving their nausea and vomiting than any other drug they have tried.’’ In 1982, a 78.9% effectiveness rate was found for smoked mar- ijuana. By 1983 the report was conclusive in its findings, stating: The California Program also has met its research objectives. Marijuana has been shown to be effective for many cancer chemotherapy patients, safe dosage levels have been established and a dosage regi- men which minimizes undesirable side ef- fects has been devised and tested. The California Research Advisory Panel continued to review data on marijuana until 1989 with similar results.23 As noted, the research conducted as a re- sult of passage of nearly three dozen state laws through the federal government’s IND program had moved marijuana research to the final phase of review prior to approval of the drug for prescription availability. The momentum was building and the federal gov- ernment had to act to slow the movement for medical marijuana. 4. Back to the legal arena Although the US Court of Appeals re- versed and remanded the DEA for the third time in 1980, the agencies took no action on the NORML petition. On June 22, 1981 NORML filed an Emergency Motion to Compel Compliance with the court’s order. The agencies responded that they were taking action on THC alone because they expected a pharmaceutical company to file a New Drug Application (NDA) for the drug. Three days after NORML filed with the Court of Ap- peals, the NDA was filed. In response to the NORML motion the FDA stated that it planned a ‘legislative type hearing’ concerning natural marijuana.24 On March 9, 1982, the FDA published a pro- posed scheduling of THC.25 The agencies continued to take no action on medical mari- juana. NORML once again filed an Emer- gency Motion to Compel Compliance in April 1982. In response the Court ordered the agencies to submit a report to the Court every 90 days on the progress on NORML’s petition.26 Finally on May 13, 1983, HHS recommended that marijuana remain in Schedule I. NORML wrote to DEA requesting hear- ings on the rescheduling of THC, which could have delayed availability of THC for up to 2 years. The DEA agreed to request hearings on natural marijuana if NORML did not request hearings on THC. On April 1, 1986, DEA wrote the Chief Administrative law judge of DEA, Francis L. Young, re- questing hearings on natural marijuana. On 24 A legislative type hearing is an administrative law term of art. It involves a hearing on the record, with witnesses before an administrative law judge who makes a recommendation to the Administrator of the agency. 25 47 Fed. Reg. 10080 (March 9, 1982). 26 NORML versus DEA, 79-1660 (D.C. Cir. 1982). 23 Annual Report of the California Research Advisory Panel submitted to the Governor and Legislature from 1981 (Twelfth Annual Report) to 1989 (Twentieth Annual Report).
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328 325 June 24, 1986 hearings were announced in the Federal Register.27 After 14 years of litiga- tion, three reversals of the agency by the US Court of Appeals and numerous other legal actions, NORML finally got hearings on the medicinal use of marijuana. 5. Hearings before the DEA The hearings commenced in 1986. The is- sue the court considered was whether the marijuana plant, considered as a whole, could be transferred from Schedule I to Schedule II of the Controlled Substances Act. Two sub issues that had to be considered in order to make this determination were: (1) whether the marijuana plant has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions; and (2) whether there is a lack of accepted safety for use of marijuana under medical supervision. As part of the hearing procedures 59 witnesses sub- mitted sworn statements, along with numer- ous documents. Hearings were held from November 1987 to February 1988 in Wash- ington, DC, San Francisco and New Orleans to cross-examine the witnesses chosen by the parties. On September 6, 1988 Judge Young issued his opinion.28 Judge Young recommended that marijuana be rescheduled to Schedule II of the CSA. In making this ruling Judge Young stated: There are those who, in all sincerity, argue that the transfer of marijuana to Schedule II will ‘send a signal’ that marijuana is ‘OK’ generally for recreational use. This argument is specious. It presents no valid reason for refraining from taking an action required by law in light of the evidence. If marijuana should be placed in Schedule II, in obedience to the law, then that is where marijuana should be placed, regardless of misinterpretation of the placement by some. The reason for the placement can, and should, be clearly explained at the time the action is taken. The fear of sending such a signal cannot be permitted to over- ride the legitimate need, amply demon- strated in this record, of countless sufferers for the relief of marijuana can provide when prescribed by a physician in a legiti- mate case. The evidence in this record clearly shows that marijuana has been accepted as capa- ble of relieving the distress of great number of very ill people, and doing so with safety under medical supervision. It would be un- reasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefit of this substance in light of the evidence in this record.29 Judge Young’s ruling was a recommenda- tion. The final decision was left to the Ad- ministrator of the DEA. Within days of the ruling the DEA sent a cable to all field offices saying: ‘‘DEA will be filing vigorous excep- tion to the findings’’ (Randall and O’Leary, 1998, p. 295). On December 29, 1989 the DEA made it official, publishing its decision in the Federal Register rejecting Judge27 51 Fed. Reg. 22946 (June 24, 1986). 28 In the Matter of Marijuana Rescheduling Petition, No. 86-22, (September 6, 1988, Judge Young). A complete copy of the decision, briefs and sworn statements has been published in a two volume set. R.C. Randall, Editor, ‘‘Marijuana, Medicine and the Law, Vol. I and Vol. II. They can be purchased at www.familywatch.org. 29 In the Matter of Marijuana Rescheduling Petition, No. 86-22, (September 6, 1988, Judge Young).
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328326 Young’s recommendations (Randall and O’Leary, 1998, p. 319). Once again an appeal was filed in the US Court of Appeals. This time both the Alliance for Cannabis Therapeutics and NORML filed the appeal. On April 27, 1991 the Court rejected the DEA’s findings and once again ordered them to reconsider. The court was concerned with the standards used by the agency in judging whether marijuana was properly scheduled (Randall and O’Leary, 1998, p. 366). The DEA went back and ‘reconsidered’ their position on medical marijuana and reached the same conclusion. Again, the parties appealed to the US Court of Appeals. This time the DEA finally won.30 The result should not be interpreted as a vindication for DEA, rather as an indication of how adminis- trative law favors the administrative agency. As the expert in the field, courts are only willing to urge reconsideration with appropri- ate standards. Once a satisfactory process is developed it is unlikely the court will substitute its judgment for that of the agency so long as something in the record supports their claim. Of course, there is always something in the record on the agency side since they help create the record. Therefore if the agency wants to keep the status quo, they will almost always be able to do so. But, the numerous remands and the decision of Judge Young sent a strong message to the public, particularly doctors and patients, about the safety and effectiveness of marijuana as medicine. 6. The politics of medical marijuana evolves While litigation continued, the politics of medical marijuana took some twists and turns. Public support for medical marijuana grew, in part due to the attention that litigation and state legislation attracted and in part to peo- ple’s experience with marijuana as a medicine. This produced two reactions. At the federal level access to medical marijuana became even more restricted, at the local level people began to actively seek medical marijuana. The Bush Administration, while fighting the recommendation of Judge Young and seeing research reach the final step before approval, decided to clamp down on access to medical marijuana. At the same time pressure for medical marijuana increased as ACT started a project called the Marijuana AIDS Research Service (MARS). MARS helped AIDS pa- tients and doctors apply for access to medical marijuana. This resulted in hundreds of appli- cations to the FDA. In June 1991 news reports suggested that HHS might close the IND program (Randall and O’Leary, 1998). One year later it became official: the IND program was closed. Patients who had applied as well as those who had been approved but had not yet received medical marijuana were told to try the THC pill. Only the small number of patients who were already receiving marijuana would continue to receive it. The closure of the IND program resulted in not only the denial of much needed medicine to patients but also a halt in the flow of research on medical marijuana. Since then, the federal government’s party line is that: ‘‘There is not enough research to show marijuana is safe and effective.’’ However, it was their own decisions that created the lack. At the local level there were new rumblings. In San Francisco marijuana activists were able to get Proposition P on the ballot, an initiative recognizing medical marijuana. The proposi- tion passed with an astounding 79% of the vote in November 1991. Polling conducted by the ACLU in 1994 found overwhelming support for medical marijuana, support as high as 84%. After the rescheduling litigation failed in 199430 ACT versus DEA, 15 F.3d 1131 (D.C. Cir. 1994).
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328 327 Table 1 The results of the votes of seven jurisdictions who voted on medical marijuana initiatives in 1998 NoYesState Alaska 81 319111 166Proposition 8. Allows the medical use of marijuana. (42.25%)(57.75%) Arizona 385 014Proposition 300. Allows medical use of all Schedule I drugs (No is the reform 517 876 (42.6%) (57.4%)position). Colorado 118 352 (57%) 89 614 (43%)Initiative 19 Allows the medical use of marijuana N.B.: This vote was partially counted and will not count because the state i claimed not enough signatures were gathered. As a result there will be another vote on this in 2000. Nevada 241 463 (59%) 170 234 (41%)Question 9 Allows the medical use of marijuana. Oregon 270 787 (55%) 220 944 (45%)Measure 67 Allows the medical use of marijuana. Washington Initiative 692 Allows medical Use of marijuana. 581 743826 689 (58.70%) (41.30%) Washington DC 31%69%Initiative 59 Allows the medical use of marijuana. N.B.: Congressional action has prevented results from being published. These results are from an indepen- dent exit poll conducted for Americans for Medical Rights (The poll’s margin of error is 3.6 percentage points). a national movement, based on this broad public support, emerged. In 1996 California considered Proposition 215 which protected medical marijuana patients and their providers from prosecution. It passed with 56% of the vote. In Arizona an initiative that medicalized drug control, allowing for prescription of not only marijuana but all other Schedule I drugs, passed with an astounding 62% support. The federal government reacted by digging in its heels and saying no to the state laws, threaten- ing doctors and community-based marijuana dispensaries.31 This resulted in litigation filed by proponents of medical marijuana as well as by the federal government. This litigation is still ongoing. The federal government’s resistance also resulted in more medical marijuana initiatives. In 1998 seven jurisdictions voted on medical marijuana initiatives, six states Alaska, Ari- zona, Colorado, Nevada, Oregon, Washing- ton and Washington, DC. These initiatives were spearheaded by Americans for Medical Rights. In all seven jurisdictions the initiatives passed by large margins (Table 1). In March 1999 the National Academy of Sciences’ Institute of Medicine completed a review of the medical use of marijuana and related issues. The report, ‘Marijuana and Medicine: Assessing the Science Base’, was commissioned by the Office of National Drug Control Policy in response to the successful 31 Statement Released by Barry R. McCaffrey, Director of the Office of National Drug Control Policy, The Administra- tion’s Response to the Passage of California Proposition 215 and Arizona Proposition 200, December 30, 1996, p. 2.
  • K.B. Zeese : International Journal of Drug Policy 10 (1999) 319–328328 ballot initiatives of 1996. The Institute of Medicine is the gold standard of American medicine and it was expected to broadly en- dorse the federal government’s prohibition of marijuana. Instead, the IOM report rec- ognized the therapeutic benefits of medical marijuana and urged that marijuana be made available to individual patients while research continued on the development of new marijuana based drugs. After 30 years of effort we are in many respects at the same place. But the reality is that more and more voters consider mari- juana a medicine. A substantial amount of research supports the view that marijuana is safe and effective. Most patients are aware of its positive health effects and if they need it are able to find it, albeit illegally. At the state and local levels, the laboratories of our democracy, new policies are being put in place. While the federal government con- tinues to oppose medical marijuana they are losing control of the debate. At the same time, the public sees the drug war advocates in the federal government as extreme in their refusal to allow even the most seri- ously ill to have access to a medicine they need. If these advocates are not careful, they may lose not only the medical mari- juana issue but also the marijuana issue in total. References Randall RC, O’Leary AM. Marijuana Rx, The Patients Fight for Medicinal Pot. Thunder’s Mouth Press, 1998. Vinciguerra et al. Inhalation marijuana as an anti- emetic for cancer chemotherapy. New York State J Med, October 1988; 525–527. .

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