Legalizing Marijuana: Evolving Medical Use Policy - Research Paper Example

 Legalizing Marijuana: Evolving Medical Use Policy within California, Rhode Island and Massachusetts Abstract Consensus on the medical use of marijuana has evaded physicians, health professionals and those representing a populace trained to think of all drugs as bad and illegal. This paper examines the medical use of marijuana in the United States as an evolving policy in three states--California, Rhode Island, Massachusetts—and the legitimate health care and legal concerns involved in decisions. Discussions and conclusions involving its use as a socially acceptable practical medical remedy are presented in counterpoint to the drug’s identity as a harmful prohibited substance by federal law. Sources cited support and/or explain such policies, providing an eclectic view that clarifies the issue from the legal, social and medical perspectives. Legalizing Marijuana: Evolving Medical Use Policy within California, Rhode Island and Massachusetts The use of marijuana as a medical remedy has been the subject of debate for almost thirty years. The federal government has been wrestling with the question, unable or unwilling to come to terms with a coherent policy for medical professionals, leaving states in the position of determining policy that may or may not in the end be legally acceptable by the federal government, leaving patients and health care professionals in medical limbo. While state’s also wrestle with the question, other questions have been raised as to whether the issue can be legally decided there. The Daily Telegram of Michigan addressed the problem in an editorial. “At issue: Approval of a state petition to allow medical marijuana use. Our view: The issue will go to state voters in November, but action is wasted unless federal officials change their guidelines.” (Daily Telegram, March 2008) The editorial goes on: “...Many patients battling cancer, glaucoma, multiple sclerosis and even AIDS report that cannabis, the drug in marijuana, relieves their suffering without nausea... In 1999, the National Academy of Sciences Institute of Medicine reviewed scientific studies of marijuana's therapeutic uses, and concluded that "there are some circumstances in which smoking marijuana is a legitimate medical treatment...A year ago (2007) the state Democratic Party passed a resolution at its convention that doctors should not be sanctioned for recommending marijuana use, and that seriously ill people should not be subject to criminal sanctions...” (Daily Telegram, March 2008) California While it seems logical to assume some authorities have given their approval to medical use of marijuana, the reality is, federal law prohibits marijuana use. When California passed a law approving medical use it was struck down in a 2005 U.S. Supreme Court decision based on Federal law. “The Supreme Court in 2005 in Raich v. Gonzales ruled that the federal government can prosecute medical marijuana patients, even in states with compassionate use laws (such as California) and several medical marijuana dispensaries in California have since been subject to Drug Enforcement Administration raids.” (Marijuana: The Facts) Despite this decision, Marijuana: The Facts goes on to report that Congress had the option to protected patients and health professionals from prosecution by adding an amendment to the Justice Department spending bill sponsored by Rep. Maurice Hinchey (D-22nd/NY) and Rep. Dana Rohrabacher (R-46th/CA) that would have prohibited the department from spending any money to undermine state medical marijuana laws. The amendment did not pass, but a recent reintroduction and vote saw a significant increase in yes votes—a sign, perhaps, that support is growing on the political level. Ten states currently protect patients from criminal prosecution despite the federal edicts-- Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington. Focusing on California as one state challenging federal law, “Fifty-six percent of voters approved Proposition 215 (compassionate use) on November 5, 1996. The law took effect the following day. It removed state-level criminal penalties on the use, possession and cultivation of marijuana by patients who possess a "written or oral recommendation" from their physician that he or she "would benefit from medical marijuana." (NORML, California: Summary) While the measure (later overturned) allows marijuana patients to possess and/or cultivate the plant, guidelines were set forth in 2003 by the California legislature in Senate Bill 420, which imposes statewide guidelines outlining how much medicinal marijuana patients may grow and possess. Under the guidelines, qualified patients and/or their primary caregivers may possess no more than eight ounces of dried marijuana and/or six mature (or 12 immature) marijuana plants. However, S.B. 420 allows patients to possess larger amounts of marijuana when such quantities are recommended by a physician.” (NORML, California: Amendments) The bill also protects dispensaries and requires the California Department of State Health Services to establish a voluntary medicinal marijuana patient registry, which to date has not been done. Rhode Island Entering the picture a bit later, challenging Governor Carcieri’s 2005 veto of the state’s medical marijuana use bill, the Rhode Island House voted to override the veto, making Rhode Island the 11th state to legalize marijuana for medical use. “Governor Carcieri's concerns notwithstanding, the Supreme Court decision (2005, Raich v. Gonzales) did not actually overturn state law. Rhode Island legislators recognized this and took a second vote to establish the three fifths majority necessary to override the veto.” (Drug Policy News, 2006) "The fact that this override passed by an even larger margin than the original override last year says everything you need to know about how well the law has worked, and how completely uncontroversial it's been, said Ray Warren, director of state policies for the Marijuana Policy Project.” (Stopthedrugwar.org, June 2007). Rhode Island was the first state to legalize medical marijuana since the Supreme Court decision. In June 2005 the Providence Business News reported that the state Senate had approved legislation that protected patients and their primary caregivers who use and prescribe marijuana for medical reasons from arrest. The legislation granted a state ID card that would protect patients from arrest under state drug possession laws, despite the fact that the Supreme Court ruled earlier that federal officials have the authority to enforce federal marijuana laws. Most drug arrests, statistically, come at the state level. The state passed its original bill for legalizing medical use of marijuana in 2006, over the objections and veto by then governor. In 2009, they took the policy one step further. “In a historic first, Rhode Island legislators today made their state the first ever to expand an existing medical marijuana law to allow for state-licensed compassion centers to grow and distribute marijuana to registered patients.” (Salem News.com, June 16 2009) In March of 2009 New Mexico became the first state to grant a license to a medical marijuana producer based on a law allowing the medical use of the drug, prompting Karen O'Keefe, director of state policies for the Marijuana Policy Project in Washington, D.C., to remark, “"We are seeing a historic shift to allowing state-licensed, regulated medical marijuana production and distribution..."(Salem News.com, June 16 2009) In the same month Rhode Island legislators passed a bill that would allow non-profit marijuana stores to sell the drug to patients for medicinal purposes. “If it becomes law, the bill would allow so-called compassion centers to sell marijuana to registered patients with debilitating illnesses. Right now, 680 patients are registered with the Department of Health's medical marijuana program.” (WPRI.com, June 2009) WPRI reports, “Sick patients and their caregivers shouldn’t have to risk their safety and deal with criminals to get the relief they need” said bill sponsor Senator Rhoda Perry (D-Dist. 3, Providence). Rhode Island was compassionate enough a few years ago to recognize the benefit of marijuana for those who are suffering, and I’m proud that we’re now taking the next logical and necessary step and recognizing that patients need a safe, legal means to get it.”(WPRI.com, June 2009) Massachusetts A report in the Daily News of Newburyport states, “On the heels of Rhode Island's recent approval of medical marijuana use, lawmakers here (Massachusetts) are pushing a measure, with the support of some Newburyport-area legislators, that would allow doctors to prescribe marijuana. Backers say people who suffer from debilitating pain and chronic diseases should be able to gain relief without fear of arrest, something 11 states have approved.” (Daily News of Newburyport, January 16, 2006) Massachusetts has had a law on the books since 1992 approving the use of medical marijuana but complications involving supplies and who will provide them have essentially kept the law moot and patients without the medicinal marijuana for illnesses. The state has lagged behind its neighboring state. While legislators were encouraged in 2006 that a law similar to Rhode Island’s would be passed, the plan was shelved for three years until May 2009, when House Bill 2160 regulating the distribution of the substance came under review by a public health committee. Problems surrounding passage of a bill in 2006 or any formal legalization of the practice are set forth in an article in the Daily News of Newburyport. Main objections consisted of opposition by then Governor Mitt Romney; local concerns surround addition in the Merrimack Valley, and, once again, the former decision of the Supreme Court Raich v. Gonzales that state laws allowing the practice are trumped by federal prohibitions against it. Under the recent proposal sponsored by Brookline Democrat Rep. Frank I. Smizik, the state would issue ID cards similar to those proposed in Rhode Island with an original stipulation appointing one caretaker to handle or grow marijuana for a disabled patient. The measure assures control over production of the “product” by the state, a sticking point with some politicians. An important and perhaps troubling caveat for physicians and health care workers places tight restrictions on which afflictions can be treated by the drug, thus removing the decision on the drug’s use from health care professionals. The drug is currently prescribed for HIV/AIDS, severe pain and nausea, multiple sclerosis and Crohn's disease. In June 2009 Rep. Barney Frank formally introduced a bill (HR 2835) to allow states to make their own medical marijuana laws free of federal interference, a move that will undoubtedly open the way for not only Massachusetts, but for other states reluctant to break federal law in order to move ahead with legalizing marijuana for medical use. The bill, if passed, would remove federal interference in state decisions. It would also move the drug into a separate FDA schedule. Marijuana’s current status, Schedule 1, designates it as having no medical value, a high risk of abuse and a harmful substance, making researching its medical benefits difficult if not impossible. Moving the substance to Schedule 2 would recognize its medical value and place it in a new regulatory framework for immediate consideration by the FDA as a candidate for the approval process. Frank’s bill coincides with proposals by the American College of Physicians that”…urges an evidence-based review of marijuana's status as a Schedule I controlled substance to determine whether it should be reclassified to a different schedule. (ACP, Position 4, p 1) The bill, if passed, barring other obstacles, is expected to not only pave the way for the legalization of medical marijuana in the state, but create a path for other states reluctant to break federal law, to move forward with the legalization programs, at least for medical use similar programs. Legalization of the drug under guidelines similar to that applied to alcohol is another matter entirely, but on that may benefit from research that alters its designation as harmful. Issue Statement In examining the policies it is clear that while legalizing marijuana as a valid remedy for various illnesses may be forthcoming, the path to achieving that goal in the face of social and political resistance was and remains an obstacle. Indications are that the Obama administration may be opening the way for changes in federal policy that will make it easier for states to develop their programs free from the fear of federal prosecution for caregivers and patients. Martin Shieff reports “The Obama administration's decision to permit the local dispensation of marijuana in America if it is in compliance with local and state laws is a small move in a complicated jungle of conflicting U.S. legal regulations on drug policy.” (UPI, Shieff, 2009) He goes on to clarify that while the decision does not make the sale of marijuana legal in 37 states where it is a legally banned substance it stands to help the 13 state currently wrestling with legalizing marijuana for medical use. “...it removes a long-embarrassing complication in the 13 states, including California, where the dispensation and sale of the drug for medical purposes has been permitted. Up to now, in those 13 states, state and local authorities permitted this trade, but federal authorities were committed to shutting it down.(UPI, Shieff, 2009) Part of the decision is based on use of drug enforcement resources already stretched to the limits controlling the spread of drugs considered lethal. Making it easier for states to pass laws legalizing marijuana for medical use would allow those resources to focus on more serious issues. The move away from federal interference, some believe, may also encourage states other than the 13 already doing so to pass laws legalizing the use of marijuana for medical purposes. However, this decriminalization for medical use could and may lead to the decriminalization of marijuana for general use, a separate issue that could result in state resistance and present legal complications of its own. Other issues involve the medical communities insistence that while supporting the use of marijuana for medical use, not enough research has been done to determine its actual therapeutic benefit, and for which purposes it may be used. A position paper published by the American College of Physicians spells out its concerns and proposals. “Although the indications for some conditions (e.g., HIV wasting and chemotherapy-induced nausea and vomiting) have been well documented, less information is available about other potential medical uses. Additional research is needed to clarify marijuana's therapeutic properties and determine standard and optimal doses and routes of delivery.” (ACP, Executive Summary 2008, p1) Considering the paper’s call for more research, it is clear that beyond the legalization of marijuana for medical use, and the political and legal considerations, other important issues arise for physicians. While health professionals may obtain the legal right to prescribe the drug, there is concern regarding its prudent use without proper research into its properties, currently stifled by its illegal status with the government and FDA. Without proper research, the drug, if shifted to a Schedule II designation, may simply allow its use medically on a limited basis when, with proper through research it could be approved legally for uses beyond current limited allowed uses, as in Massachusetts, for HIV/AIDS, severe pain and nausea, multiple sclerosis and Crohn's disease only. Case in point is a Massachusetts former health care worker who claims that marijuana is the only drug that helps the excruciating migraine headaches she suffers, a treatment that under a limited use law would not be allowed. (Evil Weed...2009) Stakeholders The stakeholders in the issue include patients, physicians, health care providers, government and law enforcement officials, marijuana suppliers, and, one can say, society at large given the impact of the legalization of any substance for use by the public. The depth and breadth of those involved complicates the issue but provides interesting contrast of opinions based on a wide variety of interests and concerns. From patients who simply want relief from symptoms to drug counselors to doctors who want to know what they are prescribing and for what, the legalization of marijuana for medical uses presents a myriad of problems and answers. “Some, like David Evans, special adviser to the nonprofit Drug Free America Foundation of St. Petersburg, Fla., applaud the government’s view, saying marijuana has not gone through a rigorous US Food and Drug Administration approval process.” (Evil Weed, 2009) Physicians from the APC would agree, but want the therapeutic aspects of the drug tested for reasons other than stalling its approval for medical use. Yet one can empathize with Evans, whose life goal working for the organization is to free Americans from drug addiction. Evans, it can be assumed, fear if the drug is legalized for medical use the likelihood of its overall approval can not be far behind. Whether this is good or ill remains a matter of societal opinion, and not everyone agrees. The article Evil Weed, 2009 goes on to say, “But that skepticism (Evans) frustrates leading marijuana researchers like Dr. Donald Abrams, a cancer specialist at San Francisco General Hospital. ‘Every day I see people with nausea secondary to chemotherapy, depression, trouble sleeping, pain…I can recommend one drug [marijuana] for all those things, as opposed to writing five different prescriptions.’’’(Evil Weed, 2009) DEA agents and other narcotics law enforcement officials might be relieved to have one more banned substance off of their plates to deal with from an enforcement level; others who have seen the ravages of drugs in general might not feel the same. While marijuana may not be placed in the same category with heroine or other dangerous substances, someone using and driving may create similar DUI problems on the road. A parent may fear the legalization for medical use will lead to an overall approval of one more substance abused by children. Despite all concerns, the course of policy seems clear. "Now that the Obama administration has announced a (government) policy change, state legislators seem to feel safer adopting a sensible, regulated system of medical marijuana distribution that avoids the mistakes of California, where dispensaries sprang up with no rules. This is a historic (and inevitable) step forward."(Salem News.com, June 16, 2009) Sources Foreman, J. (July 13, 2009). Evil weed or useful drug? The pros and cons of medical marijuana, http://www.boston.com/news/healtharticles/2009/07/13/ Krause, N. (Wednesday, 10 June 2009). RI Senate Approves Marijuana Stores. WPRI.com,http://www.wpri.com/dpp/news/local_news/local_wpri_providence_s enate_passes_medical_marijuana_compassion_center_bill_20090609_nek Sieff, M. Published: March 20, 2009. Obama to Permit Medical Marijuana Use. Source: United Press International (Wire) Copyright 2009 United Press International, http://hempworld.com/HempPharm/articles/medmar.html American College of Physicians. Supporting Research into the Therapeutic Role of Marijuana. Philadelphia: American College of Physicians; 2008: Position Paper. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.), http://www.acponline.org/advocacy/where we stand/other issues/medmarijuana.pdf Drug Policy Alliance Network, Marijuana: The Facts http://www.drugpolicy.org/marijuana/medical/ Drug War Chronicle. ( June 22, 2007). Medical Marijuana: Rhode Island Legislature Overrides Veto to Make Law Permanent, http://www.stopthedrugwar.org/chronicle/491/rhode island legislature override veto medical marijuana Drug Policy News, (Tuesday, January 3, 2006) Rhode Island Legislature legalizes Medical Marijuana. http://www.drugpolicy.org/news/010306rhodeisland.cfm Marijuana Policy Project, Massachusetts. Lawmakers consider medical marijuana. The Daily News of Newburyport, January 16, 2006. http://www.mpp.org/states/massachusetts/news/lawmakers-consider-medical-marij.html Marijuana Policy Project, Michigan. Daily Telegram. Editorial: Medical Marijuana Wrong as State Issue, March 5, 2008, http://www.mpp.org/states/ohio/news/editorial-medical-marijuana.html Salem News.com. (June 16, 2009) Rhode Island to License Medical Marijuana Dispensaries, http://www.salemnews.com/articles/june162009/rhode_island_disp_6-16-09.php The Daily News of Newburyport, (January 16, 2006). Lawmakers Consider Medical Marijuana, http://www.mpp.org/states/massachusetts/news/lawmakers-consider- medical-marij.html The National Organization Working to Reform Marijuana Laws. (NORML) California http://www.norml.org/index.cfm?Group_ID=4525&wtm_view=medical Read More