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Political and Medical Views on Medical Marijuana and its Future Muni Rubens

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Department of Health Promotion and Disease Prevention , Florida International University , Miami , Florida , USA Published online: 09 Jan 2014.

Click for updates To cite this article: Muni Rubens (2014) Political and Medical Views on Medical Marijuana and its Future, Social Work in Public Health, 29:2, 121-131, DOI: 10.1080/19371918.2013.821351 To link to this article: http://dx.doi.org/10.1080/19371918.2013.821351

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Social Work in Public Health, 29:121–131, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1937-1918 print/1937-190X online DOI: 10.1080/19371918.2013.821351

Political and Medical Views on Medical Marijuana and its Future

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Muni Rubens Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA

The policies, laws, politics, public opinions, and scientific inferences of medical marijuana are rapidly changing as the debate on medical use of marijuana has always been political, rather than scientific. Federal law has barred the use of medical marijuana though 18 state governments and Washington, DC, support the medical use of marijuana. Unfortunately, not many studies exist on medical marijuana to back these laws and policies. The judiciary, on the other hand, has elicited a diverse response to medical marijuana through its rulings over several decades. Some rulings favored the federal government’s opinion, and others supported the larger public view and many state governments with legalized medical marijuana. Public opinion on legalizing medical marijuana has always favored the use of medical marijuana. The movement of scientific knowledge of medical marijuana follows an erratic, discontinuous pathway. The future place of medical marijuana in U.S. society remains unknown. The three forces—scientific knowledge, social-political acceptance, and laws—play a role in the direction that medical marijuana takes in society. Overcoming political-social forces requires a concerted effort from the scientific community and political leaders. The results of scientific research must guide the decisions for laws and medical use of marijuana. This article aims to trace the political dilemma and contradictory views shared by federal and state governments and predict the future of medical marijuana by tracing the past history of medical marijuana with its bumpy pathway in the socialpolitical arena. Keywords: Medical marijuana, state policies, federal policies, judicial decisions, public opinion, complex adaptive systems theory, scientific studies

INTRODUCTION “Medical marijuana” exists in the present society as an oxymoron as it contains the words medical and marijuana and depicts two sides of a political predicament. Similar to the name, the politics and the therapeutics of medical marijuana also appear unprincipled (Bostwick, 2012). Even though classified as a Schedule I agent and a potentially highly abusive substance with virtually no medicinal use, the general public and some physicians voice strong opinions about marijuana’s ability to treat several medical conditions (Rosenthal & Kleber, 1999). Marijuana continues to be a recreational drug, and its illicit use endures in epidemic proportions in the United States. On the other hand, smoking of marijuana for medical use persists in expanding Address correspondence to Muni Rubens, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA. E-mail: [email protected]

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its range, especially after many states proceeded to legalize its consumption (Thomas, 2010). Advocates of medical marijuana legalization claim that smoking marijuana elicits harmless effects and improves the quality of life, especially in chronically ill patients (Voelker, 1994). But others argue that continuous use of marijuana portends addiction and psychiatric side effects (Fallik, 2010). Although an increasing number of states are preparing to legalize medical marijuana, the federal government remains steadfast in its view to keep marijuana as a restricted drug (Hoffmann & Weber, 2010). Can marijuana be consumed as a drug by seriously ill patients when prescribed by physicians? Policies, laws, politics, public opinions, and scientific inferences interact to complicate what should be a straight forward answer to a simple question, but no general consensus exists currently. Federal law has banned the use of medical marijuana, defining it as a Schedule I drug and constraining research on its medical use whereas several state governments support the use of medical marijuana, based on popular opinion and political ideology, in the absence of a strong scientific basis. Hence, this article aims to trace the political dilemma and contradictory views shared by federal and state governments and predict the future of medical marijuana. SCIENTIFIC STUDIES AND OPINIONS Not many studies exist on medical marijuana in the United States, mainly due to restrictions imposed by the federal government. Obtaining permission from federal agencies to conduct clinical trials remains difficult for medical marijuana, a scheduled drug. Large-scale randomized control trials require approval from the Food and Drug Administration (FDA). Even if a study receives approval from the FDA, researchers find it difficult to obtain marijuana for studies. The National Institute on Drug Abuse (NIDA) remains the only legal body authorized to cultivate large amounts of marijuana in a special extension site of the University of Mississippi and distribute it for clinical research within the country. Contrary to provision methods for other drugs under Schedule I, marijuana can only be provided legally by the NIDA, an agency under strict federal control, and importing the drug legally from abroad continues to be impossible (Harris, 2006; Thurstone et al., 2011). By the 1980s, anecdotal evidence of increasing medical use of marijuana in glaucoma and to treat the nausea and vomiting from chemotherapy drugs incited scientific interests to investigate the drug (Myers, 2011). According to the 1982 Institute of Medicine (IOM) report Marijuana and Health, the preliminary research coupled with anecdotal evidence warranted a closer look at medicinal cannabis. On the backdrop of the public discussion on the practicality and effectiveness of marijuana for medical use, National Institute of Health in 1997 organized a conference to review available data on the medical use of marijuana and the feasibility of future research. The experts attending the conference from various medical specialties recommended the need to further study the safety and efficacy of marijuana (Cohen, 2009). The IOM published another report in 1999, Marijuana and Medicine, and found that marijuana functions to treat chronic pain and physical symptoms through different mechanisms in the brain than conventional drugs for the same problems (Joy et al., 1999). This new information on marijuana presented enticing opportunities for drug companies to develop novel drugs through refinement of chemical cannabinoids, and the IOM advocated more researches on these ventures. Multiple cannabinoids exist in marijuana with delta 9, tetrahydrocannabinol (THC), and cannabidiol being the most common. Each cannabinoid exerts a different effect on the human body (Hollister, 2000). The 1999 IOM report did find that the antianxiety and sedative effect of marijuana can be beneficial and produced much less addiction than alcohol. This led to an aggressive response from federal governmental agencies like FDA, the Substance Abuse and Mental Health Services Administration (SAMHSA), and NIDA that in various statements echoed

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the IOM report about the lack of scientific studies to support the medical use of marijuana (Harris, 2006; Kane, 2001). Even with constraints, a handful of researches proceeded to conduct clinical trials after many legal and administrative hassles. Abrams et al. (2007) published the first more recent clinical trial about smoked marijuana in a peer-reviewed journal, after a lapse of nearly 30 years from previous studies completed in the 1970s. This prospective randomized placebo-control trial focused on the efficacy of medical marijuana in the treatment of HIV-associated chronic neuropathic pain. The results demonstrated a reduction of daily pain variables by 34% among people who smoked marijuana (Abrams et al., 2007). In a similar study, Wallace et al. (2007) found that a medium dose of smoked marijuana reduced pain induced by injections of capsaicin among 15 volunteers. Another double-blinded, placebo-controlled, cross-over study of marijuana demonstrated a dose related analgesic response against central and peripheral neuropathic pain. However, some of the participants in this study exhibited adverse effects like acute cognitive impairments (Wallace et al., 2007). Martin-Sanchez et al. (2009) performed a meta-analysis on 18 studies using oral or spray cannabis preparations compared to placebo for chronic pain and found modest efficacy but also found potentially serious side effects to some extent or totally offset the advantageous effects.

STATE AND LOCAL POLICIES AND LAWS ON MEDICAL MARIJUANA Medical use of marijuana with a physician’s recommendation is legal in 18 states and Washington, DC, under varying statutes. The states eliminating local criminal penalties for medicinal purposes of marijuana include Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington. California became the first state to legalize marijuana in 1996 (Hoffmann & Weber, 2010). Under the state act, seriously ill patients can cultivate, possess, and consume medical marijuana with recommendations from a physician. The law further provides protection for physicians to issue such recommendations. In a majority of states, the patients enrolled in state-run medical marijuana programs can acquire the help of caregivers to grow marijuana plants (Pacula et al., 2002). Although state law does not violate national legal authority, it definitely contravenes the federal law. Federal law prohibits the prescription of marijuana by physicians and the distribution by pharmacies. In states with legalized medical marijuana, doctors can recommend marijuana use to their patients under the protection of the Physician Patient Communications First Amendment (McCarthy, 2004). However, these acts contravene federal law, and federal agencies possess the authority to arrest and prosecute such cases for violation of federal rules (Cohen, 2010; LeVay, 2000; Mikos, 2009). Illinois, New York, and Ohio have pending legislation to legalize medical marijuana.

DISPUTES BETWEEN FEDERAL AND STATE POLICIES ON MEDICAL USE OF MARIJUANA The pharmacology of marijuana dates back to 1851 when the U.S. Pharmacopeia (USP) listed the cannabis sativa plant as a legitimate drug with several medicinal uses (Thomas, 2010). In 1864, USP in its fourth edition described the process of extracting alkaloids and medical compounds from the plant. According to documents published by Department of Health, Education, and Welfare, physicians regularly prescribed medical marijuana until the Marijuana Tax Act of 1937 (LeVay, 2000). Although the act did not criminalize the possession or use of marijuana, a penalty existed for users and handlers (Mikos, 2009).

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The U.S. Congress in 1970 enacted the Controlled Substances Act (CSA) as Title II of the Comprehensive Drug Abuse Prevention and Control Act. The legislation merged many laws that governed the manufacturing and distribution of numerous illicit and prescription drugs. This law created five schedules (Schedule I to V) and allocated drugs into the five categories based on medicinal use, undesirable side effects, and potential abuse problems. Schedule I contained the most restricted classification and Schedule V the most relaxed grouping of drugs. Marijuana’s placement went into Schedule I along with heroin, LSD, and PCP, ascribing it to this classification due to a lack of safety, very high abuse potentials, and lacking an accepted medical use (Kane, 2001). Hence, under federal law, marijuana lacks acceptance as a drug for medical use and bars physician from prescribing it and pharmacists from compounding it. Although the Controlled Substances Act underwent amendments several times since its inception in 1970, none of the revisions relaxed any of the restriction on marijuana as an illicit drug (Mikos, 2009). In 1998, during the 105th Congress, the House passed a resolution to maintain the existing policies for keeping marijuana under Schedule I (Tiersky, 1998). This resolution went into the Omnibus Appropriations Act of 1999. Congress amended the act unfavorably for legalization of marijuana the very same year, for fear of Washington, DC’s, achievement of legalization status through district ballot counting procedures. The Supreme Court later dismissed the amendment and allowed the District of Columbia legislation to conduct ballot counting. The district ballot counting initiative succeeded with a majority (69%) of voters favoring the legalization of medical marijuana (Marijuana Policy Project, 2012). However, Congress continued to obstruct the enactment of these initiatives through implementation of the District of Columbia Appropriations Act also known as the Barr Amendments that curtailed the autonomy of district legislation process for legalization of medical marijuana. The 111th Congress in 2009 finally eliminated such initiatives in local legislatures by the binding rules of federal laws (DeBonis, 2009). In the 108th Congress, Representatives Hinchey and Rohrabacher proposed amendments to the 2004 Commerce, Justice, and State Appropriations Bill to prevent the Justice Department from interfering with the implementation of favorable medical cannabis laws in the states with current legalization of marijuana. The House voraciously opposed the amendments against the Justice Department and federal policies several times between 2003 and 2007. The opponents succeeded in disproving the safety and efficacy of marijuana as a medically prescribed drug (Kamin & Wald, 2012). The 108th Congress received the bill, Steve McWilliams Truth in Trials Act, to allow marijuana users and handlers to reveal in federal court the legality covered by state law. The bill contained the named Steve McWilliams who committed suicide after federal trial found him guilty of distributing medical marijuana to seriously ill patients under California law. The bill was reintroduced in 2009, this time as Truth in Trial Act. Like other marijuana bills, the Committee on Energy and Commerce rejected it (U.S. Legislative Information, 2013). During the 110th Congress, the Senate Committee on Health, Education, Labor, and Pensions recommended amendments to the Prescription Drug User Fee Act, and this proposed change would have led to the close down of all state-run medical marijuana programs. The amendment described a plan to monitor all the existing state run medical marijuana programs by the Secretary of Department of Health and Human Services (HHS) for FDA regulations that could have automatically led to shut downs of marijuana programs. However, the amendment failed to be incorporated into the law due to lack of strong consensus and a failure to undergo judicial review (Eddy, 2007). Marijuana came close to being rescheduled as Schedule II drug when the 110th Congress received the Medical Marijuana Patient Protection Act for consideration to provide legal protection for medical use of marijuana in accordance with the state law. But the House Committee on Energy and Commerce rejected the bill. The bill went to the 111th Congress also but failed to gain any favorable support. Congressional members introduced various versions of the Medical Marijuana

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Patient Protection Act each year since 1997, but none of the proposals saw the light of day (Fox, 2012).

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JUDICIAL VERDICTS The judiciary elicited a diverse response to medical marijuana through its rulings over several decades despite the constant bickering between federal perspectives and state views. Some rulings favored the federal government’s opinion, and others supported the larger public view, and many state governments with legalized medical marijuana (Mikos, 2009). Many past rulings exist, mostly against, the legality of medical marijuana in several U.S. courts and many battles continue in the judicial system. One major case between the U.S. government and the Oakland Cannabis Buyers’ Cooperative (OCBC) exemplifies the dispute. The Department of Justice in early 1998 sued the OCBC for cultivating and distributing marijuana for medical use against federal law. The Northern District Court of California ruled in favor of the government and issued an injunction. The OCBC appealed against the decision at the Ninth Circuit Appeal Court, and the judge concluded that medical need validates a justification against the federal marijuana law. The federal government appealed to the Supreme Court, and the Supreme Court rejected the medical requirement pretext presented by the OCBC. The Supreme Court further clarified saying medical necessity fails as a valid defense against criminal use and distribution of the drug as defined by several clauses under the Controlled Substance Act of 1970 (Okie, 2005). Another case illustrates how the federal government threatened to revoke the license and impel administrative action on physicians who prescribed marijuana to their patients after California enacted a state medical marijuana law in 1996. Some patients and physicians of California challenged the action in a federal court leading to a court battle (McCarthy. 2004). The court ordered immediate injunction, preventing federal authorities from taking any action against the physicians under their First Amendment rights. The case went on to Ninth Circuit Appeal Court that upheld the lower court ruling. The government appealed to the Supreme Court, but the court declined to take up the case (Okie, 2005; Mikos, 2009). In 2002, when Drug Enforcement Administration (DEA) agents destroyed their medical marijuana plants, two patients and their caretakers from California sued the federal government (Gonzales v. Raich, previously Ashcroft v. Raich) claiming that by enforcing the CSA, DEA agents violated the federal Commerce Clause, medical necessity doctrine and Due Process Clause of the Fifth, Ninth, and Tenth Amendments to the Constitution of the United States (Gostin, 2005). Following an unfavorable ruling from the Ninth Circuit Court of Appeals, the federal government appealed to the Supreme Court. In 2005, Supreme Court ruled that even with a favorable state law, federal government can criminalize medical marijuana production under the Federal Commerce Clause. The judgment, in a footnote, said, We acknowledge that evidence proffered by respondents in this case regarding the effective medical uses for marijuana, if found credible after trial, would cast serious doubt on the accuracy of the findings that require marijuana to be listed in Schedule I. (Legal Information Institute, 2013)

A California based advocacy group in 2007 called Americans for Safe Access (ASA) filed a suit against HHS when it rejected a petition to correct four statements the government made in 2001 regarding medical marijuana. ASA made its petition based on the Data Quality Act of 2001, which issues guidelines and directs federal agencies to provide quality, objectivity, utility, and integrity of information when disseminating material. If HHS accepts the petition by the advocacy group, it represents one more significant step toward rescheduling marijuana. The case remains ongoing (Legal Information Institute, 2013).

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PUBLIC OPINION Every nationwide public opinion poll on legalizing medical marijuana favored the use of medical marijuana by seriously ill patients when recommended by the physician. In a random telephone survey among 1,033 adults nationwide by CBS News in October 2011, 77% people said that they favor legalizing medical use of marijuana. The participants were asked the question, “Should doctors be allowed to prescribe marijuana for serious illnesses?” Only 17% of people surveyed responded against the medical use of marijuana, and 6% didn’t express any opinion (Backus, 2011). Since 1995 many nonpartisan organizations and news media carried out 27 nationwide opinion polls. Only one survey indicated that less than 50% of the respondents favored the use of medical marijuana (Cohen, 2006). Blendon and Young (1998), in a research that analyzed 47 nationwide surveys done between 1978 and 1997, concluded that even though Americans strongly oppose the illicit use of marijuana and consider it a dangerous drug, they support its legalization for medical use. In a random telephone survey among 1,002 people in California indicated that 80% respondents support medical marijuana (Mikos, 2009). The drug norms set by the local society emerged to a more permissive viewpoint to back the use of marijuana for medicinal purposes. COMPLEX ADAPTIVE SYSTEMS THEORY Complex adaptive systems theory provides a framework to conceptualize the evolution of the legalization of the use of medical marijuana. Society functions in nonlinear fashions with a variety of elements, such as human behavior, sociocultural, political-government, and legal-judicial factors. According to Holden (2005), complex adaptive system theory encompasses nonlinear relationships among interdependent forces in social, political, government and judicial processes. Ludwig von Bertalanffy (1968) founded general systems theory. His theory concentrated on the complexity and interdependence in linear systems to form regularly intermingling or symbiotic groups of actions or segments to create a whole. By ascertaining the particular elements in a system, one can identify the parts or segments impacting the decision making outcomes. Warren et al. (1998) described an extension of systems theory to a more dynamic nonlinear complex process called complex adaptive systems theory. The complex nonlinear factors promote change in the system in response to input and feedback within the resources available to a system. Because a system functions as an autonomous and self-organizing entity, change occurs constantly and new information changes the direction the entity moves. Figure 1 outlines the complex adaptive system theory conceptualization of the forces involved in the legalization of medical marijuana. The arrows indicate directions of relationships between the subparts of the system. Repeated interactions occur between subparts. Groups continually submit request to change the same laws year after year, and even though the law may not change, it influences the behavior in other parts of the system. Examples include states legalizing marijuana at the state government level to provide access for patient consumption, the use of the First Amendment to protect the communication between patients and physicians, the support of multiple medical authorities to instigate research for new knowledge, and the advisory by the Department of Justice to restrain from using federal resources to prosecute users of medical marijuana. These situations created subtle changes within the larger social system. THE FUTURE OF MEDICAL MARIJUANA Consequently, the future place of medical marijuana in U.S. society remains an unknown entity, but tracing the past history of medical marijuana with its bumpy pathway in the social political

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FIGURE 1 Conceptual framework showing how federal and state policies and laws evolved against each other. DEA D Drug Enforcement Administration; FDA D Food and Drug Administration; NIDA D National Institute on Drug Abuse.

arena provides a glimmer of the possible future course. History endows one with the logical and illogical thought processes and actions taken on medical marijuana. The three forces play a role in the direction that medical marijuana takes in society. These forces include scientific knowledge, social-political acceptance, and laws. Researchers must move the scientific knowledge ahead for marijuana to become a medically sound therapeutic treatment for health conditions. The grassroots level did assist in establishing anecdotal evidence in the 1970s to 1990s that provided direction for the few trials that occurred in the last 30 years. Research on medical marijuana followed a slow path in getting started due to the many barriers obstructing the scientific process. The biggest hurdle entailed the lack of funding and support for such research, but a paradigm shift is occurring. Montagne (2012) describes the case of medical marijuana as representing a traditional tautology conveyed by challengers to new ideas. Adversaries to novel innovations in concepts and ideals declare that the absence of scientific confirmation on the effectiveness of a treatment, like medical marijuana, indicates a reason to not perform research to generate scientific information to appraise the new concept. This circular reasoning fails to have anything to do with science. Instead, this thinking exemplifies fear, ignorance, politics, personal convictions, or financial factors but certainly shows no consideration for patients in need of novel innovations for conditions with ineffective treatments. Overcoming the barrier to new scientific ideas requires willingness on the side of scientists to continue to compile scientific research and evidence to confirm or disprove the safety and effectiveness of drugs like marijuana. The few randomized clinical studies on medicinal cannabis demonstrate a movement in the right direction to produce research on the subject (Grant et al., 2012). Overcoming political-social forces requires a concerted effort on the part of the scientific community to use the past learning from failure to not only scientifically investigate marijuana as a medical treatment, but to also use the data to educate the political leaders and opponents about effective uses of marijuana to bring about changes in the laws. Medical leaders possess a

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high degree of intellectual capability to think outside of the metaphorical box and view issues in new ways. Researchers need to come up with novel strategies to restrict the power of religion, politics, mass media, social perceptions, and beliefs. The results of scientific research must guide the decisions for laws and medical use of marijuana (Montagne, 2012). The movement of scientific knowledge follows an erratic, discontinuous pathway. A paradigm shift can occur rapidly with disruption of the current thinking or it can transpire in a protracted slow-moving process with little bits of information released at a time. Much of scientific progress follows the second paradigm shift in new knowledge. The movement of medical marijuana knowledge appears no differently. More than 30 years elapsed from the time of the initial anecdotal case studies to the current randomized trial on medical marijuana in pain, nausea, and vomiting from chemotherapy drugs to muscle spasticity conditions. Times are changing with medical organizations coming together in support of changes to the laws. Therefore, medical marijuana continues to nudge into the mainstream of use. Given the negative effects of smoking, a different form of the drug will most likely be approved. Some form of cannabinoids will eventually become conventional treatment in the future for a limited number of medical conditions. DISCUSSION From a system’s theory point of view, the constant flux of change provides a provision for new adaptations to occur in a system (Kitson, 2009). The social-political system drives the direction of acceptance or rejection of an issue like medical marijuana. The current history of medical marijuana in the United States dates back to 1937 when the federal government implemented the Marijuana Tax Act and created a penalty for users and handlers of marijuana (LeVay, 2000). This Act generated an obstacle to the consumption of marijuana when illicit drug use surged in the 1960s in addition to impeding research on this substance. The next barrier arose with the Controlled Substance Act of 1970 that placed marijuana in the Schedule I class (Kane, 2001). The Schedule I category implied the drug lacked safety and any acceptable medical use and thereby prevented any physicians from prescribing the drug and prohibited pharmacists from compounding or dispensing marijuana. From a systems point of view, these actions slowed the process of studying the efficacy and safety of marijuana as a drug. The DEA and FDA placed illicit, addictive substances in the Schedule I category, because these drugs held no current acceptable medical use, produce a high potential for addiction and could potentially harm the body. After the rise of the counterculture of youth, their altered lifestyles, use of illicit drugs, and protest during the 1960s, the government acted in a protective role to shield the public from the harmful effects of illicit drugs (Institute of Medicine, 1982). The use of marijuana for recreational use compounds the problem of legalizing medical marijuana, because opponents allege that the ultimate goal of the legalization of medical marijuana applies impetus to legalize recreational marijuana especially with the passing of the legislation in Washington State and Colorado in November 2012 (Associated Press, 2012). Recreational users smoke marijuana for the intoxicating feelings that includes such effects as mild euphoria, relaxation, and perceptual alteration, but negative experiences occur as well such as dysphoria, anxiety, paranoia, panic, and psychosis (Bostwick, 2012). The private sector of citizens moved the process for the use of medical marijuana forward by providing anecdotal evidence in the 1970s to 1990s on effects of the marijuana substance in glaucoma and the nausea and vomiting in cancer treatment (LeVay, 2000). These anecdotal situations provide case studies or the first level of evidence of effects of marijuana in disease states. These cases provided the impetus for further research on marijuana and human illness. Research commenced and produced the synthetic drug, Marinol, in 1992 that contained the active

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ingredient THC from marijuana. The synthetic drug became a Schedule II drug but failed to receive widespread support due to a lesser degree of effectiveness than marijuana. This drug study moved the science on marijuana ahead as researchers around the same time identified two cannabinoid receptors in the brain to help explain how the substance works in the body. Court cases ensued between patients smoking marijuana to treat medical conditions that failed to respond to conventional treat, and the judicial system upholding the law under the Controlled Substance Act. Many patients lost their court cases, and all attempts to change marijuana to a Schedule II drug failed. To circumvent the law, the State of California became the first state in 1996 to pass a law at the state level for compassionate use of marijuana and to eliminate criminal penalties for using marijuana for medicinal purposes. Seventeen other states followed suit over the next 25 years (Bostwick, 2012). The social acceptability and the access for patients to obtain marijuana for medicinal use continued to expand over the years. A landmark court case (Conant v. Walters) transpired in 2002 to provide protection to physicians and patient communication in states with medical marijuana laws as long as the physician only recommends marijuana and neither prescribes nor dispenses the drug. This situation exemplifies another positive shift in our social system in favor of marijuana. By the beginning of the 21st century, the research community found ways to instigate studies on the therapeutic effects of marijuana for uses identified from anecdotal cases. The medical community expressed all along the need to conduct tried-and-true experimental trials and not promote medicinal products by popular vote (Kane, 2001).

CONCLUSION Organized medicine admonishes the federal government for the current situation with medical marijuana. The American Medical Association, the Institute of Medicine, and the American College of Physicians argue that the fragments of state laws fail to bring about clinical standards needed for marijuana (Bostwick, 2012). If the drug could be placed under a Schedule II designation, regular evaluation and research by industry could occur. Established medicine supports thorough scientific evaluation to move knowledge forward on marijuana. Devising stringent laws can safeguard policies and practices from any undue exploitation for recreational use by both the general public and licensed drug manufacturers. Any policy toward commercialization of marijuana or any of its derivatives can be limited in scope to prevent the widespread use of these products for illicit abusive uses. The movement of medical marijuana into the mainstream of society continues, albeit, slowly due to the many barriers obstructing progress. These initiatives provide a firm line between the terms therapeutic drugs and recreational drugs, and the oxymoron changed to benevolence.

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Political and medical views on medical marijuana and its future.

The policies, laws, politics, public opinions, and scientific inferences of medical marijuana are rapidly changing as the debate on medical use of mar...
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