The California Senate approved SB 439 on Monday. The bill, which is co-authored by Senate President Pro-Tem Darrell Steinberg (D-Sacramento) and Senator Mark Leno (D-San Francisco) clarifies the scope of protections offered by the state’s medical cannabis laws and codifies guidelines published by the Attorney General in 2008. SB 439 will formally recognize the right of patients’ cooperatives and collectives to maintain storefront facilities (dispensaries) to provide medicine for members, an interpretation supported by Americans for Safe Access (ASA) since lawmakers adopted the Medical Marijuana Program Act (SB 420) in 2003. The bill also expands protections to employees of patients’ associations and recognizes that members buy their medicine from the associations.
ASA supports SB 439 because uncertainty about the scope of California’s medical cannabis laws has led to differing interpretations and inconsistency in law enforcement around the state. Some cities and counties regulate and tax storefront facilities, while others ban them outright or turn a blind eye to their operation. Lobbyists for law enforcement are promoting a narrow interpretation of the law, which leaves patients in some jurisdictions without safe, legal, and dignified access to medicine. Patients and lawmakers need more clarity about what is legal in California, and SB 439 is an important step in that direction.
At a hearing before the Senate Public Safety Committee, President Pro-Tem Steinberg told his colleagues that SB 439 was a starting point. We can expect substantial amendments as the bill moves through one of more committees in the Assembly and on to a final vote on the Assembly floor before September 13. Differences between the Senate and Assembly versions will be resolved in a concurrence committee made up of members of each house. The Governor will have thirty days to sign or veto the bill.
Advocates must be vigilant and practical in the effort to complete this bill. There are many voices in Sacramento this year trying to influence the outcome. Lobbyists for law enforcement, local government, community groups, and others will be pushing for changes we don’t like. We have to push back and ask for what we want with a unified voice. ASA will be calling on members and friends to be a part of that conversation for the rest of the legislative season. Be sure you are a part of that process by making your voice heard. Sign up for our mailing list to stay informed and find out how you can participate online and face-to-face with lawmakers.
ASA and our coalition allies at Californians to Regulate Medical Marijuana (CRMM) have developed the Principles of Sensible Medical Cannabis Regulation to help lawmakers understand what we want to see in state regulations. We developed these principles after a year of conversations that started at the California Unity Conference in 2012 and are still ongoing. Constituents took these principles with them to visit dozens of legislative offices at our California Medical Cannabis Policy Summit and Lobby Day May 5-6. If you agree that principles like these make sense, please join ASA and CRMM in asking lawmakers to support them.
This is going to be a big year for medical cannabis in California. The legislature is determined to do something about the issue, so let’s work together to be sure they do the right thing!
The California Supreme Court ruled on Monday that medical cannabis dispensaries are legal under state law, but cities and counties can still ban them. The decision in City of Riverside v. Inland Empire Patients Health and Wellness Center is disappointing, but it is not the end of the fight for safe and dignified access to medicine in approximately two hundred communities where patients’ associations are banned. The Supreme Court pointed out that “nothing prevents future efforts by the Legislature, or by the People, to adopt a different approach.” That means the ball is in your court now.
Ask your California lawmakers to protect safe access for every legal patient by adopting statewide regulations based on our “Principles of Sensible Medical Cannabis Regulation.” Two measures before the state legislature seek to regulate medical cannabis activity – AB 473 by Assemblymember Tom Ammiano (D-San Francisco) and SB 439 by Senate President Pro-Tem Darrell Steinberg (D-Sacramento) and Senator Mark Leno (D-San Francisco). Act now to be sure these two measures, which are still being finalized by lawmakers, reflect what patients and other medical cannabis stakeholders want to see.
Almost one hundred members of Americans for Safe Access (ASA) and our allies hit the halls of the State Capitol Building on Monday to take our pro-regulation message directly to our elected Representatives. The California Medical Cannabis Policy Summit and Lobby day was a success, but we need to stay at the table as the legislative session continues. You can ask your Assemblymember and Senator to adopt sensible regulations whether or not you were at the Capitol this week. Send a message right now.
ASA will be rolling out new programs this summer to help patients and advocates fight local bans with new legislation and voter initiatives. Your participation and support will be the key to success in Sacramento and in communities statewide. You can start helping by joining ASA or making an additional contribution right now.
I want to say a special thank you to everyone who attended the summit and lobby day, and especially to our sponsors – California NORML, United Food and Commercial Workers Union, Bay Area Safe Alternatives, Greater Los Angeles Collectives Alliance, Emerald Growers Association, Coalition for Cannabis Policy Reform, Berkeley Patients Group, Crusaders for Patients Rights, Good Fellows Smoke Shop, and Desert Organic Solutions Collective.
Thank you for acting to support regulations and fighting with ASA for safe access for everyone.
Bunny Hethcox is a 54-year-old mother of two and grandmother of six. A real estate broker for 17 years, Bunny taught her kids drugs were bad. But Bunny also suffers from fibromyalgia, PTSD, depression and anxiety, and one day while driving with her son, she had a bad panic attack and was unable to find her xanax. After pulling over, sweating and shaking, her son pulled a joint from his pocket and said “I think you need this more than I do.” It took her a minute to decide whether to yell at him or try it, but once she did, she discovered that cannabis calmed her considerably.
Hydrocodone, oxycodone, codeine, Demerol and various other drugs had failed to ease the pain of her fibromyalgia, but after using medical cannabis for several months for her anxiety, she found that the pain lifted and her intense PTSD symptoms became tolerable. That got her doing some research on cannabis and the history of its prohibition.
Last January, she got involved with politics for the first time, doing a lobby day at the Wisconsin state capitol. After a disappointing visit with her representative, she decided to find help changing the law. She came across the ASA website only ten minutes before the deadline for scholarship applications to ASA’s National Conference in Washington D.C., but got it in on time. She got the scholarship, and off she went to DC for the first time, worried about flying alone and what she’d find at the conference.
After meeting doctors, scientists, lawyers and leaders of medical research from the Netherlands, Canada and Israel she knew she needed to do what she could to help people get safe and legal access. She asked how to start an ASA chapter in Wisconsin, and on April 13, Bunny held the first meeting.
“We are now on our way to help Wisconsin become a legal State,” she says. “I have two choices, live in pain and suffer with anxiety and depression by keeping the law or break the law by medicating myself with cannabis to live a normal life. I choose cannabis.”
Last week, Kal Penn, who plays Kumar in the “stoner” film franchise Harold & Kumar, spoke to Huffington Post Live about President Obama’s marijuana policies. During the April 26th interview, Penn defended recent Justice Department attacks on dispensaries in medical marijuana states like California, citing articles he read from a Google search.
Unfortunately, we cannot always rely on a pliant mainstream media — that too often quotes Justice Department officials without any counterpoint — to provide consistently factual information.
Take, for example, the rationale that forms the basis for the Obama Administration’s most sweeping closures of dispensaries in California, Colorado and Washington State: they’re within 1,000 feet of a school. Using threats of asset forfeiture and criminal prosecution, the Justice Department has succeeded in shuttering hundreds of dispensaries in the past couple of years.
However, if Penn had done his homework, he would have found out that in California, where well over 500 dispensaries have closed for fear of retaliation by federal drug enforcement officials, dispensaries are only required to be at least 600 feet from schools:
No medical marijuana cooperative, collective, dispensary, operator establishment, or provider who possesses, cultivates, or distributes medical marijuana pursuant to this article shall be located within a 600-foot radius of a school.
Also glossed over by Penn was the Obama Administration’s callous attitude about the impact of these dispensary closures. Each of the shuttered dispensaries provided medical marijuana to hundreds, often thousands of qualified patients who are now left with little option to find a medicine that’s legal under state law.
And, believe it or not, the dispensary operators and their landlords who are warned with letters of imminent legal action are the lucky ones. The dispensaries that are targeted with aggressive SWAT-style raids stand to lose much more. At minimum, those dispensary operators can expect seized bank accounts, computers, patient records, and other property.
However, if there are arrests, federal defendants can expect 5-10 years in prison. Over the past few months, several state-compliant dispensary operators and cultivators have been sentenced to lengthy prison terms, including California dispensary operator Aaron Sandusky (10 years), Michigan Cultivators Jeremy and Jerry Duval (5 years and 10 years, respectively), and John Marcinkewciz (5 years), as well as Montana cultivator Chris Williams (5 years). Another Montana cultivator, Richard Flor, died in federal custody last August while serving a 5-year sentence.
Indeed, Penn’s failure to understand the impact of the Obama Administration’s policies on medical marijuana is symptomatic of the lies being told to the American public and the impunity with which it’s being done. President Obama and Attorney General Eric Holder have both claimed that they are not targeting those in compliance with state law, but refuse to confront the evidence that belies such pronouncements.
It’s about time that the federal government admits that the devastating and costly effects of its enforcement policies in medical marijuana states are unnecessary and unproductive. All patients are asking for is a compassionate and even-handed policy that treats medical marijuana like a public health issue.
I am so excited to be attending the ASA California Medical Cannabis Policy Summit and Lobby Day this weekend. The event last year was absolutely brilliant. Steph and the Sacramento ASA Chapter did an outstanding job organizing the event, and together, we accomplished the impossible. Imagine visiting EVERY representative in Sacramento in ONE day. What an undertaking! We might qualify for a Guinness Book of World Records.
Lobbyists have a lot of power in Sacramento, but legislators really take notice when an “ordinary” citizen takes the time to show up in their offices. The value is priceless.
Seriously, I learned so much about being an EFFECTIVE advocate: how to make appointments to talk to your representatives, how to address them, how to prepare my talking points, and how to follow up after the meeting. This training has served me well during the past year and I have developed relationships with several legislators as a result.
Another great reward for attending the conference is the sense of community that comes when you meet activists from other areas. It is empowering to know that we have so much support. I guarantee that you will have a great opportunity to network and build relationships with other activists.
The most important lesson I learned from the Conference is that even seemingly impossible tasks can be accomplished by creating a systematic and well executed plan of action.
Sadly, but not unexpectedly, last week the Court of Appeals for the District of Columbia Circuit denied a petition for rehearing filed be Americans for Safe Access in ASA v. DEA. After more than a decade of legal wrangling with the federal government over the medical efficacy of marijuana and its relative lack of abuse potential, the D.C. Circuit gave great deference to the Drug Enforcement Administration (DEA) position that marijuana has no proven medical value. In doing this, the D.C. Circuit not only ignored voluminous evidence of marijuana’s medical efficacy, but it held the petitioners to a standard above and beyond that advanced by the government itself. Out of thin air, the Court interpreted the phrase “adequate and well-controlled studies” to require FDA-approved Phase II or Phase III studies, rather than the common meaning of the term. A similar such standard as that interjected into the proceedings by the Court at the last possible moment had already been rejected by the same Court and others in the cases of Grinspoon v. DEA, 828 F.2d 881 (1st Cir. 1987) and Doe v. DEA, 484 F.3d 561 (D.C. Cir. 2007). This, coupled with the failure of the Court even to consider marijuana’s lack of abuse potential, was the basis for ASA’s recent petition for rehearing.
Unfortunately, for medical marijuana patients and others, the extremely small number of active judges on the D.C. Circuit makes rehearing en banc (by the entire circuit) next to impossible. Because there are only eight active judges on the D.C. Circuit, en banc review is extremely rare, with only one petition granted by this Court last year. Thus, the next legal step is to challenge the DEA’s action in the Supreme Court of the United States through a petition for writ of certiorari , which must be filed within ninety days. This opens the possibility for arguments that exceed those allowed under the recently denied petition for rehearing. It also provides an opportunity to raise awareness of this wrong-headed approach to medical marijuana at the highest judicial level.
Stay tuned for more details on the upcoming appeal to the U.S. Supreme Court in ASA v. DEA.
California Senator Lou Correa (D-Santa Ana) has proposed a bill that would turn most of the state’s legal medical cannabis patients into criminals. SB 289 will make it a crime to drive with any amount of a controlled substance in your blood, unless the drug was prescribed by a doctor. The bill makes no exception for medical cannabis patients, whose medicine is recommend by a doctor, as opposed to prescribed. That means trouble for responsible, law abiding medical cannabis patients statewide.
Regular medical cannabis users may have detectable levels of tetrahydrocannabinol (THC), one of the active compounds in cannabis, for up to two days after using medicine (See G. Skopp and L. Potsch, “Cannabinoid concentrations in spot serum samples 24-48 hours after discontinuation of cannabis smoking,” Journal of Analytical Toxicology 32: 160-4, 2008). However, measurable impairment from medical cannabis use may only last a few hours. This means that a legal medical cannabis user will be in violation of SB 289, because he or she has a detectable amount of THC long after there is any potential for impairment.
ASA is asking medical cannabis supporters to speak up against SB 289 to protect legal patients from unnecessary arrest. The bill will be heard in the Senate Public Safety Committee on Tuesday, April 30, so your California Senator needs to hear from you now.
Testing for cannabis and medical cannabis impairment is a controversial topic nationwide. Voters in the state of Washington approved an absurdly-low threshold for cannabis-impairment when they approved I502 last year, and rule makers in Colorado seemed poised to do the same. Why the zero-tolerance approach to cannabis and medical cannabis, even where it is legal? Certainly no one wants to see impaired drivers on the road, but the root of the issue is stigma. Zero tolerance measures like SB 289 ignore science and rely instead on the perception of cannabis and medical cannabis users as irresponsible and dangerous on the road. Stigma makes laws that enshrine discrimination plausible, and that in turn, gives medical cannabis opponents the chance to push back on safe access.
California law already makes driving while impaired by any drug – legal or otherwise – a crime. We do not need another bill to turn up the heat a little more – especially when some of those drivers are obeying the law. Lawmakers should reject SB 289 and rely on science and common sense when making policy.
Patient advocacy group Americans for Safe Access (ASA) filed recommended amendments today to draft regulations which were issued last month by the Massachusetts Department of Public Health (DPH) in order to implement Question 3, the state’s new medical marijuana law. The amendments were filed in advance of a scheduled hearing by the Public Health Council that took place today in Boston.
The draft regulations are the product of many weeks of deliberation, during which time DPH sought input from medical marijuana patients and other stakeholders, including ASA, the Massachusetts Patient Advocacy Alliance (MPAA) and the American Civil Liberties Union (ACLU). Seeking a broad range of feedback, DPH held public hearings earlier this month in Boston, Plymouth, and Florence.
In November, sixty-three percent of voters approved Question 3, making Massachusetts the 18th medical marijuana state. Question 3 establishes a framework that allows qualifying patients with serious illnesses to get a recommendation from their licensed physician for the use of marijuana, and further enables patients to obtain their medicine from a registered Medical Marijuana Treatment Center (MMTC). Overseen by DPH, the MMTCs will be licensed to cultivate, process, and sell medical marijuana to qualifying patients who are allowed to obtain up to 10 ounces in a 60 day period. Patients who qualify under a hardship provision will be able to cultivate for themselves if unable to access a MMTC due to distance, disability, or low income.
And, while patient advocates are generally pleased with the draft regulations and the progress made by DPH, there remain concerns over a few provisions that could limit patients’ access to medical marijuana. For example, the regulations require physicians to register with DPH and undergo mandatory training before being authorized to recommend marijuana to their patients. Patients are concerned that this requirement will chill physician participation in the program and make it more difficult for patients to obtain a recommendation.
Dr. Karen Munkacy, an anesthesiologist and delegate to the Massachusetts Medical Society, as well as a board member of ASA, testified at today’s hearing. While Dr. Munkacy agreed that educating doctors about medical marijuana would be helpful, she said in a previous statement that, “I have concerns about any regulation that would create additional obstacles for physicians who want to incorporate this medicine into their practice.”
The draft regulations also prohibit patients from obtaining their medication from more than one MMTC, and place unique and onerous restrictions on minors who might benefit from medical marijuana. Advocates argue that these types of restrictions create unnecessary barriers to treatment. Dr. Munkacy testified today that:
If we limit this medicine only to dying children, then it is not legally available for the 80 percent of children who live longer than six months after their cancer diagnosis. Childhood cancer is rare, but distraught parents, who are already dealing the nightmare of their child having cancer, shouldn’t also have the nightmare of buying their children’s medicine from back alley drug dealers.
Although Massachusetts law allows certain qualifying patients to cultivate their own medical marijuana, advocates argue that the draft regulations unduly limit such activity. For example, patients that can show their income, disability, or lack of mobility is an impediment to obtaining their medicine from an MMTC, they may be able to cultivate it themselves or find a caregiver to grow it for them. However, the financial hardship threshold, as it stands, only includes the poorest of the poor and excludes patients who still have a legitimate economic barrier to purchasing their medicine from an MMTC. Also, the lack of an appeals process for patients seeking hardship qualification denies them due process rights that are part of other social services programs.
After the final draft regulations have been completed, DPH will present them again to the PHC on May 8th and, if adopted, they will go into effect on May 24th.
Nothing happens in the state legislature just because it should. Sometimes laws get passed because those with a financial interest in the outcome influence lawmakers. In some cases, political favors get traded to get something done. And all too often, lobbyists are the only voices lawmakers hear when they make choices that affect citizens. That is what is happening with medical cannabis in Sacramento right now, and I hope you will join me there next month to change that conversation for the better.
Medical cannabis patients and other stakeholders are meeting in Sacramento May 4-6 for the California Medical Cannabis Policy Summit and Lobby Day. The goals of the event are to develop strategies and skills necessary to adopt beneficial legislation for medical cannabis this year, and to take that message to lawmakers in person. Americans for Safe Access (ASA) and our partners at Californians to Regulate Medical Marijuana (CRMM); a coalition of patients, cultivators, organized labor, and others; is organizing this event to be sure that patients are at the table when important decisions about regulating medical cannabis are made this year.
You can help shape the future. Last year, we brought hundreds of patients to the State Capitol and helped push medical cannabis legislation further than anyone thought possible. Lawmakers noticed our grassroots coalition and started to take us more seriously. We need that influence now more than ever. Bills to regulate cultivation, distribution, and testing of medical cannabis are on the table right now. Proposals about additional taxation are on the way. We cannot afford to be silent right now. Someone is going to influence lawmakers on good and bad legislation this year. If it is not you, it will be lobbyists, law enforcement, and others who want to roll back safe access in California.
We will have a special fundraising reception on Saturday night, and then spend all day Sunday building strategies and skills for the citizen lobby day on Monday. We will start on Monday with a press conference, and then we hope to visit every lawmaker in Sacramento to talk about what we want to see in California. We will all meet back for a complimentary VIP reception on Monday evening.
We have a great opportunity to do something positive for patients, cultivators, workers, and others. If lawmakers from all over the state hear in person from constituents in their Districts, we can show them that there is a safe political space to stand up for medical cannabis. That is why I am going to Sacramento: to make a difference. Will you be there with me?
When the Maryland Senate voted earlier today to approve HB 1101 today, it failed to become the 19th medical cannabis (marijuana) state. In spite of the bill’s comendable intentions, it remains highly flawed. Some have touted the HB 1101 approach as a “yellow light” on medical cannabis, yet sadly, it can only be seen as a “yellow light” on a “bridge to nowhere.”
In spite of the bill’s laudable intent, the approach is completely untested, and causing even greater concern, the program is almost certainly unimplementable for legal, financial and practical reasons. In fact, the Maryland Department of Legislative Services found that participation program is “expected to be low (or nonexistent)” and will “not likely to be able to comply with the bill’s requirement to set its fees at a level sufficient to offset program costs…unless it sets its fees at a level that would likely be prohibitively high.”
Legal Reasons for Concern
HB 1101 would allow patients to obtain medical cannabis from “Academic Medical Centers” (AMCs), which are essentially teaching-hospitals that have federal approval to conduct trails on human subjects. While this is creative way to reinvent how medical cannabis is distributed to patients, only one potentially eligible AMC (Sinai Hospital in Baltimore) has expressed interest in becoming an AMC. However, by becoming an AMC, the hospital would likely be placing its credentials to conduct research on human subjects in jeopardy. Considering that federal interference is one of the reasons Maryland has been reticent to adopt a proven safe access model, it does not add up why Maryland would be encouraging its facilities to endanger the credentials.
But let’s assume for a moment that this legal concern is not in fact an issue…
The DLS analysis points out that HB 1101 must be able to offset the financial costs incurred by the commission that will be set to implement it. While the DLS report mentions that the state might not be able to find any willing and eligible AMCs, it concludes that even if Sinai or another institution stepped forward and applied to be an AMC, the program would still be unable to offset its anticipated costs. Moreover, the state will have to bear the costs of establishing the administrative rules for the program, even if no AMCs ever apply to the state. It’s rare feat for an essentially symbolic piece of legislation to come with a price tag, but that’s what HB 1101 does, meaning Maryland taxpayers could be forced to pay for a program that may not serve any of the state’s patient population.
But let’s assume for a moment that the price tag issues are not a factor…
Dubious Practical Value
Absent concerns about the financial and legal viability of HB 1101, the program still contains practical flaws that would make it arguably the least patient-friendly bill in the country. The bill fails to grant physicians to right to recommend cannabis to their patients unless an eligible AMC has been approved by the state to recommend and distribute medical cannabis for certain conditions. In other words, if an AMC did not have foresight to include a patient’s particular condition in its application to become an AMC, the patient would be shut out from the program. This would be particularly harmful to patients with rare conditions and conditions for which medical cannabis is an emerging therapeutic option. This also means that the Commission would have to approve conditions, and given the strong resemblance of the work group created by SB 308 (2011) that had difficulty meeting its statutory requirements, it would also require the state’s patients to take a serious gamble that the Commission could meet its function.
Geography is another practical concern that should resonate with patients across the state. The most likely AMCs (Sinai, Johns Hopkins Hospital, and the University of Maryland Hospital) are all in Baltimore. Patients who do not live along the I-95 corridor, such as combat veterans living with PTSD in Cumberland, or retirees with cancer living on the Eastern Shore, may have to drive 2-3 hours each way in order to access their AMC to obtain medicine. Even if a patient is fortunate to have a caregiver assist them, the potential 6-hour trip is a completely unnecessary burden to safe access.
So what are Maryland patients left to assume? As someone who lived in Maryland for over 30 years, and has most of my loved ones still residing in the state, there was no state in 2013 that I had more personal hope for than Maryland. I really wanted Maryland to be the next medical marijuana state, but HB 1101 simply falls short, and significantly so.
Maryland’s new medical may make lawmakers feel better, but it remains extremely unlikely that it will do the same for the state’s patient population.
Yesterday, the New Hampshire House of Representatives overwhelmingly passed House Bill 573, by a voted of 286-64. The bill is expected to pass the Senate, which approved similar legislation last year. In fact, the year’s bill will provide patients with greater access options, as they will be able to purchase medical cannabis from a state-regulated dispensary in addition to being able to cultivate their own medicine in an enclosed, locked facility. While last year’s bill was vetoed by the previous governor (the veto fell just 2 shorts shy of being overridden), it is expected that it will again pass the senate followed this time with the signature of newly elected Governor Maggie Hassan.
ASA worked with NH state Representative Donald “Ted” Wright to help with language as the bill made its way through the Health, Human Services and Elderly Affairs Committee, and commends the work of the committee and each of the legislators that voted in favor of the bill that will create true safe access in New Hampshire. Although the bill failed to included protections against housing, employment or education discrimination, HB 573 is a very patient friendly bill, and will provide access to patients living with any of a number of debilitating conditions. Unfortunately, the same can not be said about legislation that is about to pass the Maryland General Assembly.
Late on Wednesday, it was announced that both the Maryland House Health and Government Affairs and Judiciary Committees approved HB 1101, a bill that would in theory create an access model where patients would obtain medicine from hospitals that are approved to conduct research on human subjects. Earlier this month, Maryland was considering a true safe access, HB 302, which would have been created access through dispensaries and cultivation while providing patients with the strongest privacy protections in the nation. Instead, this system can only be described as a symbolic bill because even the state’s own Department of Legislative Services (DLS) analysis said the likelihood that any facility is approximately “nonexistent.” In fact, the state’s analysis noted that;
“Both the University of Maryland Medical System (UMMS) and the Johns Hopkins University (JHU) previously advised (with regards to a similar bill introduced in the 2012 legislative session) that they did not intend to participate in the program as academic medical centers. JHU and UMMS have confirmed that their intentions have not changed. It is unclear how many, if any, other institutions are eligible (and willing) to participate as
academic medical centers under the bill.”
In other words, the state has no idea (or confidence for that matter) that there is a single facility in the state that will provide medical cannabis to patients with a qualifying condition. Even less friendly for patients is the fact physicians will not be able to write recommendations for conditions for which they have not been pre-approved to recommend. In fact, there is not a single debilitating medical condition that a patient in Maryland would be guaranteed access for under this law, bad news for Marylanders with rare conditions.
Worse still, this completely unproven approach is anticipated to be a financial quagmire for the state. The DLS analysis further states that,
“Because participation in the program is expected to be low (or nonexistent)…DLS advises that the commission is not likely to be able to comply with the bill’s requirement to set its fees at a level sufficient to offset program costs (notwithstanding that some costs, including those associated with the required database, are the responsibility of DHMH rather than the commission) unless it sets its fees at a level that would likely be prohibitively high.”
In other words, if by some miracle, some eligible facility stepped forward to become a provider of medical cannabis, the state would be hemorrhaging money on the program. Regardless of whether a facility stepped forward, the state would still bear the expense of promulgating unimplementable regulations. Bottom line, Maryland is about to pass the expensive symbolic medical cannabis law in history.
So there you have it. Neither Maryland nor New Hampshire are set to pass perfect medical cannabis bills in 2013, but the difference between them is night versus day. Or should I say, sickness vs. wellness.
San Diego Assistant District Attorney (ADA) Chris Lindberg decided this week to try Jackson for a third time in as many years. Jackson, who operated the San Diego dispensary Answerdam Alternative Care Collective (AACC), was raided by a multi-agency law enforcement task force in 2008 and again in 2009. Jackson was tried the first time on possession and distribution charges, but was acquitted by a jury in 2009.
Unsatisfied with that result, ADA Lindberg, likely at the behest of San Diego District Attorney Bonnie Dumanis, tried Jackson a second time on charges levied after the 2009 raid on AACC. The second trial was not considered “double jeopardy” by the court because the prosecution was based on a different raid. During Jackson’s second trial in 2010, Lindberg prevented him from using a medical marijuana defense and, as a result, was convicted this time on the same charges of possession and distribution.
Outraged by this official persecution of a law-abiding dispensary operator and the waste of taxpayer dollars, Americans for Safe Access (ASA) appealed Jackson’s conviction in late 2011. In a unanimous landmark decision by California’s Fourth District Court of Appeal, Jackson’s conviction was overturned in October 2012. The court also held that Jackson should have been entitled to a medical marijuana defense, rejecting arguments made by both Lindberg and the Attorney General that patients must take part in the cultivation used to supply dispensaries.
Although the Attorney General decided not to appeal the 2012 ruling overturning Jackson’s conviction, in an unusual move Lindberg appealed to the California Supreme Court. Clearly disappointed by the High Court’s decision earlier this year not to review the case, Lindberg is seeking to try Jackson again. This time, however, Jackson is ensured a defense at trial.
The new trial, which has been set for May 1st in San Diego County Superior Court, is clearly a waste of taxpayer dollars in a time of fiscal crisis, but is also a futile attempt to undermine patients’ rights to safely and legally obtain their medication from storefront dispensaries.
Since the landmark appellate ruling, San Diego Mayor Bob Filner has indicated his disinterest in prosecuting state-compliant dispensary operators in the city. Mayor Filner has also promised to help pass an ordinance that would establish local dispensary regulations, thereby making Jackson’s third trial that much more superfluous, yet still injurious for Jackson.
It seems doubtful to say the least that Jackson could now be convicted by a jury. It’s long past time for law enforcement in San Diego to abandon its hostile stance toward medical marijuana and allow California law to be implemented without further interference.
Following overwhelming approval of the medical marijuana ballot initiative in November, Massachusetts’ patients are waiting for safe access to their medicine as the state proceeds with implementation. We aren’t there yet, but so far progress is continuing in the right direction, thanks to the work of patient advocates from around the state. There have been a number of exciting advancements over the last several weeks.
The Attorney General issued a ruling that cities and towns cannot ban medical treatment centers from opening. Despite the overwhelming passage of the initiative that won in 350 out of 351 communities, a small minority of municipalities had attempted to forbid treatment centers from operating within their jurisdictions, largely based on unfounded fears about how treatment centers will work. Supporters within these towns have been frustrated with local officials’ attempting to overturn the will of the voters by passing bans. The AG has decided that these efforts are not legal, based on the reasoning that if one town can ban treatment centers, they all can. If that happened, implementation of the medical marijuana law would be impossible, and therefore these local bans are not permitted under state law. However, the AG also found that cities and towns can pass temporary moratoriums or zoning ordinance to address treatment center siting, as long as they do not ban the centers outright.
In other important developments, we saw an impressive turn out from patients at three recently convened listening sessions where the Massachusetts Department of Public Health (DPH) was soliciting input as the agency works on writing the regulations that will determine how the medical marijuana program will work. We thank Dr. Lauren Smith, Acting Commissioner of DPH, and her staff for making the time to travel around the state and listen to patients and others on issues regarding implementation.
The Massachusetts Patient Advocacy Alliance (MPAA) remains committed to making sure that patients, their family members, and medical professionals have a voice in the process. Once again advocates in Massachusetts have risen to the occasion, and we’ve proven nothing is more powerful than patients coming forward to speak about their experience. Read media coverage to hear directly from patient advocates at the Worcester session, Boston session, and Holyoke session.
Americans for Safe Access (ASA), (through their board member, Karen Munkacy MD) has been working closely with MPAA and DPH. ASA has presented information on patient access, physician education, patient education, recommendations for dispensaries (written in collaboration with the American Herbal Products Association) and what is a reasonable 60 day supply of MMJ.
We expect draft regulations to be released at the end of March, and then there will be one or two public hearing(s) around April 19. The month of April will be a critical period for patients and others to formally submit testimony to DPH on how implementation should be carried out.
I am honored and delighted to be able to publish here for the first time a new comprehensive piece written by Dr. Lester Grinspoon, Emeritus Professor of Psychiatry at Harvard Medical School, entitled “Cannabinopathic Medicine”. Dr. Grinspoon started writing this piece in 2012, when I was privileged to read an early draft and give editorial suggestions. He has been looking for a suitable venue for publishing it where it could be read widely. I am grateful that he agreed to allow me to use this blog space to share it. It is approximately 6,000 words and well worth a read.
First, a brief introduction. Dr. Grinspoon, who is in his eighties, is a great physician and researcher who has been a co-author, instructive mentor, and guide of mine. He is known for his pioneering work on the social and medicinal uses of cannabis, but before that, he made significant contributions such as introducing the use of lithium in the treatment of bipolar disorder, the starting of the Harvard Mental Health letter, and many other achievements such as senior psychiatrist at the Massachusetts Mental Health Center in Boston for 40 years, fellow of the American Association for the Advancement of Science and the American Psychiatric Association, founding editor of the The American Psychiatric Association Annual Review, and editor of the Harvard Mental Health Letter for fifteen years, to name a few. It is a wonderful turn of events that Dr. Grinspoon’s home state Massachusetts passed a voter initiative by wide margin to legalize the medicinal use of cannabis for patients with conditions that a physician believes may benefit from its use. That law went into effect this year and now, as of this month, Harvard Medical School-affiliated faculty, in collaboration with the Massachusetts Medical Society, are producing and editing AMA-certified continuing medical education online course series on the medicinal uses of cannabis, vindicating Dr. Grinspoon’s remarkable foresight from over 40 years prior.
Without further adieu, here is Dr. Grinspoon’s latest piece on cannabis use, where we are going with it as a as society, and where we should be going.
Cannabinopathic Medicine byLester Grinspoon, M.D.
A native of Central Asia, cannabis (hemp) may have been cultivated as long as 10,000 years ago. It was certainly cultivated in China by 4000 BC and in Turkestan by 3000 BC. It has long been used as a medicine in India, China, the Middle East, Southeast Asia, South Africa, and South America. The first evidence of the medicinal use of cannabis is an herbal published during the reign of the Chinese emperor Chen Nung 5000 years ago. It was recommended for malaria, constipation, rheumatic pains, “absentmindedness”, and “female disorders.” Another Chinese herbalist recommended a mixture of hemp, resin, and wine as an analgesic during surgery. In India cannabis had been recommended to quicken the mind, lower fevers, induce sleep, cure dysentery, stimulate appetite, improve digestion, relieve headache, and cure venereal disease. In Africa it was used for dysentery, malaria, and other fevers. Today certain tribes treat snakebite with hemp or smoke it before childbirth. Hemp was also noted as a remedy by Galen and other physicians of the classical and Hellenistic eras, and it was highly valued in medieval Europe. The English clergyman Robert Burton, in his famous work The Anatomy of Melancholy, published in 1621, suggested the use of cannabis in the treatment of depression. The New English Dispensatory of 1764 recommended applying hemp roots to the skin for inflammation, a remedy that was already popular in Eastern Europe. The Edinburgh New Dispensary of 1794 included a long description of the effects of hemp and stated that the oil was useful in the treatment of coughs, venereal disease, and urinary incontinence.
However, in the West cannabis did not come into its own as a medicine until the mid-19th century. The first Western physician to take an interest in cannabis as medicine was W.B. O’ Shaughnessy, a young professor at the Medical College of Calcutta, who had observed its use in India. He gave cannabis to animals, satisfied himself that it was safe, and began to use it with patients suffering from rabies, rheumatism, epilepsy, and tetanus. In a report published in 1839, he wrote that he had found Cannabis Indica, (a solution of cannabis in alcohol, taken orally) to be an effective analgesic. He was also impressed with its muscle-relaxant properties and called it “an anticonvulsive remedy of the greatest value.”
O’Shaughnessy returned to England in 1842 and provided cannabis to pharmacists. Doctors in Europe and the United States soon began to prescribe it for a variety of physical conditions. Cannabis was even given to Queen Victoria for the treatment of her painful pre-menstrual cramps by her court physician. It was admitted to the United States Pharmacopeia in 1850 and commercial cannabis preparations soon became widely distributed through drugstores. Pharmacies welcomed the arrival of this “new” medicine, Cannabis Indica, because at that time their shelves held few truly effective drugs to offer the practitioners of allopathic medicine. As its use became increasingly widespread, clinical reports on cannabis accumulated and by the turn of the century, more than 100 papers were published in the Western medical literature recommending it for various illnesses and discomforts and extolling its remarkably limited toxicity.
The decline in the usage of Cannabis Indica began toward the end of the century. Both the potency of cannabis preparations and its absorption from the bowel were too variable, and individual responses to orally ingested cannabis seemed erratic and unpredictable. Another reason for the neglect of research on the analgesic properties of cannabis was the greatly increased use of opiates after the invention of the hypodermic syringe in the 1850s allowed soluble drugs to be injected for fast relief of pain; cannabis products are insoluble in water and so cannot easily be administered by injection. The end of the 19th century saw the development of such synthetic drugs as aspirin, chloral hydrate, and barbiturates. Two of the most common symptoms for which Cannabis Indica was prescribed were pain and insomnia, and now physicians could prescribe easy-to-take pills of known potency for these two problems, hastening the decline of cannabis as a medicine. But the new drugs had striking disadvantages. More than 1000 people die from aspirin-induced bleeding each year in the United States, and barbiturates are, of course, far more dangerous.
But the Marijuana Tax Act of 1937 was the ultimate death-knell for Cannabis Indica. This law was the culmination of a campaign organized by the Federal Bureau of Narcotics under Harry Anslinger in which the public was led to believe that cannabis, now commonly referred to as marijuana, was addictive and that its use led to violent crimes, psychosis, and mental deterioration; it is now confined to Schedule 1 under the Controlled Substances Act of 1970 as a drug that has a high potential for abuse, lacks accepted medical use, and is unsafe for use even under medical supervision. The film Reefer Madness, made as part of Anslinger’s campaign, may be a joke to the sophisticated today, but it was once regarded as a serious attempt to address a social problem; the atmosphere and attitudes it exemplified and promoted continue to influence our culture, albeit much less so today. The Marijuana Tax Act was not directly aimed at the medical use of cannabis; its purpose was to discourage recreational marijuana smoking. Almost incidentally the law made medical use of cannabis difficult because of the extensive paperwork and fees required of doctors who wanted to prescribe it. The Federal Bureau of Narcotics followed up with “anti-divergent” regulations that contributed to physicians’ disenchantment. Its removal from the United States Pharmacopeia and the National Formulary in 1942 signaled both the end of physicians’ interest in and allopathic medicine’s institutional embrace of cannabis. Furthermore, physicians allowed themselves to become ignorant about this drug as they have, since the mid-1930s, been increasingly exposed along with every other citizen to the deceptive propaganda against marijuana propagated by the United States government and such private organizations as the Partnership for a Drug Free America.
The concept of marijuana as a medicine virtually disappeared for several decades. Then in the 1960s, as large numbers of people began to use marijuana recreationally, claims of its medical utility began to appear, not in the medical literature but in the form of letters to popular magazines like Playboy. Typically these accounts were written by surprised and excited recreational users who had serendipitously discovered that marijuana relieved one or another of a variety of symptoms and syndromes. Over the next several decades, the grapevine word of these rediscovered medical utilities continued to grow. With the advent of the AIDS epidemic and the discovery of marijuana’s ability to reduce the nausea and therefore the threat of the “weight reduction syndrome of AIDS”, this reappearance of the concept of cannabis as a medicine gathered enough momentum to be publicly palpable. It was at this time that public pressure on the government to reconsider its obdurately held position developed in earnest, but with little success to date at the federal level.
There is an important difference in the way cannabis was used as a medicine in the latter
half of the 19th century and the way it has been generally administered since its reemergence as a sub rosa medicine in the mid-20th century. In its earlier iteration it was dispensed orally as an alcoholic solution; now it is primarily taken through the pulmonary system as smoke. The emergence of cannabis as a recreational drug began in the early part of the 20th century and has continued to grow. One of the reasons it has grown to the point where it can now be considered a part of Western culture is its introduction as a smokable drug. A good deal of mystery and uncertainty surrounds the story of the “reefer’s” debut in the United States. It is generally thought that in the early decades of the 20th century the custom of smoking “the weed” in cigarette form traveled with groups of itinerant Mexican workers across the border in the southern and southwestern states; it is now overwhelmingly the mode of administration used by the millions who use it as a medicine or for any other reason today.
This change in the route of administration has greatly enhanced its usefulness as a medicine because it solved the problem of providing the correct dose. One of the major problems that doctors in the 19th century faced with Cannabis Indica was that there were no reliable bioassays at that time and so physicians could never be sure that they had prescribed the correct dose. If too much was prescribed, the patient might experience discomfort in the form of anxiety but this would not be immediately evident because it takes about one to two hours for the effects of orally administered cannabis to be experienced. However, because physicians of the 19th century understood that this was a drug of unusually limited toxicity, they were not as concerned about overdosing as they were about providing an inadequate dose. The major advantage of smoking is the rapidity with which the medicinal effect appears; symptom relief will occur in a matter of minutes. And perhaps even more importantly, this very rapid feedback allows the patient to titrate his own dose for his particular symptom with much more precision than can his physician. He just leisurely puffs until one of two things happens; he either begins to experience symptom-relief or he becomes somewhat high or anxious at which point he stops. It is no longer believed that the smoke from marijuana is harmful to pulmonary or oropharyngeal tissues. But, for those patients who prefer not to smoke, there now is the option of using an instrument called a vaporizer which allows one to inhale the cannabinoids free of the combustion products of the cannabis plant.
In what may be the first attempt to reestablish the place of cannabis in mainstream allopathic medicine, the National Organization for the Reform of Marijuana Laws (NORML) in 1972 petitioned the Bureau of Narcotics and Dangerous Drugs, later renamed the Drug Enforcement Administration (DEA), to transfer marijuana to Schedule II so that the research necessary for the Food and Drug Administration (FDA) approval could be undertaken. Without this approval it cannot be clinically researched nor can it be legally prescribed. As the proceedings continued, other parties joined, including the Physicians Association for AIDS Care. It was only in 1986, after many years of legal maneuvering, that the DEA acceded to the demand for public hearings required by law. During the hearings, which lasted two years, many patients and physicians testified and thousands of pages of documentation were introduced. In 1988 the DEA’s own Administrative Law Judge, Francis L. Young, declared that marijuana in its natural form fulfilled the legal requirement of currently accepted medical use in treatment in the United States. He added that it was “one of the safest therapeutically active substances known to man.” His order that the marijuana plant be transferred to Schedule II was overruled, not by any medical authority, but by the DEA itself, which issued a final rejection of all pleas for reclassification in March 1992.
Meanwhile, growing demand forced the FDA to institute the Individual Treatment IND (commonly referred to as a Compassionate IND) for the use of physicians whose patients needed marijuana. The application process was made enormously complicated, and most physicians did not want to become involved, especially since many believed there was some stigma attached to prescribing marijuana. Between 1976 and 1988 the government reluctantly awarded about a half-dozen Compassionate INDs for the use of marijuana. In 1989 the FDA was deluged with new applications from people with AIDS, and the number granted rose to 34 within the year. In June 1991, the Public Health Service announced that the program would be suspended because it undercuts the Administration’s opposition to the use of illegal drugs. After that no new Compassionate IND’s were granted, and the program was discontinued in March 1992. Four patients are still receiving marijuana under the original program; for everyone else it is at the federal level an outlaw medicine.
Despite its federal illegality, beginning in 1996 with California’s passage of its Proposition 215, 18 states and the District of Columbia have established legislation which makes it possible for patients suffering from a variety of disorders to use the drug legally with a recommendation from a physician. Unfortunately, because each state arrogates to itself the right to define which symptoms and syndromes may be lawfully treated with cannabis, many patients with legitimate claims to the therapeutic usefulness of this plant must continue to use it illegally and therefore endure the extra layer of anxiety imposed by its illegality. California and Colorado are the two states in which the largest number of patients for whom it would be medically useful have the freedom to access it legally. New Jersey appears to be shaping up as one of the most restrictive, and for that reason it is likely that only a small fraction of the pool of patients who would find marijuana to be as or more useful than the invariably more toxic conventional drugs it will displace will be allowed legal access to it. The framers of the New Jersey legislation may fear what they see as chaos in the distribution of medical marijuana in California and Colorado, a fear born of their concern that the more liberal parameters of medical use adopted in these states have allowed its access to many people who use it for other than strictly medical reasons.
Because so many people are now having an opportunity to observe relatives or friends who are successfully, safely and relatively inexpensively using marijuana as a medicine, it will not be long before an overwhelming majority of citizens demand the same rights. There are now six other states working on medical marijuana legislation; this is a reflection of recent polls which show that more than 70% of American citizens now support the legal availability of marijuana as a medicine. These additional states and their citizens will inadvertently become part of an ongoing large social experiment in how best to deal with the reinvention of the “cannabis as medicine” phenomenon. Already we have learned a great deal from this ongoing experiment; one of the most important is that the states which have the more restricted and limited medical indications for allowable use of marijuana as a medicine have the largest number of patients who are compelled to use it illegally, while those which are the least restricted with respect to allowable medical indications unintentionally provide it to many people who use it for other purposes.
Shortly after O’ Shaughnessy introduced cannabis as a new medicine, modern Western medicine (allopathic medicine) signaled its acceptance when it was entered into the various Western pharmacopeia in the mid-19th century. It was expected, certainly by the 1990s, that it would be readmitted as a legitimate medicine, given the mountain of largely anecdotal evidence which establishes both its efficacy and safety, and its potential (once free of the prohibition tariff) to be much less expensive than pharmaceutical industry products it will replace. The two major agencies of this resistance to its readmission are the US government and the medical/pharmaceutical establishment.
Today drugs must undergo rigorous, expensive and time-consuming research to win approval by the FDA before they can be marketed as medicines. The first step made in trying to move the federal government was to petition it to move cannabis from its Schedule I status in the Controlled Substances Act to Schedule II so that it would then be possible to do the kinds of controlled studies essential to the presentation of any new drug to the Food and Drug Administration (FDA) for approval in accordance with the protocol used by the pharmaceutical industry. As noted above, the first attempt to petition the FDA and DEA to move marijuana to Schedule II was initiated in 1972 and after two decades of hearings and delays the DEA rejected all pleas for reclassification. Another two decades have passed and, with the exception of a handful of small-to-medium sized randomized controlled trials of smoked cannabis in chronic pain, spasticity, and wasting syndrome, the federal government continues to block the possibility of demonstrating that marijuana could satisfy the FDA criteria for a safe and efficacious addition to the pharmacopeia by continuing to insist, against overwhelming evidence to the contrary, that it is properly placed in Schedule I. In actuality it is now clear that marijuana no more belongs in Schedule I than does aspirin.
The purpose of the FDA testing is to protect the consumer by establishing both safety and efficacy. First, the drug’s safety (or rather, limited toxicity) is established through animal and then human experiments. Next, double-blind controlled studies are conducted to determine whether the drug has more than a placebo effect and is more useful than an available drug. As the difference between drug and placebo may be small, large numbers of patients are often needed in these studies for a statistically significant effect. Medical and governmental authorities insist that before marijuana is made legally available to patients, this kind of study should be performed for each of the indications for which it is proposed to be used. At the same time, the government refuses to reconsider its inappropriate assignment of marijuana to Schedule I, therein making it impossible by imposing a tight and heavily controlled monopoly on research-approved cannabis production and distribution to undertake the kind of studies presently demanded by the FDA for its reintegration into modern Western medicine.
But with the accumulation of an enormous amount of anecdotal evidence, it has now become doubtful whether these FDA rules should apply to marijuana. There is now little question about its safety. It has been used for thousands of years by millions of people with very little evidence of significant toxicity. Similarly, no further double-blind studies are needed to prove marijuana’s efficacy. Any astute clinician who has some knowledge of the accumulated clinical experience of patients who have used marijuana as a medicine knows that it is efficacious to some degree for many people with various symptoms and syndromes. Anecdotal evidence commands much less attention than it once did, yet it is the source of much of our knowledge of synthetic medicines as well as plant derivatives. Controlled experiments were not needed to recognize the therapeutic potential of chloral hydrate, barbiturates, aspirin, curare, insulin, or penicillin— pharmaceuticals introduced before the double-blind controlled study was invented.
Anecdotes present a problem that has always haunted medicine: the anecdotal fallacy or the fallacy of enumeration of favorable circumstances (counting the hits and ignoring the misses). If many people suffering from, say, muscle spasms caused by multiple sclerosis take marijuana and only a few get much better relief than they could get from conventional drugs, those few patients would stand out and come to our attention. They and their physicians would understandably be enthusiastic about marijuana and might proselytize for it. These people are not dishonest, but they are not dispassionate observers. Therefore, some may regard it as irresponsible to suggest on the basis of anecdotes that cannabis may help people with a variety of disorders. That might be a problem if cannabis were a dangerous drug but, in fact, it is remarkably safe. Even in the unlikely event that only a few people with multiple sclerosis find that it provides relief from muscle spasm, it can be argued that cannabis should be available to them because it costs so little to produce and the risks are so small.
The benefits of any medicine must be weighed against the risks. Fortunately, there is unusually good evidence on the potential health hazards of marijuana—far better than the evidence on most prescription drugs. Not only has cannabis been used for thousands of years by many millions of people, but there is much recent research on its safety inspired by the federal government’s interest in discovering toxic effects to justify its policy of prohibition. The potential dangers of marijuana when taken for pleasure and its possible usefulness as a medicine are historically and practically interrelated issues: historically, because the arguments used to justify the suppression of recreational use have had a disastrous influence on views of its medical potential; practically, because it is more likely to be safe as a medicine if it is relatively safe as a euphoriant. As the evidence makes it increasingly clear that cannabis is relatively benign, it is becoming more and more difficult to deny that a risk-benefit analysis now satisfies all requirements for medical use.
Penicillin was discovered in 1929, but the discovery was ignored by the medical establishment for more than a decade until the first clinical trial with six patients who suffered from a variety of infections; all were successfully treated. After this debut in 1941, penicillin rapidly earned the reputation as the wonder drug of the 1940s. It earned that reputation for three reasons: it was remarkably non-toxic, even at high doses; it could be produced inexpensively on a large scale; and it was extremely versatile, acting against microorganisms that cause a great variety of diseases, from pneumonia to syphilis. In all three respects cannabis suggests parallels: it is remarkably safe; once it is free of the prohibition tariff it will be inexpensive; and it is effective against a large number of symptoms and syndromes. Penicillin did not undergo modern FDA approval scrutiny because its safety and efficacy had been well established by the time the FDA adopted the present protocol for approving new drugs. Marijuana is now in the same position vis-à-vis the FDA; it has accumulated, both from recreational and medicinal use, more than enough evidence of its safety and efficacy.
As its reputation as a medicine grew, so did the demand for legal access. In 1996, California became the first state to provide legal (as far as the state was concerned) access for specified signs and symptoms and under controlled conditions. Over the next 15 years 16 other states and the District of Columbia followed suit, but the defined parameters of availability, particularly the rules for distribution and the medical reasons for which use would be allowed, have generally become more constricted. In these states the only involvement with the medical establishment is the requirement that the patient receive a note from a physician stating that he believes the patient’s condition would be helped by cannabis; these notes allow the patient to receive a state-issued medical marijuana registration card which may cost $100 or more annually. Each state establishes its own rules for the growing and dispensing of medical marijuana. These states now allow thousands of people to legally purchase a growing variety of marijuana products upon the presentation of these cards or, in some states, the physician’s letter to one of the state-sanctioned dispensaries. It is estimated that 2 1/2 to 3% of the residents of California are now credentialed to buy marijuana legally in what is estimated to be between a 1 1/2 to 2 1/2 billion dollar business. One has only to visit one of the California dispensaries to see how sophisticated this industry is becoming, with a range of newly developed cannabis products; beyond having perhaps a dozen or more different strains of herbal cannabis to choose from, there is a large choice of edible and even topical marijuana medications. The patient who wants to use a pipe, bong or vaporizer will find a large and growing selection to choose from. There now exist a few laboratories equipped to measure the percentage of individual cannabinoids and terpenes, and to provide assurance against contamination with insecticides or fungi.
The rapidly increasing number of patients who are now seeking cannabis as a medicine is fueling a burgeoning medical marijuana enterprise which is becoming increasingly sophisticated. There are the growers who are becoming more adept at breeding new strains which may be more beneficial to patients with particular needs, as for example the present effort to develop strains high in cannabidiol (CBD,a non-psychoactive cannabinoid) . There are now a number of publications aimed at the medical marijuana community, most notably O’Shaughnessy’s, the Journal of Cannabis Clinical Practice, published in San Francisco. The recently formed physicians’ professional organization, the Society of Cannabis Clinicians (SCC), promotes clinical cannabis research.
Despite harassment by the federal authorities, especially in California, all aspects of this alternative medicine which is beginning to look like a new school or philosophy of medicine will continue to grow and become more sophisticated as it is embraced by more and more patients, legally or illegally. This new medicine, bolstered by the fundamental understandings in biology and physiology that have come from the discovery and study of the endogenous cannabinoid signaling system, which might be called “cannabinopathic medicine”, joins other alternative schools of medicine such as naturopathic medicine, homeopathic medicine and osteopathic medicine. Cannabinopathic medicine is being practiced all over this country, openly in the states which have made it legal, and clandestinely in those which have yet to do so. Osteopathic medicine, which was first practiced in the latter part of the 19th century, has now moved so close to allopathic medicine in its training and practice that it has become integrated with modern Western medicine. In the early days of medical marijuana it was assumed that it would become integrated into Western medicine as a new therapeutic; thus the effort which began in 1972 to persuade the federal government to change its Controlled Substances Act Schedule I status to Schedule II as the essential first step toward collecting the kind of data necessary for the FDA’s medicinal drug approval process. While the government has in the past made tentative moves in the direction of accepting the reality of marijuana’s medical capacities, including the now defunct Compassionate IND program and the relatively recent decisions to move synthetic THC (Marinol) from Schedule I to Schedule II, and several years later to Schedule III (less harmful than drugs in Schedules I and II), it has steadfastly refused to release herbal marijuana from its Schedule I restrictions.
Today, even if it were free of its Schedule I chains, its path to legitimacy as a pharmaceutical faces other obstacles. A big one is the availability of funding for the kind of research which would allow it to be presented to the FDA. The cost of this research runs to upwards of $800 million per drug. Pharmaceutical companies do not undertake such costly research unless they have been awarded the 20 year new drug patent and are reasonably sure that, once approved, the drug will sell for the price they will need to charge during that exclusive period to cover these costs and make a profit. The pharmaceutical companies, however, have no interest in herbal marijuana because it cannot be patented. Only in the case of some orphan drugs does the government support these developmental costs. An exception to this rule occurred in the early 1980s when the government provided major funding to a small pharmaceutical company, Unimed, towards its development of a synthetic THC which was called dronabinol (Marinol). The government assumed that with Marinol’s legal availability it would then be possible to assert that there was no longer a need for medicinal marijuana as there was now a commercially available cannabinoid pharmaceutical product. The problem with this strategy became obvious to every patient who tried to substitute Marinol for smoked or ingested marijuana; it simply did not work nearly as well as herbal marijuana. The primary reason that some patients use Marinol today is because it is legal.
The vast majority of people who use cannabis as a medicine must suffer the anxiety, uncertainty, and risk associated with obtaining and using an illegal substance. The responses of physicians, as indicated by patients’ stories, vary a great deal. With the exception of a small minority of physicians, such as those who comprise the Society of Cannabis Clinicians, physicians’ attitudes toward marijuana as a medicine generally range from outspokenly negative to varying degrees of skepticism; a few are hostile or contemptuous, some are indifferent or unconvinced, and a growing number offer at least some encouragement or moral support. Unfortunately, even the most sympathetic are either afraid to do more because of the law or are unable to provide advice because they have been misinformed about cannabis and simply know too little about its therapeutic value. Physicians of a century ago knew much more about cannabis than do contemporary physicians whose education about new drugs comes largely from the pharmaceutical industry. Today’s physicians are often introduced to therapeutic marijuana by their patients, but even those physicians who become educated about this drug may be afraid to recommend what they know or suspect to be the best treatment out of fear that they might lose their reputations, licenses, and careers. Even if marijuana were available as a Schedule II medicine, pharmacies would be reluctant to carry it and physicians would hesitate to prescribe it. Through computerized monitoring, the DEA could know who was receiving prescription marijuana and how much. It could hound physicians who, by its standards, prescribed cannabis too freely or for reasons it considered unacceptable. The potential for harassment would be extremely discouraging. Unlike other Schedule II drugs, such as cocaine and morphine, cannabis has many potential medical uses rather than just a few. Many people would undoubtedly try to persuade their doctors that they had a legitimate claim to a prescription. Doctors would not want the responsibility of making such decisions if they were constantly under threat of discipline by the DEA. Furthermore, many doctors would not consider prescribing cannabis at all because they are victims of the government’s misinformation campaign. Some still believe and promote such hoary myths as the notion that marijuana is addictive or leads to the use of more dangerous drugs.
Despite the growing appreciation of its safety and usefulness as a medicine there is, after more than three decades of effort, little hope that herbal marijuana will soon be integrated into modern Western medicine. And even if it were, there would be enormous problems in controlling the distribution of a controlled medicine which has now become an established and popular Western culture recreational drug The pharmaceutical industry will continue to develop cannabinoid products and the government will make Control Substances Act scheduling accommodations, as they did with Marinol, to make them available as prescription drugs. Some of them will be very useful and a few may, for specific symptoms or syndromes, be more useful than herbal marijuana, but it is unlikely that they will ever displace it; herbal marijuana will always provide more choice, be less expensive and more readily available. Because the commercial success of its cannabinoid products will vary directly with the severity of the prohibition, the pharmaceutical industry will predictably put even more pressure on the government to maintain or even strengthen its prohibition.
However, the realities of human need are incompatible with the demand for a legally enforceable distinction between medicine and all other uses of cannabis. Marijuana simply does not conform to the conceptual boundaries established by 20th century institutions. It is truly a sui generis substance; is there another relatively benign drug which is capable of heightening many pleasures, has a large and growing number of medical uses and has the potential to enhance some individual human capacities? The only workable way of realizing the potential of this remarkable substance, including its full medical potential, is to free it from the present dual set of regulations – – those that control prescription drugs in general and the special criminal laws that control psychoactive substances. These mutually reinforcing laws establish a set of social categories that strangle its uniquely multifaceted potential. The only way out is to cut the knot by giving marijuana the same status as alcohol – – legalizing it for adults for all uses and removing it entirely from both the medical and criminal control systems.
Perhaps in part because so many Americans have discovered for themselves that marijuana is both relatively benign and remarkably useful, moral consensus about the evil of cannabis is becoming uncertain and shallow. The authorities pretend that eliminating marijuana traffic is like eliminating slavery or piracy, or eradicating smallpox or malaria. The official federal government view is that everything possible has to be done to prevent everyone from ever using marijuana, even as a medicine. But there is also an informal lore of marijuana use that is far more tolerant. Many of the millions of cannabis users in this country not only disobey the drug laws but feel a principled lack of respect for them. They do not conceal their bitter resentment of laws that render them criminals. They believe that many people have been deceived by their government, and they have come to doubt that the “authorities” understand much about either the deleterious or the useful properties of this drug. This undercurrent of ambivalence and resistance in public attitudes towards marijuana leaves room for the possibility of change, especially since the costs of prohibition are so high and rising.
Because multifaceted marijuana is now here to stay as a very useful and safe medicine, as a superior recreational drug, and as an enhancer of a variety of human capacities, this more than 70-year-old destructive prohibition cannot endure much longer. It is reasonable to assume that had there never been a marijuana prohibition, smoked marijuana, because it is both more reliable and easier to titrate, would have displaced Tincture of Cannabis as the cannabinoid medicine of choice. Without prohibition, marijuana would have become as easily accessible as aspirin. It would have provided the first opportunity for herbal marijuana to compete with pharmaceutical products and its success would have assured its place as an integral part of modern allopathic medicine. However, can we now assume that the end of the prohibition against herbal marijuana, which must come sooner or later, will see it regain its rightful place in modern medicine? Given the enormous influence of contemporary big Pharma on the medical establishment and the government, this is not so clear. It is not just a matter of big Pharma losing out on the enormous profits to be made with cannabis in its herbal form, but also, what it would lose from the diminished sales of many of its products which will have to compete with herbal marijuana. Even the cannabinoid products that the pharmaceutical industry has and will continue to develop are unlikely to win many if not most clinical contests on a level playing field with cannabinopathic medicine’s gold standard, herbal marijuana, for which, as a product of nature, there are no exclusive rights..
In the face of the ongoing prohibition cannabinopathic medicine will continue to grow and develop. It will continue to collect data to help it discover new medicinal uses; to develop new strains to more effectively target particular symptoms and illnesses; to generate new modifications of herbal products to facilitate topical application, ingestion and smoking or inhaling; and it will continue to train people in the newest and best ways to use these products. In states which have not legalized the use of cannabis as a medicine, all aspects of the practice of cannabinopathic medicine will continue to be subterranean. In the states which have already made it more or less legally available as a medicine (depending on the comprehensiveness of the list of symptoms and syndromes for which the state allows it to be used as a medicine) cannabinopathic practice continues to be only partially transparent. Because it is unlikely that any state will ever include pre-menstrual syndrome or intractable hiccups, for example, as indications for which cannabis may be useful, patients suffering from these and many other disorders will have to continue to use cannabis covertly or wait until after the prohibition comes to an end as it recently has in Colorado and Washington. This is consistent with my belief that it will be impossible to realize the full potential of this plant as a medicine, not to speak of the other ways in which it is useful, in the setting of this destructive prohibition.
On her 30th birthday (March 19 in 2012), doctors discovered a cancerous mass in my sister’s right breast. She was rushed to the emergency room for an emergency mastectomy and was newly pregnant at the time. For a grueling year, she suffered extensive chemotherapy treatments , during which she secretly used cannabis to ease her anxiety and nausea instead of drugs proscribed by her doctors which were known to harm the fetus. Her healthy and beautiful daughter Chloe was born via scheduled cesarean with no complications other than slight prematurity. My sister lives in Virginia, where medical cannabis is barely a conversation. Today, a year later on March 11th, a new mass was found in her left breast. Unless we do something to help her, my sister will unnecessarily continue to suffer through her treatments.
I have always championed the medicinal properties of cannabis and believe it should be easy to obtain and available to whoever needs it. But nothing drives that fact home harder than experiencing it on the front lines through a loved one’s suffering. My sister is not alone. There are so many people struggling with extreme pain, discomfort and agony on a daily basis. Every single one of them deserves relief.
I joined ASA to not only end my story and voice to the fight for safe access to medical cannabis but to empower others to take action as well. Today, I do so by urging you to join ASA.
ASA’s 45 day Spring Membership Drive launched yesterday. Our goal, to obtain 3,000 new members starts with you. Incidentally, it’s a great time to join because we are offing a bunch of membership incentives with each membership level.
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According to Matt Taibbi, in his latest Rolling Stone exposé on the banking and financial industry “Too Big to Jail,” HSBC “helped to wash hundreds of millions of dollars for drug mobs, including Mexico’s Sinaloa drug cartel,” and also “moved money for organizations linked to Al Qaeda and Hezbollah, and for Russian gangsters; helped countries like Iran, the Sudan and North Korea evade sanctions.”
Yet, as outrageous as these transgressions are, the Justice Department refuses to criminally prosecute the bankers committing federal crimes right under the nose of the U.S. government.
At a press conference where the Justice Department announced a settlement between the government and HSBC, in which the bank was forced to pay $1.9 billion, but without any individual being fined or prosecuted, Assistant Attorney General Lanny Breuer had this to say:
Had the U.S. authorities decided to press criminal charges, HSBC would almost certainly have lost its banking license in the U.S., the future of the institution would have been under threat and the entire banking system would have been destabilized.
So, the lesson we’re supposed to take from that is this:
if you’re a banker you can commit federal felonies and all you have to endure is a slap on the wrist. However, if you’re in any other line of business and you commit federal felonies, all bets are off.
If you’re a medical marijuana provider, for example, the Justice Department will not just look the other way as it did for years with HSBC. Instead, you can expect the government to come after you with the full force of the law.
Over the past four years, the Obama Administration has spent millions of taxpayer dollars criminally prosecuting scores of people, arguably in compliance with their state’s medical marijuana laws. Montana medical marijuana cultivator Chris Williams was most recently sentenced to 5 years in federal prison. California-based dispensary operator Aaron Sandusky was sentenced a few weeks earlier to 10 years. Michigan cultivators and medical marijuana patients Jeremy and Jerry Duval were sentenced late last year to 5 and 10 years in prison, respectively. All four of these defendants were convicted at trial after being denied a medical marijuana defense.
In medical marijuana-related cases, the government goes out of its way to stack the legal deck against defendants. It’s bad enough that the Justice Department expends significant resources to prosecute those trying to comply with state law, but to also deny them a defense is shameful.
Two bills currently in Congress would attempt to change that dynamic. HR689, the “States’ Medical Marijuana Patient Protection Act” would reclassify the drug for more widespread use and research, while HR710, the “Truth in Trials Act” would grant an affirmative defense in federal court cases. Passage of these bills would go a long way in bringing fairness to our country’s public health policy.
However, much more needs to be done before our skewed approach to medical marijuana is corrected. For example, some of the same banks that were at least partly responsible for our recent economic crash — like Wells Fargo and Bank of America — are in collusion with the federal government to deny financial services to legally compliant medical marijuana businesses.
Just in case you missed it: the Justice Department looks the other way when large banks launder foreign drug cartel money in our own country, but works with large banks to deny services to legally compliant medical marijuana businesses. And that’s if they’re lucky. If the Justice Department decides to target such businesses, as it has with hundreds of them, the owners could spend years in prison.
Justice in America has often been selective, though rarely has it been starker than this.