Medical marijuana refers to the use of marijuana (cannabis) as a prescription drug, most notably as an anti-emetic. Due to the widespread use of cannabis as a recreational drug, even in jurisdictions where it is illegal, its use in medicine is a controversial issue—particularly in the United States.
Cannabis has been used for medicinal purposes since at least 2,000 years ago. Surviving texts from China, India, Greece and Persia confirm that its hallucinogenic properties were recognized, and the ancient doctors used it for a variety of illnesses and ailments. These included a whole host of gastrointestinal disorders, insomnia, headaches and as a pain reliever, frequently used in childbirth. The earliest recorded reference to medicinal marijuana is in the Ry-Va (ancient Chinese Pharmacopeia), believed to have been written in the 15th century BC. These ancient uses are well-documented, but are not proof that cannabis is a useful medicine.
Cannabis as a medicine was common throughout most of the world in the 1800s. It was used as the primary painkiller until the invention of aspirin. Modern medical and scientific inquiry began with doctors like O'Shaughnessy and Moreau de Tours, who used it to treat melancholia, migraines, and as a sleeping aid, analgesic and anticonvulsant.
By the time the United States banned the plant (the first country to do so), it was no longer extremely popular. The only opponent to the bill, The Marihuana Tax Act, was the representative of the American Medical Association.
Later in the century, researchers investigating methods of detecting marijuana intoxication discovered that smoking the drug reduced intraocular pressure. High intraocular pressure causes blindness in glaucoma patients, so many believed that using the drug could prevent blindness in patients. Many Vietnam War veterans also believed that the drug prevented muscle spasms caused by battle-induced spinal injuries. Later medical use has focused primarily around its role in preventing the wasting syndromes and chronic loss of appetite associated with chemotherapy and AIDS, along with a variety of rare muscular and skeletal disorders. Less commonly, cannabis has been used in the treatment of alcoholism and addiction to other drugs such as heroin and the prevention of migraines.
In 1972 Tod H. Mikuriya, M.D reignited the debate concerning marijuana as medicine when he published "Marijuana Medical Papers 1839-1972".
Later in the 1970s, a synthetic version of THC, the primary active ingredient in cannabis, was synthesized to make the drug Marinol. Users reported several problems with Marinol, however, that led many to abandon the pill and resume smoking the plant. Patients complained that the violent nausea associated with chemotherapy made swallowing pills difficult. Smoked marijuana takes effect almost immediately, and is therefore easily dosed; many patients only rarely smoke enough to feel the mental effects, as this is usually far more than is necessary for the medical effects -- many complained that Marinol was more potent than they needed, and that the mental effects made normal daily functioning impossible. In addition, Marinol was far more expensive, costing upwards of several thousand dollars a year for the same effect as smoking a weed easily grown throughout most of the world. Many users felt Marinol was less effective, and that the mental effects were far more disastrous; some studies have indicated that other chemicals in the plant may have a synergistic effect with THC.
In addition, during the 1970s and 1980s, six US states' health departments performed studies on the use of medical marijuana. These are widely considered some of the most useful and pioneering studies on the subject.
History
Early studies on efficacy
New Mexico
Approved by the Food and Drug Administration, the study included 250 patients and compared smoked marijuana to oral THC. All participants were referred by an MD and had failed to control vomiting using at least three alternative antiemetics. Patients chose smoking marijuana or taking the THC pill. Multiple objective and subjective standards were used to determing the effectiveness.
New York
New York ran a large scale study using 199 patients who had not found success with other antiemetic therapies. Each patient received 6,044 marijuana cigarettes, which were provided to the patient during 514 treatment episodes
Tennessee
27 patients had failed on other antiemetic therapies, including oral THC.
California
A series of studies throughout the 1980s involved 90 - 100 patients a year. The study was designed to make it easier for patients to enter the oral THC part of the study. Patients who wanted smoked marijuana had to be over 15 years old (oral THC patients had to be over 5) and use the drug only in the hospital and not at home. Smoked marijuana patients also had to receive rare and painful forms of chemotherapy.
Michigan
165 patients were randomly assigned to use either Torecan, an antiemetic, or smoked marijuana. The randomization process failed, however, and the patients were allowed to crossover.
Georgia
119 patients that had failed using other antiemetics were randomly assigned to oral THC pills and either standardized or patient-controlled smoking of marijuana
Current status of medical marijuana around the world
Albania
In spite of laws prohibiting growing and possessing cannabis, enforcement has been virtually nil. There have been fewer than ten arrests in five years.
Australia
After politicians in the Australian Capital Territory voted to allow doctors to determine when cannabis was appropriate for their patients, intense lobbying by the federal government resulted in the legislation being overturned.
Belgium
Though still illegal, the Belgian government has recently initiated trials to determine the effectiveness of medical marijuana, and may soon decriminalize possession of small amounts.
Cameroon
Growing cannabis for any reason is illegal, though AIDS and cancer patients are allowed to use the drug to treat their symptoms.
Canada
In Hitzig v. Canada, a court again declared Canada's Marihuana Medical Access Regulations unconstitutional "in not allowing seriously ill Canadians to use marijuana because there is no legal source of supply of the drug." In effect, this means that Canadians can not be prosecuted for using marijuana medically because the Marihuana Medical Access Regulations gives patients the right to do so, but does not set up any legal apparatus for obtaining cannabis. Back in July 2000, in the 'Parker' (epileptic Terry Parker) decision, another judge had made a declaration of invalidity of Canada's drug laws as they relate to the 'simple possession' of marijuana due to the lack of a reasonable exemption from the law for medicinal use. The Canadian government was given one year (a suspension of the declaration of invalidity) to remedy the situation, and created the Marihuana Medical Access Regulations. These regulations have been repeatedly deemed unconstitutional in a series of court decisions including 'Hitzig.' In a similar case based upon these decisions, lawyer Brian McAllister argued on behalf of a 16 year old that because the Canadian government, after setting up the MMAR, never re-enacted the relevant section of the Controlled Drugs and Substances Act, Canada effectively has no prosecutable laws prohibiting the 'simple possession' of any amount of cannabis. Representatives of the United States federal government have claimed that decriminalizing cannabis in Canada may disrupt border trade and relations between the two countries; many Canadians believe that this remains the primary obstacle to decriminalization in Canada.
Germany
Like mentioned in the general part, use is legal, and possession of small amounts is not enforced.
Israel
A small number of people have been granted special permission to use cannabis for medical uses by the Health Ministry.
Jamaica
Cannabis possession remains illegal for any reason, though enforcement is scarce. A recent panel recommended legalizing possession for adults for recreation or medical use.
Japan
All THC-containing forms of cannabis have been illegal since 1948, when the occupying forces of the United States enacted the Hemp Control Law after World War 2.
Luxembourg
Cannabis possession is now legal for adults for recreational or medical uses as long the possessor is not near a campus and no children are involved. A loophole in the law makes it impossible for police to search or seize cannabis, making enforcement difficult.
Netherlands
Cannabis has been legally available for recreational use in Amsterdam-area coffee shops for several years. It is also available without a prescription for medical uses. Recently, Dutch physicians have acknowledged that the coffee shops are inadequate and are working on a method of prescribing cannabis to patients.
Scott David Findlay, a paraplegic, was convicted of cannabis charges. The judge, Robert Spear (Dunedin District Court) offered to allow community service instead of imprisonment, but Findlay does not recognize the validity of New Zealand's cannabis laws and would not perform community service. Judge Spear claimed this was a "hollow protest" that he was nonetheless allowed to make, and sentenced him to three months imprisonment.
In 2003, GW Pharmaceuticals, the UK company granted the exclusive licence to cultivate cannabis for medicinal trials announced the completion of its clinical trials. The company has said that it is on track for obtaining regulatory approval to license the manufacture and sale of a cannabis based medicine starting in 2004.
The official policy of the federal government in the United States is that medical marijuana is a myth, promulgated by activists who have the eventual goal of legalizing all drugs.
New Zealand
Health Minister Annette King has stated that she is not "unsympathetic to using cannabis in a medicinal form. But that's different to saying we should let everybody smoke it." Her official position is that more conclusive studies are needed, and a method of regulating dosage is necessary before she support medical access to cannabis.Portugal
Since 2001, possession of any drug for personal use has been legal, though sale and trafficking are still criminal offenses.
Switzerland
Though all possession and cultivation remains illegal, the Upper House of Parliament has moved towards allowing for decriminalization.
United Kingdom
In 1998, a House of Lords inquiry recommended that cannabis be made available with a doctor's prescription. Though the government of the UK has not accepted the recommendations, new long-term clinical trials have been authorized. Increasingly, juries have returned verdicts of "not guilty" for people charged with marijuana possession for medical use.United States
Medical marijuana is illegal for any reason at the federal level, however thirty-three states and the District of Columbia have legislation on the books which allows for medical exemptions to state marijuana laws. Seven states have made recent attempts to enforce these regulations, with California being the most notable. Drug Enforcement Agency agents (a federal agency) has recently arrested several medical marijuana growers and sellers whose actions, while legal under state law, still violate federal law. Under Proposition 215, Californians are allowed to have access to medical marijuana. Several jurisdictions, including Oakland, California and San Mateo County, California have announced plans to distribute medical marijuana to patients. Ed Rosenthal, who worked on behalf of the city government of Oakland, was recently convicted on marijuana charges in a federal court. Since the trial, the jurors who convicted him have unanimously spoken out arguing that the trial was not fair and that they regret their conviction, because evidence that Rosenthal was working on behalf of the city and was told by DEA agents and city officials that he was immune to prosecution was suppressed as irrelevant to the trial.Citations of modern medical reports on marijuana
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