The Medical Use of Marijuana
"Doctors are not the enemy in the 'war' on drugs; ignorance and hypocrisy are. Research should go on, and while it does, marijuana should be available to all patients who need it to help them undergo treatment for life-threatening illnesses. There is certainly sufficient evidence to reclassify marijuana as a Schedule II drug. ... As long as therapy is safe and has not been proven ineffective, seriously ill patients (and their physicians) should have access to whatever they need to fight for their lives."
-- The New England Journal of Medicine, August 7, 1997

Marijuana prohibition applies to everyone, including the sick and dying. Of all the negative consequences of prohibition, none is as tragic as the denial of medicinal marijuana to the tens of thousands of seriously ill patients who could benefit from its therapeutic use.

It is clear from available studies and rapidly accumulating anecdotal evidence that marijuana is therapeutic in the treatment of a number of serious ailments and is less toxic and costly than the conventional medicines for with which it may be substituted.2 In many cases, marijuana is more effective than the commercially available drugs it replaces.3 Prestigious groups such as the National Academy of Sciences (NAS) Institute of Medicine (1982), the Federation of American Scientists (1994), the Australian Commonwealth Department of Human Services and Health (1994), the American Public Health Association (1995), and the British Medical Association (1997), as well as New England Journal of Medicine editor Jerome Kassirer, publicly endorse the medicinal use of marijuana. Most recently, an National Institutes of Health (NIH) report released this August urged the federal government to play an active role in facilitating clinical evaluations of medical marijuana. The report -- assembled by a panel of NIH experts and researchers from February's "Workshop on the Medical Utility of Marijuana" conference -- concluded that marijuana "looks promising enough [in the treatment of certain serious illnesses] to recommend that there be new controlled studies done."4

The best established medical use of smoked marijuana is as an anti-nauseant for cancer chemotherapy. During the 1980s, smoked marijuana was shown to be an effective anti-emetic in six different state-sponsored clinical studies involving nearly 1,000 patients.5 For the majority of these patients, smoked marijuana proved more effective than both conventional prescription anti-nauseants and oral THC (marketed today as the synthetic pill, Marinol).6 Currently, many oncologists are recommending marijuana to their patients despite its prohibition.7

In addition to its usefulness as an anti-emetic, scientific and anecdotal evidence suggests that marijuana is a valuable aid in reducing pain and suffering for patients with a variety of other serious ailments. For example, marijuana alleviates the nausea, vomiting, and the loss of appetite experienced by many AIDS patients without accelerating the rate at which HIV positive individuals develop clinical AIDS or other illnesses.8 Furthermore, it is generally accepted -- by the National Academy of Sciences (NAS) and others -- that marijuana reduces intraocular pressure (IOP) in patients suffering from glaucoma, the leading cause of blindness in the United States.9

Clinical and anecdotal evidence also points to the effectiveness of marijuana as a therapeutic agent in the treatment of a variety of spastic conditions such as multiple sclerosis, paraplegia, epilepsy, and quadriplegia. A number of animal studies and a handful of carefully controlled human studies have supported marijuana's ability to suppress convulsions. A summary of these findings was published by the National Academy of Sciences' (NAS) Institute of Medicine in 1982.10

Between 1978 and 1996, legislatures in 34 states and the District of Columbia passed laws recognizing marijuana's therapeutic value.11 Twenty-five of these laws remain in effect today.12 Most recently, voters in two states -- Arizona and California -- overwhelmingly passed laws allowing for the legal use of marijuana under a physician's supervision. Unfortunately, states are severely limited in their ability to protect patients from criminal prosecution or provide medical marijuana to those who need it by federal prohibition. In addition, federal officials have threatened to sanction physicians who recommend or prescribe marijuana in compliance with state laws.13 Clearly, patients who could benefit from marijuana's therapeutic value are being held hostage by a federal government that continues to treat the issue as if it were part of the "war on drugs" instead of a legitimate public health issue.

It is critical to separate this public health issue from the "war on drugs." This is a question of whether seriously ill patients should be allowed to use marijuana legally under a doctor's supervision. Recreational use would remain illegal. Basic compassion and common sense demand that we allow America's seriously ill citizens to use whatever safe medication is most effective to alleviate their pain and suffering.

The American public support such a change in the law. Nationwide polls conducted by the American Civil Liberties Union (ACLU) and others demonstrate that as much as 85 percent of the public favor giving seriously ill patients legal access to medical marijuana.14 In fact, nearly 25 percent of respondents told the ACLU that they had a sick family member or friend who used marijuana medicinally.15

NORML first raised this issue in 1972 in an administrative petition asking that marijuana be moved from schedule I to schedule II of the federal Controlled Substances Act so that it could be prescribed as a medicine. After 16 years of legal battles and appeals, in 1988, the Drug Enforcement Administration's own administrative law judge, Judge Francis Young, found: "Marijuana has been accepted as capable of relieving distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record."16 Judge Young recommended "that the Administrator transfer marijuana from Schedule I to Schedule II, to make it available as a legal medicine." 17 The DEA Administrator overruled Judge Young, and the Court of Appeals allowed that decision to stand, denying medical marijuana to seriously ill patients. Congress must act to correct this injustice.

Rep. Barney Frank (D-MA), recently introduced H.R. 1782, a bill to reschedule marijuana from schedule I to schedule II, and eliminate federal restrictions which currently interfere with an individual state's decision to permit the medical use of marijuana. The effect of this law would be to permit the individual states to decide for themselves whether to permit the medical use of marijuana for seriously ill patients.

H.R. 1782 is not a mandate from Washington and would not require any state to change its current laws. It is a states' rights bill that acknowledges the will of the American people and would allow states to determine for themselves whether marijuana should be legal for medicinal use. It is a common-sense solution to a complex issue and would provide a great deal of relief from suffering for a large number of people. NORML implores Congress to support this compassionate proposal to protect the ten of thousands of Americans who currently use marijuana as a medicine and the millions who would benefit from its legal access. Many seriously ill patients find marijuana the most effective way to relieve their pain and suffering and federal marijuana prohibition must not, in good conscience, continue to deny them that medication.


1 - George Annas, "Reefer Madness -- The Federal Response to California's Medical-Marijuana Law," New England Journal of Medicine, August 7, 1997.

2 - American Public Health Association, Resolution 9513: Access to Therapeutic Marijuana/Cannabis (Washington, DC: APHA Public Policy Statements, 1995); Commonwealth Department of Human Services and Health, The health and psychological consequences of cannabis use (Canberra, Australia: Australian Government Publishing Service, 1994), pp. 185-199; Federation of American Scientists, Medical Use of Whole Cannabis (Washington, DC: Statement of the FAS, 1994); National Academy of Sciences Institute of Medicine, Marijuana and Health (Washington, DC: National Academy Press, 1982), pp. 139-151; Lester Grinspoon, M.D. et al., Marihuana, The Forbidden Medicine (second edition) (New Haven, Connecticut: Yale University Press, 1997); John Morgan, M.D. et al., Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence (New York City: Lindesmith Center, 1997), pp. 17-25.

3 - Lester Grinspoon, M.D. et al., Marihuana, The Forbidden Medicine.

4 - National Institutes of Health, Workshop on the Medical Utility of Marijuana (Washington, DC: U.S. Department of Health and Human Services, 1997); David Storey, "Marijuana could have healthy effects," Reuters News Service, August 8, 1997.

5 - R.C. Randall, Cancer Treatment & Marijuana Therapy (Washington, DC: Galen Press, 1990), pp. 217-243; Kevin Zeese, Marijuana: Medical Effectiveness Is Proven By Research (Falls Church, Virginia: Common Sense for Drug Policy, 1997.)

6 - Ibid.; Vincent Vinciguerra, M.D. et al., "Inhalation marijuana as an antiemetic for cancer chemotherapy," New York State Journal of Medicine, pp. 525-527.

7 - Rick Doblin, et al., "Marihuana as Anti-emetic Medicine: A Survey of Oncologists' Attitudes and Experiences," Journal of Clinical Oncology: July 1991, pp. 1275-80; John Morgan, M.D. et al., Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence, p. 20.

8 - Commonwealth Department of Human Services and Health, The health and psychological consequences of cannabis use, p. 195; Richard Kaslow, M.D., et al., "No Evidence for a Role of Alcohol or Other Psychoactive Drugs in Accelerating Immunodeficiency in HIV-1 Positive Individuals," Journal of The American Medical Association, June 16, 1989, pp. 3424-29.

9 - National Academy of Sciences Institute of Medicine, Marijuana and Health, pp. 140-151; Commonwealth Department of Human Services and Health, The health and psychological consequences of cannabis use, pp. 191-199.

10 - National Academy of Sciences Institute of Medicine, Marijuana and Health, pp. 145-146.

11 - Alabama, Alaska, Arkansas, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Iowa, Illinois, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Vermont, Washington, Wisconsin, West Virginia.

12 - Alabama (S. 559); Arizona (Proposition 200)*; California (Proposition 215); Connecticut (H.B. 5217); District of Columbia (Bill No. 4-123); Georgia (H.B. 1077); Iowa (S.F. 487); Illinois (H.B. 2625); Louisiana (H.B. 1187); Massachusetts (H. 2170); Minnesota (H.F. 2476); Montana (H.B. 463); New Hampshire (S.B. 21); New Jersey (A.B. 819); New Mexico (H.B. 329); New York (S.B. 1123-6); Rhode Island (H.B. 79.6072); South Carolina (S.B. 350); Tennessee (H.B. 314)**; Texas (S.B. 877); Vermont (H.B. 130); Virginia (S.B. 913); Washington (S.B. 6744); West Virginia (S.B. 366); Wisconsin (A.B. 697).

13 - George Annas, "Reefer Madness -- The Federal Response to California's Medical-Marijuana Law."

14 - American Civil Liberties Union, National Survey of Voters' Opinions on the Use and Legalization of Marijuana for Medical Purposes (Washington, DC: March 31, 1995 - April 5, 1995); Gary Langer, "Poll: Pot Favored as Medicine," ABC News, May 29, 1997; Lake Research Poll, Americans Overwhelmingly Favor Allowing Doctors to Prescribe Marijuana for Medicinal Purposes (New York City: February 5-9, 1997.)

15 - American Civil Liberties Union, National Survey of Voters' Opinions on the Use and Legalization of Marijuana for Medical Purposes.

16 - In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Opinion, Recommended Ruling, Findings of fact, Conclusions of Law, and Decision of Administrative Law Judge, September 6, 1988 (Washington, DC: Drug Enforcement Administration, 1988).

17 - Ibid.

* H.B. 2518, a bill passed by the Legislature this spring to overturn the medical marijuana provision included in Proposition 200, has been frozen by a referendum pending a public vote in November 1998.

** Although H.B. 314 was repealed in 1992, marijuana remains a Schedule II drug under Tennessee law when it is used medicinally.