Medical cannabis in the United States

Map of US state cannabis laws
Cannabis laws in the United States1
----
  Jurisdiction with legalized cannabis.
  Jurisdiction with both medical and decriminalization laws.2
  Jurisdiction with legal psychoactive medical cannabis.
  Jurisdiction with legal non-psychoactive medical cannabis.
  Jurisdiction with decriminalized cannabis possession laws.
  Jurisdiction with cannabis prohibition.
---- 1 Includes laws which have not yet gone into effect.
2 Marked states have only legal non-psychoactive medical cannabis. ---- * Cannabis remains a Schedule I substance under federal law as of 2016.
* Some cities and Indian Reservations have legalization policies separate from their surrounding states.
* Cannabis is illegal in all federal enclaves.

In the United States, the use of cannabis for medical purposes is legal in 29 states, plus the territories of Guam and Puerto Rico, and the District of Columbia, as of April 2017.[1][2] Several other states have more restrictive laws permitting the use of cannabidiol (CBD) oil only, with limitations imposed on THC content.[1] There is considerable variation in medical cannabis laws from state to state, including how it is produced and distributed, how it can be consumed, and what medical conditions it can be used for.[3]

The first state to effectively legalize medical cannabis was California in 1996, when voters approved Proposition 215 by a 56–44 margin. Several states followed with successful ballot initiatives in 1998, and in 2000 Hawaii became the first state to legalize by state legislature.[4] In recent years, medical cannabis has spread to the Southern United States, as Florida, Arkansas, and West Virginia have all approved its use.

At the federal level, cannabis remains a prohibited substance by way of the Controlled Substances Act of 1970. Under the CSA, the Drug Enforcement Administration classifies cannabis as a Schedule I drug, determined to have a high potential for abuse and no accepted medical use – thus prohibiting its use for any purpose. The Justice Department has enforced this policy through various means, including criminal prosecutions, civil asset forfeiture, and paramilitary-style raids targeting medical cannabis providers, and various penalties threatened or initiated against other individuals involved in state-legal medical cannabis activities (doctors, landlords, state officials and employees).[5] In December 2014, however, the Rohrabacher–Farr amendment was signed into law, prohibiting the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws.[6]

Public support for allowing the medical use of cannabis has remained strong since Gallup first polled the subject in 1999, finding 73% in favor.[7] A February 2017 Quinnipiac poll found national support at 93%.[8]

Early medical use in the U.S.

The medical use of cannabis dates back thousands of years, to ancient China, India, and Egypt.[4] It was popularized in Western medicine by the Irish physician William Brooke O'Shaughnessy, who was introduced to the drug in the 1830's while living abroad in India.[9] O'Shaughnessy found a number of medical applications for cannabis from the experiments he conducted, noting in particular its analgesic and anticonvulsant effects.[10] He returned to England with a supply of cannabis in 1842, after which its use as medicine quickly spread throughout Europe and the United States.[11]

Cannabis pills sold by Parke, Davis & Co.

Cannabis was entered into the United States Pharmacopeia in 1850, as a treatment for neuralgia, tetanus, typhus, cholera, rabies, dysentery, alcoholism, opiate addiction, anthrax, leprosy, incontinence, snakebite, gout, convulsive disorders, tonsillitis, insanity, excessive menstrual bleeding, and uterine bleeding.[10] It was widely available in pharmacies and even grocery stores during the latter half of the 19th century, priced affordably relative to other drugs with no requirement for a doctor's prescription.[10] Cannabis was commonly sold in tincture form by Parke-Davis, Eli Lilly, E. R. Squibb & Sons, and other drug manufacturers.[12]

By the end of the 19th century, the use of cannabis in medicine had declined due to a number of factors, including difficulty in controlling dosages and the rise in popularity of synthetic and opium-derived drugs.[11] The advent of the hypodermic syringe also allowed these drugs to be injected for immediate effect, in contrast to cannabis which is not water-soluble and therefore cannot be injected.[12] Additionally, as fears regarding the recreational use of cannabis began to take hold (prompted by sensationalist media reports and government propaganda campaigns),[10] states began passing legislation to restrict the sale and possession of cannabis, eliminating its availability as an over-the-counter drug.[13] By 1936, every state had passed a law of this manner.[10]

The use of cannabis as medicine further declined with the passage of the Marihuana Tax Act of 1937. The purpose of the act was to prohibit all non-medical use of cannabis in the U.S.; however, it also had the effect of severely curtailing medical use of the drug, due to new fees and regulatory requirements put in place that imposed a significant burden on doctors prescribing cannabis.[13] For this reason the American Medical Association opposed the Marihuana Tax Act of 1937, but to no avail.[13] Cannabis was removed from the U.S. Pharmacopeia in 1941, at the urging of famed anti-cannabis crusader Harry Anslinger.[12]

During the 1960's, as large numbers of people began to use cannabis recreationally, the medical utility of cannabis was rediscovered by some as anecdotes began to appear about its effectiveness in treating a variety of medical conditions.[11] It was officially banned for even medical use, however, following the passage of the Controlled Substances Act in 1970. Despite the strict federal prohibition in place, cannabis continued to gain renewed interest as medicine in the 1970's and 1980's, in particular due to the testimonials of cancer and AIDS patients who reported significant relief from the effects of chemotherapy and wasting syndrome.[14] The smoking method of consumption – popularized by recreational users of the drug – offered particular aid to patients who had trouble keeping down oral medication (without vomiting), and also offered advantages in terms of rapid onset of action and the ability to more carefully control dosages.[3]

Federal policy

Controlled Substances Act

On October 27, 1970, the Comprehensive Drug Abuse Prevention and Control Act of 1970 was signed into law by President Richard Nixon. Title II of the act – the Controlled Substances Act – established a system under which all controlled substances are categorized, varying from Schedule I (the strictest classification) to Schedule V (the least strict). Cannabis was placed in the Schedule I category, assumed to have a high potential for abuse and no accepted medical use – thus prohibiting its use for any purpose.[15] This placement was intended only as a temporary measure, however, pending the results of a commission formed under decree of the CSA to study the dangers of cannabis.[12] Formally known as the National Commission on Marihuana and Drug Abuse, the Shafer Commission – led by former Pennsylvania governor Raymond P. Shafer – determined in its March 1972 report to the President and Congress that the societal harms caused by cannabis were limited, and recommended removal of criminal penalties for possession and distribution of small amounts of the drug.[16] Although the report did not specifically address the scheduling of cannabis,[17] it did not contain any findings that supported continued placement in the Schedule I category, and members of the commission acknowledged that cannabis did not meet the Schedule I criteria.[18] This was of no consequence, however, as President Nixon strongly denounced the work of the commission, and no action was taken to move cannabis into a less restrictive category.[16] The Schedule I classification of cannabis remains in place today, alongside other drugs such as heroin, MDMA, DMT, LSD, and peyote – none of which can be prescribed. Schedule II drugs – determined to have a high potential for abuse but also some accepted medical use (thus able to be prescribed) – include cocaine, PCP, methamphetamine, oxycodone, and fentanyl.[19][20]

Rescheduling efforts

Since enactment of the Controlled Substances Act in 1970, there have been a number of efforts seeking to have cannabis placed into a less restrictive category, but none have succeeded. The Drug Enforcement Administration is granted authority under the CSA to change the classification of any drug, based upon the recommendation of the Food and Drug Administration which evaluates all drugs for safety and efficacy.[3] As recently as 2016, the FDA has determined that cannabis has "no currently accepted medical use in treatment in the United States", in response to a rescheduling petition filed with the DEA in 2011 by the governors of Washington and Rhode Island.[21] Other efforts to petition the DEA have also been unsuccessful, spanning the years 1972–1994, 1995–2001, and 2002–2013.[22][23] Congressional attempts to reschedule have failed as well, including a 1981 bill introduced by Reps. Stewart McKinney and Newt Gingrich that grew to 84 cosponsors but never received a floor vote.[24]

The classification of cannabis as a Schedule I drug was first challenged by the National Organization for the Reform of Marijuana Laws (NORML) in a 1972 petition to the Drug Enforcement Administration (known at the time as the Bureau of Narcotics and Dangerous Drugs).[25] After a decade of legal battles in which the DEA refused to consider the petition, public hearings were finally held on the matter beginning in 1986.[26] In September 1988, after two years of extensive public hearings,[11] DEA chief administrative law judge Francis L. Young ruled in favor of moving cannabis to a Schedule II classification, stating that "Marijuana, in its natural form, is one of the safest therapeutically active substances known to man" and "The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the 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."[15] In December 1989 however, DEA Administrator John Lawn overruled Judge Young's determination,[12] and in February 1994 a final ruling on the original 1972 petition was issued when a U.S. Court of Appeals upheld the decision to keep cannabis a Schedule I drug.[13]

Compassionate IND program

Despite an official policy denying the medical value of cannabis, the federal government began providing the drug to a limited number of patients through the Compassionate Investigational New Drug program in 1978. The program was created following a lawsuit filed by Robert Randall, a Washington, D.C. resident who was arrested for cultivating cannabis in 1975.[27] Citing the glaucoma that threatened to take his eyesight, Randall employed a "medical necessity" defense at trial to justify his use of cannabis.[27] The charges against Randall were dismissed, and as a result of an ensuing petition filed with the FDA, Randall became the first person to receive cannabis from the federal government in 1976.[27] After his supply was cut off in 1978, he filed a lawsuit to have it restored,[27] setting in motion the creation of the Compassionate Investigational New Drug program shortly thereafter.[28] The program allowed patients with serious medical conditions to receive a regular supply of cannabis from the federal government; however, only 13 patients ended up participating due to the very complicated and drawn-out application process involved.[11]

The Compassionate IND program was closed to new patients in 1992, due to a flood of new applications from AIDS patients and concerns that the program undercut Bush administration efforts to combat illegal drug use.[29] James O. Mason, the head of U.S. Public Health Service, explained that keeping the program in place invited the "perception that this stuff can't be so bad", and noted that AIDS patients provided with cannabis would be more likely to engage in unsafe sex.[30] Twenty-eight applications that had recently been approved were rescinded, and only the 13 patients who were already receiving cannabis were allowed to do so moving forward.[11] As of 2016, most of the original 13 patients had perished but at least two were known to be still receiving cannabis from the federal government.[31]

Federal enforcement

Clinton administration

Concurrent with the re-election of President Bill Clinton in November 1996, California voters approved Proposition 215 to legalize the medical use of cannabis, and a similar (but ultimately ineffective) measure was passed in Arizona. In response, the Clinton administration threatened to criminally prosecute doctors who prescribe or recommend cannabis, as well as revoke licenses for the prescription of controlled substances and block participation in Medicare and Medicaid.[32] A group of physicians challenged this policy as a violation of First Amendment rights, and in September 2000 prevailed in the case Conant v. McCaffrey, which upheld the right of physicians to recommend (but not prescribe) cannabis.[3] In addition to threats leveled against doctors, the administration conducted raids on a number of medical cannabis facilities, and initiated civil and criminal legal actions against patients and providers.[5] At trial, jurors were prohibited from hearing arguments that defendants were acting in accordance with state medical cannabis laws, therefore providing the federal government with a significant advantage in carrying out prosecutions.[5] Drug czar Barry McCaffrey also railed strongly against the medical use of cannabis – deriding it as "Cheech & Chong medicine" – and worked behind closed doors to coordinate a media campaign to sway public opinion against approving further medical cannabis initiatives.[33]

Bush administration

Despite speaking in support of states' rights on the issue during his 2000 presidential campaign,[34] President George W. Bush intensified the federal crackdown on medical cannabis during his 8 years in office, with more than 260 raids conducted and 84 individuals prosecuted by his administration.[5] Heavy use of paramilitary tactics and gear was common in execution of the raids, along with the frequent use of civil forfeiture, allowing cash and property to be seized without need for a criminal conviction.[5] In 2007, the administration began targeting landlords renting to medical cannabis facilities, informing property owners that they faced up to 20 years in prison for violating the "crack house statute" of the CSA, in addition to seizure of their properties.[15] Drug czar John P. Walters was particularly opposed to the medical use of cannabis, campaigning against initiatives in a number of states in what medical cannabis advocates charged was an inappropriate use of taxpayer dollars and a violation of the Hatch Act.[35] During Bush's second term, in June 2005, the Supreme Court ruled in favor of the federal government's ability to enforce federal law in states that have legalized medical cannabis, in the case Raich v. Gonzalez.[3]

Obama administration

The presidency of Barack Obama was noted for a strong federal crackdown on medical cannabis during his first term in office, despite early indications that his administration would take a more relaxed approach. During his 2008 campaign for president, Obama expressed support for allowing states to implement their own medical cannabis policies, stating "I'm not going to be using Justice Department resources to try to circumvent state laws on this issue."[36] These comments were then echoed by the administration in March 2009 when Attorney General Eric Holder stated that only medical cannabis providers "who violate both federal and state law" would be targeted for prosecution.[37] Additionally, an October 2009 memo from Deputy Attorney General David Ogden laid out further guidelines for federal enforcement while also largely affirming the earlier-stated hands-off approach for state-legal medical cannabis activities.[37] Despite these public indications of lessened enforcement from the Obama administration, however, an increasing number of raids were conducted during Obama's first two years in office, surpassing even the Bush administration in frequency.[36]

"Cannabis is Medicine, Let States Regulate!" protest in San Francisco, April 4, 2012

Federal enforcement efforts against medical cannabis were further intensified in early 2011 (shortly after Michele Leonhart was confirmed as DEA Administrator),[37] as U.S. Attorneys began sending out letters to state officials and employees in several states, threatening criminal prosecution for implementing new laws regulating the distribution of medical cannabis.[5] Some letters even threatened seizure of state buildings used to conduct activities such as the processing of medical cannabis licenses.[38] In response to requests for clarification from numerous elected officials, a new memo was issued by Deputy Attorney General James M. Cole in June 2011, setting forth the conditions under which federal law would be enforced.[36] The Cole memo asserted that recent actions taken were actually consistent with the 2009 Ogden memo, and that the Ogden memo protections only applied to individuals and not commercial operations.[38] As the federal raids continued following release of the memo, U.S. Attorneys began sending out hundreds of letters over the next two years threatening civil forfeiture and criminal prosecution for landlords who were renting their properties to dispensaries and cultivation facilities.[5] By June 2013, the total amount spent from the Obama administration's crackdown on medical cannabis had climbed to $289 million, surpassing the previous 8 years of the Bush administration by $100 million.[5] And the number of raids conducted during Obama's first 4 1/2 years had reached 270, in contrast to 260 during Bush's 8 years.[5]

Early in President Obama's second term, in August 2013, the Justice Department issued a new "Cole memo" setting forth the conditions under which federal cannabis law would be enforced. The memo was prompted in particular by the recent legalization of non-medical cannabis in Washington and Colorado, but also addressed enforcement in medical cannabis states.[38] Regarding the medical use of cannabis, the memo was considered to take a significantly more deferential approach towards the states (compared to the June 2011 memo), similar in nature to how the 2009 Ogden memo was originally widely interpreted.[38] Federal enforcement efforts were further scaled back with the enactment of the Rohrabacher–Farr amendment in December 2014, although the Justice Department initially continued with a number of prosecutions until a pair of court rulings determined it was interpreting the amendment incorrectly.

Rohrabacher–Farr amendment

On December 16, 2014, a landmark victory was achieved for medical cannabis at the federal level with the signing into law of the Rohrabacher–Farr amendment. Initially introduced by Reps. Maurice Hinchey, Dana Rohrabacher, and Sam Farr in 2003, the amendment prohibits the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws. It failed by a vote of 152–273 upon its initial introduction in 2003, and was defeated five more times over the next decade until it passed the House by a 219–189 vote on May 30, 2014, as an attachment to the CJS Appropriations bill for fiscal year 2015.[39] It did not receive a vote in the Senate, but was inserted (without a vote) into the $1.1 trillion "cromnibus" spending bill during final negotiations, which became law with President Obama's signature on December 16, 2014.[40] The Rohrabacher–Farr amendment passed the House by an even larger margin (242–186) in June 2015,[41] then won approval in a 21–9 Senate Appropriations Committee vote,[42] and was signed into law as part of the FY 2016 omnibus appropriations bill on December 18, 2015.[43] The amendment was subsequently included in a series of spending bills approved in 2016 and 2017, with the most recent extension expiring on September 30, 2017.[44]

Although the Rohrabacher–Farr amendment offers important protections for state-legal medical cannabis activities, it does not change the legal status of cannabis, and must be renewed each fiscal year in order to remain in effect.[6] The Justice Department has also interpreted the amendment in a manner vastly different from the authors' intent, which it has used to justify a number of raids and prosecutions after the law's enactment.[45] U.S. District Judge Charles Breyer ruled against the Justice Department in October 2015, however, stating that the DOJ interpretation "defies language and logic" and "tortures the plain meaning of the statute", and was "counterintuitive and opportunistic".[46] The Ninth Circuit Court of Appeals similarly rejected the DOJ's arguments in an August 2016 ruling.[47]

State policy

Early laws (late 1970's through 80's)

Due to increasing public awareness of the medical benefits of cannabis, and in anticipation of forthcoming changes to federal policy, a number of states passed laws addressing the medical use of cannabis in the late 1970's and early 1980's.[13] New Mexico was the first to do so in 1978, and by the end of 1982 over thirty states had followed suit.[48] The majority of these laws sought to provide cannabis through federally-approved research programs administered by the states, using cannabis supplied by the National Institute of Drug Abuse. Only seven states ended up implementing the programs however,[3] due to the large bureaucratic and regulatory obstacles imposed by the federal government.[11] Other states passed laws allowing doctors to prescribe cannabis, or reclassifying cannabis in a state's internal drug scheduling system. These laws were largely ineffectual though, due to the continued prohibition of medical cannabis at the federal level.[3] A few states passed laws establishing the ability to use a "medical necessity" defense at trial.[13] By the mid-80's, however, efforts to pass new medical cannabis laws had ground to a halt, and a number of existing laws were either repealed or allowed to expire.[13]

California (early and mid-1990's)

Beginning in the early 1990's in the state of California, medical cannabis advocates began to gain ground with a series of legislative achievements at the state and local level. In 1991, 79% of San Francisco voters approved Proposition P, which called on state lawmakers to pass legislation allowing the medical use of cannabis.[12] Additionally, the city board of supervisors passed a resolution in August 1992 urging the police commission and district attorney to "make lowest priority the arrest or prosecution of those involved in the possession or cultivation of [cannabis] for medicinal purposes" and to "allow a letter from a treating physician to be used as prima facia evidence that marijuana can alleviate the pain and suffering of that patient's medical condition".[49] The resolution allowed the open distribution of cannabis to AIDS patients and others throughout the city, most notably through the San Francisco Cannabis Buyers Club which was operated by medical cannabis activist Dennis Peron (who spearheaded Proposition P and later the statewide Proposition 215).[50] Similar clubs appeared outside San Francisco in the ensuing years as other cities passed legislation to support the medical use of cannabis. The Wo/Men's Alliance for Medical Marijuana was founded in 1993 after 75% of Santa Cruz voters approved Measure A in November 1992.[51] And the Oakland Cannabis Buyers' Cooperative was founded in 1995 shortly before the city council passed multiple medical cannabis resolutions.[51]

Following the lead of San Francisco and other cities in California, state lawmakers passed Senate Joint Resolution 8 in 1993, a non-binding measure calling on the federal government to allow physicians to prescribe cannabis.[30] Legislators then approved Senate Bill 1364 in 1994, seeking to reclassify cannabis as a Schedule II drug at the state level.[30] And Assembly Bill 1529 was approved in 1995, to create a "medical necessity" defense for patients with a physician's recommendation for cannabis, for treatment of AIDS, cancer, glaucoma, or multiple sclerosis.[30] Both SB 1364 and AB 1529 were vetoed by Governor Pete Wilson, however, paving the way for the passage of Proposition 215 in 1996.[30]

Modern laws (1996 to present)

Frustrated by vetoes of medical cannabis bills in successive years, medical cannabis advocates took the issue directly to the voters of California by collecting 775,000 signatures for qualification of a ballot initiative in 1996.[52] Proposition 215 – the Compassionate Use Act of 1996 – was subsequently approved with 56% of the vote, legalizing the use, possession, and cultivation of cannabis with a physician's recommendation for the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or "any other illness for which marijuana provides relief".[53] The law also asked state legislators to "implement a plan to provide for the safe and affordable distribution of marijuana" to patients, which was addressed several years later with the passage of Senate Bill 420.[54]

Also in 1996, 65% of Arizona voters approved Proposition 200, a drug policy reform initiative containing a provision allowing the use of cannabis with a doctor's prescription.[55] The medical cannabis portion of the initiative was then essentially repealed by state legislators a few months later,[56] but the change was rejected by Arizona voters in a 1998 veto referendum.[57] Ultimately the medical cannabis provision was ineffective, however, due to language that created significant conflict with federal law (use of the word "prescribe" instead of "recommend").[3]

In 1998, medical cannabis initiatives were voted on in the states of Washington, Oregon, Alaska, and Nevada – all of which passed.[15] Also, in Washington, D.C., Initiative 59 to legalize the medical use of cannabis passed with 69% of the vote, but a series of amendments introduced by Rep. Bob Barr and approved by Congress prevented its implementation for over a decade.[58] The initial Barr amendment was enacted prior to the November 1998 election but after ballots had been printed, thereby allowing D.C. voters to vote on the initiative but preventing the results from being made public.[59] The amendment was challenged in court by the American Civil Liberties Union on grounds that it violated First Amendment rights, and in September 1999 U.S. District Court Judge Richard W. Roberts agreed, overturning the Barr amendment.[60] Rep. Barr then introduced a similar amendment which became law in November 1999, setting off a long legal battle[61] until finally in December 2009 the Barr amendment was removed from the annual D.C. appropriations bill, allowing the original 1998 ballot initiative to move forward.[58]

Medical cannabis dispensary in Denver

Following the approval of several ballot measures in 1998, Maine voters passed a medical cannabis initiative in 1999 that was expanded by both the state legislature and another ballot initiative in subsequent years.[3] In 2000, medical cannabis initiatives were passed in the states of Colorado and Nevada, with Nevada's initiative passing for a second consecutive election as required to amend the state's constitution.[62] Also in 2000, Hawaii became the first state to legalize medical cannabis by state legislature.[15]

In the following years, medical cannabis was legalized by state legislature in Vermont (2004), Rhode Island (2006), New Mexico (2007), New Jersey (2010), Delaware (2011), Connecticut (2012), Illinois (2013), New Hampshire (2013), Maryland (2014), Minnesota (2014), New York (2014), Ohio (2016), Pennsylvania (2016), and West Virginia (2017). Medical cannabis was legalized by ballot measure in Montana (2004), Michigan (2008), Arizona (2010), Massachusetts (2012), Arkansas (2016), Florida (2016), and North Dakota (2016).[1][2] As of April 2017, 14 states have legalized by ballot measure and 15 by state legislature.[2] The U.S. territories of Guam (2014, ballot measure)[63] and Puerto Rico (2015, executive order)[64] have also legalized the medical use of cannabis.

According to various organizations tracking cannabis policy in the U.S., 29 states are considered to have passed effective medical cannabis laws, as of April 2017.[1][65][66] Additionally, Louisiana passed a medical cannabis law by state legislature in 2015 (with further revisions in 2016), but these organizations do not currently classify Louisiana among the 29 states, due to significant conflicts with federal law that have prevented full implementation of the state law,[3] as well as restrictions put in place on methods of consumption and THC content.[1] NORML does consider Louisiana to be one of 30 medical cannabis states, however.[67][68]

Low-THC, high-CBD laws

In addition to the states that have passed comprehensive medical cannabis laws, a number of states have passed more restrictive laws that do not allow the use of products exceeding a specified concentration of tetrahydrocannabinol (THC), the main psychoactive component of cannabis. The purpose of these laws is to allow the use of products containing high levels of cannabidiol (CBD), a non-psychoactive component of cannabis that has been shown to be effective in the treatment of seizure disorders, particularly in children.[69] The use of CBD oil to treat seizure disorders gained increased attention with a number of media reports in 2012 and 2013, and by 2014 a number of states had enacted legislation to allow for the use of such products.[3] According to the National Conference of State Legislatures, 16 states are considered to have passed low-THC, high-CBD medical cannabis laws.[1]

Research

As a Schedule I drug in the U.S., clinical research on cannabis must be approved by the Food and Drug Administration and a license must be obtained from the Drug Enforcement Administration specific to conducting research on Schedule I drugs. The petition to the FDA is submitted in the form of an Investigational New Drug application,[23] which the FDA has 30 days to respond to.[70] DEA licenses for research are issued for Schedules I and Schedule II–V drugs,[23] with the Schedule I license mandating stricter compliance requirements such as the manner in which substances are stored and secured.[71] The DEA review process can take up to a year.[71]

In addition to FDA approval and DEA registration, other requirements have been imposed for cannabis research in the U.S. that do not exist for any other drug, which has had a significant effect in limiting the amount of research conducted. One such requirement was established in 1999 when it was mandated that all proposed research be submitted to the U.S. Public Health Service for approval.[70] This rule had an especially hindering effect as there was no timeline in which the PHS was required to respond, with some reviews taking years to complete.[70] In June 2015, however, the PHS review was eliminated to streamline the process for approving medical cannabis research.[72]

Clinical research on cannabis also requires approval from the National Institute on Drug Abuse, which is the sole provider of cannabis for research purposes in the U.S. Without the NIDA approving a study and agreeing to supply cannabis, research cannot be carried out as long as there is not another source licensed by the federal government – a circumstance that has presented a significant barrier to cannabis research in the U.S.[70] Compounding the problem is that the NIDA's stated mission is to support research on the causes, consequences, prevention, and treatment of drug abuse and drug addiction, and not the medicinal uses of drugs.[73] As a result, many studies on the therapeutic benefits of cannabis are either denied or altered to comply with the limited scope and mission of the NIDA.[70] There is also no timeline in which the NIDA is required to respond to proposals (as with the PHS review), which has resulted in delays ranging from months to years.[22] Additionally, the cannabis provided by the NIDA has been criticized as being inferior to that which is commonly used by medical cannabis patients in states where it is legal.[22] Criticisms of NIDA-supplied cannabis include high amounts of stems and seeds,[74] high mold and yeast levels,[75] low THC content,[22] and low diversity of strains available.[76]

NIDA monopoly

Since the agency's inception in 1974, the NIDA has been the sole provider of cannabis for research purposes in the U.S., contracting with the University of Mississippi for cultivation of the cannabis.[22] The monopoly has been maintained by the refusal of the Drug Enforcement Administration to issue another license for cultivation and distribution of the cannabis, which the DEA has claimed is consistent with the terms of the U.N. Single Convention on Narcotic Drugs that was ratified in 1961.[70] Others have disputed this interpretation of the treaty however (including the U.S. State Department),[77] and the DEA's interpretation is not consistent with the fact that multiple licenses have been issued for the production of other Schedule I drugs.[23] The DEA has also cited the possibility of diversion from cultivation facilities as a justification for not issuing additional licenses.[70]

Craker application

Critics of the NIDA monopoly have pointed to the case of University of Massachusetts Amherst professor Lyle Craker as an example of the DEA's undue resistance to granting additional cultivation licenses. Professor Craker's endeavor to obtain a license began in June 2001, when he submitted an application to the DEA, which, later in 2001, the DEA claimed to have lost.[22] After a photocopy was resubmitted, the DEA rejected the application in February 2002, because it did not have an original signature.[78] In July 2002, the original application was returned to Professor Craker unprocessed, with a date stamp showing it had been received in June 2001.[22] The application was then resubmitted in August 2002, upon which the DEA confirmed receipt.[78] On July 24, 2003, a notice regarding Craker’s application was filed in the Federal Register, with a public comment period ending on September 23, 2003.[22] In October 2003, U.S. Senators from Massachusetts John Kerry and Ted Kennedy wrote a letter to DEA Administrator Karen Tandy in support of granting Professor Craker a license.[79] On December 10, 2004, however, following a lawsuit filed over unreasonable delay in responding to the application, the DEA rejected Craker's application.[74] Professor Craker then filed another lawsuit in response to the rejection, and also requested a hearing on the matter from a DEA Administrative Law Judge, which was granted.[22] On February 12, 2007, after extensive public testimony and evidence-gathering on the subject, DEA Administrative Law Judge Ellen Bittner issued an 87-page opinion in favor of granting Professor Craker a license.[80] Additionally, in September 2007, 45 members of Congress wrote to DEA Administrator Karen Tandy urging her to approve the application in accordance with Judge Bittner's ruling.[81] Almost two years later, however, in January 2009, Acting DEA Administrator Michele Leonhart overruled Judge Bittner's recommendation and declined to issue a license.[82] In February 2009, 16 members of Congress wrote to Attorney General Eric Holder asking him to withdraw the ruling,[83] and an additional letter was sent from Sens. John Kerry and Ted Kennedy in April 2009.[84] The ruling was upheld by Leonhart in an August 2011 decision, however,[85] and again by the First Circuit Court of Appeals in April 2013.[22]

August 2016 announcement

On August 11, 2016, the DEA announced intention to issue additional licenses for the cultivation of research-grade cannabis, which would end the decades-long monopoly held by the NIDA and University of Mississippi.[86][87] As of July 2017, however, 25 applications have been submitted to the DEA and none have been approved, with no timeline given by the DEA for approval of any licenses.[88]

Advocacy

Support

Organizations

Americans for Safe Access is the leading advocacy group in the U.S. dedicated to medical cannabis policy reform. Founded in 2002 by medical cannabis patient Steph Sherer, it has grown to over 100,000 members in 50 states.[89] Other groups include the National Organization for the Reform of Marijuana Laws (NORML), Marijuana Policy Project, and Drug Policy Alliance, although these focus more broadly on policy reform regarding both medical and non-medical use.

Medical organizations that have issued statements in support of allowing patient access to medical cannabis include the American Nurses Association,[90] American Public Health Association,[91] American Medical Student Association,[92] National Multiple Sclerosis Society,[93] Epilepsy Foundation,[94] Leukemia & Lymphoma Society,[95] National Women's Health Network,[96] Gay and Lesbian Medical Association,[96] and several AIDS advocacy organizations.[97][98][99]

Religious denominations in the U.S. that have voiced support for allowing the medical use of cannabis include the Episcopal Church, Presbyterian Church (USA), United Church of Christ, United Methodist Church, Union for Reform Judaism, and the Unitarian Universalist Association.[100]

American Legion, the nation's largest military veterans organization, passed a resolution at their September 2016 annual convention calling on Congress to remove cannabis from the list of Schedule I drugs.[101] In December 2016, the organization lobbied the incoming Trump administration to reclassify cannabis as a Schedule III drug.[102]

The National Conference of State Legislatures, a group representing state legislators from across the country, passed a resolution at their August 2016 annual summit calling for cannabis to be removed from the list of Schedule I drugs.[103] The U.S. Conference of Mayors similarly passed a resolution in June 2013 calling for the Controlled Substances Act to be amended to allow states to implement their own cannabis policies.[104]

Delegates at the July 2016 Democratic National Convention voted to approve a party platform calling for cannabis to be removed from the list of Schedule I drugs, as well as calling for a "reasoned pathway for future legalization".[105]

Individuals

Medical cannabis supporters demonstrate in Los Angeles (August 2007)

Individuals who have been particularly active in efforts to advocate for the medical use of cannabis include Robert Randall, Dennis Peron, Ed Rosenthal, Steve Kubby, Steve DeAngelo, Richard Lee, Jon Gettman, Brownie Mary, and Tod H. Mikuriya. Former talk show host Montel Williams is a well-known advocate who uses cannabis to treat his multiple sclerosis, a topic he has testified about in a number of states considering medical cannabis legislation.[106] Former U.S. Surgeon General Joycelyn Elders has also testified in support of medical cannabis legislation in several states.[107]

Members of Congress who have introduced legislation to allow the medical use of cannabis include Ron Paul,[108] Barney Frank,[108] Maurice Hinchey,[109] Sam Farr,[109] Dana Rohrabacher,[109] Steve Cohen,[110] Don Young,[110] Jared Polis,[111] Earl Blumenauer,[111] Tom Garrett,[112] Rand Paul,[113] and Bernie Sanders.[114] Rep. Rohrabacher (R–CA) has been particularly active in congressional reform efforts, introducing multiple medical cannabis bills including the Rohrabacher–Farr amendment for a number of years until it became law in 2014.[115][116][117] He also uses a cannabis-based drug to relieve the symptoms of his arthritis.[118]

Eugene Monroe, Jim McMahon, Jake Plummer, and Kyle Turley are among a group of former NFL players that have advocated for allowing the use of cannabis in the league, as a treatment option for concussions and a pain reliever that can reduce reliance on addictive opioid drugs.[119][120][121] NBA head coach Steve Kerr has also voiced his support for the use of medical cannabis in professional sports.[122]

Dr. Sanjay Gupta, neurosurgeon and chief medical correspondent for CNN, has produced a three-part documentary series for the network – titled "Weed" – arguing in favor of the medical benefits of cannabis.[123] Gupta was initially dismissive toward the medical use of cannabis, but upon researching further he changed his mind and wrote a column apologizing for his past views.[124] Filmmaker Jed Riffe has also explored the subject in his 2006 documentary "Waiting to Inhale".[125]

Opposition

The American Academy of Pediatrics,[126] American Psychiatric Association,[127] and American Society of Addiction Medicine[128] oppose the legalization of medical cannabis outside the FDA approval process. However, the AAP also supports rescheduling of cannabis for the purpose of facilitating research.[126]

Notable individuals who have been active in efforts to maintain prohibition on the medical use of cannabis include Barry McCaffrey,[33] John Walters,[129] Andrea Barthwell,[130] Bill Montgomery,[131][132] Mark Souder,[133] Chuck Rosenberg,[134] Sheldon Adelson,[135] Mel Sembler,[136] and Kevin Sabet.[137]

Former U.S. Rep. Bob Barr was a particularly ardent opponent of medical cannabis in Congress, introducing the "Barr amendment" which blocked implementation of a 1998 Washington, D.C. ballot initiative legalizing the medical use of cannabis.[138] After leaving Congress, however, Barr rescinded his earlier views[139] and joined Marijuana Policy Project to lobby for repeal of the legislation he originally authored.[140]

Other

The American Medical Association[141] and American College of Physicians[142] do not take a position on the legalization of medical cannabis, but have called for the Schedule I classification to be reviewed. The American Academy of Family Physicians similarly does not take a position, but does support rescheduling in order to facilitate research.[143] The American Cancer Society notes the hindering effect on research imposed by the Schedule I classification of cannabis, and has called on the federal government to examine options for better enabling scientific study of the drug.[144]

Cannabinoid drugs

There are currently two cannabinoid drugs that can be legally prescribed in the U.S., and a third expected to commence sales in 2017. The non-psychoactive drug cannabidiol is also sold by a number of online retailers, although the legality is unclear.

Dronabinol

Dronabinol is THC that has been manufactured synthetically in a laboratory, as opposed to being extracted from the cannabis plant.[145] It has been approved by the FDA in pill form as Marinol and in oral solution form as Syndros.

Marinol

Marinol is a sesame oil suspension of dronabinol encapsulated in a gelatin shell.[3] It received FDA approval in 1985 for the treatment of nausea and vomiting associated with chemotherapy, and additionally in 1992 as an appetite stimulant for the treatment of AIDS-related weight loss.[11] Marinol was classified as a Schedule II drug upon its initial introduction, and was moved to Schedule III in 1999.[15] Marinol was developed by Unimed Pharmaceuticals, although initial research on the drug was mostly funded by the U.S. government.[9] Unimed Pharmaceuticals was acquired by Solvay Pharmaceuticals in 1999.[146]

Syndros

Syndros is a liquid oral formulation of dronabinol approved for treatment of chemotherapy-induced nausea and vomiting as well as AIDS-related weight loss. Syndros received FDA approval in July 2016,[147] and was assigned a Schedule II classification by the DEA in March 2017.[148] Syndros is manufactured by Insys Therapeutics, which received attention in 2016 for contributing heavily to the defeat of a cannabis legalization measure in Arizona, in an apparent attempt to protect market share for the newly developed drug.[149][150] Syndros is expected to launch on the U.S. market in August 2017.[151]

Nabilone

Nabilone is a synthetic cannabinoid similar in molecular structure to THC.[152] It is sold in pill form only as the drug Cesamet.

Cesamet

Cesamet received FDA approval in 1985 for treatment of chemotherapy-induced nausea and vomiting.[153] It was discontinued by its manufacturer Eli Lilly in 1989 for commercial reasons, and U.S. rights to the drug were sold to Valeant Pharmaceuticals in 2004.[153] In 2006, Valeant received FDA approval to resume sales of the drug.[153] Cesamet has remained a Schedule II drug since it was first introduced on the market.[20]

Cannabidiol

Cannabidiol (CBD) is a non-psychoactive component of cannabis known for its anticonvulsant, anti-inflammatory, and anti-anxiety effects, among other medical uses.[154][155] The FDA has not approved cannabidiol for any use however, and the DEA considers cannabidiol to be a Schedule I drug.[156] Despite the Schedule I classification, a number of online retailers sell CBD products to all 50 states, claiming their products are legal because they are derived from the stalks and seeds of industrial hemp plants.[157] The federal government has yet to take action against these retailers.

Effects of legalizing medical cannabis

A 2016 study found that state medical cannabis laws are associated with significant drops in violent crime.[158] A 2017 study similarly found that introduction of medical cannabis laws caused a reduction in violent crime in American states that border Mexico.[159]

A 2013 study found that medical cannabis legalization is associated with an 8-11% reduction in traffic fatalities.[160]

Several studies have found decreased rates of opioid use and abuse in states that have legalized cannabis for medical purposes.[161][162][163][164][165]

Several studies have found no increase in cannabis use among teens in states that have legalized for medical purposes.[166][167][168][169][170][171][172]

Qualifying conditions

Below is a comparison of common qualifying conditions that will allow a patient to receive medical cannabis in each state. The table is not comprehensive and could include out-of-date information. Low-THC, high-CBD states are not listed.

State Cancer Glaucoma HIV/AIDS Parkinson's disease Multiple sclerosis Epilepsy Seizures Wasting syndrome Crohn's disease PTSD
Alaska[173] Yes Yes Yes No Yes Yes Yes Yes No No
Arizona[174] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Arkansas[175] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
California[176] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Colorado[177] Yes Yes Yes No Yes Yes Yes Yes No Yes
Connecticut[178] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Delaware[179] Yes No Yes No Yes Yes Yes Yes No Yes
District of Columbia[180] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Florida[181] Yes Yes Yes Yes Yes Yes Yes No Yes Yes
Hawaii[182] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Illinois[183] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Maine[184] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Maryland[185] Yes Yes Yes No Yes Yes Yes Yes No Yes
Massachusetts[186] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Michigan[187] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Minnesota[188] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Montana[189] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Nevada[190] Yes Yes Yes No Yes Yes Yes Yes No Yes
New Hampshire[191] Yes Yes Yes Yes Yes Yes Yes Yes Yes No
New Jersey[192] Yes Yes Yes No Yes Yes Yes No Yes Yes
New Mexico[193] Yes Yes Yes Yes Yes Yes No Yes Yes Yes
New York[194] Yes No Yes Yes Yes Yes Yes Yes Yes Yes
North Dakota[195] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Ohio[196] Yes Yes Yes Yes Yes Yes Yes No Yes Yes
Oregon[197] Yes Yes Yes No Yes Yes Yes Yes No Yes
Pennsylvania[198] Yes Yes Yes Yes Yes Yes Yes No Yes Yes
Rhode Island[199] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Vermont[200] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Washington[201] Yes Yes Yes No Yes Yes Yes Yes Yes Yes
West Virginia[202] Yes No Yes Yes Yes Yes Yes Yes Yes Yes

Data additionally obtained from Leafly[203] and ProCon.org.[2]

See also

References

  1. 1 2 3 4 5 6 "State Medical Marijuana Laws". National Conference of State Legislatures. Retrieved July 11, 2017.
  2. 1 2 3 4 "29 Legal Medical Marijuana States and DC". ProCon.org. Retrieved July 11, 2017.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 State-By-State Medical Marijuana Laws, Marijuana Policy Project, December 2016
  4. 1 2 "History of Marijuana as Medicine - 2900 BC to Present". ProCon.org. Retrieved April 29, 2017.
  5. 1 2 3 4 5 6 7 8 9 What's the Cost? -- The Federal War on Patients (PDF), Americans for Safe Access, June 2013, retrieved April 29, 2017
  6. 1 2 Sullum, Jacob (January 4, 2016). "The Federal Ban on Medical Marijuana Was Not Lifted". Reason. Retrieved February 7, 2017.
  7. ↑ "Illegal Drugs". gallup.com. Retrieved February 7, 2017.
  8. ↑ Angell, Tom (February 23, 2017). "Poll: Voters Want Trump To Respect State Marijuana Laws". MassRoots. Retrieved February 26, 2017.
  9. 1 2 Mack, Alison; Joy, Janet (2001). Marijuana As Medicine?: The Science Beyond the Controversy. Washington, D.C.: National Academies Press. ISBN 978-0-309-06531-3.
  10. 1 2 3 4 5 Booth, Martin (June 2005). Cannabis: A History. New York: St. Martin's Press. ISBN 0-312-42494-9.
  11. 1 2 3 4 5 6 7 8 Grinspoon, Lester (August 16, 2005), History of Cannabis as a Medicine (PDF)
  12. 1 2 3 4 5 6 Boire, Richard Glen; Feeney, Kevin (January 26, 2007). Medical Marijuana Law. Ronin Publishing.
  13. 1 2 3 4 5 6 7 Pacula, Rosalie Piccardo (February 2002). "State Medical Marijuana Laws: Understanding the Laws and Their Limitations" (PDF). Journal of Public Health Policy. doi:10.2307/3343240.
  14. ↑ Joy, Janet E.; Watson, Stanley J.; Benson, John A. (1999), Marijuana and Medicine -- Assessing the Science Base (PDF), Washington, D.C.: National Academy Press
  15. 1 2 3 4 5 6 Eddy, Mark (April 2, 2010), Medical Marijuana: Review and Analysis of Federal and State Policies (PDF), Congressional Research Service
  16. 1 2 Zeese, Kevin (March 20, 2002). "Once-Secret "Nixon Tapes" Show Why the U.S. Outlawed Pot". AlterNet. Retrieved May 16, 2017.
  17. ↑ Gardner, Fred (August 5, 2014). "How Nixon Destroyed the Evidence on Marijuana". marijuana.com. Retrieved May 16, 2017.
  18. ↑ Armento, Paul (March 22, 2012). "40 Years Ago Today: Congress Was Told To Tell The Truth About Marijuana; They Didn’t". NORML. Retrieved May 16, 2017.
  19. ↑ "DRUG SCHEDULING". dea.gov. Retrieved May 4, 2017.
  20. 1 2 "Controlled Substances" (PDF). usdoj.gov. Retrieved May 4, 2017.
  21. ↑ Johnson, Carrie (August 10, 2016). "DEA Rejects Attempt To Loosen Federal Restrictions On Marijuana". NPR. Retrieved April 15, 2017.
  22. 1 2 3 4 5 6 7 8 9 10 The DEA: Four Decades of Impeding And Rejecting Science (PDF), Drug Policy Alliance / Multidisciplinary Associations for Psychedelic Studies, June 2014
  23. 1 2 3 4 Hudak, John; Wallack, Grace (October 2015), "Ending the U.S. government’s war on medical marijuana research" (PDF), Center for Effective Public Management at Brookings, The Brookings Institution
  24. ↑ "H.R.4498 — 97th Congress (1981-1982)". congress.gov. Retrieved July 20, 2017.
  25. ↑ Zeese, Kevin (September 1, 1999). "History of medical marijuana policy in US". International Journal of Drug Policy. 10 (4). doi:10.1016/S0955-3959(99)00031-6. Retrieved May 2, 2017.
  26. ↑ "Medical Use Introduction" (PDF), NORML, May 23, 2011
  27. 1 2 3 4 Patients in the Crossfire (PDF), American for Safe Access, 2004
  28. ↑ de Coning, Lexi (June 23, 2016). "Irvin Rosenfeld: Meet the Longest-Surviving U.S. Federal Marijuana Patient". MassRoots. Retrieved May 17, 2017.
  29. ↑ "U.S. to halt distributing 'pot' to ill". The Washington Post. June 19, 1991.
  30. 1 2 3 4 5 Vitiello, Michael (1998). "Proposition 215: De Facto Legalization of Pot and the Shortcomings of Direct Democracy". McGeorge School of Law. Retrieved April 30, 2017.
  31. ↑ Rabinski, Gooey (February 22, 2016). "U.S. Government Supplies Free Medical Cannabis to Select Patients". MassRoots. Retrieved April 22, 2017.
  32. ↑ "Clinton Plan Attacks Medical Marijuana Initiatives, Targets Doctors". NORML. January 2, 1997. Retrieved May 7, 2017.
  33. 1 2 Forbes, Daniel (July 27, 2000). "Fighting “Cheech & Chong” medicine". Salon. Retrieved February 19, 2017.
  34. ↑ Hsu, Spencer S. (October 22, 1999). "Bush: Marijuana Laws Up to States". The Washington Post. Retrieved May 7, 2017.
  35. ↑ "MPP Files Complaints Charging Drug Czar Violated Election Laws". Drug War Chronicle. StoptheDrugWar.org. December 6, 2002. Retrieved May 7, 2017.
  36. 1 2 3 Sullum, Jacob (October 2011). "Bummer -- Barack Obama turns out to be just another drug warrior". Reason. Retrieved May 7, 2017.
  37. 1 2 3 Dickinson, Tim (February 16, 2012). "Obama's War on Pot". Rolling Stone. Retrieved May 7, 2017.
  38. 1 2 3 4 "THIRD TIME THE CHARM? -- State Laws on Medical Cannabis Distribution and Department of Justice Guidance on Enforcement" (PDF), Americans for Safe Access, November 25, 2013
  39. ↑ Sherer, Steph (May 31, 2014). "First major victory in the fight to end federal interference". Americans for Safe Access. Retrieved December 27, 2016.
  40. ↑ Liszewski, Mike (December 10, 2014). "Congress Set to Pass Landmark Medical Marijuana Legislation". Americans for Safe Access. Retrieved December 27, 2016.
  41. ↑ "Rohrabacher Hails Passage of Medical Marijuana Amendment" (Press release). June 4, 2015. Retrieved December 27, 2016.
  42. ↑ Liszewski, Mike (June 11, 2015). "Senate Committee Approves Mikulski Medical Marijuana Amendment with Strong Bipartisan Support". Americans for Safe Access. Retrieved December 27, 2016.
  43. ↑ Liszewski, Mike (December 16, 2015). "Congress Set to Reauthorize the Rohrabacher-Farr Medical Cannabis Amendment". Americans for Safe Access. Retrieved December 27, 2016.
  44. ↑ Angell, Tom (May 8, 2017). "Trump Might Ignore Congress’s Medical Marijuana Rider". MassRoots. Retrieved May 8, 2017.
  45. ↑ Zilversmit, Marc (April 28, 2016). "Obama’s Iran-Contra -- The president is spending money that Congress has explicitly told him he can’t spend". Slate. Retrieved May 9, 2017.
  46. ↑ Ingraham, Christopher (October 20, 2015). "Federal court tells the DEA to stop harassing medical marijuana providers". The Washington Post. Retrieved December 27, 2016.
  47. ↑ Ferner, Matt (August 16, 2016). "The Largest Federal Appeals Court Tells DOJ To Back Off State-Legal Medical Marijuana". The Huffington Post. Retrieved December 27, 2016.
  48. ↑ Markoff, Steven C. "State-by-State Medical Marijuana Laws". ProCon.org. Retrieved May 31, 2017.
  49. ↑ "Proposition P". marijuanalibrary.org. Retrieved April 30, 2017.
  50. ↑ Gardner, Fred (August 26, 2014). "The Cannabis Buyers Club: How Medical Marijuana Began in California". marijuana.com. Retrieved May 4, 2017.
  51. 1 2 Heddleston, Thomas R. (June 2012). "From the Frontlines to the Bottom Line: Medical Marijuana, the War on Drugs, and the Drug Policy Reform Movement". UC Santa Cruz Electronic Theses and Dissertations. Archived from the original on February 16, 2014.
  52. ↑ "Medical Marijuana Initiative Qualifies For November Ballot". NORML. June 6, 1996. Retrieved April 30, 2017.
  53. ↑ "Proposition 215: Text of Proposed Law" (PDF). ProCon.org.
  54. ↑ Medical Cannabis Dispensing Collectives And Local Regulation (PDF), Americans for Safe Access, February 2011
  55. ↑ "Drug Reform Measure Signed Into Law In Arizona". NORML. December 9, 1996. Retrieved May 1, 2017.
  56. ↑ "Arizona Bill Delays Medical Marijuana Use". Los Angeles Times. Associated Press. April 16, 1997. Retrieved May 1, 2017.
  57. ↑ Spivack, Sarah (November 12, 1998). "Doctors leery to prescribe marijuana as medication". Arizona Daily Wildcat. Retrieved May 1, 2017.
  58. 1 2 "Congress Lifts Ban on Medical Marijuana for Nation's Capitol". Americans for Safe Access. December 13, 2009. Retrieved April 26, 2017.
  59. ↑ Slevin, Peter; Murphy, Caryle (November 4, 1998). "Marijuana Vote Results Kept Secret". The Washington Post. Retrieved April 26, 2017.
  60. ↑ "Democracy Held Hostage". ACLU. December 31, 2000. Archived from the original on January 14, 2006. Retrieved April 26, 2017.
  61. ↑ "Timeline of Initiative Events". Marijuana Policy Project. Archived from the original on September 18, 2008.
  62. ↑ "Medical Marijuana Initiatives Pass In Colorado and Nevada; Californians Pass Initiative To Keep Non-Violent Drug Offenders Out Of Jail". NORML. November 9, 2000. Retrieved June 1, 2017.
  63. ↑ Schwartz, Carly (November 4, 2014). "Guam Legalizes Medical Marijuana". HuffPost. Retrieved April 26, 2017.
  64. ↑ Kreps, Daniel (May 4, 2015). "In Surprise Move, Puerto Rico Legalizes Medical Marijuana". Rolling Stone. Retrieved April 26, 2017.
  65. ↑ "West Virginia Becomes 29th Medical Marijuana State as Gov. Jim Justice Signs SB 386 Into Law". Marijuana Policy Project. April 19, 2017. Retrieved April 29, 2017.
  66. ↑ Mangone, David (April 5, 2017). "West Virginia Becomes 29th State with Comprehensive Medical Cannabis Program". Americans for Safe Access. Retrieved April 29, 2017.
  67. ↑ "West Virginia: Governor Signs Limited Medical Marijuana Measure Into Law". NORML. April 27, 2017. Retrieved April 29, 2017.
  68. ↑ "Medical Marijuana". NORML. Retrieved April 29, 2017.
  69. ↑ "16 States with Laws Specifically about Legal Cannabidiol (CBD)". ProCon.org. Retrieved April 27, 2017.
  70. 1 2 3 4 5 6 7 The Obstruction Of Medical Cannabis Research In The U.S. (PDF), Americans for Safe Access, April 2009
  71. 1 2 Zielinski, Alex (August 17, 2016). "The DEA Hasn’t Made Marijuana Research Any Easier". ThinkProgress. Retrieved May 15, 2017.
  72. ↑ Nelson, Steven (June 22, 2015). "Major Pot Research Barrier Goes Up in Smoke". U.S. News & World Report. Retrieved May 15, 2017.
  73. ↑ "Federal Obstruction of Medical Marijuana Research". Marijuana Policy Project.
  74. 1 2 Gardner, Fred (December 18, 2014). "DEA Upholds Grower’s Marijuana Monopoly". CounterPunch. Retrieved July 14, 2017.
  75. ↑ Hellerman, Caleb (March 8, 2017). "Scientists say the government’s only pot farm has moldy samples — and no federal testing standards". PBS. Retrieved May 15, 2017.
  76. ↑ Hudak, John (August 11, 2016). "The DEA’s marijuana decision is more important than rescheduling". The Brookings Institution. Retrieved May 15, 2017.
  77. ↑ Collins, Beth (May 6, 2016). "State Department States NIDA Monopoly on Research Marijuana Unnecessary". Americans for Safe Access. Retrieved May 15, 2017.
  78. 1 2 "DEA Lawsuit Timeline". Multidisciplinary Association for Psychedelic Studies. Retrieved July 14, 2017.
  79. ↑ U.S. Senators from Massachusetts Send Letter to DEA (PDF), Multidisciplinary Association for Psychedelic Studies, October 20, 2003
  80. ↑ Smith, Phillip (February 16, 2007). "Medical Marijuana: DEA Judge Says Let Professor Grow Marijuana for Research Purposes". StoptheDrugWar.org. Retrieved July 14, 2017.
  81. ↑ "Congress urges DEA to OK medical cannabis research" (PDF). Americans for Safe Access. September 17, 2007.
  82. ↑ "Bush Administration Deals Eleventh Hour Blow To Scientific Freedom". ACLU. January 12, 2009. Retrieved July 14, 2017.
  83. ↑ February 5th letter to Holder from Olver (PDF), Americans for Safe Access, February 5, 2009
  84. ↑ Kerry/Kennedy letter to Deputy Attorney General Ogden (PDF), Multidisciplinary Association for Psychedelic Studies, April 29, 2009
  85. ↑ "DEA Upholds Federal Marijuana Monopoly, Obstructing Privately-Funded FDA Research" (Press release). Multidisciplinary Association for Psychedelic Studies. PR Newswire. August 24, 2011. Retrieved July 14, 2017.
  86. ↑ "DEA Eliminates 48-Year-Old Monopoly on Research-Grade Marijuana, Clearing Pathway for FDA Approval and Rescheduling" (Press release). Multidisciplinary Associations for Psychedelic Studies. August 11, 2016. Retrieved May 15, 2017.
  87. ↑ Nelson, Steven (August 11, 2016). "DEA Ends Half-Century Pot Monopoly, But Withholds Big Prize for Reformers". U.S. News & World Report. Retrieved May 15, 2017.
  88. ↑ Staggs, Brooke Edwards (July 2, 2017). "DEA hasn’t loosened marijuana cultivation monopoly while applications from researchers mount". The Cannifornian. Retrieved July 14, 2017.
  89. ↑ "About". Americans for Safe Access. Retrieved February 9, 2017.
  90. ↑ Therapeutic Use of Marijuana and Related Cannabinoids (PDF), American Nurses Association, 2016
  91. ↑ "Resolution on Medical Marijuana". druglibrary.org. Retrieved July 10, 2017.
  92. ↑ "American Medical Student Association (AMSA) - Medical Marijuana". ProCon.org. Retrieved July 10, 2017.
  93. ↑ "Medical Marijuana (Cannabis) FAQs". National Multiple Sclerosis Society. Retrieved July 10, 2017.
  94. ↑ Gattone, Philip M.; Lammert, Warreb (February 20, 2014). "Epilepsy Foundation Calls for Increased Medical Marijuana Access and Research" (Press release). Washington, D.C.: Epilepsy Foundation. Retrieved July 31, 2017.
  95. ↑ "Medical Marijuana Use and Research" (PDF). maps.org. Leukemia & Lymphoma Society. Retrieved July 12, 2017.
  96. 1 2 "New York Times full-page ad - March 6, 2002" (PDF). Coalition for Compassionate Access. Archived from the original (PDF) on April 1, 2003.
  97. ↑ "Health Endorsements - Detailed Reference". NORML. Retrieved February 10, 2017.
  98. ↑ "Medical Marijuana Endorsements and Statements of Support". Marijuana Policy Project. Retrieved February 10, 2017.
  99. ↑ ""Should Marijuana Be a Medical Option?" - Summary of Positions". ProCon.org. Retrieved February 12, 2017.
  100. ↑ "Religious Organizations Supportive of Medical Marijuana". Marijuana Policy Project. Retrieved February 10, 2017.
  101. ↑ Angell, Tom (September 6, 2016). "American Legion Calls for Marijuana Rescheduling". marijuana.com. Retrieved February 12, 2017.
  102. ↑ Angell, Tom (December 9, 2016). "Powerful Veterans Group Pushes Trump On Marijuana Rescheduling". marijuana.com. Retrieved February 12, 2017.
  103. ↑ Angell, Tom (August 10, 2016). "State Lawmakers Tell Feds to Reschedule Marijuana". marijuana.com. Retrieved February 13, 2017.
  104. ↑ Altieri, Erik (June 24, 2013). "US Conference of Mayors Unanimously Pass Resolution Calling for the Feds to Respect Local Marijuana Laws". NORML. Retrieved February 13, 2017.
  105. ↑ Hotakainen, Rob (July 26, 2016). "Democrats become first major party to back pathway to legalizing pot". McClatchy. Retrieved February 14, 2017.
  106. ↑ "Montel Stumps for Legalized Medical Marijuana". Fox News. September 17, 2004. Retrieved February 19, 2017.
  107. ↑ Morgan, Fiona (June 24, 2008). "Dr. Joycelyn Elders, former U.S. Surgeon General". Indy Week. Retrieved February 12, 2017.
  108. 1 2 Kampia, Rob (June 22, 2011). "Barney Frank and Ron Paul Introduce Bill to End Federal Marijuana Prohibition". The Huffington Post. Retrieved February 19, 2017.
  109. 1 2 3 Everett, Burgess (April 8, 2015). "Lawmakers warn DOJ to back off medical marijuana prosecutions". Politico. Retrieved February 19, 2017.
  110. 1 2 Ferner, Matt (March 24, 2015). "Historic Medical Marijuana Bill Gains Momentum". The Huffington Post. Retrieved February 19, 2017.
  111. 1 2 Ferner, Matt (February 20, 2015). "Two House Bills Would End Federal Prohibition Of Marijuana". The Huffington Post. Retrieved February 19, 2017.
  112. ↑ Ingraham, Christopher (March 2, 2017). "Virginia Republican introduces bill to end federal marijuana prohibition". The Washington Post. Archived from the original on March 7, 2017. Retrieved March 14, 2017.
  113. ↑ Ferner, Matt (March 10, 2015). "Senate Bill Would Effectively End The Federal War On Medical Marijuana". The Huffington Post. Retrieved February 19, 2017.
  114. ↑ Reilly, Molly (November 4, 2015). "Bernie Sanders Introduces Bill Ending The Federal Ban On Marijuana". The Huffington Post. Retrieved February 19, 2017.
  115. ↑ "Rep. Rohrabacher Introduces Bipartisan "Respect State Marijuana Laws Act of 2013"" (Press release). April 12, 2013. Archived from the original on November 17, 2016. Retrieved February 24, 2017.
  116. ↑ "Rohrabacher: Allow VA Doctors to Prescribe Medical Marijuana" (Press release). November 21, 2014. Archived from the original on November 17, 2016. Retrieved February 24, 2017.
  117. ↑ "Rohrabacher, Farr Hail Medical Marijuana Amendment in Funding Bill" (Press release). December 16, 2014. Archived from the original on November 17, 2016. Retrieved February 24, 2017.
  118. ↑ Ferner, Matt (May 24, 2016). "GOP Congressman Says He Uses Medical Marijuana To Ease Arthritis Pain". The Huffington Post. Retrieved February 9, 2017.
  119. ↑ O'Keeffe, Michael; Foote, Dustin; Vinton, Nathaniel (June 18, 2016). "Jim McMahon, other NFL veterans push for marijuana as painkiller". New York Daily News. Retrieved February 24, 2017.
  120. ↑ Benes, Ross (September 21, 2016). "Inside NFL's Backwards Marijuana Policy". Rolling Stone. Retrieved February 24, 2017.
  121. ↑ Saracevic, Al (November 19, 2016). "Can cannabis cure the NFL’s ills?". San Francisco Chronicle. Retrieved February 24, 2017.
  122. ↑ Hanyes, Chris (December 4, 2016). "Steve Kerr says he used marijuana for back pain, hopes leagues soften stance". ESPN. Retrieved February 9, 2017.
  123. ↑ Gupta, Sanjay (April 16, 2015). "It's time for a medical marijuana revolution". CNN. Retrieved February 9, 2017.
  124. ↑ Gupta, Sanjay (August 8, 2013). "Why I changed my mind on weed". CNN. Retrieved February 9, 2017.
  125. ↑ "Waiting to Inhale". Jed Riffe Films + Electronic Media. Retrieved February 9, 2017.
  126. 1 2 American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use, American Academy of Pediatrics, January 26, 2015, retrieved July 11, 2017
  127. ↑ "Position Statement on Marijuana as Medicine" (PDF). American Cancer Society. Retrieved July 12, 2017.
  128. ↑ "Public Policy Statement on Marijuana, Cannabinoids and Legalization" (PDF). American Society of Addiction Medicine. September 21, 2015.
  129. ↑ "Illinois Medical Marijuana Bill Stymied by Drug Czar Appearance -- for Now". stopthedrugwar.org. February 18, 2005. Retrieved February 19, 2017.
  130. ↑ Lombardi, Kristen (October 17, 2003). "Snake-oil salesmen". The Boston Phoenix. Retrieved February 19, 2017.
  131. ↑ Stern, Ray (December 22, 2016). "County Attorney Bill Montgomery Continues His Failing Crusade Against Arizona's Medical Marijuana Law". Phoenix New Times. Retrieved February 19, 2017.
  132. ↑ Pishko, Jessica (November 7, 2016). "This Arizona Prosecutor Is Waging a Strange War on Weed—and That’s Just the Beginning". The Nation. Retrieved February 19, 2017.
  133. ↑ "Rep. Mark Souder, Longtime Anti-Marijuana Zealot, Resigns Amid Scandal". Marijuana Policy Project. May 18, 2010. Retrieved February 19, 2017.
  134. ↑ Rough, Lisa (November 18, 2015). "Petition to Fire DEA Chief Gains Traction". Leafly. Retrieved June 12, 2017.
  135. ↑ Adams, Ben (July 1, 2016). "Why Does Casino Billionaire Sheldon Adelson Hate Weed So Much?". Leafly. Retrieved February 19, 2017.
  136. ↑ Auslen, Michael (October 21, 2016). "Marijuana amendment faces biggest foe in GOP heavyweight, anti-drug crusader". Tampa Bay Times. Retrieved February 19, 2017.
  137. ↑ Thomas, Dillon (September 20, 2016). "Former White House Advisor Speaks Out Against Legalization Of Marijuana In Arkansas". 5 News. Retrieved February 19, 2017.
  138. ↑ "Medical Marijuana Patients Celebrate: Georgia Rep. Bob Barr Defeated in GOP Primary". Marijuana Policy Project. August 20, 2002. Archived from the original on October 12, 2008. Retrieved February 19, 2017.
  139. ↑ Barr, Bob (October 11, 2008). "Federal Drug War Rethought". The Huffington Post. Retrieved February 19, 2017.
  140. ↑ Frates, Chris (March 27, 2007). "Bob Barr Flip-Flops on Pot". Politico. Retrieved February 19, 2017.
  141. ↑ Use of Cannabis for Medicinal Purposes (PDF), American Medical Association, 2009
  142. ↑ Supporting Research into the Therapeutic Role of Marijuana (PDF), American College of Physicians, February 2016
  143. ↑ "Marijuana -- AAFP Policies". aafp.org. Retrieved July 10, 2017.
  144. ↑ "Marijuana and Cancer". American Cancer Society. Retrieved July 12, 2017.
  145. ↑ "MARINOL (Dronabinol) Capsules" (PDF). fda.gov. Retrieved June 26, 2017.
  146. ↑ "Unimed Approves Acquisition By Solvay". Chicago Tribune. From Tribune News Services. June 12, 1999. Retrieved June 25, 2017.
  147. ↑ "Insys Therapeutics Announces FDA Approval of Syndros" (Press release). Phoenix: MarketWatch. GlobeNewswire. July 5, 2016. Retrieved June 27, 2017.
  148. ↑ Ingraham, Christopher (March 24, 2017). "A pharma company that spent $500,000 trying to keep pot illegal just got DEA approval for synthetic marijuana". The Washington Post. Retrieved June 27, 2017.
  149. ↑ Fang, Lee (September 12, 2016). "Pharma Company Funding Anti-Pot Fight Worried About Losing Business, Filings Show". The Intercept. Retrieved June 27, 2017.
  150. ↑ Levin, Sam (April 3, 2017). "Big Pharma's anti-marijuana stance aims to squash the competition, activists say". The Guardian. Retrieved June 27, 2017.
  151. ↑ "Will SYNDROS Potential Replace SUBSYS Challenges" (Press release). New York: Yahoo Finance. Accesswire. June 16, 2017. Retrieved June 27, 2017.
  152. ↑ "CESAMET (nabilone) Capsules" (PDF). fda.gov. Retrieved June 26, 2017.
  153. 1 2 3 Rubin, Rita (May 16, 2006). "2nd synthetic marijuana drug OK'd for chemo effects". USA Today. Retrieved June 26, 2017.
  154. ↑ Goldberg, Catherine; Janikian, Michelle (August 4, 2016). "Here's How CBD Can Help Ease Your Pain". Leafly. Retrieved June 26, 2017.
  155. ↑ "The CBD User's Manual: Everything You Need to Know About Marijuana's Most Medicinal Molecule". AlterNet. July 8, 2016. Retrieved June 26, 2017.
  156. ↑ Summers, DJ (March 22, 2017). "Is CBD Oil Legal? Depends on Where You Are and Who You Ask". Leafly. Retrieved June 26, 2017.
  157. ↑ Belville, Russ (March 20, 2017). "DEA: CBD Oil Is Not ‘Legal in All 50 States’". High Times. Retrieved June 26, 2017.
  158. ↑ Shepard, Edward M.; Blackley, Paul R. (2016-01-13). "Medical Marijuana and Crime Further Evidence From the Western States". Journal of Drug Issues: 0022042615623983. ISSN 0022-0426. doi:10.1177/0022042615623983.
  159. ↑ Gavrilova, Evelina; Kamada, Takuma; Zoutman, Floris. "Is Legal Pot Crippling Mexican Drug Trafficking Organizations? The Effect of Medical Marijuana Laws on US Crime". The Economic Journal. ISSN 1468-0297. doi:10.1111/ecoj.12521.
  160. ↑ Mark Anderson, D.; Hansen, Benjamin; Rees, Daniel I. (May 2013). "Medical Marijuana Laws, Traffic Fatalities, and Alcohol Consumption". The Journal of Law and Economics. 56 (2): 333–369. doi:10.1086/668812.
  161. ↑ "Legalized Marijuana Could Help Curb the Opioid Epidemic, Study Finds". NBC News. Reuters. March 27, 2017. Retrieved April 3, 2017.
  162. ↑ Ingraham, Christopher (September 15, 2016). "New study finds that medical marijuana may be helping to curb the opioid epidemic". The Washington Post. Archived from the original on September 20, 2016. Retrieved March 18, 2017.
  163. ↑ Ingraham, Christopher (July 13, 2016). "One striking chart shows why pharma companies are fighting legal marijuana". The Washington Post. Archived from the original on February 13, 2017. Retrieved March 18, 2017.
  164. ↑ Ingraham, Christopher (July 14, 2015). "How medical marijuana could literally save lives". The Washington Post. Archived from the original on January 19, 2017. Retrieved March 18, 2017.
  165. ↑ Doyle, Kathryn (August 25, 2014). "Prescription painkiller deaths fall in medical marijuana states". Reuters. Retrieved March 18, 2017.
  166. ↑ Ingraham, Christopher (June 16, 2015). "A huge new study finds that medical marijuana doesn’t “send the wrong message” to kids". The Washington Post. Archived from the original on April 14, 2016. Retrieved March 18, 2017.
  167. ↑ Ingraham, Christopher (July 29, 2014). "Medical marijuana opponents’ most powerful argument is at odds with a mountain of research". The Washington Post. Archived from the original on April 12, 2016. Retrieved March 18, 2017.
  168. ↑ Ferner, Matt (April 25, 2014). "Legalizing Medical Marijuana Doesn’t Lead To More Teens Smoking Pot: Study". The Huffington Post. Retrieved March 18, 2017.
  169. ↑ Downs, David (June 19, 2013). "Medical marijuana laws’ impact on teen use". SFGate. Retrieved March 18, 2017.
  170. ↑ Bindley, Katherine (June 19, 2012). "Medical Marijuana Does Not Increase Teen Drug Use, Study Shows". The Huffington Post. Retrieved March 18, 2017.
  171. ↑ Szalavitz, Maia (November 3, 2011). "Study: Legal Medical Marijuana Doesn’t Encourage Kids to Smoke More Pot". Time. Retrieved March 18, 2017.
  172. ↑ Bailey, Eric (September 7, 2005). "Pot Use Down Where Medical Use OK". Los Angeles Times. Retrieved March 18, 2017.
  173. ↑ "Alaska Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  174. ↑ "Arizona Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  175. ↑ "Arkansas Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  176. ↑ "California Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  177. ↑ "Colorado Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  178. ↑ "Connecticut Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  179. ↑ "Delaware Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  180. ↑ "District of Columbia Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  181. ↑ "Florida Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  182. ↑ "Hawaii Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  183. ↑ "Illinois Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  184. ↑ "Maine Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  185. ↑ "Maryland Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  186. ↑ "Massachusetts Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  187. ↑ "Michigan Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  188. ↑ "Minnesota Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  189. ↑ "Montana Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  190. ↑ "Nevada Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  191. ↑ "New Hampshire Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  192. ↑ "New Jersey Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  193. ↑ "New Mexico Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  194. ↑ "New York Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  195. ↑ "North Dakota Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  196. ↑ "Ohio Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  197. ↑ "Oregon Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  198. ↑ "Pennsylvania Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  199. ↑ "Rhode Island Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  200. ↑ "Vermont Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  201. ↑ "Washington Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  202. ↑ "West Virginia Medical Marijuana Law". NORML. Retrieved July 5, 2017.
  203. ↑ "State-By-State MMJ Qualifying Conditions". Leafly. Retrieved July 7, 2017.
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