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SECTION 7. LEGALISING MEDICAL USE - THE
Brief history of reform
1996 the state of California passed the Compassionate
Use Act, (Health and Safety Code 1132.5). "To ensure that
seriously ill Californians have the right to obtain and
use marijuana for medical purposes where the medical use
has been recommended by a physician". This had been proposed
by petition of over 20,000 people, and passed with 56%
of the state vote, in a referendum known as Proposition
215, or The Medical Use of Marijuana Initiative. The state
of Arizona passed a similar law at the same time.
code provides that State possession and cultivation
laws "shall not apply to a patient, or a patient"s
primary care giver, who possesses or cultivates marijuana
for the personal medical purposes of the patient, upon
the written or oral recommendation or approval of a
law is specifically about raw herbal cannabis (marijuana).
It does not appear to apply to THC or other extracts
or synthetics. (dronabinol is available on prescription).
Permitting cultivation potentially removed the problems
of obtaining supplies. Permitting the assistance of
a "primary caregiver" was an essential element,
allowing access to the drug for people too sick to grow
or obtain it, or who lived in inconvenient locations
such as nursing homes.
members of Cannabis Buyers Clubs, the most common reasons
given for medical use included anorexia, nausea, vomiting,
insomnia, depression, anxiety/panic attacks, arthritis
and other pain relief, AIDS related illnesses, muscle
spasm, and harm reduction (reducing or controlling other
drug or alcohol abuse).
to District Attorneys, police, and doctors suggested
that a doctor must have approved the marijuana use,
but need not have issued a formal written prescription.
The amount must be appropriate to the patients medical
needs - possession for sale, and sale, remain crimes
in any circumstance. In Californian law, possession
of under 28.5 grams (1oz) is usually deemed to be for
personal use, and dealt with by a written citation and
confiscation, which would still apply in all non- medical
of practice were produced in several areas for police,
doctors, and care givers. In February 1997 the State
Attorney General (who campaigned against the Proposition)
issued detailed guidelines for law enforcement officials,
on enforcing laws against marijuana in the light of
the changes. This suggested that suspects claiming medical
necessity would have to be:
residents who were seriously ill,
ii/ had been
examined by a doctor, who had determined that their
health would benefit from marijuana use,
not be engaged in conduct that endangers others, such
as driving a car,
not be involved in any diversion for non-medical purposes,
such as furnishing to friends or using strictly for
not possess or grow more than needed for personal medical
use. - It was suggested that one plant would produce
one pound of marijuana, or 1,000 "joints",
and that therefore "one can argue that two or more plants
would be cultivation of more than necessary for personal
medical use." Alternatively, possession of more than
28.5 grams might be more than personally medically necessary.
vi/ If a
suspect claimed to be a primary caregiver they must
have been specifically designated by the patient, in
advance, and have specific knowledge of the doctor"s
police forces issued medical marijuana user photo-ID
cards to patients after checking their doctors recommendations,
to avoid them having to prove their case repeatedly.
in February, the San Francisco Department of Public
Health issued guidelines for dispensing medical marijuana,
including standard forms for doctors" recommendations
and nominating "primary care-givers", and
a code of practice for dispensing centres, mostly concerned
with very careful record-keeping.
July 1998 Oakland City Council adopted a limit of 24oz
(1 1/2lb or 680g), or 100 plants, on the amount of marijuana
to be allowed for medicinal use by any one patient.
This was based on the amount needed for 3 months supply
(a typical growth cycle), by patients in receipt of
medicinal marijuana in the wake of the Randall case
(see below), smoking 10 pure cannabis cigarettes per
day each containing 0.9g of cannabis with 2% THC.
U.S. Government and medical marijuana
US Federal government opposed Proposition 215 before and
after it was voted into law, arguing that it was against
national and international law to allow possession or
cultivation of cannabis for any purpose. This opinion
has been challenged in the US courts on several grounds,
and is currently being disputed. It seems very likely
that in the long term Federal law will override the State
legislation, and the Compassionate Use Act will be overturned.
uses of cannabis were effectively banned in the USA
from 1937, under the Marijuana Tax Act. The Controlled
Substances Act 1972 is similar in outline to British
drug control laws; it places cannabis and its derivatives
in Schedule I, among the drugs which "have no accepted
medical use in the United States and have a high abuse
potential". There are five schedules, substances
in the lowest can be distributed without a prescription
but only by a pharmacist.
have been occasional attempts and recommendations to
re-introduce the medical use of marijuana, e.g. California
Research Advisory Panel 1970, compassionate Investigative
New Drug status until 1991, numerous local and federal
court cases. In 1977, a glaucoma sufferer, Robert Randall,
was acquitted of growing cannabis plants, on appeal,
on the defence of medical necessity. He successfully
petitioned the federal government to provide him with
legal marijuana to preserve his eyesight. He was eventually
entered on a research project, and was provided with
a regular supply of government-grown, ready-rolled,
neat marijuana "joints" of a standardised
strength from the National Institute on Drug Abuse"s
research centre. He is still smoking them regularly
to this day. Several other individuals later obtained
supplies from the government, for various ailments,
in each case after long court cases and negotiations.
The requirement in general was to prove medical needs
which could not satisfactorily be met by other drugs,
or by synthetic cannabinoids. The Randall case established
a precedent that herbal cannabis, smoked, could be more
effective in treating some conditions than extracts
same ready-made "joints" were available to
suitably qualified researchers in the US from the early
1970"s on. The synthetic cannabinoid Marinol (dronabinol)
was made available for research and a limited range
of prescriptions in 1985. Other cannabinoids have been
available for research through NIDA. In 1988, the Drug
Enforcement Administration's chief administrative law
judge recommended reclassifying marijuana so that it
could be prescribed, but no action was taken.
Distributing medical cannabis - Buyers Clubs
validity of sales by non-profit clubs, often co-operatives,
acting as "primary care givers" or cannabis
dispensaries, was unclear in the law. Several were shut,
and some re-opened, in legal actions in the early months
after the Act was passed. In March 1997 the Superior Court
in San Francisco ruled that such a club could be legal,
if members had each designated the club as primary care
giver, it was non-profit, each person treated had a doctors
recommendation, and they kept detailed records of what
was dispensed to whom. This was overturned on appeal by
Federal authorities, and at the end of May 1998 several
clubs were closed down by court orders. Others have shut
voluntarily pending legal appeals. At the same time the
State Attorney General has brought another case that the
clubs do not qualify as "primary care givers"
under the Act.
of the cannabis buyers clubs had existed before the
law was passed, and played a large part in the campaign
for Proposition 215. Several were linked with existing
AIDS and cancer-victim activist groups. There were over
30 such clubs in early 1998, the largest with over 9,000
members. Many people who were too sick to obtain or
grow their own claimed that the clubs were their only
potential source of marijuana. Cannabis was grown by
club members, and sold in small amounts to other members,
without profit, as smokeable marijuana, powdered in
capsules, tea, or cookies, usually but not always for
the patient to take away.
ethnographers had a Drug Policy Foundation research
grant to analyse 12,000 intake forms from one buyers
club, with the goal of determining the distribution
of disease categories and demographic characteristics
of members. However, the club was raided in March 1996,
temporarily shut down, and the records remain sealed.
Instead, the researchers investigated the way members
used the club, and the impact of its closing, by interviews
and observations. Respondents reported highly positive
health benefits from marijuana itself, and even greater
benefits from the social aspects of the clubs, which
they described as providing important emotional support
groups, of therapeutic value to the sick and terminally
position of individuals or their care-givers who can
provide their own medical marijuana, remains unclear:
They are not breaking California laws at present, but
they are breaking Federal law.
7.3.5 A document
released by the California Medical Association in January
1998 invoked the Federal law and told physicians in
the state to steer clear of prescribing marijuana. The
federal "Drugs Czar" had suggested publicly
that they might lose their licences to prescribe common
drugs if they co-operated with proposition 215.
late May 1998, the Mayor, City Supervisors, District
Attorney and Public Health Director of San Francisco
were proposing a new bill to establish a model for the
distribution of marijuana to medically ill patients,
who would no longer be able to obtain supplies when
the clubs were banned . They felt that without the co-
operation of most doctors, or the club distribution
network, the law would be almost impossible to implement,
even if it was legitimate under federal law. At one
point it was seriously suggested by these officials
that the City and County public health service should
grow and distribute the marijuana, or make arrangements
with existing medical clinics to do so. Another suggestion
was that police could provide confiscated marijuana
to qualified patients.
the same time, police, prosecutors and lawmakers from
all over California met in Sacramento to consider strategies
for fully implementing Proposition 215. They concluded
that it would be impossible without the co-operation
of the federal government, which they were very unlikely
to get. Federal agency representatives did not attend.
of the participants, including the California Medical
Association, concluded that a necessary first step would
be to persuade the federal government to reclassify
marijuana from Schedule I to Schedule II. A Schedule
II designation would allow physicians to directly prescribe
marijuana to patients, removing the need for private
Problems and benefits of the Californian model
fact that Proposition 215 got on the ballot at all, and
was then passed by 56% of the vote, indicates a wide public
acceptance of the use of marijuana for medical purposes.
It is an issue in this year"s local elections for
Governor, State Attorney-General, and Mayor of San Francisco,
with most candidates supporting some level of medical
use, even when they are hostile to this particular way
of providing it. In Oregon a similar referendum has qualified
for the ballot, in Nevada a similar petition failed to
achieve the required number of signatures in two small
Act supports medical use of herbal cannabis (marijuana).
It does not affect the possibility of using derivatives
or synthetic cannabinoids if they are appropriate. This
recognises that marijuana is by far more easily available,
already being used illegally in some cases, and cheaper.
There is extensive anecdotal evidence that it is more
effective in some illnesses. The effects of marijuana
are undoubtedly different from those of any single derivative
and there seems no reason to doubt the views expressed
by individual patients that smoked cannabis is more
effective and easier to control. Similar control might
be achieved by inhalers or other routes using synthetic
or extracted cannabinoids.
Act supports cultivation for personal medical use. This
is the most obvious way to provide cannabis, a common
plant which can be grown easily almost anywhere. It
avoids patients having to add to the criminal economy,
and is cheaper for them. However, it provides uncertain
doses of a complex drug with variable effects. This
could be mitigated in monitored, larger scale, or collective
production: fine quality control on plant products,
though perhaps not to pharmacologists" standards,
is well established in the food, beverage and tobacco
care givers" were authorised to possess or grow
cannabis for others" personal medical use. This
made access to the drug possible for people too sick
to grow or go out and get their own, or who lived where
home cultivation was impractical, such as in hospices.
of certifying and monitoring medical use were put in
place. Police and prosecutors" responses to the
legal change were devised. No doubt they will be extensively
tested in the local courts.
small numbers of patients have the wherewithal, patience,
and knowledge to regularly grow enough of their own
cannabis plants, of the right quality, for their medical
needs. In some cases pollen or moulds might exacerbate
medical problems. Buying from the illegal market offers
risks of arrest, (though not prosecution), lack of availability
when needed, and of poor quality and prices. Distribution
from police seizures, or cultivation and distribution
by medical services, have been suggested but met legal,
political, moral and practical difficulties.
co-operative Buyers Clubs offered one workable method
of producing and distributing enough marijuana for medical
needs, without a surplus available for diversion. They
could also have been used for quality and dosage control.
Their legal position was at best ambiguous. Their development
was ad hoc and in some cases illegal. As well as extreme
hostility by Federal and some State law officials, they
were damaged by personality politics and, especially,
by over enthusiastic promotion by some advocates of
legal marijuana. Nevertheless, the clubs were so successful
that the State authorities have had to consider taking
over their role now that they have been shut down.
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