Are medical marijuana laws just a gateway drug?

Marijuana will never be legalized because pot smokers cannot remember when to go to the polls. “Darn, I thought that was Super Thursday.” Drew Carey

Call me a nerd if you like, but if there’s one thing that I find the most frustrating about the debate over marijuana legalization, it’s the lack of good, reliable data for public health. The biggest reason for that is how difficult it is for public health researchers to collect data about people’s use of an illegal substance. People tend to be reluctant to talk openly about their participation in activities that could get them arrested.

Is it legal anywhere?

Of course, even the legality question is not a straightforward one. Despite laws allowing marijuana use for medical and even recreational purposes in 23 states and the District of Columbia, the federal government still has the authority to raid dispensaries and homes if it sees fit to.

Map of marijuana laws by state

Although cannabis is still illegal as a Schedule I drug under the federal Controlled Substances Act, many 23 states and the District of Columbia have passed their own laws allowing marijuana for medical or even recreational use. Source: Governing, 2015.

In 2002, the Drug Enforcement Agency raided the homes of California residents Angel Raich and Diane Monson and destroyed their marijuana plants. What Raich and Monson were doing was legal under a 1996 California state law, but not under federal law. Raich, Monson and two anonymous caregivers sued the federal government, and the case made it all the way to the U.S. Supreme Court in Gonzales v. Raich. In 2005, the Supreme Court decided 6-3 in favor of the federal government.

In spite of the ruling in favor of the Bush administration (the Gonzales in Gonzales v. Raich was Attorney General Alberto Gonzales), the Obama administration decided to leave marijuana users in these states alone. But another change in presidential administrations in 2017 could lead to a change in enforcement, as Chris Christie suggested when he was on the campaign trail.

Does medical marijuana need tighter regulations?

For people like me who live in states where marijuana is illegal under all circumstances, it may be difficult to picture exactly how things work in a state that permits medical marijuana. So I’ll let Drew Carey explain what it’s like in California, where marijuana is legal for medical purposes.

What Carey left out was how gray and unregulated the medical marijuana marketplace is in California.

It’s very easy to get a medical marijuana card in California. And, if you ask the right doctor, you can get one for virtually any medical condition you can think of. And the right doctor is pretty easy to find.

Doc 420 billboard

This “trusted and experienced” California medical marijuana doctor, advertises with billboards. She also has a website at www.doc420.com.

I don’t know about you, but all this strikes me as very bad medicine.

Before Colorado decided to legalize cannabis for recreational purposes beginning in 2015, it allowed medical marijuana. And, just like in California, the unregulated market (especially after 2009) led to some alarming medical practices. Here’s how one Colorado physician explained it.

Suppliers of pot to medical marijuana card holders are designated as primary care givers (yes, appallingly close to the term primary care providers). Additionally, the bulk of medical marijuana recommendations are written by a small number of doctors who make huge incomes without practicing within accepted standards that the rest of us must follow (performing diagnostic work-ups, counseling on the risks and benefits of possible treatments, and following up on effectiveness and side effects of treatment). Laurie D. Berdahl, MD, Medical Economics, 2012.

This might seem harmless to you, but there have been some negative public health outcomes as a result of lax medical marijuana regulations. And, fortunately, there is some credible data available on this.

Hospital discharges coded as marijuana-dependent increased 1% per month (95% CI=0.8, 1.1, p<0.001) from 2007 to 2013. A change in trend was detected in poison center calls mentioning marijuana (p<0.01). After 2009, poison center calls increased 0.8% per month (95% CI=0.2, 1.4, p<0.01). Poison center calls also increased 56% (95% CI=49%, 63%, p<0.001) in the period following the policy change. Further, there was one hospital discharge coded as dependent for every 3,159 (95% CI=2465, 3853, p<0.001) medical marijuana registrant applications. Davis, et al. Am J Prev Med. 2016 Mar;50(3):373-9

The American Public Health Association agrees.

APHA urges federal, state, and local governments to regulate commercially legalized marijuana in partnership with state and local health departments, including the provision of resources to local and state public health agencies for the purpose of reducing and preventing marijuana’s use, misuse, and abuse. American Public Health Association

Come on, (this is because you want to) get higher

Of course, there are lots of credible studies that demonstrate the positive effects of marijuana for treating certain serious medical conditions. But is that really what is going on with most people who use medical marijuana? Probably not.

Many voters believed this arrangement would help people who couldn’t get relief from cancer or from serious, debilitating illness any other way. In reality, however, only 2% of users in our state report having cancer, and only 1% each report glaucoma, cachexia, HIV, and seizures. In Colorado, most users request marijuana for nonspecific complaints, use unregulated doses, and have used pot recreationally in the past. It’s fortunate for the marijuana industry that no test can confirm that someone has severe pain, because that is the reason given by 94% of our state’s applicants…

Our children in Colorado grow up now thinking that marijuana is a medicine. I think this has led kids to believe pot has low risk, so they self-prescribe it for anxiety, headaches, or whatever ails them.

But what I find most shocking is when prenatal patients use marijuana. They’ve often heard that it’s good for nausea and pain and ask me, “Isn’t it a legal medicine now?” Then I have the task of trying to convince them to stop because marijuana is a developmental neurotoxin, potentially changing the fetal brain permanently.

Laurie D. Berdahl, MD, Medical Economics, 2012.

Colorado residents ultimately decided to stop the charade that medical marijuana laws were primarily about healing the sick and allowed people to use pot recreationally. At least that’s an honest approach. (Interestingly, much of the promised tax revenue that was supposed to be generated from full marijuana legalization in Colorado hasn’t materialized.)

California is taking a different approach. In 2015, California Gov. Jerry Brown signaled a major policy shift on medical marijuana by signing the California Medical Marijuana Regulation and Safety Act. This was partly driven by the U.S. Department of Justice’s insistence on “robust regulations” at the state level as a condition of DOJ and DEA leaving them alone. Voters will need to approve these new regulations by way of a ballot initiative in 2016.

I’m not (cough-cough) holding my breath for that to happen.

 

Mixed feelings about Obama’s medical marijuana policy

Cannabis is an illegal drug. It was made illegal by the Federal Controlled Substances Act. However the citizens of California saw fit to create a loophole for medical marijuana through Proposition 215.

That would be all fine and good if the citizens of California actually had the constitutional authority to do that. During the Bush administration, the Drug Enforcement Agency, well aware of the farce of California’s referendum, raided several facilities that were packaging and distributing medical marijuana.

A court battle was imminent, and indeed the U.S. Supreme Court got involved in 2005. The court’s ruling should have been obvious from the beginning to anyone even remotely familiar with the U.S. Constitution: the federal law superceded the state law because that’s what the Supremacy Clause is designed to do. Here it is:

This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the contrary notwithstanding. United States Constitution, Article VI, paragraph 2

So the DEA (and, by extension the Bush administration) won that battle. Yet the new Obama administration’s response to this is simply to tell the DEA to look the other way when it comes to these medical marijuana facilities. Attorney General Eric Holder could get a key to the City of Berkeley very soon.

But I’m not so sure I agree with this approach.

From my tone you might guess that I am anti-marijuana. You would guess wrong. I am in favor of legalizing marijuana for medicinal and recreational purposes even though I do not smoke and would not smoke even if it were legal.

But just like the federal law supercedes the state law, my love for the U.S. Constitution and the rule of law supercedes my personal position on marijuana. Through a constitutionally valid process, elected federal lawmakers made a bad law in the Federal Controlled Substances Act. But, for better or for worse, that is the law. And isn’t it the attorney general’s job to enforce the laws that are on the books?

If marijuana does indeed have legitimate medical benefits, then by all means allow researchers to make a case to the Food and Drug Administration.

Instead of trying to sidestep it through a loophole or under the guise of states’ rights, I say the Obama administration should be more courageous. It’s time to take on this issue head-on and revise the Federal Controlled Substances Act so that marijuana is made legal. If people would stop seeing marijuana as a pharmaceutical and start seeing it the same way they see alcohol then there might be a stronger argument for legalization.

In the meantime, you should know that the “Mr. Greenbud” candy bar in your pocket is still illegal no matter what people in California say.