Due to the potential of medical cannabis to provide relief to millions of patients in the United States, the need for state and federal governments to immediately increase research and legalize medical cannabis prescription is imperative. In this three-part series of articles, I will outline (1) the history of medical cannabis law in the United States, (2) information about cannabis as medicine and barriers that researchers and providers face in increasing access of this medication to patients who could benefit from its use, and (3) organizational and patient/caregiver support for medical cannabis legalization and what you can do to advocate for medical cannabis legalization, schedule modification and an increase in research.
The Compassionate Care Act in New York State
The Compassionate Care Act (S-04406A) of New York State provides for the legal use of medical marijuana. The legislation would enable patients who have been certified by a health care provider to use medical marijuana to register with the New York State Department of Health (NYSDOH) and receive a patient identification card. The bill allows specially approved organizations, such as hospitals or community health centers, to dispense the medical marijuana to registered patients under NYSDOH supervision.
To date, the bill has passed the New York State Assembly and stalled in the New York State Senate four times. For the first time, it has been added by the New York State Assembly to the state budget proposal. Recently, New York’s Governor Cuomo has decided to utilize the Olivieri law of 1980 to allow for the experimental use of medical cannabis at 20 institutions across New York State. However, this experimental use will still limit access to thousands of patients who could benefit from medical cannabis in New York. The office of the governor has said that he will sign the Compassionate Care Act if the New York State Senate passes the bill.
Recently, I established and led a team of medical students at Albany Medical College’s Medical Student Advocacy Day in January 2014. We advocated in support of the Compassionate Care Act and spoke with senators at the New York State Capitol building in Albany, NY. In March 2014, I provided testimony as a medical student in support of the Compassionate Care Act at a Senate roundtable discussion at the New York State Legislative Office Building, which was led by Senator Diane Savino, the sponsor of the bill.
Legal History of Medical Cannabis Use
Against the advice of the American Medical Association, cannabis was removed from the US Pharmacopeia as a medicinal substance in 1942. Cannabis became illegal in the United States in the early 20th century for the following reasons:
False Information and Lack of Scientific Study: Anti-cannabis advocates incorrectly claimed that cannabis use:
increased the likelihood of heroin addiction. The ‘gateway theory’ to more dangerous drugs is not supported by research, including animal studies. Studies that have supposedly “supported” the gateway theory are correlational, and correlation does not imply causation. However, contact with underground networks that sell cannabis due to its illegal status (which also sell cocaine, methamphetamine, heroin, etc.), increases chances of coming into contact with more dangerous substances. Legalizing medical cannabis will regulate sales from safe, legal dispensaries and therefore eliminate the underground “middleman”;
increased the chances of developing mental illness. While cannabis can exacerbate symptoms of some psychotic mental health disorders, it does not cause mental illness. Medical cannabis may actually prove beneficial in treatment of some mental disorders, such as PTSD;
increased aggression in the average person (not supported by research).
Economic: William Randolph Hearst, a wealthy entrepreneur and the owner of newspapers that printed “yellow journalism” articles (sensationalized and often falsified information) about cannabis, had a stock in the lumber and paper companies. This is relevant because industrial cannabis can be used to make paper in a more ecologically and economically friendly manner than paper made from wood pulp (additionally, the cannabis plant produces highly nutritious seeds and can be used to make cloth and other goods). There was therefore a conflict for Hearst in the availability of the hemp/cannabis plant, and he was able to use his influence to demonize it.
Racist: The first Federal Bureau of Narcotics commissioner, Harry Anslinger, used racist tactics to ensure cannabis prohibition, saying, “There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.”
In 1976, the Investigational New Drug (IND) program was opened by the federal government when Judge James Washington ruled that “… Medical evidence suggests that the medical prohibition [of medical cannabis] is not well-founded” in the case of U.S. v. Randall. With this program, patients were able to petition the government to receive cannabis legally for medical conditions. After a large increase in applications in the 1980s and early 1990s, largely caused by the AIDS epidemic and the benefits of cannabis for HIV/AIDS patients (specifically for treatment of “wasting syndrome” and its associated symptoms), the IND program was closed to new applicants in 1992.
Today, four patients (who had been accepted prior to the IND program cancellation) still continue to receive legal medical cannabis from the federal government. A study conducted in 2002 called “Chronic Cannabis Use in the Compassionate Investigational New Drug Program: An Examination of Benefits and Adverse Effects of Legal Clinical Cannabis,” with the IND patients still receiving medical cannabis from the government as participants, found the following:
“Cannabis smoking, even of a crude, low-grade product, provides effective symptomatic relief of pain, muscle spasms and intraocular pressure elevations in selected patients failing other modes of treatment.”
“These clinical cannabis patients are able to reduce or eliminate other prescription medicines and their accompanying side-effects.”
“Clinical cannabis provides an improved quality of life in these patients.”
“The side effect profile of NIDA cannabis in chronic usage suggests some mild pulmonary risk.”
“No malignant deterioration has been observed.”
“No consistent or attributable neuropsychological or neurological deterioration has been observed.”
“No endocrine, hematological, immunological sequelae have been observed.”
Twenty US states and Washington, D.C. have legalized the use of medical cannabis, including Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington.
Medical cannabis legalization is supported by 88-89% of New York voters, according to a recent poll conducted by Quinnipiac University. The support transcends bipartisan divisions.
The second of three installments of “Medical Cannabis: A Matter of Patients, Not Politics” will cover cannabis as medicine and the barriers to research that investigators face. Check back on March 24 for the second part in the series.
Thank you to Dr. Mitch Earleywine, PhD, who authored the main reference of this article and also provided additional feedback.
Thank you to Will Jaffee for being the editor of this article, and to the entire staff of in-Training.
Thank you to Gretchen Gunn, Steven Obrzut, Alex Sadasivan, Elizabeth McIntosh, Eric Martin Nyberg, and Eric Brown for their assistance in the Compassionate Care advocacy group on Medical Student Advocacy Day in January 2014. Thank you also to Phyllis Ying for her help as leader of the public health advocacy group, and to her, Ajay Major, and Xin Guan for their organization of Medical Student Advocacy Day.
Author’s note: The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, Albany Medical College, Albany Medical Center, in-Training, or any affiliated organization.