Medical Marijuana: Uses, Legality, and Policy Debate

Introduction: The Controversy Over Medical Marijuana

Although marijuana is an illegal drug, it has many potential advantages and disadvantages for medical purposes. Because of the legal status surrounding its use, only a limited number of states have legalized marijuana for medical purposes.

There is a running controversy over marijuana policy in the United States. While there is considerable debate about its benefits, the federal marijuana policy remains highly restrictive, and the trafficking of the substance is still treated as a criminal act. On the other hand, some states have enacted more liberal amendments to their laws. State legislatures and citizen groups have recently challenged the federal policy and have come out in support of legalizing marijuana (Khatapoush & Hallfors, 2004).

The problem is compounded by the fact that other drugs used in palliative care are also considered dangerous to society as a whole. The question dividing the attention of government officials, politicians, individuals, and policymakers is whether it is right to allow a single drug to be accessed freely — even under the care of supervising medical practitioners — while at the same time harshly punishing the possession and use of other drugs. Critics argue that opening the door for marijuana will ultimately open it for other substances, and that marijuana is as addictive and dangerous as those other drugs. The medical benefits of marijuana are also questioned. Under such circumstances, and in the broader interest of society, many argue it is better to deny access than to take risks. That is the current policy in many states and at the national level. Whether that position is correct requires an examination of the nature of the substance and its uses.

What Marijuana Is and Its Medical Applications

In herbal systems of treatment, the medical use of cannabis has historically addressed nausea, improved appetite, and reduced pain. It was used for centuries as medicine, particularly in palliative care. Modern medicine employs derivatives of the hemp plant as well as synthetic products containing the same chemical compounds — cannabinoids. The drug dronabinol, for example, is available for medical purposes in the United Kingdom and Canada. In Canada, its use for the treatment of multiple sclerosis has been approved, and the Canadian government has further permitted the medical use of smoked cannabis on a physician's recommendation (Degenhardt & Hall, 2008). Patients who suffer from painful conditions such as epilepsy, HIV infection, cancer, and multiple sclerosis have therefore been able to access the drug. This is noteworthy given that no fully verified information about the safety of smoking cannabis for medical purposes currently exists (Degenhardt & Hall, 2008).

The term marijuana refers to "a mixture of the leaves and flowering tops of the Indian hemp plant, known as Cannabis sativa" (New World Encyclopedia, 2002). Although marijuana remains an illegal drug in many jurisdictions, awareness of its acceptance as a medical treatment has grown. "In 2001, the Canadian government responded to demands to allow marijuana for medical use if authorized by a doctor, for patients with severe symptoms related to cancer, multiple sclerosis, and epilepsy" (Degenhardt & Hall, 2008). The legal controversy surrounding the drug represents one of the central disadvantages of pursuing its medical use. "Cultivating hemp for marijuana is illegal, but a few countries list it under the federal Controlled Substances Act (1970) as a Schedule I substance" (New World Encyclopedia, 2002). Because of the many issues related to the medical use of marijuana, understanding its causes and effects is essential.

It should be noted that for a long time there was not enough medical research to support the use of marijuana in relieving symptoms of the most severe diseases. Among the documented advantages are its effectiveness in relieving nausea, vomiting, and acute pain, as well as in improving appetite in people with HIV-related disorders (Degenhardt & Hall, 2008). Data on the adverse effects of marijuana are also available in considerable quantity. An alarming fact is that in the United States, marijuana has been widely used for recreational purposes for decades. Since 1996, over thirty-two percent of the U.S. population had tried the drug at least once, and five percent were still users at that time (Joy, 2002).

Research on Benefits, Risks, and Dependency

There has been no systematic study of either the benefits of the drug or its alleged problems and patterns of use. One frequently cited concern is that marijuana is a "gateway" drug — that is, that a person who uses it will eventually try stronger substances. Children who have used marijuana are said to be more likely to use cocaine than those who never used the drug (Khatapoush & Hallfors, 2004). However, research by Khatapoush and Hallfors (2004) concluded that the liberalization of marijuana policy in California did not produce greater overall drug use. Their research further found that medical marijuana policy did not influence youth attitudes toward or use of marijuana (Degenhardt & Hall, 2008).

Can cannabis create dependency? The evidence suggests that cannabis dependence can develop, though there is currently limited information on the risk of dependency even in supervised medical use. Research has also raised concerns about the relationship between cannabis use and the onset of psychosis. While short-term medical use of cannabinoids and cannabis extracts appears to carry no clearly established risk, the effects of long-term use remain poorly understood. There is therefore a pressing need for more extensive research before the soundness of particular treatments and policies can be reliably determined (Degenhardt & Hall, 2008).

The drug's addictive nature implies a high potential for abuse. Critics contend that marijuana has no established medical utility and is unsafe to use even under medical supervision, which is why it remains subject to stringent regulatory controls. Despite increasingly severe sanctions over time, recreational use and the costs of enforcement have both risen, and efforts since the 1970s to relax federal policies — such as rescheduling marijuana — have failed (Khatapoush & Hallfors, 2004). It can therefore be said that there is neither conclusive proof that marijuana is harmful nor definitive evidence that it is effective as a palliative drug. There is a general belief that marijuana has both short- and long-term adverse effects on "the brain, the heart, the lungs, the immune system, and on learning and social behavior" (Hyatt, 2006).

The FDA — Food and Drug Administration — has no role in regulating the manufacture, composition, labeling, or purity of marijuana products (ASHP, 2007). In the case of complainant Raich, where the freedom to use the drug for palliative care was at issue, the court appeared to make considerable effort to balance the individual's liberty interest against the government's interest (Hyatt, 2006). In such cases, medical marijuana is used to prolong a patient's life, and the liberty interest involved sits at the highest level of constitutional protection (Hyatt, 2006).

Medical conditions linked with severe pain — as in the case of Monson, where medicinal marijuana was used to relieve severe pain — ought to be brought under constitutional protection. In brief, the policy of constitutional protection should be legally extended to medicinal marijuana. Beyond the general arguments for its necessity, there must also be a careful balance between a harsh anti-drug law and an individual's liberty interest in his or her own existence (Hyatt, 2006). The controversy appears to have been largely resolved in Canada, where the government has liberalized its policy. Some other countries have followed suit.

Conclusion

The use of marijuana for medical purposes is, by many accounts, justified if we are to go by the opinions and actions of nations like Canada and Germany. Researchers in the medical community have found that marijuana has both advantages and disadvantages for medical purposes, and the benefits appear to outweigh the drawbacks. Even as a recreational drug, it does not appear to be severely harmful or addictive, and does not seem to cause significant drug dependency in most users. Under these circumstances, there would be little justification for resisting a change in marijuana policy in the United States to permit medical use of the drug. However, the issue is complicated further by a broader clamor to liberalize marijuana use altogether.