In the 20th century, marijuana has been used more for its euphoric effects than as a medicine. Its psychological and behavioral effects have concerned public officials since the drug first appeared in the southwestern and southern states during the first two decades of the century. By 1931,
at least 29 states had prohibited use of the drug for nonmedical purposes.3 Marijuana was first regulated at the federal level by the Marijuana
Tax Act of 1937, which required anyone producing, distributing, or using marijuana for
medical purposes to register and pay a tax and which effectively prohibited nonmedical use
of the drug. Although the act did not make medical use of marijuana illegal, it did make it expensive and inconvenient. In 1942, marijuana was removed from the U.S.
Pharmacopoeia because it was believed to be a harmful and addictive drug that caused psychoses, mental deterioration, and violent behavior.
In the late 1960s and early 1970s, there was
a sharp increase in marijuana use among adolescents and young adults. The current legal
status of marijuana was established in
1970 with the passage of
the
Controlled Substances Act, which divided drugs into five schedules and placed marijuana in Schedule I, the category for drugs with
high potential for abuse and no accepted medical use (see Appendix C, Scheduling Definitions). In
1972, the National Organization for the Reform of
Marijuana Legislation (NORML), an
organization that supports decriminalization of marijuana, unsuccessfully petitioned the
Bureau of Narcotics and Dangerous Drugs to move marijuana from Schedule I to
Schedule II. NORML argued that
marijuana is therapeutic in numerous serious ailments, less toxic, and in many cases more effective than conventional medicines.13 Thus, for 25
years the medical marijuana movement has been closely linked with the marijuana decriminalization movement, which has colored the debate. Many people criticized that association in their letters to IOM and during the public workshops of this study. The argument against the medical use of marijuana presented most often to the IOM study team was that "the medical marijuana movement is a Trojan horse"; that
is,
it is a deceptive tactic used by advocates of marijuana decriminalization who would exploit the
public's sympathy for seriously ill patients.
Since NORML's petition in 1972,
there have been a variety of legal
decisions
concerning marijuana. From 1973 to 1978, 11 states adopted statutes that decriminalized
use of marijuana, although some of them recriminalized marijuana use in the 1980s and
1990s. During the 1970s,
reports of the medical value of marijuana began to appear, particularly claims that marijuana relieved the nausea associated with chemotherapy.
Health departments in six states conducted small studies to investigate the reports. When the AIDS epidemic spread in the 1980s, patients found that marijuana sometimes relieved their symptoms, most dramatically those associated with AIDS wasting. Over this period
a number of defendants charged with unlawful possession of marijuana claimed that they were using the drug to treat
medical conditions and that violation of the law was therefore justified (the so-called medical necessity defense). Although most courts rejected these
claims, some accepted them.8
Against that
backdrop, voters in California and Arizona in 1996 passed two referenda that attempted to legalize the medical use of marijuana under particular conditions. Public
support for patient access to marijuana for medical
use appears substantial; public
opinion polls taken during 1997 and 1998 generally reported 60—70
percent of respondents in favor of allowing medical uses of marijuana.15 However, those referenda are at odds with federal laws regulating marijuana, and their implementation raises
complex legal questions.
Despite the current level of interest, referenda and public discussions have not been
well informed by carefully reasoned scientific debate. Although previous reports have all called for more research, the nature of the research that will be most helpful depends
greatly on the specific health conditions to be addressed. And while there have been
important recent
advances in our understanding of
the
physiological effects of marijuana, few of the recent investigators have had the time or resources to permit detailed analysis.
The results of those advances, only now beginning to be explored, have significant
implications for the medical marijuana debate.
Several months after the passage of the California and Arizona medical marijuana referendums, the Office of National Drug Control Policy (ONDCP) asked whether IOM
would conduct a scientific review of the medical value of marijuana and its constituent
compounds. In August 1997, IOM formally began the study and appointed John A. Benson Jr. and Stanley J. Watson Jr. to serve as principal investigators for the study. The charge to IOM was to review the medical use of marijuana and the harms and benefits attributed to it (details are given in Appendix D).
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