Law, policy, history and circumstance have all contributed
to the odd state of affairs in which the DEA maintains that
unless they say so, marijuana use has no therapeutic benefits
whatsoever, regardless of its observed effects on patients
with various physical maladies.
A significant group of marijuana users affected by scheduling
decisions are individuals who use marijuana for therapeutic
purposes. Their use of marijuana underscores the importance
of Zinberg's analytical perspective.
While the government has not acknowledged an accepted
medical use for marijuana in the United States, significant
numbers of citizens use marijuana as a therapeutic agent at
their own risk. The legislative history insists that the impact
of scheduling decisions on these individuals also be considered
in this rulemaking procedure, irrespective of findings regarding
marijuana's medical use as a possible prescription substance.
If marijuana does not have a significant dependence liability
according to conventional medical standards, there is little
justification for punishing medical use of marijuana by individuals
on their own responsibility with criminal sanctions.
In 1993 Lester Grinspoon, also of the Harvard Medical
School, published Marihuana, the Forbidden Medicine describing
the illicit use of marijuana as a therapeutic agent.(14) Among
the patients who describe their therapeutic use of marijuana
is Stephen Jay Gould, the widely respected expert on evolutionary
biology and widely published on scientific topics and process.
In 1989 the Administrator of DEA rejected the recommendation
of an Administrative Law Judge that marijuana be placed in
schedule II because the substance had an accepted medical
use in the United States and was safe for use under medical
supervision.(15) This decision was ultimately upheld by the
U.S. Court of Appeals as within the Administrator's discretion.(16)
In those proceedings, petitioners presented numerous
affidavits and testimony regarding individuals' therapeutic
use of marijuana. According to DEA this information has no
"The evidence presented by the pro-marijuana parties
regarding use of marijuana to treat various other ailments
such as pain, decreased appetite, alcohol and drug addiction,
epilepsy, atopic neuroderatitis, scleroderma and asthma was
limited to testimony of individuals who had used marijuana
for those conditions and the testimony of the psychiatrists
or general practice physicians mentioned earlier. There is
not a shred of credible evidence to support any of their claims."(17)
Petitioners presented testimony of patients with multiple
sclerosis whose use of marijuana allowed them to get up out
of their wheelchairs and walk, when without the drug, they
could not. According to DEA, these patients are suffering
from drug-induced delusions.
"Why do scientists consider stories from patients and
their doctors to be unreliable? First, sick people are not
objective scientific observers, especially when it comes to
their own health. We have all heard of the placebo effect.
. . Second, most of the stories come from people who took
marijuana at the same time they took prescription drugs for
their symptoms . . . Third, any mind-altering drug that produces
euphoria can make a sick person think he feels better. . .
Fourth, long-time abusers of marijuana are not immune to illness.
Many eventually get cancer, glaucoma, MS and other diseases.
People who become dependent on mind-altering drugs tend to
rationalize their behavior. They invent excuses, which they
can come to believe, to justify their drug dependence."(18)
The credibility of patient anecdotes depends on two corroborative
factors. First, if marijuana does not have a significant dependence
liability, then it does not have reinforcing effects that
contribute to denial, which, as expressed by DEA, is when
users "invent excuses, which they can come to believe, to
justify their drug dependence." The primary assessment of
a drug's ability to produce reinforcing effects is self-administration.
As Cicero explains not all self-administration is harmful.
Testimony of sufficient weight for an Administrative Law Judge
to conclude that marijuana has an accepted medical use is
of great relevance to the separate question of evaluating
marijuana's abuse potential.
DEA argues that expert testimony from scientists should
concern the field of the scientist's expertise.
"In reviewing the weight to be given to an expert's opinion,
the facts relied upon to reach that opinion and the credentials
and the experience of the expert must be carefully examined.
The experts presented by the pro-marijuana parties were unable
to provide a strong scientific or factual basis to support
their opinions. In addition, many of the experts presented
by the pro-marijuana parties did not have any expertise in
the area of research in the specific medical area being addressed."(19)
A psychiatrist from the Harvard School of Medicine such
as Dr. Lester Grinspoon is certainly qualified to evaluate
the extent to which drug dependence has prejudiced a patient's
account of the therapeutic use of marijuana. Consequently
his recent book on marijuana's medical use is an expert's
account of the incidence of non-abusive use of marijuana in
the United States. Grinspoon's book and the full record of
testimony in the case ultimately decided in ACT v. DEA provide
valuable evidence of the scope, duration and significance
of marijuana's use as a therapeutic agent in the United States.
As this petition establishes, the dependence liability
of marijuana is not a settled scientific issue; indeed this
petition argues that there is substantial evidence that marijuana
does not have a sufficient dependence liability to justify
schedule I or II placement under United States law.
The second corroborative factor is the evidence provided
by the discovery of the cannabinoid receptor system in the
human brain, which provides a scientific explanation for the
mechanisms of action behind marijuana's therapeutic effects.
As described above by the pioneers of the cannabinoid revolution,
research on cannabinoids is now focused on developing the
considerable therapeutic potential of this system and cannabinoid
When Hollister prepared his 1986 paper for the Pharmacological
Reviews, he also reviewed the issue of marijuana's therapeutic
use. As cited above, he concluded that marijuana may prove
to have greater therapeutic potential than other social drugs.
In this passage, he elaborates on the therapeutic potential
"Therapeutic uses for marijuana, THC, or cannabinoid
homologs are being actively explored. Only the synthetic homolog,
nabilone, has been approved for use to control nausea and
vomiting associated with cancer chemotherapy. While little
doubt remains that marijuana, THC, and nabilone are effective
for this use, the advent of other drugs that are equally effective
but with fewer adverse effects may make this use moot. Use
of marijuana to reduce intraocular pressure in patients with
glaucoma requires a feasible topical preparation of cannabinoids.
Although some cannabinoids have analgesic activity, the abundance
of new opiod analgesics with little dependence liability provides
tough competition. The use of marijuana as a muscle relaxant,
though promising, has not yet been studied. Clinical studies
to establish the efficacy of cannabidiol as an anticonvulsant
or to compare it with other anticonvulsants are still to be
done. Other therapeutic uses, such as treatment of bronchitis,
migraine, anorexia, and alcoholism, are most unlikely prospects."(20)
Hollister once served as the chairman of the Drug Evaluation
Committee of the CPDD. In this 1986 passage he refers to "competition"
between marijuana and other analgesics. Hollister states that
there is "little doubt" that marijuana is effective as an
anti-nausea agent. He refers to ongoing research on cannabidiol,
one of the non-psychoactive constituent chemicals, regarding
convulsions.(21) These comments establish that it is an underlying
assumption of contemporary research that marijuana has therapeutic
benefits, regardless of whether or not it has a legally defined
"accepted medical use in the United States."
Also in 1986, Raphael Mechoulam, in an interview with
the International Journal of the Addictions, also confirms
that marijuana has therapeutic potential.
"In summary, THC or cannabis may have important effects
in the areas of pain control, as antiasthmatics, to treat
glaucoma, and as part of cancer treatment as an antiemetic
during chemotherapy. All these are important activities. Unfortunately,
not much work is being done, certainly not when one compares
it with what needs to be done. . .
"Knowing what I know today, I would have worked more
on the therapeutic aspects of cannabis. This area apparently
needs a major push that it has not had up 'till now, particularly
given that it has therapeutic potential. One of the reasons
that it has not been pushed was that most pharmaceutical companies
years ago were afraid to go into that field. Companies were
"burnt" working on amphetamines and LSD."(22)
The 1990 article by Miles Herkenham, Allison Lynn and
colleagues on the "Cannabinoid receptor localization in brain"
also verifies that the therapeutic potential of marijuana
is a fundamental assumption supporting modern cannabinoid
research, and begins to provide a basis for understanding
how this potential is realized.
"There are virtually no reports of fatal cannabis overdose
in humans. The safety reflects the paucity of receptors in
medullary nuclei that mediate respiratory and cardiovascular
"Anticonvulsant and antiemetic effects of cannabinoids
have therapeutic value. The localization of cannabinoid receptors
in motor areas suggests additional therapeutic applications.
Cannabinoids exacerbate hypokinesia in Parkinson disease but
are beneficial for some forms of dystonia, tremor, and spasticity."(23)
In a 1992 article published in the Annals of the New
York Academy of Sciences, Herkenham made additional comments.
"The localization of cannabinoid receptors in motor areas
suggests therapeutic applications. Cannabinoids exacerbate
hypokinesia in Parkinson's disease but are beneficial for
some forms of dystonia, tremor, and spasticity. The association
of cannabinoid receptors with GABAergic striatal projection
neurons suggests roles for cannabinoids in control of movement,
perhaps therapeutic roles in hyperkinesis and dystonia. Cannabinoids
have been shown to be beneficial for some forms of dystonia
and spasticity. . . Further work may show the basis for reported
usefulness in controlling nausea and stimulating appetite
in patients receiving chemotherapy for cancer or AIDS."(24)
Abood and Martin confirm that:
"There have been reports to indicate that the cannabinoids
may be effective in treating pain, convulsions, glaucoma,
muscle spasticity, bronchial asthma, nausea and vomiting.
These disorders are currently treated with drugs that are
structurally distinct from cannabinoids . . .Obviously, new
strategies are crucial for treating patients who are unresponsive
to current therapy or suffer severe side-effects."(25)
Martin and Abood express concern about the use of marijuana
by individuals with already compromised immune systems. They
note "the lack of conclusive evidence" of any adverse effect
on the immune system, but express concern that findings from
experimental research could be a source of alarm. Abood and
Martin's concern should be balanced by the statements of Herkenham
above, and the explicit comments on marijuana's effect on
the immune system by Lynn and Herkenham above.
Further evidence that the therapeutic potential of marijuana
is a fundamental assumption supporting contemporary research
can be found in the newsletter of the National Institute on
Drug Abuse, NIDA Notes. In an article discussing the discovery
of "Marijuana's Natural Counterpart", the author points out
"Other NIDA-funded researchers are uncovering what appear
to be other naturally occurring compounds that act like marijuana.
Investigators believe that they will be able to show that
these compounds help the body cope with stress, pain, and
Certainly when these scientists refer to therapeutic
potential they mean that useful drugs can be developed from
the study of marijuana. However their comments have additional
value in that they verify that marijuana has therapeutic mechanisms
of action. It is these mechanisms which scientists seek to
better understand in order to unlock the pharmaceutical drug
making potential of the cannabinoid family of chemicals. Regardless
of the status of scientific knowledge about the action of
marijuana on these therapeutic mechanisms, science has proved
that these mechanisms actually exist. They are not figments
of the dependence-produced craving of marijuana users experiencing
serious organic illnesses.
Once again, regarding reports from marijuana users of
medical benefits DEA maintains that "there is not a shred
of credible evidence to support any of their claims."(27)
There is in fact substantial evidence to support their claims,
as the above comments from professional pharmacological and
medical journals indicate.
Policymakers have a legal obligation to consider the
impact of prohibitive scheduling of marijuana on individuals
who use the drug for its therapeutic potential at their own
risk. Prohibitive scheduling calls for the criminal prosecution
of patients who grow marijuana for personal medical use for
the crime of manufacturing a controlled substance. Instead
of arresting medical marijuana patients, their medical use
of marijuana should be studied by the medical community to
aid researchers in developing effective cannabinoid therapeutic