Medical marijuana is an oft-debated and polarizing subject. It inspires images of everything from a drive-thru dispensary on a sunny California beach to an ailing cancer patient desperately seeking a reprieve from the effects of chemotherapy.
For my own part, I have no dog in the fight. To me, the real question is simple “what does the science tell us?” As with most pharmacy-grade medicines, we should be looking to studies, clinical trials, and research to objectively assess the benefits of treatment against the possible harmful effects.
More than a dozen states now legalize the medical use of marijuana, and a few (most notably Colorado) permit recreational uses without a prescription. Some states narrow the list of conditions that qualify for a marijuana prescription while others are far more liberal defining the boundaries of medical use.
Many of these laws came to be through ballot measures sent to voters or through the state legislative process. This is an extremely unconventional method of making assessments about medicine. Pharmaceuticals are generally approved for medical use through scientific research, development and clinical trials.
Imagine if drugs as common as Prozac or Adderall or even Oxycontin became available only through a political process. We would condemn such practices as frustrating the advancement of medicine and technology.
A bill is now pending that would decriminalize medical marijuana in Georgia, but it comes with two unavoidable and politically-motivated obstacles: (1) no one in Georgia can legally grow it; and (2) federal law still views marijuana as an illegal substance. The practical effect is that patients must leave Georgia to obtain medical marijuana and the movement of marijuana across state lines is a technical violation of federal law.
To be clear, the chances of a federal prosecution for possession of medical marijuana are slight, but the risk cannot be utterly ignored. In the past, the Supreme Court has told us that medical necessity is not a defense to federal drug charges related to medical marijuana. In another case, the Supreme Court concluded that federal law trumps state law even when cultivation and possession of medical marijuana does not cross state lines.
This means that someone can be charged with federal crimes even if he or she is obeying state regulations, and by leaving a gaping hole in the Georgia legislation, that is the risk that exists. It is, perhaps, the price of doing business.
Of course, at the federal level, Congress possesses the power to reclassify marijuana, but by listing marijuana as a “Schedule I” drug, the federal government disavows any medical benefit from marijuana. This decision is political and not scientifically defensible. Even the Georgia Legislature noted that the medicinal purposes of marijuana have been known for thousands of years. But as it stands, medical marijuana policy is the fragmented byproduct of political negotiation rather than sound science and medicine.
There are many issues when it comes to crafting an appropriate medical marijuana policy. It seems to me that the easiest ones — like access for the patients who need it and the economics of decriminalizing it — are the ones bogged down the most by politics.
Unfortunately, this prevents us from reaching the more difficult issues: who gets to use medical marijuana (qualifying conditions, patient age, responsiveness to conventional treatments), efficacy studies, and long-term consequences. We cannot seriously approach evidence-based medicine in the case of marijuana unless we can move past the territorial puffery.