Medical Cannabis Policy Update: Summer '08
Conyers Questions Federal Tactics on Medical Marijuana
Federal interference with state medical marijuana programs has drawn the ire of a powerful congressman whose committee oversees the Drug Enforcement Administration.
House Judiciary Committee Chairman John Conyers (D-MI) has demanded that the DEA explain the raids and intimidation tactics it has been orchestrating against medical marijuana patients and caregivers in California and elsewhere.
On April 29, Conyers (D-MI) sent a letter to DEA Acting Administrator Michele Leonhart challenging her interference in state medical marijuana programs. Chairman Conyers' action resulted from months of nationwide activism by Americans for Safe Access and other patient advocates, as well as concerned elected officials.
Mr. Conyers first voiced his concerns about DEA interference after a series of coordinated California raids in December. He is the highest ranking elected official to challenge the DEA's tactics since medical cannabis raids in California escalated dramatically in 2007. The congressman's letter is the first step towards Congressional hearings of the DEA by the House Judiciary Committee.
The letter questions the DEA's heightened raid activity across California
and its intimidation of property owners with threats of prosecution and
asset forfeiture because they rent to medical cannabis dispensaries.
In reference to letters the DEA has been sending landlords, Chairman Conyers pointedly asks, "is the use of civil asset forfeiture, which has typically been reserved for the worst drug traffickers and kingpins, an appropriate tactic to employ against individuals who suffer from severe or chronic illness and are authorized to use medical marijuana under California law?"
Mr. Conyers' letter also recognizes how the State of California benefits from the estimated $100 million in sales taxes medical marijuana dispensaries pay annually. He asks Leonhart whether she has considered that the DEA's actions are "negatively impacting the ability of state and local officials across California to collect tax revenue, which they are entitled to under California law."
Over the past several months, ASA and advocates all over the country have lobbied Congress to convene hearings on the DEA's attacks on medical marijuana patients. Dozens of legal, tax-paying dispensaries have been shut down from DEA raids or evictions by their landlords, and many more face the same fate if Congress does not intervene.
"Chairman Conyers' letter to DEA has emphasized the greater need to seek effective solutions that will advance safe and legal access to cannabis for therapeutic use and research," said Caren Woodson, ASA Director of Government Affairs, who has been lobbying the offices of the House Judiciary Committee about this issue for months. "However, before we can begin to develop a sensible national policy on medical marijuana, we must end federal attacks on patients and their care providers."
ASA's work with the House Judiciary Committee was bolstered by a statewide effort to get California's elected officials to call for an end to the harmful tactics of the DEA. ASA and its allies were successful in garnering strong letters of support from several elected officials, urging Chairman Conyers to hold hearings. Among those who spoke up were Orange County Supervisor Chris Norby, Los Angeles City Councilmember Dennis Zine, and the mayors of Berkeley, Oakland, San Francisco, Santa Cruz, and West Hollywood.
to read the letter from Chairman Conyers.
Frank bill would stop federal interference with state programs, allow doctors to prescribe
Bi-partisan legislation to allow the medical use of marijuana was introduced in April by U.S Representative Barney Frank (D-MA) together with Reps. Ron Paul, M.D. (R-TX), Dana Rohrabacher (R-CA), Sam Farr (D-CA) and Maurice Hinchey (D-NY).
H.R. 5842, also known as "The Medical Marijuana Patient Protection Act," prohibits interference by the federal government with the implementation of state-authorized medical marijuana programs. It would also reclassify marijuana from a Schedule I drug to a Schedule II drug - the same class as cocaine and methamphetamine - a move that would allow physicians to legally prescribe it.
"I think it is poor law enforcement to keep on the books legislation
that establishes as a crime something which in fact society does not seriously
wish to prosecute," said Rep. Frank in a statement released by his
office. "In my view, having federal law enforcement agents engaged
in the prosecution of people who are personally using marijuana is a waste
of scarce resources better used for serious crimes. In fact, this type
of prosecution often meets with public disapproval."
HR 5842 would also provide patients with protection from criminal prosecution under the federal Controlled Substances Act (CSA) and the Food, Drug, and Cosmetic Act (FDCA).
As rationale for the bill, Rep. Frank pointed to the recent federal prosecutions of patients "using marijuana for medical purposes in states that have voted - usually by public referenda - to allow such use." He also noted that federal interference has stymied some state medical marijuana programs.
"Most states that have made medical use of marijuana legal have
been unable to actually implement their laws,
The Supreme Court of the United States in its most recent consideration of the issue ruled that there was no legal conflict between federal and state laws. States are under no obligation to make medical use a crime, simply because federal law considers it to be. But state officials frequently voice concern about patients and caregivers being caught in the conflict - licensed by the state on the one hand, prosecuted by federal authorities on the other.
Specifically, the proposed medical marijuana patients act prevents the federal government from prohibiting or restricting:
(1) a physician from prescribing or recommending marijuana for medical use,
(2) an individual from obtaining, possessing, transporting within their state, manufacturing, or using marijuana in accordance with their state law,
(3) an individual authorized under state law from obtaining, possessing, transporting within their state, or manufacturing marijuana on behalf of an authorized patient, or
(4) an entity authorized under local or state law to distribute medical marijuana to authorized patients from obtaining, possessing, or distributing marijuana to such authorized patients.
Similar versions of the Patient Protection Act have been introduced in previous sessions of Congress. The legislation has been referred to Subcommittee on Health.
ASA Defeats County Challenge; San Diego Wants Supreme Court Review
An appeals court has ruled that California's medical marijuana laws must be implemented. A handful of counties had challenged the ID card program the state legislature established, saying that federal prohibition trumped state law. That challenge was rejected by a judge in 2006 and again by an appeals court this month. In both instances, the courts sided with attorneys from Americans for Safe Access, the ACLU and the California Attorney General's office, who all argued that federal and state laws can exist side by side.
In a unanimous opinion, the Fourth District Court of Appeal ruled that federal law does not preempt the state's medical marijuana program. Nonetheless, San Diego County supervisors have voted to appeal the decision to the state Supreme Court.
"This is a huge win for medical marijuana patients, not only in California, but across the country," said Joe Elford, Chief Counsel of Americans for Safe Access, who argued before the appellate court on behalf of patients. "This ruling makes clear the ability of states to pass medical marijuana laws with an expectation that those laws will be upheld by local and state, if not federal, officials."
San Diego County officials filed suit against the state in 2006, hoping to avoid implementing the medical marijuana ID card program mandated by state law. They were originally joined by Merced and San Bernardino counties in arguing that California's medical marijuana laws were not valid because federal laws prohibiting all marijuana use supercede any state law. Merced abandoned the challenge and began implementation after losing in superior court later that year.
In rejecting that argument, Justice Alex McDonald wrote for the court that the federal Controlled Substances Act (CSA) "signifies Congress's intent to maintain the power of states to elect 'to serve as a laboratory in the trial of novel social and economic experiments without risk to the rest of the country' by preserving all state laws that do not positively conflict with the CSA."
ASA argued on behalf of the interests of patients in the original case and the appeal, filing briefs along with the ACLU Drug Law Reform Project. Officials from the City of San Diego broke with their county counterparts and filed an amicus 'friend of the court' brief in the appeal, siding with the Attorney General and medical marijuana patient advocates.
"More than eleven years after the passage of Proposition 215, it's about time that we all got on the same page with regard to medical marijuana and the protections afforded by California law," said Elford. "With two appellate court decisions clearly stating that federal law should not be an excuse to avoid enforcing state law, it is now time for full implementation in California."
In March, the California Supreme Court denied review of City of Garden Grove v. Superior Court, another appellate court case that found the state's medical marijuana law was not preempted by federal law.
ASA will be launching a campaign soon to educate elected officials across
the state about their obligation to implement state law, in particular
the state ID card program, and the benefits of doing so for both law enforcement
and medical marijuana patients.
Dispensary Owner Obeyed State, Local Laws but Faces Federal Prison Sentence
The federal interference in state medical marijuana programs that prompted Rep. Conyers to question the DEA's tactics were on full display in a California courtroom recently -- including federal felony charges against a man licensed to provide cannabis to patients and threats of asset forfeiture against an uninvolved property owner.
On August 5, the closely watched federal trial of medical marijuana dispensary owner Charlie Lynch, 46, resulted in guilty verdicts on all counts. He faces a minimum of five years in prison, even though he operated his dispensary legally under state law, complied with regulations set by Morro Bay city officials, and contacted federal authorities about his plans.
Lynch, a successful software developer with no prior criminal record, sought and received a business license from the city and was welcomed to the local Chamber of Commerce. Central Coast Compassionate Caregivers was open for 11 months before federal agents raided it on March 29, 2007.
Soon after the raid, Lynch reopened his dispensary. The next month, Lynch's landlord was threatened by the DEA with forfeiture of his property unless he evicted Lynch, leading to the dispensary's closure in May 2007.
"It is a huge waste of taxpayer resources for the federal government to spend millions of dollars attacking someone who was abiding by local and state law in every respect," said ASA Chief Counsel Joe Elford. "It is shameful and a tragedy for Mr. Lynch and his patients."
Federal medical marijuana trials typically forbid any mention of state or local laws, or even the medical conditions of the patients. But attorneys for Lynch persuaded the judge to allow limited testimony from the Morro Bay mayor and city attorney.
During the week-long trial, Lynch testified that he made repeated calls to the DEA to determine if he could operate legally, finally talking to an agent who told him to check state and local laws. Lynch's federal public defenders also introduced evidence showing that he maintained scrupulous records and enforced an uncompromising ethical code of conduct for his employees.
Further confusing the lines between federal and state laws, the federal investigation against Lynch was aided by San Luis Obispo Sheriff Pat Hedges, even though Lynch was in full compliance with state and local regulations. Hedges is being sued by a former patient of Lynch's for seizing her confidential medical records in the dispensary raid.
Lynch was found guilty of conspiracy to possess and possession with intent to distribute marijuana and concentrated cannabis, manufacturing marijuana, knowingly maintaining a drug premises, and sales of marijuana to a person under the age of 21. He is currently scheduled to be sentenced on October 20, though defense attorneys are seeking postponement until after January 15.
For more on the Lynch case and what you can do about it, see ASA's blog
ASA-Sponsored Bill Goes to Governor's Desk
The California legislature has taken action to guarantee employment rights for cannabis patients.
The state senate this month sent to the governor's desk an assembly bill that would prevent discriminating against patients in "hiring, termination, or any term or condition of employment" based on their status as a state-qualified medical cannabis user or a positive drug test for marijuana.The bill was introduced in answer to a California Supreme Court decision that found medical marijuana patients can be fired for positive drug tests, even if their cannabis use is legal under state law and occurs only outside the workplace.
The bill leaves intact existing state law prohibiting consumption at the workplace and protects employers from liability by allowing exceptions for jobs where physical safety could be a concern.
"The California legislature has stood up for the right of patients to work and be productive members of society," said ASA Chief Counsel Joe Elford, who represented Gary Ross, the software engineer whose firing became a test of California's medical marijuana law. "Now the governor must act to protect the jobs of thousands of law-abiding Californians who are fighting serious illnesses such as cancer and HIV/AIDS."
The employment rights bill has the support of unions representing nearly 1 million workers in California, as well as the National Lawyers Guild and several HIV/AIDS advocacy organizations.
More about the bill can be seen at www.AmericansForSafeAccess.org/AB2279.
After abandoning a plan to have state officials cultivate cannabis for patients, the New Mexico Department of Health has proposed licensing private growers.
The department is seeking public comment on draft rules governing the licensure of medical marijuana producers, distribution and manufacture of cannabis, and patient identification cards. A public hearing on the identification card program and other proposed regulations will be held Sept. 8 in Santa Fe.
The proposed regulations provide for two kinds of licensed producers: a qualified patient producing cannabis for personal use; and a nonprofit private entity producing no more than 95 mature plants and seedlings at any time. The nonprofit must sell marijuana at a consistent price without volume discounts. The number of qualified patients and general public safety will be considered in determining the number and location of approved licenses
The Washington state health department has filed proposed rules to define a 60-day supply of medical cannabis. The rules set the supply at 24 ounces of useable cannabis, up to six mature plants, and up to 18 immature plants.
Many local activists are rising in opposition to these proposals, instead encouraging the Department to adopt the 100 sq foot and 35oz limitations - as these are more scientifically based than numbers of plants, as plant sizes can vary considerably.
The health department action was ordered in 2007 by the Washington Legislature as part of changes it made to the state's medical marijuana law. The Washington medical cannabis program established by voter initiative in 1998 allows the use of marijuana for "terminal or debilitating illnesses" when recommended by a physician.
The current state program limits patients to a 60-day supply, but does not define supply. That has created confusion among patients, doctors, advocates, and law enforcement.
Under the law, physicians may use "medical evidence" to justify
recommending less or more marijuana than limits set in the rules. The
amounts in these rules were set after the agency reviewed published studies
on the medical use of marijuana; took input from patients, advocates,
doctors, law enforcement, and the public; and researched the laws and
rules of other states that allow the use of medical marijuana.
Officials from Hawaii's state Department of Public Safety were quick to apologize to the state's 4,200 cannabis patients, after releasing their confidential medical records to a Honolulu newspaper.
But many patients were alarmed by the violation of their privacy, and advocates say the mistake highlights the dangers of putting law enforcement agencies in charge of public health matters.
Hawaii is the only state where law enforcement is responsible for administering the medical marijuana program.
The Hawai'i Tribune-Herald reported June 27 that the department had provided a database with patient names and addresses, the locations of their plants, their certificate numbers, and their prescribing doctors.
The breach of privacy was inadvertent, and the newspaper did not name
any of the patients. The Public Safety director sent letters of apologies
to each of the 4,200 patients, and asked the newspaper to destroy the
Under state law, patient names and other information can only be disclosed to law enforcement as verification that patients are in the program.
Resolution Goes to Full American Medical Association for November Vote
The prestigious American Medical Association (AMA) will consider endorsing therapeutic use of cannabis at its next interim meeting in November.
In June, the Medical Student Section (MSS) of the AMA, led by an ASA medical advisor, approved a resolution urging the physicians group to support the reclassification of marijuana for medical use. The MSS will send the resolution to the AMA House of Delegates for a final vote in November.
"While it is an historic occasion for any section of the AMA to endorse medical marijuana, the MSS is merely affirming existing science and urging the adoption of a sensible medical marijuana policy," said AMA-MSS member Sunil Aggarwal, who serves on ASA's Medical and Scientific Advisory Board and is pushing the effort to gain AMA endorsement. "As a future medical doctor, I look forward to exploring and utilizing the many medical benefits of cannabinoid medicines in patient care."
With nearly 50,000 members, the MSS is the largest and most influential organization of medical students in the United States.
"This is a positive and necessary step in the right direction," said Dr. David Ostrow, a member of the AMA and Chair of ASA's Medical and Scientific Advisory Board. "We are hopeful that the full house of delegates will follow the example set by the American College of Physicians and place the needs and safety of our patients above politics."
In February, the American College of Physicians (ACP) adopted a resolution that called for rescheduling marijuana to make it available by prescription and expanding research into its medical efficacy. With 124,000 members, the ACP is the country's second largest physician group and the largest organization of doctors of internal medicine.
Since 1996, twelve U.S. states have adopted medical marijuana laws. Public opinion polls consistently show that as many as 4 out of 5 Americans support access to medical marijuana.
The AMA-MSS resolution is online at AmericansForSafeAccess.org/downloads/MSS-AMA_Resolution.pdf.
Swedish researchers report success using the endocannabinoid system to fight non-Hodgkin lymphoma.
The findings, published in the International Journal of Cancer, show that a cannabinoid agonist halts the spread and growth of cancerous tumors in animals with non-Hodgkin lymphoma. Investigators report that mice treated with the cannabinoid agonist experienced a 40 percent reduction in tumor weight.
The researchers conclude that ability of cannabinoids to both restrict the proliferation of cancer cells and reprogram the cells to die off makes "the endocannabinoid system a potential new therapeutic target for individualized therapy in lymphomas."
These findings are consistent with earlier studies that have shown cannabinoids can halt the spread of many types of cancers, including brain, breast, lung, prostate and pancreatic cancers.
Two recently published studies have confirmed that cannabis is effective in treating neuropathy, a type of pain that does not respond to other drugs. This brings to four the number of recent placebo-controlled clinical studies that have demonstrated that cannabis can control nerve pain better than available alternatives. All four studies have been sponsored by the University of California Center for Medical Cannabis Research and funded by the state of California in response to the resistance of federal researchers to cannabis studies.
In the first study (Journal of Pain, 2008 Jun;9(6):506-21), researchers at UC Davis led by Barth Wilsey, M.D., found that even low doses of smoked cannabis can be effective in managing hard-to-treat neuropathic pain. Investigators found that low- and high-dose cannabis produced similar levels of pain relief, reducing both the intensity and unpleasantness of the often unbearable nerve pain.
The researchers note that cannabis not only fights pain itself but also interacts with opiod painkillers to increase their effectiveness, particularly in neuropathic pain. They also note that using isolated synthetic cannabinoids such as THC (dronabinol) does not provide the same degree of efficacy as a whole-plant preparation of cannabis.
Interestingly, investigators observed that "cannabis does not rely on a relaxing or tranquillizing effect but rather reduces both the core component of nociception [the nerve transmission of pain] and the emotional aspect of the pain experience to an equal degree."
In the second study (Neuropsychopharmacology, 2008; DOI: 10.1038/npp.2008.120), UC San Diego School of Medicine researchers led by Ronald J. Ellis, M.D., Ph.D., used a double-blind, placebo-controlled clinical trial to assess the impact of smoked cannabis on 28 HIV patients with neuropathic pain not adequately controlled by other pain-relievers, including opiates. The patients reported pain relief was greater with cannabis than with a placebo.
"Neuropathy is a chronic and significant problem in HIV patients as there are few existing treatments that offer adequate pain management to sufferers," the lead researcher said. "We found that smoked cannabis was generally well-tolerated and effective when added to the patient's existing pain medication, resulting in increased pain relief."
The other recent California pain studies were conducted by Donald I.
Abrams, M.D., Professor of Clinical Medicine at UCSF, who reported efficacy
in short-term treatment of HIV neuropathy (Neurology,
2007, 68:515-521); by Mark Wallace, M.D., Program Director for the UCSD
Center for Pain Medicine, who found that normal volunteers subjected to
chemically induced pain which mimics neuropathy also responded to medium
doses of cannabis (Anesthesiology,
A new anti-inflammatory compound that is not psychoactive has been found in large concentrations in the cannabis plant. The compound, which can ease swelling, pain and inflammation, may lead to the development of new treatments for such diseases as rheumatoid arthritis, multiple sclerosis and Crohn's disease.
The chemical, called beta-caryophyllene, helps combat inflammation without affecting the brain. Researchers demonstrated in an animal study that beta-caryophyllene attaches to CB-2 cannabinoid receptors, producing the anti-inflammatory effect, but not to the CB-1 receptors, which are associated with the psychoactive effects of THC and other cannabinoids.
Analysis of cannabis has found it to contain as much as 35% beta-caryophyllene.
Other common plants that contain the oil include black pepper, oregano,
basil, lime, cinnamon, carrots, and celery. (Proc.
Natl. Acad. Sci., June 2008. doi:10.1073/pnas.0803601105.)
A statistical study has found that passing state laws legalizing the medical use of cannabis does not increase the drug's While many patients report cannabis use has a positive impact on mental health issues ranging from anxiety to depression, such use is controversial and rarely studied.
A recent pair of case studies from Austria, published last month in the journal of the International Association for Cannabis as Medicine, describe oral administration of synthetic THC (dronabinol) helping two women with chronic depression.
The author reports that 8 out of 10 depressive patients he has treated with synthetic THC exhibited "swift improvement." He concludes that clinical studies of the "effectiveness of cannabinoids for the treatment of depression … are desirable and promising." (Cannabinoids 2008;3(2):8-10.)