LEGISLATIVE UPDATE
New
Bill to Allow Medical Defense in Some Federal Marijuana
Trials
Farr’s"Truth in Trials" Act Would
Recognize State Medical Cannabis Laws
Patients who use medical cannabis under state programs
would no longer fear federal prosecution, if a new bill
before Congress becomes law.
The bipartisan "Truth in Trials" act, introduced
by U.S. Representative Sam Farr (D-CA) with more than
twenty original co-sponsors, would allow defendants in
federal marijuana cases to present evidence that they
were in compliance with their state's medical marijuana
law.
Federal rules of evidence currently exclude any type of
medical defense to marijuana charges, even when a patient
is using cannabis under the direction of a physician and
is in compliance with a state's medical cannabis program.
Thirteen states have laws that allow authorized patients
to use and possess cannabis, but federal law classifies
marijuana as a drug with no accepted medical use.
Farr's press release quoted the Oakland-based national
medical cannabis advocacy group Americans for Safe Access
to explain the importance of the bill:
"The Truth in Trials bill seeks to restore the balance
of justice and bring fundamental fairness to federal medical
marijuana trials," said Caren Woodson, ASA's Government
Affairs Director. "This legislation complements the
recent Justice Department guidelines for federal prosecutors
and is now more necessary than ever."
While the newly released guidelines from the Justice Depart-ment
caution federal prosecutors against bringing cases against
individuals operating under state medical marijuana law,
those individuals still lack legal protection.
"This is a common sense bill that will help stop
the waste of law enforcement and judicial resources that
have been spent prosecuting individuals who are following
state laws," Rep. Farr said in a statement introducing
the bill. "This legislation is about the fair treatment
of defendants in medical marijuana trials, plain and simple."
More than two dozen federal cases involving medical cannabis
are currently pending. Because medical cannabis patients
and their providers are allowed no medical defense at
trial or mention of state law, convictions are nearly
assured, and many defendants take plea bargains in an
effort to reduce mandatory sentences of up to 20 years
in prison.
The fate of Charles Lynch is a case in point. Lynch, a
locally licensed medical marijuana provider in Morro Bay,
California, was prosecuted, convicted and sentenced to
federal prison, even though he had obtained a city business
license, complied with local zoning rules, and even been
welcomed into the Chamber of Commerce.
"I was denied an affirmative defense despite my strict
adherence to local and state medical marijuana laws,"
said Lynch, who is currently free on bail pending his
appeal. "Passage of this bill will allow jurors to
hear the entire story."
Nearly 40 health organizations and advocacy groups are
endorsing the bill, including patient groups such as Americans
for Safe Access, National Association of People with AIDS,
National Minority AIDS Council, and AIDS Action Council.
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FEDERAL UPDATE
Federal
Policy on Medical Marijuana Turns Corner
Justice Department Tells Prosecutors to Respect State
Law
In a sharp departure from previous federal policy, the
U.S. Department of Justice has softened its stance on
medical cannabis. In a memo issued in October, the Justice
Department told U.S. Attorneys that they should not expend
resources prosecuting medical cannabis patients and their
caregivers in states that have adopted laws on medical
use.
The memo's tacit recognition of both the legitimate medical
applications of cannabis and the rights of patients whose
doctors advise them to use it marks a policy reversal
from previous administrations, which have spent the past
13 years undermining state medical cannabis laws. The
change makes good on a campaign promise of President Barack
Obama, who said he sympathized with cannabis patients
and opposed using federal resources to interfere with
state medical cannabis programs.
The memo came shortly after ASA Executive Director Steph
Sherer, Government Affairs Director Caren Woodson and
Special Advisor David Krahl, Ph.D. met with Justice Department
officials in Washington D.C. and explained the need for
a written directive.
"Medical marijuana patients and advocates have worked
hard for this victory," said Sherer. "We're
grateful that President Obama intends to keep his promise
not to undermine state medical marijuana laws, but we
need a comprehensive national policy that promotes research
and protects all patients."
While President Obama had said on the campaign trail that
he would end the raids, Drug Enforcement Administration
(DEA) actions continued as Attorney General Eric Holder,
went through the confirmation process, including four
coordinated raids in Los Angeles on the day Holder was
sworn in.
Following those raids in early February, a White House
spokesman reiterated President Obama's intention to implement
a new policy. Three weeks later, Attorney General Holder,
appearing at a news conference with the DEA's administrator,
said the campaign promise "is now American policy."
ASA had sought a written statement of that policy to guide
federal prosecutors and judges. U.S. Attorneys in California
and elsewhere had said that it would be business as usual
with prosecuting medical cannabis cases until they were
told to stop.
Some federal judges have recently balked at imposing federal
prison sentences and have sought clarification from the
Justice Department about how the new policy affects federal
defendants who complied with state law. While the memo
states that the new policy does not change federal law
or alter the rules for federal marijuana trials, where
evidence of medical necessity or compliance with state
law is routinely excluded as irrelevant, advocates hope
it will affect current federal prosecutions.
"The change of direction is what's most important,"
said ASA Chief Counsel Joe Elford. "This memo gives
prosecutors a reason to think twice and judges a chance
to eliminate prison time."
Fourteen states and the District of Columbia, with a total
population of more than 78 million Americans, have enacted
medical cannabis laws.
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NATIONAL UPDATE
AMA
Urges Reclassifying Marijuana as Medicine
Physicians Want More Research and Development
The leading national doctors' group has said cannabis
should be classified as a medicine and called for more
research into the drug's potential. The move by the American
Medical Association, the largest organization of physicians
with nearly 250,000 members, urges the federal government
to reschedule marijuana to a level with other medicines
and make it available for more cannabinoid drug development
research and clinical trials.
The November decision by the AMA marks a change in policy
for the organization, which has historically supported
the federal government's contention that there are no
currently accepted medical uses for cannabis. Led by ASA
Medical and Scientific Advisory Board member Dr. Sunil
Aggrawal, the AMA's Medical Student Section pushed the
larger organization to change its position based on the
thousands of published, peer-reviewed scientific articles
exploring the therapeutic applications of cannabis and
cannabinoids, including 79 controlled clinical trials.
"It's been 72 years since the AMA has officially
recognized that marijuana has both already-demonstrated
and future-promising medical utility," said Dr. Aggarwal,
who was one of the expert reviewers. "The AMA has
written an extensive, well-documented, evidence-based
report."
The AMA's formal recognition of the established science
has larger policy implications. The U.S. federal government
has long used the AMA's opposition to medical cannabis
as justification for its own position. But the AMA's report
also urges the federal government to reconsider the classification
of cannabis as a Schedule I drug. Reclassifying it as
a medicine would, the AMA notes, help meet "the goal
of facilitating clinical research and development of cannabinoid-based
medicines, and alternate delivery methods."
In February 2008, a position similar to the AMA's was
adopted by the American College of Physicians, the country's
second-largest physician group and the largest organization
of doctors of internal medicine. That resolution also
called on the federal government to review marijuana's
classification as a highly dangerous drug with no medical
use.
"The two largest physician groups in the U.S. have
established medical marijuana as a health care issue that
must be addressed," said ASA Government Affairs Director
Caren Woodson. "Both organizations have underscored
the need for change by placing patients above politics."
The AMA joins the American Nurses Association, the American
Academy of Family Physicians, the British Medical Association,
the Canadian Medical Association, and dozens of other
organizations of health professionals in recognizing established
therapeutic uses and calling for more research.
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CONGRESSIONAL UPDATE
DC:
Congress Restores Medical Cannabis Vote
District of Columbia’s 1998 Voter Initiative
Was Barred from Taking Effect
After 11 years, voters in Washington, D.C. have been vindicated.
The initiative they passed in 1998 to protect medical
cannabis patients will finally take effect.
Tucked into an appropriations bill now on the desk of
President Obama for his signature is a lifting of "the
Barr Amendment," an act of Congress which not only
overturned the will of 69% of the District's voters but
sealed the vote count from public view. That action was
widely denounced as a trampling of democratic principles,
and has even been renounced by the former-congressman
who introduced the amendment, Bob Barr (R-GA).
"By restoring Washington, D.C.'s medical marijuana
law, Congress has recognized both its importance as a
health issue and the depth of public support," said
Caren Woodson, ASA's Govern-ment Affairs Director. "D.C.
is not just joining the 13 states with protections for
patients; the conflict with federal prohibition is now
playing out where our national legislators live."
D.C.'s Initiative 59, the "Legalization of Marijuana
for Medical Treatment Initiative of 1998," removes
criminal marijuana penalties for qualified patients, up
to four designated caregivers per patient, and non-profit
corporations that cultivate, purchase, and distribute
cannabis for patients.
Doctors may provide written or oral recommendations for
any condition that may be helped by cannabis, and caregivers
need not be designated in writing to be protected under
the law. Patients are entitled to grow and possess a sufficient
quantity to ensure that they can maintain treatment "without
depletion of their supply of marijuana."
Because Washington, D.C. is a special entity under the
jurisdiction of the federal government, the District must
submit the original 1998 initiative to Congress for a
30-day review period before the law can go into effect.
The District's local government will then be responsible
for implementing the initiative.
Washington, D.C., while not a state, has a representative
to Congress and a population similar to two states with
medical cannabis laws
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STATE UPDATE
CALIFORNIA:
Regulation Battle in LA
Advocates Push City Council for Dispensary Ordinance  The
second-largest city in the U.S. is poised to enact an
ordinance regulating storefront medical cannabis dispensaries.
The process that began in 2005 has been fraught with controversy,
but the Los Angeles City Council is down to finalizing
details such as zoning restrictions. Americans for Safe
Access, led by California Director Don Duncan, an LA resident,
has been working closely with city officials to craft
responsible regulations, fighting the LA City Attorney's
office every step of the way.
Newly elected city attorney Carmen Trutanich refused repeated
requests from city council committees to produce language
for an ordinance that would regulate the operation of
storefront medical cannabis dispensing collectives. The
city attorney is part of a small group of local officials,
which include the Los Angeles and San Diego district attorneys,
who contend that medical cannabis can never be legally
sold under state law. He has told the council that they
should ban all sales, prompting the threat of legal action
from Americans for Safe Access and other advocates.
 "Neither
the Los Angeles City Attorney nor the City Council has
the right to ban activity that is protected under state
law," said ASA Chief Counsel Joe Elford. "Medical
marijuana sales have been deemed legal by the state legislature,
the courts, and the California Attorney General."
ASA also organized local patients and advocates to appear
at city council meetings, with upwards of 400 supporters
flooding committee hearings on the issue. That public
pressure has resulted in the modification of some of the
most unreasonable and unworkable restrictions.
That prompted DA Cooley to pile on, saying any actions
by the City Council are "irrelevant" because
"100%" of dispensaries are operating illegal,
and he intends to bring felony charges against them.
"The DA is playing politics and trying to intimidate
patients and caregivers in the process," said Elford.
"He can waste taxpayer money on prosecutions, but
he won't get convictions. The law is on our side."
When California voters passed Prop 215 in 1996, they directed
state and local officials to devise mechanisms to ensure
"safe and affordable distribution of marijuana."
In 2003, the state legislature did just that by saying
cooperatives and collectives are exempt from state laws
prohibiting marijuana sales and maintaining a place where
sales occur. In August 2008, California's Attorney General
issued guidelines recognizing the legality of medical
marijuana dispensaries and described how dispensing collectives
can operate in compliance with state law. In addition,
California's state tax authority, the Board of Equalization,
has ruled that medical cannabis is a taxable commodity
and collected estimated tax revenue in excess of $100
million from the state's cannabis dispensaries in 2008.
Popular support for legal access to medical cannabis and
regulated means of distribution has only increased. Recent
polling in Los Angeles found 77% of county voters support
"uniform licensing and regulation" of medical
cannabis dispensaries. Only 14% oppose dispensaries.
At least 500 dispensaries are operating currently in Los
Angeles, a city of 4 million, but the council intends
to restrict that number to as few as 70.
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COLORADO:
Fight Over ‘Caregiver’  Medical
cannabis dispensaries have been springing up in Colorado,
particularly since the state Board of Health ruled that
such storefront establishments meet the definition of
qualified caregiver. In November, Governor Bill Ritter
Jr. directed dispensaries to obtain retail-sales licenses
and start paying sales tax, a move advocates welcomed
as a further legitimization of dispensaries as a distribution
model for the state. Colorado is the second state, after
California, to tax and regulate medical cannabis.
But the issues has been clouded by a state appellate court
ruling that the 'caregivers' the law authorizes to provide
cannabis to patients must assume responsibility for providing
shelter or personal assistance to qualify. Immediately
after, the Board of Health reversed its previous decision
in an impromptu meeting. Activists from Sensible Colorado,
an ASA affiliate, went to court and got the decision overturned
-- at least temporarily -- by successfully arguing that
the meeting was a violation of the Colorado Open Meetings
Law.
Chief Denver District Judge Larry Naves, in voiding the
Board's action, chided them for losing sight of the rights
of patients:
"These people have without dispute, serious problems
for which they have prescriptions for medical marijuana.
There was no mention of the impact of this change on these
people. There is no consideration of how plaintiffs and
others who need medical marijuana would obtain it."
Colorado has an estimated 100 storefront dispensaries
and at least 1,000 registered individual caregivers who
deliver cannabis to patients. State officials estimate
they can collect up to $15 million annually on medical
cannabis sales, and city and county taxes could account
for an additional $45 million a year.
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OREGON:
State Rescheduling, More Access  Medical
cannabis patients in Oregon now have the option of obtaining
their medicine in a café setting in Portland, and
state lawmakers have rejected the federal government's classification
of the drug.
By an overwhelming majority in both houses, Oregon state
legislators have directed the State Board of Pharmacy to
reclassify marijuana as a drug with medical benefits. By
a margin of 26-2 in the Senate and 58-1 in the House, lawmakers
amended Oregons' controlled substances law to remove cannabis
from Schedule I, which is reserved for highly dangerous
drugs with a high potential for abuse and no accepted medical
use. The measure, which takes effect January 1, gives the
Board 180 days to determine an appropriate classification.
Qualified patients in Portland, one of the centers for medical
treatment in the state, now have the option of obtaining
and using cannabis in a members-only café opened
in November by the Oregon chapter of the National Organization
for the Reform of Marijuana Laws. To use the café,
patients must be registered with the Oregon Medical Marijuana
Program and members of Oregon NORML.
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NEW
MEXICO: More Growers Licensed, Access Expanded 
Officials in New Mexico are slowly expanding the state's
medical cannabis program. They have just approved four
new producers of cannabis, expanded the list of conditions
covered by the program to 15, and scheduled hearings to
consider adding five more conditions.
New Mexico is the only state to license growers of cannabis.
The first nonprofit cultivator was approved in March but
ran out of marijuana shortly after it began distribution
in July and is not expected to have more for months. Under
state law, producers may have no more than 95 plants.
With 755 approved patients in the state and more being
added each week, it was impossible for a single provider
to meet demand.
New Mexico's medical cannabis program "will continue
to proceed carefully," said Health Secretary Dr.
Alfredo Vigil in announcing the latest licensing. "We
can meet the needs of our patients while not creating
an excess supply."
The health department estimates each producer should be
able to supply about 100 people. Of the 755 approved patients,
more than 200 have been authorized to grow their own marijuana.
A medical advisory board is considering petitions for
adding five new health conditions to the Department of
Health's medical marijuana program. The conditions under
consideration are Hepatitis C; cluster headaches; bipolar
disorder and obsessive compulsive disorder; chronic, inflammatory
arthritis; and Blepharospasm, a neurological disorder
that causes a twitch of the eyelid.
Most recently, the Department of Health approved cannabis
use for eight new conditions, including Post Traumatic
Stress Disorder. Since it was added to the list of approved
conditions, PTSD quickly overtook chronic pain as the
number one indication for authorized patients, according
to Dr. Steve Jenison of the Department of Health.
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MAINE:
Voters OK Dispensaries, Lawmakers Tinker 
By almost 57%, Maine voters passed a referendum expanding
the state's decade-old medical cannabis law. Voters said
that they wanted to, in the words of the ballot measure,
"change the medical marijuana laws to allow treatment
of more medical conditions and to create a regulated system
of distribution."
In addition to establishing non-profit dispensaries to
provide medical marijuana to patients with a doctor's
approval, the referendum also established a statewide
ID card system to protect patients from arrest and added
chronic pain to the list of authorized conditions.
A state taskforce, established by the governor soon after
voters approved the referendum, is responsible for implementing
the new law. Unlike many states that provide for voter
initiatives, in Maine, state officials have the power
to reword the law from its original form.
Officials say they want to create strict guidelines to
prevent abuse before it takes effect early next summer.
The governor's taskforce will determine how the drug is
dispensed, establish quality control guidelines, and balance
confidentiality with police oversight. But officials are
struggling to estimate how many people will sign up with
the program and how many dispensaries should operate.
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RESEARCH UPDATE
Studies
Demonstrate Cannabinoids Relieve Intractable Pain  Several
recent studies have confirmed the effectiveness of cannabis
and its constituent components in treating types of pain
that are difficult to treat with conventional therapies.
Clinical trials have shown that a whole-plant extract
of marijuana relieves intractable cancer pain. The double
blind, randomized, placebo-controlled trial found pain
scores improved significantly with a cannabis extract
compared to placebo or THC alone. Researchers report that
the combination of plant cannabinoids in the dosage-controlled
cannabis extract Sativex "is an efficacious adjunctive
treatment for cancer-related pain" for patients who
do not get relief from opiates. Between 25% and 45% of
cancer patients experience neuropathic pain, a chronic
condition associated with nerve injury.
The effectiveness of cannabis and cannabinoids in relieving
neuropathic pain has been demonstrated in more than three
dozen preclinical and clinical trials, a new review by
researchers at the University of Georgia has found. They
note that "a large number of research articles have
demonstrated the efficacy of cannabinoids" and conclude
"cannabinoids show promise for treatment of neuropathic
pain." [Neurotherapeutics. 2009 Oct;6(4):713-37.]
Several sets of researchers have recently published findings
on the efficacy of cannabinoids in treating pain resulting
from spinal cord injuries (SCI). A French team, noting
that "very few pharmacological studies have dealt
specifically with neuropathic pain related to SCI,"
suggests that for "refractory central pain, cannabinoids
may be proposed on the basis of positive results in other
central pain conditions (e.g. multiple sclerosis)."
[Ann Phys Rehabil Med. 2009;52(2):124-41.]
Researchers at the University of Miami have demonstrated
in an animal model of SCI pain that cannabinoids yield
more consistent positive results than conventional analgesics
such as opiates, which "decrease in efficacy with
repeated treatment over time." They conclude that
drugs targeting the body's cannabinoid receptors "hold
promise for long-term use in alleviating chronic SCI pain."
[J Rehabil Res Dev. 2009;46(1):135-43.]
Enhancement of the body's natural cannabinoids also holds
promise for treating neuropathic pain, according to researchers
at Virginia Common-wealth University. Noting that the
ability of cannabinoids to reduce pain after nerve injury
is "well known," but "their psychoactive
side effects have damped enthusiasm for their therapeutic
development," researchers studied the effect of reducing
two enzymes that degrade the body's natural cannabinoids.
They found that inhibiting the enzymes "reduces neuropathic
pain through distinct receptor mechanisms of action"
that "present viable targets" for developing
new drugs. [J Pharmacol Exp Ther. 2009 Sep;330(3):902-10.]
Cannabinoids have been shown to work in concert with opiod
drugs in relieving neuropathic pain. Researchers at Mount
Sinai School of Medicine suggest that direct and indirect
interactions between opioid and cannabinoid receptors
not only enhance analgesia but may reduce the development
of tolerance to opiates. They conclude studies of such
interactions are "critical for understanding how
the receptor systems involved in pain relief are altered
during acute or chronic pain" so better therapies
can be created. [Curr Opin Pharmacol. 2009 Oct 24.]
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RESEARCH UPDATE
More
Studies Show
Cancer-Fighting Effects of Cannabinoids
Two new studies of the effects on cancer cells of the primary
cannabinoids in marijuana—Delta (9)-tetrahydrocannabinol
(THC) and cannabidiol (CBD)—have again demonstrated
remarkable cancer-fighting effects.
Researchers in Thailand evaluated the anti-tumor effects
of THC on cholangiocarcinoma cells, an often-fatal type
of cancer that attacks the liver's bile ducts. They found
that "THC inhibited cell proliferation, migration and
invasion, and induced cell apoptosis." At low levels,
THC reduced the migration and invasion of cancer cells;
at high concentrations, THC triggered cell-death in tumors.
In short, THC reduced the activity and number of cancer
cells, leading the authors to conclude that it can be "potentially
used to retard cholangiocarcinoma cell growth and metastasis."
[Cancer Invest. 2009 Nov 16.]
German scientists, noting that cannabinoids such as THC
“exhibit a broad variety of anticarcinogenic effects"
studied the effect of cannabidiol (CBD) on cancer cell invasion.
They found that the non-psychoactive cannabinoid inhibited
the invasion of both human cervical cancer and human lung
cancer cells. By manipulating cannabidiol's upregulation
of a tissue inhibitor, researchers may have revealed a mechanism
of CBD's tumor-fighting effects. A further in vivo study
demonstrated "a significant inhibition" of lung
cancer metastasis in mice treated with CBD. The researchers
conclude CBD may be "a therapeutic option for the treatment
of highly invasive cancers." [Biochem Pharmacol. 2009
Nov 13.]
The usefulness of cannabis in controlling the side-effects
of noxious cancer treatments has been conclusively shown
in clinical trials with humans, but the broad tumor-fighting
effects of cannabinoids demonstrated in laboratory and animal
research has yet to be explored in human trials.
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RESEARCH UPDATE
Brain
Research Shows Import of Endocannabinoids
Research has yielded what a recently published article
calls "remarkable progress in understanding the biological
actions of marijuana and cannabinoids." The author
notes that new understanding of the actions of the body's
endogenous cannabinoid system (ECS), particularly in the
brain, "will allow specific therapeutic targeting
of the different components of the ECS in health and disease."
Of particular note are the "surprising new fundamental
roles" that the ECS plays in "inhibition of
neurotransmitter release," an effect implicated in
the myriad of therapeutic effects demonstrated for cannabis
and cannabinoids. [Int Rev Neurobiol. 2009;88:335-69.]
New brain research indicates potential for new anti-anxiety
and antidepressant drugs that target the ECS. Italian
scientists found that preventing the deactivation of one
of the body's natural cannabinoids produced "marked
anxiolytic-like and antidepressant-like effects in rats
and mice" without the full behavioral effects of
THC or cannabis. The researchers conclude that their finding
"supports the hypothesis that the [endocannabinoid]
system plays an important role in anxiety and mood disorders."
[Int Rev Neurobiol. 2009;85:57-72.]
The neuroprotective qualities of cannabinoids - their
ability to protect brain cells from toxic over-excitation
- are well established, but recent research has shown
that cannabinoids have a unique capacity to generate new
neurons in older brains. An upcoming article in the journal
of Molecular Psychiatry reports that researchers have
shown that treating aged rats with a cannabinoid produced
new neurons in the hippocampus, a major part of the brain
that plays important roles in long-term memory and spatial
navigation. The findings have important implications for
the treatment of age-related mental impairment. [Mol Psychiatry.
2009 Dec;14(12):1067, 1068-9.]
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RESEARCH UPDATE
MS
Symptoms Relieved by Cannabis Extract
The efficacy of cannabis extracts for treating debilitating
symptoms of Multiple Sclerosis has been shown in multiple
studies. A new review of randomized controlled trials
of cannabis extracts that combine delta-9-tetrahydrocannabinol
(THC) and cannabidiol (CBD) finds "a trend of reduced
spasticity in treated patients." Researchers systematically
evaluated six studies and "found evidence that combined
THC and CBD extracts may provide therapeutic benefit for
MS spasticity symptoms."
The studies showed significant disparity between objective
measures of spasticity reduction and subjective reports
of symptom relief, a result that has led researchers to
suggest that the objective measures should be reevaluated.
[BMC Neurol. 2009 Dec 4;9(1):59.]
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