Medical Marijuana

Also known as: Medical cannabis

Definition: The use of the drug marijuana, which is derived from the dried leaves and flowers of the herbal plant Cannabis sativa, for medicinal and therapeutic purposes. Though the marijuana was widely outlawed in the twentieth century, its medical use was increasingly accepted in the 1990s and into the twenty-first century. By 2023, thirty-eight US states and the District of Columbia had legalized medical marijuana. Twenty-three of those states and Washington, D.C., had also legalized marijuana for recreational purposes.

Medical and Therapeutic Uses

Medical marijuana, or cannabis, and its constituent cannabinoids, such as THC (delta-9 tetrahydrocannabinol), have long been used for medicinal purposes due to reported analgesic, muscle relaxant, and other effects. The drug is most commonly administered by smoking dried leaves and buds of the Cannabis sativa plant, though it can also be processed into other forms such as oils, topical or oral solutions, or pills.

Marijuana was used as early as 2700 BCE in China and India and then spread worldwide to treat conditions such as pain, seizure, muscle spasm, poor appetite, nausea, insomnia, asthma, depression, and menstrual cramps. In 2000 BCE Egyptians used marijuana to treat sore eyes. The Greek doctor Galen prescribed marijuana for flatulence.

The Chinese in 200 CE used marijuana as an anesthetic. In twelfth-century Africa, marijuana (known as dagga) was used to treat snakebites, anthrax, dysentery, and malaria. As the drug tends to dry out mucous membranes, it was used in fifteenth-century India to treat congestion, and the juice of the marijuana seed was used for earaches.

In the eighteenth century in the United States, marijuana was used to treat sexually transmitted diseases and incontinence. A tincture of marijuana (marijuana soaked in alcohol) was used in the nineteenth century to improve appetite, sexual interest, mental disorders, gout, cholera, and hydrophobia. The British in the nineteenth century used marijuana to treat facial tics and the pain, nausea, and spasms associated with rabies and tetanus. However, marijuana was increasingly outlawed and stigmatized in many societies, limiting scientific research into its actual medicinal properties.

Despite legal obstacles, marijuana continued to be used medicinally and some studies were conducted into its effects. Beginning in the 1970s, it was shown to be effective in treating glaucoma (high intraocular pressure). People who used other glaucoma treatments experienced headache and blurred vision and could develop a tolerance for conventional drugs, making medical marijuana a favorable option. However, treating glaucoma with marijuana is of short duration because eye pressure increases again after three to four hours.

In the late twentieth and early twenty-first centuries, scientists and doctors increasingly examined marijuana's potential for treating a wide variety of other conditions and symptoms. These included adrenal and airway diseases, adult attention deficit hyperactivity disorder, nausea associated with acquired immunodeficiency syndrome (AIDS), anorexia, anxiety, arthritis, bruxism (teeth grinding), bulimia, chemotherapy-associated nausea and vomiting, chronic fatigue, chronic pain, constipation, depression, diabetes symptoms, diarrhea, epileptic seizures, intestinal disorders, kidney problems, migraines (associated pain, nausea, and vomiting), obesity, phantom limb pain, post-traumatic stress disorder, schizophrenia, spasticity (uncontrollable muscle flexing, loss of fine motor functioning, and choking resulting from spinal cord injury, stroke, cerebral palsy, or multiple sclerosis), stuttering, tinnitus, tooth and gum pain, and whiplash. Indeed, the wide range of potential applications led some to consider marijuana a "wonder drug." Yet while reports were promising in many cases, medical professionals frequently noted that more research would be necessary before marijuana could be considered a proven treatment for specific conditions. Issues with the legality of the drug also continued to complicate research.

Even in areas where medical marijuana gained considerable acceptance, health practitioners noted that it could come with side effects or complications like any other medication. For example, because marijuana is known to stimulate appetite, it may be prescribed for persons needing to gain weight (such as those with AIDS or cancer who lose lean body tissue in a process called "wasting"). However, the THC in marijuana increases levels of fat more so than lean tissue, which could lead to unhealthy weight gain in people with diabetes and in persons who are obese.

Other hazardous consequences of marijuana use that may outweigh any therapeutic benefits include paranoia, pneumonia, diarrhea, short-term problems with thinking and working memory, and altered immune function. Smoked marijuana contains high levels of tar, thus leading to an increased risk of lung and throat damage. Also, marijuana may potentiate the effects of alcohol.

Though there is much debate over the addictive potential of marijuana, health professionals generally recognize that users may form marijuana dependence. Marijuana users can experience withdrawal symptoms such as restlessness, anxiety, irritability, insomnia, muscle tremor, sweating, and changes in heart rate. According to the National Institute on Drug Abuse, between 9 and 30 percent of people who use marijuana develop a marijuana use disorder, especially if marijuana is used for long periods of time. A person who smokes marijuana for the first time may experience anxiety and panic attacks, and persons with bipolar disorder who smoke marijuana may notice increased mania and rapid cycling.

The correct dosing of marijuana can be difficult. Marijuana, in addition to being smoked, can be delivered in the following ways: through vaporizers, which may reduce harmful chemicals entering the lungs (takes effect within minutes and lasts for two to four hours); through topical applications, which are useful for reducing pain and inflammation; through nasal spray; through rectal suppository; sublingually (sprayed under the tongue); through lozenges; and through ingestion. The effects of marijuana take longer (up to two hours) if ingested because the compounds have to be digested before entering the bloodstream. The effects can last four to eight hours. There have been no documented cases of fatal marijuana overdose.

Marinol (generic dronabinol) is a synthetic THC in pill form available by prescription. However, some say the medicinal effect of marijuana requires many compounds found in the plant, of which THC is only one. In addition, it might be difficult to swallow a pill if one is nauseous or vomiting, and the effects of Marinol do not appear rapidly. Furthermore, Marinol can cost significantly more than marijuana, and dosage is harder to modify than smoked marijuana. Cannabidiol, or CBD, is another ingredient found in cannabis. It has been suggested to offer medical benefits but does not have psychoactive effects; therefore, it is increasingly being prescribed by doctors and distributed by dispensaries for myriad medical conditions.

The Law

Marijuana has long faced legal obstacles in the United States, including for medical use, and remains technically illegal at the federal level. The Marijuana Tax Act of 1937 required expensive taxes and paperwork and discouraged medicinal and recreational uses of the drug. The 1970 Comprehensive Drug Abuse Prevention and Control Act classified marijuana as a schedule I controlled substance (along with heroin and LSD); a schedule I categorizations holds that the drug has no approved medical value, making it unavailable for medical use. In contrast, schedule II drugs have an accepted medical use.

Despite federal restrictions, in the 1990s states began to legalize medical marijuana. California was the first, with Proposition 215 (the Compassionate Use Act of 1996), which stated a person may use medical marijuana with a physician’s recommendation. The law allowed for marijuana cultivation and gave caregivers the right to buy marijuana for the patient. A patient must see a licensed physician to document a medical condition that merits the use of marijuana. Alaska, Oregon, Washington, and Maine were the other states to legalize medical marijuana in the 1990s. Many others followed suit throughout the 2000s and 2010s.

Possession of marijuana, even for medicinal use, remained a federal offense, but in 2013 the administration of President Barack Obama released a statement, known as the Cole Memorandum, that it would not enforce prohibition in most cases in states with well-regulated legalized marijuana industries. An appropriations law passed in 2014 prevented the US Department of Justice (DOJ) from spending funds to take action against states' medical marijuana schemes. While some politicians resisted allowing federal agencies to conduct research into the benefits and risks of using marijuana to treat certain medical conditions, by July 2016 the US Food and Drug Administration (FDA) announced its support of research into the medical use of marijuana. In 2020 the FDA released draft guidance on the development of drugs containing cannabis. Meanwhile, the US Department of Veterans Affairs allowed veterans to use marijuana for medical reasons while still accessing government-sponsored health care. Veterans were required to obtain the marijuana from a state in which medical marijuana is legal; they could not get the drug from the VA itself.

Early in 2017, President Donald Trump's attorney-general, Jeff Sessions, launched a DOJ review of marijuana enforcement; in response, the governors of Colorado, Washington, Alaska, and Oregon petitioned him to maintain existing regulations or enforcement, citing economic and safety concerns. The following January, Sessions revoked the Obama-era Cole Memorandum that deprioritized marijuana enforcement, leaving enforcement open to the discretion of federal prosecutors. Legislators introduced several bills to reschedule and decriminalize or legalize marijuana in Congress during the 2017–8 session, but these stalled in committee.

In mid-2018, the FDA approved Epidiolex, a purified CBD syrup, to treat Dravet syndrome and Lennox-Gastaut syndrome, rare and severe forms of epilepsy that typically manifest beginning in early childhood. This marked the first FDA approval of a cannabis-derived medication. Several synthetic THC and cannabis-mimicking drugs also received FDA approval.

According to the National Conference of State Legislatures (NCSL), by 2023 thirty-eight states, as well as Washington, D.C., Guam, Puerto Rico, and the US Virgin Islands, had legalized the use of medical marijuana and approved implementation of comprehensive medical cannabis programs. Additionally, twenty-three states (as well as Washington, D.C., and Guam) had legalized marijuana for recreational use. Meanwhile, popular support for marijuana legalization continued to grow; by the end of 2022, according to a Pew Research Center study, 59 percent of US adults felt that marijuana should be legal for both recreational use by adults and medical use, an additional 30 percent felt that it should be legal only for medical purposes, and only 10 percent opposed any form of marijuana legalization.

Opponents of decriminalizing medical marijuana argue that its use will lead to recreational use, addiction, and increased crime. They also fear that marijuana is a gateway to harder drugs, although this theory has been disproven by multiple scientific studies.

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