Medical marijuana

1. Behind the Scene Look at Legalizing Medical marijuana

2. Emperor ShenNung of China used Marijuana as treatment in 2737 BC • Medical marijuana use spread to Asia, Middle East, and Eastern Africa History Ancient History 19th Century • William Brooks O’Shaughnessy, MD, FRS (1841) • Ohio State Medical Society was commissioned to do marijuana study (1860) • Marijuana was listed as medicine in the US Pharmacopoeia (1870)

3. Pure Food and Drug Act of 1906 • Harrison Narcotics Tax Act of 1914 • National Prohibition Act of 1920 History 20th Century Demonization of Marijuana William Rudolph Hearst “MARIJUANA MAKES FIENDS OUT OF BOYS IN 30 DAYS” “STATE FINDS MANY CHILDREN ARE ADDICTED TO WEED”

4. Federal Bureau of Narcotics 1930 • Marijuana Tax Act 1937 • Boggs Act and Narcotics Control Act 1950 • Controlled Substance Act 1970 HISTORY 20th Century cont’ Father of Drug War Harry J Anslinger

5. Controlled Substance Acts Drug Schedule • Schedule I • (A) The drug or other substance has a high potential for abuse. • (B) The drug or other substance has no currently accepted medical use in treatment in the United States. • (C) There is a lack of accepted safety for use of the drug or other substance under medical supervision. • Schedule II • (A) The drug or other substance has a high potential for abuse. • (B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. • (C) Abuse of the drug or other substances may lead to severe psychological or physical dependence. • Schedule III • (A) The drug or other substance has a potential for abuse. Less than drugs or other substances in Schedules 1 and II. • (B) The drug or other substance has a currently accepted medical use in treatment in the United States. • (C) Abuse of the drug or other substances may lead to moderate or physical dependence or high psychological dependence. Drug schedules

6. Controlled Substance Acts Drug Schedule • Schedule IV • (A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III. • (B) The drug or other substance has a currently accepted medical use in treatment in the United States. • (C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule III. • Schedule V • (A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule IV. • (B) The drug or other substance has a currently accepted medical use in treatment in the United States. • (C) Abuse of the drug or other substances may lead to limited physical dependence relative to the drugs or other substances in Schedule IV. Waiting to Inhale Drug schedules

7. Investigational New Drug (IND) Compassionate Access Program history 20th Century cont’ • Compassionate Use Act 1996

8. Current users 21st Century Medical Use Alaska 1.0 oz. usable California 8.0 oz. usable Colorado 2.0 oz. usable Hawaii 3.0 oz. usable Maine 2.5 oz. usable Michigan 2.5 oz. usable Montana 1.0 oz. usable Nevada 1.0 oz. usable New Mexico6.0 oz. usable Oregon 24 oz usable Rhode Island 2.5 oz. usable Vermont 2.0 oz. usable Washington 24 oz. usable Money.cnn.com

9. Legislative Background • Favorable medical marijuana laws have been enacted in 36 states since 1978 • Six of these laws have expired or been repealed • 31 states and the District of Columbia have laws on the books that recognize marijuana’s medical value. • 9 states have therapeutic research program laws that fail to give patients legal access to medical marijuana because of federal obstructionism • 8 states and the District of Columbia solely have symbolic laws that recognize marijuana’s medical value but fail to provide patients with protection from arrest. • Since 1996, 13 States have enacted laws that effectively allow the use of medical marijuana. A 14th state Maryland, has established an affirmative defense law that protects patients who possess medical marijuana from jail sentences but not fines. Maryland’s law does not however allow cultivation

10. Legislative background • What is an effective state law? • a state law must remove criminal penalties for patients who use and possess marijuana with their doctor’s approval and certification • Effective laws must also allow the patient to grow their own marijuana or allow a provider to do so for the patient.

11. Legislative background • Present State Law • 9 of the 13 effective medical marijuana laws were enacted through the ballot initiative process. • They are as follows: Alaska, California, Colorado, Maine, Michigan, Montana, Nevada, Oregon and Washington. • The other 4 effective laws were passed state legislatures of Hawaii, New Mexico, Rhode Island and Vermont. • Hawaii and New Mexico-enacted by the governors’ signatures • Rhode Island law -enacted over the governor’s veto • Vermont-governor allowed the medical marijuana legislation to become law without his signature

12. Federal government laws prohibit the use of medical marijuana, however the federal government cannot force states to have laws that are identical to federal law nor can the federal government force state and local police to enforce federal laws. • Thus, 99% of all marijuana arrests in the nation are made by state and local (and not federal) officials. Present Federal Law

13. Since 2001 federal courts have handed down decisions on 3 significant medical marijuana cases: US Oakland Cannabis Buyers’ Cooperative (OCBC), Gonzales v Raich and Conant v Walters • In OCBCthe federal court decided that medical necessity cannot be used to avoid a federal conviction for marijuana distribution • In the Raichcase the court held that the federal government can arrest and prosecute patients in states where medical marijuana is legal under state law. • In the Conant case, the Ninth Circuit held that doctors cannot be prosecuted for recommending medical marijuana to their patients Judicial decisions

14. The medical use of marijuana remains a criminal offense under federal law • Federal marijuana penalties assign up to 1 year in prison for as little as one marijuana cigarette and up to 5 years for growing even 1 plant. There is no exception for medical use of marijuana and several states channel this law. • There were 86,627 marijuana arrests in the United States in 2006, 89 % of which were for possession only. Even if 1% of those arrested used it for medical reasons, then there will be more than 7,000 medical marijuana arrests every year! • It must be noted that even though patients can be penalized at the federal level for violating federal marijuana laws, a state government is not required to have identical laws Legal Implications

15. The Federal Controlled Substances Act of 1970 established a series of five “schedules” (categories) into which all illicit and prescription substances are placed • Schedule I (marijuana)- the substance as having a high potential for abuse and no currently accepted medical use in treatment in the U.S • Schedule II: substances are however are defined as having accepted medical use but with severe restrictions. For example: Cocaine, Opium • Schedule III, IV and V: are progressively less restrictive. Examples: Anabolic steroids, Hydrocodone Changing Federal Law ?

16. DEA: Has the authority to move marijuana to into a less restrictive schedule since • US Secretary of Health and Human Services (HHS) : can declare that marijuana meets sufficient standards of safety and efficacy since the FDA is part of the US Department of Health and Human Services. • Congress: can change it by perhaps passing a bill to move marijuana to a less restrictive schedule since it created the Controlled Substance Act (CSA) . Congress can also remove the criminal penalties for the medical use of marijuana regardless of what schedule it is in Can Federal Law be changed?

17. Issues of medical marijuana use • Controversial • Smoking • Control • California

18. Should the Federal Government step in? • California • 17.5 million in seized marijuana this year • Dispensaries increase • Production increase • Enforcement increase • Director of State Division of Law Enforcement – George Anderson- “I do think its increasing” Policy & Administration implications

19. Use of Federal Resources • Attorney General Eric H. Holder Jr. –” It will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers who are complying with state laws on medical marijuana.” • What this means for non-medical users on a federal level • The Federal Government will not tolerate misuse of the law, but who will monitor it? • Department of Health and Human Services • State Enforcement • How do states monitor this “misuse” • Consider California • Considering Iowa Who should prosecute?

20. Changing customer service needs • Shifting the paradigm from marijuana the drug to marijuana the medicine • Complying with the accommodations set forth by new state laws non governmental organizations

21. Hospitals • Private not-for-profit colleges and universities Examples

22. Regulation • Law enforcement • Medical alternative • Courtroom implications • Greater good Our position