What Is Happening with Medical Marijuana Policy? In the United States, marijuana has been a controlled substance for the lifetime of most people living today. But there has been a movement for several decades to bring back medical applications of the drug. Many states have now legalized marijuana for medical purposes, although restrictions regarding its use vary from state to state. For example, Dr. Sanjay Gupta, a neurosurgeon who has served as a chief medical consultant in broadcast journalism and was vetted for the position of Surgeon General by President Barack Obama, publicly chronicled how his viewpoint changed on medical marijuana through documentary research. “When it comes to marijuana…there are very legitimate medical applications…. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research.” He further specified, “There is now promising research into the use of marijuana that could impact tens of thousands of children and adults, including treatment for cancer, epilepsy, and Alzheimer’s, to name a few.” Many medical professionals disagree, however. There is also a strong position that the evidence for medical marijuana is unclear and that alternative treatments exist with fewer risks and unknowns. Another view is that different people react differently to the same medication, and that different people face different risks when it comes to using a particular drug. Therefore it can be useful to have options. In this view, as a medicine, cannabis may be a good choice for some people and a bad choice for others. Some medical professionals have prescribed cannabis for cancer, anorexia, AIDS, glaucoma, chronic pain, arthritis, insomnia, migraines, anxiety, depression, headache, nausea, epilepsy, asthma, premenstrual tension, drug withdrawal and other conditions. When we examine the historical statements about the drug, contemporary medical uses are very similar to ancient ones. However, medical professionals do not universally agree that medical marijuana is beneficial, and those who are willing to prescribe it acknowledge that it is not an FDA-approved medication and that it is still classified as a Schedule I narcotic by the federal government. If a state has approved medical marijuana, it is generally recommended that the state medical association develop standardized physician criteria for writing medical marijuana recommendations and share the criteria with law enforcement and the public. In the United States, a synthetic cannabinoid, “dronabinol,” was approved for use in 1986. It is marketed as Marinol capsules and is indicated for treatment of anorexia associated with weight loss in patients with AIDS, and for the nausea and vomiting associated with cancer chemotherapy for patients who have failed to respond adequately to conventional drugs aimed at suppressing those symptoms. Some medical marijuana opponents point to Marinol as an alternative to medical marijuana in its smoked form. On the other hand, proponents of medical marijuana note that Marinol can lead to death, while smoked marijuana has never caused a documented overdose fatality. Medical marijuana supporters also argue that Marinol takes one hour to reach full effect, while smoked cannabis acts within minutes. In Canada in 2005 and in the United Kingdom in 2010, a prescription medicine called Sativex was released. It is a mouth spray for treating spasticity in patients with multiple sclerosis. It contains a synthetic version of THC. Sativex is currently under review by the FDA for use in the United States. U.S. research trials for medical marijuana must follow a strict process that has considerably limited the amount of federally approved research activity. A proposal must first gain approval from the FDA. After that, a marijuana permit must be obtained from the Drug Enforcement Administration. Last but not least, a supply of medical marijuana must be obtained from the National Institute on Drug Abuse (NIDA), which controls all approved medical marijuana grown for research purposes in the United States. While the Obama administration removed the earlier need for marijuana research proposals to be approved by the Public Health Service, the application process remains difficult and lengthy. That is largely because of marijuana’s federal classification as a Schedule I narcotic. Despite the hurdles, some research is happening, leading to developments like a new federal patent on cannabinoids for their use as antioxidants and neuroprotectants. A number of bills have also been introduced to reduce the red tape and expand research. And NIDA has vowed to “build farm capacity flexible enough to accommodate various levels of demand for research marijuana and marijuana products over the next five years.” NIDA, in fact, renewed a contract with the University of Mississippi (where the marijuana is grown) for up to $68.7 million through 2020. Research studies are also taking place elsewhere. At the end of 2014, the Colorado Board of Health announced that it would spend over $8 million to study the efficacy of medical marijuana. Three of the studies need federal approval and therefore require marijuana supplied by NIDA. Five other observational studies involve participants providing their own marijuana. The incredible variety of cannabis plant strains makes it difficult to have consistency in medical marijuana products. Typically, medical marijuana also requires different doses and types for different ailments. This variability will no doubt be an ongoing complication to medical marijuana research, since the FDA drug review process requires exact quantities and composition of drugs for recipients. Drug approvals in the United States take an average of 12 years from invention to market, and only one in 5,000 makes the cut. Many are paying close attention to the scientific discussions and the political positioning taking place among physicians, health insurance companies, health care organizations, policymakers, patients, parents, schools and communities. Influential medical institutions such as the Mayo Clinic and UnitedHealth Group recognize these conversations, the need for more research, and the increase in states supporting medical marijuana, but have refrained from taking a stance on the issue, instead publishing educational information and calling for more research. The debate over the value of marijuana as medicine is an interesting and often heated one, with knowledgeable people weighing in on both sides of the issue. Regardless of one’s personal views, it is important to always keep in mind that marijuana is a potent drug deemed addictive by the National Institutes of Health (NIH) and illegal by the federal government. While it is important to stay updated on legal trends and ramifications, it is even more important to concentrate on efforts to prevent marijuana misuse and abuse—especially among youth. Arguments for Medical Marijuana Arguments Against Medical Marijuana Legalization of medical marijuana offers access to a medication that may effectively treat many health conditions. Marijuana provides another alternative for those who have experienced unsuccessful treatment with other medications and modalities. The passage of medical marijuana laws sets a precedent for medicinal usage of the plant and validates the need for medical research trials. Medical marijuana may reduce powerful opioid prescriptions, if research proves its effectiveness for chronic pain. Cannabinoids, chemical compounds in marijuana with apparent medical benefits, can be extracted, replicated and applied in ways that don’t involve smoking, thereby eliminating negative impacts of that methodology. Marijuana dispensaries run by state governments, as opposed to illegal markets, should provide safer regulation, safer products and state tax profits. Medical marijuana is not approved by the FDA, and research is lacking to support its use for many of the conditions for which it is prescribed. Medical marijuana policies make marijuana increasingly accessible and reduce the perception of risk, which is particularly concerning for youth. Medical marijuana increases the number of people using marijuana, which in turn increases the number of people at risk for addiction. Addiction and other adverse health effects from using marijuana have individual and social costs. Smoking marijuana can lead to a host of medical problems, similar to those that present in tobacco smokers and negative effects like lung cancer may outweigh potential benefits. Medical marijuana could lead to decreased public perception of harm, and could thereby increase illicit use. In some states that allow medical marijuana, medical professionals question the legitimacy of some prescribing physicians and their reasons for recommending medical marijuana. What Is Happening with Recreational Marijuana Policy? Many more states have legalized medical marijuana than those that have legalized adult recreational marijuana. In those that have legalized recreational marijuana, you cannot be arrested, ticketed or convicted for using marijuana as long as you follow the laws related to age, place and amount of consumption. However, you can still get arrested for selling or trafficking marijuana if you aren’t following state laws on licensure and taxation. Recreational marijuana markets introduce more variables and policy considerations. While the Obama administration chose not to interfere with state recreational marijuana laws as long as states were abiding by their respective laws and keeping retail businesses within their own borders, current or future administrations could decide to challenge such laws. Recreational marijuana poses legal risk given that it is still currently against federal law to sell, use or possess marijuana. The U.S. Controlled Substances Act is the relevant federal law, and it defines a controlled substance as a drug or chemical that is illegal or needs to be very strictly regulated. The law also establishes several categories, or “schedules,” of controlled substances that are used to determine penalties for possessing, using or misusing drugs, or selling individual types of substances. A drug is categorized in a particular schedule based on several factors: Scientific knowledge about the drug and its effects The likelihood that the drug will be misused or abused How the drug is (and has historically been) misused or abused How the drug poses a risk to the public Whether the drug currently has accepted medical uses Whether use of the drug can lead to addiction Whether the drug is used or likely to be used in making another controlled substance Schedule I drugs are considered the most dangerous; Schedule V drugs are considered the least dangerous. According to current federal law, heroin, LSD, ecstasy and marijuana are all classified as Schedule I drugs. Although the Obama administration did not interfere with states that legalized recreational marijuana, the federal law does limit those states in certain ways. For example, marijuana in those states must be grown, sold, used and taxed within state borders without using federal land, federally-managed resources like water or federally regulated banks. Retail marijuana businesses also cannot deduct business expenses on their federal income taxes. In addition, colleges, universities and employers in states where marijuana is legal can still enforce alcohol and other drug policies that reflect federal rather than state regulations. States with legalized recreational marijuana have generated handsome tax revenues as a result. Colorado, for example, reported $700 million in marijuana sales and nearly $70 million in tax revenue in 2014. These figures, of course, don’t include the costs that those states will incur from marijuana-related hospitalization, regulation and policing—figures that are still being quantified. Several more states are debating legalization, and could be attracted to the potential tax dollars. It’s worth restating, however, that state budgets with recreational marijuana revenue could be put at risk if stricter federal enforcement ever returns. Colorado and Washington are seen by many as testing grounds for legalization, and it is still too early to draw definitive conclusions about the impact on adult and youth usage patterns, crime rates, substance use disorder rates, vehicular deaths and other relevant financial and social effects. As such states learn from their experience, they are also attempting to identify best-practice regulatory policies to address state versus municipal conflicts, the tenuous federal versus state conflict, research trials, cultural considerations, federal bank funding issues and more. Arguments for Legalized Recreational Marijuana Arguments Against Legalized Recreational Marijuana Marijuana is less physically harmful than the legal drug alcohol. Efforts to forcibly control rather than permit the use of marijuana have alienated and incarcerated otherwise law-abiding citizens. The U.S. government has failed to control the supply of marijuana despite high rates of incarceration for marijuana possession. Universal access to treatment and educational programs can decrease the demand for marijuana (as it has for tobacco use). Most people who use marijuana do not go on to use other drugs. Legalization would permit tax income, some of which could be used to provide treatment and fund prevention programs. Government regulation would permit oversight of the drug’s purity and provide a means for levying sanctions against those who divert marijuana to adolescents. Marijuana is addictive, alters the natural chemical composition of the brain and affects physiological functions throughout the body. Use equals risk—when more people smoke marijuana, more will develop cannabis use disorders. While perhaps not as physically dangerous as some other substances, marijuana leads to a decline in cognitive skills and motivation that can affect opportunities, talent, memory, performance and interest in healthy activities. Alcohol and tobacco are legal but also produce great societal consequences, and introducing yet another legal substance to mainstream culture could have unpredictable, harmful consequences. Legalizing marijuana for adults would communicate acceptance of its use and likely decrease the perception of its harmfulness, including among youth. Marijuana use complicates the diagnosis and treatment of a variety of underlying psychiatric conditions. Frequent use of marijuana affects adolescent development; in adults, it often impairs maturation psychologically, socially, professionally and spiritually. What Is Happening with Decriminalization Efforts, and How Are Changes in Marijuana Policy Impacting Law Enforcement? You have probably heard the term “decriminalization” used in marijuana discussions. It is important to know that decriminalization is not the same as legalization. Decriminalizing simply means to significantly reduce the consequences for breaking marijuana laws. For example, states that have decriminalized marijuana typically don’t prosecute people caught with small amounts of the drug intended for personal consumption (usually under an ounce), meaning they don’t go to jail, and the offense typically doesn’t go on their criminal record. They may still get a ticket and fine, however, much like one would for a minor traffic violation or an “open container” violation for alcohol. In some states that have decriminalized marijuana, people who get caught using or possessing small amounts could also be ordered to attend educational classes on substance misuse and addiction. Decriminalization affects law enforcement efforts by lowering the priority of marijuana-related arrests. Legalization efforts have also affected law enforcement, sometimes in unanticipated ways. For example, Colorado has experienced an increase in homelessness due to people moving to the state hoping to find work in the legal marijuana industry. While the creation of any new industry does lead to more jobs, there is a limit to the number of opportunities, and many of those seeking employment are not qualified. Another unforeseen challenge for marijuana businesses is that they must comply with federal banking restrictions that require them to deal in cash, creating targets for burglaries and robberies. One of the biggest issues for law enforcement is the black, or illegal, market, which still exists even in states with legalized recreational and/or medical marijuana. States also describe a “gray” market, one in which legal producers sell inventory under the table to black-market suppliers. Personal growing laws can present law enforcement problems because they may be unclear and open to interpretation. For example, residents of Colorado might grow their limit of six marijuana plants, but could conceivably grow additional plants for family members, friends or neighbors. Cooperative spaces such as warehouses or homes converted for growing operations cause problems as well. And states also must monitor street prices to ensure the price of the legal supply remains competitive despite the taxes they levy. Otherwise, price-conscious consumers will look to black- and gray-market inventory instead. Ensuring that each cultivated plant has a license is time consuming and difficult to monitor without a warrant. Search warrants also can be difficult to obtain due to ambiguity around medical marijuana licenses and recreational laws. Seizures of illegal products are complicated as well, due to conflicting state and federal laws, and questions about what to do with the seized inventory. In addition, canines trained for drug detection may need retraining or replacement because often they have not been taught to discern between marijuana and other illegal substances. Law enforcement must also deal with drugged driving. Obviously, people should not drive while impaired by marijuana and should expect legal ramifications if they are caught doing so. The problem is enforcement. Methods for testing the effects of marijuana produce ambiguous results since THC is fat soluble, which means detectable traces linger in the body even after users are no longer intoxicated. A marijuana “Breathalyzer” test does not yet exist, technology allowing oral fluid testing is still being developed and blood tests are prohibitively expensive. In addition, current drugged driving laws run into legal obstacles when it comes to medical marijuana patients. In July 2015, Denver resident Melanie Brinegar was pulled over for an expired license plate tag, but the officer smelled marijuana and performed field and blood tests. Brinegar had a medical marijuana license and used cannabis daily for chronic pain, which meant the THC level in her blood was high. She was acquitted of drugged driving even though her blood test came back at nearly four times the legal limit. Complicating the problem further is the combined use of alcohol and marijuana. The risk from driving under the influence of both alcohol and cannabis is greater than the risk of driving under the influence of either alone, and data from Colorado shows impaired driving related to marijuana is increasing. Authorities need to clearly define the behaviors that constitute impairment and determine consistent ways of identifying and measuring those behaviors. Law enforcement also must tackle other public safety concerns, such as explosions or fires that result from home growers attempting to make marijuana extracts like hash oil—a dangerous process that requires proper equipment to ensure safety. As one might suspect, this issue also affects medical facilities and first responders. Other safety concerns related to growing operations include toxic mold, THC in the air and on surfaces, and unsafe carbon dioxide and carbon monoxide levels due to fertilizers, pesticides, and disconnected vents— methods used to enhance plant growth. Edible marijuana products are causing medical issues as well, due to accidental ingestion and potency issues. In Colorado, hospitalizations related to marijuana have increased 218 percent from 2000 to 2013. “Marijuana tourism” also contributes to the problem because most tourists are novice users with, in too many cases, little education to guide their use. Trafficking of marijuana is another problem, especially in a state such as Colorado, which shares borders with seven other states. In 2014, law enforcement intercepted Colorado marijuana destined for other states 360 times—a 592 percent increase over the yearly average between 2005 and 2008. And driving across the border is not the only way the drug is being trafficked. From 2010 through 2014, the number of known parcels containing Colorado marijuana being mailed to other states increased 2,033 percent. Inventory tracking for marijuana outlets helps, but it has taken time to set up tracking systems. Colorado authorities did not have an established data collection system when marijuana laws changed—important for measuring crime rates, hospitalizations and so on. Suffice it to say, the nation is just beginning to understand the impact of changing marijuana policy on law enforcement.