The federal government argues that allowing sick people to obtain marijuana for medicinal use will make the drug laws impossible to enforce. Seeking to shut down the Oakland Cannabis Buyers' Cooperative, it warns that "drug traffickers, acting under the guise of 'medical necessity,' will be able to manufacture and distribute marijuana with impunity."
Although the Supreme Court seemed receptive to such claims when it heard oral arguments in the case at the end of March, the government's fears have not been realized in California, where voters approved a proposition sanctioning the medical use of marijuana five years ago. Growers and distributors are still convicted under state law, and the proposition does not seem to have affected overall marijuana use.
Drug warriors are wrong to think that letting patients use marijuana to relieve nausea, restore appetite, alleviate pain, or control spasms will inevitably lead to free availability of the drug for all uses. They are also wrong to imply that such an outcome is the real goal of medical marijuana advocates -- who, according to Clinton drug czar Barry McCaffrey, are perpetrating "a cruel hoax" on sick people to advance the cause of legalization.
Many patients really do get relief from marijuana that they cannot obtain from legal alternatives, either because those drugs don't work for them or because they can't stand the side effects. The U.S. Court of Appeals for the 9th Circuit observed that the government "has offered no evidence to rebut (the Oakland cooperative's) evidence that cannabis is the only effective treatment for a large group of seriously ill individuals."
Still, the drug warriors are right to be worried. Their inflexibility on this issue has made it easy to portray them as heartless fanatics who'd rather let someone's grandmother waste away while undergoing chemotherapy than concede that there might be anything good to be said about marijuana.
The medical marijuana debate has also called attention to the arbitrariness of the government's drug distinctions. When doctors can prescribe cocaine and morphine, it's hard to understand why marijuana is completely off-limits.
A week before the Supreme Court heard the Oakland case, the Drug Enforcement Administration officially rejected a petition to move marijuana out of Schedule I, the most restrictive drug category. The DEA argued that marijuana meets the criteria for Schedule I because it has "no currently accepted medical use" (not surprising, since it's illegal) and "a high potential for abuse" (with abuse defined as illegal use).
Considering the pros and cons of marijuana as a medicine tends to reveal myths as well as circular reasoning. When the National Academy of Sciences prepared a report on the issue at Barry McCaffrey's request, it concluded not only that there was substantial evidence of marijuana's therapeutic utility, but that the drug's dangers had been greatly exaggerated.
When it came to marijuana's potential side effects, the main concern of the report's authors was not "amotivational syndrome" or brain damage or heroin addiction -- commonly alleged hazards for which they found little or no evidence. Rather, they were worried about the respiratory effects of smoking, of particular concern with frail patients who use the drug frequently.
Instead of endorsing cannabis as a medicine, the NAS panelists called for the development of inhalers that could rapidly deliver measured doses of marijuana's active ingredients (THC and possibly one or two other chemicals) without the toxins generated by burning the plant. In the meantime, they said, marijuana should be available to patients with no viable alternatives -- the same sort of people who would be covered by a "medical necessity" defense.
Nine states, including California, allow patients to use marijuana, and their laws will still apply to state and local police and prosecutors (who handle the vast majority of marijuana cases) even if the Supreme Court rules against the Oakland club. But the prospect of a THC inhaler suggests that the viability of the medical marijuana issue will be limited.
Once there's a legal alternative that's safer than smoked marijuana and works just as well, reformers with a broader agenda will have to proceed without the sympathetic attention generated by cancer and AIDS patients. They will have to defend marijuana as an intoxicant rather than a medicine, thereby alienating anyone who thinks pot smoking is acceptable only in special circumstances. At that point the drug warriors will breathe a sigh of relief, and the reformers may regret all that talk about medical necessity.