Definition and Background
Introduction
In recent years, the debate of legalizing medical marijuana has become a hot topic. Some individuals don’t believe that there is sufficient scientific knowledge to support its medicinal uses while others believe that there is. Many discussions on the legalization of marijuana focus on legalizing it for recreational use, however, this entry will focus solely on the controversy surrounding it medicinally. This entry will focus on the origins of medical marijuana and explore the controversy surrounding its legalization by presenting perspectives from both supporters and opponents.
Definition and Background
According to state law, the term “Medical use of Marijuana” is defined as “the production, possession, or administration of marijuana for the exclusive benefit of a qualifying patient in the treatment of his or her terminal or debilitating illness” (RCW 69.50.101: Definitions). In this definition, the word “administration” means “to apply a controlled substance, whether by injection, inhalation, ingestion, or any other means, directly to the body of a patient by (1) a practitioner authorized to prescribe or (2) the patient or research subject at the direction and in the presence of the practitioner” (RCW 69.50.101: Definitions ). The term “medical marijuana” refers to using marijuana for medicinal rather than recreational purposes; it is not a new form of marijuana. In context, marijuana can refer to either the “cannabis plant or more specifically the plant’s dried leaves and flowers” (“Medical Marijuana.”). There are more than four hundred chemicals contained in marijuana, in which almost a third have been identified as cannabinoids (“Medical Marijuana.”). The most active of these cannabinoids is delta-9-tetrahydrocannabinol or more commonly known as THC. Medical research has shown to support the use of marijuana, more specifically the cannabinoids (THC) in marijuana, to treat an array of symptoms (“Medical Marijuana.”). Marijuana can be prescribed to treat symptoms of “AIDS, glaucoma, cancer, multiple sclerosis (MS), epilepsy, and chronic pain” (“Medical Marijuana.”). Because cannabinoids are lipophilic (tending to combine with or dissolve in lipids or fats), they can be administered via several methods and mechanisms including water pipes, pills, brewed “tea”, additives to foods, inhaled through a vaporizer, absorbed through the mucous membrane in the mouth, or drops in the eye or nose (“Medical Marijuana”).
Historical Context
To gain a comprehensive understanding of the present-day controversy of the legalization of medical marijuana, its origins must be traced and understood. This section will provide insight into the origins of marijuana and how it has become a controversial topic in recent years.
The use of marijuana medicinally can be traced back to as early as the third millennium B.C where Chinese Emperor Shen Nung is credited with the first scientific investigations of cannabis (Mantel, Barbara). During this time, the emperor advocated the use of marijuana in the form of tea to treat conditions from gout to malaria (Mantel 2017) Around this same time period, word of the medicinal uses of marijuana spread from Central Asia to the Indian subcontinent and across the Middle East into Europe (Warf, Barney). In Martin A. Lee’s book, Smoke Signals, he notes that “there is a general consensus among scholars that cannabis… was introduced to the western hemisphere in the sixteenth century through the slave trade. Black captives brought cannabis seeds with them aboard slave ships.” (Lee 15). Cannabis was incorporated into folk medicine as a treatment for several ailments (Mantel, Barbara).
Irish surgeon William O’Shaughnessy is credited by historians with the widespread introduction of marijuana into the Western medicine (Mantel, Barbara). While a professor at the Medical College of Calcutta in the 1830s, O’shaughnessy noted the effects of marijuana after administering it orally to patients and documenting that it reduced the pain of rheumatism, stilled seizures and eased the muscle spasms of tetanus and rabies. After returning to England in 1842, O’shaughnessy relayed the results to pharmacists and doctors in both Europe and the U.S who began prescribing tinctures and extracts for numerous conditions (Mantel, Barbara).
Not long after, chemist had created synthetic painkillers and sedatives, such as aspirin, which marijuana had trouble competing with (Mantel, Barbara). Additionally, opium-based medicines along with nasal spray and cough medicines were more widely available (Mantel, Barbara). In Barbara Mantel’s article “Does cannabis offer health benefits” she writes, “By 1900, according to historians, an estimated 3 percent of the U.S. population was addicted to medicinal opiates, raising public alarm (Mantel, Barbara). In response to this alarming statistic, the Harrison Narcotic Act of 1914 was created which “required doctors and pharmacists to record narcotic drug transactions and to pay a stamp tax on them” (Mantel, Barbara). However, marijuana was excluded from this act.
The use of marijuana became associated with a negative connotation. In the book Dying to Get High authors Wendy Chapkis and Richard Webb write “… the term marijuana was used to more effectively associate the recreational use of cannabis with the one million Mexican immigrants who had entered the southwest in the first three decades of the twentieth century” (Chapkis and Webb 24). The year 1919 marked a transition towards the illegalization of marijuana as Texas was the first state to change its legal stance regarding the drug, even referring to it as ‘loco weed’ (Serbay, Sheila). In the same way that cocaine had become a feared drug by linking it to African Americans, this was evidently another governmental response to associate a drug with a minority group (Chapkis and Webb 24).
In 1930 in an effort to illegalize marijuana, Harry Anslinger, head of the Federal Bureau of Narcotics, proposed the inclusion of recreational and medical marijuana in the Harrison Act (Mantel, Barbara 2017). Although this inclusion into the Harrison act failed, Anslinger persisted. Chapkis and Webb write that “[Anslinger’s] efforts to bring marijuana under governmental control drew on Prohibition-era morality, established public fears of opiate addicts, and racist propaganda focused primarily on Mexicans and urban Blacks” (Chapkis and Webb 24). To take it a step further, “the FBN fabricated lurid and sensational stories of assault, rape, murder, and mayhem allegedly perpetrated by marijuana smokers” (Chapkis and Webb 24). Anslinger used the exaggerated accounts to push for the passage of a new law, the Marijuana Tax of 1937. This tax was an effort to prevent the prescription of marijuana noting that P the medicinal use of marijuana had already declined” (Chapkis and Webb 24). The act passed becoming the first federal legislation regulating cannabis on a national level. This act taxed marijuana at one dollar an ounce for specified medical or industrial use and one hundred dollars an ounce for unspecified uses (Chapkis and Webb 25). Despite the passing of the Marijuana Tax Act, research on proving the therapeutic uses of cannabis continued. Individual physicians and medical researchers continued to show interest in its effects (Chapkis and Webb 25).
During the 1960s and 70s, the use of marijuana for recreational purposes surged. In response, the Controlled Comprehensive Drug Abuse Prevention and Abuse Act was passed. This law took precedence over all prior federal drug statutes and divided most drugs into different schedules based on their safety, medicinal value, and risks of abuse (Chapkis and Webb 29). Under this act, marijuana was classified as a Schedule 1 controlled substance meaning “it has no currently accepted medical se, a high potential for abuse, and is unsafe even if used under a doctor’s supervision” (Chapkis and Webb 29). In May of 1972 the National Organization for the Reform of Marijuana Laws (NORML) filed a petition to reschedule marijuana to “make the drug available for medical applications” (Chapkis and Webb 30). The petitions were denied by Drug Enforcement Agency (DEA) and marijuana remained (and remains) a Schedule 1 drug.
The DEA’s decision to not reclassify marijuana led to the increase in applications for the Federal Drug Administration’s (FDA) Compassionate Investigational New Drug Program, which was the only legal source of medical marijuana in the United States (Chapkis and Webb 32). This program allowed legal access to physician recommended medication. In response to the surge in applications, the government suspended the program entirely. Chapkis and Webb write, “[This] decision… may have been facilitated by the fact most of the new applications were from those living with AIDS… the majority of people with AIDS were gay men and intravenous (IV) drug users- so-called guilty victims” (Chapkis and Webb 32). Chapkis and Webb go on to say, “…access to a drug like cannabis associated with pleasure may have been seen as a “reward” that discreditable individuals did not deserve” (Chapkis and Webb 32).
This restriction to medicinal marijuana only propelled public interest and “political activism” (Chapkis and Webb 32). In 1996, California became the first state to legalize medical marijuana, however, the federal government threatened to revoke the licenses of any physician who recommended cannabis (Chapkis and Webb 32). California physicians responded by suing “Drug Czar” Barry McCaffrey and other drug officials for violation of their First Amendment Right to free speech. A temporary and then permanent injunction was issued against federal interference in physician-patient conversation about marijuana (Chapkis and Webb 33). Even so, the majority of physicians were still hesitant to recommend marijuana. In the next years, Alaska, Oregon, and Washington followed in California’s footsteps in voting to legalize marijuana (Mantel, Barbara). However, these states only allowed recommendations for a small number of medical conditions.
In 1999, after reviewing scientific evidence, the National Institute of Medicine issues a report stating, “For patients who suffer simultaneously from severe pain, nausea, and appetite loss, such as those with AIDS or who are undergoing chemotherapy, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication.” It also dismissed the notion that marijuana was a gateway drug to harsher drugs, but also noting that “smoked marijuana delivers most of the same harmful substances found in tobacco smoke and that variability of the mix of compounds in each plant makes it difficult to predict marijuana’s precise effect” (Joy, Benson and Watson).
In the 2000s attitudes towards medical marijuana have changed. Most notably in 2010, the Obama administration instructs U.S. attorneys to no longer prosecute seriously ill patients who use cannabis if they are in compliance with state laws. In 2016 the DEA started accepting applications for more government- registered growers in order to increase the amount of cannabis available for research. Recently, in 2017, the National Academies of Sciences, Engineering, and Medicine concluded that cannabinoids can aid in treating chronic pain, muscle spasms in MS, and chemotherapy-induced nausea and vomiting.
It is important to note that even though marijuana is considered illegal by federal law, individual states have laws legalizing it. Federal laws are generally applied only to individuals who possess, cultivate, or distribute large quantities of cannabis (“Federal Marijuana Law”).
Description: Map showing states where medical marijuana is legal. Source: Mantel, B. CQ researcher
Controversy and Perspectives
The debate of whether or not medical marijuana should be legalized has existed for decades. Both supporters and opponents of the issue hold strong reasonings for their stances.
Opponents of legalizing medical marijuana believe that marijuana does not hold any credible effects of treating said illnesses nor has it been researched enough. They also believe that marijuana is actually more dangerous than beneficial. The article “Marijuana is Dangerous for its Users and Others” states that according to the Office of National Drug Control Policy, “the use of marijuana can lead to dependence” (U.S. Drug Enforcement Administration). It goes on to state that those who use marijuana heavily develop withdrawal symptoms when they have not used the drug for a period of time (U.S. Drug Enforcement Administration). This type of behavior is noted to meet the criteria for substance dependence established by the American Psychiatric Association (U.S. Drug Enforcement Administration). Opponents also hold skepticism that legalizing medical marijuana will send a message that cannabis is acceptable leading to increased recreational use (Mantel, Barbara ). Critics point out the risks associated with the use of marijuana. In Kathy Koch’s article “Should doctors be able to prescribe the drug?” she quotes Rep. John L. Mica, chairman of the Government Reform Criminal Justice Subcommittee, who states that ““scientific studies show “absolutely incontestable” evidence that the “THC in marijuana damages the brain, the lungs, the heart, reproductive and immune systems” and that “marijuana is linked to increases in aggressive and violent behavior”” (Koch, Kathy). Many opponents also focus on the dangers associated with smoking marijuana noting that “marijuana is carcinogenic, harms the body’s respiratory, immune and reproductive systems, affects short-term memory and ability to learn and is a “gateway” to harder narcotic use” (Koch, Kathy). Another viewpoint opponents present is that there are medications that are already available that are more effective (Koch, Kathy).
Proponents of legalizing medical marijuana note its effectiveness in several ailments. Kotch writes that proponents say marijuana “is an effective, safe and inexpensive alternative for treating nausea caused by AIDS medications and cancer treatments, intractable pain, muscle spasms, glaucoma, epilepsy, anorexia, asthma, insomnia, depression and other disorders” (Koch, Kathy “Medical Marijuana”). Proponents also point out that the government has “demonized all drug use” which has “systematically and hysterically resisted science” (Koch, Kathy ). Barbara Mantel cites Morgan Fox, communications manager at the Marijuana Policy Project, stating “whole-plant marijuana, whether as dried flowers, edibles, oils and other forms, should be available to the public through dispensaries with a doctor’s recommendation because they are less expensive than prescriptions, and many patients find they work better” (Mantel, Barbara). Proponents advocate the use of medical marijuana under a doctor’s recommendation or evaluation, not simply a ‘free for all’ or self-prescribed medical marijuana. Another argument by proponents is that it is safer than some pain relieving drugs used today. Again, Barbara Mantel quotes Fox who states, “More people die from Tylenol every year than have ever died from marijuana,” (Mantel, Barbara).
An interesting fact to point out in this controversy is that although medical marijuana is currently federally illegal, the main active ingredient, THC, is legally prescribed in medication such as dronabinol and nabilone which treat anorexia in AIDS patients and nausea and vomiting in people undergoing chemotherapy (Rudski, Jeffrey M). These are the exact symptoms which proponents of legalizing medical marijuana advocate marijuana treats.
Aside from the medical controversy associated with medical marijuana, there is a social controversy as well. In an article by Jeffrey Rudski, he writes, “Legalization does not necessarily translate into universal acceptance or adoption” (Rudski, Jeffrey M). He reports that even though Canada legalized marijuana in 2001, users experienced stigmas within their social circles as well as with healthcare providers and even law enforcement (Rudski 2017). He also states that California undergraduates reported that a job applicant who used medical marijuana was stereotyped as being less qualified than a Vicodin-using applicant, despite the fact that medical marijuana has been legal in California for almost two decades (Rudski 2017). The debate to legalize is not limited to health reasons but presents an argument for social liberation as well.
Description: Chart showing support for medical use of marijuana; Source: Mantel, B. CQ researcher
Relation to Politics of Health
Michel Foucault is credited with coining the term “biopower” which is an extension of “disciplinary power”. It can be best understood as “Biopolitics is a technology of power that grew up on the basis of disciplinary power. Where discipline is about the control of individual bodies, biopolitics is about the control of entire populations” (Kelly, Mark). In relation to health, “biopower” refers to the state monitoring and controlling the health of populations (Kelly, Mark). The government’s position on both federally outlawing medical marijuana and classifying it as a schedule 1 drug displays the government’s use of biopower. The health of populations who are dependent upon medical marijuana is now in the hands of the government; ultimately, they control who to “live and let die” (Baele, Stephane J.). The idea of “deservingness” introduced by Beatrix Hoffman is seen in the controversy of legalizing medical marijuana (Hoffman 246). The state’s decision to suspend the Compassionate Investigational New Drug Program, not only exerted their biopower, but also displayed their stance of who was to be deserving of such benefits and who should be excluded. As Chapkis and Webb stated that many of the applicant to the program were “gay men and intravenous (IV) drug users”, access to medical marijuana was seen as a “reward” for “discreditable individuals”. As the AIDS epidemic was rampant during this time period, and gay men were at the forefront of the epidemic, the government largely disregarded these individuals, excluding them from needed healthcare. Once again, the extent to which the government plays a part in individual health or health of populations can be observed. The use of medical marijuana puts health in an “ideological position” as termed by Jonathan Metzl (Metzl 2). This “‘ideological position” of health means using health as a moral compass which we use to judge others. As an example, Metzl describes how when we see a person smoking we think smoking is bad for your health therefore they are a bad person (Metzl 2010). In the same sense, we also tend to think of ourselves as healthy because we do not smoke. (Metzl 2010). In the same way, the use of medical marijuana has become an ideological position of health. Society not only passes judgment on these individuals, but also excluding them from certain sectors. As stated earlier, this negative view of marijuana originated with Mexican immigrants who used marijuana for recreational purposes. These views have transcended into today’s society. Lastly, a key component in the state recognizing marijuana as an effective pharmaceutical is the burden of scientific knowledge. Scientific knowledge refers to the accepted research needed to prove the effectiveness of marijuana in treating specific ailments. The controversy in doing so is that the government refuses to sponsor such research on the drug, debilitating the process needed to prove its effectiveness. The research medical marijuana that has been conducted has yielded contradicting evidence which supports proponents and opponents of its legalization. Adriana Petryna wirtes, “… scientific knowledge…[has] become [a] cultural resource through which citizens stake their claims for social equity…” (Petryna 4). In order to advocate for the legalization of medical marijuana, citizens must produce scientific knowledge which proves its legitimate medical value. Petryna goes on to say, “How scientific knowledge is valued and the level at which it is said to hold significance can affect the planning of state interventions…” (Petryna 4). Even if scientific knowledge is produced, individual states and the federal government ultimately decide if this information is significant or credible. Even so, governments can choose to accept or deny the evidence at hand which corresponds to their decision to legalize or illegalize medical marijuana. Medical marijuana is a great example of how governments can affect the health of individuals.
Works Cited
“Medical Marijuana.” Opposing Viewpoints Online Collection, Gale, 2017. link.galegroup.com/apps/doc/PC3010999128/OVIC?u=nash87800&xid=3a1082d7. Accessed 20 Nov. 2017.
“Federal Marijuana Law.” Americans for Safe Access, www.safeaccessnow.org/federal_marijuana_law.
Aggarwal, Sunil K., et al. “Dosing Medical Marijuana: Rational Guidelines on Trial in Washington State.” Medscape General Medicine, Medscape, 11 Sept. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2100129/.
Baele, Stephane J. “Foucault’s Prediction of ‘Live and Let Die’.” Refugees, Refugees, 26 Apr. 2016, www.newsdeeply.com/refugees/community/2016/04/26/foucaults-prediction-of-live-and-let-die-2.
Bostwick, J Michael. “Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana.” Mayo Clinic Proceedings, Elsevier, 1 Feb. 2012, www.sciencedirect.com/science/article/pii/S0025619611000218.
Chapkis, W., and Richard J. Webb. Dying to Get High: Marijuana as Medicine. New York University Press, 2008.
Grotenhermen, F. (2003). Pharmacokinetics and pharmacodynamics of cannabinoids. Clinical Pharmacokinetics, 42, 327-360.
Hoffman, Beatrix. “Sympathy and Exclusion Access to Health Care for Undocumented Immigrants in the United States.” A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship, The Univ. of North Carolina Press, 2006, pp. 237–254.
Janet E. Joy, John A. Benson Jr. and Stanley J. Watson Jr., eds., “Marijuana and Medicine: Assessing the Science Base,” Institute of Medicine, 1999, pp. viii–ix
Kelly, Mark. “Michel Foucault: Political Thought.” Internet Encyclopedia of Philosophy, www.iep.utm.edu/fouc-pol/#H7.
Koch, Kathy. “Medical Marijuana.” CQ Researcher, 20 Aug. 1999, pp. 705-28, library.cqpress.com/cqresearcher/cqresrre1999082000.
Lee, Martin A. Smoke Signals: a Social History of Marijuana– Medical, Recreational and Scientific. Scribner, 2013.
Mantel, B. (2017, July 21). Medical marijuana. CQ researcher, 27, 605-628. Retrieved from http://library.cqpress.com/
Mantel, Barbara. “Medical Marijuana.” CQ Researcher, 21 July 2017, pp. 605-28, library.cqpress.com/cqresearcher/cqresrre2017072100.
Metzl, Jonathan, and Anna Rutherford. Kirkland. “Why Against Health?” Against Health How Health Became the New Morality, New York University Press, 2010, pp. 1–11.
Petryna, Adriana. “Life After Chernobyl.” Life Exposed: Biological Citizens after Chernobyl, Princeton University Press, 2013, pp. 1–33.
RCW 69.50.101: Definitions., app.leg.wa.gov/RCW/default.aspx?cite=69.50.101.
Rudski, Jeffrey M. “Treatment Acceptability, Stigma, and Legal Concerns of Medical Marijuana are Affected by Method of Administration.” Journal of Drug Issues 44.3 (2014): 308-20. ProQuest. Web. 19 Nov. 2017.
Serbay, Sheila, Russell, Jason, and Hammond, Clare. Medical Marijuana Final Project: Review of History, Alternative Positions, and Government Position (2012): ProQuest Dissertations and Theses. Print.
U.S. Drug Enforcement Administration. “Marijuana Is Dangerous for Its Users and Others.” Medical Marijuana, edited by Noël Merino, Greenhaven Press, 2011. Current Controversies. Opposing Viewpoints in Context, link.galegroup.com/apps/doc/EJ3010753210/OVIC?u=nash87800&xid=d60fc3f1. Accessed 19 Nov. 2017. Originally published as “The DEA Position on Marijuana,” 2006.
Warf, Barney. “High Points: The Historical Geography of Cannabis.” Geographical Review, www.academia.edu/10622742/HIgh_Points_The_Historical_Geography_of_Cannabis.
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