Overview
Cannabis sativa, a name that has become more and more prominent in the news in the last two decades. Although not a new drug, the topic of medical marijuana is a newer one. Within the last twenty-one years, medical marijuana use has come to light as a treatment option available for those who are suffering from chronic or debilitating medical conditions. There are currently more states that have legalized marijuana than states that have not. Starting in 1996, California was the first state to legalize medical marijuana for those suffering from debilitating medical conditions. Medical marijuana is legal in twenty-nine states and the District of Columbia. After that, slowly but surely, more states have jumped on the bandwagon and have transitioned towards legalization. Conversation within the political realm surrounding the topic has sparked a movement that many are in favor for. With it being such a selling point in today’s political campaigns, the legalization of both medical and recreational marijuana is becoming ever so prevalent. As expected, there will always be backlash and controversy concerning topics of great discussion. Each state is different concerning how they decide to go about taxes and regulations. Concerning healthcare, marijuana have significant health benefits for people who are suffering from various medical conditions. Not only does medical marijuana have significant health benefits for those suffering, it positively supports the local and state economy.
Social, Cultural & Organizational Factors
In today’s social culture, marijuana use and reference has become mainstream. There is a huge population that is in favor of the legalization of both medical and recreational marijuana and it is often times piggybacked as a political campaign point for politicians running for office. Although there are always two sides to the issue, there is a strong foundation and network of support for those states that have legalized medical marijuana. In Colorado and California especially there are group that advocate for the continuation of medical marijuana use (Klofas, & Letteney, 2012). The Colorado Alternative Medicines (CAM) group is a well-known group that advocates for the research for medical marijuana use as a medicinal option. In California, there is the Oakland Cannabis Buyers Cooperative (OCBC) which also acts as an advocate for the use of medicinal marijuana. Through these groups, as well as others, the presence of support for medicinal marijuana has become more prevalent. If there were to be more groups that advocate for the use of medical marijuana, it would only be harder for the state and federal government to fight back. In today’s main stream cultural marijuana use is advertised in many ways. Whether it be in a TV show like Weeds, in music, or when marijuana is advertised everywhere. Being that it is normalized in the American culture, the topic of marijuana is not something shocking. Even the world’s greatest swimmer, Michael Phelps has been in the spotlight for smoking marijuana. Weeds, a Showtime Original Series, is based around a mother who starts selling marijuana to support her family after the passing of her husband and the financial turmoil they were left in (Weeds – Official Series Site). These are just examples of how mainstream marijuana has become, which only influences the advocacy of medicinal marijuana.
Major influences
At the state level, there is such an influence on medical marijuana as a therapeutic alternative to medication. Governmental advocacy and support for medical marijuana is a sound influence on the legalization of medical marijuana. The government, depending on the topic of discussion, can be a strong advocate in support of against something. As the state governments continues to support medical marijuana, there is an increase in the support from American citizens. Although there will never be unanimous support, medicinal marijuana is becoming more popular. As stated before, there are twenty-nine states, as well as the District of Columbia that are in favor of medical, as well as recreational marijuana. The states that currently legalize medical marijuana are: Arizona, Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington State and the District of Columbia. These states have broadly legalized medical marijuana There are only 9 states that have legalized recreational marijuana, which are: Oregon, California, Washington, Maine, Mass, Nevada, Colorado, DC, Alaska. California, being the first state to legalize medical marijuana, was the pioneer of this movement.
In 1996, California passes the Compassionate Use Act which allows patients to possess and use medical marijuana if recommended by their physician (Reinarman, Nunberg, Lanthier, & Heddleston, 2011). The Compassionate Care Act has been enacted in various states which again, ultimately allows patients suffering from certain chronic or debilitating illness to possess and use medical marijuana without prosecution (PROCON). In New Jersey, “patients who use marijuana to alleviate suffering from debilitating medical conditions, as well as their physicians, primary caregivers, and those who are authorized to produce marijuana for medical purposes” are protected from arrest, prosecution, property forfeiture, criminal and other penalties. In 2012, the New Jersey Medical Marijuana
As of October 2009, the Obama Administration encouraged federal prosecutors to avoid prosecuting people who distribute medical marijuana, as long as they follow the state laws in place for each individual state (NCSL). Four years later, in 2013, the United States Department of Justice announced to Colorado and Washington that it will “defer the right to challenge their legalization laws…”, as long as they create solid, state enforced laws surrounding marijuana distribution and possession. Many states that have legalized medical marijuana have developed some form of patient registry, which, in turn, can provide protection against arrest for possession. Many states allow an individual to possess a certain amount of marijuana. For example, in New Jersey an individual is allowed to possess 2 ounces of usable marijuana (PROCON). In Oregon, it is much higher, at 24 ounces and 24 plants, 6 mature and 18 immature plants. According to Coos County, Oregon, an immature marijuana plant is a Cannabis plant that has no flowers and is a seedling (COOS). A mature plant is defined as any plant that is not an immature plant.
Political Ramifications
One of the arguments against medical marijuana is that there is a lack of regulation. Regulation concerning potency, standardization, or dosing are all arguments against medical marijuana legalization. In support of medical marijuana, there are advisory boards in place in order regulate growing, production, and distribution. This advisory board consists of fifteen members will serve by appointment of the governor. It is made up of experts from “marijuana testing, treatment centers, a registered medical marijuana patient, a representative from marijuana retail consumers, two experts in public health, two experts in law enforcement, two experts in social welfare for social justice and two attorneys with experience in providing legal services to marijuana businesses, consumers or patients” (Greiman, 2017). Boards such as these oversee the political cloud surrounding medical marijuana. The idea and introduction of medical marijuana as a treatment option has led to an influx of new legislation and requires people to step up into positions to advocate for it on behalf of those who need it as a primary treatment option.
Due to the varying arguments surrounding medical marijuana, there are federal restrictions on research concerning the pharmaceutical uses. The Food and Drug Administration (FDA) has marijuana classified as a Schedule 1 drug, meaning it has no current accepted medical use (Bostwick, 2012). Other drugs in this category are street drugs and drugs with a high abuse potential such as heroin, MDMA, and LSD. Due to this classification, scientific research concerning the medical use of marijuana ultimately ceased. In order to research the effects of marijuana as a medicinal option, marijuana can only be obtained from the University of Mississippi. Although accessible through the university, conducting research is a struggle. The National Institute of Drug Abuse (NIDA) lacks the desire to conduct medical research around marijuana as they are known to only focus on the detrimental effects. Saying that research has been initiated, there are three government agencies that oversee the research process. The FDA focuses on the safety and efficacy aspect of research. The NIDA supplies the material, such as the marijuana. Lastly, the Drug Enforcement Agency (DEA) permits the researcher to conduct their research with the granting of a license. Though these three agencies work together to oversee research concerning marijuana, each has the power to end the process at any point in time.
Medical marijuana has created such a divide between the federal government and the state-level government. Having twenty-nine states fighting against the federal government in support of medical marijuana, there is great pressure placed upon the federal government to consider it as a legitimate treatment option (Bostwick, 2012). As stated before, at the state-level, those who require medical marijuana as a part of their medication regimen have limits concerning the amount of marijuana they can possess at a single time, including plants. Concerning who is approved for medical marijuana use, physicians are only permitted to prescribed it to those with serious medical illnesses, as well as any illness where marijuana can provide relief. Begin prescribed medical marijuana, the patient or designated caregiver is required to present a registration card. This card is good for at most a year, and requires recertification if need be. Although it may seem easy to add medical marijuana to one’s medication regimen, it isn’t as easy as one thinks. There are many regulations and guidelines physicians, individuals, caregivers, and producers need to follow in order to stay within good standing. With that being said, for those who do need medical marijuana, there is a variety of debilitating illnesses that can be treated with it.
Benefit or Lose?
Marijuana, as stated before, is currently classified as a Schedule I drug. As this, marijuana has “no currently accepted medical use” and a “high abuse potential” (Bostwick, 2012). Physicians and people in the community much so agree that there is promise surrounding its ability to combat debilitating medical. Through research, there has been promise surrounding potential pharmacologic uses. Dating back to 1854, the United States deemed marijuana legitimate by listing it in the US Dispensatory, as it was commonly contained in medicines, for “insomnia and headaches, to anorexia and sexual dysfunction…”. During this time, cannabis-containing products were compounded into extracts, tinctures, cigarettes, and plasters. Fast forwarding to 1999, a study found benefits such as increased appetite in AIDS patients in which they were suffering from wasting syndrome. It also was found to combat nausea and vomiting from chemotherapy and severe pain.
The most commonly known compound in cannabis is -9-tetrahydrocannabinoil, also known as THC (Ashton, 1999). THC is the psychoactive ingredient in cannabis which can be in concentrations as low as 0.2% to as high as 30%. In most cases, growers will cross different strains to produce more median strength strains of cannabis, with concentrations between 4% and 8%. Medical marijuana can refer to two of three forms. The two most common are phytocannabinoids and synthetic cannabinoids. Phytocannabinoids consist of the various compounds found in the C sativa plant, THC and cannabidoil being the most effective. Synthetic cannabinoids are the laboratory-produced compounds of THC and cannabidoil that are developed and used in pharmaceutical cannabinoid-related products. 8-THC, a cannabinoid, easier and cheaper than 9-THC, was found to be “completely effective” in managing emesis due to chemotherapy treatments. In acute postoperative patients, cannabinoids produced similar analgesic effects on the body as 60mg of Codeine (Campbell, Tramèr, Carroll, Reynolds, Moore & McQuay). More effective, is the therapeutic effects surrounding neuropathic pain and spasticity. Spasticity is the hyperactivity of muscles where the muscle will not relax. This can result in pain, fatigue, and can interfere with basic bodily functions (Spasticity Management, 2014).
Those who are suffering from cancer are going to benefit from medical marijuana the most. The effect that marijuana has on nausea and vomiting are the strongest support that advocates for medical marijuana have. Chemotherapy-induced nausea and vomiting (CINV) is a very prominent problem surrounding those who are going through chemotherapy (Cotter, 2009). Chemotherapy is a chemical drug treatment that kills fast growing cells in the body, like cancer cells (Chemotherapy, 2017). In the body, chemoreceptors activate neurotransmitters in the brain which trigger the emetic responses in the body, leading to nausea and vomiting. It has been found that marijuana and THC is effective in controlling nausea and vomiting in patients going through chemotherapy (Cotter, 2009). Compared to a placebo, the evidence supports that marijuana has antiemetic effects. When compared to ondansetron and prochlorperazine, both antiemetics, marijuana had comparable effects on nausea and vomiting. Quality of life is important, especially when going through chemotherapy. Chemotherapy, overall, destroys the human body. The side effects of chemotherapy can be worse than the cancer itself. Having one more option in the pharmaceutical arsenal to use can positively influence one’s quality of life which is important in cancer management.
Patients with Multiple Sclerosis (MS), a condition where the immune system attacks the myelin sheath that encases nerve fibers, causing a disconnect in the synapse of nerve impulses (Multiple Sclerosis, 2017). Spasticity is where there is muscle over activity due to the lack of communication between the brain and spinal cord as well as distal nerves. Inhaled marijuana was effective in reducing spasticity (Corey-Bloom, Wolfson, Gamst, Jin, Marcotte, Bentley & Gouaux). It is thought that marijuana relieves spasticity by creating euphoria or pain relief that potentially decreases the perception of muscle spasticity.
In a non-healthcare perspective, the medical marijuana business has boomed. In 2015, the legal marijuana business created 18,000 new full-time jobs in Colorado (Ingraham, 2016). By 2020, it is expected that there will be over a quarter million jobs created. (Borchardt, 2017). Meaning, not only do those who need medical marijuana benefit from legalization, both the community, local and state economies benefit as well. Also, in 2015, the legal marijuana business generated $2.4 billion to contribute to Colorado’s economy. Adam Orens, founder of the Marijuana Policy Group, explained “if this is done right, taxed right, this industry can bring real economic benefits to the state” (Ingraham, 2016). It is estimated that most of this business does not come from new sources, but it come from the previously unregulated black market, shifting to legal suppliers. Orens suspected that 90 percent one the market will come from regulated, licensed dealers while the other 10 percent will come from home growers and the remaining small black market dealers that haven’t gotten into the legal market. A survey completed by the Marijuana Business Daily concluded that the marijuana business already employs up to 150,000 workers and 90.000 are in the literal “plant-touching” companies. One of the arguments that deters potential employees is the idea of the Drug Enforcement Agency (DEA) will prosecute them under federal law. Fortunately for these workers, the U.S. appeals court concluded that the federal government cannot prosecute those who grow and distribute medical marijuana if they comply with state laws.
Medical marijuana benefits both those who need it for maintenance of their chronic illness, while also creating jobs and funding the local and state economies. Those who suffer from chronic illness and require medical marijuana as a part of their pharmaceutical regimen, benefit from medical marijuana being legal. Those who work for the medical marijuana business benefit from legalization of medical marijuana. Not only do individuals benefit from medical marijuana to sustain work; those who run dispensaries, as well as operate the whole business are benefitting from legalization because they no longer are part of the black market. Given these professionals abide to the state laws surrounding medical marijuana growing and distributing, there is only benefit. Had there been an overturn of this law, thousands of people would lose a treatment regimen, thousands of people would lose their jobs, and the local and state economy would take a hit and the marijuana industry would transition back into a black market.
Economic Impact
Marijuana has a high economic value to the states that support its legalization. Overall, legal marijuana sales surpassed those of Dasani water, Oreos and Pringles in a year span (Greiman, 2017). In 2015, total sales for legal marijuana totaled $3.4 billion. To put it into perspective, Dasani water accrued $1.02 billion in annual sales. Each individual state is able to regulate how much in taxes they are willing to tax those producing and consuming marijuana. In some states, like Oregon, medical marijuana is not taxed. In other states like Colorado, there is a 15% tax for excision, 10% sales tax plus the 2.9% state sales tax (Greiman, 2017). The economic benefit does not stop at the yearly accruement towards the local government, it also pours money in education and other programs. $12 million is poured into education, drug prevention programs, and youth programs. These programs are based around the impact that marijuana has on the individual, community and federal level. Although the arguments surrounding medical marijuana typically advocate for the individual and how it benefits them, but there is more to the conversation. The medical marijuana business has created job opportunities. With over 1,000 medical marijuana dispensaries opening, there is a need for employees (Reinarman, Nunberg, Lanthier, & Heddleston, 2011). This creates thousands of jobs and pours money into the economy, in just California alone. There are also delivery services and other businesses that piggyback off on the dispensaries which also creates jobs and puts money into the local economy.
Other Viable Options
Being that medicinal marijuana is an alternative therapy to drugs like opioids and benzodiazepines, there are viable alternatives to medical marijuana. The opioid epidemic in the United States has skyrocketed. Drug overdose is the leading cause of accidental deaths in the United States, surmounting to 52,404 deaths in 2015 (Lucas, 2017). The advocacy for medical marijuana as an alternative therapy is important due to the addictive qualities of opioids and benzodiazepines. Opioids, also known as narcotics, are available as prescription medications (Treating pain: When is an opioid the right choice? 2017). They are often prescribed for the management of acute and chronic pain. There is a risk for dependence and can increase one’s risk for eventual heroin use. Benzodiazepines are used to treat acute anxiety, providing short-term relief (Lorazepam (Oral Route) Description and Brand Names, 2017). They are central nervous system depressants and also put people at risk for dependence. Due to the tolerance build up when taking these medications long term, there is an increased risk of addiction as well as tolerance, which leads to the need for more of the medications at a time (Lucas, 2017). One of the arguments against opioid use is that as tolerance builds, the need for more pills is increased. Pills are expensive, this can ultimately lead to the switching over to heroin as a cheaper alternative. It was reported that four out of five heroin users started with prescription opioids. In the case of marijuana, it has been shown that marijuana presents as a safe and effective way to control pain in lieu of opioids. Although marijuana is one way to begin to combat the heroin and opioid epidemic, it is just the starting point. Arguing that medical marijuana be a viable alternative to opioids and benzodiazepines is a starting point in the battle to legalize medical marijuana in all fifty states.