By Elaine A. Lisko, Health Law & Policy Institute

On November 3, voters in five states and the District of Columbia will be asked to consider ballot initiatives allowing patients to use marijuana for medicinal purposes. The five states are Alaska, Colorado, Nevada, Oregon, and Washington. If voters in these states approve the initiatives, they will follow the lead of California and Arizona voters who approved such initiatives in 1996.

Key provisions of the current initiatives include: (1) limiting access to patients with registry identification cards, the issuance of which depends upon written documentation from the patient’s physician that the patient has been diagnosed with a debilitating medical condition and that the physician has concluded that the patient may benefit from the medical use of marijuana; (2) limiting the amount of marijuana that the patient may possess at any one time—ranging from one to two ounces; (3) excepting from protection any non-medical use of marijuana; (4) restricting how and where the patient may use marijuana for medical purposes—for example, proscribing use in a way that endangers others or in a place open to the general public; (5) relieving insurers from being liable for any reimbursement claims; and (6) allowing minors access to medical marijuana only when parental consent is first obtained. Among the medical conditions that are considered debilitating are cancer, glaucoma, positive status for HIV or AIDS, and medical conditions or treatment that produce cachexia, severe pain, severe nausea, seizures, or persistent muscle spasms.

Proponents of the medicinal use of marijuana argue:

• Marijuana is effective in mitigating or treating symptoms associated with cancer, AIDS, glaucoma, multiple sclerosis, epilepsy, and chronic pain;
• Marijuana is not addictive and is therapeutically safe;
• If medicinal marijuana is not legalized, patients who use it to relieve their conditions risk being exposed to contaminated or chemically adulterated marijuana and to criminal prosecution and property forfeiture;
• A majority of the states already have therapeutic research programs in place, indicating public support for ending the prohibition on medicinal marijuana.

• Other approved drugs can meet the needs of patients with debilitating medical conditions;
• Marijuana harms vital organs and systems, including the brain, heart, lungs, and immune system, and interferes with learning, memory, judgment, and perception;
• Medicinal marijuana has not been shown to be safe and efficacious through adequate and well-controlled studies and has not gained wide acceptance by medical experts;
• The legalization of medicinal marijuana is the first step to general decriminalization.

• A split at the federal level, with members of Congress introducing but not yet enacting bills in favor of and opposed to medicinal marijuana. Compare H.R. 1782 (The Medicinal Use of Marijuana Act, introduced by Rep. Barney Frank (D-Mass.) on 06/04/97) with H.J.R. 117 (A joint resolution expressing Congress’ belief that marijuana is dangerous and addictive and should not be legalized for medicinal use, introduced by Rep. Bill McCollum (R-Fla.) on 04/30/98, passed in the House on 09/15/98, and received in the Senate on 09/16/98);

• A struggle between the application of federal and state law, with a federal court entering an injunction on October 13 against the continued operation of a California medical marijuana club under the terms of the 1996 state law in light of a federal law banning marijuana distribution. SeeJudge Orders California "Marijuana Club" Closed (October 14, 1998), found at http://www.cnn.com/US/9810/14/marijuana.calif.reut/;

• A split at the state level, with the Colorado legislature passing a bill expressing concerns opposing the legalization of medicinal marijuana the same year the Colorado voters are considering a ballot initiative approving the medicinal use of marijuana. Compare Colorado H.J.R. 1042 (introduced on 04/16/98, passed in the House on 04/27/98 and in the Senate on 04/28/98) with Colorado Ballot Measure 4 (introduced on 09/14/98 and up for public vote on 11/03/98);

• A reconsideration at the state level, with Arizona submitting a ballot initiative to its voters amending the provisions of the 1996 state law to postpone the medicalization of Schedule I drugs until such time as the U.S. Congress authorizes the medicinal use of marijuana or the federal Food and Drug Administration authorizes the medicinal use of marijuana and the federal Drug Enforcement Administration reschedules marijuana. See Arizona Ballot Measure 6 (introduced on 07/09/98 and up for public vote on 11/03/98).