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AAHPM Summer Quarterly 2012 : Page 13

SUMMER 2012 13 MARIJUANA Care Specialists Know? have created a medical defense for patients possess-ing marijuana (see Figure 1 ). 1,10-12 Three court cases decided during George W. Bush’s presidency brought clarity to the federal government’s view of these state laws. In the 2001 case, US v Oak-land Cannabis Buyers’ Cooperative , the US Supreme Court held that the distribution of marijuana violated the CSA and was illegal under federal law. 13 A year later, although it upheld physicians’ constitutional free speech right to discuss marijuana as a treatment option for their patients, the US Court of Appeals affirmed that the CSA disallowed physicians from helping patients to obtain marijuana. 14 Similarly, the US Supreme Court ruled in 2005 that the Drug Enforce-ment Agency could enforce the CSA against medical marijuana users without invalidating state laws. 15 Despite decriminalization of medical marijuana pos-session in many states, the courts held that marijuana possession remained illegal under federal law, spe-cifically the provisions of the CSA of 1970 8 ; however, the practical issue was not one of legality but of whether the federal law would be enforced. In October 2009, under the presidency of Barack Obama, the US Department of Justice formally announced that it would not prosecute medical marijuana users who had complied with applicable state laws. 16 Figure 1. Legalization of Medical Marijuana by State = Medical Marijuana Decriminalized A Limited Evidence Base Although medical marijuana’s illegality under federal law is clear (but almost universally unenforced), its clinical benefits and potential health risks remain controversial, largely due to insufficient medical research. There are very few randomized controlled trials (RCTs) that examine medical marijuana’s posi-tive clinical effects, 1 but the limited research data available suggest that early claims about marijuana’s purported beneficial effects were surprisingly accu-rate (see Table 1 ). = Affirmative Defense for Medical Marijuana Possesion These 12 RCTs, which involved 302 patients, suggest that medical marijuana may have some benefit in the manage-ment of chemotherapy-induced nausea, HIV-related anorexia and neuropathic pain, capsaicin-induced pain, spasticity from multiple sclerosis, and elevated intraocular pressure. 17-27 However, to qualify for a change in schedule under the CSA, VOL. 13

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