ASA Policy Positions
Cannabis as a Medicine
Background: Between 1840 and 1900, European and American medical journals published more than 100 articles on the therapeutic use of cannabis. In the early 1900s, pharmaceutical giant Eli Lilly produced whole plant cannabis extract for sale to patients whose physicians recommended it. Today, new studies are being published in peer-reviewed journals that demonstrate cannabis has medical value in treating patients with serious illnesses such as AIDS, glaucoma, cancer, multiple sclerosis, epilepsy, and chronic pain. The US National Library of Medicine includes more than 6,500 published scientific articles on medical applications for cannabis. Although the federal government continues to ignore the medical efficacy of cannabis, many of the isolated compounds found in the cannabis plant are being researched and used medically. In fact, Nabilone and Dronabinol, which are isolated cannabis compounds, are currently prescribed and sold for medical use in the United States.
Findings: Numerous controlled clinical studies have confirmed cannabis's therapeutic benefit in relieving an array of symptoms for people living with cancer, HIV/AIDS, multiple sclerosis, Alzheimer's, hepatitis, arthritis, and chronic pain, among many other conditions. In addition, in February 2010, the University of California’s Center for Medicinal Cannabis Research (CMCR) presented a report to the California legislature summarizing the findings of 10 years of research on cannabis and cannabinoids. As a result of their research, the CMCR presented evidence that cannabis is a promising treatment in selected pain syndromes caused by injury or diseases of the nervous system, and for painful muscle spasticity due to multiple sclerosis.
Position: Clinical research affirms that cannabis can safely and effectively alleviate symptoms of serious and chronic medical conditions.
Reclassifying Medical Cannabis
Background: With the passage of the Controlled Substances Act in 1970, cannabis was categorized as a Schedule I substance indicating no medical value and a high potential for abuse. Several presidential administrations since then have aggressively enforced federal cannabis laws even in states that have adopted laws to permit the use and distribution of cannabis for medical purposes. Despite the growing body of evidence to support therapeutic use of cannabis, the federal government continues to ignore the rescheduling recommendations of its own DEA Administrative Law Judge Francis Young, who ruled in 1988 that, “Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care.” The current attempt to reclassify cannabis by administrative petition was started in 2002 by the Coalition for Rescheduling Cannabis (the CRC includes groups like the American Alliance for Medical Cannabis, Americans for Safe Access, the National Organization for the Reform of Marijuana Laws, and Patients Out of Time). That petition is now pending before the DEA for final approval.
Findings: The federal status of cannabis as a dangerous drug with no medical value is at the heart of the conflict between federal and state laws. As long as cannabis remains classified as a Schedule I substance, medical cannabis patients across the country will lack reasonable, fair and equal protection. The refusal by the federal government to recognize the medical efficacy of cannabis has directly impeded efforts to implement various state medical cannabis laws. And, while sufficient evidence exists in the US and elsewhere of the medical value of cannabis, the federal government, under the authority of the National Institute on Drug Abuse, keeps a stranglehold on research efforts, emphasizing harm-based studies over the investigation of medical efficacy.
Position: ASA strongly supports the reclassification of cannabis in order to expand research on this important and promising therapeutic substance and to better establish laws that reasonably, fairly and equally protect patients in the US.
Medical Cannabis: Not Just for the Dying
Background: It was never the intention of patients or the elected officials who have helped to pass medical cannabis laws that medical cannabis should only be for the dying. In fact, most of the patients who have pioneered such laws are not terminally ill, but suffer from such maladies as glaucoma, arthritis, multiple sclerosis, anorexia, HIV, and chronic pain. As such, all state medical cannabis laws that have been passed were adopted with the intention of protecting and providing safe access to a patient population that suffers from a wide array of medical conditions, not simply terminal illnesses.
Findings: The first medical cannabis law passed in the US ensured that “seriously ill Californians have the right to obtain and use cannabis for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of cannabis in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine or any other illness for which cannabis provides relief.” Subsequent state laws have also incorporated a wide array of medical conditions and have decided not to restrict medical cannabis use only to those patients who are terminally ill. These decisions have reflected reports and studies from countless patients who have treated serious but not necessarily life-threatening illnesses.
Position: Given that scientific studies have shown that cannabis counteracts or mitigates a number of illnesses and side effects from other treatments, patients deserve choices in their health care options and should not have to be terminally ill in order to take advantage of the proven benefits of medical cannabis.
Medical Cannabis Research
Background: Examples of the medical use of cannabis have existed for thousands of years, not the least of which was the production and distribution of cannabis tinctures by pharmaceutical giant Eli Lilly at the turn of the 20th century. Yet, the scientific investigation into this important and promising therapeutic substance is not what it could be. Only in the last few years have we seen the needed increases in medical cannabis research, but such studies have predominantly been outside the US. Still, even studies inside the US have shown that cannabis can be used to effectively treat neuropathic pain for people living with HIV/AIDS and multiple sclerosis, as well as treat nausea and stimulate appetite.
Findings: With the use of a science-based approach, several countries around the world are investigating the therapeutic qualities of cannabis and expanding our knowledge base. For example, scientists in Israel are uncovering ways of treating Alzheimer’s with cannabis, and researchers in Spain are studying the effects of cannabis on brain cancer. Unfortunately, in the US, a Byzantine approval process hinders scientists’ ability to obtain research grade cannabis for studies and clinical trials. The federal government maintains a monopoly on the production of research grade cannabis and uses an approval process run by the National Institute on Drug Abuse and the Drug Enforcement Administration, federal agencies with a clear bias against medical cannabis. As a result, scientists in the US face federal hurdles that don’t exist in other countries, which skews and stifles meaningful research. Efforts to overturn the government’s monopoly and employ a more reasonable research approval process have so far failed. Yet, patient advocates continue to fight for increased research, not to establish the medical efficacy of cannabis, that has been done; to expand our knowledge and understanding of this important therapeutic substance.
Position: According to the DEA’s own Administrative Law Judge Mary Ellen Bittner expanded medical cannabis research is “in the public interest.” ASA agrees. The federal government should better invest in the therapeutic research of medical cannabis. The monopoly on access to research grade cannabis should be dismantled to allow additional licensed facilities to produce a sufficient, consistent and high quality supply for scientists. The federal government must also create incentives for expanded research and retool the research approval process to eliminate a bias for abuse studies and the onerous requirements unique to the US.
Cannabis: Not Always the Best Medicine
Background: One of the main arguments used by opponents of medical cannabis is that other medication works better. While this is often true, there are other factors to consider. Some effective pharmaceutical medication is also toxic with harmful side effects, whereas cannabis is relatively harmless and can diminish the need for pharmaceutical medication.
Findings: While some medical conditions may respond better to pharmaceutical medication, medical cannabis is often less expensive and more effective than pharmaceutical alternatives. For example, ASA has received countless reports from patients who have either significantly reduced or eliminated altogether their use of narcotics and pain medication by replacing it with medical cannabis.
Position: Medical cannabis is certainly not the BEST option for everyone, nor should it be the FIRST option for a physician to consider, but we believe most Americans agree with us that all patients and physicians should have as many effective options available to them as possible to combat pain or symptoms of a serious or chronic illness.
Legalization of Cannabis for Recreational Use
Background: As the national debate heightens around the legalization of cannabis (or marijuana) for recreational use, policy makers, the media, as well as ASA members and affiliates have called on ASA to take a position on these issues. ASA was founded to focus only on medical cannabis issues. Recreational use and medical use have only the criminal justice system in common.
Findings: Issues such as access, police harassment, and the price and quality of medicine will still be relevant to the patient community despite the adoption of a policy of legalization for recreational use. The federal refusal to recognize the medical efficacy of cannabis causes more harm and difficulty for patients than any failure by local or state governments to adopt policies of legalization of cannabis for recreational use. Any system of regulation should not be built on the backs of current medical cannabis laws.
Position: The legalization of cannabis for recreational use is a separate issue from safe and legal access to cannabis for therapeutic use. We caution policy makers against letting the debate surrounding legalization of cannabis for recreational use obscure the science and policy regarding the medical use of cannabis.
Recognition and Regulation of Distribution Centers
Background: Based on the positive impact of California’s distribution system, other medical cannabis states have decided to address this important issue of safe access. Some states like Maine, New Mexico and Rhode Island, preferred a state-regulated medical cannabis distribution system. While other states like California, Colorado, Michigan and Montana have preferred to regulate distribution at the local level. Regardless of the methodology, however, the trend is moving toward enhanced access to medical marijuana as a result of regulated distribution systems.
Findings: After conducting a study on the impact of local medical cannabis dispensary regulations in California, Americans for Safe Access found that reasonable regulations not only improve the lives of patients though increased access and availability, but that they also reduce crime and community complaints around those dispensaries. In many cases, dispensaries actually helped to revitalize struggling neighborhoods. On the other hand, unreasonable or onerous regulations can have the effect of cutting off access to medical cannabis and can act as de facto bans on distribution in communities that rely on such access.
Position: ASA supports the sensible regulation of dispensaries to the extent that such regulations recognize the legality of medical marijuana distribution and offer reasonable methods to comply with local and state laws.
Background: All state laws, with the exception of New Jersey’s, have recognized the need for patients to self-cultivate medical cannabis.
Findings: Because cannabis comes in literally thousands of different strains with very different effects on the body, it is important for patients to be able to determine which strains work best for their particular condition and to be allowed to cultivate those strains for consistency and quality. In addition, obtaining cannabis from the illicit market or through legal distribution centers can be prohibitively expensive for patients, whereas self-cultivation can significantly reduce that financial burden. Patients should not have to rely exclusively on a centralized production and distribution system, which often falls short in meeting their needs.
Position: Patients should have the right to grow their own medical cannabis in a variety of ways. Patient cultivation is necessary to ensure that patients have safe and affordable access to medical cannabis
Testing Medical Cannabis
Background: Medical cannabis has been used safely for thousands of years, and there is no evidence to suggest that it represents a real harm to patients. With some medical cannabis laws in the final stages of implementation, there is beginning to be more attention placed on quality control. Because of the lack of interest and funding at the federal level in performing quality control testing of medical cannabis, such testing has been conducted more independently and at the local level.
Findings: Multiple findings over the years have concluded that cannabis is relatively harmless, not the least of which was from a 1988 Drug Enforcement Administration (DEA) review of marijuana’s classification as a Schedule I drug, in which Chief DEA Administrative Law Judge Francis L. Young stated that, “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man.” Despite reluctance by federal and state governments to conduct quality control testing on medical cannabis, various independent organizations made up of concerned patients, providers, scientists and other experts are working to improve medicine safety and quality by establishing industry standards and guidelines for patients, large-scale cultivators and distributors alike.
Position: Although ASA is not aware of any serious harm that has resulted from consuming cannabis, contaminated or not, we believe that testing can help provide better information to patients about the medication they’re using as well as enhance their options. Testing should be used as a way to enhance rather than restrict access
Who Should Qualify as a Patient?
Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able-Bodied Males,” condemning certain patients by visual assessment alone.
Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.
Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions
Taxation of Medical Cannabis
Background: Difficult economic times have forced cash-strapped local and state governments to secure more creative sources of revenue. One such source is the taxation of medical cannabis. Starting off the trend, the California Board of Equalization (BOE) voted in 2005 to implement a policy that taxed the sale of medical cannabis. Since then, the BOE has collected millions of dollars from hundreds of dispensaries across California. Regardless of the financial windfall from taxing cannabis, sales taxes are inherently regressive and disproportionately impact “consumers,” in this case medical cannabis patients. Since then, other state and local governments have imposed taxes on medical cannabis.
Findings: Regressive sales taxes are harmful to patients and make medical cannabis more unaffordable than it already is. ASA has publicly opposed taxes on several grounds, including the hardship to patients, that prescribed medicines are non-taxable, and the real danger of self-incrimination. Taxes invariably and unintentionally restrict access to medical cannabis.
Position: Any tax on medical cannabis is a tax on patients. ASA opposes excessive taxes that are designed to raise revenue, but it does not oppose low-impact fee structures designed to offset administrative costs.