Editor's note: In November 1996, California voters spoke loudly and clearly about medical marijuana. By approving Proposition 215, they declared that seriously ill patients and their primary caregivers should be exempted from prosecution under state law for cultivating and possessing marijuana (if the patient’s physician recommended using the drug for treatment). The Oakland Cannabis Cooperative was organized to distribute marijuana to qualified patients for medical purposes. In a typical move, however, the federal government sued to stop the Oakland Cannabis Buyers Cooperative from carrying out its activities. The feds based their decision on a federal law, the Controlled Substances Act, which prohibits the manufacture and distribution of various drugs (including marijuana). On May 14, 2001, in a unanimous decision, the United States Supreme Court sided with the government and the Controlled Substances Act. The Court noted that marijuana is specifically listed in the category of substances that Congress has determined to have no medical benefit. However, due to the medical marijuana movement, the Supreme Court’s decision, in all likelihood, is not the final word. Thus, the battle for those who could benefit from the drug’s use will continue.

"It becomes bracingly difficult to hear from anti-drug fundamentalists that they would rather see a patient, suffering from cancer, vomit in pain, than permit him to smoke a marijuana cigarette."
William F. Buckley, Jr.

Corinne Millet smokes grass. She has done so every day for twenty years. Yet this unassuming Nebraska woman, a wheelchair-bound widow in her late sixties, hardly fits the Cheech-and-Chong stereotype of the spaced-out pothead.

Millet suffers from glaucoma, a degenerative disease of the eye and the leading cause of blindness in the United States. She employs marijuana medicinally—utilizing its ability to relieve intraocular pressure—to stabilize her condition.

In this, she is like thousands of Americans who have discovered the therapeutic properties of the herb that many prefer to call by its Latin name, cannabis. Unlike all but seven others, Corinne has the official blessing of the federal government.

She is one of the fortunate few who have benefited from a 1972 challenge to drug prohibition laws. That suit, brought by Robert Randall, another glaucoma victim, contended that his arrest for marijuana cultivation violated his rights as a patient for whom there was no substitute medication. The court agreed.

As a result, the FDA was forced to include marijuana in its Investigational New Drug (IND) program. Individual applications (called Compassionate INDs) for use of the drug were permitted. A farm in Mississippi would supply approved recipients.

Corinne Millet had been hesitant about pot because, like many, she’d been socially conditioned to fear the killer weed. But deciding that "my sight means more to me than being afraid of a plant," she tried it and found smoking one joint like drinking a single martini. (Medical users commonly don’t want, nor do they get, the "high" sought by recreational users.)

More important, the drug worked. The glaucoma’s progression halted. In addition, marijuana unexpectedly ameliorated her arthritis. "It was so wonderful," she recalls, "to be free of pain after all those years."

She applied for her IND, waded through the requisite paperwork, and was accepted. She could not have been happier. Doctors had told her she had perhaps three years of vision left when she discovered that cannabis relieved the stress on her fragile optic nerve.

Millet got what she needed. But the FDA’s actions hardly led to a flood of newly-legal pot smokers. In the first twelve years of the regulations’ existence, only half a dozen Compassionate INDs were awarded. When demand rose sharply with the spread of AIDS in the late Eighties, the agency came under intense pressure from the Bush administration, which contended that its drug policy was being undercut. The program was suspended in June, 1991, and discontinued 9 months later.

Al Byrne (Lcdr., USN, ret.) believes he knows why. Al and his wife, R.N. Mary Lynn Mathre, are co-founders of Patients Out of Time (www.medicalcannabis.com), a non-profit that disseminates information about medical marijuana.

With a no-nonsense military approach, Byrne says, "It’s simple. Medical marijuana is the linchpin of the entire War on Drugs. Once resistance to it ceases, the whole structure is going to collapse, and they can’t face that. They’re going to fight to the bitter end."

Al and Mary Lynn will be fighting, too. Last year they organized the National Clinical Conference on Cannabis Therapeutics, sponsored by the University of Iowa College of Medicine. It brought together doctors, nurses, scholars, and policy wonks from all over the country.

That a prestigious university would sponsor such a conference, and attract attendees from across the political spectrum, is indicative of the widespread interest in medical marijuana.

As is activity at the state level. There, what is being mounted is nothing less than the most serious challenge to federalism since school desegregation.

Thirty-four states have some form of statute allowing doctors to prescribe cannabis. Nine have seen voter initiatives enacted. Seven have proposals pending in their legislatures.

Public support for change is overwhelming: 79% favored medical use in an ACLU poll; 73% in a Gallup poll; and an astonishing 85% in an NBC poll. Institutional endorsement has come from the American Bar Association, National Association of Attorneys General, American Academy of Family Physicians, Federation of American Scientists, New England Journal of Medicine, Episcopal Church of the U.S. and dozens of other major organizations. The governors of New York, New Mexico, and Minnesota have backed policy re-evaluation.

How many people who would be affected by relaxation of the law is unknown, but Oregon’s experience may be instructive. In Oregon, after voters passed a pro-medical initiative, the state health department began supervised distribution of the drug. Patients with doctors’ prescriptions are eligible and, in the program’s first year of operation (2000), over a thousand signed up. That translates into nearly 100,000 patients nationwide, a number that is likely to increase dramatically as treatment gains general acceptance.

Against this burgeoning grassroots movement stands the Drug Enforcement Administration (DEA), which stubbornly refuses to move the drug out of Schedule 1 [see sidebar], and has challenged in federal court the medical marijuana defense allowed defendants in those states where decriminalization has been achieved.

The Controlled Substances Act (CSA), USC 8:11-12, classifies drugs, from Schedule 1 (prohibited) to 5 (freely available). Marijuana is in Schedule 1, which means it must meet all of the following criteria: unsafe, even under medical supervision; no accepted medical use; high potential for abuse.

Marijuana’s scheduling was challenged by the National Organization for Reform of Marijuana Laws (NORML), and the resultant reclassification hearing ran from 1986-88. At the end of this exhaustive investigation, DEA administrative law judge Francis Young called marijuana "the safest therapeutically active substance known to man," and ordered it rescheduled.

The DEA appealed the ruling, its position was upheld in 1989 by a Court of Appeals, and there the matter stands.

The DEA has some powerful allies: the alcohol and tobacco lobbies, who fear eventual approval of recreational marijuana; paper pulp, cotton producing and other industrial enterprises threatened by the cultivation of hemp (which derives from cannabis plants); and pharmaceutical companies who don’t want a readily-available herb competing with their expensive products.

Drug companies’ cosncerns are probably well taken. Medical marijuana users testify to an efficacy exceeding that of prescription medications in a wide variety of conditions, including glaucoma, spasticity, nausea, and pain relief. Before prohibition began in 1937, marijuana derivatives were the most frequently-prescribed preparations in the national pharmacopeia. The American Medical Association hotly contested their elimination.

One comparison: for many chemotherapy patients needing an anti-nauseant, a few cents’ worth of homegrown pot could replace Marinol (synthetic marijuana), selling for $800/100 capsules, or Zofran, which costs a stunning $145/day.

A major threat is obviously posed to these monopolies by something with no profit potential. But there may be more to the story. The pharmaceutical giants are probably aware that some smaller European companies have gotten the jump on them in several related areas. Netherlands-based HortaPharm, for example, has been patenting cannabis strains modified to provide specific active ingredients, while British GW Pharmaceuticals has been working on cannabis delivery systems that don’t involve smoking.

How long can this potent coalition hold out against the will of the people? As long as necessary, it would seem.

No one knows this better than Jon Gettman, a determined public policy activist who’s been grappling with the drug control bureacracy for years. Gettman contends that "the DEA is violating its own guidelines under the CSA by keeping marijuana in Schedule 1," and in 1995 he petitioned the agency (as any citizen may) to change its position.

While none of the three classification criteria is truly being met, Gettman chose to focus on just one of them. Attaching every reference in the scientific literature since the Young decision, Gettman pointed out that no formal study—from 19^th century British efforts to the latest Institute of Medicine report—has ever stated that marijuana has a high abuse potential. "What then," he asked, "is the DEA’s justification for its scheduling decision?"

His weighty petition was referred to the Department of Health and Human Services for evaluation, and is still there. Department officials, prodded for an update in October, 2000, said that the review is in its final stages and the HHS recommendation will be forthcoming "in the near future."

In the meantime, patients seeking U.S. government help will have to wait, or move to states that have defied federal law and legitimized compassionate user programs.

Judging by Corinne Millet’s experience, they’d better not invest too much faith in the feds.

In 1990, Millet appeared as a sanctioned cannabis recipient in NORML’s first public presentation on the issue, a panel discussion broadcast nationally by CSPAN and attended by, among others, a number of law enforcement officials.

Shortly thereafter, Corinne was visited by DEA agents demanding to know whom she was peddling marijuana to. Her government shipments of the drug suddenly ceased. The distraught woman begged her doctor for assistance, and he in turn raised hell with those who were supposed to be supplying her medicine.

Well, she got it back. Six unmedicated weeks later.

But by then she had lost eighty percent of her peripheral vision.

For good.