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Medical Use of Marijuana:
Public Health vs. Criminal Justice Approach (03-29-01)

A News Analysis By Terence T. Gorski

The issue of medical marijuana for the treatment of seriously ill patients is a public health issue, not a criminal problem.  Seriously ill patients in severe pain should receive treatment from the medical and behavioral health professionals.  Medication decisions should be made by  patients and their doctors.  When issue of drug abuse or dependence become a concern addiction and mental health providers should be involved .  It would be tragic if we began arresting and prosecuting terminally ill patients undergoing chemotherapy for using marijuana to seek symptom relief.  Alternatives are available within a Public Health Framework for resolving this issue. Steve Grinstead developed a comprehensive Addiction-free pain Management System that can offer numerous alterative other than marijuana to pain patients.  Addiction and mental health professional should be concerned about legislation affecting the medical use of marijuana because it carries with it broad implications for the future direction of funding trends in the United States.  Letís invest in a Public Health Addiction Policy that would fund addiction-free pain management clinics in every community.  We could then allow medical exceptions for using marijuana as a medication if the client is under the care of both a physician who prescribes it and the care of an addiction pain management specialists who assures the client has access to other effective tools for pain management and helps assure the marijuana is not abused.

<Mr. Gorski Is Available To Speak Or Consult On 
Public Health Addiction Policy As An Alternative To The War On Drugs>

Addiction and mental health professional should be concerned about legislation affecting the medical use of marijuana because it carries with it broad implications for the future direction of funding trends in the United States.  Since the mid-1980ís the US approach to drug abuse has been controlled by a Criminal Justice Drug Policy that views addicted people as criminals and punishment and the threat of punishment as primary tools for dealing with the criminal addicts.  As a result, millions of dollars have been stripped from the nationís addiction, mental health, and social programs to feed the growing complex of prisons and supportive industries.

To promote implementation of a Public health Addiction Policy, any decisions that support the primacy of enforcement professionals over medical and public health professionals when it comes to the prevention and treatment of illness need to be opposed and alternative mechanisms recommended.  Since, when it comes to addiction, these issues relate around the appropriate use and control of illicit drugs, it is  easy to focus on the drug and the opinions of law enforcement authorities while ignoring the vital human questions and the myriad of unforeseen consequences that could lead to continued human right violations for the addicted people of this nation.

The issue of the medical use of marijuana is one focal point that illustrates the implications of this conflict.  The position of addiction and mental health providers is important and should be strongly considered in the formulation of national policy.

Public Health Addiction Policy vs. Criminal Justice Drug Policy

The question at the heart of the ideological conflict between the Public Health and Criminal Justice Policies is whether health care professionals or enforcement professionals should be in charge of the national drug control strategies.  The real battle is between two political policies.

A nation operating under a Public Health Addiction Policy will seek and value the input of medical and behavioral health professionals whenever considering legislation that could effect the well being, pain, and suffering of sick people.  The role of law enforcement and the need to preserve legal leverage to prosecute other criminals would be a secondary consideration.

A nation operating under a Criminal Justice Drug Policy will put  the current drug laws in a place of supremacy and seek to interpret all related issues in a way that will facilitate additional arrests and convictions.  The rights and well being of citizens will become a secondary consideration.

When operating under a Criminal justice Drug Policy law enforcement has vested interest in eliminating medical and behavioral health professionals from the development of drug control legislation and its enforcement.  They also seek to criminalize and demonize any medical or behavioral health professional who compassionately seeks to deal with sick people in a way that either directly violates drug law or would make it more difficult to arrest and prosecute drug offenders.

Medical Marijuana Use Ė One Focal Issue

The issue of the medical use of marijuana is a focal point that exposes both sides of this conflict.  Terminally ill patients in severe pain and chronic pain patients should receive treatment from the medical and behavioral health professionals.  The choice of medications and approaches to treatment should be made between patients and their doctors who work with addiction and mental health service providers to deal with any related addiction and mental health problems that often accompany these seriously ill clients.

Historically, the enforcement community has seen medical and behavioral health providers as adversaries when it comes to the prescription and use of control substances.  Physicians ability to prescribe pain medications has been seriously limited in many states.  Doctors have been prosecuted for prescribing "excessive pain medications" for chronic pain patients.  In these these cases law enforcement professionals, who are not medical experts, were the sole judge of medical practice.  These prosecutions are a part of an overall crackdown on prescribing without any demonstration through individual cases that the prescription practices constitute abuse.  Similar clashes between medicine and law enforcement can be seen in the treatment of heroine addicts using methadone maintenance.

The issue of medical marijuana for the treatment of seriously ill patients is a public health issue.  It not a criminal issue.  It would be tragic if we began arresting and prosecuting terminally ill patients undergoing chemotherapy for using marijuana to seek symptom relief.

Many addiction and mental health professionals see this as unlikely, but it isnít so.  Several individuals whose only crime is the use of marijuana to deal with medical symptoms have been arrested, convicted, and imprisoned.  It does seem seems inconceivable, but other atrocities have occurred when enforcement policies replace public health policies in  dealing with medical conditions.  Many drug addicted women, for example,  are imprisoned within  hours of the birth of their children with no effort being made to medically intervene and offer treatment that would allow the infant to stay in the closely supervised care of the mother in residential rehabilitation center.

The Current Supreme Court Case On Medical Marijuana

One aspect of drug law reform involves the growing efforts to gain an exception to federal drug laws that allow medical patients to use marijuana for medicinal purposes. 

A Supreme Court Case, United States v. Oakland Cannabis Buyers' Cooperative, No. 00-151, is currently underway that involves Proposition 215, the Compassionate Use Act.  California voters passed Proposition 215 in a 1996 referendum despite a federal law that considers marijuana to have "no currently accepted medical use."  

Two lower federal courts in California have held that a marijuana distribution center in Oakland could invoke "medical necessity" as a defense against the federal government's effort to get an injunction to stop the operation of the "cannabis clubs."

The medical-necessity defense recognized by Judge Charles Breyer of Federal District Court in San Francisco is narrowly defined. It applies only to those who suffer from a "serious medical condition"; who will "suffer imminent harm" without access to marijuana; whose condition or symptoms will be eased by marijuana; and who had "no reasonable legal alternative" to the drug.

The California Medical Association supported the Oakland group, as did civil liberties and drug policy organizations and a group of local sheriffs and officials from other states that have adopted medical marijuana initiatives.

Briefs containing information about current practices of using marijuana to combat glaucoma, the nausea of chemotherapy, and the wasting syndrome of AIDS were submitted to the justices. There is also debate in the briefs over whether a legal drug called Marinol, a synthetic version of the active ingredient in marijuana, offers the relief that some patients find in smoking marijuana.  Although federal agencies are not yet persuaded of the benefits of medical marijuana, they are continuing to study it to determine "whether it has the effect that's described."  Notice that the critical legal opinion comes from Federal Enforcement Agencies, not Public health Agencies.

California itself was not a party to the case, but the California attorney general, Bill Lockyer, filed a brief on behalf of the Oakland cooperative. "The federal government threatens to cross the line of state sovereignty and interfere with a traditional state right," the attorney general said. Mr. Lockyer said states had a "traditional right to regulate for the health and welfare of their citizens."

According to the NY Times, the justices were openly skeptical that a defense of "medical necessity" could be properly recognized.  Justice Kennedy said the lower courts had effectively engaged in a "huge rewriting" of the federal law that places marijuana within schedule I of controlled substances, those with no accepted medical use.

It is interesting to note that the federal government did not seek criminal prosecution under the law to close pharmacy-like marijuana clubs.  Instead, they sought a federal court injunction to stop the cannabis clubs from distributing the drug. 

The legal matter before the supreme court is not about the validity of Proposition 215 and its position that there should be a medical exemption for some people to use marijuana for medical reasons.  The current court case is about what discretion the lower courts had in responding to the request for the injunction.  As a result, it is unlikely that this court will issue a definitive ruling on the future of the growing number of medical marijuana initiatives.  Nine states have now adopted similar medical marijuana laws.

Should we have laws that allow the arrest, conviction, and imprisonment of seriously ill patients for using marijuana in an effort to ease their sufferring when everything else has failed?  Should we have a law that allows the imprisonment of doctors for giving advice or failing to report their patientís drug use to the police?  Should we invest tax payer dollars in expanding enforcement efforts while reducing medical, addiction, and mental health treatment for the individuals imprisoned.

Addiction-free Pain Management - An Effective Alternative

Alternatives are available within a Public Health Framework for resolving this issue. Steve Grinstead who developed a comprehensive Addiction-free pain Management System that can offer numerous alterative other than marijuana to pain patients.  Letís invest in a public health a addiction policy that would fund addiction-free pain management clinics in every community.  We could then allow medical exceptions for using marijuana as a medication if the client is under the care of both a physician who prescribes it and the care of an addiction pain management specialists who assures the client has access to other effective tools for pain management and helps assure the marijuana is not abused.

<Mr. Gorski Is Available To Speak Or Consult On 
Public Health Addiction Policy As An Alternative To The War On Drugs>

 

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